Competence Assessment for Independent Spinal Surgery

Introduction to Competence Assessment

The British journal of neurosurgery guidelines state that a fellow cannot perform spinal surgeries independently until the neurosurgical trainers at that hospital formally assess his competence and grant him appropriate clinical privileges based on demonstrated technical skills and outcomes 1, 2

The available guidelines make clear that training completion does not automatically equal competence to practice independently, as stated by the British journal of neurosurgery 1, 2, 3
Neurosurgical trainers must decide whether any surgeon—including fellowship-trained ones—is sufficiently experienced to operate independently, with supervision, or with assistance at their specific institution, according to the British journal of neurosurgery 1, 2, 3
The responsibility for determining surgical competence rests with the trainers and credentialing bodies at the hospital where privileges are being requested, not with the fellow's previous training program, as stated by the British journal of neurosurgery 1, 2

The neurosurgical trainers at the hospital have explicit responsibility to ensure patient safety by ensuring that fully trained neurosurgeons are responsible for patient care and that all surgeons have access to help and advice, as stated by the British journal of neurosurgery 1, 2, 3
The neurosurgical trainers must make decisions about whether surgeons can operate independently, with direct supervision, or with assistance based on demonstrated competence, according to the British journal of neurosurgery 1, 2, 3
The trainers must answer truthfully if patients ask about the experience of those who will perform their surgery, as stated by the British journal of neurosurgery 1, 2, 3, 4

The Joint Commission on Accreditation of Healthcare Organizations mandates that granting clinical staff privileges must be based on assessment against professional criteria specified in medical staff bylaws 5, 6, 7
Physicians themselves are charged with identifying the criteria that constitute professional competence and evaluating their peers accordingly 5, 8
The assessment of competence is complex and multidimensional; therefore, isolated recommendations or credentials alone may not be sufficient for judging overall competence 6, 9

Experience alone does not guarantee competence in performing complex procedures like spinal surgery 10
Simply completing a certain number of procedures without proper assessment of outcomes and technique may not ensure patient safety 11
Completion of a fellowship or residency does not automatically guarantee competence 11

Assessment should be based on actual cognitive knowledge and technical skills rather than solely on the structure of training 11
Evaluation should include review of the surgeon's performance on procedures similar to those for which privileges are requested 5, 8
When the competence of a physician requesting privileges is not clear, monitoring the candidate's interpretations or administration of a test may be appropriate 11
Quality assurance programs should include periodic review of a random sample of procedures by independent experts to confirm continued competence 11

Imposing an arbitrary time requirement without assessment of actual competence is not evidence-based 5, 6
This approach could unnecessarily delay qualified surgeons from practicing within their competence 10