The PGY4 spends 12 months at Rush University Medical Center as the intermediate level resident. During this time the PGY4 is given extensive exposure to all major neurosurgical procedures as either the surgeon or first assistant. One to three months are dedicated to endovascular neurosurgery and three months to pediatric neurosurgery. The PGY4 resident assists the chief resident in making the service run smoothly and also assists the PGY2 with ward work and consultations. Successful completion for credit of the primary examination of the American Board of Neurological Surgeons is required during the PGY4 year.

• 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
• Assist in the teaching of interns, medical students and NS1 (PGY2) residents
• 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
• Describe evaluation and treatment of common pediatric neurosurgery pathology
• Demonstrate detailed knowledge of post-operative complications and their avoidance in pediatric neurosurgery and pediatric neurosurgical trauma

• Demonstrate the ability to assist at and perform 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
• Assist and perform common pediatric neurosurgery operations

• 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
• Continue previous research efforts or produce for publication a journal article
• Utilizes CNS SANSwired, MedHub, GME-Today and other web-based tools
• Demonstrate critical self-assessment

• 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 and responsibility
• Evaluate and make initial recommendations regarding consults to neurosurgery
• Communicate effectively with families of pediatric neurosurgery patients

• 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
• 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

• 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
• Understand the important role neurosurgery plays in emergency care
• 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

The PGY4 is a senior resident on the service. On the three month endovascular neurosurgery rotation, the PGY4 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 and for the other six months the PGY4 resident will scrub on all operative neurosurgical cases. A three month 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 PGY4 resident will participate in the weekly pediatric brain tumor clinic and the craniosynostosis clinic, attend their teaching lectures and morbidity and mortality conferences. The PGY4 attends the AFIP Neuropathology course if he/she has not during their PGY3 year. The PGY4 is expected to continue self-directed learning as relevant to current cases and take the ABNS primary examination for credit.

• 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 Mock Orals
• ABNS Primary Examination results for Credit
• 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
• Graduation Day/Academic Day – Research Presentation
• End-of-Rotation review of all evaluations and data by Program director