Intended for healthcare professionals


Clinical skills in spinal assessment and management

BMJ 2009; 339 doi: (Published 19 August 2009) Cite this as: BMJ 2009;339:b3242
  1. Samena Chaudhry, specialist registrar, trauma and orthopaedics 1,
  2. Peter A Bodkin, specialty trainee 4, neurosurgery2
  1. 1Department of Spinal Surgery, Royal Orthopaedic Hospital, Birmingham
  2. 2Western General Hospital, Edinburgh
  1. sxc602{at}

The clinical skills in spinal assessment and management course was produced by the Raven Department of Education at the Royal College of Surgeons. Its aim is to teach trainees to assess and initially manage patients presenting with spinal conditions in the emergency department, outpatient, and ward settings. Courses are held twice a year, usually at the college but sometimes at other venues.

Who is it for?

This course is specifically aimed at orthopaedic and neurosurgical trainees at specialty trainee 2 level and above, but is also suitable for anyone who is likely to have a day to day commitment to the care of patients who have had a spinal injury or who need elective or emergency spinal surgery. Indications for spinal surgery are expanding, as illustrated by the recent guidance from the National Institute for Health and Clinical Excellence on management of metastatic spinal cord compression.1 The ageing of the population means that increasing numbers of people need decompression for stenosis, often combined with correction of degenerative scoliosis. It is essential that all orthopaedic or neurosurgical trainees have a thorough grounding in the assessment and management of spinal patients.

Why did you do it?

“As I embarked upon my six month stint in spinal surgery, I realised the need to be competent in the basic management of spinal conditions both in the outpatient and ward setting but also when handling on-call spinal referrals for the region. I wanted to review the basic science and embryology of the specialty briefly but then concentrate on the actual assessment of the spinal patient and looked for a course that covered examination skills as well as diagnosis and management.”

—Samena Chaudhry

“As a neurosurgical trainee I spend most of my time in clinic examining patients with spinal disorders. It is easy to be blasé about these clinical encounters because they are so common. I think it is imperative, however, that one should be continually endeavouring to improve and refine one’s examination skills and not rely on the rudimentary skills learnt at medical school.

“I have also felt uncomfortable at times when dealing with patients with spinal cord injuries. For the majority of orthopaedic and neurosurgical trainees (apart from those who have had the benefit of working in a spinal injuries unit) these cases are a rarity.”

—Peter A Bodkin

How much effort did it entail?

Material is sent out before the course and should be read beforehand. The pre-course multiple choice questions provide a useful (but informal) assessment of learning to date. Studying this material initially seemed an onerous task, but the booklets were mostly in an easy to read question and answer format. The course itself is two full days, from 8 30 am until 6 pm with regular breaks for refreshments.

Each day comprises a few key short and sharp lectures, practical sessions, and small group seminars. Lectures reinforce the key points from the pre-course material and the small group sessions give ample time to practise skills as well as discuss controversial points and ask questions.

Is there an exam?

Apart from the informal multiple choice questions on the first day there is no exam.

Is it fun?

“The course is enjoyable; it is led by a group of friendly consultants and attended by trainees from two different specialties, which makes it interesting. Socialising is made possible by working in small groups and getting to know each other initially and also by a course dinner on the first night where participants can chat to the highly regarded faculty from the world of orthopaedics and neurosurgery in an informal setting.”


“Absolutely. I think one of the most worthwhile reasons to do the course is to break down the ‘them and us’ mentality that frequently exists between orthopaedic surgeons and neurosurgeons. Spinal surgery is a specialty shared between two disciplines but which frequently lacks interspecialty communication and a sharing of ideas.”


How much does it cost?

The course is £300, which includes all refreshments and lunches in addition to the pre-course reading material, which is useful for the FRCS Orth exam when it comes to revision time.

Was it worth while?

This was one of the most useful courses we have been on during higher surgical training. It helped us review and understand the basic science of the spine as well as develop practical skills, for example how to apply a halo. The most useful part of the course is in dealing with spinal cord injuries. Very few neurosurgeons or orthopods have had the benefit of working on a spinal injuries unit. We are, however, expected to deal with these extremely complex patients when they arrive in accident and emergency.

Would you recommend it?

Anyone who is in the beginning of specialty training in orthopaedics or neurosurgery should consider attending this course.

Top tips?

  • Book early to guarantee a place. Early booking also ensures accommodation at the college, which is conveniently located and cheaper than a hotel

  • Wear comfortable clothing—especially useful for the trauma scenarios where you are logrolling and lifting patients on and off spinal boards

  • Read the course material, as the key messages are reinforced throughout the course.

Further information

Royal College of Surgeons of England—; spinal{at}; 020 7869 6337. Next course 26-27 November 2009


  • Competing interests: None declared.


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