Rotation Goals & Objectives

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Suggested Goals and Objectives for the Student/Intern Neurosurgical Rotation

GOALS

To acquire a body of knowledge and skills necessary to evaluate and manage conditions and disorders requiring neurosurgical operative intervention or management

OBJECTIVES

Residents will be proficient in communicating with children, teens, adults and their families, in recognizing normal development and family interactions and deviations from normal, in evaluating and treating common problems, in recognizing the need for neurological surgery, in recognizing the need for hospitalization and/or consultation of the neurosurgical patient, and in managing patients in an acute or emergent setting.  Specifically, they will become competent in the following areas of knowledge, skills and attitudes:

NEUROSURGERY

Core Competencies

Osteopathic Philosophy and Osteopathic Manipulative Medicine

·         Does the student/resident understand the philosophy behind osteopathic manipulative treatment

·         Does the student/resident understanding the role of the musculoskeletal system in disease, including somato/visceral reflexes, alterations in body framework, and trauma

·         Does the student/resident know the indications and contraindications to osteopathic manipulative treatment

·         Does the student/resident demonstrate an understanding of the multiple methods of treatment including high-velocity/low amplitude (HVLA), strain/counter strain, and muscle energy

·         Does the student/resident document in the medical record, his/her use of osteopathic principles and osteopathic manipulative treatment in the continuity of care of their patients

Interpersonal and Communication Skills

• Demonstrate effective interpersonal and communication skills.

Medical Knowledge

• How is the student’s/resident’s medical knowledge in this rotation specialty evolving?

Patient Care

• Please rate the student’s/resident’s ability to obtain a comprehensive medical history.
• Please rate the student’s/resident’s ability to perform a comprehensive physical examination.
• Please rate the student’s/resident’s ability to assess patient’s problems.
• Please assess the student’s/resident’s ability to integrate information to develop a differential diagnosis.
• Please rate the student’s/resident’s ability to implement a treatment plan based on the available data.
• Able to diagnose and manage neurosurgical disorders and neurosurgical emergencies.
• Refer patients with neurosurgical problems in a timely manner and appropriately.
• Able to assist in the operating room.
• Performs preoperative and postoperative care.
• Utilizes appropriate studies to diagnose and manage common neurosurgical diseases.

Practice-Based Learning and Improvement

• Does the student’s/resident’s educational discussion indicate a thorough, systematic review of the topic.

Professionalism

• How well does the student/resident demonstrate the attitudes, behavior and interpersonal skills essential in relation to patients, their families, and other health care professionals?

System-Based Practices

• Does the student/resident advocate for quality patient care and assist patients in dealing with system complexities.

Secondary Competencies

Clinical Judgment

• Clinical Judgment and Synthesis: Spends appropriate time for the complexity of the problem.  Uses terminology that is meaningful and unambiguous.  Presents information concisely, accurately, and in adequate detail without significant omissions or digressions.  Integrates medical facts and clinical data and weighs alternatives, understands limitations of knowledge.  Incorporates consideration of costs, risks and benefits.

Procedures & Practical Experience

• In completing a procedure, demonstrated awareness of the background, indications, contraindications, anatomical considerations, and complications of the procedure.

Neurological Surgery MEDICAL KNOWLEDGE

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.

Students and residents will be expected to improve their proficiency in obtaining a neurological history and conducting a neurological examination. This will be aided both by reading assignments and by patient encounters supervised by senior resident and attending staff members.

Students and residents will be expected to become more familiar with aspects of operative care of patients. Students and residents will spend time in the operating room assisting more senior residents, or attending neurosurgeons, with surgeries. The student and 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 student and 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 student and resident may function as a surgical assistant in the operating room and will be expected to develop surgical skills that will allow the student and 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 student and 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 student and residents will participate in the in-patient care and management of the neurosurgery patients, including both pediatric and adult patients. The student and 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.

 Areas to develop neurosurgical knowledge:

1.    Basic neurological and surgical anatomy

2.    Perioperative medical evaluation and management

3.    Nutrition

A.          Nutritional assessment

B.          Nutritional support

1)          Enteral nutrition

2)          Parental nutrition

4.    Fluid and electrolytes

5.    Wounds

A.          Mechanisms of wound healing

B.          Anesthesia

C.         Hemostasis

D.         Irrigation and debridement

E.          Closure

F.          Dressing materials

G.         Suturing materials

6.    Transfusion

A.          Indications and complications

B.          RBC

C.         Platelet

D.         Clotting factors

7.    Trauma

A.         Primary survey

B.         Resuscitation – Basic and advanced life support

C.         Secondary survey

1)          Head – Glasgow coma scores

a)    Intracranial pressure

b)    Hematoma

c)    Fractures

d)    Concussion

2)          Spine – Neurological Assessment

a)    Neurological deficit

b)    Fracture

c)    Hematoma

d)    Instability

3)          Peripheral Nervous System

a)    Avulsion

b)    Stretch

c)    Crush

8.      Intensive Care Unit Management

A.       Assessment

B.       Fluid management

C.       Wound care

D.       Analgesia

E.       Nutrition

F.        Cardiopulmonary management

G.       Infections

9.      Nervous system cancer

10.   Hydrocephalus

11.   Neurovascular

A.       Arterial trauma

B.       Carotid stenosis

12.   Stroke

13.   Seizure

14.   Infections of the nervous system

15.   Movement disorders

16.   Dementia

17.   Demyelinating disorders

18.   Imaging: Nervous system; CT scan; MRI scan; x-rays; invasive procedures; non-invasive procedures.

19.   Anesthesiology: sedation; analgesia; anesthetics.

20.   Pathology: gross; microscopic; pathophysiologic; imaging.

21.   Rehabilitation

SKILLS to learn and assist:

1.              Ability to oral-tracheal, naso-tracheal intubate

2.              Anesthesia

3.              Arterial line placements

4.              Central line placements

5.              Conscious sedation cases

6.              Feeding tube placements

7.              Foley catheter insertions

8.              Histories and physicals

9.              Interpretation of each: Angiograms, MRIs, CAT scans, and TCDs

10.           Irrigation and debridement

11.           Lumbar puncture

12.           Nutrition management which includes total parental nutrition

13.           Operative notes

14.           Osteopathic structural exam and diagnosis

15.           Post-operative notes

16.           Pre-operative notes

17.           Presentation of cases at formal conference

18.           Risks and benefits discussion

19.           SOAP notes

20.           Surgical assistance

21.           Suturing and knot tying techniques

22.           Swan Ganz catheters

23.           Trauma triage

24.           Ventilator management

25.           Ventriculostomies

26.           Wound closures

27.           Wound management

 IMPLEMENTATION

 Learning about neurosurgical care occurs during one block rotation in neurosurgery.  Formal lectures are given weekly, during Neurosurgical Grand Rounds and in AOA Internship conferences. 

 EVALUATION

 Evaluations will be completed by the faculty and student/residents after each clinical rotation.

For a list of Suggested Readings please click here.