How spine surgeon training has evolved


As spine surgeons grow in their career, their teaching methods have also changed with time. 

Five spine surgeons discuss how their physician training skills have evolved.

Ask Spine Surgeons is a weekly series of questions posed to spine surgeons around the country about clinical, business and policy issues affecting spine care. Becker's invites all spine surgeon and specialist responses.

Next question: What's one thing keeping you up at night in 2024? 

Please send responses to Carly Behm at by 5 p.m. CST Wednesday, June 5.

Editor's note: Responses were lightly edited for clarity and length.

Question: How have your teaching methods changed over time?

Harel Deutsch, MD. Co-Director of the Rush Spine Center (Chicago): The residency teaching methods have changed dramatically. When I was a resident in the late 20th century, the idea was that you would spend many hours in the hospital and learn through osmosis and through practice. Medical practice would become reflexive. Of course, we have moved to the 80 hour work week and further decrease in time spent during residency. I think the hours spent are still necessary but off loaded to fellowships and the early years of practice and continuing education has an even more critical role.

Mladen Djurasovic, MD. Norton Leatherman Spine Center (Louisville, Ky.): Our teaching methods have definitely evolved over the past 10 years. For one thing, our fellows tend to come into fellowship with much more first-hand experience in basic spine techniques than we used to see 10 to 20 years ago. At one time it was common that incoming fellows hadn't put in a pedicle screw or performed a lumbar decompression, but now our incoming fellows almost always have experience with basic techniques such as these. 

Another thing that has really transformed teaching is the use of navigation. With the use of navigation, we can see directly where a trainee is putting an implant, and this allows us to have confidence in their placement of screws as we can directly visualize what is happening on a screen. This allows us to be less "handsy" during a case as we can see early on if there is a problem with a screw trajectory. 

Finally, members of our faculty have made a very conscious effort to give our trainees lectures on "real-world" topics (eg. finding a job, negotiating a contract, how to succeed in their first years in practice, etc.). This is information that they often haven't heard before in an organized formal setting and they really appreciate learning about these topics.

Brian Gantwerker, MD. The Craniospinal Center of Los Angeles: While I am not a teaching attending, and I don't teach residents, I do sometimes get asked to do guest lectures. One of my favorite teaching moments was when over a period of six weeks, I taught game developers how to do spine surgery. I mean that virtually, not literally. We learned about biomechanics, instrumentation, and anatomical considerations. This culminated in them coming to observe me in surgery. It was incredibly fulfilling and something so outside of my everyday life that it gave me real joy. The app is being released and currently is in play-testing, and I am incredibly proud of my mentees. My methods of teaching are essentially from my dad, who was an actual grammar school teacher. He was a great explainer and always used great metaphors.  

Even now, when I explain surgery to patients, we have a mini-anatomy course and I show them their films on a big-screen TV. Using examples they can relate to in their own lives, Relating to your pupils, be they patients, other physicians, or even game developers is key to teaching - and I think that will never change.

Neel Anand, MD. Cedars-Sinai Spine Center (Los Angeles): While my teaching methods have not dramatically changed over time, I have continued to refine them so key principles are more effectively delivered and retained.

I am a firm believer in the principles and comprehension of the basic anatomy, pathology, and physiology – which I emphasize during teaching. As a result, the answers come automatically once they are understood. 

Finally, in my experience, I find it imperative for fellow surgeons to see the long-term results of patients when it comes to the use of new technology to validate its efficacy.

Christian Zimmerman, MD. St. Alphonsus Medical Group and SAHS Neuroscience Institute (Boise, Idaho): Having been taught by the best of mentors, where mutual respect, meritorious accomplishment and communal expectation were the methods towards one's learning and success. Didactics were informational and utilitarian, not punitive. Work ethic and board scores were expectantly high. 

As this translates to my practice and graduate school instruction, it seems that 'more carrot and less stick' if you will, works best and subsequent student evaluations reveal likewise. Deadlines for paper and project presentations and punctuality are as stringent as this taskmaster gets anymore.

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