PGY-7 Chief Neurosurgery

The ACGME Guidelines state: There must be a 12-month period of time as senior/chief resident on the clinical service of neurological surgery in the sponsoring institution or it’s approved participating institutions. The senior/chief resident must have major or primary responsibility for patient management with faculty supervision. The senior/chief resident should also have administrative responsibility as designated by the Program Director.

The chief neurosurgical year is spent between Cooper University Hospital and Abington Memorial Hospital. Throughout the chief neurosurgical resident year, residents will continue to participate in educational lectures, grand rounds presenting cases, researching relevant journal articles, and discussing cases with attendings and junior resident staff. The chief resident will delegate and oversee resident involvement in these settings, ensuring the resident involvement is level appropriate and the appropriate content is addressed. The chief resident will also take on administrative responsibilities, as designated by the program director. The clinical rotations will be Spine, Oncology, Functional and Vascular. 

Chief Neurosurgery PGY-7 (Spine)

Patient Care:

• The “OR chief” manages the neurosurgical operative service and has the first choice of operative cases. Duties include coordinating 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.
• The Chief will provide back up call for the junior residents on the service.
• Systematically review treatment outcomes for spinal cord tumors.
• Participate in quality improvement for spinal cord tumors.
• Duties include assisting the services with ICU and floor procedures as well as inpatient and emergency room consults. The Clinical chief will also perform clinical rounds on his postoperative patients and participate in their clinical management.
• Systematically review outcomes for neurocritical care patients.
• Participate in quality improvement for a neurocritical care unit.
• Develop a standard neurocritical care unit management protocol.
• Lead multidisciplinary neurocritical care team.
• Systematically review treatment outcomes for pediatric neurosurgical patients.
• Participate in quality improvement for pediatric neurological surgery.
• Perform surgical stabilization of the spine in a patient aged less than three years.;
• Systematically review treatment outcomes for spinal disorders.
• Participate in quality improvement for spinal disorders.
• Lead interdisciplinary team in the management of complex spinal disorders.
• Independently perform advanced procedures.

Medical Knowledge:

• Chief Residents are expected to master the medical knowledge categories described as “senior” in all previous subspecialty medical knowledge descriptions.
• Organize and assign topics for the weekly Resident academic conference.
• Contribute to the peer-reviewed literature in spinal cord tumors.
• Participate in spinal cord injury research and clinical trials.
• Contribute to the peer-reviewed literature in spinal degenerative disease, trauma, tumor, or infection.
• Describe molecular abnormalities associated with CNS congenital anomalies and tumors.

Chief Neurosurgery PGY-7 (Oncology)

Patient Care:

• The “OR chief” manages the neurosurgical operative service and has the first choice of operative cases. Duties include coordinating 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.
• The Chief will provide back up call for the junior residents on the service.
• Systematically review treatment outcomes for brain and tumors.
• Participate in quality improvement for brain and spinal cord tumors.
• Participate in or lead a multidisciplinary brain tumor team.
• Formulate a medical and/or surgical plan for the management of hypersecretory disorder patients with pituitary problems, based on the endocrine evaluation and radiologic evaluation.
• Correlate the radiologic findings and endocrine findings regarding management options and management of other complex medical problems that may bear on the planning of surgery or other management as determined by both the rotation evaluation and surgical evaluation.
• Plan and perform either craniotomy or transsphenoidal surgery for patients with hypersecretory pituitary disorders as measured by the rotation evaluation and surgical case evaluation.
• Manage the complications of surgery and endocrine changes as the result of pituitary surgery as measured by the rotation evaluation.
• Communicate with consultants, families, and patients regarding long-term management of patients with pituitary hypersecretory disorders as measured by the rotation evaluation.
• Instruct the patient and family regarding long-term management plan for patients with mass lesions from the pituitary and communicate with consultants regarding this plan as measured by the rotation evaluation and surgical case evaluation.
• Duties include assisting the services with ICU and floor procedures as well as inpatient and emergency room consults. The Clinical chief will also perform clinical rounds on his postoperative patients and participate in their clinical management.
• Systematically review outcomes for neurocritical care patients.
• Participate in quality improvement for a neurocritical care unit.
• Develop a standard neurocritical care unit management protocol.
• Independently perform advanced procedures.

Medical Knowledge:

• Chief Residents are expected to master the medical knowledge categories described as “senior” in all previous subspecialty medical knowledge descriptions.
• Organize and assign topics for the weekly Resident academic conference.
• Contribute to the peer-reviewed literature in brain and spinal cord tumors.
• Participate in brain tumor research and clinical trials.
• Describe molecular abnormalities associated with CNS congenital anomalies and tumors.

Chief Neurosurgery PGY-7 (Functional)

Patient Care:

• The “OR chief” manages the neurosurgical operative service and has the first choice of operative cases. Duties include coordinating 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.
• The Chief will provide back up call for the junior residents on the service.
• Duties include assisting the services with ICU and floor procedures as well as inpatient and emergency room consults. The Clinical chief will also perform clinical rounds on his postoperative patients and participate in their clinical management.
• Systematically review outcomes for neurocritical care patients.
• Systematically review treatment outcomes for epilepsy and/or movement disorders.
• Participate in quality improvement for epilepsy and/or movement disorders.
• Systematically review treatment outcomes for pain and/or peripheral nerve disorders.
• Participate in quality improvement for pain and/or peripheral nerve disorders.
• Systematically review treatment outcomes for pediatric neurosurgical patients.
• Participate in quality improvement for pediatric neurological surgery.
• Formulate diagnostic and management plans for a patient with a functioning CSF shunt and chronic headaches.
• Counsel expectant parents regarding fetal congenital anomalies.
• Independently perform advanced procedures.

Medical Knowledge:

• Chief Residents are expected to master the medical knowledge categories described as “senior” in all previous subspecialty medical knowledge descriptions.
• Organize and assign topics for the weekly Resident academic conference.
• Contribute to the peer-reviewed literature in epilepsy and/or movement disorder treatment, chronic pain and/or peripheral nerve disorders.
• Describe molecular abnormalities associated with CNS congenital anomalies.
• Describe expected outcomes after surgery for epilepsy and movement disorders.
• Describe responses to electrical stimulation around intended DBS targets and in various regions of eloquent cortex.
• Describe indications for lesional vs. neuromodulatory interventions.
• Describe the role of radiosurgery for functional lesions.
• Describe indications for Vagus nerve stimulation (VNS), callosotomy, and hemispherectomy.
• Describe expected outcomes after surgery for chronic pain (e.g., microvascular decompression [MVD], DREZ lesions, cordotomy).
• Describe expected outcomes after surgery for peripheral nerve disorders (e.g., neurolysis, direct anastomosis, grafting).
• Describe the anatomy and physiology of spinal cord lesioning for pain (myelotomy, cordotomy).
• Describe the effects of surgical diversion on CSF physiology.

Chief Neurosurgery PGY-7 (Vascular)

Patient Care:

• The “OR chief” manages the neurosurgical operative service and has the first choice of operative cases. Duties include coordinating 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.
• The Chief will provide back up call for the junior residents on the service.
• Duties include assisting the services with ICU and floor procedures as well as inpatient and emergency room consults. The Clinical chief will also perform clinical rounds on his postoperative patients and participate in their clinical management.
• Systematically review outcomes for neurocritical care patients.
• Participate in quality improvement for a neurocritical care unit.
• Develop a standard neurocritical care unit management protocol.
• Lead multidisciplinary neurocritical care team.
• Systematically review treatment outcomes for neurovascular disease.
• Participate in quality improvement for neurovascular disease.
• Independently perform advanced procedures.

Medical Knowledge:

• Chief Residents are expected to master the medical knowledge categories described as “senior” in all previous subspecialty medical knowledge descriptions.
• Organize and assign topics for the weekly Resident academic conference.
• Participate in cerebrovascular research and clinical trials.
• Contribute to the peer-reviewed literature in endovascular treatment of stroke and intracerebral hemorrhage.
• Describe advanced intra-cranial monitoring (e.g., brain tissue oxygenation, jugular venous oxygen saturation, microdialysis).
• Describe advanced imaging for CVA (e.g., cerebral metabolism, perfusion).
• 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.

Practice Based Learning and Improvement, Interpersonal and Communication Skills, Professionalism and System-based Practice (Accrued throughout PGY-7)

Practice Based Learning and Improvement:

• The Chief Resident will coordinate the monthly quality assurance and morbidity and mortality conferences. These case reviews provide feedback to the faculty and staff on medical and surgical errors, either as a result of individual or systematic problems. This conference provides a tremendous opportunity for practice based learning and improvement.
• The Chief Resident will organize the annual PCOM Neurosurgery Symposium. This includes setting the course agenda, including the lectures and lab stations. The Chief will also help the Program Director prepare the budget and secure sponsors.
• Learn and demonstrate practice-based learning and improvement that involves investigation and evaluation of their patient care, appraisal and assimilation of scientific evidence, and improvements in patient care.
• Exhibit motivation with an active and aggressive attitude toward learning.
• Demonstrate field of knowledge through evidence of literature, methods of management, advantages and disadvantages of alternative treatments of their own patient care, appraisal and assimilation of scientific evidence and improvements in patient care.
• Exhibit research aptitude with curiosity, creativity, and ability to evaluate and analyze data through the utilization of resources and independent work.

Professionalism:

• The Chief Residents are expected to lead the other residents by example. This includes the highest levels of professional behavior when interacting with other residents, nurses, health care personnel, families and patients.
• Manifest a commitment to carrying out professional responsibilities, adherence to ethical principles, and sensitivity to a diverse patient population.
• Display integrity through honesty, discretion and a commitment to excellence and ongoing professional development.
• Ethical principles are evident through a commitment to provision or withholding clinical care, confidentiality of patient information, informed consent and business practices.

Interpersonal and Communication Skills:

• Develop and use interpersonal and communication skills that result in effective information exchange and teaming with patients, their families, and professional associates.
• Demonstrate oral communication skills through clarity of expression, articulateness, and grammar allowing effective information exchange with patients, their families and other health professionals.
• Display written communication skills with accurate and timely documentation, progress, operative and discharge notes are written completely and promptly.
• In relating to patients, the resident is interested, honest, understanding and explains clearly to the patient’s satisfaction the details related to diagnosis, proposed treatment, and its implications.

Systems Based Practice:

• Coordinate the call schedule.
• Supervise the resident vacation and meeting schedule.
• Provide overall supervision of resident manpower assignments on a daily basis for this very busy neurosurgical service.
• Conduct a monthly residents-only meeting to discuss programmatic issues in preparation for the monthly resident meeting with the Program Director.
• Manifest actions that 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.
• Demonstrate resourcefulness through the management of available resources.