Curriculum

Curriculum

The overall curriculum includes clinical and didactic learning experiences. Policies and procedures to which residents must adhere include those of the Department of Neurosurgery and those of the Graduate Medical Education (GME) Department for residents and fellows. Both manuals are given to each resident yearly.

Advanced Clinical Training Areas

  • Pain Management and Movement Disorders - We have one of the most active deep-brain stimulation programs for Parkinson’s disease in the country.
  • Cranial Nerve Disorders - We are an international referral center for conditions such as trigeminal neuralgia and hemi-facial spasm.
  • Complex Spine - We perform hundreds of instrumentation cases per year to treat degenerative disease or trauma. (We are a Level 1 Trauma Center.)
  • Neuro-oncology - We perform hundreds of craniotomies each year for tumor resection; we also perform LINAC-based radiosurgery procedures.
  • Neuroendoscopy - Our program is led by one of the pioneers in the field; both spine and intra-cranial applications are performed.
  • Skull Base and Neurovascular - We perform more than 100 surgeries for aneurysms and a range of skull-base surgeries per year.

 


Clinical Rotations

 

Click on the rotation title to see an overview, reading list, goals and objectives, competencies, and evaluation for the rotation

Plastic Surgery
Trauma ICU
Neurology
Neuro-ophthalmology
Neuropathology
Neuroradiology
Neuroradiology - SRS
Pediatric Neurosurgery

 

Surgical Subspecialties - Plastic Surgery
While on general surgery service, the resident will rotate one month through the plastic surgery service; attend all neurosciences didactic conferences, including subspecialty program conferences; and see all inpatient consults with senior resident or attending staff. The primary function of this rotation is to learn about patients with myocutaneous flaps or decubitus ulcers and learn management of wounds, wound healing, and the various suture techniques. Competencies for this rotation are as follows:

  • Medical Knowledge – At the end of this rotation, the resident will be able to understand the pathophysiology of wound healing and understand the causes, prevention and treatment of postoperative wound complications, such as infection and dehiscence.
  • Patient Care and Assessment – At the end of this rotation, the resident will be able to demonstrate the ability to manage complex wound care for patients and perform comprehensive history and physicals and preoperative assessments in outpatient clinics and in-house consults.
  • Practiced-Based Learning – At the end of this rotation, the resident will be able to provide basic care to wounds, debride wounds and close simple wounds and make and close incisions.
  • System-Based Practice – At the end of this rotation, the resident will be able to understand system-based practice of vocational rehabilitation, nursing homes and insurance issues.
  • Interpersonal and Communication Skills – At the end of this rotation, the resident will be able to discuss medical issues with patient and patient families while guarding patient’s privacy and collaborate effectively with colleagues and other health professionals.
  • Professionalism – At the end of this rotation, the resident will be expected to act in a professional manner at all times, expected to be compassionate in his or her dealings with patients and patient families, and expected to receive constructive criticism positively and develop improvement plan.

 

Surgical Subspecialties - Trauma ICU

While on general surgery service, the resident will rotate one month through the trauma intensive care unit; attend all neurosciences didactic conferences, including subspecialty program conferences; see all in-patient consults with senior resident or attending staff; and attend outpatient clinics.

The goals and objectives of the Trauma ICU rotation are for the PGY1 neurosurgery resident to learn comprehensive management of trauma patients, including coordinating care of patients with head and neck, chest, abdomen, and extremity injuries and treatment plans for severe soft tissue and pulmonary infections, respiratory failure, hemodynamic instability, renal failure and major bleeding.

Competencies for this rotation are as follows:

  • Medical Knowledge – After this rotation, the resident will be able to build solid fundamentals of knowledge in anesthesiology, critical care and trauma patient management; understand the epidemiology, diagnosis, surgical treatment and critical care of patients with blunt and penetrating trauma and complex multi-system injuries; understand the anatomy, physiology and pathology of all body systems affected by trauma including the central nervous system, cardiovascular system and pulmonary system; and understand cranial trauma including fracture, cerebrospinal fluid leaks, epidural hematomas, subdural hematomas, concussion, contusion and lacerations.
  • Patient Care and Assessment – At the end of this rotation, the resident will be able to develop a comprehensive management plan of the trauma, shock and critical care patients including ventilator management and perform concise history and physical examinations.
  • Practiced-Based Learning – At the end of this rotation, the resident will be able to coordinate the care of patients; insert IV & central lines and chest tubes and assist in bronchoscopy; and take responsibility and learn from errors.
  • System-Based Practice – At the end of this rotation, the resident will be able to utilize computer systems and other available resources to obtain patient testing results to provide the best care for the trauma patient, utilize computer systems to enter orders for patient testing/consults, and understand system-based practices of vocational rehabilitation, nursing homes and insurance issues.
  • Interpersonal and Communication Skills – At the end of this rotation, the resident will be able to effectively present comprehensive, concise management plans to supervising faculty and multiple team members for the care of Trauma ICU patients and discuss medical issues with patients and families while guarding patient’s privacy.
  • Professionalism – At the end of this rotation, the resident will be expected to act in a professional manner at all times, expected to be compassionate in his or her dealings with patients and patient families, and expected to receive constructive criticism positively and develop an improvement plan.

 

Neurology
 

During PGY1, the neurosurgery resident will spend 3 months on the neurology service, including the Comprehensive Epilepsy and Comprehensive Stroke services;  attend all neurosciences didactic conferences, including subspecialty program conferences; and
see outpatient consults under the direct supervision of senior residents and attending staff.

Required reading is as follows:  Principles of Neural Science (Kandel, Schwartz and Jessell),  Principles of Neurology  (Victor & Adams), and Textbook of Neurology  (Merritt)

Goals and objectives for this rotation are for the resident to be provided with the opportunity to learn all aspects of evaluating, diagnosing and managing of patients with neurologic diseases under the supervision of an attending neurologist. The resident will understand the role of neurology in the context of the medical and surgical specialties and subspecialties.

Competencies for this rotation are as follows:

  • Medical Knowledge – The resident will become able to understand the presentation of common neurologic syndromes mimicking neurosurgical disorders; establish fundamental competency and understanding of the clinical pathologic presentations of spasticity and movement disorders, epilepsy, neuromuscular disorders and neuroimmunologic disorders; develop differential diagnostic skills to initiate appropriate workup of primary neuralgic disorders on the basis of sound neurophysiologic, neuroanatomic and neuropathologic principles; develop proficiency/mastery of comprehensive neurological examination; and develop fundamental competencies in the interpretation of EEG, EMG and NCV.
  • Patient Care and Assessment – The resident will be able to integrate the principles of basic neurological science with in-depth clinical outpatient experiences and adult inpatient consultations.
  • Practice Based Learning – The resident will be able to locate, appraise and assimilate evidence from scientific studies and evidence-based medicine relating to neurologic disorders and disease.
  • Systems Based Practice – The resident will be able to function as a team member in the Comprehensive Epilepsy and Stroke services and establish fundamental competency in the evaluation of the socioeconomic impact of neurologic practice in the context of current medical economics and malpractice issues.
  • Interpersonal and Communication Skills – The resident will be able to foster a collegial/collaborative working relationship with neurologic colleagues.
  • Professionalism – The resident will be competent to demonstrate a high level of professionalism at all times with administrative faculty and nursing staff.

 

At the end of this rotation, the Neurology faculty will complete an evaluation form based on the goals and objectives outlined above.

 

Neuro-ophthalmology

The resident will rotate 6 months on the neuro-ophthalmology service (in conjunction with neuroradiology/SRS rotation);  attend once-weekly clinics; and be involved periodically in operating room cases.

Reading list and supplemental reading: Walsh & Hoyt’s Clinical Neuro-Ophthalmology: The Essentials, 2nd ed. (Miller et al.), Lippincott, Williams & Wilkins; Wills Eye Manual  (Rhee et al.), Lippincott Williams & Wilkins; Ophthalmology Clinical Signs and Differential Diagnosis, Kanski et al.

Goals and objectives of this rotation are as follows: The director of the Division of Neuro-ophthalmology serves as a mentor for outpatient and inpatient consultations and provides didactic sessions on the anatomy and physiology of the visual pathways and the interpretation of visual field examinations. Operative experiences for intraorbital/intracranial lesions are gained through a team approach with the neuro-ophthalmologists and the neurosurgeons, especially with transcilliary orbital-frontal approaches.

Competencies for this rotation are as follows:

  • Medical Knowledge – At the end of this rotation, the resident will be able to acquire detailed knowledge of ophthalmic anatomy; understand ophthalmic manifestations of neurologic disease; and understand emergency situations in neuro-ophthalmology and how they are handled.
  • Patient Care and Assessment – At the end of this rotation, the resident will be able to perform a detailed neuro-ophthalmologic exam under dilation, including sensory motor and fundus exam; recognize important physiology and pathology of the eye; and gain familiarity with various ophthalmic surgical techniques and their relation to neurosurgery.
  • Practice-Based Learning: - The resident will be able to develop the ability to learn from one’s own mistakes and be given opportunities to reproduce exam skills on multiple patients.
  • Systems-Based Practice - The resident will be able to effectively utilize the resources available to make optimal healthcare decisions.
  • Interpersonal and Communication Skills – The resident will be able to effectively exchange information with patients, their families and other health professionals and observe and participate in patient counseling for informed consent and various diagnosis/prognoses.
  • Professionalism – The resident will be able to demonstrate consistent adherence of ethical principles and sensitivity to all patients regardless of gender, age, culture, religion, sexual preference, socioeconomic status, beliefs, behaviors or disabilities and develop a personal program of learning to foster continued professional growth and development with guidance from the teaching staff.

 

At the end of this rotation, the neuro-ophthalmology faculty will complete an evaluation form based on the goals and objectives outlined above.

Neuropathology

During PGY3, the neurosurgery resident will (1) rotate 2 months on neuropathology; (2) learn systematic review of neuropathological slides in all aspects of neuropathology, including approximately 100 slides under 20 different categories. The residents are expected to review the slides independently. The attending will discuss each case with the residents after residents have rendered a diagnosis and read the related chapter for each category of the disease; (3) attend all brain cutting conferences to learn the basic roles in gross examination of the human brain and the common gross pathology of the brain and spinal cord; (4) attend microscopic and didactic lectures in neuropathology; and
(5) participate in interpretation of frozen sections and all neurosurgical pathological specimens.

Reading list/supplemental reading: Surgical Pathology of the Nervous System and its Coverings, 4th ed. (Peter Burger et al.), Neuropathology, a reference test of CNS Pathology, 2nd ed. (Ellison Love), Escourolle and Poirier Manual of Basic Neuropathology, 4th ed., and World Health Organization Classification of Tumours – Pathology and Genetics Tumours of the Nervous System, 2007.

Goals and objectives of this rotation are that the resident understands the basic pathological features and pathological processes of common disorders of the nervous system. This training will help the trainee to pass the board exam and to offer better patient care by understanding neuropathology.

Competencies for this rotation are as follows:

  • Medical Knowledge - After this rotation the resident should be able to develop competency in neuropathologic classification and nomenclature and understand the correlation with clinical and pathological findings and the impact of the neuropathological findings on patient management.
  • Patient Care and Assessment - After this rotation the resident should be able to develop correlative clinical interpretation skills of gross and microscopic pathological findings in neurological disease and neurosurgical specimens and utilize neuropathologic correlations to develop neurosurgical and adjunctive patient treatment plans.
  • Practice-Based Learning - After this rotation, the resident will be able to develop appropriate skills in touch preparation and frozen section techniques in neuropathology, establish fundamental competency in a gross and microscopic examination of the central nervous system and its pathologies, and actively participate in the examination of neurosurgical case and autopsy specimens.
  • Systems-Based Practice - During this rotation the resident will be able to serve as a liaison between the clinical neurosurgical service and the pathologists and work closely with pathology residents and attending neuropathologists in the preparation of neuropathology reports.
  • Interpersonal and Communication Skills – During this rotation the resident should be able to establish and foster collaborative interactions with neuropathology colleagues.
  • Professionalism – The neurosurgery resident is expected to engage in a professional manner at all times; demonstrate consistent adherence to ethical principles and sensitivity to all patients regardless of gender, age, culture, religion, sexual preference, socioeconomic status, beliefs, behaviors or disabilities; and promote the principles of confidentiality and informed consent.

At the end of this rotation, the Neuropathology faculty will complete an evaluation form based on the goals and objectives outlined above.

 

Neuroradiology
 

During PGY3, the neurosurgery resident will rotate 6 months in neuroradiology, in conjunction with rotation in SRS and neuro-ophthalmology and maintain advanced cardiac life support certification.

Reading list/supplemental reading:

  • Diagnostic Neuroradiology. Anne G. Osborn. St. Louis: Mosby-Year Book, Inc., 1994.
  • Neuroradiology: The Requisites. Robert I. Grossman and David M. Yousem. 2nd ed. St. Louis: Mosby, 2003.
  • Diagnostic Imaging: Brain. Anne Osborn, Susan Blaser, Karen Salzman, eds. AMIRSYS, 2004
  • Diagnostic Imaging: Head and Neck. H. Ric Harnsberger, Patricia Hudgins, Richard Wiggins, Christian Davidson, eds. AMIRSYS, 2004
  • Practical Neuroangiography. Pearse Morris. Philadelphia: Lippincott Williams & Wilkins, 1997.
  • Interventional Neuroradiology: Strategies and Practical Techniques. J. J. Connors III and Joan C. Wojak. Philadelphia: W. B. Saunders Company, 1999.
  • Magnetic Resonance Imaging of the Brain and Spine [Volumes 1 and 2]. Scott W. Atlas. 3rd ed. Philadelphia: Lippincott Williams & Wilkins, 2002.
  • Diagnostic Imaging: Spine. Jeff Ross, Michael Brandt-Zawadzki, Mark Chen, Kevin Moore, Karen Salzman, eds. AMIRSYS, 2004
  • Pediatric Neuroimaging. A. James Barkovich. 4th ed. Philadelphia: Lippincott-Raven Publishers, 2005
  • Journals and other resources such as Radiology, American Journal of Roentgenology, RadioGraphics, American Journal of Neuroradiology, The American College of Radiology Teaching File, The American College of Radiology Syllabi on Neuroradiology, The American College of Radiology CD-ROM discs on Neuroradiology, web-based

    Aunt Minnie, and Medpics

Goals and objectives for this rotation are that the resident will become thoroughly familiar with all aspects of neuroradiology, including myelography/CT, angiography/CT, MRI, and neurointerventional procedures. The resident will become familiar with all aspects of administering and monitoring sedation of the conscious patient.

Competencies for this rotation are as follows:

  • Medical Knowledge – The resident will be competent in the techniques and interpretation of myelography and lumbar puncture, angiography (including neurointerventional procedures) of the intracranial and extracranial vessels, MRI of the brain (including MR angiography), head and neck (including neck, orbit, and temporal bone), and spine; understand the techniques and indications for MR spectroscopy, perfusion imaging, and PET; and learn all aspects of administering and monitoring sedation of the conscious patient; learn the protocols and interpretation of CT, angiography, and MRI of the brain (including CT angiography, CT myelography, and MR angiography), head and neck (including neck, orbit, and temporal bone), and spine.
  • Patient Care and Assessment – The resident will be able to participate in the pre- and post-procedural care of patients undergoing CT myelography and CT angiography procedures, including obtaining informed consent and rounding on patients; continue rounding on any patient who has sustained a complication, following a procedure, until resolution; and interpret the CT scans and assess the patient.
  • Practice-Based Learning – The resident will be able to gradually function independently in the interpretation of radiological scans (CT, MRI, angio) but will be supervised during daily interpretation sessions with faculty; contribute cases to the departmental teaching file (one per week), with images and a description of imaging findings and teaching points, with references; and collect missed cases for monthly quality assurance conference.
  • Systems-Based Practice – The resident will be able to maintain a procedure log, including the tracking of complications and their outcomes; learn the appropriate indications for CT (with and without contrast) as well as myelography and the proper progression of imaging studies in the evaluation of trauma, headache, back pain, and suspected increased intracranial pressure; learn the appropriate indications for angiography of the intracranial and extracranial circulation; learn the proper progression of imaging studies in the evaluation of atherosclerotic vascular disease, vascular trauma, and intracranial hemorrhage; and review the appropriate indications for MRI of the brain (including MR angiography), head and neck (including neck, orbit, and temporal bone), and spine. The resident will also review the proper progression of imaging studies in the evaluation of stroke, vascular trauma, cord compression, back pain, neoplasm, and intracranial hemorrhage. The resident will also learn the proper progression of specialized imaging studies such as MR spectroscopy, perfusion imaging, and PET.
  • Interpersonal and Communication Skills – The resident will be able to preview all cases before reviewing with staff, in order to form an independent interpretation opinion and develop communication skills with staff; communicate urgent and unexpected findings on radiology studies to the referring physician in a timely manner; be especially conscious of his or her interactions with patients and members of their family; relate information clearly and concisely; demonstrate good listening skills; and show appropriate compassion.
  • Professionalism - The resident will become competent in maintaining professionalism by adhering to neuroradiology’s requirements/policies: (1) remain in the clinical area of assignment throughout the day; any “down time” should be used for reading; (2) if you are scrubbed into a procedure as noon conference approaches, ask the attending if you may be excused for conference; (3) return to the service by 1:30 p.m. if there is a noon conference; if not, return by 1 p.m.; (4) remain on service until the end of the work day, which is typically 6 p.m. but is determined each day by your attending (in other words, do not leave the service until your attending gives you permission to do so); and (5) dress in a manner appropriate for the duties you are expected to carry out on a particular day. Scrubs are reserved for rotations requiring procedures. Lab coats must be worn over scrubs.  The resident will conduct verbal and written communications with the radiology faculty, clinicians, hospital staff, patients and their families in a professional manner, adhering to the ethics of the profession and hospital policy.  Professionalism encompasses the following characteristics: altruism; respect for others; honor; integrity; ethical behavior; accountability; excellence; duty-advocacy; social responsibility; and cultural competence. In order to facilitate the formation of professionalism, several methods will be employed by the program, including 360-degree evaluations, performance feedback, and group discussions.

At the end of this rotation, each member of the faculty will complete an evaluation form based on the goals and objectives outlined above. The resident will have the opportunity to review and sign this form at the next meeting with the advisor or the program director. At any time during the rotation, the resident may request verbal feedback from the faculty. The resident may also review his or her evaluations in the coordinator’s office during regular business hours. Finally, if the resident would like to discuss a specific evaluation with a faculty member, this will be promptly facilitated by the program director.

 

Neuroradiology - SRS

The neurosurgery resident will rotate for 6 months in Neuroradiology – SRS in conjunction with rotations through neuro-ophthalmology.

Reading list/supplemental reading:  Stereotactic Radiosurgery, Loeffler, Alexander & Landsford, 1993

Goals and objectives are for the resident to acquire requisite background information to understand the indications for and the various techniques used to perform radiosurgery.

Competencies for this rotation are as follows:

  • Medical Knowledge: - The resident will understand various sources and mechanical techniques of radiosurgery; understand dose parameters and likelihood of radiation necrosis; understand basics of planning including arc design and avoidance of critical structures; and understand radiation sensitivities of various pathologies and normal structures.
  • Patient Care and Assessment - The resident will be able to learn to place a head ring, with attention to position and preprocedure sedation; perform lesion outlining and treatment plan with the physicist; review plans with the radiation oncologist and neurosurgeon with justification of decisions made; and become familiar with important features of planning software such as dose-volume histogram.
  • Practice-Based Learning - The resident will be able to foster personal growth and development and learn from his or her own errors.
  • Systems-Based Practice - The resident will be able to effectively utilize the resources available to make optimal healthcare decisions.
  • Interpersonal and Communication Skills – The resident will be able to effectively exchange information with patients, their families and other health professionals.
  • Professionalism – The resident will be able to demonstrate respect, responsibility and sensitivity in relating to colleagues at all levels; demonstrate consistent adherence of ethical principles and sensitivity to all patients regardless of gender, age, culture, religion, sexual preference, socioeconomic status, beliefs, behaviors or disabilities; and promote the principles of confidentiality and informed consent

 

At the end of this rotation, the Radiation Oncology faculty will complete an evaluation form based on the goals and objectives outlined above.
 

Pediatric Neurosurgery

During PGY3, the neurosurgery resident will rotate 4 months on a pediatric service; attend all required pediatric conferences; take call as scheduled by the pediatric chief resident; and participate in outpatient clinics and inpatient consultations.

Goals and objectives of the rotation are to provide an educational pediatric neurosurgery experience in patient care activities compliant with ACGME’s required competencies. The resident will gain knowledge in the anatomy, physiology, pathophysiology, and presentation of diseases in children that a neurosurgeon may be called upon to diagnose and treat.

The resident will function as an integral member of the affiliated pediatric program under the direction of that program’s faculty. The resident will prepare lectures, conferences, journal clubs, and morbidity and mortality reviews at the affiliate program. Literature reading from text books, journals and computer-based learning may be expected.

Competencies for this rotation are as follows:

  • Medical Knowledge - During the pediatric rotation the resident will become competent in: embryologic development of the central nervous system and its application to clinical pediatric neurosurgical patient disease processes; developmental neuroanatomy, neurophysiology and neuroradiology as a foundation for clinical problem solving and decision making in pediatric patients; and ER evaluation and management of head injury, spine/spinal cord injury, shunt malfunction/infection and postoperative medical/surgical complications.
  • Patient Care and Assessment - During the pediatric rotation the resident will become competent in performing comprehensive neurosurgical histories and physicals on pediatric patients with elective, traumatic and emergency neurosurgical diseases/disorders and develop comprehensive daily progress notes/documentation.
  • Selecting appropriate utilization and interpretation of diagnostic studies (CT/MR) pertinent to the pediatric population; conducting outpatient/clinic evaluation and followup of pre and postoperative children to include history-taking skills, general and neurological examination skills, the development of an appropriate workup, plan of management and providing for appropriate followup of surgical and nonsurgcial pediatric patients; and critical care management of ill, injured, or postoperative children with special emphasis on pediatric ventilator and medication issues.
  • Practice-Based Learning - During the pediatric rotation the resident will become technically proficient across the surgical spectrum of common pediatric neurosurgical disorders – hydrocephalus, craniosynostosis, tethered cord syndrome, tumors, and spinal injuries/anomalies, and assist in major surgical procedures and achieve competency in basic opening and closing techniques in pediatric patients, pediatric head injury and spine injury management, ventriculoperitoneal shunting, evaluation and management of spinal dysraphism, ventriculostomy and intracranial pressure monitoring, lumbar puncture, ventilator management, nutritional management, arterial line placement, and halo placement.
  • Systems-Based Practice - During the pediatric rotation the resident will become competent in participation/preparing for lectures, conferences, journal clubs and morbidity and mortality reviews comparing and contrasting adult versus pediatric neurosurgical disease/disorders with respect to evaluation and management and utilizing current literature and research from textbooks, journals and computer-based learning experiences on pertinent pediatric neurosurgical issues.
  • Interpersonal and Communication Skills - During the pediatric rotation the resident will become competent in effectively communicating with affiliate staff.
  • Professionalism - During the pediatric rotation the resident will become competent in maintaining a professional relationship with affiliate staff at all times.

At the end of this rotation, the pediatric neurosurgery faculty at Children’s Hospital of Pittsburgh (and any other outside facilities) will carefully and thoroughly evaluate the resident’s performance to ensure that fundamental competencies are established in this area of neurosurgical practice. Part of this evaluation includes a review of the resident’s involvement as a primary or assistant surgeon in pediatric neurosurgical cases.

 


PGY1

 

The first-year rotations are organized to allow maximum exposure to subspecialties to learn preoperative/postoperative and outpatient care with an emphasis on history and physical examination, interpersonal and communication skills, and professionalism.

Overall curriculum:

  • 3 months in an ACGME-accredited surgical service, which may include rotations in general surgery, plastic surgery, trauma ICU or vascular surgery
  • 3 months in an ACGME-accredited neurology service learning the fundamentals of a comprehensive neurological history and examination and evaluating and developing treatment plans for a variety of neurological diseases
  • 6 months in neurosurgery service learning the day-to-day clinical and academic functions of the neurosurgical service to enable a smooth transition to PGY2
  • Attend all neuroscience didactic conferences, including subspecialty program conferences.
  • Attend outpatient clinics according to subspecialty schedule.
  • Take SANS online self assessment examination.
  • Maintain case log through ACGME site and provide all required documentation for resident portfolio.
  • Obtain certification in ATLS/ACLS and Fundamental Critical Care Support.
  • Obtain certification in ventriculostomies and twist-drill subdural hematoma drains and provide appropriate documentation to resident coordinator.

 

 

Competencies after completing PGY1:

Medical Knowledge – Manage subspecialty medical disorders based on a thorough knowledge of basic and clinical science.

Patient Care and Assessment

  • Direct basic management plans for inpatient and outpatient care under the supervision of appropriate senior resident and attending staff of each subspecialty.
  • Develop the necessary skills to formulate a comprehensive patient history and physical.
  • Provide basic interpretation of laboratory results and radiological studies.
  • Demonstrate the ability to apply knowledge of anatomy in patient care situations both in and out of the operating room.

 

Practice Based Learning

  • Develop the necessary skills to formulate an accurate patient history and physical to be presented to the senior resident or attending staff of various subspecialties.
  • Choose the appropriate diagnostic radiological and laboratory studies to establish an accurate diagnosis of the patients.
  • Develop technical skills for general surgery patients.
  • Develop technical skills for neurosurgery patients including ventriculostomies and twist drill drain procedures after being supervised and certified.
  • Take responsibility for errors and learn from them.

 

System Based Practice

  • Understand the structure, function and interface of multiple complex subspecialty programs and organizations.
  • Choose the appropriate cost-effective diagnostic and laboratory studies to establish an accurate diagnosis for the various subspecialties.
  • Utilize computers and new technology.

 

Interpersonal and Communication Skills – Collaborate effectively with colleagues and other health professionals.

Professionalism

  • Demonstrate respect, responsibility and sensitivity in relating to colleagues at all levels.
  • Demonstrate consistent adherence of ethical principles and sensitivity to all patients regardless of gender, age, culture, religion, sexual preference, socioeconomic status, beliefs, behaviors or disabilities.
  • Promote the principles of confidentiality and informed consent.

 

Evaluations are sent to the respective program directors at the end of every subspecialty rotation. The neurosurgery program director relies on these evaluations to determine if a resident has satisfactory performance and is mastering essential competencies to advance into the PGY2 neurosurgery year.


 

PGY2

 

The primary goal of the PGY2 neurosurgical year is to augment and establish fundamental competency in the clinical neurosciences and critical care, as well as to establish and augment basic surgical and neurosurgical skills during daytime work hours and when on call. The PGY2 resident will have close, daily personal interaction with the teaching faculty for each patient with whom he/she is involved. Operating room responsibility/involvement is secondary to critical care, outpatient experience and attendance at didactic lectures in this year.

Overall Curriculum

  • Rotate 12 months on the AGH clinical adult neurosurgery service.
  • One day per week devoted to teaching in the outpatient clinics.
  • Prepare and present at least one didactic national neurosurgical conference.
  • Begin preparation of at least one manuscript/book chapter in close collaboration with neurosurgical faculty
  • Introduction to fundamentals of clinical education by being involved in the teaching of rotating medical students and residents from other services.
  • Take SANS on-line self assessment examination at sans.cns.org
  • Attend all mandatory neurosurgical and neuroscience conferences.
  • Prepare one lectures each semester for journal club, ethics and spine conferences.
  • Pass Step III of the USMLE test by June 30th.
  • Take written neurosurgical boards for practice.
  • Maintain case log thru ACGME site and provide all required documentation for resident portfolio.

 

 

Competencies
Medical Knowledge - The resident will be able to:

  • Perform comprehensive neurosurgical histories and physicals on patients with elective, traumatic, emergency and non-emergency neurosurgical diseases/disorders.
  • Review indications and interpretation of laboratory and radiographic imaging (CT/MR) studies.
  • Take call with senior and/or chief resident and the attending staff backup learning time management and prioritization skills.
  • Management head and spine/spinal cord injuries.
  • Know basic neuroanatomy, neurophysiology and neuroradiology as a foundation for clinical neurosurgical problem-solving and decision making.
  • Gain knowledge of the ethics and socioeconomics of neurosurgery.
  • Clinical Procedures. (Refer to “Exhibit A” for Specific Knowledge and Performance requirements)using written board exam, SANS-wired program, AANS on-line courses, Oral Exam evaluations, Skull Base Lab workshops, and bi-annual core evaluations & technical proficiencies.

 

Patient Care and Assessment – The resident will be able to:

  • Attend all scheduled outpatient clinics with assigned faculty performing outpatient neurosurgical evaluations/treatment plan, history & physicals and to address patient/family psychosocial issues.
  • Round alone and with resident team members writing comprehensive daily progress notes documenting all aspects of patient evaluations and treatment decisions.
  • Manage critical care neurosurgical patients with traumatic and non-traumatic disorders/diseases and achieve competencies in: ventilator management, arterial line placement, and central venous and Swan-Ganz catheter placements.
  • Assist in major surgical procedures and achieve competency in: basic opening and closing techniques for craniotomies and spinal procedures, placement of ventriculostomies and intracranial pressure monitors, twist-drill craniotomy, lumbar puncture and lumbar spinal drains, tongs/halo placement.
  • Keep track of log of all procedures performed using Observed Exam (clinic and rounds), bi-annual core evaluations & technical proficiencies, and patient survey/ Feed back cards

 

Practice Based Learning – The resident will be able to:

  • Do an analysis of complications and their avoidance thru active involvement in weekly morbidity and mortality conference.
  • Establish evidence-based guidelines approach to neurosurgical patient care.
  • Participate in clinical neurosurgical research projects to develop basic competencies in writing abstracts, book chapters and/or articles.
  • Develop teaching skills with medical students/residents rotating through neurosurgery from other services and other members of the healthcare team.
  • Develop a personal program of learning to foster continued professional growth and development with guidance from the teaching staff.
  • Use Journal Club with Statistics, Set New/Evaluate Old Goals, Case Logs, Yearly Scholarship Logs, and SANS-wired.

 

Systems Based Practice – The resident will be able to:

  • Utilize computer resources within the system to access information to enhance patient care.
  • Apply evidence-based information to clinical decision making in a cost effective manner.
  • Develop competency for medical records completion
  • Use QI Team Projects and Formal Lectures.

 

Interpersonal and Communication Skills - The resident will be able to:

  • Effectively communicate with other members of the healthcare team, patients and patients’ families.
  • Develop appropriate patterns of interaction with other members of the resident team.
  • Focus on and develop a compassionate approach to deal with patients, their illness and to the patients’ families
  • Use Observed Exam, Patient Survey, and Feedback cards

 

Professionalism – The resident will be able to:

  • Exhibit good work habits such as reliability, preparation, cooperation and efficiency.
  • Demonstrate compassion, respect and consideration for the patients and their families.
  • Demonstrate a high level of professionalism at all times
  • Use Project Professionalism/AMA virtual Mentor, 360 degree evaluation (non-neuro staff, residents, self), and Feedback cards

 

The faculty will evaluate the residents on the core competencies and technical proficiencies bi-annually based on the goals and objectives outlined above
 

PGY3

 

During the PGY3 year, the resident will function as in integral member of the teaching program in each rotation under the direction of that program’s faculty. He/she will prepare lectures for journal clubs, ethics, spine and morbidity and mortality conferences. Extensive literature reading from text books, journals and computer-based learning will be expected from the resident.

The objective of the rotations during the PGY3 year is to expand and enhance all skills and competencies from the PGY2 year and utilize all knowledge obtained from specialty rotations in the practice of neurosurgery.

Overall Curriculum

  • Rotate 6 months on elective/selective rotations in neuroradiology/radiation oncology and neuro-ophthalmology.
  • Rotate 3 months in neuropathology.
  • Rotate 3 months in pediatric neurosurgery at the Children’s Hospital of Pittsburgh (or another facility if approved).
  • Attend all mandatory Neuroscience Core Curriculum Conferences.
  • Prepare lectures for journal club, ethics, spine and morbidity and mortality conferences.
  • Write at least one abstract, book chapter or article for presentation at a national neurosurgical/neuroscience conference (attend conference if abstract accepted)
  • Take SANS on-line self assessment examination.
  • Maintain case log thru ACGME site and provide all required documentation for resident portfolio.
  • Take call with senior and/or chief resident and the attending staff backup while rotating through subspecialties to maintain neurosurgical skills.
  • Take written neurosurgical boards for practice or credit.
  • Work with medical students teaching history and physical fundamentals.

 

 

The objective of the neuroradiology rotation is to ensure fundamental competency and learning skills in the clinical and neuroanatomic interpretation (and in some instances performance) of all aspects of diagnostic neuroradiology. Experience and knowledge with radiosurgery will be obtained. Rotation supervised by Melanie Fukui, MD, Director of Neuroradiology. (Separate detailed “goals and objectives” for neuroradiology is available.)

The objective of the neuropathology rotation is devoted to the fundamental competency and practical aspects of the neuropathological examination of the central nervous system. Both technical and interpretative aspects of neuropathology are emphasized. Rotation supervised by Frank Pu, MD, PhD, Director of Neuropathology, Department of Pathology, Allegheny General Hospital. (See separate “goals and objectives” for Neuropathology.)

The objective of the neuro-ophthalmology rotation is for the resident to become familiar with the diagnosis and management of disorders commonly seen in neuro-ophthalmology and to learn the skills necessary for testing these disorders such as examining pupils, visual fields, motility and the fundus using an ophthalmoscope. Rotation supervised by Erik Happ, MD, Director of Neuro-ophthalmology. (Separate detailed “goals and objectives” for neuro-ophthalmology is available.)

The objectives for the pediatric rotation focus exclusively on the identification of disorders of the pediatric nervous system which require neurosurgical evaluation and/or treatment. Specific areas to be developed or enhanced are detailed in Exhibit A. Rotation at Children’s Hospital of Pittsburgh is supervised by Ian Pollock, MD, Director of Pediatric Neurosurgery. (Separate detailed “goals and objectives” for neuro- pediatrics is available.)

Competencies
Medical Knowledge - The resident will be able to:

  • Maintain and expand on all skills and competencies learned in the NS1&NS2 years (Refer to Exhibit A for specific knowledge and performance requirements)
  • Begin to direct critical care management and non-operative neurosurgical care under the direct supervision of a faculty member.
  • Accurately interpret laboratory and imaging studies (CT/MR/MRA/CTA/PET:CT).
  • Develop patient care treatment plans and effectively communicate these orders.
  • Acquire necessary skills to diagnosis and perform radiosurgery procedures.
  • Obtain educational skills in neuropathology, neuroradiology, neuro-ophthalmology and neuro-pediatrics and begin implementation of these skills.
  • Take call with senior and/or chief resident and the attending staff backup to maintain and enhance neurosurgical skills
  • Use Written Board Exam, SANS-wired, Oral Exam, Skull Base lab workshops, bi-annual evaluations, and end of rotation evaluations

 

Patient Care and Assessment - The resident will be able to:

  • Expand on their teaching skills while working with medical students on the fundamentals of history and physicals
  • Demonstrate clear and concise patient care plans and implement them under the direct supervision of a faculty member.
  • Perform selected surgical procedures under direct supervision such as laminectomy and intermediate-level craniotomies (refer to Specific Knowledge and Performance Requirements)
  • Assist in major surgical procedures and, under direct guidance of a faculty member, perform portions of the operation that are appropriate to the resident’s level of training.
  • Keep track of log of all procedures performed.
  • Use Observed Exam (clinics/operating room), patient survey, post-exam/feedback cards, bi-annual evaluations, and end of rotation evaluations

 

Practice Based Learning – The resident will be able to:

  • Demonstrate an ongoing and improving ability to learn from errors.
  • Perform a clinical or basic neurosciences research project that is appropriate for presentation at a national scientific meeting and for subsequent publication.
  • Develop fundamental research skills.
  • Analyze complications and their avoidance in pediatric patients through regular morbidity and mortality conferences.
  • Seek out and utilize evidence-based guidelines in the evaluation and management of pediatric patients.
  • Analyze complications and their avoidance in pediatric patients through regular morbidity and mortality conferences at Children’s Hospital.
  • Seek out and utilize evidence-based guidelines in the evaluation and management of pediatric patients.
  • Use Journal club with Statistics, set new goals/evaluate old goals, yearly scholarship logs, SANS-wired, and case Logs

 

Systems Based Practice – The resident will be able to:

  • Apply cost effectiveness and evidence-based approaches to the previously acquired clinical decision making skills
  • Understand practice management issues such as patient processing, E&M coding, procedural terminology, documentation of services rendered and reimbursement process related issues.
  • Demonstrate an understanding of practice opportunities, practice types, health care delivery systems and medical economics.
  • Use computer resources in evaluating and managing pediatric neurosurgical patients.
  • Use QI Team Projects and formal lectures


Interpersonal and Communication Skills - The resident will be able to:

  • Demonstrate ability to provide compassionate care to patients and their families.
  • Demonstrate a high level of interpersonal communication skills with other residents.
  • Demonstrate a compassionate and objective approach to patient counseling.
  • Effectively communicate with other members of the healthcare team with particular emphasis on patients and their families and the unique nature of the physician/parent/child interaction
  • Use Observed Exam, Patient Survey, and Feedback cards

 

Professionalism – The resident will be able to:

  • Demonstrate a high level of professionalism at all times with patients, family members, faculty, staff and other residents.
  • Exhibit good work habits such as reliability, preparation, cooperation and efficiency.
  • Demonstrate compassion, respect and consideration for the patients, their families and the unique physician/parent/child interactions in pediatric neurosurgery.
  • Use Project Professionalism/ AMA Virtual Mentor, 360-degree evaluation, and feedback cards

 

The faculty will evaluate the residents on the core competencies and technical proficiencies bi-annually based on the goals and objectives outlined above
 

 

PGY4

 

The objective of the PGY4 year is to further expand and enhance the skills and competencies learned from the previous year during the neuroradiology, neuro-ophthalmology, neuropathology and pediatric rotations. This year is devoted solely to clinical neurosurgery. The resident will begin to be involved with supervising and teaching responsibilities in addition to expanding their surgical experience.

Overall Curriculum

  • Rotate 12 months in clinical neurosurgery
  • One day per week devoted to teaching in the outpatient clinics.
  • Take call with senior and/or chief resident and the attending staff backup
  • Attend all mandatory conferences and lectures.
  • Prepare lectures for journal club, ethics, spine and morbidity and mortality conferences.
  • Attend scheduled outpatient clinics with assigned faculty.
  • Take SANS on-line self assessment examination.
  • Maintain case log thru ACGME site and provide all required documentation for resident portfolio.
  • Take written neurosurgical boards for credit (if necessary).

 

Competencies
Medical Knowledge -  The resident will be able to:

  • Expand knowledge base in neuroanatomy, neurophysiology, neuropharmacology and basic neurosciences by attending the Woods Hole RUNN course.
  • Begin to teach and mentor lower level residents in critical care, operative skills, patient work-up, and evaluation and management skills.
  • Demonstrate the ability to evaluate the medical literature in journal clubs.
  • Attempt to pass the neurosurgical written board exam.
  • Assume an increasingly active role in didactic conference preparations and discussions.
  • Use Written Board Exam, SANS-wired, Oral Exam, bi-annual evaluations and competencies, and skull base lab workshops

 

Patient Care and Assessment - The resident will be able to:

  • Accurately interpret complex laboratory and imaging tests.
  • Provide and direct clear and concise in-patient and out-patient treatment plans.
  • Demonstrate competency in their performance of mid-level surgical procedures (spine and cranial) appropriate to their level of training. (Refer to Specific Core Clinical Knowledge Requirements)
  • Use Observed Exam (clinics/operating room), patient survey (post-exam/feedback cards), and bi-annual exam: procedures

 

Practice Based Learning - The resident will be able to:

  • Perform a clinical or basic science research project appropriate for presentation at a national scientific meeting and for subsequent publication.
  • Demonstrate sound habits of personal scholarship and scientific inquiry.
  • Demonstrate on ongoing and improving ability to learn from errors.
  • Use Journal club with Statistics, set new goals/evaluate old goals, yearly scholarship logs, SANS-wired, and case logs

 

System Based Practice: The residents will be able to:

  • Demonstrate an understanding of practice opportunities, practice types, health care delivery systems and medical/socioeconomics.
  • Maintain log of all procedures performed utilizing ACGME case log system.
  • Use QI Team Projects and Formal Lectures

 

Interpersonal and Communication Skills - The resident will be able to demonstrate a high level of interpersonal communication skills with patients and staff using Observed Exam, Patient Survey, and Feedback cards

Professionalism - The resident will be able to demonstrate a high level of professionalism at all times with administrative faculty and nursing staff using Project Professionalism/ AMA Virtual Mentor, 360-degree evaluation, and Feedback card
 

PGY5

 

The objective of PGY5 is for the resident to assume the senior resident status with an increasing decision making role regarding patient care and to embrace more responsibility in the management of patients serving as primary surgeon in selected cases where competency has been established. A more active role is assumed in the teaching of junior residents and medical students, and emphasis is placed on developing competency in practice-based learning and improvement by providing the opportunity of organizing and implementing various clinical/didactic conferences.

The last 3 months of PGY5 are spent formulating a research/academic plan that will be enacted during the subsequent research year. Those residents interested in basic neuroscience research will be assisted in identifying and developing their area of interest. Once an area has been established, the resident will be directed to the appropriate basic scientist, in which the goals and objectives of the research can be best met. This may be within the Allegheny General Hospital, Allegheny-Singer Research Institute, The Pittsburgh Tissue Engineering Initiative, Carnegie Mellon University, or another institution (either in Pittsburgh or nationally). Research funding opportunities will also be identified and pursued. Each resident will be assigned a faculty mentor to assist them step-by-step through this process. For those residents inclined to pursue a clinical track, at this time they would select one of the areas of advanced clinical training.

Overall Curriculum

  • Rotate 12 months on neurosurgical rotation
  • Begin planning/formulating a research/academic plan for the following year (during last three months).
  • One day per week devoted to teaching in the outpatient clinics.
  • Attend all mandatory neurosurgical/neuroscience conferences.
  • Prepare lectures for journal club, ethics, spine and M&M conferences.
  • Attend all outpatient clinics with assigned faculty.
  • Take call with junior residents under direct attending faculty supervision.
  • Attend one national neurosurgical conference and any major neurosurgery/neurosciences meeting where the resident has an abstract or paper accepted.
  • Take written neurosurgical boards for credit (if necessary).
  • Maintain case log thru ACGME site and provide all required documentation for resident portfolio.

Competencies
Medical Knowledge - The resident will be able to:

  • Maintain and expand their knowledge base in all skills and competencies from previous years.
  • Expand knowledge in neuroanatomy, neurophysiology, neuropharmacology and basic neurosciences with appropriate application to patient care issues.
  • Performing at the level of a senior resident with duties and responsibilities delegated by the Chief Resident.
  • Supervise and teach lower level residents the appropriate methods of evaluation, management and follow up of neurosurgical patients with elective, traumatic and emergency disorders/diseases.
  • Direct the critical care management and high-level non-operative neurosurgical care for patients.
  • Accurately interpret complex laboratory and imaging studies (MRA, CTA, angiography)
  • Assume an increasingly active role in didactic conference preparations and discussions.
  • If a research year is elected:
  • Evaluate scientific and clinical merits of neurosurgical literature.
  • Identify area of interest and appropriate basic science/clinical faculty mentor.
  • Identify available research resources; both within and outside of AGH.
  • Identify potential sources of funding; utilize offices of grants and contracts within ASRI and the AGH Institutional Review Board.
  • Develop background for research from comprehensive review of scientific literature and development of preliminary research proposal/protocol.
  • Develop a timeframe for research completion.
  • Learn the fundamentals of research methodology, biostatistics, literature review, critical analysis.
  • Use Written Board Exam, SANS-wired, Oral Exam, skull base lab workshops, bi-annual evaluations: competencies

 

Patient Care and Assessment – The resident will be able to:

  • Refine and assume an increasing role in routine operative procedures by performing those components appropriate to faculty-observed skills and to first assist in complex cases.
  • Demonstrate microsurgical techniques for vascular and tumor surgery, spinal instrumentation surgery and epilepsy surgery.
  • Perform complex level procedures under close supervision.
  • Attend all outpatient clinics with assigned faculty.
  • Use Observed Exam (clinics and operating rooms), Patient survey, post-exam/feedback cards, bi-annual evaluations: procedures

 

Practice Based Learning – The resident will be able to:

  • Expand and improve his patient care through increasing participation in morbidity and mortality conferences and development of an ongoing and improving ability to learn from errors.
  • Incorporate the principles of adult and lifelong learning into personal scholarship and scientific inquiry.
  • Demonstrate an ongoing and improving ability to learn from errors.
  • Participate in statistics course.
  • Use Journal Club with Statistics, Set New/evaluate old goal, Case Log, Yearly Scholarship logs, SANS-wired

 

Systems Based Practice – The resident will be able to:

  • Evaluate the medical socioeconomic impact of neurosurgical practice and understanding the current environment in medical economics and malpractice issues.
  • Demonstrate an understanding of practice opportunities, practice types and health care delivery systems.
  • Keep track and log all procedures performed in ACGME case log system.
  • Use QI team projects, Formal Lectures

 

Interpersonal and Communication Skills - The resident will be able to:

  • Coordinate communication with consultants, referring physicians and integrate neurosurgical healthcare providers into an effective patient care team.
  • Use Observed Exam, Patient Survey, and Feedback Cards

 

Professionalism – The resident will competently function as a role model and mentor to instill good work habits and compassionate approaches to patient care in junior neurosurgical residents and to use Project Professionalism/ AMA Virtual Mentor, 360-degree Evaluation, and Feedback Cards.
 

PGY6 or PGY7 Chief Resident Year

 

The primary objective of the chief resident year is to provide an increasing level of responsibility, technical expertise and competency, both in and out of the operating rooms so that the resident will be capable of functioning independently as a neurosurgeon on completion of the training program.

Overall Curriculum

  • Serve as chief resident on adult neurosurgical service.
  • Direct, with faculty supervision, the chief resident outpatient clinic.
  • Will supervise and direct the daily activity of all residents under his/her level of training.
  • Will perform all administrative aspects of running the neurosurgical service to include administration of outpatient chief resident clinic, coordination of hospital admissions, coordination of operating room schedules, assignment of PA’s, assignment of cases to junior residents, teaching of neurosurgery residents, medical students and rotating residents through the service and coordination/direction of neurosurgical teaching conferences including the Wednesday morning didactic lecture series in coordination with the program director.
  • Create resident call schedules following all duty hour rules.
  • Serve as primary operating surgeon in the operating room*
  • Direct daily rounds, establish management plan of inpatients*
  • Pass neurosurgical board written examination, if not passed yet.
  • Serve as a member of the Neurosurgery Clinical Competency Committee and Residency Interview Committee.
  • Participate in clinical neurosurgical research writing at least one abstract, book chapter or paper.
  • Attend one national neurosurgical conference and any major neurosurgery/neurosciences meeting where the resident has an abstract or paper accepted.
  • Consult with the Program Director concerning job opportunities, fellowship training and career advancement.
  • Maintain case log thru ACGME site and provide all required documentation for resident portfolio.

* Under the direction of faculty supervision.

 

Competencies
Medical Knowledge - The chief resident will become fully able to:

  • Manage outpatient, inpatient, critical care, operative evaluation and followup of all diseases/disorders currently under the preview of independent neurosurgical practice.
  • Supervise, teach and mentor clinical growth for all lower level residents and neurosurgical healthcare team members.
  • Direct patient care conferences.
  • Successfully pass the neurosurgical written board examination (if not already passed)
  • Use Observed Exam, Written Board Exam, SANS-wired, Oral Exam, Skull Base Lab, bi-annual evaluations (competencies)

 

Patient Care and Assessment – The chief resident will become fully able to:

  • Maintain and expand on skills and competencies learned in previous years.
  • Refine the highest level of patient care skills.
  • Refine all neurosurgical operative skills to be competent in performing all accepted/current neurosurgical procedures (refer to Specific Core Clinical Knowledge requirements)
  • Independently (with appropriate faculty oversight) manage his/her own outpatient neurosurgical clinic.
  • Integrate applied research, current neurosurgical literature and evidence-based guidelines directed to advancing patient safety and care.
  • Use Observed Exam (clinics and operating room), Patient survey, post-exam/feedback cards, and bi-annual evaluations: procedures

 

Practice Based Learning – The chief resident will become fully able to:

  • Develop skills and competencies to become an independent practicing neurosurgeon.
  • Develop administrative skills of the neurosurgical service by maintaining the resident call schedule ensuring adherence to the 80-hour work week restrictions, coordinate resident vacation schedules, coordinate all neurosurgical conferences and assign junior resident responsibilities for patient care, operating room, critical care and clinic responsibilities.
  • Refine his teaching skills.
  • Use Journal club with Statistics, Set new/evaluate old goals, Case Logs, Yearly Scholarship Logs, SANS-wired

 

Systems Based Practice – The chief resident will be able to:

  • Know about cost-effective neurosurgical care.
  • Utilize consultants appropriately.
  • Understand the socioeconomic impact of clinical neurosurgical decisions
  • Receive exposure to different practice types and opportunities.
  • Maintain a log of all procedures performed in the ACGME case log system.
  • Use QI Team Projects and Formal lectures

 

Interpersonal and Communication Skills - The chief resident will be able to:

  • Communicate effectively both verbally and in consultation reports, operative reports, and written communications with referring physicians.
  • Responsibly complete all medical records.
  • Communicate daily with Program Director regarding neurosurgical service issues.
  • Use Observed Exam, Patient Survey, Feedback cards

 

Professionalism – The chief resident will be fully competent to:

  • Function as a role model and mentor to junior residents.
  • Instill the professional characteristics of reliability, preparedness, cooperation and efficiency while demonstrating compassion, respect and consideration to the junior residents.
  • Maintain patient privacy and confidentiality and instill those characteristics to the junior residents.
  • Use Project Professionalism/ AMA Virtual Mentor, 360-degree evaluation, Feedback Cards
     

 

PGY7  or PGY6 Research or Advanced Clinical Training Year

 

Overall Curriculum for Research or Advanced Clinical Training Year

  • 12 months devoted to laboratory/clinical research or assumption of advanced clinical training.
  • Attend all mandatory neurosurgical/neuroscience conferences.
  • Prepare lectures for journal club, ethics, spine and M&M conferences.
  • Take “chief” call one day out of 7.
  • Write at least one abstract, book chapter or article.
  • Maintain case log thru ACGME site and provide all required documentation for resident portfolio.

Goals and objectives for research:

  • Organize and perform laboratory project organized in prior year.
  • Perform extensive review of literature pertaining to project.
  • Submit abstract of work to major scientific meeting
  • Review fundamentals of research design and biostatistics.

 

Goals and objectives for advanced clinical training:

  • Select area of subspecialization as outlined below.
  • Function at level of fellow with supervised assumption of responsibilities of pre-operative evaluation, interpretation of diagnostics and surgical planning.
  • Perform surgical procedures at highest level of proficiency (as per Exhibit A)
  • Assume graduated responsibility for post-operative care while patient is in-house as well as in clinic.
  • Assume first phone call responsibility for patients both in and out of house.
  • The advanced “subspecialty” can focus on any area offered in the AGH neurosurgery department:  Epilepsy Surgery, Pain Management and Movement Disorders, Cranial Nerve Disorders, Complex Spine Surgery, Functional and Stereotactic Surgery, Neuro-Oncology, Neuro-Endoscopy, Skull Base Neurovascular Surgery.
    This type of subspecialty focus is intended to supplement and intensify basic experience in those areas received during regular clinical neurosurgical rotations. This has the additional benefit for the resident to allow adequate time for involvement in the relevant clinical research pertinent to the subspecialty.

 

Competencies
Medical Knowledge - The resident will become fully able to:

  • Maintain and expand on all skills and competencies learned in the prior years.
  • Expand and refine the broad base knowledge in their chosen subspecialty.
  • Use Observed Exam, Written Board Exam, SANS-wired, Oral Exam, Skull Base Lab, bi-annual evaluations: competencies

 

Patient Care and Assessment - The resident will be fully able to:

  • Refine all neurosurgical operative skills
  • Maintain case log of all procedures performed.
  • Use Observed Exam (clinics and operating room), Patient survey (post-exam/feedback cards), bi-annual evaluations: procedures

 

Practice Based Learning – The resident will be able to:

  • Develop academic growth through collaboration with research faculty.
  • Master the fundamentals of research methodology, biostatistics, literature review and critical analysis.
  • Use Journal club with Statistics, Set new/evaluate old goals, Case Logs, Yearly Scholarship Logs, SANS-wired

 

Systems Based Practice – The resident will be able to:

  • Obtain available research resources – both within and outside of AGH.
  • Obtain funding for research project by utilizing offices of grants and contracts within ASRI and the AGH Institutional Review Board.
  • Follow a timeframe for research completion.
  • Use QI Team Projects, Formal lectures

 

Interpersonal and Communication Skills - The resident will be able to:

  • Communicate research needs effectively with faculty and all members of research department.
  • Use Observed Exam, Patient Survey, Feedback cards

 

Professionalism – The resident will be able to:

  • Perform duties in a professional manner at all times.
  • Develop a personal program of learning to foster continued professional growth and development with guidance from the teaching staff.
  • Use Project Professionalism/ AMA Virtual Mentor, 360-degree evaluation, Feedback Cards

 


 

Policies and Procedures

 

The following are the Policies and Procedures for the Department of Neurosurgery which are adhered to in conjunction to the GME’s Resident and Fellow Policies and Procedures. Both manuals are given to each resident yearly.

Evaluations

There are numerous evaluation methods and tools utilized throughout the academic year that carefully measure the competency based outcome for each resident. Overall evaluations and milestone assessments of the residents are completed by the faculty twice a year at the end of each semester along with oral examinations to prepare for their specialty board exam. At the end of each rotation, members of the faculty from the rotation will complete an evaluation of the resident based on the goals and objectives outlined in this manual.

Advancement to the next level of training is based on satisfactory achievement of the established objectives and competencies, as determined by the Clinical Competency Committee.

The resident will have the opportunity to review the evaluations and discuss the results with the program director. At any time during the year, the residents may request verbal feedback from the faculty. They may also review their evaluations in the coordinator’s office during regular business hours. Finally, if they would like to discuss a specific evaluation with a faculty member, this will be promptly facilitated by the program director.

Details of the evaluation tools utilized are:

  • Bi-annual evaluations – overall evaluations based on core competencies and procedure techniques completed online utilizing New Innovations evaluation program twice a year.
  • 360 / Peer / Self evaluations – residents are evaluated by non-neurosurgery professional staff, nursing staff, their peers and themselves. Comparisons will be made between their own thoughts of themselves versus how their peers view them.
  • Observed Exams – the resident will perform a full history and physical and have discussions with the patient under the direct observation of a faculty member and evaluated accordingly.
  • Post-exam/feedback cards – to be used following the observed exam for the patient care rendered during the visit. Feedback cards will also be placed in the clinic units to be available to the patients, patient’s families and nursing staff for both positive and negative comments of the resident.
  • Portfolio Review to include:
    • Case Logs - residents will be expected to record their surgical cases within the ACGME case log database as part of the six-month Portfolio Review.
    • Yearly scholarships logs – residents will be required to provide a summary of all scholarly activity including abstracts, papers, posters, etc,, at the end of each semester.
    • Quality Improvement (QI) Project – this will entail residents working in teams of two on projects selected during M&M conference. A particular problem would be analyzed in a series of meetings with appropriate staff and ancillary personnel. A six month interim project report will be submitted for their portfolio and also at year end.
    • Project Professionalism/AMA Virtual Mentor – this will be a presentation and discussion performed by each of the residents every six months. The subject selected would be from the aforementioned sources dealing with both professionalism as well as socioeconomic topics. The resident will then prepare a one-page summary for inclusion in his or her portfolio.
    • SANS Life Long Learning - a CNS online self-assessment examination tool for the resident. The program director/faculty will randomly request the residents to complete the in-service examinations, usually once a year and the results will be filed in their portfolio.


Resident Advancement/Disciplinary Action

Residents will undergo evaluations every six months by means of various tools including the core competency, technical proficiency, “360” evaluation, oral exam, observed exam and the results from various QI , journal club and ethics projects. These evaluations will be placed in the resident portfolios and reviewed by the members of the Clinical Competency Committee (CCC), which will determine the status of each individual resident for the next six month period. The CCC will also review the detailed achieved milestones of each resident. These status designations follow a three-color code format. Residents given a “green” are in good standing with no concerns regarding behavior or performance. A “yellow” indicates a concern with which the committee wishes to formally communicate to the resident, but does not require any specific remedial action. A “red” indicates a serious concern by the committee regarding behavior or academic performance and automatically necessitates a remediation plan, as outlined by the Program Director and approved by the committee. The committee will decide the time duration of this remediation, and at the conclusion of this time period determine whether the resident will: 1) be returned to good standing or 2) continue on a program of remediation for a time interval designated by the committee or 3) is to be terminated.

At all times the program will follow the Academic Improvement Policy as noted in the Allegheny Health Network Medical Education Consortium GME Policy and Procedures Manual.

Any allegations of misconduct by a resident will be handled in accordance with the GME Misconduct Policy.

The Termination/Suspension process is set forth in the Allegheny General/Institutional Resident Policy and Procedures Manual

CGME Grievance Policy

The Neurosurgery Residency program adheres to the Grievance/Due Process Policy detailed in Allegheny General’s Resident Policy and Procedures Manual

Duty Hours/Fatigue

The neurosurgery program acknowledges the effects of prolonged work periods that can cause extreme fatigue which can be detrimental to the surgeon’s health and to patient care. Our program recognizes the signs, symptoms and impact of sleepiness and fatigue on the resident and therefore adheres to the GME Resident Fatigue policy outlined in the AGH/Institutional Resident Policy and Procedure Manual. If resident fatigue becomes an issue, the resident should notify the chief resident or the program director and appropriate action will be taken.

Specifically, our program adheres to the 80-hour work week averaged over four weeks with one in seven days free of clinical activities averaged over a four-week period. Residents should have at least 10 hours off between duty periods. Call is restricted to no more than 24 consecutive hours.

The institution and department offer several conferences throughout the year addressing the issues related to sleep deprivation and fatigue. At a minimum, residents will be required to attend one of these lectures.

Moonlighting

The resident is not required to do moonlighting. Any moonlighting must be expressly authorized in writing by the program director and the duty hour rules must be strictly adhered to.

Supervision Policy

All residents will have appropriate supervision for all patient procedures by attending staff. The attending physician will be available and accessible to instruct, supervise and consult with the residents to provide a learning environment in which the residents will be able to assume increasing responsibility of all aspects of patient care.

The department follows the same supervision policies as the institution

Ventriculostomy Policy

The performance of all bedside ventriculostomies will be done in observance of the following regard to sufficient training of the operator:

All junior level residents new to the neurosurgery service will require the supervision of at least ten (10) ventriculostomies prior to them achieving the status of performing these procedures by themselves.

This supervision is to be carried out by a more senior resident already qualified or by the attending staff.

A listing of the patients on whom the procedure was performed as well as the initials of the supervising resident/staff will be provided to the resident coordinator. The coordinator will then post the resident's name on the intranet site which provides guidance throughout the hospital on who is qualified to perform which procedures. It will also be posted in the New Innovations Residency Suite program.

Twist-drill SDH Drains Policy

Residents must first be certified to perform ventriculostomies prior to Twist-drill Drain certification. Similar to the ventriculostomy guidelines:

Junior residents must be supervised in the performance of five (5) twist-drill drain procedures with appropriate documentation prior to achieving independent status for these procedures.
A listing of the patients on whom the procedure was performed as well as the initials of the supervising resident/staff will be provided to the resident coordinator who will then post the resident's name on the intranet site which provides guidance throughout the hospital on who is qualified to perform which procedures.

Additional Procedures

The chief will observe the resident performing the following procedures during their PGY1-PGY2 year and will certified them upon competency:

♦Lumbar puncture ♦ Central line placement ♦ Arterial line placement ♦ Lumbar spinal drain.

These procedures will also be listed on the intranet and the New Innovations program.

Conflict of Interest Guidelines

In accordance with AGH GME policy, the Department of Neurosurgery requires all residents to follow these guidelines at all times, whether on or off-site. Any questions on interpretation of these guidelines should be directed to the program coordinator, program director and/or Department Chair.