Annual Expectations
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Annual Expectations
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Program Curriculum OutlineThe program is structured to provide a wide variety of academic and clinical experience. Each year progressively builds upon the previous, culminating as chief at the base hospital. The residents share annually in the surgical experience of at least 400 cases per chief resident, and admissions of at least 100 per resident per year. The educational experience is formulated upon direct teaching not relying solely upon resident chores. The main objective is to provide excellence in the neurosurgery resident’s education; it is not to provide manpower as demonstrated by the uniquely high ratio of attending neurosurgeon to resident. Since the attending faculty neurosurgeons act as a collective group and cover all hospitals in the program the educational experience is multi-faceted yet congruent. The base hospitals and the affiliated hospital each provide a unique experience adding to a well-rounded program. Thus together each experience is necessary and insures a well-rounded understanding.
Each facility’s resident team will consist of senior and junior residents. If there are sufficient number of residents the team members will change partners and institutions every three months as appropriate. All residents will continue to meet weekly with neurosurgical attendings for conference and will participate in the neurosurgical attendings morning report that is held every day or as possible.
All Neurosurgical Residents will document strict adherence to the 80- hour per week work rule as currently defined and described in “VII. Duty Hours and On-call Responsibilities” and “Basic Standards for Residency Training in Neurological Surgery”.
Below are the minimal training requirements for each academic year during neurosurgical residency. Additionally, the neurosurgical resident should use the academic and clinical competence as outlined in Appendix one as a study guide.
Year 1 (PGY-2) Measurement of Core Competencies Academic Skills (see appendix) Reading and lectures will concentrate on basic science knowledge in neuroanatomy and neurophysiology as applied to the management of neurosurgical patients; topics to be covered include a review of applied neuroanatomy, cerebral metabolism, cerebral blood flow dynamics, intracranial pressure and its management, and basic neuropharmacology. Clinical topics to be studied will include the basic aspects of craniospinal trauma, cerebral neoplasms, and disorders of the spine. Emphasis will be on recognition, diagnosis, and the understanding of principles of management.
The resident will be expected to read assigned journals and present articles for the monthly Journal Club. Residents will prepare oral case presentations for the weekly Case Management Conference.
The resident will also be taught how to write a scientific paper using the Case Report as the format for the first year required paper. The outline of the paper must be presented by December of that academic year.
Clinical Skills (see appendix)Residents will be expected to improve their proficiency in obtaining a neurologic history and conducting a neurologic examination. This will be aided both by reading assignments and by patient encounters supervised by senior resident and attending staff members.
Residents will be expected to become more familiar with aspects of operative care of patients. Residents will spend time in the operating room assisting more senior residents, or attending neurosurgeons, with surgeries. The residents will be expected to read about the specific operations being performed and be able to discuss relevant anatomy, pathology, and management options for each specific patient. This will also be the time for the residents to familiarize themselves with neurosurgical instrumentation. They will be taught the use of specific equipment such as a variety of cranial headrests, self-retaining retractor systems, stereotactic frames, surgical microscopes, and frameless stereotaxy.
The resident will function as a surgical assistant in the operating room and will be expected to develop surgical skills that will allow the resident to participate in basic aspects of surgery including opening and closing wounds, creating burr holes both with power and manual instrumentation, inserting a variety of types of intracranial pressure monitoring devices and the neurosurgical management of the processes and diseases listed below.
The residents will also participate in outpatient clinic activities, and will begin to evaluate patients in this setting. They will start seeing patients in the emergency room under the guidance of senior residents and attending neurosurgeons. The residents will participate in the in-patient care and management of the neurosurgery patients, including both pediatric and adult patients. The resident will become familiar with the neurological management of infection, trauma, hydrocephalus, radiculopathy, spinal disease, tumors, stroke, degenerative disease, seizures, peripheral nerve disease, vascular disease, congenital defects, intensive care management and other neurological conditions.
During the neuroradiology rotation, the resident attends a wide variety of neuroimaging conferences and learns the basics of neuroimaging. The resident is expected to become proficient in interpreting all aspects of contemporary neuroimaging.
MEASURED PROFICIENCIES The metrics chosen to assess the neurosurgery resident’s achievement of any competency must parallel the teaching process (es) employed by the neurosurgery residency program. As such, the neurosurgery program will have flexibility when choosing methodologies to assess a resident’s performance. Additionally, assessment tools vary in their reliability and validity. Therefore, more than one assessment tool should be used when assessing neurosurgical residents to improve the overall accuracy, the following are acceptable standardized methods with demonstrable efficacy and following that are specific recommendations for the neurosurgical resident. ·360-Degree Evaluation: An assessment tool used to rate the performance of a resident. All individuals that have contact with the resident should complete the evaluation. ·Checklist: An assessment tool used to evaluate specific behaviors or tasks that are components of a more complex activity. ·Objective Structured Clinical Examination (OSCE): An assessment tool that consists of multiple stations. The stations include various elements of clinical encounters. The stations include standardized patients. ·Monthly Service Rotation Evaluation. ·Procedure/Case Logs. ·Portfolios: An assessment tool used to document learning experiences. Usually a compilation of written documents (i.e., case logs, procedural logs, research activity, committee involvement, lectures and conferences attended, etc.). ·Written Examination. ·Chart Stimulated Oral Recall Examination: An assessment tool used to assess clinical problem-solving ability. Provides the ability to investigate the examinee’s rationale for requesting information (i.e., historical or physical examination data), interpretation of information provided, and management of selected cases, not evident by simply reviewing the chart.
The neurosurgical resident will demonstrate clinical competence in Osteopathic philosophy and osteopathic manipulative medicine, as well as neuroscience knowledge. This can be accomplished in a variety of ways, eventually by an examination of a single national standardized patient. The examination will be graded, issuing a pass or fail score.
The neurosurgical resident will demonstrate clinical competence patient care, interpersonal, communication skills and professionalism. This can be accomplished in a variety of ways, eventually by the examination and video review of three patients. This will then be critiqued by the attending staff, and psychologists if available. The neurosurgical resident must also participate in, pass and have endorsed the hospital based core competence exercises in these areas.
The neurosurgical resident will demonstrate clinical competence practice based learning and system based learning and improvement. This can be accomplished in a variety of ways, eventually culminating in the examination of three national standardized neurosurgical patients. The resident will then review those patients with the faculty. The examination will be graded, issuing a pass or fail score. After the review the residents as a group will review each patient in a round table discussion.
Additionally each resident will be given a single case for oral discussion. The examination will be graded, issuing a pass or fail score. The case will demonstrate clinical neuroscience competence.
The neurosurgical resident must keep a surgical log. The log must demonstrate proficiency in neurosurgical procedures. The program director or designee must sign each group of procedures. The neurosurgical resident during this year must complete with proficiency: Feeding tube placements Nutrition management which includes total parental nutrition Arterial line placements Foley catheter insertions Conscious sedation cases Ability to oral-tracheal, naso-tracheal intubate Central line placements Swan ganz catheters Ventriculostomies Trauma triage Ventilator management Wound closures SOAP notes Histories and physicals Pre-operative notes Operative notes Post-operative notes Interpretation of each: Angiograms, MRIs, CAT scans, and TCDs Risks and benefits discussion Presentation of cases at formal conference Osteopathic structural exam and diagnosis Submission of IRB proposal Submission of abstract Power-point presentation See on-line ACOS Neurosurgery Curriculum for suggested study guidelines
YEAR 2 (PGY – 3) Measurement of Core Competencies Academic Skills (see appendix) The resident will continue to read both assigned topics and readings designed to expand the neurosurgical knowledge base. The depth and breath of case management discussions will be expected to expand. Residents will be expected to be able to manage the patients on service with supervision by the chief resident and the attending staff but hopefully with a decreasing reliance on them for day-to-day management direction. It is during this year that the residents will be able to complete their requirements in Neurology, see below.
The annual paper will be expected to be of more substance than merely a case report, although an expanded case report format will be acceptable. The outline of the paper must be presented by December of that academic year.
The resident will be expected to read assigned journals and present articles for the monthly Journal Club. Residents will prepare oral case presentations for the weekly Case Management Conference.
Clinical Skills (see appendix)The resident will continue to assist in surgery and function as the first assistant in most cases. The resident will be expected to develop skills on a level to allow the resident to perform under supervision more of the surgical procedures; specifically being able to open, expose the relevant pathology, assist in its removal, close most cranial and spinal cases and become proficient in the operative treatment of the conditions listed below. The resident will begin to perform under supervision more of some of the less complex surgical procedures.
The resident will continue to elevate all Emergency Room patients for whom neurological consultation is requested. The resident will be expected to demonstrate improved skills in the areas of diagnosis and management of these patients.
The residents will also continue to participate in the office care of neurological patients to become more familiar with out – patient management problems and their solutions and also to gain additional facility in clinical diagnostic skills. The residents will participate in the in-patient care and management of the neurosurgery patients, including both pediatric and adult patients. The resident will become proficient with the neurological management of infection, trauma, hydrocephalus, radiculopathy, spinal disease, tumors, stroke, degenerative disease, seizures, peripheral nerve disease, vascular disease, congenital defects, intensive care management and other neurological conditions.
During neurology, the junior resident learns to evaluate and manage patients with neurological disorders. After completing this rotation, the resident should have a thorough understanding of the neurologic examination, neurologic case management and clinical neurology.
MEASURED PROFICIENCIES The metrics chosen to assess the neurosurgery resident’s achievement of any competency must parallel the teaching process (es) employed by the neurosurgery residency program. As such, the neurosurgery program will have flexibility when choosing methodologies to assess a resident’s performance. Additionally, assessment tools vary in their reliability and validity. Therefore, more than one assessment tool should be used when assessing neurosurgical residents to improve the overall accuracy, the following are acceptable standardized methods with demonstrable efficacy and following that are specific recommendations for the neurosurgical resident. ·360-Degree Evaluation: An assessment tool used to rate the performance of a resident. All individuals that have contact with the resident should complete the evaluation. ·Checklist: An assessment tool used to evaluate specific behaviors or tasks that are components of a more complex activity. ·Objective Structured Clinical Examination (OSCE): An assessment tool that consists of multiple stations. The stations include various elements of clinical encounters. The stations include standardized patients. ·Monthly Service Rotation Evaluation. ·Procedure/Case Logs. ·Portfolios: An assessment tool used to document learning experiences. Usually a compilation of written documents (i.e., case logs, procedural logs, research activity, committee involvement, lectures and conferences attended, etc.). ·Written Examination. ·Chart Stimulated Oral Recall Examination: An assessment tool used to assess clinical problem-solving ability. Provides the ability to investigate the examinee’s rationale for requesting information (i.e., historical or physical examination data), interpretation of information provided, and management of selected cases, not evident by simply reviewing the chart.
The neurosurgical resident will demonstrate clinical competence in Osteopathic philosophy and osteopathic manipulative medicine, as well as neuroscience knowledge. This can be accomplished in a variety of ways, eventually by an examination of a single national standardized patient. The examination will be graded, issuing a pass or fail score.
The neurosurgical resident will demonstrate clinical competence patient care, interpersonal, communication skills and professionalism. This can be accomplished in a variety of ways, eventually by the examination and video review of three patients. This will then be critiqued by the attending staff, and psychologists if available. The neurosurgical resident must also participate in, pass and have endorsed the hospital based core competence exercises in these areas.
The neurosurgical resident will demonstrate clinical competence practice based learning and system based learning and improvement. This can be accomplished in a variety of ways, eventually culminating in the examination of three national standardized neurosurgical patients. The resident will then review those patients with the faculty. The examination will be graded, issuing a pass or fail score. After the review the residents as a group will review each patient in a round table discussion.
Additionally each resident will be given a single case for oral discussion. The examination will be graded, issuing a pass or fail score. The case will demonstrate clinical neuroscience competence.
The neurosurgical resident must keep a surgical log. The log must demonstrate proficiency in neurosurgical procedures. The program director or designee must sign each group of procedures. The neurosurgical resident during this year must complete with proficiency: ICU patient management Wound openings SOAP notes Histories and physicals Pre-operative notes Operative notes Post-operative notes ICD-9/10 coding Microscope usage Evacuation hematoma Interpretation of each: Angiograms, MRIs, CAT scans, and TCDs Risks and benefits discussion Presentation of cases at formal conference Osteopathic structural exam and diagnosis Submission of IRB proposal Submission of abstract Power-point presentation Pass ACLS and ATLS course EEG interpretation SSEP interpretation Brain death Exams See on-line ACOS Neurosurgery Curriculum for suggested study guidelines
YEAR 3 (PGY– 4) Measurement of Core Competencies Academic Skills (see appendix) The resident will be expected to broaden the scope of his reading branching out from the usual text reference and to begin to explore other available literature on topics relevant to the problems encountered on service. The resident will be directly responsible for the medical students assigned to the neurosurgical service for elective rotations.
The resident will be expected to read assigned journals and present articles for the monthly Journal Club. Residents will prepare oral case presentations for the weekly Case Management Conference.
The annual scientific paper is expected to be more sophisticated in nature than those of the first two years. The Neurosurgical Resident must also submit a paper for publication. The outline of the paper must be presented by December of that academic year. A poster session for the Annual Clinical Assembly of Osteopathic Specialists may be submitted in lieu of the paper for this or succeeding years. Clinical Skills (see appendix)The resident will by this time be assuming a greater role in the management of the outpatient, office population. He will be expected to be able to evaluate new patients in this setting and to discuss their diagnosis and management options. The residents will participate in the in-patient care and management of the neurosurgery patients, including both pediatric and adult patients. The resident will demonstrate advanced skills in the neurological management of infection, trauma, hydrocephalus, radiculopathy, spinal disease, tumors, stroke, degenerative disease, seizures, peripheral nerve disease, vascular disease, congenital defects, intensive care management and other neurological conditions.
In the operating room, the resident should be performing more of the surgical procedures under supervision and with the attending staff acting as first assistant during the phases of the operation performed by the resident. The technical skill level of the resident will be expected to improve through the course of the residency program and the resident will demonstrate advanced neurosurgical operating skills in the management of the diseases and processes listed above.
During the rotation in neuropathology is supervised by an attending pathologist/neuropathologist. The resident is to assume an active role in reviewing histological specimens, brain-cutting conferences and in assisting the pathologist/neuropathologist in the laboratory. This rotation is designed to expose the junior resident to the basics of the evolving discipline of neuropathology. The Neurosurgery residents are encouraged to attend the Armed Forces Institute of Pathology Updates in neuroradiology and neuropathology.
MEASURED PROFICIENCIES The metrics chosen to assess the neurosurgery resident’s achievement of any competency must parallel the teaching process (es) employed by the neurosurgery residency program. As such, the neurosurgery program will have flexibility when choosing methodologies to assess a resident’s performance. Additionally, assessment tools vary in their reliability and validity. Therefore, more than one assessment tool should be used when assessing neurosurgical residents to improve the overall accuracy, the following are acceptable standardized methods with demonstrable efficacy and following that are specific recommendations for the neurosurgical resident. ·360-Degree Evaluation: An assessment tool used to rate the performance of a resident. All individuals that have contact with the resident should complete the evaluation. ·Checklist: An assessment tool used to evaluate specific behaviors or tasks that are components of a more complex activity. ·Objective Structured Clinical Examination (OSCE): An assessment tool that consists of multiple stations. The stations include various elements of clinical encounters. The stations include standardized patients. ·Monthly Service Rotation Evaluation. ·Procedure/Case Logs. ·Portfolios: An assessment tool used to document learning experiences. Usually a compilation of written documents (i.e., case logs, procedural logs, research activity, committee involvement, lectures and conferences attended, etc.). ·Written Examination. ·Chart Stimulated Oral Recall Examination: An assessment tool used to assess clinical problem-solving ability. Provides the ability to investigate the examinee’s rationale for requesting information (i.e., historical or physical examination data), interpretation of information provided, and management of selected cases, not evident by simply reviewing the chart.
The neurosurgical resident will demonstrate clinical competence in Osteopathic philosophy and osteopathic manipulative medicine, as well as neuroscience knowledge. This can be accomplished in a variety of ways, eventually by an examination of a single national standardized patient. The examination will be graded, issuing a pass or fail score.
The neurosurgical resident will demonstrate clinical competence patient care, interpersonal, communication skills and professionalism. This can be accomplished in a variety of ways, eventually by the examination and video review of three patients. This will then be critiqued by the attending staff, and psychologists if available. The neurosurgical resident must also participate in, pass and have endorsed the hospital based core competence exercises in these areas.
The neurosurgical resident will demonstrate clinical competence practice based learning and system based learning and improvement. This can be accomplished in a variety of ways, eventually culminating in the examination of three national standardized neurosurgical patients. The resident will then review those patients with the faculty. The examination will be graded, issuing a pass or fail score. After the review the residents as a group will review each patient in a round table discussion.
Additionally each resident will be given a single case for oral discussion. The examination will be graded, issuing a pass or fail score. The case will demonstrate clinical neuroscience competence.
The neurosurgical resident must keep a surgical log. The log must demonstrate proficiency in neurosurgical procedures. The program director or designee must sign each group of procedures. The neurosurgical resident during this year must complete with proficiency: 10 cases of ICU patient management ICU management Wound openings SOAP notes Histories and physicals Pre-operative notes Operative notes Post-operative notes ICD-9/10 coding Microscope usage Evacuation hematoma Removal of herniated disk Pedicle screw fixation/complex spinal instrumentation assistance Graft harvesting Tumor resection assistance Vascular surgery assistance Peripheral nerve surgery assistance VP shunt insertion at either end Osteopathic structural exam and diagnosis Interpretation of each: Angiograms, MRIs, CAT scans, and TCDs Risks and benefits discussion Presentation of cases at formal conference Submission of IRB proposal Submission of abstract Power-point presentation Brain Death Exams See on-line ACOS Neurosurgery Curriculum for suggested study guidelines
YEAR 4 (PGY-5) Measurements of Core Competencies Academic Skills (see appendix) The resident by this time will have become well versed in the underlying scientific basis of neuropathophysiology and how that relates to the formulation of management options and how those options produce the desired effects. It is anticipated that the resident will have acquired the ability to critically evaluated Neurosurgical literature, particularly journal articles, relative to form, structure, and validity. The Neurosurgical Resident must also submit a paper for publication. The outline of the paper must be presented by December of that academic year.
The resident will begin to spend more time involved in the training of the more junior residents in the program by lectures and discussions concerning various aspects of the junior resident academic curriculum, by supervising and critiquing patient evaluations, and by supervising operative aspects of patient care.
The resident will be expected to read assigned journals and present articles for the monthly Journal Club. Residents will prepare oral case presentations for the weekly Case Management Conference.
Clinical Skills (see appendix)During this year of training, the resident will assume more responsibility for patient care including performing more of the surgery under supervision.
The surgery along with junior residents who will assist. The resident will be expected to demonstrate progressive advancement, clinical and technical skills sufficient to advance to the Chief year.
During this year of training, the resident will take a more active role in the outpatient, office activities. In addition, he will be expected to coordinate junior resident activities such as academic programs, call and vacations schedules, and other administrative activities. The residents co-manage the in-patient care and management of the neurosurgery patients, including both pediatric and adult patients. The resident will demonstrate competence in the neurological management of infection, trauma, hydrocephalus, radiculopathy, spinal disease, tumors, stroke, degenerative disease, seizures, peripheral nerve disease, vascular disease, congenital defects, intensive care management and other neurological conditions.
MEASURED PROFICIENCIES The metrics chosen to assess the neurosurgery resident’s achievement of any competency must parallel the teaching process (es) employed by the neurosurgery residency program. As such, the neurosurgery program will have flexibility when choosing methodologies to assess a resident’s performance. Additionally, assessment tools vary in their reliability and validity. Therefore, more than one assessment tool should be used when assessing neurosurgical residents to improve the overall accuracy, the following are acceptable standardized methods with demonstrable efficacy and following that are specific recommendations for the neurosurgical resident. ·360-Degree Evaluation: An assessment tool used to rate the performance of a resident. All individuals that have contact with the resident should complete the evaluation. ·Checklist: An assessment tool used to evaluate specific behaviors or tasks that are components of a more complex activity. ·Objective Structured Clinical Examination (OSCE): An assessment tool that consists of multiple stations. The stations include various elements of clinical encounters. The stations include standardized patients. ·Monthly Service Rotation Evaluation. ·Procedure/Case Logs. ·Portfolios: An assessment tool used to document learning experiences. Usually a compilation of written documents (i.e., case logs, procedural logs, research activity, committee involvement, lectures and conferences attended, etc.). ·Written Examination. ·Chart Stimulated Oral Recall Examination: An assessment tool used to assess clinical problem-solving ability. Provides the ability to investigate the examinee’s rationale for requesting information (i.e., historical or physical examination data), interpretation of information provided, and management of selected cases, not evident by simply reviewing the chart.
The neurosurgical resident will demonstrate clinical competence in Osteopathic philosophy and osteopathic manipulative medicine, as well as neuroscience knowledge. This can be accomplished in a variety of ways, eventually by an examination of a single national standardized patient. The examination will be graded, issuing a pass or fail score.
The neurosurgical resident will demonstrate clinical competence patient care, interpersonal, communication skills and professionalism. This can be accomplished in a variety of ways, eventually by the examination and video review of three patients. This will then be critiqued by the attending staff, and psychologists if available. The neurosurgical resident must also participate in, pass and have endorsed the hospital based core competence exercises in these areas.
The neurosurgical resident will demonstrate clinical competence practice based learning and system based learning and improvement. This can be accomplished in a variety of ways, eventually culminating in the examination of three national standardized neurosurgical patients. The resident will then review those patients with the faculty. The examination will be graded, issuing a pass or fail score. After the review the residents as a group will review each patient in a round table discussion.
Additionally each resident will be given a single case for oral discussion. The examination will be graded, issuing a pass or fail score. The case will demonstrate clinical neuroscience competence.
The neurosurgical resident must keep a surgical log. The log must demonstrate proficiency in neurosurgical procedures. The program director or designee must sign each group of procedures. The neurosurgical resident during this year must complete with proficiency: ICU management SOAP notes Histories and physicals Pre-operative notes Operative notes Post-operative notes ICD-9/10 coding Microscope usage Evacuation hematoma Removal of herniated disk Pedicle screw fixation/ complex spinal instrumentation Graft harvesting VP shunt insertion at either end Osteopathic structural exam and diagnosis Tumor resection Vascular surgery Peripheral nerve surgery Independent surgery under supervision Interpretation of each: Angiograms, MRIs, CAT scans, and TCDs Risks and benefits discussion Presentation of cases at formal conference Submission of IRB proposal Submission of abstract Power-point presentation Brain Death Exams See on-line ACOS Neurosurgery Curriculum for suggested study guidelines
YEAR 5 (PGY-6) Measurements of Core Competencies Academic Skills (see appendix) The resident will continue to expand his knowledge base by additional reading on a variety of topics. In addition, the resident will be expected to be responsible for more of the junior level resident education. The resident will be expected to complete his research project and prepare an extensive written paper on a chosen topic. The outline of the paper/project must be presented by December of that academic year.
The resident will be expected to read assigned journals and present articles for the monthly Journal Club. Residents will prepare oral case presentations for the weekly Case Management Conference.
Clinical Skills (see appendix)During the chief resident year, the resident will assume management of the Neurosurgical service. This will provide the resident with the continued opportunity to evaluate patients, select management options, and perform the surgery along with junior residents who will assist. The resident will be expected to demonstrate progressive advancement of clinical and technical skills culminating in the completion of the residency program.
During this final year of training, the resident will take a more active role in the outpatient, office activities. In addition, he will be expected to coordinate junior resident activities such as academic programs, call and vacation schedules, and other administrative activities. The residents will manage the in-patient care of the neurosurgery patients, including both pediatric and adult patients. The resident will demonstrate consistent expertise in the neurological management of infection, trauma, hydrocephalus, radiculopathy, spinal disease, tumors, stroke, degenerative disease, seizures, peripheral nerve disease, vascular disease, congenital defects, intensive care management and other neurological conditions.
MEASURED PROFICIENCIES The metrics chosen to assess the neurosurgery resident’s achievement of any competency must parallel the teaching process (es) employed by the neurosurgery residency program. As such, the neurosurgery program will have flexibility when choosing methodologies to assess a resident’s performance. Additionally, assessment tools vary in their reliability and validity. Therefore, more than one assessment tool should be used when assessing neurosurgical residents to improve the overall accuracy, the following are acceptable standardized methods with demonstrable efficacy and following that are specific recommendations for the neurosurgical resident. ·360-Degree Evaluation: An assessment tool used to rate the performance of a resident. All individuals that have contact with the resident should complete the evaluation. ·Checklist: An assessment tool used to evaluate specific behaviors or tasks that are components of a more complex activity. ·Objective Structured Clinical Examination (OSCE): An assessment tool that consists of multiple stations. The stations include various elements of clinical encounters. The stations include standardized patients. ·Monthly Service Rotation Evaluation. ·Procedure/Case Logs. ·Portfolios: An assessment tool used to document learning experiences. Usually a compilation of written documents (i.e., case logs, procedural logs, research activity, committee involvement, lectures and conferences attended, etc.). ·Written Examination. ·Chart Stimulated Oral Recall Examination: An assessment tool used to assess clinical problem-solving ability. Provides the ability to investigate the examinee’s rationale for requesting information (i.e., historical or physical examination data), interpretation of information provided, and management of selected cases, not evident by simply reviewing the chart.
The neurosurgical resident will demonstrate clinical competence in Osteopathic philosophy and osteopathic manipulative medicine, as well as neuroscience knowledge. This can be accomplished in a variety of ways, eventually by an examination of a single national standardized patient. The examination will be graded, issuing a pass or fail score.
The neurosurgical resident will demonstrate clinical competence patient care, interpersonal, communication skills and professionalism. This can be accomplished in a variety of ways, eventually by the examination and video review of three patients. This will then be critiqued by the attending staff, and psychologists if available. The neurosurgical resident must also participate in, pass and have endorsed the hospital based core competence exercises in these areas.
The neurosurgical resident will demonstrate clinical competence practice based learning and system based learning and improvement. This can be accomplished in a variety of ways, eventually culminating in the examination of three national standardized neurosurgical patients. The resident will then review those patients with the faculty. The examination will be graded, issuing a pass or fail score. After the review the residents as a group will review each patient in a round table discussion.
Additionally each resident will be given a single case for oral discussion. The examination will be graded, issuing a pass or fail score. The case will demonstrate clinical neuroscience competence.
The neurosurgical resident must keep a surgical log. The log must demonstrate proficiency in neurosurgical procedures. The program director or designee must sign each group of procedures. The neurosurgical resident during this year must complete with proficiency: ICU management SOAP notes Histories and physicals Pre-operative notes Operative notes Post-operative notes ICD-9/10 coding Microscope usage Evacuation hematoma Removal of herniated disk Pedicle screw fixation/ complex spinal instrumentation Graft harvesting VP shunt insertion at either end Tumor resection Vascular surgery Peripheral nerve surgery 400 additional cases of independent surgery under supervision Interpretation of each: Angiograms, MRIs, CAT scans, and TCDs Risks and benefits discussion Presentation of cases at formal conference Osteopathic structural exam and diagnosis Submission of IRB proposal Submission of abstract Power-point presentation Brain Death Exams See on-line ACOS Neurosurgery Curriculum for suggested study guidelines
Conference Schedule (Example) Lecture schedule will be provided separatelyWeekly: Trauma Team Grand Rounds Thursday Morning Multidisciplinary Rounds regarding Neurosurgery Patients Neurosurgery Resident/Nurse Conference Basic Science and Neurosurgical Clinical Conference Mondays at 3:00 PM Neuro-Oncology/Neuroradiology Conference Mondays at 4:30 PM
Monthly: Neuropathology/Brain Cutting Thursdays Journal Club Mondays Morbidity and Mortality Mondays
Annual: American College of Osteopathic Surgeons Annual Meeting Congress of Neurological Surgeons Annual Meeting American Association of Neurological Surgeons Annual Meeting Other neurosurgical meetings/courses Financial support will be provided for all neurosurgery residents to attend one meeting or course per year during the first four years; the chief resident will be financially supported for one meeting and one course.
Suggested Reading AssignmentsMonthly Journals: Journal of Neurosurgery Journal of Neurosurgery Spine Journal of Neurotrauma Neurosurgery Neurosurgical Clinics of North America Surgical Neurology Stroke Spine Annals of Neurology Neurology American Journal of Neuroradiology Any others that may be selected
Text Assignments: During the first year of training, the resident is to complete the Principles of Neural Science by Kandel and Schwartz or comparable neuroscience recognized authoritative textbook.
By the end of the second month of the first clinical neurosurgery rotation, the resident is to complete Neurologic Differential Diagnosis by Patten and Localization in Clinical Neurology by Brazis, Masdeu and Biller or comparable clinical neurology recognized authoritative textbook. These books will be available in the hospital library, and/or in the program director’s office.
Within the first six months of clinical neurosurgery, the resident is to complete the following sections of Neurosurgery by Williams and Wilkins, or comparable sections of Neurological Surgery by Youmans:
Volume One: Parts 1-V (all sections) Parts VI, B, 65: Gliomas Part VI, C, 67: Brain Metastases Part VI, D, 71: Meningiomas Part VI, N, 126: Spine Metastases Volume Two: Part VII, A, 139-142: Cerebral Blood Flow, Energy Metabolism, Ischemia Part VII, B, 159: Cerebral Aneurysms Part VIII, A: Head Trauma Volume Three: Part XII (all sections): Spine Disorders
By the end of the first year of clinical neurosurgery, the resident is to read Volume I of Microneurosurgery by Yasargil or comparable microneurosurgical recognized authoritative textbook.
By the end of the final year, the resident is expected to have read all volumes of the texts listed above, and others as necessary and as recommended by the program director.
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