The Role of the Spine Surgeon in Medical Education

Reflections on current and future challenges in spine care and education with Thomas E. Mroz, MD

20 January 2021

This article was featured in the Winter 2020-2021 AO Spine NA community newsletter. Read the full newsletter here.

Education will never be the same again. We are witnessing a remarkable change in both teaching and learning experiences. The COVID-19 pandemic has shaped all forms of human communication and fast-forwarded digitalization in education—medical education is no exception. AO Spine recently conducted a study on COVID‐19 and the current and future challenges in spine care and education (*). For reflections from an educator's perspective, we talked with Dr. Thomas E. Mroz about the role of the spine surgeon in medical education.

In the AO Spine survey, over 80% of respondents said they were interested in continued use of novel learning modalities. If a centralized web‐based collaboration platform were established, 33.9% said they would be active readers and 59.8% would both read and contribute. But when asked if they would attend a scheduled medical conference from March–April 2020, already then 33.7% reported being either unsure or not likely to attend.

The research gathered views from 902 spine surgeons around the world. The results testify to the rapid change and adoption of the new medical education landscape.

Amidst the uncertainty, Thomas Mroz sees a silver lining in the fast digitalization of medical education. “The pandemic accelerated the adoption of digital platforms. The technologies existed already before, but the adoption in medical education lagged. The situation forced medical education to evolve and to maintain our ability to educate fellows, spine surgeons, and practitioners around the world,” Mroz summarizes.

Although the outreach with digital channels is wide, Mroz is concerned about opportunities for interaction. “A very important part of learning, the different face-to-face settings where we can actively share ideas over microphone or across a table, is decreasing now. We all have attended conference calls or e-meetings with lectures on various platforms. These are not environments where it is easy to ask questions.”

85.2% of respondents of the AO Spine COVID-19 study with residents and fellows, reported that the pandemic has hurt their overall experience. Mroz stresses the importance of fellowships in the current environment. “I don’t think the pandemic has in any way, shape, or form diminished the importance of fellowships. A fellowship is an important stage in a surgeon's career, in the educational and training processes, where one moves from residency into a fellowship and really owns the skillset.”

Peer learning more popular than ever

Peer-to-peer learning has taken many new forms with digitalization, and while there are many advantages, Mroz also sees a strong need for an anchor. “This means someone must keep challenging individuals to become better, regardless of the level they’re at. Sharing ideas with peers is a robust platform for growth, but you also need to challenge peers in a discussion or conversation to do the same.”

Mroz reminds us that having an objective and validated data source for driving the peer-to-peer learning or exercise is an absolute must. “When talking about peer learning, I think it is important to understand the part of the conversation on standards and guidelines in spine surgery. They are the pillars of how we practice as a spine community. It does not mean that we should not share ideas beyond existing standards or guidelines and question them. Can we do things better? Can we adopt new technologies? Or can we use machine learning, as an example, to change how we approach spine care? I fully support and recognize the importance of peer learning, but it must be anchored to what the acceptable standards are,” Mroz concludes.

Online assignments have become one of the most common forms of peer-to-peer learning. What are the cons of online peer learning—is there is a possibility for spreading false information? “The freedom to exchange ideas is paramount and incredibly important. Oftentimes, the threat with digital platforms is simply this: anybody can say whatever they want and the recipient of the knowledge or information might think: wow, this person has a million followers, it must have merit, it must be true! That is a real threat, because not everything propagated on digital and social platforms is necessarily true. It may not be the right thing to do for patient care, it's just somebody's idea."

Like most of us, Mroz also follows influencers online, many of whom are real thought leaders. "The majority of their approaches, I totally get and agree with. But then I come across other things that—from where I sit—don't make a lot of sense and are not in the best interest of the spine community. So, the question of the hour is, what mechanism could there be, not to censor, but to fact-check the content of online discourse in the context of medical education? I don’t have the answer, but I want to make sure that there is no negative influence on how a patient is treated, regardless of who that patient is.”

The role of a mentor remains the same

There are already certain differences visible in fellowships of pre-COVID times and now. Mroz points out that already before COVID, a lot of our networking happened online and digitally, but it was always enhanced by face-to-face interactions and society meetings. "Now, the face-to-face-part has almost completely gone away. Thus, fellowships, mentors, fellowship directors, and the staff at the institutions have become even more paramount to one's career path.”

Networking has always been a big advantage of being part of the AO Spine community, and Mroz is happy to see AO Spine opening new platforms for discussion. “Being a part of AO Spine has been incredibly important for me. Year after year at our annual meetings and through the variety of digital platforms, there has been just an amazing amount of conversations between fellows from different programs. When you have that kind of freedom to share ideas, it engenders a healthier conversation about spine care. For fellowships within the AO Spine community, it provides for unprecedented networking.”

"Networking has always been a big advantage of being part of the AO Spine community."

Mroz continues, the role of a mentor cannot be overstated. “My mentor was Dr. Jeff Wang, and if one is as lucky as I was to come across a mentor like him—selfless and interested in your professional development—the value of the experience cannot be overstated. Training with Jeff Wang was the best decision of my professional life.

I always recommend that people who are interviewing for a fellowship really look into the mentor. Our goals are different: some want to go into private practice, others into an academic setting at a tertiary care center. The requirements and expectations from the mentor are also going to be different. A good mentor can enhance and propel your career to a trajectory that not every program can."


(*) Nolte MT, Harada GK, Louie PK, Mccarthy MH, Sayari AJ, Mallow GM, Siyaji Z, Germscheid N, Cheung JP, Neva MH, El-Sharkawi M, Valacco M, Sciubba DM, Chutkan NB, An HS, Samartzis D. COVID-19: Current and future challenges in spine care and education - a worldwide study. JOR SPINE: (e1122).

Thomas Mroz co-edited the AO Spine Textbook 2020 with Michael Steinmetz and Jeffrey Wang. The Textbook is a comprehensive overview on surgical management of the spine and aims to improve spine surgery education throughout the world. (**) Steinmetz MP, Mroz TE, Wang JC. AO Spine Textbook: Comprehensive Overview on Surgical Management of the Spine: Jaypee Brothers, Medical Publishers Pvt. Limited; (736 pages) 2020.

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