Rotation Goals & Objectives
Suggested Goals and Objectives for the Student/Intern Neurosurgical Rotation
To acquire a body of knowledge and skills necessary to evaluate and manage conditions and disorders requiring neurosurgical operative intervention or management
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:
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
Practice-Based Learning and Improvement
Procedures & Practical Experience
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
A. Nutritional assessment
B. Nutritional support
1) Enteral nutrition
2) Parental nutrition
4. Fluid and electrolytes
A. Mechanisms of wound healing
D. Irrigation and debridement
F. Dressing materials
G. Suturing materials
A. Indications and complications
D. Clotting factors
A. Primary survey
B. Resuscitation Ė Basic and advanced life support
C. Secondary survey
1) Head Ė Glasgow coma scores
a) Intracranial pressure
2) Spine Ė Neurological Assessment
a) Neurological deficit
3) Peripheral Nervous System
8. Intensive Care Unit Management
B. Fluid management
C. Wound care
F. Cardiopulmonary management
9. Nervous system cancer
A. Arterial trauma
B. Carotid stenosis
14. Infections of the nervous system
15. Movement disorders
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.
SKILLS to learn and assist:
1. Ability to oral-tracheal, naso-tracheal intubate
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
26. Wound closures
27. Wound management
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.
Evaluations will be completed by the faculty and student/residents after each clinical rotation.