421 Quantifying the Opportunity Cost of Neurosurgical Resident Education

Abstract

INTRODUCTION: Education is at the core of neurosurgical residency, but little research has been done on the opportunity cost of surgical education. METHODS: SAP structures cases into zones of proximal development (opening, exposure, key section, and closing) and is used to evaluate resident mastery. All 1-4 level ACDF non-reoperative cases between March 2014 and March 2022 from one attending surgeon at Duke University were divided into three groups: cases without residents, cases with residents prior to implementation of SAP (before June 2018) and cases with residents after implementation with SAP (after June 2018). Surgical times for all cases were collected via electronic record review. Times were compared within levels of surgery between groups. RESULTS: There were 2140 ACDF cases identified, of which 1758 were done independently, 223 with residents prior to SAP, and 159 with residents and SAP. Across 1, 2, 3, and 4 level ACDF surgeries, cases with residents took longer to complete than when done independently, with SAP adding additional time. For 2-level ACDF cases, the average surgical time was 72.0 ± 18.2 min independently, 121.7 ± 33.7 min pre-SAP, and 143.4 ± 34.9 min post-SAP, with t-tests showing significant differences between all three groups. CONCLUSIONS: There is a significant time cost for neurosurgeons to educate residents, but with some additional time, more structured education can be implemented. There is also a significant monetary cost to educating residents compared to operating independently, since it is expensive to run an operating room. Since attending neurosurgeons lose opportunities to perform more surgeries when working with residents, there is a need to incentivize and compensate surgeons who dedicate time to education.