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Pain medicine fellow neuromodulation surgical skill assessment tool: a pilot
  1. Thomas P Pittelkow1,2,
  2. Jonathan M Hagedorn1,2,
  3. Markus A Bendel1,2,
  4. Jason S Eldrige1,2,
  5. Matthew J Pingree1,2,
  6. W. David Mauck1,2,
  7. Halena M Gazelka1,2,
  8. Tim J Lamer1,2,
  9. Rebecca A Sanders3,
  10. Heather A Billinges1,4 and
  11. Susan M Moeschler1,2
  1. 1Mayo Clinic, Rochester, Minnesota, USA
  2. 2Division of Pain Medicine, Department of Anesthesiology and Perioperative Medicine, Mayo Clinic, Rochester, Minnesota, USA
  3. 3Kansas Spine and Specialty Hospital, Wichita, Kansas, USA
  4. 4Office of Applied Scholarship and Education Science, Mayo Clinic, Rochester, MN, USA
  1. Correspondence to Dr Thomas P Pittelkow, Mayo Clinic Rochester, Rochester, MN 55905, USA; pittelkow.thomas{at}


Objective Spinal cord stimulation (SCS) is an evidence-based therapy for the treatment of refractory pain. Current American College of Graduate Medical Education requirements for pain medicine fellowship graduation include observation of five neuromodulation cases. Matriculating fellows have varying degrees of technical skill, training, and experience. The purpose of this study was to use an innovative skill-based assessment tool using the validated Zwisch scale to evaluate fellow surgical performance during SCS cases.

Design Cross-sectional survey

Setting Mayo Clinic, Rochester, Minnesota.

Subjects Consultant faculty (10) in the Division of Pain Medicine and pain medicine fellows (5).

Methods A list of faculty-driven neuromodulation surgical objectives was formed and a rubric was created that focused on technical approach, imaging, epidural access and wound closure. Consultants who perform surgical cases were instructed to use the Zwisch scale as a guide to evaluate fellow surgical performance during a neuromodulation case. Faculty and fellows were surveyed before and after implementation of the tool to determine their satisfaction with use of the skill assessment tool.

Results The consultants reported they were more satisfied, consistent, and efficient with feedback provided to the trainee on every aspect of neuromodulation surgical cases. The improvement was most significant during the fellows’ intraoperative skill assessment. The fellows indicated increased satisfaction, improved communication, and increased efficiency of feedback when the tool was utilized. The fellows reported greater intraoperative skill assessment and consistency of feedback provided.

Conclusions The diverse nature of primary specialty backgrounds observed in pain medicine fellowship training offers a unique opportunity to assess and improve fellow skill and surgical competence in the field of neuromodulation. Both faculty and fellows reported improved satisfaction, consistency and efficiency with feedback provided. Importantly, this pilot project observed that implementation of a skill assessment tool was beneficial for both the faculty and fellow as the feedback received was viewed as strongly beneficial to the educational experience.

  • neuromodulation
  • education
  • chronic pain
  • resident education

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  • Contributors TPP, JMH, HAB, and SMM were responsible for the conception and design, acquisition, data analysis and interpretation and full composition of the manuscript. MAB, JSE, MJP, WDM, HMG, TJL, and RAS were responsible for the acquisition of data, reporting of data, and final composition/review of the manuscript.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial, or not-for-profit sectors.

  • Competing interests None declared.

  • Patient consent for publication Not required.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Data availability statement All data relevant to the study are included in the article or uploaded as supplementary information.