Development of a Canadian competency-based spine surgery fellowship education curriculum

Background: A recent CSS membership survey motivated the development of a nationally based spine surgery fellowship education curriculum. Our purpose was to develop competency-based curricula through an expert consensus method as a tool for educators and trainees. Methods: A fellowship working group of 32 spine surgeons from across the country was assembled. A modified Delphi approach refined an initial curriculum list (108 cognitive, 84 procedural competencies). This list was generated by reviewing Canadian and U.S. accreditation standards, continuing medical education and fellowship content through national/international spine societies as well as perceived gaps in training syllabi as deemed by the authors. A consensus threshold of 70% was chosen, with up to 5 rounds of blinded voting performed. Members were asked to ratify items into either a general comprehensive or focused/advanced curriculum. Results: Twenty-eight of 32 consultants (88%) responded and participated in voting rounds. Seventy-eight (72%) cognitive and 63 (75%) procedural competencies reached 70% consensus in the first round. This increased to 82 cognitive and 73 procedural items by round 4. Remaining unresolved were 14 of 24 pediatric, and group members ratified the addition of a separate pediatric curriculum. There were 6 cognitive and 7 procedural items that did not reach threshold after 4 rounds. All 13 remaining items were deemed important to include and were ratified to the respective curriculum based on a final fifth round majority vote. Final curriculum documents developed include a general comprehensive curriculum (91 cognitive and 53 procedural items), a focused/advanced curriculum (22 procedural items) and a pediatrics curriculum (22 cognitive and 9 procedural items). Conclusion: Through a consensusbuilding approach, the study authors have developed competencybased curricula anticipated to be of educational value to spine surgery fellowship educators and trainees. To our knowledge, this is the first nationally based effort of its kind.