The PGY2 year consists of a nine-month clinical rotation in the NICU and in the ward on the Neurosurgical Service at Rush. This rotation focus is on the complex, interdisciplinary environment of a hospital-based state-of-the-art neurosurgical practice. The PGY2 is instructed in principles of systems-based practice that includes working with the health care team of neurointensivist, nurse-practitioners and nurses on the evaluation, neurological work-up and the medical management of the NSICU and ward patients. The PGY2 also learns the recognition and management of neurosurgical complications, including CSF leak, hydrocephalus, intracranial hypertension, spinal cord compression, seizure, cerebral edema, metabolic derangement and stroke.

The PGY2 will assist in the operating room whenever possible on major procedures and be expected to perform as a surgeon on minor neurosurgical procedures such as burr holes, shunts, peripheral nerve operations, basic craniotomies and stereotactic biopsies.

The PGY2 also spends one-half day per week in clinic evaluating outpatients with the program director, Dr. Vincent Traynelis. Second year residents select a research project and an advisor, either within the Department of Neurosurgery or a related discipline, or with certain exceptions, at a nearby institution. The resident presents a research proposal to the Director of Residency Research, Dr. Roy Bakay in preparation for his/her PGY4 research year.

The PGY2 will also complete a three-month rotation at Children’s Memorial Hospital. This rotation focus is to obtain more extensive knowledge and understanding of the pediatric patient presenting problems including trauma, hydrocephalus, intracranial problems, congenital spinal anomalies, craniosynostosis as well as understanding the laboratory studies and diagnostic imaging required to evaluate infants and children.

Medical Knowledge
The resident(s) will be able to:

• Demonstrate a working knowledge of neuroanatomy and physiology
• Describe the diagnosis of CSF leak after trauma, cranial surgery and spinal surgery
• Describe the common changes of metabolism and nutritional requirements of trauma patients and their evaluation
• Describe the clinical presentation, evaluation and treatment of infections which commonly occur in critical care neurosurgical patients
• Describe the common causes of intracranial and intraspinal hemorrhage, i.e. aneurysmal disease, vascular malformations, hypertension, vasculopathies, degenerative diseases, hemorrhagic arterial infarction and venous infarction
• Differentiate the basic categories of pain syndrome, i.e. acute, chronic, nociceptive (including complex regional pain syndromes), myofascial, cancer-related and postoperative
• Demonstrate ability to work effectively as an assistant in cranial & spinal surgery and performing basic neurosurgical procedures
• Participation in the Simulation Lab Critical Care modules
• Recognize the specific role of the pediatric neurosurgeon in the management of pediatric care and develop age appropriate interactions with children
• Learn to take appropriate histories with emphasis on development and recognition of the critical role of the mechanism of injury
• Begin to understand the differences in physiology across age groups in the young and the influence of neurosurgical interventions on them
• Describe evaluation and treatment of common pediatric neurosurgery pathology
• Develop an understanding of the spectrum of the central nervous system neurosurgical disease and disorders in the young
• Realize the importance for the necessity of close monitoring and reevaluation in the infant or child with a central nervous disorder
• Develop and understand the laboratory studies and diagnostic imaging required to evaluate infants
• Develop an understanding of the diagnosis and treatment of neurotrauma children
• Take the ABNS primary examination for self-assessment

Patient Care
The resident(s) will be able to:

• Demonstrate appropriate neurological work-up and patient management of NICU and ward patients.
• Demonstrate the ability to manage and prioritize with supervision, emergent neurosurgical complications on NICU and Ward patient
• Demonstrate the appropriate management of nutrition
• Demonstrate the ability to obtain and evaluate proper radiological studies
• Demonstrate the ability to perform basic neurosurgical operations under direct supervision: lumbar disc surgery, burr holes, CSF shunts (ventricular and lumbar), peripheral nerve operations, basic craniotomies and stereotactic biopsies
• Demonstrate the ability to perform basic bedside procedures: CSF shunt tap, lumbar puncture/lumbar drain placement, ventriculostomy, ICP/LICOS/perfusion monitors, arterial line placement, central venous access placement and endotracheal intubation
• Demonstrate the ability of out-patient neurosurgical medical history taking and physical examination
• Demonstrate the ability to use sterile techniques and universal precautions
• Assist and perform common pediatric neurosurgery operations

Practice-Based Learning and Improvement
The resident(s) will be able to:

• Locate, appraise and utilize scientific evidence related to the patient’s health problem
• Apply knowledge of study design and statistical methods to critically appraise the medical literature
• Facilitates the learning of students and other health care professionals
• Utilize CNS SANSwired, MedHub, GME-Today and other web-based tools
• Demonstrate critical self-assessment

Interpersonal and Communication Skills
The resident(s) will be able to:

• Communicate patient information and care plans effectively with patient and their families
• Communicate patient management plans to interns and medical students
• Communicate and work with the nursing and support staff to provide the best care for patients while building teamwork, and responsibility
• Communicate effectively with families of pediatric neurosurgery patients
• Communicate effectively with other members of the neurosurgical team

Professionalism
The resident(s) will be able to:

• Pre-round on ICU patients and present timely, accurate data to the team.
• Attend daily neurosurgery ward rounds on time
• Interact effectively with interns, medical students, nursing and discharge planners
• Maintain professional rapport with the patient, the patient’s families, nurses, other physician teams and other hospital personnel
• Demonstrate a compassionate, caring approach to patients and their families
• Prepare for scheduled operative cases by reviewing the patient’s records, films and reading about the pathophysiology and presentation of the patient’s disease process and reviewing the details of the planned surgical procedure
• Demonstrate respect for patients and colleagues from diverse cultural, ethnic and religious backgrounds
• Demonstrate honesty in all professional interactions
• Demonstrate appropriate dress and grooming consistent with institutional and departmental guidelines
• Comply with all GME and Departmental policies regarding duty hours restrictions
• Accurately self-report fatigue in situations that may compromise safety and/or patient care
• Maintain primary focus on patient’s concerns

System-Based Practice
The resident(s) will be able to:

• Understand the various health care systems presently available in this country
• Demonstrate a cost-effective approach to clinical care
• Participate in effective discharge planning with hospital personnel
• Participate in the planning of long term care of neurosurgery patients with social workers, physical therapists and nurse practitioners
• Understand the moral and ethical issues pertaining to critically ill patients including: patient or family requests to withhold or withdraw treatment and organ donation
• Understand the medical and legal definitions of brain death
• Participate and demonstrate an understanding of current trends in medical care by keeping up-to-date with reading of Medical Economics and MGMA
• Participate in quality assessment and improvement initiatives instituted by national organizations (HIPPA, etc)
• Participate in quality assessment and improvement initiatives instituted by the hospital and chief medical officer
• Participate in quality assessment and improvement initiatives instituted by department of neurosurgery

The PGY2 has the primary responsibility for the daily care and management of the NICU and ward patients and for any consults or emergency room calls. This includes all ICU based neurosurgical procedures with initial supervision and independently with back-up from the senior and/or chief resident. The PGY2 will observe and participate as appropriate with the patient and the patient’s families in providing updates, treatment plan, end-of-life discussions, brain death evaluations, organ donation information, discharge and follow-up planning. The chief resident will supervise the PGY2 and reports directly to the attending and neurointensivist. The PGY2 participates in three different sets of patient rounds, i.e. early morning supervisory rounds with the Dr. Byrne, morning rounds with the neurointensivist and rounds during the day with the attendings.

In the operating room, the PGY2 is supervised by the senior and chief resident and directly supervised by the attending on the case.

The PGY2 spends half a day a week in the out-patient clinic with the program director. The PGY2 meets the patient, perform a history and physical, evaluates the patient’s reports and/or studies, and provides a summary and treatment plan, either surgical or non-surgical to the program director for his discussion and approval.

The PGY2 attends the Thursday morning multidisciplinary rounds and all of the department’s weekly didactic teaching conferences. The PGY2 presents patient cases at Chairman’s conference and once a month, the PGY2 and a neurosurgery faculty member presents a critical care conference.

The pediatric neurosurgery rotation is done under the guidance of Dr. Tadanori Tomita, Yeager Professor and Chairman of the Division of Pediatric Neurosurgery at Children’s Memorial Hospital. Participation in the cases will be dictated by the resident’s ability and case complexity, with regard to both patient safety and learning experience with supervision by the chief resident and the attending neurosurgeon. The PGY2 resident will participate in the weekly pediatric brain tumor clinic and the craniosynostosis clinic, attend their teaching lectures and morbidity and mortality conferences.

PGY2 Competencies Evaluation Methods:

• Direct observation by Program director and attendings
• Twice a year electronic evaluation by neurosurgical attendings in MedHub
• Annual 360 degree electronic evaluation by operating room nurses, ICU and ward nurses, and out-patient clinic staff in MedHub
• Annual out-patient clinic evaluation by program director
• Annual Mock Orals
• ABNS Primary Examination results for self-assessment
• Annual self-evaluation
• Quarterly oral evaluations by attendings at a private conference portion of Department meeting
• Regular review of medical documentation in patient’s charts by neurosurgery attending(s)
• MedHub resident learning portfolio
• MedHub duty hours report/analysis
• MedHub conference attendance report/analysis
• Resident Research Project Report by Residency Research Director
• Graduation Day/Academic Day – Research Presentation
• End-of-Rotation review of all evaluations and data by Program director