253 - The Skin-to-Skin Program: A New Paradigm in MIS Training. Initial Resu...

#253 The Skin-to-Skin Program: A New Paradigm in MIS Training. Initial Results on Adoption Rates

MIS Techniques and Outcomes

Poster Presented by: J.A. Sclafani


J.A. Sclafani (1)
C.W. Kim (1)

(1) Spine Institute of San Diego, San Diego, CA, United States


Background: Previous studies suggest a difficult learning curve is the main obstacle to adoption of MIS techniques. Typical MIS cadaver courses involve crowded lab stations with limited individual hands-on experience. Such MIS training programs may be insufficient to overcome learning curve issues, leading to a poor adoption rate. The Skin-to-Skin (S2S) cadaver course is an intensive program designed to overcome learning curve barriers and increase the adoption rate of MIS techniques. This study is an assessment of MIS adoption rate after attending the S2S course.

Methods: An email-based survey was sent to all past S2S participants to assess the importance of several characteristics of the S2S curriculum and surgeon adoption rate of MIS after course completion. Participants were assigned an impact score based on the number of MIS procedures they performed during the initial one year period after S2S training (Impact score: 0= zero cases, 1= one case only, 2= 2-3 cases, 3= 4-10 cases, 4= 11-20 cases, 5= greater than 20 cases). An S2S trained surgeon with an impact score ≥ 4 was considered a major adopter of MIS techniques. Participants who performed MIS procedures prior to attending S2S were excluded from adoption rate calculations.

Results: Data was obtained for 43/45 (96%) of S2S trained surgeons within the first year after training. Unique, important features of the S2S course were: a single surgeon to each cadaver (92%), observation of live surgery as a component of the cadaver course (100%), availability of the S2S host surgeon after the course to discuss upcoming cases (83%), and provision of a detailed technique guide (92%). In terms of practice patterns, the average impact factor after S2S training was 2.7 (n=43). An impact score ≥ 3 was assigned to 56% (n=24/43), ≥ 4 was assigned to 35% (n=15/43), and ≥ 5 was assigned to 28% (n=12/43) of S2S trained physicians. The major adoption rate was 6/33 (18%) after a single S2S course.

Conclusions: Participants of the S2S cadaver course found the curriculum to contain several unique features that are critical to adoption of MIS techniques. The initial findings demonstrate that the S2S program produces a high adoption rate of MIS techniques. Continued surveillance is necessary to determine the sustainability of MIS practice patterns after the initial adoption period.