Pain medicine fellow neuromodulation surgical skill assessment tool: a pilot

• Published in: Regional anesthesia and pain medicine Vol. 45; no. 1; pp. 38 - 43
• Main Authors: Pittelkow, Thomas P, Hagedorn, Jonathan M, Bendel, Markus A, Eldrige, Jason S, Pingree, Matthew J, Mauck, W. David, Gazelka, Halena M, Lamer, Tim J, Sanders, Rebecca A, Billinges, Heather A, Moeschler, Susan M
• Format: Journal Article
• Language: English
• Published: England BMJ Publishing Group Ltd 01-01-2020; Copyright by American Society of Regional Anesthesia and Pain Medicine; BMJ Publishing Group LTD
• Subjects: Anesthesiology; Chronic pain; education; Epidural; Feedback; Medical education; Medicine; neuromodulation; Original article; Pain; Regional anesthesia; Rehabilitation; resident education; Scholarships & fellowships; Skills; Spinal cord; United States > US; Minnesota; neuromodulation; chronic pain; education; resident education
• ISSN: 1098-7339; 1532-8651
• DOI: 10.1136/rapm-2019-100761

ObjectiveSpinal cord stimulation (SCS) is an evidence-based therapy for the treatment of refractory pain. Current American College of Graduate Medical Education requirements for pain medicine fellowship graduation include observation of five neuromodulation cases. Matriculating fellows have varying degrees of technical skill, training, and experience. The purpose of this study was to use an innovative skill-based assessment tool using the validated Zwisch scale to evaluate fellow surgical performance during SCS cases.DesignCross-sectional surveySettingMayo Clinic, Rochester, Minnesota.SubjectsConsultant faculty (10) in the Division of Pain Medicine and pain medicine fellows (5).MethodsA list of faculty-driven neuromodulation surgical objectives was formed and a rubric was created that focused on technical approach, imaging, epidural access and wound closure. Consultants who perform surgical cases were instructed to use the Zwisch scale as a guide to evaluate fellow surgical performance during a neuromodulation case. Faculty and fellows were surveyed before and after implementation of the tool to determine their satisfaction with use of the skill assessment tool.ResultsThe consultants reported they were more satisfied, consistent, and efficient with feedback provided to the trainee on every aspect of neuromodulation surgical cases. The improvement was most significant during the fellows’ intraoperative skill assessment. The fellows indicated increased satisfaction, improved communication, and increased efficiency of feedback when the tool was utilized. The fellows reported greater intraoperative skill assessment and consistency of feedback provided.ConclusionsThe diverse nature of primary specialty backgrounds observed in pain medicine fellowship training offers a unique opportunity to assess and improve fellow skill and surgical competence in the field of neuromodulation. Both faculty and fellows reported improved satisfaction, consistency and efficiency with feedback provided. Importantly, this pilot project observed that implementation of a skill assessment tool was beneficial for both the faculty and fellow as the feedback received was viewed as strongly beneficial to the educational experience.