The PGY3 spends 12 months at Rush University Medical Center. During this time the PGY3 is given extensive exposure to all major neurosurgical procedures. One of these months is dedicated to endovascular neurosurgery in which the PGY3 will participate in all endovascular neurosurgery cases. On days when there are no endovascular procedures, the PGY3 resident will scrub on all operative neurosurgical cases. The PGY3 resident assists the chief resident in making the service run smoothly and also assists the PGY2 with ward work and consultations.

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

• Demonstrates a complex working knowledge of neuroanatomy and physiology.
• Define stereotactic radiosurgery
• Describe the difference between radiosurgery and radiation therapy
• Describe the potential indications and reported complications for radiosurgery
• Describe the anatomy of the mesial temporal lobe
• Define medically intractable epilepsy
• Describe different seizure types (partial, partial-complex, generalized, etc)
• Describe the pathophysiology of Parkinson’s disease and cerebellar tremor
• Describe the common causes of intracranial and intraspinal hemorrhage including: aneurysmal disease, vascular malformations, etc
• Describe the evaluation, medical and surgical treatment of common spinal pathologies
• Describe the evaluation and treatment of trigeminal neuralgia
• Describe indications for open versus endovascular treatment of cranial vascular disease
• Assist in endovascular procedures
• Participation in the Simulation Lab Critical Care Module
• Assist in the teaching of interns, medical students and the PGY1 and PGY2 residents
• Take the ABNS primary examination for self-assessment

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

• Demonstrate the ability to manage and prioritize with supervision, emergent neurosurgical complications on NICU and Ward patient
• Demonstrate the ability to obtain and evaluate proper radiological studies
• Demonstrate the ability to use sterile techniques and universal precautions
• Demonstrate the ability to assist at major surgical procedures under direct supervision., i.e. craniotomy for meningioma and metastasis, open and needle brain biopsy, CSF diversion shunt, lumbar laminectomy, lumbar fusion with instrumentation, cervical laminectomy, cervical fusion with instrumentation, and anterior cervical discectomy and fusion
• Discuss appropriate pre and post medical and surgical management for cervical, thoracic and lumber herniated discs
• Discuss appropriate pre and post medical and surgical management for cervical, thoracic and lumber spinal stenosis
• Discuss appropriate pre and post medical and surgical management for craniotomies for different types of neoplasms
• Discuss appropriate stereotactic frame placement in regard to target localization and purpose of the procedure (biopsy, craniotomy, functional radiosurgery)
• Demonstrate the ability to assist at and perform neurosurgical endovascular procedures

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

• Review health care journals and discuss implications of policy change to patient care
• 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
• Demonstrate improvements in clinical judgment, including the ability to recognize and learn from errors
• Utilizes 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 the 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, responsibility and enthusiasm
• Communicate effectively about our program and department with applicants interviewing for the Match
• Evaluate and make initial recommendations regarding consults to neurosurgery

Professionalism
The resident(s) will be able to:

• Attend daily neurosurgical 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
• Demonstrate respect for patients and colleagues from diverse cultural, ethnic and religious backgrounds
• Demonstrate honesty in all professional interactions
• Demonstrate appropriate dress and grooming style 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:

• 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
• Understand and discuss health care delivery systems, the economics of medicine and begin to learn Evaluation and Management Coding
• 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 (JCAHO, 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 the department of neurosurgery

In the operating room, 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 junior chief resident and the attending neurosurgeon on the case. On the one-month endovascular neurosurgery rotation, the PGY3 participates in all of the endovascular neurosurgery cases supervised by Dr. Demetrius Lopes, our endovascular neurosurgeon and Dr. Michael Chen, a neurointerventionalist, who has a conjoint faculty appointment in our department. On days when there are no endovascular neurosurgery cases the PGY3 resident will scrub on the other operative neurosurgical cases.

The PGY3 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 junior chief resident will supervise the PGY3 and reports directly to the attending and neurointensivist.

PGY3 Competencies Evaluation Methods:

• Twice a year electronic evaluation by neurosurgical attendings in MedHub
• Annual 360 degree electron evaluation by operating room nurses, ICU and ward nurses in MedHub
• 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 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