Educational Goals and Objectives
The program aims to educate participants in both basic and clinical sciences relevant to neurosurgery, enhance cognitive and technical skills, and foster the development of clinical knowledge and surgical judgment Additionally, it includes specific rotation objectives and evaluations aligned with the six competencies established by the Accreditation Council for Graduate Medical Education.
Graduate Medical Education (ACGME) are noted below Specific technical and medical objectives to be gained within each rotation are described individually below
The educational experiences for reaching these objectives are:
• Supervised responsibility for patient management and operations
• Review of deaths, complications and errors
• Development of individualized program of reading and self-education
Evaluation of attainment of these goals is measured by faculty evaluation on clinical services, as well as evaluation by other professional staff (e.g., nursing).
The program conducts self-evaluation by gathering feedback from residents regarding the program and rotations, alongside assessments from faculty and nursing staff on residents' performance This evaluation process includes semi-annual self-assessments by residents, discussions with the Program Director (PD) about their performance, and ongoing electronic monitoring of case logs Additionally, there are semi-annual reviews with the PD focusing on the volume, breadth, and complexity of cases handled by the residents.
The Six Core Competencies
Patient Care
Residents must be able to provide patient care that is compassionate, appropriate, and effective for the treatment of health problems and the promotion of health.
Residents will acquire the necessary manual dexterity suited to their training levels while developing and implementing patient care plans This skill is cultivated through hands-on guidance from senior residents and faculty during clinical rotations, with performance assessed in the final formative evaluation at the end of each rotation.
During surgical rotations, essential learning activities that enhance competency development encompass a variety of experiences These include both inpatient and outpatient patient care, as well as comprehensive pre-operative, operative, and post-operative care Residents are required to complete and review an operative log, attend weekly academic conferences and didactic sessions focused on quality improvement, and engage in case discussions at resident conferences Additional educational opportunities involve bedside teaching, inpatient teaching rounds, and operating room instruction Participation in an evidence-based Journal Club and involvement in the pre-operative evaluation of surgical patients in an outpatient setting further enrich the learning experience.
Residents are expected to communicate effectively and demonstrate respect when interacting with patients and their families, while also obtaining comprehensive surgical histories and relevant medical records They must make informed decisions regarding diagnostic and therapeutic interventions by considering patient preferences, current scientific evidence, and clinical judgment Additionally, residents should formulate care plans that encompass pre-, intra-, and post-operative care, and provide counseling and education to patients and their families Utilizing information technology to enhance patient care decisions and education is essential, as is the competent performance of all necessary medical and invasive procedures Furthermore, residents should focus on delivering healthcare services that prevent health issues or promote wellness and work collaboratively with a multidisciplinary care team to ensure effective, patient-centered care.
Assessment includes observation of performance in these areas: a Medical interviewing b Physical examination c Procedural skills, as demonstrated with simulators and patients d Clinical judgment e Ongoing care
Medical Knowledge
Residents are required to acquire foundational medical knowledge in biomedical, clinical, epidemiological, and social-behavioral sciences, and to effectively apply this knowledge in patient care They must develop the ability to critically assess scientific information and utilize it in their practice These essential skills are cultivated through departmental lectures, conferences, morbidity and mortality discussions, and designated resident presentations.
During surgical rotations, essential learning activities that enhance competency development include weekly academic conferences focused on neuroradiology and neuropathology, alongside presentations at related conferences Trainees gain valuable educational experiences in clinical settings, hospitals, and operating rooms, and may participate in intra- and extra-mural conferences Performance on the American Board of Neurological Surgery (ABNS) primary examination is crucial, as passing this exam is required to advance to Postgraduate Year-4 (PGY-4) Additionally, involvement in a Journal Club/EBM Conference, maintaining an academic portfolio, engaging in hands-on neurosurgical simulations, and pursuing self-directed study are key components of the training process.
Residents are expected to exhibit strong investigatory and analytical thinking when faced with clinical situations, while also applying foundational and clinically supportive sciences relevant to their field A solid understanding of neuroanatomy is essential, alongside the ability to develop and execute diagnostic and treatment plans for brain and spinal cord diseases Additionally, residents should possess a comprehensive knowledge of diagnosing, preparing for, and managing surgical patients effectively.
Assessment encompasses several key components, including bi-annual mock oral examinations for PGY-2 and PGY-3 residents, daily rounds with attending physicians, written evaluations by faculty members—which include semi-annual reviews with the program director—and the ongoing development and maintenance of an academic portfolio.
Practice-Based Learning and Improvement
Residents are required to engage in practice-based learning and improvement in patient care by investigating and evaluating their clinical performance They should appraise scientific evidence and commit to lifelong learning for continuous enhancement of patient care This involves identifying personal strengths and weaknesses, setting improvement goals, and employing quality improvement methods to analyze and implement changes in practice Additionally, residents must locate and assess relevant scientific studies, utilize information technology for optimized learning, and participate in educating patients, families, and fellow health professionals This process is supported through morbidity and mortality conferences, daily discussions of patient care with faculty, and literature reviews during Journal Club sessions.
During surgical rotations, various learning activities enhance competency development, including case reviews at monthly Morbidity and Mortality (M&M) Conferences, case log evaluations during rotations and semi-annual performance reviews with the Program Director, and case discussions at weekly resident conferences Additionally, participation in an evidence-based Journal Club, delivering presentations at conferences, and engaging in hands-on neurosurgical simulations contribute to skill enhancement Further learning occurs through case discussions at the annual Network for Psychiatric Nursing Research (NPNR) review course and involvement in didactic sessions and daily teaching rounds.
Residents are expected to engage in systematic analysis of their practice experiences and implement improvement activities, while effectively locating and evaluating scientific evidence relevant to their patients' health issues They should gather and utilize data regarding their patient population and its broader context, apply knowledge of research designs and statistical methods to assess clinical studies, and leverage information technology for managing medical information and enhancing their education Additionally, residents are responsible for facilitating the learning of students and fellow healthcare professionals and defending scientific papers during Journal Club sessions.
Assessment in this program encompasses several key areas: the ability to critically evaluate scientific evidence, the maintenance of an academic portfolio, and participation in presentations at Journal Club and Evidence-Based Medicine conferences Additionally, candidates are expected to present at Neurosurgery School and Grand Rounds, demonstrating familiarity with research methods, including study designs and statistical techniques A semi-annual review of self-evaluations with the Program Director is conducted to assess the ability to collect data and assimilate feedback Furthermore, proficiency in information technology is required, along with serving as a role model for student education Finally, the evaluation of operative notes and discharge summaries by the Program Director or Assistant Program is also part of the assessment process.
Interpersonal Relationships and Communication
Residents will develop effective communication skills with healthcare professionals, as well as the ability to counsel and educate patients and families These competencies will be cultivated through daily interactions with faculty in both inpatient and outpatient settings, alongside presentations at relevant conferences The assessment of these skills will occur during clinical rotations and through evaluations from nursing staff and patients/families Faculty will ensure thorough documentation by monitoring patients' records.
During surgical rotations, key learning activities that enhance competency development include hands-on patient care experiences in both outpatient clinics and hospitals, participation in local, regional, or national professional meetings for networking, and attending lectures by attending physicians focused on communication skills Additionally, engaging in presentations during Journal Club and teaching rounds, as well as facilitating learning for medical students and mid-level providers, further enriches the educational experience.
Residents are expected to establish and maintain therapeutic, ethically sound relationships with patients while employing effective listening and communication skills, including nonverbal cues and clear explanations They should collaborate effectively as both team members and leaders within healthcare teams or professional groups Additionally, residents must demonstrate an awareness of cultural and gender differences to enhance patient care.
Assessment encompasses the observation of performance in key areas, including participation in teaching rounds and academic conferences, providing counseling and education, and delivering informed consent instructions to patients It also involves including patients in treatment decisions, actively listening to patients and other healthcare team members, and conducting 360 evaluations by allied health professionals.
Professionalism
Neurosurgical residents are expected to uphold high ethical standards and demonstrate sensitivity to patients' age, gender, and cultural differences This is achieved through daily interactions with faculty during clinical rotations and participation in relevant conferences Their progress is evaluated through faculty assessments and feedback from nursing staff, ensuring a commitment to continuity of patient care, which is further reflected in their involvement in outpatient clinics.
During surgical rotations, key learning activities enhance competency development, including training on cultural competence, compliance, and behavioral standards Opportunities for education arise through local, national, and international programs, alongside mentorship from surgical faculty Engaging in personal scientific presentations at regional and national conferences, as well as participating in Mock Oral Examinations, further solidifies learning Additionally, presenting at conferences and hosting resident applicants during neurosurgical match activities provide frequent practice Participation in Journal Club and Evidence-Based Medicine (EBM) conference presentations also contributes to comprehensive skill development.
Residents are expected to embody respect, compassion, honesty, and integrity while prioritizing the needs of patients and society over self-interest They must hold themselves accountable to patients, society, and the medical profession, demonstrating a commitment to excellence and continuous professional development Furthermore, residents should adhere to ethical principles regarding clinical care, patient confidentiality, informed consent, and business practices Additionally, they must show sensitivity and responsiveness to the diverse cultures, ages, genders, and disabilities of their patients.
Assessment of performance encompasses several key areas: demonstrating regard for the welfare of others, adhering to a strong code of moral and ethical values, and showing respect towards patients and their families It also includes maintaining respect for fellow healthcare team members, providing prompt consultations when requested, and being sensitive to patients' cultural backgrounds Additionally, accountability for one's own actions, reliability, and punctuality are essential components of effective performance evaluation in healthcare settings.
Systems-Based Practice
Residents must be aware of and responsive to health care systems, effectively coordinating patient care within various delivery models They are required to collaborate in inter-professional teams to enhance patient safety and explore systemic solutions Knowledge of risk-benefit analysis and the provision of high-quality, cost-effective care is essential, developed through daily clinical practice, interdisciplinary rounds, lectures, and presentations Participation in patient safety and quality improvement initiatives may also be necessary Faculty assessments during clinical rotations evaluate residents' understanding of the roles of specialists and their ability to collaborate effectively with other health care professionals.
During surgical rotations, key learning activities that enhance competency development include participating in case reviews at Morbidity and Mortality (M&M) Conferences, attending departmental meetings alongside chief residents, engaging in Journal Club and Evidence-Based Medicine (EBM) conferences, conducting daily rounds and conferences, planning the discharge of complex patients through case management, and completing Epic training and coding courses.
Residents are expected to understand the impact of their patient care and professional practices on other healthcare professionals, organizations, and society, while also recognizing how these factors influence their own practice They should be aware of the differences between various medical practices and delivery systems, including strategies for controlling healthcare costs and resource allocation Practicing cost-effective healthcare without compromising quality is essential, as is the ability to collaborate with healthcare managers and providers to assess, coordinate, and enhance healthcare systems Additionally, residents must demonstrate an awareness of quality improvement and safety measures in their practice.
Assessment involves evaluating performance in key areas, including the delivery of cost-effective care, comprehension of documentation and coding implications, appropriate referrals to specialists and agencies, effective coordination and management of ongoing care within the healthcare system, and ensuring timely and suitable patient discharges.
PGY-1
The resident should be able to:
As a junior-level resident, it is essential to cultivate a sense of responsibility and independence while providing care for neurosurgical patients This includes conducting thorough preoperative evaluations, managing postoperative care, and effectively writing pre and postoperative orders to ensure optimal patient outcomes.
As a sub-leader in neurosurgical teams, you will collaborate closely with senior residents and attending physicians to coordinate comprehensive patient care, ensuring proper evaluation and treatment by various healthcare professionals This role involves understanding the basic pathophysiology of neurosurgical diseases and expanding your knowledge in neurosurgery, enabling you to effectively evaluate and manage patients with complex neurosurgical issues Additionally, you will gain insights into surgical specialties while providing care for patients with multiple injuries.
Assessment: faculty and senior resident evaluations, nursing 360 evaluations,
Proficiency in essential medical procedures is crucial, including starting IVs, placing central and arterial lines, intubation, and the placement of ICP monitors and ventriculostomies It is equally important to demonstrate a strong understanding of basic neurosurgical pathophysiology and patient care in both ward and ICU settings, alongside a foundational knowledge of available surgical options.
Teach and oversee fundamental medical procedures such as line placement, intracranial pressure (ICP) monitoring, ventriculostomy, lumbar puncture, and lumbar drain placement Ensure proficiency in basic sterile techniques and bedside procedures, while assisting in operating room activities Progress to more advanced procedures under supervision, ultimately aiding in complex surgical operations.
Assessment: Supervision/log card, faculty evaluation, feedback from peers and juniors.
5 Demonstrate the development of teaching and supervision skills
Assessment: Faculty evaluation, feedback from junior residents and students.
To enhance patient care, it is essential to demonstrate improved communication skills with the patient care team and to function effectively as a team leader This includes engaging with other healthcare professionals, addressing problem-solving and dispute resolution issues, and understanding the roles of various specialists in overall patient management Effective communication with patients, hospital staff, students, fellow residents, and attending staff is crucial By planning ahead and delivering concise, impactful presentations, healthcare professionals can communicate more effectively with the patient care team.
Assessment: 360 degree evaluation via web based evaluation program including review of the core competencies.
7 Improve mastery of adult learning skills.
Assessment: Evaluation of professional growth through feedback from faculty, mentor and peers Review of research portfolio and conference performance.
PGY 2
The resident should be able to:
1 Act as “mid-level/sub leader”” on a neurosurgical team with close attending supervision Coordinate patient care to include appropriate evaluation and treatment by other health care professionals and consultants.
Assessment: Faculty and 360 degree evaluations
2 Assume leadership of larger neurosurgical teams and supervise care of neurosurgical patients at various levels of acuity with input from surgical attendings, consultants and other health care professionals.
3 Demonstrate Mastery of increasingly complex neurosurgical pathophysiology and patient care (ward and ICU) scenarios, more advanced understanding of surgical options.
4 Teach and supervise basic procedures including line placement, ICP monitor placement,
Ventriculostomy placement, lumbar puncture, lumbar drain placement, etc Begin to instruct junior residents in basic operative procedures.
Assessment: Supervision, faculty evaluation, feedback from peers and juniors.
5 Demonstrate the development of teaching and supervision skills
Assessment: Faculty evaluation, feedback from junior residents and students.
Enhance communication skills with the patient care team to function more effectively as a leader Foster effective collaboration with other healthcare professionals, showcasing improved problem-solving abilities and dispute resolution strategies Additionally, demonstrate a comprehensive understanding of the roles played by various specialists and healthcare providers in the overall management of patient care.
Assessment: 360 degree evaluation and faculty evaluation
7 Improve mastery of adult learning skills.
Assessment: Evaluation of professional growth through feedback from faculty, mentor and peers Review of academic/research portfolio and conference performance.
PGY-3
The resident should be able to:
1 Act as “leader/supervisor” on a neurosurgical team with close attending supervision.
As a senior-level leader on designated surgical teams, you will collaborate closely with the chief resident and attending physicians to oversee patient care This role involves coordinating comprehensive evaluations and treatments, ensuring effective communication among healthcare professionals and specialists.
Assessment: faculty and chief resident evaluations, nursing 360 evaluations,
3 Demonstrate Mastery of complex neurosurgical pathophysiology and patient care (ward and ICU), complete understanding of surgical options.
Teach and oversee fundamental bedside and operating room procedures, such as line placement, ICP monitor insertion, ventriculostomy placement, lumbar puncture, lumbar drain placement, and moderately complex surgical techniques involving the spine, brain, and peripheral nerves.
Assessment: Supervision/log card, faculty evaluation, feedback from peers and juniors.
5 Demonstrate the development of teaching and supervision skills
Assessment: Faculty evaluation, feedback from junior residents and students.
To enhance leadership communication skills within the patient care team, it is essential to engage effectively with other healthcare professionals This involves addressing problem-solving and dispute resolution while demonstrating an understanding of the diverse roles played by specialists in comprehensive patient management.
7 Demonstrate mastery of adult learning skills.
Assessment: Evaluation of professional growth through feedback from faculty, mentor and peers Review of academic/research portfolio and conference performance.
PGY-4/Chief Year
EDUCATIONAL GOALS AND OBJECTIVES FOR ROTATIONS BY LEVELS
Each rotation in the neurosurgery residency program has clearly defined educational goals and objectives tailored for PGY-1 and PGY-2 junior residents These guidelines are provided at the start of each academic year and are accessible to both faculty and residents A new curriculum will be available for review before the commencement of new rotations The objectives focus on essential competencies, including knowledge, patient care, practice-based learning, interpersonal communication skills, professionalism, and systems-based practices Additionally, procedure benchmarks for each service and PGY level are established, along with assessment methods for the six competencies.
PGY-1 Neurosurgery Clinical Rotation
Practice-Based Learning
a Faculty evaluation b Monthly M&M c Weekly attending rounds d Journal Club
4 Interpersonal Relationships and Communication a Faculty evaluations b Self-evaluations c 360 evaluations
5 Professionalism a Faculty critique of weekly general surgery conference b 360 evaluations by nursing c By faculty d By other resident staff members
6 Systems-Based Practice a Faculty evaluation b Input from mid-level practitioners, nurses, 360 evaluations
PGY-3 residents are expected to perform a range of complex medical procedures independently and with minimal supervision They should also be capable of guiding junior residents through various cases, demonstrating their leadership and expertise Key procedures include radiosurgery, ventriculoperitoneal (VP) shunt placement, anterior and posterior cervical approaches for decompression and stabilization, interventional procedures for spinal conditions, lumbar discectomy, peripheral nerve procedures, thoracic and lumbar instrumentation and fusion, as well as spinal surgeries such as Chiari decompression and laminectomy for dysraphism, tumors, and syringomyelia Additionally, they should be proficient in pediatric VP shunt procedures.
PGY-2 Neurosurgery Clinical Rotation
Interpersonal and Communication Skills
In the realm of patient care, it is essential to demonstrate skill and sensitivity while counseling and educating patients and their families across various clinical situations Establishing and maintaining therapeutic, ethically sound relationships with patients and families is crucial Effective collaboration as a leader within the healthcare team enhances overall patient care, supported by prompt and thorough documentation of practice activities Presenting patient information and conference materials in a clear, organized, and knowledgeable manner is vital Engaging with all personnel involved in surgical patient care fosters a collaborative environment Additionally, exhibiting leadership within the surgical team and contributing to the educational efforts of the neurosurgical residency through effective teaching and example is important Finally, evaluating the performance and competence of all surgical residency team members ensures continuous improvement and high standards in patient care.
5 Professionalism a Demonstrate respect, compassion and integrity; a responsiveness to the needs of patients and society that supersedes self-interest; accountability to patients, society and the profession; and a commitment to excellence and on-going professional development. b Demonstrate a commitment to ethical principles pertaining to provision or withholding of clinical care, confidentiality of patient information, informed consent, and business practices. c Demonstrate sensitivity and responsiveness to patients’ culture, age, gender, and disabilities. d Exhibit professionalism through timely completion of required administrative responsibilities (evaluations, recording hours, chart documentation, medical record dictations, etc.). e Maintain positive relationships. f Demonstrate accountability for actions and decisions.
6 Systems-Based Practice a Awareness and Responsiveness to the Health Care System: i Explain how patient care and other professional practices affect other health care professionals, the health care organization, and the larger society ii Discuss how these elements of the system affect their own practice. iii Differentiate how types of medical practice and delivery systems differ from one another, including methods and controlling health care costs and allocating resources. iv Incorporate the knowledge of ethical, legal, economic, and/or social factors into the activities of the entire surgical team for all components of surgical care. b Utilization of System Resources: i Practice cost-effective health care and resource allocation that does not compromise quality of care. ii Become an advocate for quality patient care and assist patients in dealing with system complexities. iii Partner with health care managers and health care provides to assess, coordinate, and improve health care and understands how these activities can affect system performance.
1 Patient Care a Weekly basic science conference b Evaluations by Faculty (including mid-rotation feedback sessions) c Attending Rounds
2 Medical Knowledge a Annual written board exam (ABNS primary exam) taken for credit b Written evaluation by faculty (including mid-rotation feedback sessions) c Faculty evaluation weekly conferences d Attending Rounds e Presentation at Surgical Case Conferences
3 Practice-Based Learning a Faculty evaluation b Monthly M&M c Weekly attending rounds d Journal club
4 Interpersonal Relationships and Communication a Faculty evaluations b Self-evaluations c 360 evaluations
5 Professionalism a Faculty critique of weekly general surgery conference b 360 evaluations by nursing c By faculty (including mid-rotation feedback sessions) d By other resident staff members
6 Systems-Based Practice a Faculty evaluation b Input from mid-level practitioners, nurses, 360 evaluations
PGY-2 residents are expected to perform various procedures with minimal supervision and guide junior residents through cases, similar to senior residents They should focus on mastering ACGME competencies and procedural skills, particularly those designated for their level Key procedures include craniotomy for pain and trauma, functional procedures, radiosurgery, transsphenoidal approaches for tumors, ventriculoperitoneal shunts, cervical decompression and stabilization techniques, interventional spinal procedures, lumbar discectomy, peripheral nerve surgeries, thoracic and lumbar instrumentation and fusion, pediatric craniotomies for brain tumors, and spinal procedures for both adult and pediatric deformity corrections Additionally, they should gain experience in pediatric VP shunts and craniotomies for epilepsy in both adult and pediatric patients.
The neurosurgery resident rotation in neuroradiology and neuropathology offers an intensive opportunity for residents to deepen their understanding of these essential fields for a successful clinical neurosurgery career Residents will collaborate with fellowship-trained clinical neuroradiologists to interpret high-volume imaging, gaining valuable insights into neuroradiological practices Additionally, they will engage with the Pathology Department, working alongside neuropathologists Throughout the rotation, residents are expected to lead case presentations at Brain Tumor and Neuroradiology conferences and demonstrate increased academic productivity, including contributions to publications.
PGY-3/Neurosurgery Clinical Rotation
As a Senior Resident and Substitute Chief, the PGY-3 in neurosurgery is expected to demonstrate comprehensive care for general neurosurgical patients, effectively managing pre-, intra-, and post-operative procedures with minimal supervision This role requires the integration of evidence-based medicine, basic science, and clinical knowledge while exhibiting leadership qualities within the neurosurgical team The resident is responsible for mentoring junior team members and is anticipated to achieve a Milestones evaluation rating between 3-5 across all categories.
Compassionate patient care involves demonstrating respectful behaviors towards patients and their families, incorporating patient preferences in decision-making, and developing tailored care plans Appropriate patient care requires overseeing the collection of accurate patient information, evaluating complex neurosurgical conditions, and comparing treatment options to make informed decisions based on patient data and current scientific evidence Effective treatment and health promotion focus on performing essential medical procedures competently, preventing health issues, and coordinating care among healthcare professionals Technical skills in patient care necessitate knowledge and judgment in performing neurosurgical procedures, preparing for operations, and ensuring patient safety during surgery Additionally, the ability to make timely decisions, demonstrate manual dexterity, and assist in complex surgical cases reflects the competencies expected of a chief resident in neurosurgery.
A PGY-3 resident must exhibit comprehensive knowledge of neurosurgical pathophysiology, critical care, pharmacology, and physiology, enabling them to formulate and implement effective diagnostic and treatment plans for brain, spine, and peripheral nerve diseases They should be proficient in advanced neurosurgery subspecialties, including trauma, tumors, and complex spine procedures, while also demonstrating competence in commonly performed surgical techniques Understanding preoperative and postoperative concerns is crucial, as is coordinating overall patient care, which encompasses initial evaluations, diagnostic studies, and consultations Familiarity with neurosurgical literature is essential for relating medical knowledge to patient care, and residents should be capable of teaching junior residents and students Surgical competence, achieved through significant knowledge and skill, is necessary for favorable patient outcomes Additionally, residents must integrate continuity of care principles into their management plans and demonstrate independence in handling pre-operative and post-operative care in an outpatient setting under appropriate supervision.
Practice-based learning and improvement in patient care involves a systematic analysis of clinical experiences and patient demographics to enhance healthcare practices Surgeons must evaluate scientific evidence relevant to their patients' health issues by locating and appraising studies, applying knowledge of research methodologies, and engaging in continuous improvement activities Utilizing information technology is essential for managing data and accessing online medical resources, which also supports the ongoing education of new surgeons Additionally, fostering the development of junior residents and emphasizing the importance of lifelong learning are critical components of enhancing surgical practice and improving patient care outcomes.
Effective interpersonal relationships and communication in healthcare involve demonstrating sensitivity and skill in counseling patients and their families across various clinical situations It is essential to establish and maintain therapeutic, ethically sound relationships while collaborating effectively as a leader within the healthcare team Timely and accurate documentation of practice activities is crucial, as is the presentation of patient information and conference materials in a clear, organized, and knowledgeable manner Engaging with all team members involved in surgical patient care enhances collaborative efforts, while exhibiting leadership within the surgical team is vital Contributing to the education of neurosurgical residents through teaching and leading by example, as well as evaluating the performance and competence of the surgical residency team, are key components of fostering a productive learning environment.
Professionalism in healthcare involves demonstrating respect, compassion, and integrity while prioritizing the needs of patients and society above self-interest It encompasses accountability to patients and a commitment to ethical principles, including informed consent and confidentiality Healthcare professionals should be sensitive to the diverse cultures, ages, genders, and disabilities of their patients Timely completion of administrative responsibilities and maintaining positive relationships are essential aspects of professionalism Ultimately, healthcare providers must take accountability for their actions and decisions to uphold the standards of their profession.
Systems-based practice involves understanding the interconnectedness of patient care and its impact on other health care professionals, organizations, and society at large It is essential for practitioners to recognize how these systemic elements influence their own practices Different types of medical practices and delivery systems vary in their methods, particularly in managing health care costs and resource allocation Ethical, legal, economic, and social considerations must be integrated into the surgical team's activities to ensure comprehensive surgical care Practicing cost-effective health care while maintaining quality is crucial, alongside advocating for patients and helping them navigate complex health care systems Collaboration with health care managers and providers is vital to assess, coordinate, and enhance health care services, ultimately improving system performance.
1 Patient Care a Weekly basic science conference b Evaluations by faculty (including mid-rotation feedback sessions) c Attending rounds
The assessment of medical knowledge includes several key components: the annual written board exam, known as the ABNS primary exam, which is taken for credit; written evaluations conducted by faculty, including feedback sessions during mid-rotation; regular faculty evaluations during weekly conferences; participation in attending rounds; and presentations at Surgical Case Conferences.
3 Practice-Based Learning a Faculty evaluation b Monthly M&M c Weekly attending rounds d Journal Club
4 Interpersonal Relationships and Communication a Faculty evaluations b Self-evaluations c 360 evaluations
5 Professionalism a Faculty critique of weekly general surgery conference b 360 evaluations c By faculty (including mid-rotation feedback sessions) d By other resident staff members
6 Systems-Based Practice a Faculty evaluation b Input from mid-level practitioners, nurses, 360 evaluations
PGY-3 residents are expected to independently perform a range of advanced procedures with minimal supervision, while also guiding junior residents as lead surgeons They should focus on mastering key ACGME competencies and procedural skills, including craniotomies for various conditions such as brain tumors, trauma, and vascular lesions, as well as endovascular procedures for neuro-oncologic issues Additional skills to be developed include functional procedures, radiosurgery, transsphenoidal approaches for tumors, and various spinal interventions like lumbar discectomy and Chiari decompression Mastery of both open and endovascular extracranial vascular procedures, along with pediatric-specific techniques such as craniotomy for brain tumors and VP shunts, is also essential for their training.
PGY-4/Chief Year: Neurosurgery Clinical Rotation
The neurosurgery PGY-4 resident must exhibit comprehensive mastery in the preoperative and postoperative care of general neurosurgical patients, demonstrating the ability to independently perform most procedures while leading the neurosurgical team As chief resident, they are expected to apply an evidence-based medicine approach that integrates basic science with clinical knowledge, while also providing effective communication and leadership models for junior team members Typically, PGY-4 residents achieve ratings of 4-5 across all categories in the Milestones evaluations.
Compassionate patient care involves demonstrating respectful behaviors towards patients and their families, incorporating patient preferences in decision-making, and developing appropriate care plans for chief residents Effective patient care requires overseeing the collection of accurate patient information, evaluating complex neurosurgical conditions, and comparing treatment options to make informed decisions based on patient needs, scientific evidence, and clinical judgment Chief residents must perform essential medical procedures competently, promote health through preventative services, and coordinate care among healthcare professionals Technical skills are vital, as residents should exhibit knowledge and psychomotor skills in neurosurgical procedures, prepare adequately for operations, and ensure patient safety during surgeries They must also demonstrate timely decision-making, manual dexterity, and competence in handling complex cases while assisting attending staff in surgical procedures with minimal supervision.
To excel in neurosurgery, residents must demonstrate mastery of neurosurgical pathophysiology, critical care, pharmacology, and physiology, along with the ability to interpret hemodynamic data They should formulate and implement effective diagnostic and treatment plans for brain, spine, and peripheral nerve diseases, while also outlining appropriate work-ups for central and peripheral nervous system disorders and their associated tissues Proficiency in advanced subspecialties, such as trauma, tumors, and pediatric neurosurgery, is essential Residents must elucidate preoperative and postoperative concerns, coordinating comprehensive patient care, including evaluations, diagnostic studies, and operative management Familiarity with neurosurgical literature and the ability to critically evaluate scientific information is crucial, as is the capability to analyze complications in a monthly M&M Conference Additionally, residents should possess a knowledge base sufficient to teach junior residents and students, demonstrating surgical competence that leads to anticipated outcomes They must integrate continuity of care principles into the overall care plan, understanding the implications of surgical disease management and the impact of continuity on patient outcomes Finally, they should demonstrate independence in managing pre-operative and post-operative care in an outpatient setting during their chief resident clinic experience, under appropriate supervision.
Practice-Based Learning and Improvement involves a systematic analysis of patient care practices, utilizing data from both the specific patient population and the broader community It emphasizes the appraisal and integration of scientific evidence related to patient health issues, applying knowledge of study designs and statistical methods to evaluate clinical studies This approach fosters continuous improvement in patient care through systematic methodologies, while also leveraging information technology for managing data and accessing online medical resources Additionally, it encourages the education of junior residents and underscores the significance of lifelong learning in the surgical field Ultimately, practitioners are expected to analyze their outcomes and implement improvements to enhance patient care effectively.
Effective interpersonal relationships and communication are essential in healthcare, requiring sensitivity and skill in counseling patients and their families across various clinical situations Establishing and maintaining therapeutic and ethical relationships is crucial, as is the ability to lead and collaborate within a healthcare team Timely and accurate documentation of practice activities is vital, alongside presenting patient information and conference materials in a clear, organized, and knowledgeable manner Engaging collaboratively with all personnel involved in surgical patient care enhances outcomes, while exhibiting leadership within the surgical team is key Additionally, contributing to the educational efforts of neurosurgical residency through effective teaching and evaluating the performance of residency team members ensures a high standard of care and professional development.
Professionalism in healthcare involves demonstrating respect, compassion, and integrity while prioritizing the needs of patients and society over self-interest It requires accountability to patients and the profession, along with a commitment to ethical principles regarding clinical care, confidentiality, informed consent, and business practices Professionals must be sensitive to patients' diverse backgrounds, including culture, age, gender, and disabilities Timely completion of administrative responsibilities, such as evaluations and medical record documentation, is essential Maintaining positive relationships and demonstrating accountability for actions and decisions are crucial components of professionalism in the medical field.
Systems-Based Practice emphasizes the importance of understanding how patient care and professional practices impact other healthcare professionals, organizations, and society at large It is crucial for practitioners to recognize how these systemic elements influence their own practices Moreover, differentiating between various medical practices and delivery systems is essential, particularly in terms of methods for controlling healthcare costs and resource allocation Ethical, legal, economic, and social factors must be integrated into the surgical team's activities to ensure comprehensive surgical care Additionally, practitioners should focus on cost-effective healthcare and resource allocation without compromising quality, advocate for quality patient care, and help patients navigate system complexities Collaboration with healthcare managers and providers is vital for assessing, coordinating, and enhancing healthcare delivery while understanding how these efforts impact overall system performance.
1 Patient Care a Weekly basic science conference b Evaluations by faculty (including mid-rotation feedback sessions) c Attending Rounds
2 Medical Knowledge a Annual written board exam (ABNS primary exam), taken for credit if not already passed as
PGY-1 Trauma (1 month)
b Written evaluation by faculty (including mid-rotation feedback sessions). c Faculty evaluation, weekly conferences d Attending rounds e Presentation at Surgical Case conferences
3 Practice-Based Learning and Improvement a Faculty evaluation b Weekly M&M c Weekly attending rounds d Journal Club
4 Interpersonal Relationships and Communication a Faculty evaluations b Self-evaluations c 360 evaluations
5 Professionalism a Faculty critique of weekly general surgery conference b 360 evaluations by nursing c By faculty (including mid-rotation feedback sessions) d By other resident staff members
6 Systems-Based Practice a Faculty evaluation b Input from mid-level practitioners, nurses, 360 evaluations
At the PGY-4 level, residents must demonstrate proficiency in a comprehensive set of procedural skills mandated by ACGME competencies for neurosurgery, enabling them to perform these procedures with minimal supervision They are expected to lead junior residents in various cases, enhancing their leadership and teaching abilities Key procedures include craniotomies for brain tumors, vascular lesions, and trauma, as well as endovascular interventions for cerebrovascular and neuro-oncologic conditions Additionally, they should gain experience in functional procedures, radiosurgery, and transsphenoidal approaches for sellar tumors Mastery of VP shunts, cervical decompression techniques, spinal interventions, and pediatric neurosurgery is also essential By actively pursuing these skills, PGY-4 residents will ensure their preparedness for independent practice and enhance their overall competency in the field.
IV SAMPLE YEAR OF ROTATIONS FOR PGY-1 NEUROSURGERY RESIDENT
The PGY-1 neurosurgery resident specializing in trauma must acquire the skills for the initial diagnostic evaluation and post-traumatic care of trauma patients, utilizing evidence-based medicine Under supervision, residents should be capable of performing minor procedures and effectively communicating with healthcare professionals and patients' families.
Compassionate patient care involves demonstrating respectful behaviors towards patients and their families, incorporating patient preferences in decision-making, and developing appropriate care plans for trauma patients Essential patient information must be gathered to make informed triage decisions, while critical evaluations of surgical indications should be presented to the chief resident Understanding diagnostic and therapeutic interventions based on patient data, scientific evidence, and clinical judgment is crucial, alongside familiarity with policies for managing trauma and critically ill patients Technical skills are essential, including performing primary and secondary surveys on injured patients and developing treatment plans under supervision Effective treatment encompasses assisting with medical procedures, coordinating care with healthcare professionals, and managing patients with elevated intracranial pressure Competence in surgical techniques, radiologic interpretation, and emergency airway management is vital for providing continuity of care and assessing patient outcomes.
To effectively manage patients with increased intracranial pressure, it is essential to develop the ability to provide timely surgical assessments and operative management Understanding the various categories of shock—cardiogenic, hypovolemic, septic, tamponade, and tension pneumothorax—along with their etiology and pathophysiology is crucial for effective treatment A multi-disciplinary approach to trauma and critical care is necessary, as is a thorough knowledge of surgical infections and complications arising from acute surgical diseases Residents should possess a solid knowledge base to educate students and demonstrate familiarity with current surgical literature in trauma and acute general surgery It is vital to relate basic medical knowledge to patient care, evaluating and applying pertinent scientific information Surgical competence must be demonstrated through significant knowledge and advanced skills to achieve expected outcomes Furthermore, integrating principles of surgical continuity of care into the overall treatment plan is important for trauma and critically ill patients A comprehensive understanding of the natural history of surgical diseases, the impacts of surgical interventions, and the role of continuity of care on surgical outcomes is necessary Lastly, ethical, legal, economic, and social factors should be incorporated into the activities of the trauma and critical care team, ensuring a holistic approach to patient care.
Practice-based learning and improvement in surgical education involves a systematic analysis of patient care practices, utilizing data from both specific patient populations and broader demographics Surgeons must locate and evaluate scientific evidence pertinent to their patients' health issues, applying knowledge of study designs and statistics to assess clinical studies on diagnostic and therapeutic effectiveness Continuous improvement is achieved through systematic methodologies and the use of information technology to manage and access medical information, which also supports ongoing education for new surgeons Additionally, experienced surgeons play a crucial role in facilitating the learning of medical students and junior residents, while emphasizing the importance of lifelong learning in enhancing surgical practice and patient care outcomes.
Effective interpersonal relationships and communication are essential in trauma and critical care settings Healthcare professionals must demonstrate sensitivity and skill in counseling patients and their families, fostering therapeutic and ethical relationships Leadership within the healthcare team is crucial, as is the ability to document practice activities promptly and accurately Presenting patient information and conference materials in a clear, organized, and knowledgeable manner enhances understanding and collaboration Engaging collaboratively with all personnel involved in surgical patient care is vital, as is contributing to the educational efforts of the surgical residency through teaching by example Additionally, evaluating the performance and competence of the surgical residency team members ensures a high standard of care.
Professionalism in healthcare involves demonstrating respect, compassion, and integrity, prioritizing the needs of patients and society over self-interest It requires a commitment to ethical principles, including confidentiality, informed consent, and responsible business practices Healthcare professionals must be sensitive to the diverse cultures, ages, genders, and disabilities of their patients Timely completion of administrative responsibilities, such as evaluations and medical record documentation, is essential for maintaining professionalism Building positive relationships and being accountable for one's actions and decisions are also key components of a professional practice.
Systems-based practice involves recognizing the impact of patient care and professional practices on fellow health care providers, the healthcare organization, and society as a whole It is essential to cultivate an awareness of how these interactions shape the overall health system and contribute to improved patient outcomes Understanding this interconnectedness is crucial for fostering effective collaboration and enhancing the quality of care delivered within the healthcare landscape.
Understanding the impact of healthcare system elements on medical practice is crucial for professionals It is essential to recognize the differences in medical practice types and delivery systems, particularly in methods for controlling healthcare costs and resource allocation Practicing cost-effective healthcare while ensuring quality for trauma and critically ill patients is vital Advocating for quality patient care and assisting patients in navigating system complexities enhances overall service delivery Collaborating with healthcare managers and providers to assess, coordinate, and improve healthcare can significantly influence system performance.
PGY1 residents are trained to effectively diagnose and manage trauma and critically ill patients, participating in a wide range of procedures, including complex wound closures and central line placements They demonstrate proficiency in handling both penetrating and blunt neck injuries and assist senior residents and attendings during laparotomies for various types of trauma.
PGY-1 Critical Care (1 month)
Effective management of critically ill surgical patients with multiple medical issues requires a comprehensive care plan that includes triaging patients and understanding the roles of physicians, nurses, and administrators in the ICU Surgeons play a crucial role in leading critical care by adjusting treatment interventions based on clinical and laboratory changes Initial evaluations and ongoing monitoring of neurological or behavioral abnormalities, such as seizures and delirium, are essential in the ICU It is important to establish criteria for admitting and discharging patients, as well as identifying potential organ and tissue donors and the procedures for family contact Understanding the physiological responses to various stressors, including sepsis and trauma, is vital Knowledge of pharmacotherapeutics for critically ill patients, including vasopressors and antibiotics, is necessary for effective treatment Nutritional support and the principles of managing postoperative fever should also be outlined Distinguishing between septic and hypovolemic shock is critical, as is analyzing treatments for seizures and acute mental status changes, focusing on airway management, electrolyte levels, and medication interactions.
Phenobarbital and Dilantin are essential in managing stress responses, including metabolic, hormonal, cardiovascular, and renal changes, while intravenous fluids must be carefully administered High stress hormone levels can significantly alter glucose metabolism It is crucial to differentiate between low cardiac output and hypotensive/hypertensive states by analyzing preload, pump function, and afterload Specific fluid compositions impact bodily functions, and understanding when to initiate ventilation support is vital A thorough review of respiratory physiology reveals the pathologies linked to ventilation and perfusion deficits Ventilator mechanics, including modes and triggering mechanisms, should be analyzed for effective use Monitoring devices, such as arterial and central venous catheters, provide critical information on hemodynamics, with varying accuracy and costs Identifying and classifying acid-base disturbances in critically ill patients is essential, along with addressing complex acid-base issues through electrolyte replacement Preoperative assessments should predict a patient's need for critical care based on existing health conditions and surgical requirements Tissue oxygen supply and demand can be evaluated through calculations of oxygen delivery and consumption, considering factors like cardiac output and hemoglobin saturation The evaluation and treatment of bleeding disorders, including DIC and thrombocytopenia, require understanding their causes and therapies Lastly, endocrine-related problems in critical care, such as thyroid and adrenal disorders, necessitate specific therapeutic approaches.
PGY-1 Neurosurgery Service (9 months)
Practice-based Learning
a Faculty evaluation b Weekly M&M c Weekly attending rounds d Twice weekly multidisciplinary teaching rounds
4 Interpersonal Relationships and Communication a Faculty evaluations b Self-evaluations c 360 evaluations
5 Professionalism a 360 evaluations b By faculty (including mid-rotation feedback sessions) c By other resident staff members
6 Systems-Based Practice a Trauma Surgery Case conference b Multidisciplinary teaching rounds c Department of Surgery M&M
PGY-1 Neurology Rotation (1 months)
The goals of this program focus on enhancing technical proficiency through structured index procedures, ensuring residents develop the necessary competencies Participants will learn to conduct thorough history and physical examinations, fostering clinical judgment and effective decision-making in both operative and non-operative contexts Additionally, residents will engage in comprehensive data gathering and case log organization, while also mastering the development and execution of patient care plans Time management and task prioritization skills will be cultivated to optimize overall efficiency in patient care.
The objectives of this article include conducting a thorough neurological examination, gaining foundational knowledge in diagnosing and managing status epilepticus, ischemic stroke, and intracranial hemorrhage Additionally, it emphasizes the importance of compassionately and clearly communicating diagnoses and treatment rationales to patients and their families, as well as demonstrating the correct technique for performing a lumbar puncture.
The primary goals of this training program are to enhance understanding of neurological conditions, their differential diagnoses, and relevant treatments Trainees will become familiar with common neurological disorders, including stroke, multiple sclerosis, and epilepsy, while also learning about the neurologic manifestations associated with prevalent medical illnesses Additionally, participants will explore the neuropharmacology of the medications used to treat these conditions, ensuring a comprehensive grasp of both the diseases and their therapeutic approaches.
The article aims to educate readers on the essential aspects of emergency management for neurological patients, focusing on diagnosis, treatment, and triage, particularly for conditions like hemorrhagic and ischemic strokes, status epilepticus, and Guillain-Barre Syndrome Additionally, it covers important procedures such as diagnostic and therapeutic lumbar punctures Readers will also gain familiarity with critical neurodiagnostic techniques, including Electroencephalogram (EEG) and Electromyography (EMG), as well as imaging modalities relevant to neurological assessments.
3 Practice-Based Learning and Improvement
The primary goals include understanding the organization and management of clinical databases and registries, critically assessing effective treatments and technologies, and demonstrating the ability to investigate and evaluate patient care by appraising scientific evidence to enhance outcomes Additionally, it emphasizes the effective use of information technology to document and gather medical information, supporting ongoing education and continuous improvement in patient care.
The objectives of this article are to showcase the ability to comprehend and evaluate evidence related to management alternatives, ensure the maintenance of secure patient logs during neurology service, and recognize the importance of risk-benefit analysis in clinical decision-making.
To achieve successful team organization and goals, it is essential to actively participate in tasks aligned with individual responsibilities Effective communication with families and patients is crucial, as well as fostering collegial interactions with physicians, nurses, and other healthcare professionals Utilizing strong listening skills and employing nonverbal cues, along with clear questioning and writing abilities, ensures the efficient exchange of information within the team.
The primary objectives include collecting comprehensive data from written and verbal sources, such as the referring provider, the patient, and the electronic medical record This information should be presented to the attending physician in an organized manner Effective and compassionate counseling for both the patient and their family is essential Additionally, consulting with other specialists, when necessary, should be conducted both in writing and verbally Finally, it is crucial to document all data in the electronic medical record and summarize the findings logically and coherently.
To achieve excellence in patient care, it is essential to demonstrate initiative and a strong sense of responsibility, while also exercising empathy and responsiveness to the needs of patients and colleagues Upholding a commitment to quality care is crucial, alongside exhibiting ethical behavior in all interactions with patients and professional peers.
The primary objectives include taking responsibility for patient care, diagnosis, and treatment under suitable supervision while ensuring compassionate communication with patients and their families It is essential to prepare for and address patient care needs effectively, demonstrating a strong work ethic and professional demeanor in all interactions with both patients and colleagues.
The primary goals include showcasing the ability to work efficiently within diverse healthcare delivery systems while providing comprehensive care to patients of all ages Additionally, it emphasizes the importance of understanding risk-benefit analysis to ensure high-quality, cost-effective patient care.
The objectives include the implementation of practice guidelines to enhance patient care, showcasing effective consultation and referral processes for optimal clinical management, and utilizing precise medical data to improve communication and patient management Additionally, it emphasizes the importance of understanding community resources to address both the short-term and long-term needs of patients.