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This is a SAMPLE of the INSTITUTION Neurosurgery Residency Training Manual. Program Directors, Directors of Medical Education, and the Osteopathic Medical Education Committee are responsible for the content. The following SAMPLE is only placed here as a guide.

 
Neurological Surgery Residency Program Training Manual (Updated 6/30/08)

Neurological Surgery Program Requirements

 

The Neurosurgery Residency Program Training Manual is a living document meant to provide specific information for residents and faculty in the  neurosurgical training program. This manual complements the THE INSTITUTION AOA Residency Training Handbook and is to be utilized together. All policies of these, as well as the AOA and ACOS, and any other specific governing are to be followed.

 

SECTION 1

Mission

The  Neurological Surgery Program sole objective is to train the complete neurosurgeon who is exceedingly competent in academic and clinical neurosurgery, who practices medicine with kindness and compassion, who communicates with respectful logical actions and words, who integrates Osteopathic philosophy into the care of not only the nervous system but also the entire person, who progressively improves the individual and societal practice of medicine fostering education, camaraderie and cooperation, who excels in the business and professional aspect of medicine nurturing growth, research, teaching, and best standards of practice, and who can solidify the many facets of medicine leading to improved patient and public instruction and confidence.

 

Facilities

The Neurosurgery Residency program is based at core hospital facilities and affiliate hospitals complying with Osteopathic Postdoctoral Training Institution (OPTI) and JCAHO/AOA status. The clinical material will be derived from clinical services, based at tertiary care medical centers. This service is under the direction and supervision of the AOA/ACGME/ABNS neurosurgical board certified program director.

 

Core Competencies

The program has incorporated within it and mandates that the seven core competencies set forth by the AOA be measured and mastered. These measured “Core Competencies” are medical knowledge, patient care, interpersonal and communication skills, professionalism, practice-based learning and improvement, systems-based practice, and Osteopathic principles and philosophy. The program also provides the potential for individualization in several areas including basic sciences, clinical electives, and research. The program is designed to provide residents a thorough grounding in fundamental knowledge of the neurosciences, as well as to develop diagnostic and therapeutic judgment along with the requisite surgical skills, needed to practice neurological surgery. The core competencies documents are provided separately.

 

Basic science rotations ensure well-rounded education and include neuroradiology, neuropathology, and neurology. Varieties of clinical elective rotations are possible, and shall be arranged for the neurosurgery residents depending on particular interest. Electives can also be arranged at other facilities, depending on expressed interest.

 

Objectives

To produce competent specialists in neurological surgery the program provides the residents with adequate didactic, clinical, communicative, professional and Osteopathic experiences and competencies. The program is designed to correlate basic science material with the clinical manifestations of diseases of the nervous system with particular emphasis on those with surgical therapies. The program will satisfy the requirements for completion as outlined by the American Osteopathic Association, will demonstrate measured neurosurgical, osteopathic, professional, progressive, communicative, and business competencies, and will qualify the resident to sit for the Neurosurgery board certification examinations as outlined by the American Osteopathic Board of Surgery.

 

Neurological Surgery training is rigorous and demanding; it cannot be limited to the surgical aspects of diseases of the nervous system. It must encompass those essential competencies of all medicine including Osteopathic philosophy, patient care, interpersonal and communication skills, professionalism and practice improvement and those essential to the practice of neurological surgery such as neuroanatomy, neurophysiology, neuropharmacology, neuroradiology, neuropathology, and medical neurology. These areas will be covered directly and indirectly through required rotations, supplemental courses, required reading, and lectures as well as ongoing day-to-day integration of these areas in the management of patients. The formidable curriculum will be tightly integrated with aspects dealing with the whole health of the body and its affect on the nervous system, such areas must include critical care medicine, traumatology, and nutritional support—none of these can be divorced from the care of the neurosurgical patient. These concepts are also emphasized through reading, lectures, and clinical decision-making. Lastly, attention to research in the clinical neurosciences provides additional challenges to be met by the developing resident and allows them to improve the practices of neurosurgery.

 

Any specific postgraduate courses in basic sciences (taken during the PGY 1 or 2 years) will be made by the program directors to accommodate the specific needs of each resident. The neurosurgical resident will complete a common surgical residency or the appropriate time during the first neurosurgical residency year to fulfill the requirement of 3 months of General Surgery training. These arrangements will be within the framework and guidelines of the AOA and the ACOS. The residency will be six successful years in length and conform to the standards set forth by the AOA/COPT/PTRC/ACOS and the American Osteopathic Board of Surgery (AOBS). The Basic Standards from the AOA and ACOS will be provided separately.

 

Program Design Schedule

This neurosurgery residency will commence after graduation from a Commission on Osteopathic College Accreditation (COCA) approved medical school has been completed, and will last six years, unless one year of remedial education is required.

 

Year 1 (OGME-1R/PGY1):    Must complete the requirements of a first year resident as outlined in the ACOS Basic Standards for the AOA approved common surgical OGME-1R year. These rotations, which provide well-rounded exposure in multiple areas of medicine, may be scheduled as 12 one-month rotations or 13 four-week rotations or any combination thereof.  Rotations for ˝ day per week, for 46 weeks, in a neurosurgery out-patient clinic or office, One month of  Emergency Medicine, One month of female reproductive medicine, One month of pediatrics, One month ICU, Two months of internal medicine, Four months of general surgery, Two months of electives in Neurosurgery.

 

Year 2 (OGME2/PGY2):        3 months neurology, unless one year of neurology training was completed in the formal residency program, 1 month neuro-radiology, 1 month neuropathology

                                               7 months Neurosurgery

 

Year 3 (OGME3/PGY3):        9 months Neurosurgery

                                               Micro neurosurgical course option (can be completed during other years)

                                                   

Year 4 (OGME4/PGY4):        9 months Neurosurgery

 

Year 5 (OGME5/PGY5):        Elective/research+

                                               9 months Neurosurgery

 

Year 6 (OGME6/PGY6):        12 months Neurosurgery

 

Twelve months of electives may be spent in clinical neurosurgery including the neurosurgery subspecialty areas arranged though affiliated training sites, or research (basic or clinical) as determined to be appropriate by the program director.

 

There must be a minimum of thirty-six months of clinical neurological surgery.

 

The final twelve months of the program must be spent as chief resident in the primary training institution, under appropriate supervision, and demonstrating advanced-level responsibilities.

 

The resident must be assigned periodically and preferably during the chief year, to neurosurgeon offices for orientation to office practice.

 

Affiliated training sites are not permitted during the first neurosurgery year and may not exceed a total of fifteen months during the four-year period. Short courses of two weeks or less will not apply to the fifteen-month limit.

 

Rotation Schedule

The tentative rotation schedule for neurosurgical residents will be provided at the beginning of each academic year. The tentative rotation schedule is subject change based upon unforeseen circumstances. Any changes will be presented to the neurosurgical residents as early as possible. The schedule is provided separately.

 

Program Overview

This program is designed to provide Neurosurgical Residents with a basic fund of knowledge that will allow them to recognize, diagnose, and treat with compassion and understanding the neurosurgical patient. The program is designed to expose the resident to all phases of the neurosurgical practice. The program has developed well-defined year-to-year progression goals, which address academic, clinical, communicative, professionalism, and practice improvement concerns as can be seen from the following information.

 

·Each Neurosurgical Resident must pass the requirements of each year before advancing to the next year or before successful graduation from the neurosurgical residency. The resident must document in approved logs the demonstration of core competencies in all seven areas. The resident must complete a research paper, an evaluation by the program director, and an evaluation of the program and program director before being allowed to advance to the next year or before graduation.

·Each Neurosurgical Resident must annually take the annual national standardized written In-Service Neurosurgical Exams.  The program director will be responsible for following up on the areas of deficiency.

·Specifically, the program requires that the resident Neurosurgical Residents complete prior to graduation from the neurosurgical residency:

·Demonstrate the ability to integrate the sciences applicable to neurological surgery with clinical experiences in a progressive manner.

·Demonstrate critical thinking and problem-solving skills.

·Demonstrate the ability to interpret and participate in clinical research

·Demonstrate osteopathic diagnoses and manipulative therapy, as appropriate, in the care of patients

·Demonstrate competent clinical patient care in a progressive manner, which results in the ability to provide complete patient management

·Demonstrate proficient psychomotor skills required of a competent neurological surgeon

·Collaborate effectively, and share knowledge with colleagues and allied health professionals

·Educate patients and their families concerning health care needs

·Make sound, ethical, and legal judgments in the practice of neurological surgery

·Promote a broad understanding of the role of neurological surgery as it relates to other medical disciplines.

·Develop professional leadership and management skills.

·Foster lifelong learning in medical education that results in personal and professional growth.

·Develop interest in and understanding of research in the specialty.

·Provide residents with the knowledge, skills, and abilities to meet certification requirements of the AOA through the American Osteopathic Board of Surgery (AOBS)

·Participate in community and professional organizations

·Obtain proficiency in a fundamental knowledge of basic neurosciences including: neuroanatomy, neurophysiology, neurochemistry and neuropharmacology.

·Obtain a practical working knowledge of neuroradiology, neuropathology, and neurology.

·Develop the expected thorough, in-depth knowledge of clinical neurosurgery.

·Develop excellence in clinical judgment expected for that year.

·Develop expected excellence in the techniques of neurosurgery.

·Develop an interest in fundamental research techniques.

·Develop an interest in teaching.

·The necessary skills and knowledge to deliver quality and cost effective osteopathic neurosurgical care.

·A mastery of the principles of surgery.

·The expertise to obtain detailed and accurate neurologic histories.

·The skills to conduct a thorough and accurate neurologic examination.

·The ability to formulate a differential diagnosis based on critical evaluation of symptoms and signs.

·The acumen to order appropriate and properly utilized laboratory aids to document and substantiate the clinical diagnosis.

·The ability to formulate a medical and surgical management program to include nutritional support, cardiopulmonary support, fluid management, the appropriate use of neuropharmacology and functional rehabilitation.

·The necessary technical skills to perform safely a wide variety of neurosurgical procedures.

·A thorough understanding of the fundamentals of anesthesia and neuroanesthesia.

·A familiarity with basic neuroscience and diseases of the central and peripheral nervous system, including: pathology and pathophysiologic mechanisms of neurologic disease; neuroendocrinology; metabolism and pharmacology of the brain, spinal cord, peripheral nerve and muscle.

·A thorough understanding of the techniques and interpretation of the ancillary aids to the diagnosis of neurologic diseases, including current neuroimaging modalities and neuromonitoring techniques.

·Effective, congenial, compassionate working relationships with other colleagues in medicine and surgery, as well as other health care professionals, including nurses, physiotherapists, speech / occupational therapists, neuropsychologists and social workers.

·A keen sense of responsibility and compassion towards all patients and their families.

·An understanding of current ethical, socioeconomic and medico legal issues and the implications for the practice of medicine and, specifically neurosurgery.

·An understanding of the business aspect of medicine including insurance, re-imbursement, office management, outcome assessment and quality of medicine.

·Demonstrate clinical competence in neuroscience knowledge as described in the Appendix

·Demonstrate and log with approval clinical competence in neurosurgical skills.

·Demonstrate clinical competence in the examination of the neurological and neurosurgical patient.

·Demonstrate clinical competence in neuroradiology.

·Demonstrate clinical competence in Osteopathic philosophy and Osteopathic manipulative medicine.

·Demonstrate clinical competence in patient care.

·Demonstrate clinical competence in interpersonal and communication skills.

·Demonstrate clinical competence in professionalism.

·Demonstrate clinical competence in practice based learning and improvement.

·Demonstrate clinical competence in systems based practice.

·In addition to the standards and guidelines for neurosurgery residency set forth by the AOA/ACOS, additional goals of this program are to provide Neurosurgical Residents the opportunity to:

·Make a contribution to academic and clinical neurosurgery through annual publications and presentations.

 

Residents will be responsible for patient assessment and case management under the supervision of the attending Neurosurgeon. Their responsibilities will include admission evaluation and writing orders, formulating a diagnostic and therapeutic plan in concert with attending staff.

 

The residents will be responsible for initial evaluation of patients for whom neurosurgical consultations is requested in the settings listed below, where the resident will be expected to follow specified procedures:

 

Resident Responsibilities -General

In general Neurosurgery Residents are responsible for:

·Abiding to the neurological surgery residency curriculum.

·Providing safe, effective and compassionate patient care, commensurate with level of advancement, under attending supervisors.

·Providing patient care in accordance with the provisions and standards set by the program director, neurosurgery attending staff, the affiliated hospitals and the AOA/ACOS resident responsibilities guidelines.

·Arriving to assigned duties promptly; notifying the program director or attending neurosurgeon as soon as possible if unable to report as scheduled (this includes hospital duties as well as on-call duties).

·Maintaining medical records to ensure that they accurately document the quality of care delivered tot he patient.

·Completing medical records in compliance with standards of the JCAHO/AOA, Federal and State standards and the requirements of the affiliated hospitals.

·Participating in mandatory residency clinics by examining patients and formulating treatment plans in consultation with attending faculty.

·Performing a complete history and physical examination, including osteopathic structural exam, on all patients admitted to the neurosurgery service prior to morning rounds. The record must indicate that a physician saw the patient, and that the information so solicited permitted the formulation of an opinion concerning the state of the patient’s health and the urgency of initiating treatment. The resident must provide complete documentation describing the care rendered.

·Examining patients referred for consultation by the emergency department or other medical services as soon as possible after the referral is made.  Documenting the findings on the appropriate consultation forms and, in consultation with the attending physician, formulating a management plan.

·Writing accurate and up-to-date progress notes on patients for whom the resident is responsible at time intervals warranted by the patient’s condition. The content of the progress notes must reflect the illness and document the dynamics of the disease process.

·Examining each patient before assuming a major operative role. For each case, the resident must be familiar with the rationale for surgery, surgical alternatives and imitations and risks of the surgery and must have the technical skills required for successful completion of the case.

·Develop treatment plans, commensurate with their academic and clinical ability, in cooperation and with approval of the attending physician. The treatment plan will include written orders any other orders and the content of the orders must reflect the illness and documented dynamics of the disease process. Residents are responsible for ensuring that all orders, required by the individual hospital by-laws, are countersigned by the supervising attending physician.

·Preparing accurate discharge summaries on all patients for whom the resident is responsible. This discharge summary must contain the name and hospital number, the date of admission, the chief complaints on admission, a condensed history of past and present medical illness, the important positive physical and neurological findings on admission, a brief summary of important tests and procedures, the course of the disease condition during hospitalization, the treatment given, the final diagnosis, the condition on discharge and the prognosis for the future. The discharge summary should be written/dictated on the day the patient is discharged.

·Ensuring that all progress notes, operative reports and discharge summaries are countersigned by the attending physician.

·If fully licensed, a requirement by the first neurosurgical year (PGY-2), pronouncing a patient dead when necessary and appropriate; making appropriate entry as to time of death and final diagnosis; notifying the attending physician; determining whether the patient’s death comes under the purview of the medical examiner; and taking appropriate action.

·Notifying either the program director of any case, which falls under the State law as a reportable condition and for reporting all such cases to the appropriate agency when requested to do so, by either the program director.

·Developing a personal program of self-study and professional growth with guidance from the teaching staff.

·Participating in the education of junior residents and medical student.

·Participating in institutional programs and activities involving the medical staff at the appropriate facility.

·Responding to all pages immediately.

·Maintaining a neat, safe and orderly work area.

·In addition to these responsibilities, the resident works appropriately and congenially with other residents / interns / students of other services or departments, nursing, and paramedical staff to ensure optimal patient management at all affiliated facilities.

·Ensures continuity of care for any of the patients to which the resident had been assigned.

·Coordinates conference schedule in conjunction with the program director; ensures that cases are presented at each weekly conference; schedules didactic presentation(s) for morbidity/mortality and quality assurance meetings.

·Participate and present articles at journal club

·Works with the attending staff to select cases to be reviewed at scheduled departmental morbidity/mortality and quality assurance meetings.

·Prior to attending rounds each morning, the resident on rotation is responsible for visiting every acute and preoperative patient and writing preoperative notes and orders, as appropriate. The resident then accompanies the attending during rounds, when the patients are revisited. During the rounds, management decisions are discussed and made. Rounds occur every day.

·Residents are required to attend the ACOS/NSD meeting every other year. They must present a paper or poster at the meeting. It is required that at least one resident for each five from the program present a poster each year. The Chief Resident is ultimately responsible but can delegate this to another resident with both program directors approval. Residents are required to attend either the AANS or CNS annual meeting at least every other year. Residents are required to join the ACOS-NSD.

·Each Resident must teach one lecture per year to the Medical Students.

·Coordinates visiting professorships and schedules resident presentations.

·Schedules residents to meet with training program applicants.

·Notifies academic office of any changes to the rotation schedule as they occur.

·Assists in the coordination of educational activities of medical students rotating on the neurosurgical service.

·Maintains high academic standards and stimulates other residents to produce high-quality publications in the field of neurosurgery.

·Participates fully in the educational activities of the program and, as required, assumes responsibility for teaching and supervising other residents and students.

·In compliance with AOA/ACOS regulations, the resident will submit to the program director, a monthly log of all surgical and diagnostic procedures performed during the previous month.

·In compliance with AOA/ACOS regulations, the resident will submit on Electronic Resident Logging System a daily log of all hours worked. The program director will review, and sign off responsibility for those hours. The program director will then make corrections to future work hours to ensure that the 80-hour work week rule and described in “VII. Duty Hours and On-call Responsibilities” and “Basic Standards for Residency Training in Neurological Surgery” is maintained.

·Residents who fail to complete their medical record requirements in a timely manner, or who fail to submit their forms and logs by the deadlines will not be permitted to operate until their logs are updated.

·All residents are responsible for maintaining current chart notes. Residents must document all patient care activities, including phone orders, and must sign all progress notes. Residents are responsible for ensuring that the supervising attending physician countersigns all notes.

·If a resident is going to be away from the program for vacation or a rotation, the resident must:

1.     Report to the medical Records Department on the last work day prior to the leave period to dictate and/or sign all available charts; and

2.       Report to the medical Records Department on the first workday upon return to complete all remaining charts.

 

Resident Responsibilities – Specific Areas

Emergency Room: To be available when on call to evaluate cases requiring neurosurgical consultation and to contact the attending staff after the patient has been evaluated. Residents must take call from the hospital unless otherwise directed.

 

Operating Room: To be available for all surgeries to be performed. To be in the room prior to the attending staff, and to consider issues of patient positioning, shape of incision, and location of microscope. The resident will need to be well versed with the clinical data pertaining to the patient in question, to have reviewed this material including diagnostic studies, and to have read relevant material concerning the case to be performed.

 

Floor/ICU Care: To see each patient at least once daily, and more frequently as the situation mandates. Each patient is to have a problem oriented progress note written daily. The notes are to be legible, dated and timed, and are to reflect ongoing case management. Whenever possible, neurosurgical findings and management concerns should be discussed with house staff from supporting and/or co managing services.

 

Teaching: It will be primarily the responsibility of the resident to supervise and review the work of interns and clinical clerks assigned to the Neurosurgery Service, and to conduct topic review and case management discussions with them.

 

Research: By the end of the first year, and latest by the end of the second year, each resident should develop a program of clinical research that will fulfill the requirements for publications discussed below.

 

Logs: Each resident is required to maintain an accurate ACOS electronic surgical log as well as a log that records reading assignments completed, conferences attended, and the like. Surgical logs must be maintained on a daily basis through the ACOS Operative Log System for which training will be provided separately. These should be readily available for review by the Program Director. In addition each resident must maintain in Electronic Resident Logging System on a daily basis all worked hours.

 

Scholarly Project: Each resident will be expected to do a scholarly project of their choice annually in one of the following four areas.  Before the resident begins the project the program director must approve the resident’s project.  These fours areas are only general guidelines to allow for creativity.  Examples are listed in each area.  Residents will be expected to attend sessions for review and evaluation of their projects with their program directors which should include a discussion of study design techniques and analysis.  It is recommended reviews be done on a quarterly basis.  It is imperative that written documentation of all aspects of the resident’s scholarly projects be maintained in the resident files.  Program directors need to be kept informed of the status of the resident’s projects in order for a narrative description and evaluation of the scholarly activity to be included in the Program Director’s Annual Resident Evaluation Report For Surgery.

 

1.  Clinical Research

Examples include, but are not limited to, an original scientific paper, poster session at the ACA, literature review, case study or a new surgical procedure report

 

Scientific Research Paper

The length of the paper should be at least 1500 words, double-spaced, paginated with references required for all material derived from the work of others.  It should be in proper format.  An original scientific paper can be done over several years or throughout the entire residency as long as goals are met annually and the paper is completed before resident completes the training. All other papers can only be submitted to fulfill the requirement for one year.

 

Poster Sessions

Poster Sessions are an in-depth exchange of information on a one-to-one basis, providing a medium for unusual or multiple clinical case presentations prepared with photographs, laboratory and/or radiological information. Documentation of this activity requires a photograph of the poster session and written statement that the poster was exhibited at the ACA by the resident who prepared the poster. A resident’s folder for this activity should also include a written description of at least 250 words of the objective, methods, and summary of outcomes of the clinical case presented.

 

2. Community-Based Effort

Quality Improvement Programs

This may come in the form of a community-based quality improvement program. Residents may select a specific health improvement or disease prevention issue or need within a community. The resident must identify a population of interest within a community, summarize the problem and the population, review the current literature, perform a needs assessment, and design, implement, and evaluate an intervention to address the issue or need.

 

An example of Community Education would be, but not be limited to, a well-planned lecture to a locally recognized community group or a presentation at a national level (e.g. ACA). 

 

And example of Community Service might be, but not be limited to, implementing a program and subsequently delivering medical care to an under-served or impoverished area or population.  Medical mission trips would fall into this category.

 

Written documentation of the resident’s community based efforts will be available and kept in the resident’s file.

 

3. Medical Education Quality Initiative

Improvements in medical education have led to more effective training processes and programs for medical students, interns and residents. Residents who wish to pursue medical education research projects must identify a process or program need, review the current literature, perform a needs assessment, and design, implement, and evaluate the proposed improvement project. An example of a Medical Education Quality Initiative would include, but not be limited to, preparing three lectures to be given in three different mediums to the house staff.  Subsequently evaluating the resident’s effectiveness as a lecturer and testing the knowledge retained by the attendees.

 

4. Practice Improvement Outcome

Practice Improvement Outcomes may include, but not be limited to, designing and completing a project for presentation at surgical grand rounds focusing on the root-cause analysis of a systems error occurring in the management of the patient.

 

Another example might be for the resident to review a published clinical practice guideline using an evidence-based approach and audit office charts to compare treatment, screening or diagnostic testing of patients with the recommendations of the guideline.

 

 

Call: The resident is expected to inform the office staff and answering service as to how s/he can be reached if needed. The resident is to be available promptly when called to assess a patient.

 

Outside Rotations

During the course of his/her training, a resident will be authorized by the program director to attend other courses and review courses as determined by the program director.

 

Residents are encouraged to write papers and manuscripts throughout their training. A resident who produces an abstract accepted for presentation at a national meeting may be eligible for expense reimbursement to attend that meeting.

 

Program Curriculum Outline

The 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 (OGME2-1R/PGY-1) Measurement of Core Competencies

Academic Skills (see appendix)

The length of the neurological surgery residency program is six years which includes this AOA approved common surgical OGME-1R year. The rotations will provide well-rounded experience in many areas of medicine, concentrating in the surgical field, emphasizing the neurosciences. Reading and lectures will concentrate on general post-graduate clinical knowledge in medicine, women’s health, surgery, pediatrics and neuroanatomy and neurophysiology as applied to the management of neurosurgical patients. Residents will attend basic science lectures as set through the Graduate Medical Education office. The residents will also be expected to attend neurosurgery Grand Rounds in which the 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 textbooks as described in the Goals and Objectives for each service. The reading assignments may include journals and other material. Residents will 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 obtain proficiency in each area of rotation. These include obtaining relevant history and conducting a relevant 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 clinical care of patients on the relevant rotations. Residents will spend time managing patients, assisting more senior residents, or attendings. The residents will be expected to read about the specific disease processes of the clinical patient being treated, and be able to discuss relevant anatomy, pathology, and management options for each specific patient.

 

The resident will function as a assistants for procedures.

 

The residents will also participate in outpatient continuity 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 attendings. The residents will participate in the in-patient care and management of the patients, including both pediatric and adult patients. The resident will become familiar with the management of all issues related to the clinical patient of the specific rotation.

 

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. This holds true for neuropathology and 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:

            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 (OGME2/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 3 (OGME3/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 4 (OGME4/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 5 (OGME5/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 6 (OGME6/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 separately

Weekly:               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 five years; the chief resident will be financially supported for one meeting and one course.

 

Suggested Reading Assignments

Monthly 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 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 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 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.


 

SECTION 2

Institutional Accreditation Requirements

2.1-2.5

The Neurosurgery Residency, Postdoctoral training in neurosurgery is accredited and modeled by following the guidelines set forth by the American Osteopathic Association (AOA) and the American College of Osteopathic Surgeons (ACOS) “Basic Standards for Residency Training in Neurological Surgery”.  It is sponsored by THE INSTITUTION, conducted at THE INSTITUTION. It is affiliated and integrated with OPTI , which is an AOA consortium of THE OSTEOPATHIC UNIVERSITY and other osteopathic postdoctoral training institutions.

 

2.6-2.9

The Neurological Surgery Residency Program is sponsored by and belongs to THE INSTITUTION which is responsible for all actions in and about the Neurological Surgery Residency Program, including required forms, fees and oversight. The Neurological Surgery Residency Program is directed by the Neurological Surgery Residency Program Director (PD) under the supervision of the Director of Medical Education (DME). The PD, DME, Osteopathic Graduate Medical Education Committee (OMEC) and representatives of the institution review program activity and are available to evaluate the Neurological Surgery Residency Program and meet with the Neurological Surgery Residents at least monthly, and during any AOA, ACOS, OPTI or other regulating body inspection. These same individuals are responsible for maintaining “Basic Standards for Residency Training in Neurological Surgery”, and corresponding about, correcting deficiencies and monitoring any corrective action plans.

 

Compliance with AOA Requirements, Policies, and Procedures

2.10

THE INSTITUTION will be in compliance with AOA training requirements for institutions and programs in accordance with ACOS “Basic Standards for Residency Training in Neurological Surgery”. The Neurological Surgery Residency Program continued approval depends upon meeting the highest standards as set forth by the AOA. The Neurological Surgery Residency Program and THE INSTITUTION will undergo and facilitate on-site inspections and submit required documentation within 30 days to regulating bodies. THE INSTITUTION will submit AOA annual Neurosurgical Resident Information Verification and Registration Audit (TIVRA). The Neurological Surgery Residency Program will participate in OPTI  activities, annually update AOA Opportunities program data, comply with AOA/ACOS/OPTI/THE INSTITUTION and Neurological Surgery Residency Program work hours and moonlighting policies, participate in ERAS when available for the Neurological Surgery Residency Program accepting medical students.

 

2.11-2.15

Requirements for Institutions

Participating Facilities

Each participating facility must commit to provide the highest standard of education for the neurosurgery resident and provide the appropriate environment and tools necessary for the Neurosurgery Resident to complete the training. The institutions must read and agree to the policies and principles of the neurological surgery curriculum.

 

The base hospital(s) must ensure that the neurosurgical residents are provided with professional liability coverage for the duration of their training. This coverage will include protection against awards from claims reported or filed after completion of training and shall be applicable to actions occurring within the assigned scope of responsibility for the neurosurgical program.

 

The base hospital shall be a JCAHO/AOA approved tertiary care medical facility, which averages over 100 patients in out-patient neurosurgery clinic per neurosurgery resident per year, over 100 neurosurgical admissions per neurosurgery resident per year; in addition, 100 neurosurgery consults on inpatients who were initially admitted to other services per neurosurgery resident per year and over 400 neurosurgical cases (200 major) available per chief resident per year. All base and affiliated hospitals must have a minimum of 100 clinical beds, either adult or pediatric.

 

Each hospital shall have an extensive clinical medical / surgical staff to assist and support the residents with daily patient care. Nurse practitioners, nurses, technicians and specialty therapists employed at the participating facilities share their experience and input in a multidisciplinary fashion to enhance and compliment the training of the Neurosurgical Resident.

 

The base hospital should have a neurosurgery operating room equipped with the latest neurosurgical tools including framed and frameless stereotaxy systems, current generation surgical microscope, cavitron (CUSA), Midas Rex or similar high powered drills, microdopplers, etc. and a neuro-ICU with availability of continuous neurophysiological monitoring. The base and affiliated hospitals should meet the following criteria:

 

  • The tertiary care facility should have a full range of services including primary and specialty care, trauma and emergency care, ancillary and home health services, behavioral health.
  • Sufficient patient load to train three neurosurgery residents. On average, attending neurosurgeons will do well over 400 major cases per year. The scope, volume and variety of neurosurgical cases should be more than adequate to provide residents with the necessary progressive operative experience.
  • Multiple departments and multiple divisions and AOA/ACGME-approved residencies.
  • Organized full-time pathology and radiology services. Radiologists and pathologists shall be board certified or board eligible in their respective specialties. Attending radiologists are in-house daily sufficiently to provide coverage for any significant trauma load.
  • The Department/Division of Neurosurgery shall be comprised of at least two full-time attending certified/eligible neurosurgeons.
  • Modern library with all the comprehensive neurosurgical textbooks, as well as a good selection of medical journals. Qualified librarians, who help house-staff do literature searches, inter-library loans, etc, staff the library. A permanent Education Committee to oversee the works and acquisitions of the library.

 

Affiliated hospitals must exist to complement the base hospital. The facilities and resources at the affiliated hospitals must be a JCAHO/AOA approved medical facility and be under contract with the Neurosurgical Residency program to provide training that meets the American Osteopathic Association (AOA) and the American College of Osteopathic Surgeons (ACOS) “Basic Standards for Residency Training in Neurological Surgery”.  THE INSTITUTION will maintain a written affiliation agreement with any affiliated hospital, facility or group and verify that the affiliate has a variety of patient scope and volume. THE INSTITUTION will review these agreements no longer than every five years. Each supervising physician at the affiliated and base hospital will be board certified or board eligible in their respected specialty and shall be responsible to the DME at THE INSTITUTION assisting in evaluations, information gathering and inspection as needed. Affiliated faculty must evaluate Neurological Surgery Residents at the end of a rotation and at least quarterly.

 
The Neurological Surgery Residency consists of the Base Hospital at THE INSTITUTION and the Base-Affiliated Hospital at THE AFFILIATE HOSPITAL. Each facility provides areas of specialization for optimal overall academic experience for the resident. THE INSTITUTION HOSPITAL is a trauma center, with emphasis on adult cranial trauma, adult spine trauma, vascular neurosurgery, interventional endovascular neurosurgery, skull base neurosurgery and neurocritical care. THE AFFILIATE HOSPITAL complements the extensive tertiary care facilities of THE INSTITUTION HOSPITAL by emphasizing general neurosurgery and degenerative spine surgery. It is THE AFFILIATE HOSPITAL system that provides the AOA mandated exposure to private insurers, pain clinics, continuity clinics in neurosurgery, and other areas associated with the private practice model that is not available at THE INSTITUTION HOSPITAL.
 
Sample institution hospital

INSTITUTION HOSPITAL is a tertiary care medical facility, which averages over 2000 patients in out-patient neurosurgery clinic per year, over 1000 neurosurgical admissions; in addition, 1000 neurosurgery consults on inpatients who were initially admitted to other services and over 600 major neurosurgical cases.

 

INSTITUTION HOSPITAL, is state-of-the-art, with a dedicated neurosurgery OR equipped with the latest neurosurgical tools including framed and frameless stereotaxy systems, current generation surgical microscope, cavitron (CUSA), Midas Rex high powered drills, microdopplers, etc.  We have neuro-ICU with all the latest capabilities for continuous neurophysiological monitoring.

 

Ř  THE INSTITUTION HOSPITAL is an AOA-approved facility, affiliated with the Western University of Health Sciences.

Ř  THE INSTITUTION HOSPITAL is a 500-bed tertiary care facility with full range of services including primary and specialty care, trauma and emergency care, ancillary and home health services, behavioral health and a comprehensive women’s health program.

Ř  THE INSTITUTION HOSPITAL has sufficient patient load to train twenty neurosurgery residents. On average, our attending neurosurgeons will do well over 200 major cases each. The scope, volume and variety of neurosurgical cases are more than adequate to provide residents with the necessary progressive operative experience.

Ř  THE INSTITUTION HOSPITAL has six departments and multiple divisions. For instance, there are discrete departments of surgery, orthopedics, medicine, radiology, rehabilitation medicine, and family medicine. THE INSTITUTION HOSPITAL currently has AOA-approved residencies in General Surgery, Internal Medicine, Obstetrics/Gynecology, Family Medicine.

Ř  THE INSTITUTION HOSPITAL has organized full-time pathology and radiology services. All radiologists and pathologists are board certified or board eligible in their respective specialties. Attending radiologists are in-house daily till 11 pm due to our significant trauma load.

Ř  The Division of Neurosurgery at THE INSTITUTION HOSPITAL is comprised of six full-time attending certified neurosurgeons, and one part-time.

Ř  THE INSTITUTION HOSPITAL has a modern library with all the comprehensive neurosurgical textbooks, as well as a good selection of medical journals. Two full-time qualified librarians, who help house-staff do literature searches, inter-library loans, etc, staff the library. A permanent Education Committee oversees the works and acquisitions of the library.

Ř  THE INSTITUTION HOSPITAL is a teaching hospital, so the priority of teaching residents is an already accepted norm.

Ř  THE INSTITUTION HOSPITAL is approved for intern training by the AOA and has filled numerous spots.

 

 

SAMPLE THE AFFILIATE HOSPITAL

THE AFFILIATE HOSPITAL is a tertiary care medical facility, which averages over 2000 patients in out-patient neurosurgery clinic per year, over 500 neurosurgical admissions; in addition, 1000 neurosurgery consults on inpatients who were initially admitted to other services and over 900 major neurosurgical cases.

 

THE AFFILIATE HOSPITAL  is state-of-the-art, with OR equipped with the latest neurosurgical tools including framed and frameless stereotaxy systems, current generation surgical microscope, cavitron (CUSA), Midas Rex high powered drills, microdopplers, etc.  THE AFFILIATE HOSPITAL has an ICU with all the latest capabilities.

 

Ř  THE AFFILIATE HOSPITAL is an approved facility affiliated with the Neurosurgery Residency Program.

Ř  THE AFFILIATE HOSPITAL is a 250-bed tertiary care facility with full range of services including primary and specialty care, trauma and emergency care, ancillary and home health services, behavioral health and a comprehensive women’s health program.

Ř  On average, our attending neurosurgeons will do well over 200 major cases each. The scope, volume and variety of neurosurgical cases are more than adequate to provide residents with the necessary progressive operative experience.

Ř  THE AFFILIATE HOSPITAL has multiple departments and multiple divisions. For instance, they have discrete departments of surgery, orthopedics, medicine, radiology, rehabilitation medicine, and family medicine.

Ř  THE AFFILIATE HOSPITAL has organized full-time pathology and radiology services. All radiologists and pathologists are board certified or board eligible in their respective specialties.

Ř  The Department of Neurosurgery at THE AFFILIATE HOSPITAL is comprised of eleven full-time attending certified neurosurgeons.

Ř  THE AFFILIATE HOSPITAL has a modern library with all the comprehensive neurosurgical textbooks, as well as a good selection of medical journals. The library is a staffed qualified librarian, who helps house-staff do literature searches, inter-library loans, etc.

Ř  THE AFFILIATE HOSPITAL is a teaching hospital, so the priority of teaching residents is an already accepted norm.

 

SAMPLE AFFILIATE HOSPITAL

THE AFFILIATE HOSPITAL provides the AOA mandated exposure to private insurers, continuity clinics in neurosurgery, and other areas associated with the private practice model that is not available at THE INSTITUTION HOSPITAL.

 

At THE AFFILIATE HOSPITAL neurosurgery residents are provided with an opportunity to understand national and local health care delivery systems and how they impact patient care and professional practice as well as an opportunity to understand how types of medical practice and delivery systems differ from one another including methods of controlling healthcare costs and allocating resources, and to compare varying practice facilities with regard to location, design, cost, equipment, inventories and supplies, and rented or owned facilities and equipment. The requirement of medical education is that the residents become proficient with managing an office and a practice, and for this reason the AOA has required compliance with the 7 Core Competencies two which are devoted to “Systems-Based Practice” and “Practice Management” which can be delivered at THE AFFILIATE HOSPITAL.

 

Development of the Participating Facilities

The Neurosurgery Residency Program can provide the platform by which the talents of multi-specialty practitioners (neurology, neurosurgery, rehabilitative medicine, OMT, pain management, interventional radiology, ophthalmology, oncology, ENT) can collectively create a “center of excellence” offering comprehensive management of various diseases of the nervous system.

 

The organization comprising the center of excellence should offer clinics for low back pain and spine disease, peripheral neuropathies, epilepsy, dementia, movement disorders, spasticity, dizziness/vertigo, headaches, brain and spine tumors, stroke (including aneurysms, AVMs and carotid artery disease), neurorehabilitation (stroke, brain/spinal cord injury), tethered cord and skull base surgery.

 

Commitment to OGME

2.16

THE INSTITUTION is committed to Osteopathic Graduate Medical Education as evidenced by policy and written declaration of THE INSTITUTION CEO and OGME. THE INSTITUTION is dedicated to quality in training by THE INSTITUTION and THE INSTITUTION faculty as well as a substantial willingness to comply with AOA training requirements including all elements of a competency based experience and program, faculty and Neurosurgical Resident outcome assessment.

 

Director of Medical Education

2.17-2.21

Each base hospital must be associated with an OPTI facility. In addition the base hospital must have an osteopathic physician as the director of medical education formally appointed by the base hospital, and an osteopathic medical education committee, which meets regularly throughout the academic year. The Director of Medical Education (DME) must adhere to the AOA’s “Basic Standards for Residency Training in Surgery and the Surgical Specialties” Section V, Appendices. The DME must submit the names of the residents to the AOA utilizing the “TIVRA” system or other system designated by the AOA and OPTI. The DME is the authorized point of contact regarding all official communication from the AOA regarding educational programs. The DME coordinates all AOA training programs at the base institution. The DME assures completion of all correspondence from AOA, ACOS, OPTI and THE INSTITUTION in a timely manner. The DME will also organize and implement high quality education programs, supervise all aspects of medical education, ensure compliance of evaluations and meetings, manage affiliation agreements, internal reviews, and prepare core competency plans.  The facility must also abide by the requirements in the “Site Review Workbook” which are required for certification. Any changes in DME will be communicated to the AOA and Neurosurgical Program within 30 days.

 

The institution must provide the resident with “Core Curriculum” courses and seminars specifically addressing patient care, interpersonal and communicative skills, professionalism, business of medicine and, practice improvement. These courses and seminars must be interactive and provide the resident with feedback.

 

Administrative Director of Medical Education

2.22-2.25

There may be an administrative DME who must meet the identical requirements of the DME. This person will be appointed by THE INSTITUTION, report directly to the DME and be responsible for assisting the DME as determined by the DME. This appointment will be reported to the AOA.

 

Program Director

2.26-2.30

THE INSTITUTION will appoint the Neurosurgical Residency Program Director and shall provide the Neurosurgical Residency Program Director with a written job description. The program director is responsible for assuring that the training program is in compliance with the special requirements for residency training in osteopathic neurological surgery as conducted and supervised by the AOA/ACOS/OPTI/THE INSTITUTION.

 

Each program must include a board certified (AOA/ACGME/ABNS) program director who has at least three years of clinical neurosurgical experience. There must be at least one other participating faculty that is either board certified of board eligible. One faculty member must be AOA certified or eligible in neurological surgery, the other faculty member must be board eligible in neurological surgery. Each neurological surgery faculty member must perform a minimum of 50 major neurological surgery procedures per year in the teaching institution.

 

The program director shall:

 

·Attend required educational programs sponsored by AOA/ACOS/OPTI/THE INSTITUTION for the development of program directors

·Be available to the Neurosurgical Residents and have medical privileges at base and affiliate institutions

·Establishes written educational goals and objectives of the residency training program.

·Designs the residency training program to meet the stated goals and objectives.

·Regularly, at least quarterly, evaluates the residency training program to assess its ability to achieve stated goals and objectives.

·Develops and maintains a written plan of rotation to participating institutions and approves educational conference/activity schedules.

·Monitors resident schedules to assure appropriate mix of patient care and educational activities and to avoid undue stress and fatigue among residents.

·Monitors residents’ emotional well-being and recommends counseling services as required.

·Recruits qualified teaching staff at each participating institution.

·Assures that residents are adequately supervised by the teaching staff to facilitate resident education and to promote quality patient care.

·Develops criteria for evaluating resident performance and monitors the evaluation process. Meets with each resident quarterly to review performance. Recommends and oversees remedial training as necessary.

·Implements procedures for discipline and the adjudication of complaints and grievances as per AOA/ACOS and departmental policies.

·Complies and maintains statistical and narrative descriptions of the program.

·Communicates actively with the participating attendings, to review theirs and the program’s success at meeting stated program goals and the effectiveness of the overall program.

·Notifies the AOA/ACOS/OPTI/THE INSTITUTION in writing of any major changes to the residency training program and receives committee approval before implementing such changes.

·Additionally, the program director will oversee the educational activities at each of the participating institutions.

·Participate on the THE INSTITUTION OMEC

·Participate in recruiting and selecting new candidates

·Ensures that residents on rotation at the institution are adequately supervised.

·Arranges attending coverage for resident clinics at the institutions.

·Supervises the activities of neurological surgeons in relation to resident education in the institution.

·Compiles statistical reports (logs), using formats specified by the AOA/ACOS, summarizing clinical activity performed at the institution.

·Participate in on-site program reviews

·Monitors performance of the resident(s) on rotation at the institution.

·Recommend satisfactory program completion of Neurosurgical Residents.

·Jointly administer specialty and emphasis track programs with respective program directors.

·Provide Neurosurgical Residents with all documents pertaining to the training program, Neurosurgical Resident requirements and expectations.

·Submit reports to the THE INSTITUTION DME and annual reports to ACOS.

·Participate in developing the Institutional Core Competency Plan and support education and evaluation in each competency to each Neurosurgical Resident.

·Attends Program Advisory Committee meetings on a regular basis.

·Complies with established AOA/ACOS/OPTI/THE INSTITUTION policies governing resident and medical student education.

 

The program director is responsible for the residency program, the education of the resident, and the advancement or retention of the resident for each academic year. The program director must ensure that the residency program conforms to the AOA, ACOS, Neurosurgical Discipline (NSD) guidelines and curriculum. If any program director fails to conform, they may be removed by the AOA/ACOS/OPTI/THE INSTITUTION, based upon the recommendations of the ACOS and NSD and, after notification and hearing.

 

The program director must provide an annual “Standardized In-Service Exam”, which will be given the first week in March. The program director must ensure that all neurosurgical residents are entered into the AOA “TIVRA” system each year.

 

Annual Written Report

The program directors must submit an annual written report to the NSD Chairman a minimum of 2 weeks prior to the annual ACA. The report will be incorporated into the minutes and passed along to the Board of Governor member. The program director is responsible for attending the annual NSD meeting or sending an alternate. The program director is also responsible that any requested information is provided to the NSD Residency Committee and ACOS-RESC.

 

The program director is responsible for the submission of each resident’s annual report and for the submission of the annual institution’s segregated totals of surgical cases that are available to the resident.

 

The AOA’s “Basic Standards for Residency Training in Surgery and the Surgical Specialties” documents the components of the annual resident report.

 

Components Of The Annual Resident Report

Annual resident reports are required for each training year and are reviewed by the ACOS-RESC. Residents must submit an annual report within thirty (30) days of completion of each contract year. Residents not submitting their appropriate forms (Resident’s Annual Evaluation Report of the Program Director, original research paper, segregated totals on AOA/ACOS form) within 60 days will be required to pay a $250 late fee before their training will be approved. The annual resident report consists of the following documents:

 

Program Director’s Annual Resident Evaluation Report for Surgery.

This AOA/ACOS report form is completed by the program director. The program director must include a narrative progress report of the resident. Both the resident signature and the program director signature are required to document that the resident has been counseled concerning progress. Quarterly evaluations must be submitted along with this annual report form if the promotion section of the form includes a recommendation from the program director that the training year not receive approval and/or that the resident not be advanced to the next level of training.

 

Resident’s Annual Evaluation Report of the Program Director.

This AOA/ACOS report form is completed by the resident and is held in strict confidence by the ACOS-RESC. The ACOS-RESC utilizes this form to evaluate the program director. ACOS staff notifies the ACOS-RESC when a trend of negative evaluations develops for a particular residency program.

 

Resident’s Annual Report for Surgery (segregated totals).

This AOA/ACOS electronic form is completed by the resident and signed by both the resident and the program director to verify that the information reported is accurate. This report form documents the resident’s surgical experience for the residency year. There is a different report form for each surgical specialty reviewed by the RESC. Segregated totals must reflect adequate scope, volume, and variety.

 

Institution’s Annual Segregated Totals

The program director when requested must submit to the ACOS the segregated totals of operative cases that were available at the institution for the residents to attend. This ordinarily is the segregated list of the cases performed by all faculty that are participating in resident’s training and is electronically maintained by the ACOS through the resident’s electronic logs.

 

 

Resident’s Annual Written Report

In compliance with AOA/ACOS regulations, the resident will submit to the program director, an annual segregated log of all surgical and diagnostic procedures, required cases and measured core competencies performed during the previous year.

 

The Resident must also complete the entire annual report including a research paper suitable for publication, which is described further in “Resident Responsibilities Specific Areas- Papers”. The annual report, which must be signed by the resident and program director, and is required to be submitted by July 31st following the completion of the academic year or one month after the end of the academic year. If submitted after August 31st, or after two months after the conclusion of the academic year, the resident will be fined $250.00 by the ACOS/AOBS. If a resident does not turn in their “Annual report” by September 30th, the end of the third month after completion of any year, in addition to the fine levied at the end of August, that resident may be suspended from participation in the residency program until the report has been received at the ACOS. Any suspension time will need to be made up at the end of the academic year.

 

 

Resident Evaluation

Residents are evaluated at the completion of each rotation, or at least every three months according to the following criteria: clinical judgment; medical knowledge; clinical skills, including history taking, physical examination and procedural skills; technical skills; humanistic qualities; patient care; professional attitudes and behavior including interpersonal and communicative skills; improvement; commitment to scholarship; osteopathic principles and philosophy and overall clinical competence. The evaluation will be documented on a form and kept in the resident’s file. The evaluations take place through ELECTRONIC EVALUATION LINK An electronic evaluation will be sent to faculty members to evaluate the resident. The evaluations will be returned electronically, reviewed by the program director, a copy sent to the resident, and the evaluation stored on THE INSTITUTION’s Electronic Resident Logging System website. A separate example of the evaluation from ELECTRONIC EVALUATION LINK will be provided.

 

At least semi-annually each resident meets with the full-time faculty to discuss his/her evaluations and educational and career objectives. Advancement to the next year of training is dependent upon satisfactory progress as determined by the evaluations and completion of annual reports, measured core competencies and criteria stated in the neurological surgery curriculum. Therefore, the resident and program director must also document the “Measured Proficiencies”.

 

Should the evaluations identify deficiencies, the program director and resident will develop a course of remedial education. At that time the resident will be evaluated on a monthly basis. Again, satisfactory progress must be demonstrated before the resident can advance to the next level of training. Therefore, for instances requiring remedial education the neurosurgical program duration of six years will be extended.

 

Residents will complete the required annual standardized written In-service neurosurgical exams. The annual standardized written In-service neurosurgical exam must be taken annually. The program director will be responsible for determining the areas of deficiency. The results will be distributed to the program director and the resident. The collective results, without regards to individual programs will be shared will all programs so that appropriate changes could be made in curriculum.

 

Program Evaluation

Residents evaluate their educational experience at the end of each outside rotation. The evaluation process is strictly confidential, and all residents are encouraged to complete an evaluation in order to provide the program director information on the effectiveness of the program as perceived by the residents. The results of the evaluations are summarized and distributed to pertinent faculty members. Identified rotation deficiencies are discussed at regularly scheduled neurosurgery staff meetings and corrective actions will be discussed and implemented.

 

Teaching Faculty

2.31-2.38

Program director and at least one other BC/BE participating neurosurgeon, one of which must be AOA BC/BE, will participate at the base hospital. The program director must be board certified by the AOA or ABNS. The program director must be on staff at the affiliate hospitals.

 

Attending faculty physicians are responsible for supervising the activities of the residents both in the outpatient clinics and in the operating room and for ensuring that such supervision is documented in the patient’s medical record. Attending physicians are responsible for ensuring that residents behave in an ethical and courteous manner, demonstrating effective communicative, professional and business skills. Attending physicians are also responsible for ensuring that residents demonstrate progressively improving osteopathic, clinical, academic, and surgical skills. Attending physicians are expected to attend educational and departmental conferences and are required to evaluate each resident working under his/her supervision at the completion of each rotation. Attending faculty should notify the program director of observed deficiencies in a resident’s performance as soon as possible so that a plan of remedial training may be designed and implemented. Attending physicians must adhere to any and all hospital, state and federal guidelines for the care of the patient and the supervision of residency staff. Attending faculty must read and adhere to any and all policies and philosophies of this neurological surgery curriculum. Attending faculty must participate in periodic faculty development activities. All neurosurgical faculty must practice ethical behavior and abide by AOA “Code of Ethics” and “Compact Between Residents Physicians and Their Teachers” both documents are provided separately.

 

All attending physicians participating in resident’s training should be evaluated annually by each resident and by the program director. The evaluation form should resemble the “Resident’s Evaluation of the Program Director” form available from the ACOS. The attending faculty evaluation form should be kept solely by the program director and for use solely by the program director. The evaluations take place through ELECTRONIC EVALUATION LINK. An electronic evaluation will be sent to neurosurgical resident members to evaluate the faculty. The evaluations will be returned electronically, reviewed by the program director, a copy sent to the faculty member, and the evaluation stored on THE INSTITUTION’s Electronic Resident Logging System website. A separate example of the evaluation from ELECTRONIC EVALUATION LINK will be provided.

 

Neurosurgical Attending Physicians:

Please list here 

Education Committee

2.36-2.38

THE INSTITUTION will have an Osteopathic Graduate Medical Education Committee which will work to maintain and improve program quality. The OMEC will include the DME, program directors, intern and resident representatives who have been nominated by their peers and representatives from major affiliations. The OMEC will meet at least 10 months a year and minutes of the committee meetings will be maintained. OMEC will approve affiliations. OMEC will assist the DME in developing and implementing a high-quality educational program for interns and residents. The OMEC will oversee curriculum development and participate in program, faculty, intern and resident evaluations, as well as program modification as needed. OMEC will draft and update policies which pertain to Osteopathic graduate medical education. THE INSTITUTION, the neurosurgical program and the Neurosurgical Resident are responsible for knowing and following the policies.

 

The following are SAMPLE INSTITUTION OMEC policies.

 

1-001  Resident Recruitment and Selection Policy

1-002  Non-Discrimination / Harassment Policy

1-003  Statement of Institutional Commitment to Osteopathic Medical Education

1-004  Dress Code

1-005  Protocol for Internal Review of AOA Residency Programs

1-006  Leave Guidelines for Residents

1-007  Professional Activities Outside of the Program (Moonlighting)

1-008  Residency Closure / Reduction

1-009  Work Environment

1-010  Medical Records – Timely Completion Policy

1-011  Corrective Action and Due Process Review Policy

1-012  Restrictive Covenants – Non Competition Policy

1-013  AOA/HIPAA Business Associate Agreements (BAA)

1-014  Conditions for Reappointment / Non Renewal of Contract

1-015  Resident Duty Hours

1-016  Osteopathic Program Director

1-017  Director of Medical Education

1-018  Attending Program Specific Lectures When On Rotation

1-019  Jury Duty

1-020  OMEC Exiting Intern/Resident Policy

1-021  Contracts

1-022  Teaching Faculty

1-023  Administrative Director of Medical Education/Institutional Educational Officer

1-024  Vendor Interactions

1-025  Resignation, Transfer or Non-Reappointment of Residents

1-026  Disaster Response Policy

1-027  Accommodation of Disabled Persons

1-028  Resident Supervision

 

Accreditation for Patient Care

2.39

THE INSTITUTION, and affiliated institutions participating in neurosurgical resident training should be accredited by Healthcare Facilities Accreditation Program (HFAP), JCAHO/AOA or other CMS deemed status recognized accreditation organization. THE INSTITUTION will insure that quality assurance programs are conducted in accordance with respective accrediting and regulatory agencies.

 

Internal Review Process

2.40

THE INSTITUTION will conduct an internal review of the Neurosurgical Residency Program to access compliance with THE INSTITUTION and ACOS requirements. OMEC is responsible for the development, implementation and oversight of the internal review. The internal review committee (IRC) will include faculty, residents from outside neurosurgery, a member from OPTI , and others as determined by OMEC. The IRC will provide a written report OMEC. The IRC review will take place near the mid-point of the AOA /ACOS neurosurgical program review. The IRC review will not be shared at the time of the AOA/ACOS on-site review.

 

Neurosurgical Resident Eligibility and Selection Process

2.41-2.46

Resident selection will be determined by the program director and participating neurosurgeons. When available to neurosurgery qualified candidates are required to participate in ERAS. Resident recruitment shall be conducted according to the policies and procedures of the AOA IRRP. The AOA Neurosurgical program will not discriminate with regard to sex, race, age, religion, color, national origin, disability or veteran status. Potential candidates shall conform to the following basic prerequisites:

·Graduated from a college of osteopathic medicine accredited by the AOA

·Expected:

·Successful completion all three sections of the National Board of Osteopathic Medical Examiners (NBOME), COMLEX-USA, USMLE or the FLEX examination(s) by the end of PGY-2.

·Active license to practice medicine and surgery in the state of Neurosurgical Residency by the end of PGY-2.

·Active DEA license by the end of the PGY-2.

·Demonstrate academic competence necessary for the position of Neurosurgical Resident

·Demonstrate ethical and moral character.

 

Neurosurgical Resident Financial Support and Benefits

2.47-2.51

THE INSTITUTION will provide Neurosurgical Residents with appropriate financial support and benefits. Candidates for Neurosurgical Residency will be informed in writing of terms, conditions and benefits of their appointment, to include salary and other benefits that will comply with state, federal and local laws. Specific benefits will be addressed.

 

Absences

Any absence from the neurosurgery training program in excess of 20 business days (Monday through Friday) of vacation, professional, sick or other leave may be granted by the Director of Medical Education. Any excess of 20 business days must result in extending the neurosurgical program. The OPTI , ACOS and AOA Division of Postdoctoral Training must be notified in writing of the extension.

 

Vacation

Residents may request in writing time off for vacation of not more often than one week per quarter. Residents must conform to a maximum of 20 business days off per academic year. Therefore, should days be used in other categories no vacation may be granted. See separate “Vacation Schedule and Notable Dates”.

 

Physician Assistance

THE INSTITUTION shall assist the neurosurgical resident in obtaining confidential counseling, medical, and psychological support services when needed by the neurosurgical resident including physician impairment assistance. See below stress and fatigue policy as well.

 

Liability Coverage

The base hospital(s) must ensure that the neurosurgical residents are provided with professional liability coverage for the duration of their training. This coverage will include protection against awards from claims reported or filed after completion of training and shall be applicable to actions occurring within the assigned scope of responsibility for the neurosurgical program.

 

Neurosurgical Resident Appointment Agreements

2.52-2.56

THE INSTITUTION will ensure that Neurosurgical Residents are provided with a contract that will outline the terms and conditions of the appointment and shall reference resident responsibilities, duration of appointment

 

Neurosurgical Resident Contract Responsibilities

2.57-2.60

The contract sent to the candidate’s attention should be completed at the earliest date and returned to the THE INSTITUTION within thirty-days. Any contract violation by THE INSTITUTION shall be reported immediately to the AOA Division of Postdoctoral Training. Contract requirements must be met in full. Violation of the contract by a resident may result in the loss of credit for time served in the program. A resident who breaches the resident contract may not serve an AOA-approved residency for a period of twelve (12) months following the date of the breach.

 

Grievances and Due Process for Neurosurgical Residents

2.61-2.62

THE INSTITUTION shall provide neurosurgical residents with the policies and procedures for grievance and due process that address academic and disciplinary actions that may jeopardize the neurosurgical resident’s appointment and/or career. These must address the non-renewal of neurosurgical resident’s contracts, termination of program, and failure of clinical services by the training institution. The neurosurgical resident is expected to address any concern, if possible, with the involved parties. Failing resolution, when appropriate, the neurosurgical resident must seek assistance from the Program Director, DME, THE INSTITUTION Designated Institutional Officer, Medical Director, OPTI  Academic Officer, ACOS or AOA. Please see THE INSTITUTION OMEC Policy and separate THE INSTITUTION neurosurgery policy.

 

PROBATION

A resident may be placed on probation, may be suspended, or may be dismissed for a variety of infractions if the neurosurgical resident is considered to be intellectually, educationally, temperamentally, morally or otherwise unsuited to participate or continue in the neurosurgical program. Any disciplinary action will be reported to the office of the Director of Medical Education for discussion and review, and any action taken will become part of the resident’s permanent record.

 

Academic Probation

A neurosurgical resident may be placed on continuing academic probation. During that period the resident will be expected to meet with the Program Director and the Director of Medical Education at least every three months. At that time an evaluation will be completed and sent to the ACOS/AOA. The program director will determine if the probationary period should be shortened, terminated, or extended.

 

For academic reasons a resident may be placed on suspended academic probation for a period of time not to exceed 3 months. This suspended academic probation may be for failure to complete a clinical rotation or for failure to fulfill any of the specified resident responsibilities. During the period of probation, the resident will be expected to meet with the Program Director and the Director of Medical Education. OMEC will determine if the probationary period should be shortened, terminated, or extended as well as whether or not the resident’s contract should be reviewed.

 

A resident who violates the rules of the training program/institution will be subject to disciplinary probation as follows:

First Offense:      Meeting with Program Director

Second Offense:  Probation not to exceed three months with a formal re-evaluation within that period of time to determine whether the resident can be allowed to continue in the program

Third Offense:    Automatic suspension of the resident with a meeting of the Program Director and Director of Medical Education.

                             

Violations may occur that appear serious enough to warrant immediate suspension, bypassing the first and second offense punishments. These include, but are not limited to, the following:

1)       Unauthorized use or possession of narcotics, intoxicants, or other drugs on the premises

2)       Reporting to work under the influence of alcohol or drugs

3)       Unsatisfactory performance of clinical and/or academic work

4)       Conduct detrimental to patient care or hospital decorum

5)       Other infractions deemed serious enough to warrant dismissal

 

Neurosurgical Resident Contract Termination

2.63-2.65

Suspension

A resident may be placed under suspension for failure to adhere to the requirements of the program, for failure to complete assignments, as well as for failure to properly discharge the duties of resident or comport oneself as a resident.

 

Termination of the resident contract will be carried out under the circumstances as outlined above and may be brought about due to the other events not specified in this document. Any recommendation for termination will be made in writing to the Director of Medical Education and will be discussed with the resident in the appropriate administrative forum.

 

Failure of Advancement

Each resident receives a one-year contract. During the course of that year, evaluations made by the program director, program faculty, and the supervising senior residents will be collected. Each resident will have an end of rotation evaluation, and have at least two evaluations per year. The performance of the resident during the year, the evaluations, and other available information will determine if the resident will advance to the following year of training and/or complete the program if the final year of training is in question. If the neurosurgical resident does not meet the criteria for advancement the resident may be terminated or required to undergo remedial education. If undergoing remedial education the neurosurgical resident will be placed on academic probation, subject to the terms and conditions thereof. Additional time will be added to the neurosurgical resident’s training.

 

Neurosurgical Resident Duty Hours

2.66-2.73

The program director and attending neurosurgeons must adhere to the AOA/ACOS guidelines for work hour policy described in the “Basic Standards for the Neurosurgical Residency” and provide documentation as mentioned above. At least one attending is always available for back-up call. If circumstances require a resident to work throughout the night or weekend, the resident should contact the program director, who will relieve him/her from clinical duties on the following day and arrange clinical coverage. Residents on clinical rotations will provide coverage for residents who are away on vacation, sick or leave. Residents on outside rotation may be pulled for clinical coverage especially in unforeseen and emergency situations.

Physician Health and Safety: Fatigue, Stress and Performance

Situations in which trainees work an excessive numbers of hours can lead to errors in judgment and clinical decision-making.  These errors can impact on patient safety, as well as the safety of the physician trainees through increased motor vehicle accidents, stress, depression and illness related complications.  The training institution, DME, and program directors must maintain a high degree of sensitivity to the physical and mental well being of trainees and make every attempt to avoid scheduling excessive work hours leading to sleep deprivation, fatigue or inability to conduct personal activities.

 

Physical signs and symptoms of fatigue and stress include but are not limited to: excessive tiredness; sleepiness, including falling asleep against the individual’s will (micro sleeps); irritability; depression; giddiness; loss of appetite; digestive problems; and an increased susceptibility to illness.

 

As a result of stress and fatigue there may be performance impairments such as: slowed reactions – physical reaction speed and speed of thought; failure to respond to stimuli, changes in the

surroundings, information provided; incorrect actions either physical or mental; flawed logic and judgment and an inability to concentrate; increases in memory errors, including forgetfulness; decrease in vigilance; reduced motivation; or increased tendency for risk-taking.

 

Residents have multiple resources to address fatigue and stress, these include: Program Director/Associate Program Director/Faculty; Family Physician; Physician Wellbeing Committee; and Human Resources Physician Support. Assuming a strict application of the 80-hour work rules, if a resident is still suffering from signs and symptoms of fatigue, it is important that the individual seek help for available sources for his/her own safety, and the safety of patients and colleagues.  Any faculty members observing signs and symptoms of fatigue in any resident also has a responsibility to discuss this with the individual. See separate THE INSTITUTION Neurosurgery, “Fatigue and Performance” handout.

 

The senior resident coordinates all call schedules and final approval is derived from the program director.

 

Facilities were neurosurgical residents are assigned to take call will provide an on-call room that is clean, quiet, safe and comfortable, to permit rest during call. A telephone shall be present in the on-call room. Toilet and shower facilities shall be present in or convenient to the room. Facilities shall also provide food services 24 hours per day, seven days a week. Appropriate security measures will be provided to all neurosurgical residents on hospital grounds, in on-call quarters and clinical and parking facilities.

 

Work Hours

Total duty hours include: scheduled time providing direct patient care or supervised patient care that contributes to the ability of the resident physician to meet educational goals and objectives, scheduled time to participate in formal educational activities, or scheduled time providing administrative and patient care services of limited or no educational value time needed to transfer the care of patients.

Organized educational activities are of two types: Formal educational activities include scheduled educational programs such as conferences, seminars, and grand rounds and Patient care educational activities include individualized instruction with a more senior resident or attending physician and teaching rounds with an attending physician.

 

An approximate 80 hour work week is required during the neurosurgery resident’s training to permit the development of basic competencies and fundamental neurosurgical skills as defined in the Neurosurgical Training Manual. These include:

1.             Continuity of patient care. Residents sign-out and perform resident rounds on patient daily at 6 AM followed by attending rounds at 3 PM and transfer rounds at 6 PM.

2.             Operative patient care. Residents must be available for all surgeries to be performed. They must exam each patient before assuming a major operative role. For each case, the resident must be familiar with the rationale for surgery, surgical alternatives of the case and procedure. Residents must be well versed with the clinical data pertaining to the patient in question, to have reviewed this material including diagnostic studies, and to have read relevant material concerning the case to be performed. Residents must meet pre-operatively with patients between 6:30 AM and 7:30 AM.  Residents must be in the room prior to the attending staff in order to consider issues of patient positioning, shape of incision, and location of microscope. The residents must accompany patients to the operating room from 7:30 through the end of the case and into the recovery room, the majority of the time which takes place after 3 PM with many cases lasting longer. The residents must also perform a post-operative assessment of the patient to ensure appropriate outcome.

3.             Teaching of residents formally and informally. Residents are taught during daily resident rounds by the chief resident at 6 AM, during daily attending rounds at approximately 3 PM as permitted, and during Monday formal teaching sessions from 3-7 PM.

4.             Participation in clinics from 8:30 AM – 4:30 PM where residents exam patients and formulate treatment plans in consultation with attending faculty.

5.             Participation in hospital care of the patients where residents perform complete history and physical examination, exam patients referred for consultation by the emergency department or other medical services, document findings, formulate management plan, write accurate and up-to-date progress notes on patients for whom neurosurgical residents are responsible at time intervals warranted by the patient’s condition. Residents must see each patient at least once daily, and more frequently as the situation mandates. Management concerns will be discussed with house staff from supporting and/or co managing services.

6.             Participate in institutional educational programs such as OMT rounds, trauma rounds and others.

7.             Participate in the education of junior residents and medical student with reading material and developing presentations.

8.             Completion of resident medical records to ensure that they accurately document the quality of care delivered to the patient, in compliance with standards of the JCAHO/AOA, Federal and State standards and the requirements of the affiliated hospitals. Residents must preparing accurate discharge summaries on all patients for whom the resident is responsible.

9.             Participate in the residents’ schedule of 12 hour shifts and weekend coverage.

10.          Neurosurgery call/night rotation where a single resident is on service and participates in emergency cases under supervision of senior physicians. This activity is needed to develop independent, astute, and critical thinking. This working time-frame allows residents to participate in emergency surgeries (eg. ruptured aneurysms, cauda equina syndrome, etc.), which comprise a significant component of the surgical experience and education of any neurosurgery resident.

 

 All work hours must be documented on a daily basis in Electronic Resident Logging System the training for this is provided separately.

 

Away Rotations

Any proposal for an away rotation must contain a sound educational rationale. The proposed rotation must provide an educational experience that can be obtained in the consortium-training program. The program director must approve away elective rotations in accordance with the guidelines set forth by the AOA/ACOS/THE INSTITUTION. Usually there must be institutional sponsorship for the away rotation. Requests for away rotations must be submitted to the program director at least six months in advance. Residents can request three months of other rotations. These must be exceptional opportunities not present in the participating hospitals. This requires the approval of program director. Please see separate, “Off-Service Resident Rotation” form.

 

Regulations

·Neurosurgical Resident physician total duty hours must not exceed 80 hours per week, averaged over a four-week period. Future increases for all neurosurgical training programs may be appropriate if approved by the AOA/COPT.

·Scheduled In-Hospital On-call assignments should not exceed 24 hours. Residents may remain on-duty for up to 30 hours total to complete the transfer of care, patient follow-up, or education. However, residents may not be assigned new patients, cross-coverage of other providers' patients, or continuity clinic.

·In-Hospital On-call should be no more frequent than every third night and there must be at least one consecutive 24-hour duty-free period every seven days, or 48 hours free from duty every 14 days.

·Pager On-call from home shall not be counted in the calculation of total duty hours.

·When taking Pager On-call from home, Inpatient hours worked shall be counted from the time the neurosurgical resident arrives and leaves the hospital.

·There should be a duty-free interval of at least 12 hours prior to returning to duty from being In-Hospital On-call for 24 hours.

·Limits on total duty hours must not adversely impact resident physician participation in the organized educational activities of the residency program.

·It is the responsibility of the Resident to notify the Attending, Chief Resident, and Program Director when it is known that the 80 hour work week limit will be approached so that appropriate arrangements can be made for patient care and Resident schedule adjustment or time off.

·Any abuse of the 80 hour work week must be immediately reported to the Program Director. If there is no resolution the concern must be reported to the DME, OPTI  Academic Officer and then if necessary to the ACOS and AOA (877) 325-8197.

 

Moonlighting

2.74-2.76

Moonlighting is not permitted by neurosurgical residents.

 

Monitoring of Duty Hours

2.77-2.83

The DME and OMEC shall establish a written policy to monitor duty hours and moonlighting compliance. THE INSTITUTION duty hours policy including moonlighting policies must be published in the THE INSTITUTION house staff manual.  All residents must sign an attestation of receipt of the duty hours and moonlighting policies, and the policy must be available during on-site program reviews. The OMEC committee shall be responsible for monitoring full compliance with the AOA and institutional policies and the process established by the medical education department.  This monitoring shall be done on at least quarterly and recorded in the committee minutes for review at the time of on-site visits. AOA program on-site reviews will evaluate policy compliance by interviews with residents, interviews of DME, program director, faculty and review of educational call schedules and OMEC Committee minutes. THE INSTITUTION shall be responsible for reporting results of duty hours and the monitoring of violations to OPTI  OGME committee upon request. Residents shall have three option levels of reporting of noncompliant duty hour scheduling for review without reprisal: DME, OPTI  Chief Academic Officer, AOA confidential e-mail line (www.postdoc@osteopathic.org), the AOA Postdoctoral Program Violation Hotline (877) 325-8197

 

Neurosurgical Resident Supervision Policy

2.84-2.88

Residents are expected to assume progressively increased responsibility under appropriate supervision according to their level of training, ability and experience. In all cases, residents work under the supervision of a member of the attending staff or his/her designee, who retains responsibility for the management of the patient.

 

Decisions on management or changes therein will be under the supervision of the responsible attending staff member or designee.

 

All operative procedures requiring other than local anesthesia must be supervised by a member of the attending staff. At a minimum, the attending physician will supervise the case and perform a pre- and post-operative examination and assessment. The attending physician will be present during all-important parts of the neurosurgical case whether in the operating room, clinic or hospital ward. The attending physician must become familiar with and follow any hospital by-laws, state and federal requirements for the supervision of residency staff and the care and treatment of patients.

 

Note that nothing in this requirement precludes a responsible member of the attending staff from writing orders on patients under his/her care.

 

Neurosurgical Resident Licensure Requirements

2.89

Neurosurgical Residents shall have an active license to practice medicine and surgery in California by the end of PGY-2 and an active DEA license by the end of the PGY-2.

 

Neurosurgical Resident Ethics and Integrity

2.90

All Neurosurgical Residents must practice ethical behavior and abide by AOA “Code of Ethics” and “Compact Between Residents Physicians and Their Teachers” both documents are provided separately.

 

Work Environment

2.91-2.98

THE INSTITUTION facilities and resources must be adequate to provide educational opportunities to the neurosurgical resident. THE INSTITUTION must assume the financial, technical, and educational support and provide the necessary space, facilities and learning environment for the establishment and maintenance of neurosurgical training programs and patient care. THE INSTITUTION shall provide an on-call room for neurosurgical residents that is clean, quiet, safe and comfortable, to permit rest during call.  A telephone shall be present in the on-call room.  Toilet and shower facilities should be present in or convenient to the room. THE INSTITUTION shall provide the availability of food services 24 hours a day, seven days a week. Appropriate security measures shall be provided to trainees to include hospital grounds, on-call quarters, and clinical and parking facilities. THE INSTITUTION shall have a required minimum of four organized departments or divisions to include family practice, internal medicine, obstetrics and gynecology and surgery. In addition the institution shall provide appropriate laboratory, pathology and radiology services to support OGME programs. THE INSTITUTION shall provide appropriate medical records system. Conference rooms shall be available for formal instruction. Teaching aids should be provided to facilitate learning.  Computer, video, and other electronic technologies should also be provided. THE INSTITUTION shall ensure that the training program provides sufficient scope, volume, and variety to allow the training to be a worthwhile educational experience. The patient volume and other clinical teaching resources in the in and outpatient areas must be adequate and sufficient to accommodate the needs of the neurosurgical resident to meet the program objectives.  Clinical services should not be overwhelmed with neurosurgical residents at all levels to detract from educational opportunities.

 

Library and Educational Resources

2.99-2.110

THE INSTITUTION shall provide an appropriate medical library that is properly staffed and maintained by a qualified librarian. The library should be physically located within or in close proximity to the hospital so it is readily available to neurosurgical residents. The library must be available after hours and on weekends for the neurosurgical residents. The library should be staffed for at least 35 hours per week by at least one person who holds a master’s degree in library science, or the equivalent in related experience, or an equivalent combination of education and experience. Additional library staff, as appropriate to the size and needs of the neurosurgical resident training program, should have sufficient training to assist neurosurgical residents with their information needs. Internet access must be available 24 hours for daily neurosurgical resident use.  Trained staff should be available to assist neurosurgical residents in accessing major indices/databases; i.e., Medline, Hospital Literature Index. HealthSTAR, CancerLit, etc. To ensure authoritative, up-to-date resources for neurosurgical residents, the hospital library collection should include at least those book and journals recommended for initial purchase on the most current edition of The Selected List of Books and Journals for the Small Medical Library (often called the Brandon-Hill List).  Use of the Brandon-Hill List or the Library for Internists (published by the American College of Physicians) is encouraged for further collection development in subject areas of importance to the neurosurgical resident training programs. The total number of books in the library should be sufficient in volume for the needs of the neurosurgical residents and should include medical and standards dictionaries, major indexes/databases, current textbooks, current journal subscriptions, patient education information, audiovisual software, computer software, practice guidelines, and locator tools. The library must include books, current journal subscriptions, and/or electronic access to materials about the relevant medical specialties within that hospital and for the neurosurgical resident training program subject areas for the programs offered. The library must include books, current journal subscriptions, and/or electronic access to materials about osteopathic principles and practice, osteopathic manipulative medicine. The library staff must develop a written plan for periodic assessment of the information needs of neurosurgical residents that must be updated at least every other year. A prioritization of the information needs and service requirements for neurosurgical residents must be included in this written plan. An annual library budget or other annual source of financing must be available for the replacement and updating of the library’s information resources. The library usage policy is provided separately.

 

Core Competency Requirements

2.111-2.112

THE INSTITUTION shall ensure that each program defines, teaches and evaluates, in accordance with AOA and ACOS requirements, the specific knowledge, skills, attitudes and experience required for neurosurgical residents to learn and demonstrate the following basic core competencies: Osteopathic philosophy and osteopathic manipulative medicine, Medical knowledge, Patient care, Interpersonal and communication skills, Professionalism, Practice-based learning and improvement, and  Systems-based practice.

 

The competencies shall be integrated into neurosurgical residency program. There must be an Institutional Core Competency Plan developed by the DME, approved and supported by the OMEC. This plan shall describe the methodology used for exposure and presentation to neurosurgical residents, as well as the processes utilized for assessment and evaluation of neurosurgical resident proficiency. The plan shall be updated annually with expansion of methods of teaching and evaluation. The neurosurgical residency Program Director Annual Reports for each neurosurgical resident shall measure proficiency in each competency.  The AOA Core Competency Compliance Program Document describes in detail the elements of the required plan as well as methods and options for teaching and evaluation reporting on AOA Annual Report Forms.  The core competency requirements bear the same significance in the training of residents as specific clinical knowledge and skills and are necessary for successful program completion and ability to qualify for certification board examination.  For details on Requirements and Guidelines refer to the AOA’s Core Competency Compliance Program (CCCP) located on the website at:

 http://do-online.osteotech.org/index.cfm?PageID=acc_postdocstds

 

Training Certificates of Completion

2.113-2.115

Upon satisfactory completion of the neurosurgical training program, THE INSTITUTION shall award the neurosurgical resident an appropriate single certificate jointly with its partner OPTI. These certificates shall be signed by representatives from both THE INSTITUTION and the OPTI. The certificate shall confirm the successful fulfillment of the neurosurgical residency program requirements, the starting and completion dates of the program, the name of THE INSTITUTION and program director, and the OPTI.

 

Program Changes

2.116

Neurosurgical residency program approved for training shall immediately report any administrative or major faculty change that may occur during the year to the PTRC, OPTI and to the ACOS.

 

Program Closure or Reduction

2.117

THE INSTITUTION shall have policies written and available in its house staff manual, which address the following requirements; THE INSTITUTION shall immediately notify the AOA, OPTI and its neurosurgical residents of a program closure or reduction in positions, which would impact neurosurgical residents prior to program completion. If THE INSTITUTION reduces in size or closes the neurosurgical residency program every attempt should be made to permit the current neurosurgical residents enrolled in the program to complete their training prior to such an action. In the event of a hospital or program closure or reduction in positions, which would impact neurosurgical residents prior to program completion, THE INSTITUTION shall immediately notify OPTI to aid in placement of the enrolled neurosurgical residents in other AOA, approved programs within OPTI or other structures. Severance pay shall be provided for two months when THE INSTITUTION program closure or reduction decisions prevent the neurosurgical residents from program completion in that or another geographically proximate program arranged by THE INSTITUTION and/or OPTI

 


 

Neurosurgical Curriculum

The complete Neurosurgical Curriculum can be found as a separate document, this includes all areas of training. In addition to the curriculum addressing neurology, neuropathology, neuroradiology, and intensive care, the specific goals and objectives for those THE INSTITUTION Neurosurgical Program rotations will be listed.

 

Separate Documents

Additional documents are major parts of your training manual and are provided separately. These documents will be discussed and you must provide written acknowledgement of receipt on the THE INSTITUTION Policy Acknowledgement/Attestation form provided separately. These include but are not limited to:

1.                   THE INSTITUTION Policy Acknowledgement/Attestation Form

2.                   Core Competencies

3.                   AOA Basic Standards for postdoctoral education

4.                   ACOS Basic Standards for Surgical and Surgical Subspecialties

5.                   Resident’s rotation schedule

6.                   ACOS Operative Logs System training example

7.                   Lecture schedule

8.                   Resident evaluation from Electronic Resident Logging System example

9.                   AOA Code of Ethics

10.                Fatigue and Performance Handout

11.                Off-Service Rotation Request Form

12.                AAMC Compact Between Residents Physicians and Their Teachers

13.                Faculty evaluation from Electronic Resident Logging System example

14.                Vacation Schedule and Notable Dates

15.                THE INSTITUTION OMEC Policies

16.                Neurosurgery Grievance Policy addition to THE INSTITUTION OMEC

17.                Electronic Resident Logging System training example

18.                THE INSTITUTION Library Usage

19.                Neurosurgical Curriculum

20.                Goals & Objectives for non-neurosurgical rotations in the neurosurgery residency program

21.                THE INSTITUTION AOA Residency Handbook

 

Congratulations on choosing a neurosurgery residency. Good luck in all your future endeavors.