This year the resident will be primarily responsible for the organization of the neurosurgery service and will maintain the list of patients being followed by the service and coordinate rounds with the attendings. The resident will handle the majority of the calls during the day. During this year, residents build on the experiences and knowledge gained during their first year and learn to efficiently manage all patients on the neurosurgical service. Residents will learn how to evaluate, triage, and manage patients in conjunction with the trauma and neuro-critical care services. Residents will begin performing basic bedside procedures with autonomy and will assist in the OR when time permits.
Throughout the PGY-2 year, direct oversight is provided by senior residents and attending staff regarding clinical care, conferences, and educational meetings. The residents will be asked to participate in educational lectures, grand rounds presentations, researching relevant journal articles, and discuss cases with attendings and senior resident staff.
PGY-2 will continue developing clinical knowledge and technical skills to efficiently manage patients in neuro-oncology, neuro-critical care, vascular neurosurgery, neuro-trauma, spinal degenerative disease, functional neurosurgery, peripheral nerve pathology, and pediatric neurosurgery. At the completion of this rotation, residents are expected to:
- Proficiently explain risks and benefits of neurosurgical procedures.
- Independently interpret common diagnostic studies relevant to Neurosurgery.
- Recognize and initiate work-up of complications (e.g., hematoma, infection, seizure, hydrocephalus).
- Assist with routine surgical procedures.
- Interpret radiographic neuro-axis studies.
- Manage intra-cranial hypertension (e.g., hyperosmolar agents, cerebral spinal fluid [CSF] drainage).
- Diagnose and manage spinal or hypovolemic shock.
- Interpret diagnostic studies related to functional neurosurgery.
- Assist with routine components of functional procedures (e.g., burr hole, craniotomy, generator change).
- Learn how to place stereotactic head-frame.
- Explain risks and benefits of neurosurgical procedures to parents and older children.
- Interpret diagnostic studies with accurate identification of age-related variations.
- Recognize neurosurgical urgencies and emergencies in pre-verbal children, and initiate work-up.
- Initiate management of a patient with acute spinal cord injury.
- Perform cervical traction/reduction and know how to place a Halo orthotic.
- Explain risks and benefits of surgery and endovascular therapy for aneurysms, vascular malformations, and ischemic stroke.
- Explain risks and benefits of neurosurgical procedures for TBI.
- Organize the emergency surgical team; position for craniotomy with cervical precautions.
- Understand basics of radiation and chemotherapy for brain and spinal cord tumor therapy.
- List indications for biopsy or resection of brain and spinal cord tumors.
- Categorize brain and spinal cord tumors by age, histology, and radiographic appearance.
- Can generate non-neoplastic differential diagnosis of various mass lesions.
- Understand the natural history of common intrinsic brain tumors.
- Describe the pathophysiology and medical management of intra-cranial hypertension and cerebral edema.
- Describe the etiology and imaging of traumatic intra-cranial hemorrhage and parenchymal injuries.
- Describe medical therapies for epilepsy and movement disorders.
- List surgical indications for patients with epilepsy or movement disorders.
- Describe imaging findings in common epilepsies and movement disorders (e.g., magnetic resonance imaging [MRI], Single Proton Emission Computerized Tomography [SPECT], and position emission tomography [PET]).
- Describe sources of inaccuracy in stereotaxy (e.g., brain shift, human error).
- List medical therapies for chronic pain (e.g., trigeminal neuralgia, brachial plexus neuritis).
- Describe the anatomy and physical findings of common upper extremity entrapment neuropathies.
- Describe the clinical findings and differential diagnosis of trigeminal neuralgia.
- List surgical indications for patients with chronic pain or peripheral nerve disorders.
- Describe abnormal CSF physiology and anatomy in various forms of hydrocephalus.
- Describe the radiological and clinical features of hydrocephalus, benign macrocephaly, and subdural hygroma.
- Describe medical and physical therapies for degenerative spinal disorders.
- List surgical indications and options for degenerative spinal disorders.
- Describe imaging findings in degenerative spinal disorders (e.g., x-ray, MRI, myelography).
- Describe the natural history of spinal degenerative disorders.
- Describe EMG findings in spondylotic myeloradiculopathy.
- Describe the medical treatment of spinal infections.
- Describe the use and types of external bracing in spinal trauma, tumor, or infection.
- Classify spinal fractures by mechanism and imaging appearance.
- List surgical indications, contra-indications, and options for spinal trauma, tumor, and infection.
- Describe the natural history of primary spinal tumors.
- List indications for carotid endarterectomy and carotid angioplasty/stent.
- Describe the natural history of aneurysms and vascular malformations.
- List indications for surgical and endovascular treatment of aneurysms and vascular malformations.
- Describe imaging findings in common cerebrovascular conditions.
Practice Based Learning and Improvement:
Residents must have the ability to use scientific evidence and methods to investigate, evaluate, and improve patient care practices. Each provided through role modeling by attending, participation in workshops, and direct patient care experience. Assessed through evaluation form by attending, and self-assessment.
- Demonstrate the ability to assess errors conducted in research and recognized steps to prevent such errors from reoccurring.
- Demonstrate the ability to maintain and advance individual competence and performance.
- Demonstrate a commitment to lifelong learning in surgical practice.
- Demonstrate the ability to receive constructive feedback and improve quality of patient care.
- Demonstrate the ability to apply knowledge of scientific data to improve the care of surgical patients.
- Demonstrate the ability to utilize information technology to analyze medical information.
Interpersonal and Communication Skills:
Residents must be able to demonstrate interpersonal and communication skills that assist in effective information exchange and be able to team with patients, patients’ families, and professional associates. Each provided through role modeling of Attending, participation in workshops or didactic conferences, and direct patient care experience. Assessed through evaluation form by attending, evaluation form by team members or peers and self-assessment and evaluation form.
- Demonstrate the ability to effectively communicate with patients and their families.
- Demonstrate the ability to counsel patients and families on the risks, benefits, and alternatives to surgery.
- Demonstrate the ability to communicate all adverse events in a timely fashion to patients, senior residents, and attending physicians.
- Demonstrate the ability to respond to requests of staff in a prompt and professional manner.
- Demonstrate the ability to work effectively with ancillary care and other medical professionals (e.g., pharmacist, social worker, occupational and physical therapist).
- Demonstrate the ability to provide effective and professional consultations to other physicians and health care professionals.
- Demonstrate the ability to effectively communicate with other members of the neurosurgery team
- Demonstrate the ability to complete and maintain all reports, history and physicals, consults, progress notes, and discharge summaries in a timely manner as set forth by hospital guidelines.
- Demonstrate the ability to obtain and provide information using effective listing and nonverbal communication skills.
Residents must demonstrate a commitment to carrying out professional responsibilities, adherence to ethical principles, and sensitivity to a diverse population. Each provided through role modeling by attending, participation in workshops, and direct patient care experience. Assessed through evaluation form by attending, and self-assessment.
- Demonstrate dependability, honesty, responsibility and punctuality in day to day activities.
- Demonstrate respectful behavior when interacting with residents, attending physicians, and other health care professionals.
- Explain the process of informed healthcare decision making, including the elements that must exist and specific components of an informed consent discussion.
- Demonstrate sensitivity and responsiveness to cultural differences, sexual preferences, ages, beliefs, socioeconomic status, behaviors, and disabilities of patients and professional colleagues.
- Partake in the end of life decision-making and maintenance of proper rapport with patients and families.
- Demonstrate the ability to recognize patient care issues and respond in a timely manner.
Residents must demonstrated an awareness of and responsiveness to the larger context and system of health care and the ability to effectively call on system resources to provide care that is of optimal value. Each provided through role modeling by attending, participation in workshops, and direct patient care experience. Assessed through evaluation form by attending, and self-assessment.
- Demonstrate the ability to recognize resources, providers, and systems necessary to provide high-quality neurosurgical care.
- Demonstrate the ability to appreciate the patients’ interest and convenience in care management plans.
- Demonstrate an understanding and be able to appropriately discharge patients in a timely fashion.
- Demonstrate a willingness to collaborate with administrative leaders from various departments to improve the quality of health care delivery.
- Demonstrate the ability to obtain and utilize available resources to optimize neurosurgical care
- Demonstrate ability to track operative cases and appropriately document in the case log.