The PGY4 year is set aside as a research and academic support year. The research proposal submitted as a PGY2 may be a new project or may be a continuation of the previous effort by the preceding resident. The proposal contains a discussion of the background and bibliography for the project, the thesis that is proposed, and the reason why it is to be done, the research methodology and the method of analysis. The research project constitutes commitment from the resident. Equally, if not more importantly, the resident is expected to be familiar with the scientific process that is the basis for research. The Department of Neurosurgery maintains a Residency Education fund, which provides monies for resident research projects, i.e. purchase of animals, equipment, photography, and travel expenses. In addition to the research, the PGY4 may take call two times a month, is responsible for overseeing the once-a-week didactic Board Review course, the once-a-month selection of journal articles approved by one of our attendings for Journal Club, the preparation of the anatomy-cadaver dissection course that are 4-6 times an academic year. The PGY4 will give weekly intern/medical student lectures and incorporate a critical care course in the Simulation Laboratory for the medical
student(s), the General Surgery intern on the service and the neurosurgery residents PGY 1-3. The PGY4 will be available to the applicants on the day of the interview and for any follow-up questions the applicants may have. The PGY4 resident is required to take the “Review Course in Neurological Surgery,” a ten-day course offered by the National Center for Advanced Medical Education in Chicago and take the ABNS Primary Examination for credit.

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

• 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 the teaching of interns and medical students
• Lead in the Simulation Lab Critical Care modules teaching
• Take the ABNS Primary Examination for credit

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

• 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)

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
• Demonstrate improvements in clinical judgment, including the ability to recognize and learn from errors
• Attend the 10 day “Review Course in Neurological Surgery”
• 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:

• Present intern/medical student lectures in clear, concise manner appropriate to level of training
• 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

Professionalism
The resident(s) will be able to:

• 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

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

• Understand the importance of medical knowledge through research
• Understand the importance of research projects being done and the effect on healthcare in society
• 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 year is primarily for the development of bench and clinical research skills and to develop an understanding how to critically evaluate research data. The resident will spend the majority of their time in either Dr. Bakay’s or another researcher’s lab. In our basic science laboratory, the resident is overseen by a PhD with a background in stem cells development and culture, human umbilical cord blood cells, neurodegenerative disease and basic surgical techniques. Dr. Bakay is the Resident Research Director and he meets with the PGY4 at least once weekly on an individual basis and he meets with the PGY2-PGY4 along with other neuro scientists biannually to discuss and review the progress on various research projects. Minutes of the meeting are taken and placed in the resident’s folder.

The PGY4 prepares the weekly resident Board Review course chaired by Dr. Roy Bakay, using the followings books: Intensive Neurosurgery Board Review by Thomas Psarros and Shawn Moore and Definitive Neurological Surgery Board Review by Shawn Moore and Thomas Psarros and using the Board Review flash cards. The PGY4 also selects the journal articles for the monthly Journal Club, which is overseen by an assigned attending and prepares for the 4-6 spine or brain anatomy cadaver course, which are overseen by Drs. Sepehr Sani and Juan Jimenez. The PGY4 provides the medical students and interns on the service with a weekly lecture on the topics of neuro exam, brain tumors, stenosis, disc disease, spine trauma, cord compression, subarachnoid hemorrhage, aneurysms, AVMs, hydrocephalus, concussion, epidural hematoma, subdural hematoma and intracranial hematoma. The PGY4 also incorporates a critical care course in the Simulation Laboratory for the medical student(s), the General Surgery intern on the service and the neurosurgery residents PGY1-3.

The PGY4 is expected to continue self-directed learning as relevant to current cases and take the ABNS primary examination for credit.

PGY4 Competencies Evaluation Methods:

• 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