The PGY-5 and PGY-6 years involve clinical neurosurgical practice at Cooper University Hospital, Abington Memorial Hospital, and Einstein Medical Center while it remains in the program. The year will be divided into rotations dedicated to Spine, Oncology, Vascular, and Trauma. Throughout the PGY-5 and PGY-6 years, residents will participate in educational lectures, grand rounds presenting cases, researching relevant journal articles, and discussing cases with attendings and other resident staff. Residents will be expected to participate on a level appropriate basis and will be challenged to provide a more thorough knowledge of the materials at hand. They will be more involved in the oversight of junior residents in the academic settings.
Neurosurgery PGY-5/6 (Spine)
Patient Care:
- Independently formulate a treatment plan for patients accounting for comorbidities or other complicating factors (e.g., systemic illness, radiation, chemotherapy).
- Independently perform complex procedures.
- Adapt standard treatment plans to special circumstances (e.g., previous surgery, anticipated neurological morbidity).
- Independently manage complications.
- Diagnose and manage CSF leak.
- Adapt standard treatment plans to special circumstances (e.g., previous surgery, neuropsychological limitations, developmental delay, coagulopathy).
- Adapt standard treatment plans to special circumstances (e.g., previous surgery, deafferentation pain).
- Perform advanced procedures with assistance (e.g., thoracolumbar or craniocervical reconstruction, reconstruction after infection or vertebral tumor resection).
- Prioritize the management of injuries in a polytrauma patient.
- Independently manage CNS complications.
Medical Knowledge:
- Describe expected outcomes after surgery for spinal cord tumors.
- Describe methods to assess intra-vascular volume and tissue perfusion.
- Describe expected outcomes after surgery for epilepsy and movement disorders.
- Describe the anatomy and physiology of spinal cord lesioning for pain (myelotomy, cordotomy).
- Describe the effects of surgical diversion on CSF physiology.
- Describe the risks, screening, incidence, and management of late effects from chemotherapy and radiation for childhood CNS tumors.
- Describe the natural history of cranial synostosis and tethered cord with or without surgical intervention.
- Describe expected medical and functional long-term outcomes in patients with myelomeningocele.
- Describe expected functional and pain outcomes after surgery for spinal degenerative disease.
- Describe criteria for reoperation for degenerative spinal disease.
- List indications for vertebroplasty and kyphoplasty.
- Describe the genetics, pathophysiology, and imaging findings of inflammatory spinal disorders.
- Describe expected short- and long-term outcomes and complications after surgery for spinal trauma, tumor, or infection.
- Describe factors affecting outcome in spinal tumor surgery (e.g., extent of resection).
- Describe the use of adjuncts during spinal trauma and tumor surgery (e.g., image guidance, ultrasound, monitoring).
- Describe the role of radiotherapy for treatment of spinal tumors.
Neurosurgery PGY-5/6 (Oncology)
Patient Care:
- Independently formulate a treatment plan for patients accounting for comorbidities or other complicating factors (e.g., systemic illness, radiation, chemotherapy).
- Independently perform complex procedures.
- Adapt standard treatment plans to special circumstances (e.g., previous surgery, anticipated neurological morbidity).
- Independently manage complications.
- Independently formulate a treatment plan for complex patients (e.g., failure of cerebral autoregulation, multi-organ failure, non-recoverable central nervous system [CNS] injury).
- Diagnose and manage CSF leak.
- Initiate management of cardiac rhythm disturbances.
- Adapt standard treatment plans to special circumstances (e.g., previous surgery, neuropsychological limitations).
- Manage unexpected intra-operative events (e.g., cerebral edema, hemorrhage, air embolus).
- Independently manage CNS complications.
- Independently formulate a treatment plan for pediatric patients with comorbidities or other complicating factors (e.g., other organ system congenital anomalies).
- Independently perform complex procedures in pediatric patients.
- Adapt standard treatment plans to special circumstances (e.g., developmental delay, coagulopathy).
Medical Knowledge:
- Describe expected outcomes after surgery for brain and spinal cord tumors.
- Describe the role of radiosurgery in brain tumor therapy.
- Describe the role of palliative care for brain tumor patients.
- Describe personalized medicine approaches for brain tumor treatment.
- Understand transcranial Doppler (TCD) sonography and its role in monitoring.
- Discuss the risks of CSF drainage, hyperosmolar therapy, and hyperventilation.
- Describe methods to assess intra-vascular volume and tissue perfusion.
- Describe expected outcomes after surgery for epilepsy and movement disorders.
- Describe the effects of surgical diversion on CSF physiology.
- Describe the risks, screening, incidence, and management of late effects from chemotherapy and radiation for childhood CNS tumors.
- Describe the natural history of cranial synostosis and tethered cord with or without surgical intervention.
- Describe the role of radiotherapy for treatment of spinal tumors.
- Describe the effects of surgical diversion on CSF physiology in pediatric patients.
- Describe the risks, screening, incidence, and management of late effects from chemotherapy and radiation for childhood CNS tumors.
Neurosurgery PGY-5/6 (Vascular)
Patient Care:
- Independently formulate a treatment plan for patients accounting for comorbidities or other complicating factors (e.g., systemic illness, radiation, chemotherapy).
- Independently perform complex procedures.
- Adapt standard treatment plans to special circumstances (e.g., previous surgery, anticipated neurological morbidity).
- Independently manage complications.
- Independently formulate a treatment plan for complex patients (e.g., failure of cerebral autoregulation, multi-organ failure, non-recoverable central nervous system [CNS] injury).
- Diagnose and manage CSF leak.
- Initiate management of cardiac rhythm disturbances.
- Independently manage complications.
- Adapt standard treatment plans to special circumstances (e.g., previous surgery, deafferentation pain).
- Perform advanced procedures with assistance (e.g., aneurysm coiling, vascular malformation embolization, extracranial-intracranial bypass).
- Manage unexpected intra-operative events (e.g., cerebral edema, hemorrhage, air embolus).
- Independently manage CNS complications.
- Adapt standard treatment plans to special circumstances (e.g., previous surgery, developmental delay, coagulopathy).
Medical Knowledge:
- Understand transcranial Doppler (TCD) sonography and its role in monitoring.
- Discuss the risks of CSF drainage, hyperosmolar therapy, and hyperventilation.
- Describe methods to assess intra-vascular volume and tissue perfusion.
- Describe the effects of surgical diversion on CSF physiology.
- Describe expected outcomes after surgery or endovascular therapy for intracranial and extracranial vascular disease.
- Describe the indications for medical vs. endovascular treatment of intracranial arterial stenosis.
- Describe the molecular mechanisms of ischemic protection strategies.
- Describe the genetics and inheritance of familial cavernous malformations and hereditary hemorrhagic telangiectasia.
- Describe the effects of surgical diversion on CSF physiology in pediatric patients.
Neurosurgery PGY-5/6 (Trauma)
Patient Care:
- Independently formulate a treatment plan for patients accounting for comorbidities or other complicating factors (e.g., systemic illness0
- Independently perform complex procedures.
- Adapt standard treatment plans to special circumstances (e.g., previous surgery, anticipated neurological morbidity).
- Independently manage complications.
- Independently formulate a treatment plan for complex patients (e.g., failure of cerebral autoregulation, multi-organ failure, non-recoverable central nervous system [CNS] injury).
- Systematically review treatment outcomes for TBI.
- Participate in quality improvement for TBI care.
- Participate in developing a plan for triage in a disaster management scenario.
- Reconstruct complex craniofacial injuries.
- Diagnose and manage CSF leak.
- Initiate management of cardiac rhythm disturbances.
- Prioritize the management of injuries in a polytrauma patient.
- Manage unexpected intra-operative events (e.g., cerebral edema, hemorrhage, air embolus).
- Independently manage CNS complications.
- Independently formulate a treatment plan for pediatric patients with comorbidities or other complicating factors (e.g., other organ system congenital anomalies).
- Independently perform complex procedures in pediatric patients.
- Adapt standard treatment plans to special circumstances (e.g., previous surgery, developmental delay, coagulopathy).
Medical Knowledge:
- Describe expected outcomes after TBI and the impact of intra-cranial hypertension and of surgical intervention.
- Understand transcranial Doppler (TCD) sonography and its role in monitoring.
- Discuss the risks of CSF drainage, hyperosmolar therapy, and hyperventilation.
- Describe methods to assess intra-vascular volume and tissue perfusion.
- Describe expected short- and long-term outcomes and complications after surgery for spinal trauma.
- Describe factors affecting outcome in spinal tumor surgery (e.g., extent of resection).
- Describe the use of adjuncts during spinal trauma and tumor surgery (e.g., image guidance, ultrasound, monitoring).
- Describe the molecular mechanisms of ischemic protection strategies.
- Describe the genetics and inheritance of familial cavernous malformations and hereditary hemorrhagic telangiectasia.
Practice Based Learning and Improvement, Interpersonal and Communication Skills, Professionalism and System-based Practice (Accrued throughout PGY-5 and PGY-6)
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 supervise basic neurologic procedures, and provide constructive feedback to the physicians under the chief resident’s supervision.
- Demonstrate the ability to recognize the importance of life-long learning.
- Examine and assess surgical outcomes and recognize ways to continually improve the quality of patient care.
- Be able to effectively access medical information through traditional and online sources in support of ongoing educational advancement.
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.
- Sustain therapeutic and ethically sound relationships with patients, patients’ families, and colleagues.
- Provide effective and professional consultations to other physicians and health care professionals.
- Obtain and provide information using effective listing, nonverbal, explanatory, questioning and writing skills.
- Demonstrate effective communication with patients in a language that is appropriate for their age, education level, cultural and socioeconomic background.
- Demonstrate the ability to counsel patients on the risks, goals, limits and alternatives for the majority of neurosurgical procedures.
- Demonstrate the ability to discuss the patient’s diagnosis and diagnostic and therapeutic plan with various professionals involved in the patient care (e.g., nursing, physical therapist, and social work among others).
- Demonstrate the ability to coordinate with neurosurgical, anesthesia, and OR staff to manage the daily operative schedule, assignment of residents to cover operative cases, and ensuring evening cases are staffed to the attending surgeon’s satisfaction.
- Demonstrate the ability to compassionately communicate with patients and families the findings at surgery following a surgical procedure for an injury.
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.
- Exhibit personal integrity, altruism and a commitment to ethical principles in the provision of clinical care (i.e., autonomy, benevolence, and non-malfeasance).
- Demonstrate dependability, honestly, responsibility, punctuality, and self-respect in daily activities.
- Demonstrate the ability to protect health-related patient information per HIPAA compliance.
- Recognize errors regarding omission in pre-operative, interoperate, and postoperative care of the surgical patient and work toward remediation of those errors.
- Demonstrate and maintain interactions with supervising faculty, consulting residents, physician peers, nursing and staff support.
- Demonstrate the ability to attend rounds and present timely and accurate data to members of the health care team.
- Demonstrate the ability to correctly prepare monthly call schedules of the resident physicians
- Partake and assist in leading conferences in a manner that demonstrates the highest level of global awareness regarding clinical neurosurgery.
- Develop an effective skill set required for neurosurgical service (e.g., clinical, research, and administration).
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 appropriately discharge a patient from inpatient or outpatient care.
- Demonstrate the ability to plan long-term care and rehabilitation with relatives, caregivers, and appropriate outside agencies.
- Demonstrate an understanding of legal issues regarding neurosurgery.
- Demonstrate an understanding of cost-effective hospital management and care.