Curriculum

Residents must be able to provide patient care that is compassionate, appropriate and effective for the treatment of health problems and the promotion of health. Residents are expected engage in the following:

• Participate in the day-to-day management of patients on the adult neurosurgical inpatient service.
• Organize presentations on patient care to the rounding team.
• Review radiological and laboratory studies with team members.
• Begin to develop patient care plans for routine neurosurgical problems.
• Develop technical skills in critical care and intraoperative procedures under direct supervision of senior residents and faculty members.
• Positioning of patients for spinal and cranial procedures.
• Critical care procedures, including ICP monitor placement and external ventricular drain.
• VP shunt tap/programming.
• Lumbar puncture and lumbar drain placement.
• Gather essential information in a timely manner.
• Synthesize acquired patient data and formulate a differential diagnosis and sequence critical actions for patient care.
• Begin to manage complications of procedures and other care.
• Serve as a surgical assistant for neurosurgical procedures with direct supervision by faculty members and senior residents.

Residents must demonstrate rudimentary medical knowledge of established and evolving biomedical, clinical, epidemiological and social behavioral sciences, as well as the application of this knowledge to patient care. Residents are expected engage in the following:

• Develop an introductory knowledge base in clinical neuroscience.
• Create a differential diagnosis for common neurological and neurosurgical disorders.
• Cervical and lumbar radiculopathy.
• Initial evaluation of a patient with a brain tumor.
• Initial treatment of a patient with brain hemorrhage (traumatic or spontaneous).
• Evaluation and treatment of a patient presenting with a seizure.
• Develop an understanding of the pharmacological treatment for routine neurological and neurosurgical disorders.
• Appropriate use of opioids in the treatment of acute pain (presenting and postoperative).
• Use of corticosteroids in treating brain edema.
• Endocrine replacement for patients with pituitary and hypothalamic dysfunction.
• Dehydrating and other agents used to reduce elevated ICP.
• Develop the habit of self-directed readings of the primary medical literature relating to clinically encountered problems.
• Research topics related to active patients in reference texts and journal articles.
• Critically assess the neurosurgical literature and apply to clinical problem in a selective and rational manner.
• Practice-based learning and improvement.

Residents must demonstrate the ability to investigate and evaluate their care of patients, to appraise and assimilate science evidence, and to continuously improve patient care based on consistent self-evaluation and lifelong learning.

Residents are expected engage in the following:

• Identify and perform appropriate learning activities.

• Learn to analyze their practice using quality improvement methods based on feedback.

• Incorporate feedback and formative evaluations into their daily practice.

• Locate, appraise and assimilate evidence from scientific studies related to their patients’ health problems.

• Use information technology to optimize learning.

• Apply neurological knowledge base and readings from current literature in developing care plans.

• Develop a critical and analytic approach for making clinical decisions.

• Use PubMed-based literature searches to enhance patient care.

• Assimilate clinical data and evaluate published studies in order to make lucid conference presentations (e.g., clinical care conferences, morbidity and mortality).

Residents must demonstrate interpersonal and communication skills that results in the effective exchange of information and collaboration with patients, their families and health professionals. Residents are expected to engage in the following:

• Develop communication skills in order to counsel inpatients and their families.

• Interact with families significantly and with sensitivity regarding end-of-life issues.

• Serve as the primary liaison to faculty.

• Serve as a role model and teach medical students.

• Work effectively with consultants from other services.

• Participate meaningfully in department didactic conferences.

• Formally present cases in didactic conferences.

• Team up with faculty members to present articles in journal club.

Residents must demonstrate a commitment to professionalism and an adherence to ethical principles. Residents are expected to engage in the following:

• Demonstrate compassion, integrity and respect for others.

• Be responsive to patient needs in a way that supersedes self-interest.

• Respect patient privacy and autonomy.

• Be accountable to patients, society and other professionals.

• Respect and be responsive to diverse patient populations including, but not limited to, diversity in gender, age, culture, race, religion, disabilities, national origin, socioeconomic status and sexual orientation.

• Be able to recognize and develop a plan for their own personal and professional well-being.

• Disclose and address conflict of interest or duality of interest.

• Show respect for colleagues by being on time for rounds and conferences.

• Attend all assigned conferences.

• Learn and begin to log procedures in the ACGME case log system.

Residents must demonstrate an awareness of and responsiveness to the larger context and system of health care, as well as the ability to call effectively on other resources in the system to provide optimal health care. Residents are expected engage in the following:

• Recognize and adapt to the differences in health care delivery systems in the different hospitals.

• Consider patient access to health care in designing treatment plans.

• Consider cost-effectiveness of care in a way that does not compromise the quality of patient care.

The goals and objectives of this rotation will be met by independent study by trainees, clinical teaching involving experience in both hospital and nonhospital settings under direct supervision and participation in the appropriate conference schedule.

The goals and objectives will be assessed by faculty members, allied health professionals and patients, the clinical competency committee and the program director. Milestones will be assessed by the committee as appropriate.

PGY-1 residents will be expected to display skills that meet the early patient care milestones in a variety of the subspecialty areas (e.g., brain tumor, traumatic brain Injury, spinal neurological surgery, pain and peripheral nerve disorders, vascular neurological surgery).

Though PGY-1 residents are not expected to achieve more advanced milestones, they will be assessed in the following areas:

• Information gathering and interpretation.
• Critical thinking for diagnosis and therapy.
• Patient safety.
• Quality improvement.
• Health care systems awareness.
• Evidence-based practice.
• Mentorship and teaching.
• Ethical behavior.
• Well-being.
• Interpersonal and Communication skills 1 (patient and family communication).
• Interpersonal and communication skills 2 (communication in coordination of care).

This will allow them to become used to the semi-annual evaluation and feedback process as well as to see the necessary trajectory over time to reach level 4 milestones in all areas.

This is an inpatient service on the combined neurology-neurosurgery service at Ascension Seton Medical Center Austin. It is mainly nonoperative, with procedures performed in the neurocritical care unit or ward rooms, with only occasional time spent in neurosurgical operating rooms. Time will be spent in neuropathology sessions in order to develop an understanding of the underlying pathological substrate of neurological diseases. Residents must be able to provide patient care that is compassionate, appropriate and effective for the treatment of health problems and the promotion of health.

Residents are expected to engage in the following:

• Participate in the day-to-day management of neurology, neurosurgery and neurocritical care patients.

• Develop expertise in neurology and neurocritical care procedures, initially under direct supervision and, after demonstrating adequate skills, under indirect supervision. Procedures include lumbar puncture and placement of lumbar subarachnoid drain and placement of arterial lines for blood pressure monitoring.

• Placement of central venous pressure lines for monitoring and for drug administration.

• Airway management, including placement of endotracheal tubes, managing ventilator settings and adjusting oxygen concentration for optimum tissue oxygenation.

• Cranial critical care procedures, including ICP monitor placement (e.g., externalventricular drain, pressure bolts).

• VP shunt tap/programming.

Residents must demonstrate medical knowledge of established and evolving biomedical, clinical, epidemiological and social behavioral sciences, as well as the application of this knowledge to patient care.

Residents are expected to engage in the following:

• Expand knowledge base in clinical neuroscience, with emphasis on neurological disorders and neurocritical care.

• Demonstrate knowledge of intracranial pressure management using all available tools.

• Demonstrate an ability to perform comprehensive and focused neurological examinations as appropriate for the neurological disorder of individual patients.

• Expand knowledge of neuropathology, including histopathological diagnosis of neurological and neurosurgical disorders.

• Develop the habit of self-directed readings of the primary medical literature relating to clinically encountered problems.

• Research topics related to active patients in reference texts and journal articles.

• Critically assess the neurosurgical literature and apply to clinical problem in a selective and rational manner.

Residents must demonstrate the ability to investigate and evaluate their care of patients, to appraise and assimilate science evidence, and to continuously improve patient care based on consistent self-evaluation and lifelong learning.

Residents are expected engage in the following:

• Identify and perform appropriate learning activities.

• Systematically analyze their practice using quality improvement methods.

• Implement changes with the goal of practice improvement.

• Incorporate feedback and formative evaluations into their daily practice.

• Locate, appraise and assimilate evidence from scientific studies related to their patients’ health problems.

• Use information technology to optimize learning.

• Apply neurological knowledge base and readings from current literature in developing care plans.

• Develop a critical and analytic approach for making clinical decisions.

• Use PubMed-based literature searches to enhance patient care and for teaching medical students and junior residents in basic care of patients.

• Analyze journal articles critically for practice use and for presentation in journal club.

Residents must demonstrate interpersonal and communication skills that results in the effective exchange of information and collaboration with patients, their families and health professionals. Residents are expected to engage in the following:

• Develop skill sets necessary to counsel inpatients and their families by observing more senior residents and faculty members on rounds.

• Interact with families significantly and with sensitivity regarding neurological and neurosurgical disorders, including end-of-life issues.

• Serve as the primary liaison to senior residents and faculty.

• Serve as a role model for medical students.

• Work effectively with consultants from other services.

• Interact with advance care providers in a team-based approach to care.

• Participate meaningfully in department didactic conferences.

• Formally present cases in didactic conferences.

• Team up with faculty members to present articles in journal club.

Residents must demonstrate a commitment to professionalism and an adherence to ethical principles. Residents are expected to engage in the following:

• Demonstrate compassion, integrity and respect for others.

• Be responsive to patient needs in a way that supersedes self-interest.

• Respect patient privacy and autonomy.

• Be accountable to patients, society and other professionals.

• Respect and be responsive to diverse patient populations including, but not limited to, diversity in gender, age, culture, race, religion, disabilities, national origin, socioeconomic status and sexual orientation.

• Be able to recognize and develop a plan for their own personal and professional well-being.

• Disclose and address conflict of interest or duality of interest.

• Show respect for colleagues by being on time for rounds and conferences.

Residents must demonstrate an awareness of and responsiveness to the larger context and system of health care, as well as the ability to call effectively on other resources in the system to provide optimal health care. Residents are expected engage in the following:

• Recognize and adapt to the differences in health care delivery systems in the different hospitals.

• Consider patient access to health care in designing treatment plans.

• Consider cost-effectiveness of care in a way that does not compromise the quality of patient care.

The goals and objectives of this rotation will be met by independent study by trainees and clinical teaching involving experience primarily in the hospital under direct supervision by faculty, with gradual transition to indirect supervision as milestones are reached. These goals and objectives will be assessed by faculty members, allied health professionals, patients, the clinical competency committee and the program director. Milestones will be assigned by the committee as appropriate.

PGY-1 residents will be expected to meet most, if not all level 1 milestones in neurocritical care. PGY-1 residents will also be expected to reach many of the case minimums in critical care procedures. Milestone assignments will be given in the following areas:

• Information gathering and interpretation.
• Critical thinking for diagnosis and therapy.
• Patient safety.
• Quality improvement.
• Health care systems awareness.
• Evidence-based practice.
• Mentorship and teaching.
• Ethical behavior.
• Well-being.
• Interpersonal and Communication skills 1 (patient and family communication).
• Interpersonal and communication skills 2 (communication in coordination of care).

This is a combined inpatient and outpatient rotation designed to introduce PGY-2 residents to the surgical management of cranial disorders. Residents must be able to provide patient care that is compassionate, appropriate and effective for the treatment of health problems and the promotion of health. Residents are expected engage in the following:

• Take appropriate histories, perform focused outpatient examinations and review radiological studies of patients being evaluated for cranial disorders.

• Begin to develop care plans including nonsurgical management of cranial disorders.

• Begin to develop surgical care plans for patients who fail to respond to appropriate nonsurgical treatments.

• Participate in the day-to-day management of patients with cranial disorders on the adult neurosurgical inpatient service.

• Organize presentations on patient care to the rounding team.

• Review radiological and laboratory studies with team members.

• Develop patient care plans for routine neurosurgical problems.

• Supervise medical students and junior residents in a team based approach.

• Develop initial technical skills in cranial operative procedures under direct supervision of senior residents and faculty members.

• Positioning of patients for cranial procedures.

• Registration of frame-based and frameless navigation systems.

• Craniotomy for brain tumors.

• Craniotomy for intracranial vascular lesions.

• Craniotomy for pain.

• Ventriculoperitoneal shunts.

• Gather essential information in a timely manner including performance of cranial-focused neurological examination.

• Synthesize acquired patient data and formulate a differential diagnosis and sequence critical actions for patient care.

• Begin to manage complications of cranial procedures.

Residents must demonstrate medical knowledge of established and evolving biomedical, clinical, epidemiological and social behavioral sciences, as well as the application of this knowledge to patient care. Residents are expected to engage in the following:

• Develop an introductory knowledge base in clinical neuroscience.

• Create a differential diagnosis for common cranial disorders.

• Brain tumors.

• Intracranial vascular disorders (e.g., aneurysm, AVM).

• Pain disorders treatable by cranial procedures (e.g., trigeminal neuralgia, others).

• Hydrocephalus (e.g., obstructive and communicating).

• Develop an understanding of the nonsurgical management of routine cranial disorders.

• Appropriate use of opioids in the treatment of acute pain (e.g. presenting and postoperative).

• Appropriate use of steroids to treat patients with brain edema.

• Medical management of patients with pain disorders.

• Use of anti-epileptic drugs to prevent and treat seizures.

• Use of radiation therapy, chemotherapy and other adjuvant treatments for brain lesions.

• Develop the habit of self-directed readings of the primary medical literature relating to clinically encountered problems.

• Research topics related to active patients in reference texts and journal articles.

• Critically assess the neurosurgical literature and apply to clinical problem in a selective and rational manner.

Residents must demonstrate the ability to investigate and evaluate their care of patients, to appraise and assimilate science evidence, and to continuously improve patient care based on consistent self-evaluation and lifelong learning.

Residents are expected engage in the following:

• Identify and perform appropriate learning activities.

• Learn to analyze their practice using quality improvement methods based on feedback.

• Incorporate feedback and formative evaluations into their daily practice.

• Locate, appraise and assimilate evidence from scientific studies related to their patients’ health problems.

• Use information technology to optimize learning.

• Apply neurological knowledge base and readings from current literature in developing care plans.

• Develop a critical and analytic approach for making clinical decisions.

• Use PubMed-based literature searches to enhance patient care.
• Assimilate clinical data and evaluate published studies in order to make lucid conference presentations (e.g., clinical care conferences, morbidity and mortality)

Residents must demonstrate interpersonal and communication skills that results in the effective exchange of information and collaboration with patients, their families and health professionals. Residents are expected to engage in the following:

• Develop skill sets necessary to counsel inpatients and their families.

• Interact with families significantly and with sensitivity regarding end-of-life issues.

• Serve as the primary liaison to senior residents and faculty.

• Serve as a role model and teach medical students.

• Work effectively with consultants from other services.

• Interact with advance care providers in a team-based approach to care.

• Participate meaningfully in department didactic conferences.

• Formally present cases in didactic conferences.

• Team up with faculty members to present articles in journal club.

Residents must demonstrate a commitment to professionalism and an adherence to ethical principles. Residents are expected to engage in the following:

• Demonstrate compassion, integrity and respect for others.

• Be responsive to patient needs in a way that supersedes self-interest.

• Respect patient privacy and autonomy.

• Be accountable to patients, society and other professionals.

• Respect and be responsive to diverse patient populations including, but not limited to, diversity in gender, age, culture, race, religion, disabilities, national origin, socioeconomic status and sexual orientation.

• Be able to recognize and develop a plan for their own personal and professional well-being.

• Disclose and address conflict of interest or duality of interest.

• Show respect for colleagues by being on time for rounds and conferences.

• Attend all assigned conferences.

• Log procedures in the ACGME case log system in a timely fashion.

Residents must demonstrate an awareness of and responsiveness to the larger context and system of health care, as well as the ability to call effectively on other resources in the system to provide optimal health care. Residents are expected engage in the following:

• Recognize and adapt to the differences in health care delivery systems in the different hospitals.

• Consider patient access to health care in designing treatment plans.

• Consider cost-effectiveness of care in a way that does not compromise the quality of patient care.

The goals and objectives of this rotation will be met by independent study by trainees and clinical teaching involving experience in both hospital and nonhospital settings under direct supervision by faculty and by participation in the appropriate conference schedule. These goals and objectives will be assessed by faculty members, allied health professionals, patients, the clinical competency committee and the program director. Milestones will be assigned by the committee as appropriate.

PGY-2 residents will be expected to display skills that meet most level 2 milestones and some level 3 milestones for brain tumors. PGY-2 residents will also be assessed in the following areas:

• Information gathering and interpretation.
• Critical thinking for diagnosis and therapy.
• Patient safety.
• Quality improvement.
• Health care systems awareness.
• Evidence-based practice.
• Mentorship and teaching.
• Ethical behavior.
• Well-being.
• Interpersonal and Communication skills 1 (patient and family communication).
• Interpersonal and communication skills 2 (communication in coordination of care).

Milestone assessments will be communicated at least semiannually and appropriate feedback will be directed towards the appropriate trajectory in order to reach level 4 milestones before graduation.

This is primarily an inpatient rotation with some outpatient evaluations designed to introduce PGY-2 residents to the surgical management of cranial traumatic disorders. Spine fractures and spinal cord injuries are mainly cared for on the spinal neurosurgery services. Residents must be able to provide patient care that is compassionate, appropriate and effective for the treatment of health problems and the promotion of health. Residents are expected engage in the following:

• Take appropriate histories, perform focused outpatient examinations and review radiological studies of patients being evaluated for traumatic disorders.

• Begin to develop care plans including nonsurgical management of neurotrauma disorders.

• Begin to develop surgical care plans for patients who fail to respond to appropriate nonsurgical treatments.

• Participate in the day-to-day management of patients with traumatic disorders on the adult trauma service.

• Organize presentations on patient care to the rounding team.

• Review radiological and laboratory studies with team members.

• Begin to develop patient care plans for patients with brain injuries.

• Supervise medical students and junior residents in a team-based approach.

• Develop initial technical skills necessary to treat patients with brain injuries using operative procedures under direct supervision of senior residents and faculty members.

• Positioning of patients for cranial procedures.

• Placement of intracranial pressure monitoring devices under indirect supervision of faculty members.

• Craniotomy for trauma (e.g., evacuation of hematomas, hemicraniectomy).

• Gather essential information in a timely manner including performance of cranial-focused neurological examination.

• Synthesize acquired patient data and formulate a differential diagnosis and sequence critical actions for patient care.

• Begin to manage complications of cranial procedures

Residents must demonstrate rudimentary medical knowledge of established and evolving biomedical, clinical, epidemiological and social behavioral sciences, as well as the application of this knowledge to patient care. Residents are expected to engage in the following:

• Develop an introductory knowledge base in clinical neuroscience, with an emphasis on cerebral edema, cerebral blood flow and electrolyte management.

• Create a differential diagnosis for common cranial disorders.

• Create a differential diagnosis for common cranial disorders.

• Concussion and post-concussive disorders.

• Acute and chronic subdural hematoma.

• Acute epidural hematoma.

• Brain contusion.

• Traumatic shear injury.

• Obstructive hydrocephalus.

• Develop an understanding of the nonsurgical management of routine traumatic disorders.

• Appropriate use of opioids in the treatment of acute pain (presenting and postoperative).

• Management of electrolytes in patients with brain injury including use of dehydrating agents to treat elevated intracranial pressure.

• Use of anti-epileptic drugs to prevent and treat seizures.

• Develop the habit of self-directed readings of the primary medical literature relating to clinically encountered problems.

• Research topics related to active patients in reference texts and journal articles.

• Critically assess the neurosurgical literature and apply to clinical problem in a selective and rational manner.

Residents must demonstrate the ability to investigate and evaluate their care of patients, to appraise and assimilate science evidence, and to continuously improve patient care based on consistent self-evaluation and lifelong learning.

Residents are expected engage in the following:

• Identify and perform appropriate learning activities.

• Learn to analyze their practice using quality improvement methods based on feedback.

• Incorporate feedback and formative evaluations into their daily practice.

• Locate, appraise and assimilate evidence from scientific studies related to their patients’ health problems.

• Use information technology to optimize learning.

• Apply neurological knowledge base and readings from current literature in developing care plans.

• Develop a critical and analytic approach for making clinical decisions.

• Use PubMed-based literature searches to enhance patient care.

• Assimilate clinical data and evaluate published studies in order to make lucid conference presentations (e.g., clinical care conferences, morbidity and mortality).

Residents must demonstrate interpersonal and communication skills that results in the effective exchange of information and collaboration with patients, their families and health professionals. Residents are expected to engage in the following:

• Develop communication skills necessary to counsel inpatients and their families.

• Interact with families significantly and with sensitivity regarding end-of-life issues.

• Serve as the primary liaison to senior residents and faculty.

• Serve as a role model and teach medical students.

• Work effectively with consultants from other services.

• Participate meaningfully in department didactic conferences.

• Formally present cases in didactic conferences.

• Team up with faculty members to present articles in journal club.

Residents must demonstrate a commitment to professionalism and an adherence to ethical principles. Residents are expected to engage in the following:

• Demonstrate compassion, integrity and respect for others.

• Be responsive to patient needs in a way that supersedes self-interest.

• Respect patient privacy and autonomy.

• Be accountable to patients, society and other professionals.

• Respect and be responsive to diverse patient populations including, but not limited to, diversity in gender, age, culture, race, religion, disabilities, national origin, socioeconomic status and sexual orientation.

• Be able to recognize and develop a plan for their own personal and professional well-being.

• Disclose and address conflict of interest or duality of interest.

• Show respect for colleagues by being on time for rounds and conferences.

• Attend all assigned conferences.

• Log procedures in the ACGME case log system in a timely fashion.

Residents must demonstrate an awareness of and responsiveness to the larger context and system of health care, as well as the ability to call effectively on other resources in the system to provide optimal health care. Residents are expected engage in the following:

• Recognize and adapt to the differences in health care delivery systems in the different hospitals.

• Consider patient access to health care in designing treatment plans.

• Consider cost-effectiveness of care in a way that does not compromise the quality of patient care.

The goals and objectives of this rotation will be met by independent study by trainees and clinical teaching involving experience in both hospital and nonhospital settings under direct supervision by faculty and by participation in the appropriate conference schedule. These goals and objectives will be assessed by faculty members, allied health professionals, patients, the clinical competency committee and the program director. Milestones will be assigned by the committee as appropriate.

PGY-2 residents will be expected to display skills that meet most level 2 milestones and some level 3 milestones for traumatic brain injury. PGY-2 residents will also be assessed in the following areas:

• Information gathering and interpretation.
• Critical thinking for diagnosis and therapy.
• Patient safety.
• Quality improvement.
• Health care systems awareness.
• Evidence-based practice.
• Mentorship and teaching.
• Ethical behavior.
• Well-being.
• Interpersonal and communication skills 1 (patient and family communication).
• Interpersonal and communication skills 2 (communication in coordination of care).

Milestone assessments will be communicated at least semiannually and appropriate feedback will be directed towards the appropriate trajectory in order to reach level 4 milestones before graduation.

This is a combined inpatient and outpatient rotation designed to build on the skills developed in the first two years of training and to focus on treating patients with functional disorders as delineated below. Residents will participate in multidisciplinary clinics and conferences as part of the evaluation and treatment teams for these disorders.

As functional disorders span the entire spectrum of age ranges, residents will participate in adult and pediatric evaluations and treatments in order to take advantage of the rich environment at two training sites (Ascension Seton Medical Center Austin and Dell Children’s Medical Center). Residents must be able to provide patient care that is compassionate, appropriate and effective for the treatment of health problems and the promotion of health. Residents are expected to engage in the following:

• Take appropriate histories, perform focused outpatient examinations and review radiological studies of patients being evaluated for functional disorders.

• Participate in multidisciplinary clinics with neurology and neuropsychology colleagues.

• Develop care plans including nonsurgical management of functional disorders.

• Develop surgical care plans for patients who fail to respond to appropriate nonsurgical treatments.

• Participate in weekly epilepsy and movement disorder conferences where team-based approaches to treatment are discussed.

• Present patients who are being considered for surgical management to the multidisciplinary team specific to the type of functional disorder.

• Participate in the day-to-day management of patients with functional disorders on the adult neurosurgical inpatient service.

• Organize presentations on patient care to the rounding team.

• Review radiological and laboratory studies with team members.

• Develop patient care plans for complications of functional surgical procedures.
• Develop technical skills in functional neurosurgical operative procedures under progressively less supervision of faculty members.

• Placement of stereotactic head frames for insertion of brain stimulating electrodes (movement disorders).

• Use of stereotactic devices (e.g., stereotactic frames, robotic devices, frameless stereotactic guidance) for a variety of functional disorders.

• Perform surgical procedures in the treatment of patients with movement disorders (e.g., cranial lesions, deep brain stimulating electrodes, placement and programming of pulse generators).

• Participate in surgical procedures for treatment of medically refractory epilepsy (e.g., brain electrodes for evaluation and treatment, vagus nerve stimulators, craniotomy for epilepsy).

• Placement of intraspinal catheters to treat patients with spasticity and painful conditions.

• Insertion and programming of pumps used to treat spasticity and pain.

• Gather essential information in a timely manner including performance of spine-focused neurological examination.

• Synthesize acquired patient data and formulate a differential diagnosis and sequence critical actions for patient care.

• Manage complications of spinal procedures.

• Serve as primary surgeon in most spinal neurosurgical procedures with direct supervision by faculty members.

Residents must demonstrate rudimentary medical knowledge of established and evolving biomedical, clinical, epidemiological and social behavioral sciences, as well as the application of this knowledge to patient care. Residents are expected to engage in the following:

• Develop a progressively advanced knowledge base in clinical neuroscience.

• Create a differential diagnosis for common and rare functional disorders.

• Parkinson’s disease and related movement disorders.

• Essential tremor and other disorders with tremor as a symptom.

• Epilepsy syndromes with particular attention to focal epilepsies that are treatable by surgery.

• Spasticity, either primary or acquired.

• Chronic pain syndromes including chronic neuropathic pain.

• Develop an understanding of the nonsurgical management of functional disorders.

• Appropriate use of opioids in the treatment of chronic pain in conjunction with pain management specialists.

• Medical management of patients with functional disorders (in multidisciplinary fashion with neurologists and psychologists).

• Referral for outpatient physical therapy including communication with physicians and therapists.

• Develop the habit of self-directed readings of the primary medical literature relating to clinically encountered problems.

• Research topics related to active patients in reference texts and journal articles.

• Critically assess the neurosurgical literature and apply to clinical problem in a selective and rational manner.

Residents must demonstrate the ability to investigate and evaluate their care of patients, to appraise and assimilate science evidence, and to continuously improve patient care based on consistent self-evaluation and lifelong learning.

Residents are expected engage in the following:

Identify and perform appropriate learning activities.

Learn to analyze their practice using quality improvement methods based on feedback.

Incorporate feedback and formative evaluations into their daily practice.

Locate, appraise and assimilate evidence from scientific studies related to their patients’ health problems.

Use information technology to optimize learning.

Apply neurological knowledge base and readings from current literature in developing care plans.

Develop a critical and analytic approach for making clinical decisions.

Use PubMed-based literature searches to enhance patient care.

Assimilate clinical data and evaluate published studies in order to make lucid conference presentations (e.g., clinical care conferences, morbidity and mortality).

Residents must demonstrate interpersonal and communication skills that results in the effective exchange of information and collaboration with patients, their families and health professionals. Residents are expected to engage in the following:

• Develop communication skills necessary to counsel inpatients and their families.

• Interact with families significantly and with sensitivity regarding end-of-life issues.

• Serve as the primary liaison to senior residents and faculty.

• Serve as a role model and teach medical students.

• Work effectively with consultants from other services.

• Participate meaningfully in department didactic conferences.

• Formally present cases in didactic conferences.

• Team up with faculty members to present articles in journal club.

Residents must demonstrate a commitment to professionalism and an adherence to ethical principles. Residents are expected to engage in the following:

• Demonstrate compassion, integrity and respect for others.

• Be responsive to patient needs in a way that supersedes self-interest.

• Respect patient privacy and autonomy.

• Be accountable to patients, society and other professionals.

• Respect and be responsive to diverse patient populations including, but not limited to, diversity in gender, age, culture, race, religion, disabilities, national origin, socioeconomic status and sexual orientation.

• Be able to recognize and develop a plan for their own personal and professional well-being.

• Disclose and address conflict of interest or duality of interest.

• Show respect for colleagues by being on time for rounds and conferences.

• Attend all assigned conferences.

• Log procedures in the ACGME case log system in a timely fashion.

Residents must demonstrate an awareness of and responsiveness to the larger context and system of health care, as well as the ability to call effectively on other resources in the system to provide optimal health care. Residents are expected engage in the following:

• Recognize and adapt to the differences in health care delivery systems in the different hospitals.

• Consider patient access to health care in designing treatment plans.

• Consider cost-effectiveness of care in a way that does not compromise the quality of patient care.

The goals and objectives of this rotation will be met by independent study by trainees and clinical teaching involving experience in both hospital and nonhospital settings under direct supervision by faculty and by participation in the appropriate conference schedule. These goals and objectives will be assessed by faculty members, allied health professionals, patients, the clinical competency committee and the program director. Milestones will be assigned by the committee as appropriate.

PGY-3 residents will be expected to display skills that meet most level 3 milestones and some level 4 milestones for surgical treatment of epilepsy and movement disorders, as well as pain and peripheral nerve disorders (emphasis on pain therapies). PGY-3 residents will also be assessed in the following areas:

• Information gathering and interpretation.
• Critical thinking for diagnosis and therapy.
• Patient safety.
• Quality improvement.
• Health care systems awareness.
• Evidence-based practice.
• Mentorship and teaching.
• Ethical behavior.
• Well-being.
• Interpersonal and communication skills 1 (patient and family communication).
• Interpersonal and communication skills 2 (communication in coordination of care).

Milestone assessments will be communicated at least semiannually and appropriate feedback will be directed towards the appropriate trajectory in order to reach level 4 milestones before graduation.

Residents must be able to provide patient care that is compassionate, appropriate and effective for the treatment of health problems and the promotion of health. Residents are expected to engage in the following:

• Direct the day-to-day management of a pediatric neurosurgical inpatient service.

• Supervise a junior resident and/or rotating medical students
• Manage outpatient care, including preoperative selection of surgical candidates, scheduling surgery, counseling of patients and postoperative care.

• Refine neurosurgical operative skills to include craniotomy for brain tumor spinal procedures including chiari decompressions, laminectomy fordysraphism.

• Laminectomy for spinal tumors, laminectomy for syringomyelia and correction of spinal deformity.

• Craniotomy for epilepsy.

• Critical care procedures, including ICP monitor placement, external ventricular drain, VP shunt tap/programming.

• Serve as primary surgeon for minor neurosurgical procedures and perform a significant majority of more complex procedures with direct supervision.

Residents must demonstrate rudimentary medical knowledge of established and evolving biomedical, clinical, epidemiological and social behavioral sciences, as well as the application of this knowledge to patient care. Residents are expected to engage in the following:

• Expand knowledge base in clinical neuroscience with emphasis on pediatric and developmental neurobiology.

• Demonstrate knowledge of age-appropriate developmental milestones.

• Determine age and weight adjusted medication regimens.

• Develop the habit of self-directed readings of the primary medical literature relating to clinically encountered problems.

• Research topics related to active patients in reference texts and journal articles.

• Critically assess the neurosurgical literature and apply to clinical problem in a selective and rational manner.

Residents must demonstrate the ability to investigate and evaluate their care of patients, to appraise and assimilate science evidence, and to continuously improve patient care based on consistent self-evaluation and lifelong learning.

Residents are expected engage in the following:

• Identify and perform appropriate learning activities.

• Systematically analyze their practice using quality improvement methods.

• Implement changes with the goal of practice improvement.

• Incorporate feedback and formative evaluations into their daily practice.

• Locate, appraise and assimilate evidence from scientific studies related to their patients’ health problems.

• Using information technology to optimize learning.

• Apply neurological knowledge base and readings from current literature to clinical practice.

• Develop a critical and analytic approach for making clinical decisions.

• Use PubMed-based literature searches to enhance patient care and for teaching medical students and junior residents in basic care of patients.

• Analyze journal articles critically for practical use and for presentation in journal club.

Residents must demonstrate interpersonal and communication skills that results in the effective exchange of information and collaboration with patients, their families and health professionals. Residents are expected to engage in the following:

• Develop communication skills necessary to counsel inpatients and their families.

• Interact with families significantly and with sensitivity regarding end-of-life issues.

• Serve as the primary liaison to senior residents and faculty.

• Serve as a role model and teach medical students.

• Work effectively with consultants from other services.

• Participate meaningfully in department didactic conferences.

• Formally present cases in didactic conferences.

• Team up with faculty members to present articles in journal club.
• Present detailed review of neurosurgical topics (resident seminar).

Residents must demonstrate a commitment to professionalism and an adherence to ethical principles. Residents are expected to engage in the following:

• Demonstrate compassion, integrity and respect for others.

• Be responsive to patient needs in a way that supersedes self-interest.

• Respect patient privacy and autonomy.

• Be accountable to patients, society and other professionals.

• Respect and be responsive to diverse patient populations including, but not limited to, diversity in gender, age, culture, race, religion, disabilities, national origin, socioeconomic status and sexual orientation.

• Be able to recognize and develop a plan for their own personal and professional well-being.

• Disclose and address conflict of interest or duality of interest.

• Show respect for colleagues by being on time for rounds and conferences.

• Attend all assigned conferences.

• Log procedures in the ACGME case log system in a timely fashion.

Residents must demonstrate an awareness of and responsiveness to the larger context and system of health care, as well as the ability to call effectively on other resources in the system to provide optimal health care. Residents are expected engage in the following:

• Recognize and adapt to the differences in health care delivery systems in the different hospitals.

• Consider patient access to health care in designing treatment plans.

• Consider cost-effectiveness of care in a way that does not compromise the quality of patient care.

The goals and objectives of this rotation will be met by independent study by trainees and clinical teaching involving experience in both hospital and nonhospital settings under direct supervision by faculty and by participation in the appropriate conference schedule. These goals and objectives will be assessed by faculty members, allied health professionals, patients, the clinical competency committee and the program director. Milestones will be assigned by the committee as appropriate.

PGY-3 residents will be expected to display skills that meet most level 3 milestones and some level 4 milestones in pediatric neurological surgery. PGY-3 residents will also be assessed in the following areas:

• Information gathering and interpretation.
• Critical thinking for diagnosis and therapy.
• Patient safety.
• Quality improvement.
• Health care systems awareness.
• Evidence-based practice.
• Mentorship and teaching.
• Ethical behavior.
• Well-being.
• Interpersonal and communication skills 1 (patient and family communication).
• Interpersonal and communication skills 2 (communication in coordination of care).

This is a combined inpatient and outpatient rotation designed to build on the skills developed in the first two years of training and to focus on treating patients with spinal disorders. Most of the care for patients with complex spine disorders (adult deformity/scoliosis) occurs in the outpatient spine center and inpatient spinal surgery service at Ascension Seton Medical Center Austin (site 1). This includes the multidisciplinary spine program that combines physical medicine and rehabilitation physicians, as well as physical and occupational therapists.

A multidisciplinary spine conference occurs weekly in order to share opinions and follow outcomes related to spine care. Spine surgery is performed by neurosurgeons and orthopaedic spine surgeons in a collaborative fashion. As peripheral nerve procedures are performed less often than spinal procedures, residents will prioritize these procedures in their schedule as needed to meet milestones and case minimums in peripheral nerves.

Residents must be able to provide patient care that is compassionate, appropriate and effective for the treatment of health problems and the promotion of health. Residents are expected to engage in the following:

• Take appropriate histories, perform focused outpatient examinations and review radiological studies of patients being evaluated for spinal disorders.

• Participate in multidisciplinary clinics with neurology and neuropsychology colleagues.

• Develop care plans including nonsurgical management of spinal disorders.

• Develop surgical care plans for patients who fail to respond to appropriate nonsurgical treatments.

• Participate in weekly spine conferences where team-based approaches to treatment are discussed.

• Present patients who are being considered for surgical management to the multidisciplinary team specific to the type of spinal disorder.

• Participate in the day-to-day management of patients with spinal disorders on the adult spine inpatient service.

• Organize presentations on patient care to the rounding team.

• Review radiological and laboratory studies with team members.

• Develop patient care plans for complications of spine surgical procedures.

• Develop technical skills in spine operative procedures under progressively less supervision of faculty members.

• Positioning of patients, performing initial exposure of the relevant part of the spine and registering stereotactic devices as needed.

• Anterior cervical approaches for decompression and stabilization.

• Posterior cervical approaches for decompression and stabilization.

• Interventional procedures for spinal conditions.

• Lumbar discectomy (various approaches)

• Complex deformity procedures that involve anterior and posterior approaches as developed in the surgical treatment plan.

• Use of spinal instrumentation as directed in the surgical care plan.

• Peripheral nerve procedures (e.g., carpal tunnel, ulnar decompression, peroneal nerve decompression).

• Gather essential information in a timely manner, including performance of spine-focused neurological examination.

• Synthesize acquired patient data and formulate a differential diagnosis and sequence critical actions for patient care.

• Serve as primary surgeon in most spinal neurosurgical procedures with direct supervision by faculty members.

• Supervise junior residents in basic aspects of spinal surgery.

Residents must demonstrate rudimentary medical knowledge of established and evolving biomedical, clinical, epidemiological and social behavioral sciences, as well as the application of this knowledge to patient care. Residents are expected to engage in the following:

• Develop a progressively advanced knowledge base in clinical neuroscience.

• Create a differential diagnosis for common and rare spinal disorders.

• Cervical and lumbar radiculopathy.

• Cervical and lumbar stenosis.

• Spinal fracture and spinal cord injury.

• Spinal tumors (e.g., intradural intramedullary, intradural extramedullary, extradural.

• Develop an understanding of the nonsurgical management of spinal disorders.

• Appropriate use of opioids in the treatment of acute pain (presenting and postoperative).

• Medical management of patients with acute spinal cord injury.

• Referral for outpatient physical therapy including communication with physicians and therapists.

• Develop an understanding of spine biomechanical principles as a way to determine the best surgical approach to a patient’s clinical problem.

• Research and implement medical treatments for osteoporosis in conjunction with endocrinologists.

• Develop the habit of self-directed readings of the primary medical literature relating to clinically encountered problems.

• Research topics related to active patients in reference texts and journal articles.

• Critically assess the neurosurgical literature and apply to clinical problem in a selective and rational manner.

Residents must demonstrate the ability to investigate and evaluate their care of patients, to appraise and assimilate science evidence, and to continuously improve patient care based on consistent self-evaluation and lifelong learning.

Residents are expected engage in the following:

• Identify and perform appropriate learning activities.

• Systematically analyze their practice using quality improvement methods.

• Implement changes with the goal of practice improvement.

• Incorporate feedback and formative evaluations into their daily practice.

• Locate, appraise and assimilate evidence from scientific studies related to their patients’ health problems.

• Using information technology to optimize learning.

• Apply neurological knowledge base and readings from current literature to clinical practice.

• Develop a critical and analytic approach for making clinical decisions.

• Use PubMed-based literature searches to enhance patient care and for teaching medical students and junior residents in basic care of patients.

• Analyze journal articles critically for practical use and for presentation in journal club.
• Assimilate clinical data and evaluate published studies in order to make lucid conference presentations (e.g., clinical care conferences, morbidity and mortality).

Residents must demonstrate interpersonal and communication skills that results in the effective exchange of information and collaboration with patients, their families and health professionals. Residents are expected to engage in the following:

• Develop communication skills necessary to counsel inpatients and their families.

• Interact with families significantly and with sensitivity regarding end-of-life issues.

• Serve as the primary liaison to senior residents and faculty.

• Serve as a role model and teach medical students.

• Work effectively with consultants from other services.

• Participate meaningfully in department didactic conferences.

• Formally present cases in didactic conferences.

• Team up with faculty members to present articles in journal club.

Residents must demonstrate a commitment to professionalism and an adherence to ethical principles. Residents are expected to engage in the following:

• Demonstrate compassion, integrity and respect for others.

• Be responsive to patient needs in a way that supersedes self-interest.

• Respect patient privacy and autonomy.

• Be accountable to patients, society and other professionals.

• Respect and be responsive to diverse patient populations including, but not limited to, diversity in gender, age, culture, race, religion, disabilities, national origin, socioeconomic status and sexual orientation.

• Be able to recognize and develop a plan for their own personal and professional well-being.

• Disclose and address conflict of interest or duality of interest.

• Show respect for colleagues by being on time for rounds and conferences.

• Attend all assigned conferences.

• Log procedures in the ACGME case log system in a timely fashion.

Residents must demonstrate an awareness of and responsiveness to the larger context and system of health care, as well as the ability to call effectively on other resources in the system to provide optimal health care. Residents are expected engage in the following:

• Recognize and adapt to the differences in health care delivery systems in the different hospitals.

• Consider patient access to health care in designing treatment plans.

• Consider cost-effectiveness of care in a way that does not compromise the quality of patient care.

The goals and objectives of this rotation will be met by independent study by trainees and clinical teaching involving experience in both hospital and nonhospital settings under direct supervision by faculty and by participation in the appropriate conference schedule. These goals and objectives will be assessed by faculty members, allied health professionals, patients, the clinical competency committee and the program director. Milestones will be assigned by the committee as appropriate.

PGY-3 residents will be expected to display skills that meet most level 3 milestones and some level 4 milestones for spinal neurological surgery, as well as pain and peripheral nerve disorders. PGY-3 residents will also be assessed in the following areas:

• Information gathering and interpretation.
• Critical thinking for diagnosis and therapy.
• Patient safety.
• Quality improvement.
• Health care systems awareness.
• Evidence-based practice.
• Mentorship and teaching.
• Ethical behavior.
• Well-being.
• Interpersonal and communication skills 1 (patient and family communication).
• Interpersonal and communication skills 2 (communication in coordination of care).

Milestone assessments will be communicated at least semiannually and appropriate feedback will be directed towards the appropriate trajectory in order to reach level 4 milestones before graduation.

This is a combined inpatient and outpatient rotation designed to introduce PGY-4 residents to the use of endovascular techniques to treat cranial and spinal disorders as a member of care teams. PGY-4 residents will begin with basic techniques and progress to more advanced catheter skills under the supervision of faculty members.

PGY-4 residents will already have much of the medical knowledge and technical skills required to treat disorders using open surgical techniques. This rotation will provide the resident with a unique set of endovascular skills. Residents must be able to provide patient care that is compassionate, appropriate and effective for the treatment of health problems and the promotion of health. Residents are expected to engage in the following:

• Take appropriate histories, perform focused outpatient examinations and review radiological studies of patients being evaluated for cranial and spinal disorders.

• Develop care plans that involve CNS-ES techniques as appropriate to the condition.

• Participate in the day-to-day management of patients treated with CNS-ES techniques as part of the entire care team.

• Organize presentations on patient care to the rounding team.

• Review radiological and laboratory studies with team members.

• Develop technical skills in CNS-ES procedures under direct supervision of faculty members.
  • Diagnostic cranial angiography.
  • Diagnostic spinal angiography.
  • Embolectomy for acute stroke.
  • Embolization techniques to treat cranial lesions (e.g., tumors, AVMs, fistulas).
  • Embolization of spinal lesions (e.g., tumors, fistulas).
  • Intraoperative angiography in support of open cranial vascular procedures (e.g., aneurysms, AVMs, fistulas).
  • Treatment of intracranial aneurysms using appropriate techniques (e.g., coils, stents).

• Gather essential information in a timely manner including performance of focused neurological examination.

• Synthesize acquired patient data and formulate a differential diagnosis and sequence critical actions for patient care.

• Manage complications of CNS-ES procedures under indirect and direct supervision of faculty members as skills progress.

Residents must demonstrate rudimentary medical knowledge of established and evolving biomedical, clinical, epidemiological and social behavioral sciences, as well as the application of this knowledge to patient care. Residents are expected to engage in the following:

• Develop an advanced knowledge base in clinical neuroscience as appropriate to cranial and spinal vascular pathology.

• Create a differential diagnosis for cranial and spinal vascular and tumor related disorders.

• Management of acute stroke using all non-invasive and invasive approaches.

• Vascular supply of brain tumors, AVMs and fistulas.

• Acquire knowledge on the natural history of cranial and spinal vascular disorders in order to apply or not apply appropriate CNS-ES treatment in an evidence-based approach.

• Develop an understanding of the nonsurgical management of vascular cranial and spinal disorders.

• Use of radiation therapy and other adjuvant treatments for brain lesions.

• Medical management of acute stroke in a comprehensive stroke center environment.

• Develop the habit of self-directed readings of the primary medical literature relating to clinically encountered problems.

• Research topics related to active patients in reference texts and journal articles.

• Critically assess the neurosurgical literature and apply to clinical problem in a selective and rational manner.

Residents must demonstrate the ability to investigate and evaluate their care of patients, to appraise and assimilate science evidence, and to continuously improve patient care based on consistent self-evaluation and lifelong learning. Residents are expected to engage in the following:

• Identify and perform appropriate learning activities.

• Learn to analyze their practice using quality improvement methods based on feedback.

• Incorporate feedback and formative evaluations into their daily practice.

• Locate, appraise, and assimilate evidence from scientific studies related to their patients’ health problems.

• Use information technology to optimize learning.

• Apply neurological knowledge base and readings from current literature in developing care plans.

• Develop a critical and analytic approach for making clinical decisions.

• Use PubMed-based literature searches to enhance patient care.

• Assimilate clinical data and evaluate published studies in order to make lucid conference presentations (clinical care conferences, morbidity and mortality).
• Contribute to the literature on the use of CNS-ES techniques to treat cranial or spinal disorder.

Residents must demonstrate interpersonal and communication skills that results in the effective exchange of information and collaboration with patients, their families, and health professionals. Residents are expected to engage in the following:

• Develop communication skills in order to counsel inpatients and their families.

• Interact with families significantly and with sensitivity regarding end-of-life issues.

• Serve as the primary liaison to faculty.

• Serve as a role model and teach medical students and junior residents.

• Work effectively with consultants from other services.

• Participate meaningfully in department didactic conferences.

• Formally present cases in didactic conferences.

• Team up with faculty members to present articles in journal club.

Residents must demonstrate a commitment to professionalism and an adherence to ethical principles. Residents are expected to engage in the following:

• Demonstrate compassion, integrity and respect for others.

• Be responsive to patient needs in a way that supersedes self-interest.

• Respect patient privacy and autonomy.

• Be accountable to patients, society and other professionals.

• Respect and be responsive to diverse patient populations including, but not limited to, diversity in gender, age, culture, race, religion, disabilities, national origin, socioeconomic status and sexual orientation.

• Be able to recognize and develop a plan for their own personal and professional well-being.

• Disclose and address conflict of interest or duality of interest.

• Show respect for colleagues by being on time for rounds and conferences.

• Attend all assigned conferences.

• Log procedures in the ACGME case log system in a timely fashion.

Residents must demonstrate an awareness of and responsiveness to the larger context and system of health care, as well as the ability to call effectively on other resources in the system to provide optimal health care. Residents are expected engage in the following:

• Recognize and adapt to the differences in health care delivery systems in the different hospitals.

• Consider patient access to health care in designing treatment plans.

• Consider cost-effectiveness of care in a way that does not compromise the quality of patient care.

The goals and objectives of this rotation will be met by independent study by trainees and clinical teaching involving experience in both hospital and nonhospital settings under direct supervision by faculty and by participation in the appropriate conference schedule. These goals and objectives will be assessed by faculty members, allied health professionals, patients, the clinical competency committee and the program director. Milestones will be assigned by the committee as appropriate.

PGY-4 residents will be expected to display skills that meet most level 3 milestones and some level 4 milestones for vascular neurological surgery, especially those that pertain to CNS-ES knowledge and technical skills. Residents will continue to add cases to their case logs, and in many areas will meet or exceed the case minimums for CNS-ES. PGY-4 residents will also be assessed in the following areas:

• Information gathering and interpretation.
• Critical thinking for diagnosis and therapy.
• Patient safety.
• Quality improvement.
• Health care systems awareness.
• Evidence-based practice.
• Mentorship and teaching.
• Ethical behavior.
• Well-being.
• Interpersonal and communication skills 1 (patient and family communication).
• Interpersonal and communication skills 2 (communication in coordination of care).

Milestone assessments will be communicated at least semiannually and appropriate feedback will be directed towards the appropriate trajectory in order to reach level 4 milestones before graduation.

This is a combined inpatient and outpatient rotation designed to introduce PGY-4 residents to the surgical management of cranial disorders. It will build on the foundational work of prior years and establish a firm understanding of cranial disorders that will allow the resident to transition to the leadership role of chief resident.

Residents must be able to provide patient care that is compassionate, appropriate and effective for the treatment of health problems and the promotion of health. Residents are expected to engage in the following:

• Take appropriate histories, perform focused outpatient examinations and review radiological studies of patients being evaluated for cranial disorders.

• Develop care plans including nonsurgical management of cranial disorders.

• Develop surgical care plans for patients who fail to respond to appropriate nonsurgical treatments or for conditions for which there are no effective nonsurgical treatments.

• Participate in the day-to-day management of patients with cranial disorders on the adult neurosurgical inpatient service.

• Organize presentations on patient care to the rounding team.

• Review radiological and laboratory studies with team members.

• Develop patient care plans for most cranial neurosurgical problems.

• Supervise medical students and junior residents in a team-based approach.

• Develop technical skills in cranial operative procedures under indirect and direct supervision of faculty members as skills progress.

• Positioning of patients and initial exposure of cranial contents appropriate to the lesion being treated.

• Use of frame-based and frameless navigation systems, including understanding the limitations of these techniques.

• Craniotomy for brain tumors.

• Craniotomy for intracranial vascular lesions.

• Craniotomy for pain.

• Ventriculoperitoneal shunts.

• Gather essential information in a timely manner, including performance of cranial-focused neurological examination.

• Synthesize acquired patient data and formulate a differential diagnosis and sequence critical actions for patient care.

• Manage complications of cranial procedures under indirect and direct supervision of faculty members as skills progress.

Residents must demonstrate rudimentary medical knowledge of established and evolving biomedical, clinical, epidemiological and social behavioral sciences, as well as the application of this knowledge to patient care. Residents are expected to engage in the following:

• Develop an advanced knowledge base in clinical neuroscience as appropriate to cranial pathology.

• Create a differential diagnosis for cranial disorders.

• Brain tumors — intra-axial, intracranial extra-axial including skull base.

• Intracranial vascular disorders (aneurysm, AVM).

• Pain disorders treatable by cranial procedures (trigeminal neuralgia, others).

• Hydrocephalus (obstructive and communicating).

• Develop an understanding of the nonsurgical management of routine cranial disorders.

• Appropriate use of opioids in the treatment of acute pain (presenting and postoperative).

• Appropriate use of steroids to treat patients with brain edema.

• Medical management of patients with pain disorders.

• Use of anti-epileptic drugs to prevent and treat seizures.

• Use of radiation therapy, chemotherapy and other adjuvant treatments for brain lesions.

• Develop the habit of self-directed readings of the primary medical literature relating to clinically encountered problems.

• Research topics related to active patients in reference texts and journal articles.

• Critically assess the neurosurgical literature and apply to clinical problem in a selective and rational manner.

Residents must demonstrate the ability to investigate and evaluate their care of patients, to appraise and assimilate science evidence, and to continuously improve patient care based on consistent self-evaluation and lifelong learning. Residents are expected to engage in the following:

• Identify and perform appropriate learning activities.

• Learn to analyze their practice using quality improvement methods based on feedback.

• Incorporate feedback and formative evaluations into their daily practice.

• Locate, appraise and assimilate evidence from scientific studies related to their patients’ health problems.

• Use information technology to optimize learning.

• Apply neurological knowledge base and readings from current literature in developing care plans.

• Develop a critical and analytic approach for making clinical decisions.

• Use PubMed-based literature searches to enhance patient care

• Assimilate clinical data and evaluate published studies in order to make lucid conference presentations (clinical care conferences, morbidity and mortality).

• Contribute to the literature on one or more cranial disorders.

Residents must demonstrate interpersonal and communication skills that results in the effective exchange of information and collaboration with patients, their families, and health professionals. Residents are expected to engage in the following:

• Develop communication skills in order to counsel inpatients and their families.

• Interact with families significantly and with sensitivity regarding end-of-life issues.

• Serve as the primary liaison to faculty.

• Serve as a role model and teach medical students and junior residents.

• Work effectively with consultants from other services.

• Participate meaningfully in department didactic conferences.

• Formally present cases in didactic conferences.

• Team up with faculty members to present articles in journal club.

Residents must demonstrate a commitment to professionalism and an adherence to ethical principles. Residents are expected to engage in the following:

• Demonstrate compassion, integrity and respect for others.

• Be responsive to patient needs in a way that supersedes self-interest.

• Respect patient privacy and autonomy.

• Be accountable to patients, society and other professionals.

• Respect and be responsive to diverse patient populations including, but not limited to, diversity in gender, age, culture, race, religion, disabilities, national origin, socioeconomic status and sexual orientation.

• Be able to recognize and develop a plan for their own personal and professional well-being.

• Disclose and address conflict of interest or duality of interest.

• Show respect for colleagues by being on time for rounds and conferences.

• Attend all assigned conferences.

• Log procedures in the ACGME case log system in a timely fashion.

Residents must demonstrate an awareness of and responsiveness to the larger context and system of health care, as well as the ability to call effectively on other resources in the system to provide optimal health care. Residents are expected engage in the following:

• Recognize and adapt to the differences in health care delivery systems in the different hospitals.

• Consider patient access to health care in designing treatment plans.

• Consider cost-effectiveness of care in a way that does not compromise the quality of patient care.

The goals and objectives of this rotation will be met by independent study by trainees and clinical teaching involving experience in both hospital and nonhospital settings under direct supervision by faculty and by participation in the appropriate conference schedule. These goals and objectives will be assessed by faculty members, allied health professionals, patients, the clinical competency committee and the program director. Milestones will be assigned by the committee as appropriate.

PGY-4 residents will be expected to display skills that meet most level 3 milestones and some level 4 milestones for brain tumors, epilepsy and movement disorders, and vascular neurological surgery. Residents will continue to add cases to their case logs, and in many areas will meet or exceed the case minimums for cranial procedures. PGY-4 residents will also be assessed in the following areas:

• Information gathering and interpretation.
• Critical thinking for diagnosis and therapy.
• Patient safety.
• Quality improvement.
• Health care systems awareness.
• Evidence-based practice.
• Mentorship and teaching.
• Ethical behavior.
• Well-being.
• Interpersonal and communication skills 1 (patient and family communication).
• Interpersonal and communication skills 2 (communication in coordination of care).

Milestone assessments will be communicated at least semiannually and appropriate feedback will be directed towards the appropriate trajectory in order to reach level 4 milestones before graduation.

Residents must be able to provide patient care that is compassionate, appropriate and effective for the treatment of health problems and the promotion of health. Residents are expected to engage in the following:

• Direct the day-to-day management of a pediatric neurosurgical inpatient service.

• Supervise a junior resident and/or rotating medical students.

• Manage outpatient care.
  • Preoperative selection of surgical candidates.
  • Scheduling surgery.
  • Counseling of patients.
  • Postoperative care.

• Refine neurosurgical operative skills.
  • Craniotomy for brain tumor spinal procedures, including chiari decompressions, laminectomy fordysraphism.
  • Laminectomy for spinal tumors, laminectomy for syringomyelia and correction of spinal deformity.
  • VP shunt.
  • Craniotomy for epilepsy.

• Critical care procedures, including ICP monitor placement, external ventricular drain, VP shunt tap/programming.

• Serve as primary surgeon for minor neurosurgical procedures and perform a significant majority of more complex procedures with direct supervision.

Residents must demonstrate rudimentary medical knowledge of established and evolving biomedical, clinical, epidemiological and social behavioral sciences, as well as the application of this knowledge to patient care. Residents are expected to engage in the following:

• Expand knowledge base in clinical neuroscience with emphasis on pediatric and developmental neurobiology.

• Demonstrate knowledge of age-appropriate developmental milestones.

• Determine age and weight adjusted medication regimens.

• Develop the habit of self-directed readings of the primary medical literature relating to clinically encountered problems.

• Research topics related to active patients in reference texts and journal articles.

• Critically assess the neurosurgical literature and apply to clinical problem in a selective and rational manner.

Residents must demonstrate the ability to investigate and evaluate their care of patients, to appraise and assimilate science evidence, and to continuously improve patient care based on consistent self-evaluation and lifelong learning.

Residents are expected engage in the following:

• Identify and perform appropriate learning activities.

• Systematically analyze their practice using quality improvement methods.

• Implement changes with the goal of practice improvement.

• Incorporate feedback and formative evaluations into their daily practice.

• Locate, appraise and assimilate evidence from scientific studies related to their patients’ health problems.

• Using information technology to optimize learning.

• Apply neurological knowledge base and readings from current literature to clinical practice.

• Develop a critical and analytic approach for making clinical decisions.

• Use PubMed-based literature searches to enhance patient care and for teaching medical students and junior residents in basic care of patients.

• Analyze journal articles critically for practical use and for presentation in journal club.

Residents must demonstrate interpersonal and communication skills that results in the effective exchange of information and collaboration with patients, their families and health professionals. Residents are expected to engage in the following:

• Develop communication skills necessary to counsel inpatients and their families.

• Interact with families significantly and with sensitivity regarding end-of-life issues.

• Serve as the primary liaison to senior residents and faculty.

• Serve as a role model and teach medical students.

• Work effectively with consultants from other services.

• Participate meaningfully in department didactic conferences.

• Formally present cases in didactic conferences.

• Team up with faculty members to present articles in journal club.
• Present detailed review of neurosurgical topics (resident seminar).

Residents must demonstrate a commitment to professionalism and an adherence to ethical principles. Residents are expected to engage in the following:

• Demonstrate compassion, integrity and respect for others.

• Be responsive to patient needs in a way that supersedes self-interest.

• Respect patient privacy and autonomy.

• Be accountable to patients, society and other professionals.

• Respect and be responsive to diverse patient populations including, but not limited to, diversity in gender, age, culture, race, religion, disabilities, national origin, socioeconomic status and sexual orientation.

• Be able to recognize and develop a plan for their own personal and professional well-being.

• Disclose and address conflict of interest or duality of interest.

• Show respect for colleagues by being on time for rounds and conferences.

• Attend all assigned conferences.

• Log procedures in the ACGME case log system in a timely fashion.

Residents must demonstrate an awareness of and responsiveness to the larger context and system of health care, as well as the ability to call effectively on other resources in the system to provide optimal health care. Residents are expected engage in the following:

• Recognize and adapt to the differences in health care delivery systems in the different hospitals.

• Consider patient access to health care in designing treatment plans.

• Consider cost-effectiveness of care in a way that does not compromise the quality of patient care.

The goals and objectives of this rotation will be met by independent study by trainees and clinical teaching involving experience in both hospital and nonhospital settings under direct supervision by faculty and by participation in the appropriate conference schedule. These goals and objectives will be assessed by faculty members, allied health professionals, patients, the clinical competency committee and the program director. Milestones will be assigned by the committee as appropriate.

PGY-4 residents will be expected to display skills that meet most if not all level 4 milestones in pediatric neurological surgery. PGY-4 residents will also be assessed in the following areas:

• Information gathering and interpretation.
• Critical thinking for diagnosis and therapy.
• Patient safety.
• Quality improvement.
• Health care systems awareness.
• Evidence-based practice.
• Mentorship and teaching.
• Ethical behavior.
• Well-being.
• Interpersonal and communication skills 1 (patient and family communication).
• Interpersonal and communication skills 2 (communication in coordination of care).

This is primarily an inpatient rotation with some outpatient evaluations designed to build on the trauma and critical care skills gained in preceding years. PGY-4 trauma residents will be expected to lead the cranial trauma team in a Level 1 trauma setting with faculty member backup. Spine fractures and spinal cord injury are mainly cared for on the spinal neurosurgery services. Residents must be able to provide patient care that is compassionate, appropriate and effective for the treatment of health problems and the promotion of health. Residents are expected to engage in the following:

• Take appropriate histories, perform focused examinations and review radiological studies of patients being evaluated for traumatic disorders.

• Develop care plans including nonsurgical management of neuro-trauma disorders.

• Develop surgical care plans for patients who fail to respond to appropriate nonsurgical treatments.

• Lead the adult trauma service care team in the day-to-day management of patients with traumatic disorders.

• Prioritize care as appropriate to the acute nature of traumatic brain injury.

• Synthesize all clinical data on patient care from junior members and advanced practice providers into appropriate care plans.

• Review radiological and laboratory studies with team members.

• Supervise junior residents and medical students in a team-based approach.

• Build on technical skills necessary to treat patients with brain injury under indirect supervision of faculty members including, craniotomy for trauma (e.g., evacuation of hematomas, hemicraniectomy).

• Supervise junior residents in placement of intracranial pressure monitoring devices under indirect supervision of faculty members.

• Gather essential information in a timely manner including performance of trauma-relevant neurological examination (e.g., Glasgow Coma Score, other relevant determinations).

Residents must demonstrate rudimentary medical knowledge of established and evolving biomedical, clinical, epidemiological and social behavioral sciences, as well as the application of this knowledge to patient care. Residents are expected to engage in the following:

• Develop an advanced knowledge base in clinical neuroscience especially as related to pathophysiology of brain injury, cerebral blood flow and electrolyte management.

• Create a differential diagnosis for all traumatic brain injury disorders.

• Concussion and post-concussive syndromes.

• Acute and chronic subdural hematoma.

• Complex craniofacial fractures in conjunction with other teams (otolaryngology, plastic surgery, ophthalmology).

• Acute epidural hematoma.

• Brain contusion.

• Traumatic shear injury.

• Obstructive hydrocephalus.

• Develop an understanding of the nonsurgical management of traumatic disorders.

• Appropriate use of opioids in the treatment of acute pain (presenting and postoperative).

• Management of electrolytes in patients with brain injury including use of dehydrating agents to treat elevated intracranial pressure.

• Use of anti-epileptic drugs to prevent and treat seizures.

• Develop the habit of self-directed readings of the primary medical literature relating to clinically encountered problems.

• Research topics related to active patients in reference texts and journal articles.

• Critically assess the neurosurgical literature and apply to clinical problem in a selective and rational manner.

Residents must demonstrate the ability to investigate and evaluate their care of patients, to appraise and assimilate science evidence, and to continuously improve patient care based on consistent self-evaluation and lifelong learning.

Residents are expected engage in the following:

• Identify and perform appropriate learning activities.

• Learn to analyze their practice using quality improvement methods based on feedback.

• Incorporate feedback and formative evaluations into their daily practice.

• Locate, appraise and assimilate evidence from scientific studies related to their patients’ health problems.

• Use information technology to optimize learning.

• Apply neurological knowledge base and readings from current literature in developing care plans.

• Develop a critical and analytic approach for making clinical decisions.

• Use PubMed-based literature searches to enhance patient care.

• Assimilate clinical data and evaluate published studies in order to make lucid conference presentations (e.g., clinical care conferences, morbidity and mortality).
• Contribute to the literature on treatment of cranial trauma.

Residents must demonstrate interpersonal and communication skills that results in the effective exchange of information and collaboration with patients, their families and health professionals. Residents are expected to engage in the following:

• Develop communication skills necessary to counsel inpatients and their families.

• Interact with families significantly and with sensitivity regarding end-of-life issues.

• Serve as the primary liaison to senior residents and faculty.

• Serve as a role model and teach medical students.

• Work effectively with consultants from other services.

• Participate meaningfully in department didactic conferences.

• Formally present cases in didactic conferences.

• Team up with faculty members to present articles in journal club.

Residents must demonstrate a commitment to professionalism and an adherence to ethical principles. Residents are expected to engage in the following:

• Demonstrate compassion, integrity and respect for others.

• Be responsive to patient needs in a way that supersedes self-interest.

• Respect patient privacy and autonomy.

• Be accountable to patients, society and other professionals.

• Respect and be responsive to diverse patient populations including, but not limited to, diversity in gender, age, culture, race, religion, disabilities, national origin, socioeconomic status and sexual orientation.

• Be able to recognize and develop a plan for their own personal and professional well-being.

• Disclose and address conflict of interest or duality of interest.

• Show respect for colleagues by being on time for rounds and conferences.

• Attend all assigned conferences.

• Log procedures in the ACGME case log system in a timely fashion.

Residents must demonstrate an awareness of and responsiveness to the larger context and system of health care, as well as the ability to call effectively on other resources in the system to provide optimal health care. Residents are expected engage in the following:

• Recognize and adapt to the differences in health care delivery systems in the different hospitals.

• Consider patient access to health care in designing treatment plans.

• Consider cost-effectiveness of care in a way that does not compromise the quality of patient care.

The goals and objectives of this rotation will be met by independent study by trainees and clinical teaching involving experience in both hospital and nonhospital settings under direct supervision by faculty and by participation in the appropriate conference schedule. These goals and objectives will be assessed by faculty members, allied health professionals, patients, the clinical competency committee and the program director. Milestones will be assigned by the committee as appropriate.

PGY-4 residents will be expected to display skills that meet most level 4 milestones for traumatic brain injury. Most cranial trauma-related case minimums will be achieved or exceeded. PGY-4 residents will also be assessed in the following areas:

• Information gathering and interpretation.
• Critical thinking for diagnosis and therapy.
• Patient safety.
• Quality improvement.
• Health care systems awareness.
• Evidence-based practice.
• Mentorship and teaching.
• Ethical behavior.
• Well-being.
• Interpersonal and communication skills 1 (patient and family communication).
• Interpersonal and communication skills 2 (communication in coordination of care).

Milestone assessments will be communicated at least semiannually and appropriate feedback will be directed towards the appropriate trajectory in order to reach level 4 milestones before graduation.

The PGY-5 year is mostly dedicated (protected) to research efforts related to the particular sub-specialty of interest to the resident. At the same time, there will be some clinical effort mainly to develop time management and other professional skills necessary to succeed in a clinician-scientist model of care.

Residents will take call, primarily on weekend “shifts” in order to maintain clinical skills while not interfering with research activities that are mainly occurring during weekdays. Goals and objectives for patient care are included to cover these occasional activities. Residents will be expected to attend all regular conferences and continue to advance in milestones while conducting research activities.

Residents must be able to provide patient care that is compassionate, appropriate and effective for the treatment of health problems and the promotion of health. Residents are expected to engage in the following:

• Occasionally participate in the management of patients on the adult neurosurgical inpatient service.

• Provide night coverage as appropriate to patient needs on the service.

• Review radiological and laboratory studies with team members.

• Develop patient care plans for routine neurosurgical problems.

• Provide a comprehensive sign-out to the inpatient care team.

• Provide operative neurosurgical care as required on an urgent or emergency basis as indicated by an evidence-based approach to care.

Residents must develop an advanced knowledge of the area in which they are doing research, including evolving biomedical, clinical, epidemiological and social behavioral sciences. Residents are expected to engage in the following:

• Develop an advanced knowledge base in basic, translational and clinical neuroscience.

• Research, design and implement a research study in conjunction with faculty mentors in neurological surgery and members of the appropriate related disciplines.

• Acquire the necessary knowledge to perform experiments as designed in conjunction with faculty mentors.

• Demonstrate data acquisition and analysis skills necessary to answer a hypothesis driven experiment.

• Synthesize relevant data into a set of conclusions based on the experimental design for the chosen research project.

• Develop the habit of self-directed readings of the scientific literature relating to the chosen area of research.

• Demonstrate an ability to write a scientific paper based on the chosen research project.

• Present the findings of the research project at institutional and national meetings.

Residents must demonstrate the ability to investigate and evaluate their care of patients, to appraise and assimilate science evidence, and to continuously improve patient care based on consistent self-evaluation and lifelong learning. Residents are expected to engage in the following:

• Identify and perform appropriate learning activities.

• Learn to analyze their practice using quality improvement methods based on feedback.

• Incorporate feedback and formative evaluations into their daily research activities.

• Locate, appraise and assimilate evidence from scientific studies related to their research project.

• Use information technology to optimize learning.

Residents must demonstrate interpersonal and communication skills that results in the effective exchange of information and collaboration with patients, their families, health professionals and research collaborators. Residents are expected to engage in the following:

• Develop communication skills in order to describe their rationale, execution and conclusions of their research efforts.

• Interact with students, technical assistants and faculty members in a respectful manner.

• Serve as a role model and teach medical students and other colleagues.

• Participate meaningfully in department didactic conferences.

• Formally present cases in didactic conferences.

• Team up with faculty members to present articles in journal club.

Residents must demonstrate a commitment to professionalism and an adherence to ethical principles. Residents are expected to engage in the following:

• Demonstrate compassion, integrity and respect for others.

• Be responsive to patient needs in a way that supersedes self-interest.

• Respect patient privacy and autonomy.

• Be accountable to patients, society and other professionals.

• Respect and be responsive to diverse patient populations including, but not limited to, diversity in gender, age, culture, race, religion, disabilities, national origin, socioeconomic status and sexual orientation.

• Be able to recognize and develop a plan for their own personal and professional well-being.

• Disclose and address conflict of interest or duality of interest.

• Show respect for colleagues by being on time for rounds and conferences.

• Attend all assigned conferences.

• Log procedures in the ACGME case log system in a timely fashion when on call.

Residents must demonstrate an awareness of and responsiveness to the larger context and system of health care, as well as the ability to call effectively on other resources in the system to provide optimal health care. Residents are expected engage in the following:

• Recognize and adapt to the differences in health care delivery systems in the different hospitals.

• Consider patient access to health care in designing treatment plans.

• Consider cost-effectiveness of care in a way that does not compromise the quality of patient care.

The goals and objectives of this rotation will be met by independent study by trainees and clinical teaching involving experience in both hospital and nonhospital settings under direct supervision by faculty and by participation in the appropriate conference schedule. These goals and objectives will be assessed by faculty members, allied health professionals, patients, the clinical competency committee and the program director. Milestones will be assigned by the committee as appropriate.

PGY-5 residents will be expected to display skills that meet the milestones in practice-based learning and improvement. PGY-5 residents will also be assessed in the following areas:

• Information gathering and interpretation.
• Critical thinking for diagnosis and therapy.
• Patient safety.
• Quality improvement.
• Health care systems awareness.
• Evidence-based practice.
• Mentorship and teaching.
• Ethical behavior.
• Well-being.

The chief residency year is divided into two six-month blocks based at the two main adult neurosurgery hospitals (site 1 and site 2). The overall goals and objectives are the same for the entire 12 months. This is a combined inpatient and outpatient rotation designed to provide clinical experience across the spectrum of adult neurological surgery. The chief resident has administrative responsibilities to coordinate care among all trainees at their respective hospitals as well as to organize relevant patient care and didactic conferences.

This year is not expected to be focused on subspecialty care (as will be the PGY-7 year). It is intended to provide exposure so that residents can achieve level 4 milestones in all clinical areas as well as to perform procedures most often as lead surgeon and reach or exceed case minimums in all areas. Residents must be able to provide patient care that is compassionate, appropriate and effective for the treatment of health problems and the promotion of health. Residents are expected to engage in the following:

• Take appropriate histories, perform focused outpatient examinations and review radiological studies of patients being evaluated for neurosurgical disorders.

• Develop care plans including nonsurgical management of cranial and spinal disorders.

• Supervise the day-to-day management of patients with cranial and spinal disorders on the adult neurosurgical inpatient service.

• Review radiological and laboratory studies with team members.

• Develop patient care plans for most cranial and spinal neurosurgical problems.

• Supervise medical students and junior residents in a team-based approach.

• Develop technical skills in cranial operative procedures under indirect and direct supervision of faculty members as skills progress.

• Craniotomy for brain tumors.

• Craniotomy for intracranial vascular lesions.

• Craniotomy for pain.

• Ventriculoperitoneal shunts.

• Anterior cervical approaches for decompression and stabilization.

• Posterior cervical approaches for decompression and stabilization.

• Interventional procedures for spinal conditions.

• Lumbar discectomy (various approaches).

• Complex deformity procedures that involve anterior and posterior approaches as developed in the surgical treatment plan.

• Use of spinal instrumentation as directed in the surgical care plan.

• Peripheral nerve procedures.

• Gather essential information in a timely manner including performance of focused neurological examination.

• Supervise junior residents, medical students and advanced practice providers in performing neurological examinations.

• Synthesize acquired patient data and formulate a differential diagnosis and sequence critical actions for patient care.

• Manage complications of neurosurgical procedures under indirect and direct supervision of faculty members as skills progress.

Chief residents must demonstrate advanced medical knowledge of established and evolving biomedical, clinical, epidemiological and social behavioral sciences, as well as the application of this knowledge to patient care. Residents are expected to engage in the following:

• Develop an advanced knowledge base in clinical neuroscience as appropriate to cranial and spinal pathology.

• Create a differential diagnosis for cranial and spinal disorders.

• Brain tumors — intra-axial, intracranial extra-axial, including skull base.

• Intracranial vascular disorders (aneurysm, AVM).

• Pain disorders treatable by cranial procedures (trigeminal neuralgia, others).

• Hydrocephalus (obstructive and communicating).

• Anterior cervical approaches for decompression and stabilization.

• Posterior cervical approaches for decompression and stabilization.

• Interventional procedures for spinal conditions.

• Lumbar discectomy (various approaches).

• Complex deformity procedures that involve anterior and posterior approaches as developed in the surgical treatment plan.

• Use of spinal instrumentation as directed in the surgical care plan.

• Develop an understanding of the nonsurgical management of cranial and spinal disorders.

• Appropriate use of opioids in the treatment of acute pain (presenting and postoperative).

• Appropriate use of steroids to treat patients with brain edema.

• Medical management of patients with pain disorders.

• Use of anti-epileptic drugs to prevent and treat seizures.

• Use of radiation therapy, chemotherapy and other adjuvant treatments for brain lesions.

• Maintain the habit of self-directed readings of the primary medical literature relating to clinically encountered problems that was developed in prior years.

• Research topics related to active patients in reference texts and journal articles.

• Critically assess the neurosurgical literature and apply to clinical problem in a selective and rational manner.

Residents must demonstrate the ability to investigate and evaluate their care of patients, to appraise and assimilate science evidence, and to continuously improve patient care based on consistent self-evaluation and lifelong learning. Residents are expected to engage in the following:

• Identify and perform appropriate learning activities.

• Learn to analyze their practice using quality improvement methods based on feedback.

• Incorporate feedback and formative evaluations into their daily practice.

• Locate, appraise and assimilate evidence from scientific studies related to their patients’ health problems.

• Use information technology to optimize learning.

• Apply neurological knowledge base and readings from current literature in developing care plans.

• Develop a critical and analytic approach for making clinical decisions.

• Use PubMed-based literature searches to enhance patient care

• Assimilate clinical data and evaluate published studies in order to make lucid conference presentations (clinical care conferences, morbidity and mortality).

• Contribute to the literature on one or more neurosurgical disorders.

Residents must demonstrate interpersonal and communication skills that results in the effective exchange of information and collaboration with patients, their families, and health professionals. Residents are expected to engage in the following:

Demonstrate communication skills necessary to counsel inpatients and their families.

Interact with families significantly and with sensitivity regarding end-of-life issues.

Serve as the primary liaison to faculty.

Serve as a role model and teach medical students and junior residents.

Work effectively with consultants from other services.

Participate meaningfully in department didactic conferences.

Organize conferences, including inviting residents and faculty members.

Formally present cases in didactic conferences.

Work with faculty members and program coordinator to organize the journal club.

Review cases listed for morbidity and mortality conference in advance a prepare junior residents to make presentations.

Residents must demonstrate a commitment to professionalism and an adherence to ethical principles. Residents are expected to engage in the following:

• Demonstrate compassion, integrity and respect for others.

• Be responsive to patient needs in a way that supersedes self-interest.

• Respect patient privacy and autonomy.

• Be accountable to patients, society and other professionals.

• Respect and be responsive to diverse patient populations including, but not limited to, diversity in gender, age, culture, race, religion, disabilities, national origin, socioeconomic status and sexual orientation.

• Be able to recognize and develop a plan for their own personal and professional well-being.

• Disclose and address conflict of interest or duality of interest.

• Show respect for colleagues by being on time for rounds and conferences.

• Attend all assigned conferences.

• Log procedures in the ACGME case log system in a timely fashion.

Residents must demonstrate an awareness of and responsiveness to the larger context and system of health care, as well as the ability to call effectively on other resources in the system to provide optimal health care. Residents are expected engage in the following:

• Recognize and adapt to the differences in health care delivery systems in the different hospitals.

• Consider patient access to health care in designing treatment plans.

• Consider cost-effectiveness of care in a way that does not compromise the quality of patient care.

The goals and objectives of this rotation will be met by independent study by trainees and clinical teaching involving experience in both hospital and nonhospital settings under direct supervision by faculty and by participation in the appropriate conference schedule. These goals and objectives will be assessed by faculty members, allied health professionals, patients, the clinical competency committee and the program director. Milestones will be assigned by the committee as appropriate.

PGY-6 chief residents will be expected to display skills that meet most level 4 milestones and some level 5 milestones in all areas. Residents will continue to add cases to their case logs and will likely meet or exceed the case minimums for all procedures. PGY-6 residents will also be assessed in the following areas:

• Information gathering and interpretation.
• Critical thinking for diagnosis and therapy.
• Patient safety.
• Quality improvement.
• Health care systems awareness.
• Evidence-based practice.
• Mentorship and teaching.
• Ethical behavior.
• Well-being.
• Interpersonal and communication skills 1 (patient and family communication).
• Interpersonal and communication skills 2 (communication in coordination of care).

Milestone assessments will be communicated at least semiannually and appropriate feedback will be directed towards the appropriate trajectory in order to reach level 4 milestones before graduation. By the end of the chief residency year, residents will be ready to enter a year of elective, subspecialty training based on interests developed during their previous rotations.

The PGY-7 year has much flexibility based on individual resident clinical and research interests. Goals and objectives will vary somewhat based on individual subspecialty choices, research interests and other career goals. These goals and objectives are necessarily generic for all PGY-7 residents with subspecialty goals not included, but to be developed uniquely for each resident prior to the PGY-7 year.

PGY-7 residents will be assigned clinical duties by the chief resident at the respective hospitals. The year can be divided into blocks if appropriate to the individual resident’s goals. Example: If a resident wants to specialize in functional/epilepsy, they may spend time at the adult and pediatric hospitals in order to gain knowledge and technical expertise across the spectrum of patients treated for epilepsy.

It is also likely that PGY-7 residents will divide time into clinical and research efforts in order to simulate a future clinician-scientist career where balancing these efforts is crucial to their success as junior faculty members. Residents must be able to provide patient care that is compassionate, appropriate and effective for the treatment of health problems and the promotion of health. Residents are expected to engage in the following:

• Take appropriate histories, perform focused outpatient examinations and review radiological studies of patients being evaluated for neurosurgical disorders.

• Develop care plans including nonsurgical management of cranial and spinal disorders.

• Review radiological and laboratory studies with team members.

• Develop patient care plans for most cranial and spinal neurosurgical problems.

• Supervise medical students and junior residents in a team-based approach.

• Develop technical skills in cranial and/or spinal operative procedures mainly under under indirect supervision of faculty members as skills progress (subspecialty specific procedural goals will be added as appropriate).

• Gather essential information in a timely manner including performance of focused neurological examination.

• Supervise junior residents, medical students and advanced practice providers in performing neurological examinations.

• Synthesize acquired patient data and formulate a differential diagnosis and sequence critical actions for patient care.

• Manage complications of neurosurgical procedures under indirect and direct supervision of faculty members as skills progress.

PGY-7 residents must demonstrate advanced medical knowledge of established and evolving biomedical, clinical, epidemiological and social behavioral sciences, as well as the application of this knowledge to patient care. Residents are expected to engage in the following:

• Develop an advanced knowledge base in clinical neuroscience as appropriate to cranial and/or spinal pathology (subspecialty specific knowledge base to be added as appropriate).

• Develop an understanding of the nonsurgical management of cranial and/or spinal disorders (subspecialty specific management goals to be added as appropriate).

• Maintain the habit of self-directed readings of the primary medical literature relating to clinically encountered problems that was developed in prior years.

• Research topics related to active patients in reference texts and journal articles.

• Critically assess the neurosurgical literature and apply to clinical problem in a selective and rational manner.

Residents must demonstrate the ability to investigate and evaluate their care of patients, to appraise and assimilate science evidence, and to continuously improve patient care based on consistent self-evaluation and lifelong learning. Residents are expected to engage in the following:

• Identify and perform appropriate learning activities.

• Learn to analyze their practice using quality improvement methods based on feedback.

• Incorporate feedback and formative evaluations into their daily practice.

• Locate, appraise and assimilate evidence from scientific studies related to their patients’ health problems.

• Use information technology to optimize learning.

• Apply neurological knowledge base and readings from current literature in developing care plans.

• Develop a critical and analytic approach for making clinical decisions.

• Use PubMed-based literature searches to enhance patient care.

• Assimilate clinical data and evaluate published studies in order to make lucid conference presentations (clinical care conferences, morbidity and mortality).

• Contribute to the literature on the chose subspecialty.

Residents must demonstrate interpersonal and communication skills that results in the effective exchange of information and collaboration with patients, their families, and health professionals. Residents are expected to engage in the following:

• Demonstrate communication skills in order to counsel inpatients and their families.

• Interact with families significantly and with sensitivity regarding end-of-life issues.

• Serve as the primary liaison to faculty.

• Serve as a role model and teach medical students and junior residents.

• Work effectively with consultants from other services.

• Participate meaningfully in department didactic conferences.

• Formally present cases in didactic conferences.

Residents must demonstrate a commitment to professionalism and an adherence to ethical principles. Residents are expected to engage in the following:

• Demonstrate compassion, integrity and respect for others.

• Be responsive to patient needs in a way that supersedes self-interest.

• Respect patient privacy and autonomy.

• Be accountable to patients, society and other professionals.

• Respect and be responsive to diverse patient populations including, but not limited to, diversity in gender, age, culture, race, religion, disabilities, national origin, socioeconomic status and sexual orientation.

• Be able to recognize and develop a plan for their own personal and professional well-being.

• Disclose and address conflict of interest or duality of interest.

• Show respect for colleagues by being on time for rounds and conferences.

• Attend all assigned conferences.

• Log procedures in the ACGME case log system in a timely fashion.

Residents must demonstrate an awareness of and responsiveness to the larger context and system of health care, as well as the ability to call effectively on other resources in the system to provide optimal health care. Residents are expected engage in the following:

• Recognize and adapt to the differences in health care delivery systems in the different hospitals.

• Consider patient access to health care in designing treatment plans.

• Consider cost-effectiveness of care in a way that does not compromise the quality of patient care.

The goals and objectives of this rotation will be met by independent study by trainees and clinical teaching involving experience in both hospital and nonhospital settings under direct supervision by faculty and by participation in the appropriate conference schedule. These goals and objectives will be assessed by faculty members, allied health professionals, patients, the clinical competency committee and the program director. Milestones will be assigned by the committee as appropriate.

PGY-7 residents will be expected to display skills that meet most level 5 milestones in their particular area of interest. They will continue to add cases to their case logs and will likely exceed the case minimums for all procedures in their subspecialty area. PGY-7 residents will also be assessed in the following areas:

• Information gathering and interpretation.
• Critical thinking for diagnosis and therapy.
• Patient safety.
• Quality improvement.
• Health care systems awareness.
• Evidence-based practice.
• Mentorship and teaching.
• Ethical behavior.
• Well-being.
• Interpersonal and communication skills 1 (patient and family communication).
• Interpersonal and communication skills 2 (communication in coordination of care).

By the end of the PGY-7 year, residents will be ready to enter a practice environment with the knowledge, skills and behaviors necessary to function autonomously. They will receive a final evaluation after appropriate review by the committee and program director. This evaluation will be shared with the PGY-7 resident and recorded in the permanent records of the department.