PGY-3 residents are expected to efficiently manage patients on the neurological service and mentor junior residents. In addition, this year will focus on developing and refining surgical skills for common neurosurgical procedures. PGY-3 residents will participate in weekly academic conferences, didactics, grand rounds, and tumor board meetings. The goal of this year is to transition the resident to a senior level by providing more autonomy to manage patients and perform technical procedures. The year will be divided into 4-month blocks dedicated to spice, vascular, and oncology.
Neurosurgery PGY-3 (Spine)
Patient Care:
- Independently develop a work-up and treatment plan for spinal cord tumors
- Independently perform routine bedside procedures.
- Manage complications with assistance.
- Can formulate a work-up and treatment plan for patients with chronic pain or peripheral nerve disorders (e.g., trigeminal neuralgia, carpal tunnel).
- Can formulate a work-up and treatment plan for patients with lumbar or cervical degenerative disease.
- Formulate a plan for surgical and adjunctive therapy of a patient with spinal column neoplastic disease.
- Develop the technical skill to expose and close complex procedures and complete a complex portion of the case with assistance (e.g., Anterior Cervical Discectomy and Fusion [ACDF], posterior lumbar fusion, spinal cord tumor resection, fracture stabilization).
- Generate a plan for managing case-specific complications.
- Understand the pathophysiology and imaging findings of spinal tumors (e.g., intradural tumor, vertebral metastasis).
- Understand the pathophysiology and imaging findings in spinal infection (e.g., discitis, epidural abscess, tuberculosis, osteomyelitis).
- Formulate an interdisciplinary treatment plan for patients with polytrauma.
- Properly triage patients for operative intervention.
- Perform complex procedures with assistance (e.g., emergent spinal cord decompression).
Medical Knowledge:
- Know the use and limitations of neuro-navigation and intra-operative imaging for spine surgery.
- Discuss indications for and risks of endotracheal intubation/ventilation.
- Describe the pathophysiology of chronic pain disorders.
- Describe non-operative therapies for nerve entrapment disorders.
- Describe the anatomy and physical findings of common lower extremity entrapment neuropathies.
- Describe the findings of electromyography (EMG) and nerve conduction studies in peripheral nerve disorders.
- Obtain and interpret diagnostic studies for chronic pain and peripheral nerve disorder patients.
- Describe the pathophysiology of degenerative spondylotic myeloradiculopathy.
- Describe and categorize degenerative spinal deformities by imaging (e.g., scoliosis, lumbar spondylolisthesis).
- Describe indications for anterior vs. posterior surgical approaches to the spine.
- Describe the role of instrumentation and bony fusion in surgery for degenerative spinal disorders.
- Describe the pathophysiology and imaging findings of spinal tumors (e.g., intradural tumor, vertebral metastasis).
- Describe the pathophysiology and imaging findings in spinal infection (e.g., discitis, epidural abscess, tuberculosis, osteomyelitis).
- Describe the role of instrumentation and bony fusion in surgery for spinal trauma, tumor, or infection.
Neurosurgery PGY-3 (Vascular)
Patient Care:
- Independently perform routine bedside procedures.
- Manage complications with assistance.
- Independently manage refractory intra-cranial hypertension.
- Generate a plan for managing case-specific complications.
- Recognize and initiate work-up of complications after surgery or endovascular therapy (e.g., hemorrhage, ischemic stroke, cardiovascular compromise).
- Can independently develop a work-up and treatment plan for patients with aneurysms, vascular malformations, or ischemic stroke.
- Perform complex vascular procedures with assistance (e.g., carotid endarterectomy, aneurysm clipping, arteriovenous malformation resection).
- Manage vascular complications with assistance.
- Properly triage patients for operative intervention.
- Perform complex procedures with assistance (e.g., Evacuation of intracranial hematoma).
Medical Knowledge:
- Know the use and limitations of neuro-navigation and intra-operative imaging for brain surgery.
- Describe the role of skull-base surgical approaches in aneurysm repair, attendant complications, and their management.
- Know the indications for electroencephalography (EEG) monitoring.
- Discuss indications for and risks of endotracheal intubation/ventilation.
- List indications and complications for decompressive craniectomy, CSF drainage, and barbiturate coma in traumatic brain injury (TBI).
- Describe the pathophysiology, including genetics, of the common movement disorders.
- Understand pathophysiology and underlying anatomy of common epilepsies.
- Identify common patterns of EEG abnormality.
- Describe the pathophysiology of ischemic stroke (e.g., necrotic and apoptotic cell death).
- Describe methods for evaluating cerebral perfusion and blood flow.
- List indications for surgical and endovascular treatment of complex aneurysms and vascular malformations.
- Describe the imaging and angiographic characteristics of cerebral vasculopathies (e.g., atherosclerotic disease, dissection, vasculitis).
Neurosurgery PGY-3 (Oncology)
Patient Care:
- Independently develop a work-up and treatment plan for patients with brain, skull base, or spinal cord tumors.
- Independently perform routine bedside procedures.
- Perform complex procedures with assistance (e.g., resection of eloquent glioma, ventricular or posterior fossa tumor).
- Manage complications with assistance.
- Independently manage refractory intra-cranial hypertension.
- Generate a plan for managing case-specific complications.
- Understand the pathophysiology and imaging findings of brain tumors (e.g., intradural tumor, metastasis).
- Properly triage patients for operative intervention.
Medical Knowledge:
- Recognize the common genetics of brain tumors and genetic markers that impact prognosis.
- Describe the use of advanced imaging in tumor evaluation and surgical planning (e.g., magnetic resonance [MR] tractography, functional imaging, spectroscopy).
- Know the use and limitations of neuro-navigation and intra-operative imaging for brain tumor surgery.
- Describe the role of skull-base surgical approaches in tumor resection, attendant complications, and their management.
- Know the indications for electroencephalography (EEG) monitoring.
- Discuss indications for and risks of endotracheal intubation/ventilation.
Practice Based Learning and Improvement, Interpersonal and Communication Skills, Professionalism, and System-based Practice (Accrued throughout PGY-3)
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 strategies 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 help 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 dependability, honestly, responsibility and punctuality in day-to-day activities.
- Demonstrate respectful behaviors 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 rapport with patients and families.
- Demonstrate the ability to appropriately recognize patient care issues and respond to these issues in a timely manner.
Professionalism:
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, honestly, responsibility and punctuality in day-to-day activities.
- Demonstrate respectful behaviors 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 rapport with patients and families.
- Demonstrate the ability to appropriately recognize patient care issues and respond to these issues in a timely manner.
System-based Practice:
Residents must demonstrate 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 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 the ability to apply cost effective and evidence-based approaches to the previously acquired clinical decision making.
- Demonstrate a willingness to collaborate with administration from various departments to improve the quality of health care delivery.
- Demonstrate the ability to obtain and utilize available resources to optimize neurosurgical care.