RESIDENT HANDBOOK DEPARTMENT OF NEUROSURGERY UNIVERSITY OF UTAH
EDUCATIONAL PROGRAM NARRATIVE DESCRIPTION
Description of the Program 1. Introduction The University of Utah Health Sciences Center comprises the School of Medicine, University of Utah Medical Center (UUMC, which includes the University Hospital and the Huntsman Cancer Hospital), Primary Children's Medical Center (PCMC), and the Salt Lake VA Hospital. It is the major medical teaching complex in the Intermountain West, a large geographic area extending from the Canadian border to northern Arizona and from the Rocky Mountains to western Nevada. We serve as the major referral hospital complex for patients with neurological and neurosurgical diseases and provide primary neurosurgical care for many patients within Utah and the adjacent states. All of the hospitals, which are in close proximity to each other, offer advanced state-of-the-art technology and facilities. The physicians staffing the neurosurgical service are all full-time faculty at the School of Medicine and all are board certified or eligible. All of our faculty have specific subspecialty interests assuring the residents of exposure to the full scope of neurosurgical problems and procedures. We have individuals who focus their professional efforts and research on neuro-oncology, pituitary tumors, cerebrovascular disease, complex skull base surgery, pediatric neurosurgery, spine surgery and spinal instrumentation, neurotraumatology and neurointensive care, epilepsy and functional neurosurgery, and pain. Indeed, we believe that this balance, coupled with adequate volume, and the quality of the faculty are the main strengths of our program. The Department supports active laboratory research programs in neuro-oncology and skull base surgery. Residents and Department members actively participate in spinal biomechanics research in conjunction with our Orthopedic spine colleagues in the Orthopedic Biomechanics Lab. Clinical research in spine instrumentation, neuroendoscopy, hydrocephalus, subarachnoid hemorrhage, and neuro-oncology is also being carried out. Residents are given the opportunity to work in the research laboratory during their third year in neurosurgery and have an option for additional research time if they wish. The institution is especially strong in neuroscience research with many outstanding scientists, including those in the Howard Hughes Medical Institute and the Huntsman Cancer Institute. Our faculty often collaborate with, and residents may do their research in, these affiliated laboratories. The Department had a steady growth under the direction of Dr. M. Peter Heilbrun who assumed the leadership of the Division of Neurosurgery in 1983 and became chairman of the Department of Neurosurgery in 1992 after a national search. The elevation of neurosurgery to departmental status in November of 1992 (becoming the first new department in the University of Utah Medical School in 11 years) reflects the value and contributions of the neurosurgical faculty to the teaching, research, and service mission of the School of Medicine. Dr. William T. 2
Couldwell assumed the chairmanship in 2002 and is taking the department to the next level. He has already successfully recruited three new faculty members, increased clinical and academic productivity, and strongly supports resident education. The University of Utah residency program in neurological surgery is accredited for resident education in neurosurgery by the Accreditation Council For Graduate Medical Education (ACGME). The program is intended to prepare individuals to become fully competent and compassionate neurological surgeons. Individuals completing this program will be well prepared to practice neurosurgery, possessing the knowledge base and technical skills required by this specialty. Clinical competence requires: a. b. c. d. e. f. A solid foundation of basic and clinical knowledge. The ability to perform a thorough neurological and basic physical examination on the patient. The ability to know which diagnostic studies to order and to interpret the results accurately. Advanced technical abilities refined to a high level. Diligence and compassion in dealing with patients and their families. An attitude conducive to the practice of medicine including appropriate interpersonal interaction with patients, professional colleagues and supervisory faculty, and paramedical personnel. An unyielding commitment to ethical behavior and personal integrity.
The Department has endeavored to select residents who, by their prior performance, have demonstrated their intelligence, thirst for knowledge, commitment to neurosurgery, ethical integrity, and capacity and willingness to work hard. During training, each resident will be exposed to all aspects of neurosurgery. Residents are given graduated levels of responsibility throughout the training program. The rotation schedule is designed to facilitate a stepwise accrual of knowledge and expertise. Residents also will have the opportunity to engage in scientific research. This research experience teaches the scientific method and critical scientific reasoning, preparing our graduates to evaluate future advances in the specialty. For individuals desiring an academic career, the research experience offers the opportunity to acquire knowledge and techniques that they may use in the future and positions them for future leadership roles in neurosurgery.
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During this year the resident functions as the Chief Resident in charge of the service and doing a high volume of surgical cases. During this year. Residents participate in relevant course work at the University of Utah School of Graduate Medicine. spine. NS4 (PGY5) . During this year the resident functions as the Chief Resident in charge of the service and doing a high volume of surgical cases. NS5 (PGY6) . pediatric neurosurgery.2. NS2 (PGY3) . Clinical Pediatric Neurosurgery at PCMC (6 months).Chief resident at the UUMC (12 months).Senior resident on Clinical Neurosurgery at the UUMC (6 months) and Clinical Pediatric Neurosurgery at PCMC (6 months). the resident’s NS1 – NS2 (PGY2 – PGY3) rotations are as above but the rest of their residency is as follows: NS3 (PGY4 and PGY5) .Chief resident at the UUMC (12 months). the resident is a junior member of the housestaff participating in patient care on the Adult Neurosurgery Service. Extra Research Year (optional) . During this rotation the residents are involved in the care of children with neurosurgical disorders along with a senior resident and a pediatric neurosurgery fellow. During the Neurosurgery ICU time their primary responsibility is to the ICU but they may go to the operating room when on call and as the service allows. NS5 (PGY7) .Research (24 months). Here residents are introduced to the full spectrum of adult neurosurgical disorders. The residents who choose to complete a second research year usually do so in order to conduct more involved research than can be accomplished in one year. This optional additional year has been chosen by two of our current residents. 5
. skull base. Several options for laboratory and/or clinical research in neuro-oncology. The options are the same as those listed above but specific areas of interest have been accommodated. and clinical trials are available during this year.Research (12 months).Senior resident on Clinical Neurosurgery at the UUMC (6 months) and Clinical Pediatric Neurosurgery at PCMC (6 months). and several have earned graduate degrees. NS3 (PGY4) . During this time.Neurosurgical Intensive Care at the UUMC (6 month).We allow residents to do an additional year of research if they wish. The other 6 months are focused on neuro-oncology (at Huntsman Cancer Hospital and UUMC) and peripheral nerve problems (outpatient clinics and outpatient surgery at the VA Medical Center). If they chose to do this. they begin their study of neuropathology. During this time the resident is responsible for the care of the patients in the Neurosurgical Intensive Care Unit in conjunction with the other residents on the clinical service.Clinical Neurosurgery at the UUMC (6 months). NS4 (PGY6) . They have a one-in-three call rotation from home and obtain inpatient and outpatient emergency department and surgical experience.
Rotations NS1 (PGY2) .
12 months in research. Medical Knowledge • Localize lesions within the nervous system. raised intracranial pressure. intracranial hemorrhage. • Describe common neurosurgical operations. independent reading. Neurology (3 months) is done during internship. hydrocephalus). based on the clinical findings.The residents therefore spend 36 months in clinical neurosurgery. 6 months in neurocritical care. opening and closing of simple craniotomies. and providing pre. progressing to "opening and closing" and then assuming more responsibility as their skills grow. There also is a resident clinic in which patients are evaluated by the resident and then discussed with the staff.and postoperative care in the neurosurgical intensive care unit and on the hospital floor. Assisting in the OR is rotated among the junior residents so that patient care out of the OR is neither neglected nor de-emphasized. Residents have the option of an additional research year. The residents follow these patients postoperatively in their clinic as well. • Develop a solid foundation of knowledge of the commonly encountered neurosurgery disorders.
. Junior residents also answer consultation requests from other services and the emergency room and present these patients to the appropriate staff person. • Assist in major surgical procedures and perform those portions of such procedures (under supervision) that are appropriate for level of training. They are at all times supervised by more senior residents and the faculty. By the end of the NS – 1 year the resident is expected to: Patient Care • Perform and document comprehensive Neurosurgery history and physical examination • Select and interpret appropriate investigations (laboratory studies and imaging) • Perform selected surgical procedure under direct supervision (lumbar discectomies. assisting in their surgery. place ICP monitors and EVDs). In the operating room. • Perform initial resuscitation of patients who are critically ill with neurosurgical problems (coma. daily rounds with the senior residents and the staff. head injury. The duties of the residents in each year NS-1 residents are responsible for evaluating all patients coming through the outpatient surgery department for admission prior to surgery. • Demonstrate knowledge of the anatomy and physiology relevant to clinical neurosurgery. and regular conferences. they learn how to "set up" a case and how to assist. They learn the basics of neurological evaluation and increase their knowledge about diseases affecting the nervous system from exposure to a wide variety of problems. • Generate an appropriate differential diagnosis. 3. and 6 months in neuro-oncology/peripheral nerve.
• Assist in major surgical procedures and perform those portions of such procedures (under supervision) that are appropriate for level of training. • Manage patients who are critically ill with neurosurgical problems throughout their NCC stay (coma. ACDF approach.Practice-Based Learning and Improvement • Attend M&M conference. the NS-2 resident is expected to: Patient Care • Perform and document comprehensive pediatric neurosurgery history and physical examination. • Select and interpret appropriate investigations (laboratory studies and imaging).
. • Perform selected surgical procedures under direct supervision (craniotomy for metastasis. Professionalism • Demonstrate a high level of professionalism at all times. families. raised intracranial pressure. • Provide clear unambiguous information to other health care workers. The other six months are spent as the junior resident at PCMC performing essentially the same duties as the NS-1 resident at the UUMC. The NS-2 residents in their six months at UUMC are responsible for running the neurosurgical intensive care unit. intracranial hemorrhage. they can be allowed more operative responsibility however. In addition to the goals/objectives of the previous years. Because of their increasing experience. head injury. spinal cord injury. lumbar laminectomy). ventilator management. • Demonstrate critical appraisal skills when using the medical literature. • Develop excellent interpersonal and communication skills (verbal and written). They in turn are supervised by the senior residents and faculty. nutrition). colleagues and ancillary health professionals. craniotomy for trauma. This rotation allows the resident more time to read and study than in the NS-1 year but still provides intraoperative experience when on call and as the service allows. hydrocephalus. System-Based Practice • Demonstrate an awareness of the variety of systems within which health care is provided. • Review personal involvement in M&M cases with faculty and describe the changes they will make in patient care. VP shunt insertion. They supervise and teach the NS-1 residents in regard to neurointensive care. • Demonstrate the ability to accurately and concisely document and report findings and a plan of treatment. vasospasm. • Describe treatment options and their pros and cons. Interpersonal and Communication Skills • Provide compassionate patient care as determined by patients.
• Demonstrate the ability to accurately and concisely document and report findings and a plan of treatment. The NS-3 residents spend their year focused primarily on research. • Demonstrate a detailed knowledge of neurosurgical intensive care disorders and management. and ancillary health professionals. During the NS-3 year the residents also gain further exposure to neuropathology. They function as junior residents and are on call with/supervised by a senior resident and faculty member. Practice-Based Learning and Improvement • Learn from previous research and research performed on this rotation. and based on that. They are encouraged to work either in the departmental laboratories or in other research laboratories at our institution so that they can continue to participate in teaching conferences. • Demonstrate critical appraisal skills when using the medical literature. This is approximately every third or fourth weekend. Professionalism • Demonstrate a high level of professionalism at all times. • Demonstrate knowledge of common pediatric neurosurgical disorders. In addition to the goals/objectives of the previous years. • Provide clear unambiguous information to other health care workers. families. • Review personal involvement in M&M cases with faculty and describe the changes they will make in patient care. • Develop excellent interpersonal and communication skills (verbal and written). Medical Knowledge • Acquire an in depth knowledge of the literature relevant to their research.
. plan/suggest future experiments.Medical Knowledge • Demonstrate familiarity with current neurosurgical literature. • Learn the necessary techniques for the research. the PGY4 resident is expected to: Patient Care • Develop an appropriate plan for the research rotation. Practice-Based Learning and Improvement • Attend M&M conference. The NS-3 residents also participate in the weekend call rotation at the UUMC. • Complete research tasks on time. System-Based Practice • Discuss the most cost efficient options for patient investigation and treatment. colleagues. Interpersonal and Communication Skills • Provide compassionate patient care as determined by patients.
split Sylvian fissure.Interpersonal and Communication Skills • Present/describe the research so that other residents/faculty can understand it. pterional craniotomy and exposure of ICA. • Perform selected surgical procedures under direct supervision (for example. The volume of cases is such that each can either be first assistant or primary operating surgeon as appropriate on a large number of pediatric cases. • Understand the potential implications of the research on health care delivery. The NS-4 residents spend six months as senior resident at the UUMC. Medical Knowledge • Demonstrate detailed knowledge of the current neurosurgical literature. • Understand the cost of conducting the research. insertion of VNS. • Teach/mentor PGY2/3 residents. • Demonstrate a detailed knowledge of complex neurosurgical disorders.
. The other six months are spent as senior resident at PCMC. System-Based Practice • Be aware of the clinical relevance of the research. • Select and interpret appropriate investigations (laboratory studies and imaging). • Describe treatment options and their pros and cons. the NS-4 resident is expected to: Patient Care • Teach a comprehensive neurosurgery history and physical examination. • Demonstrate detailed knowledge of complex neurosurgical procedures. • Adhere to ethical principles of animal care and experimentation (if appropriate). craniotomy for glioma. They share weekend senior resident call at the UUMC every third or fourth weekend and take occasional junior resident call. They also participate in outpatient clinics with pediatric neurosurgery attendings. closure of myelomeningocele. lumbar laminectomy. • Begin to direct in/outpatient care. In addition to the goals/objectives of the previous years. There they supervise the junior resident and share the operative experience with the pediatric neurosurgery fellow. • Adhere to ethical principles of research conduct. repair of sagittal synostosis. Professionalism • Work well independently. During this time the resident is a senior member of the Neurosurgical housestaff. craniotomy for trauma in an acutely ill patient. posterior cervical stabilization). microdiscectomy. • Teach residents/interns/students selected noncomplex surgical procedures appropriate to their level of training. They begin to direct patient care and supervise junior residents in preparation for the PGY6 (chief) year. • Assist in major surgical procedures and perform those portions of such procedures (under supervision) that are appropriate for level of training. ACDF.
• Manage and administrate the complexities of a large clinical and academic service. an understanding of the literature. • Provide clear unambiguous information to other health care workers. The NS-5 year is spent as chief resident at the UUMC. Interpersonal and Communication Skills • Provide compassionate patient care as determined by patients.Practice-Based Learning and Improvement • Attend M&M conference. work rounds. the NS-5 resident is expected to: Patient Care • Demonstrate the ability to perform all general neurosurgical procedures. • Participate actively and lead conferences in a manner that demonstrates a high level of global awareness regarding clinical neurosurgery. problem solving skills and technical skills. Medical Knowledge • Instruct and nurture junior residents in critical care related procedures. academic and clinical growth and development of junior residents. The chief resident also supervises the junior residents and coordinates the entire service including teaching. • Review personal involvement in M&M cases with faculty and describe the changes they will make in patient care. etc. call. • Manage and lead the patient care conference. • Demonstrate the highest level of patients care skills. applied research. • Demonstrate the ability to accurately and concisely document and report findings and a plan of treatment. • Assist program director in overseeing personal. families.
. The chief resident also has significantly expanded operative experience. • Demonstrate the ability to teach effectively. The chief resident is responsible for the administration of the service and oversees the smooth functioning of the operating room schedule. • Demonstrate critical appraisal skills when using the medical literature. and conferences. In addition to the goals/objectives of the previous years. intensive care unit. neurosurgical education and program building. • Understand and consider the health care costs of their management decisions. colleagues and ancillary health professionals. • Develop excellent interpersonal and communication skills (verbal and written). System-Based Practice • Demonstrate an understanding of different types of neurosurgical practice and their pros and cons. Professionalism • Demonstrate a high level of professionalism at all times.
• Demonstrate a high level of understanding regarding practice types. colleagues and ancillary health professionals. The neurosurgical staff see their private patients here and staff the resident's clinic as well. Interpersonal and Communication Skills • Demonstrate a high level of interpersonal communication skills. The neurosurgical service at UUMC has its own 11-bed neurointensive care unit. A new part of the UUMC is the Huntsman Cancer Hospital. and demonstrate high level leadership skills. which is shared with neurology. Outpatient and inpatient facilities a. • Develop skills as program builder and an administrator of the neurosurgical service.Practice-Based Learning and Improvement • Manage and administrate the complexities of a large clinical and academic service. This is a level I trauma center with 434 acute care beds and an excellent aeromedical transfer service. 4. • Incorporate evidenced-based methodologies on an ongoing basis to the clinical practice of neurosurgery. burn. When necessary. nurture. neurosurgery patients can and do overflow into the surgical. as well as a dedicated 28-bed ward adjacent to the ICU. University of Utah Medical Center (UUMC) UUMC was built in 1981 and is the major teaching hospital of the University of Utah. medical economics and medical politics. A 11
. Professionalism • Demonstrate a high level of professionalism at all times. • Develop. • Demonstrate the ability to accurately and concisely document and report findings and a plan of treatment. The outpatient clinic at UUMC is dedicated to neurosurgery five days per week. medical. or cardiac intensive care units and to other surgical wards while remaining on our service. Collegiality and cooperation among services is the rule rather then the exception. • Develop and demonstrate a high level of knowledge and skill in each of the subspecialties of neurosurgery. This is a freestanding building connected to the main hospital by indoor walkways. which is a research facility. All major medical and surgical specialties are represented with training programs in each. It is also connected to the Huntsman Cancer Institute. System-Based Practice • Demonstrate understanding of legal issues in neurosurgery. • Develop excellent interpersonal and communication skills (verbal and written). families. • Provide clear unambiguous information to other health care workers. The Huntsman Cancer Hospital contains 50 inpatient beds and 4 operating rooms. • Provide compassionate patient care as determined by patients.
b.portion of the UUMC brain tumor operations are done in the Huntsman Cancer Hospital and the neuro-oncology outpatient clinics are located there. Research facilities The Department of Neurosurgery has 3000 square feet of research space occupying one half of the fifth floor of the Biopolymer Research Building located a few hundred yards south of the medical school. It is located adjacent to the UUMC and connected via a pedestrian bridge. It is the pediatric training hospital for the University of Utah. and operating rooms. c. The additional operating rooms and outpatient clinics will further increase the volume of neurosurgical cases treated in the department. Hutchinson (Orthopedic Hand Service) at the VA. 12
. Outpatients are seen in the pediatric neurosurgical clinic located in the hospital. The Department of Neurosurgery does not cover ORs. 5.R. clinics. d. and at the Center for Advanced Medical Imaging located one mile away in Research Park. Neuroscience Institute Our department has the support of the Dean of the University of Utah Medical School to develop a Neuroscience Institute in the next two years. D. Patients are not on a specific ward but are taken care of on wards stratified by the patient's age. An existing 80. at the VA Hospital. research laboratories. There is a 32-bed ICU and 43-bed newborn ICU where neurosurgery patients treated under the joint direction of the neurosurgical service and full-time pediatric intensive care specialists.000-square-foot building located adjacent to the UUMC has been dedicated for this purpose. which are located adjacent to the Biopolymer Building. It will house the departmental offices. and the chairman of pediatrics at the University is also the medical director of the hospital. Salt Lake VA Hospital The Salt Lake VA Hospital is a 138-bed facility. Primary Children’s Medical Center (PCMC) Primary Children's Medical Center is a modern 232-bed pediatric hospital built in 1990. We believe that this will further enhance the department by providing a concentrated focus of all activity and a more collaborative environment for resident education and research. It too is a major component of the University of Utah teaching system and staffed primarily by University faculty. The building also has a vivarium with a full-time veterinarian and a small-animal support facility. Additional research equipment is available to our group in the Hughes and Eccles Research Institutes. The Institute will add to our visibility in the community and enhance our ability to move forward in our multiple areas of interest. Residents from our department participate in peripheral nerve clinics and surgery with Dr. It is the major pediatric referral center for the intermountain west. Patients can be seen every day at this facility. It is directly connected to the UUMC. outpatient clinics. or the E.
4. At PCMC. Junior residents work under the supervision of the chief resident or under the supervision of a faculty member. Dr Jensen’s lab is located in HCI. All are state-of-the-art operating rooms and are fully equipped for microneurosurgery and stereotaxis.
. 3. Dr. 2. Chief residents can select from among the cases that are being operated each day and normally both of them spend a good part of each day in surgery. with world-class laboratory research facilities. designed to evaluate spine biomechanics. Overflow to an additional OR is frequently accommodated with adequate equipment available to support such utilization. The Huntsman Cancer Institute is a national cancer institute. Intraoperative fluoroscopy is routinely used and intraoperative angiography is available. Clinical Epidemiology and Clinical Trial Design (with the option to obtain a Masters in Public Health) with Dr. It is connected via walkways to UUMC. 6. both of whom support resident research activities. The Orthopedic Lab. the Department has a full-time medical editor and a full-time media technician. 5. In addition. Operating rooms and scheduled surgery days Three operating rooms are dedicated to neurosurgery on a daily basis at UUMC with additional rooms often available as needed. including advanced microsurgery. may assist or perform the major portion of the procedure. The resident. the neurosurgery ORs have all of the same facilities as those at UUMC. depending on their level of experience and faculty judgment. Dan Fults’ lab investigating the molecular biology of brain tumors.Research opportunities with faculty members are as follows: 1. and skull base anatomy and surgical approaches. John Kestle. and stereotaxis equipment. Video monitors allow viewing of all procedures and facilitate training. Dr. under faculty supervision.
To the east of the UUMC is the Huntsman Cancer Institute (HCI). endoscopy. Couldwell’s lab investigating meningiomas. Adequate instrumentation is in place to support multiple simultaneous cases. pituitary tumors. Randy Jensen’s lab studying angiogenesis and the role of hypoxia inducible factor in malignant and benign brain tumors. Dr. Neurophysiologic monitoring is available at all times. run by Orthopedic faculty. depending on the number of rooms that are in operation simultaneously.
conducting the examination. They then staff these patients with an attending to arrive at an appropriate treatment decision. It is attended by an NS-4. plan the resident call and vacation schedule. and a neuro-critical care neurologist. Elaine Skalabrin. They perform pre-operative evaluations and post-operative care. She makes daily teaching rounds on all NCC patients and works closely with the NCC resident.). Chief residents also attend if they are available. ordering appropriate diagnostic tests. organize the resident assignments for conference. Neurosurgical attendings staff the clinic on a rotating basis. The chief residents conduct twice-daily work and teaching rounds with the residents and nursing staff. and formulating a plan of management.
. residents staff an outpatient clinic each Wednesday. Consultations from the emergency room or other hospital services are usually discussed with them before they are presented to the staff. The residents assume primary care of all neurosurgical patients in the NCC with an NS-2 resident having the primary responsibility to these patients under the supervision of the chief resident. arriving at an independent diagnosis. This includes taking the history. and surgical intensivist as needed to assist in the management of these complex patients. Dr. and select cases for presentation at conference. supervise the junior residents. Residents at all levels at both hospitals may be called upon to evaluate outpatients either pre. At PCMC the resident on call participates in the surgeons’ clinic. By the time they are at the senior and chief levels residents often are doing most or all of the procedure under staff supervision and in turn are supervising the junior residents in noncritical portions of the procedure as appropriate. Dr. Consultation is readily available with our neuro-anesthesiologist. oversee the compilation of the morbidity and mortality data. and one or two juniors (NS-1 or NS-2). pulmonologist.
Critical Care Experience The Neurosurgical service at the UUMC has its own dedicated neurosurgical intensive care unit (NCC) with 11 beds (see section A(4) above). William Couldwell.
Chief resident's responsibilities As noted above. the patient’s neurosurgical attending.R. who is the chairman of the neurosurgery department.
Outpatient experience At the UUMC. the residents assume increasing responsibility for the care of the neurosurgical patient and are allowed to perform more of the operative portions of the patient care as they progress.7.or post-operatively when their attending physician is unavailable (in the clinics or in the E. The medical director of the NCC is Dr.
8. two NS-3s. Skalabrin is a neurologist with fellowship training in neuro-critical care. They evaluate the patient and review the findings and their management plan with the surgeon.
Neuroradiology Neuroradiology is a constant component of the daily practice of neurosurgery. a rotation on the neurology service at PCMC is available. Our neuroradiologists participate in our case conferences and often give didactic presentations to the residents on Wednesday evenings.) and neuropathology slide review conference with our new neuropathologist. there is a weekly brain cutting conference (Wednesday a. at which time the relevant pathology findings are reviewed. designed by our neuropathology department (and available on CD). Each resident is required to complete a selfstudy course. Scheithauer and Vogel.
14. In addition. In addition.
Neurology The three-month neurology rotation is part of the PGY-1 year prior to starting neurosurgery.
Neuropathology Neuropathology training is a part of the NS-1 neuro-oncology/peripheral nerve rotation and the NS-3 research year. Throughout their training.
Neuroanatomy The residents are responsible for their own review of neuroanatomy and this review is carried out annually in preparation for the primary written examination for the American Board of Neurological Surgery. Residents are also exposed to clinical neurophysiology during cases involving physiological monitoring.m. S. residents are encouraged to review the biopsy and specimen material sent on their cases with Dr. 4th edition). The residents are encouraged to avail themselves with the many weekly neuroradiology teaching sessions.
Neurophysiology The same as noted above under neuroanatomy applies to neurophysiology. Chin. they focus on tumor and peripheral nerve pathology and during the NS-3 year they cover other aspects of neuropathology. Specific talks on cranial nerve anatomy are part of the Wednesday a.10. For those residents interested in pediatric neurosurgery.
13.m. they review the content of Surgical Pathology of the Nervous System and its coverings (Burger. Dr. These areas have been the subject of a number of Grand Round and resident conference presentations. In addition. It is divided between the UUMC and VA Hospital neurology services. During the neurooncology/peripheral nerve rotation. the relevant surgical anatomy is discussed as appropriate to case presentations. Chin. Studies on all patients are reviewed with the faculty and with the neuroradiology staff.
. He also regularly participates in our weekly case conferences.
Couldwell and Dr. Except for those patients who are candidates for epilepsy surgery. neurologists. Van Orman (PCMC). residents may present a current literature review centered about a specific case. Journal Club (one hour per week). trauma. The conference is attended by all the neurosurgery service. Saturday conference.
e. as well as our neuropsychologists and neuropathologist. Morbidity/Mortality conference is held each month. Topics vary and are chosen by the R3s (research residents). iii. and neuroradiologists at PCMC. Attendance of all faculty and residents is required. Limited studies related to brain death and burst suppression analysis associated with barbiturates are learned as part of the junior resident's experience in the neurocritical care unit. and by Dr. The conference serves as the most important teaching conference of the department and utilizes advanced audiovisual and computer aides to enhance the teaching.
. death. A series of didactic lectures by attendings covering a core curriculum (one hour per week). some of the neurology faculty. early reoperation. Matsuo (UUMC) and Dr. f. Hands-on session involving spinal instrumentation. neurovascular. Kestle who perform the adult and pediatric epilepsy surgery.
Teaching Daily bedside teaching rounds are made by the faculty on their respective patients. epilepsy. In addition. Critical appraisal. 1. EEG studies are rarely utilized by the neurosurgical faculty. iv.
Electroencephalography No formal training in electroencephalography is provided. The week-by-week curriculum is provided starting on page 18. practicing neurosurgeons from Utah and Idaho often attend this conference and are invited to present interesting and problem cases. The following are common examples: i. and pediatric cases. Conferences with required attendance: a. Cases based management discussions with Dr Couldwell (Department Chair) (One hour per week).15. Pediatric Neurosurgical Case Management Conference (one hour per week). Case-based teaching (one hour per week). skull plating. tumor. Cases from both institutions are presented. our epileptologists in the neurology department. During this time. Electrocorticography analysis during seizure surgery is taught by Dr. microsurgical technique.
c. The structured teaching sessions are listed below. the neurosurgery residents. Review of neuroradiology topics with neuroradiology attendings. most of the neuroradiology faculty. 16
b. attended by neurosurgeons. Cases presented include unexpected neurologic deficit. General topics are rotated between spine. ii. Review of current articles from neurosurgical journals. and any other case of unusual/adverse outcome.
Pediatric Neurosurgery Epilepsy Conference (two hours per month).
Conferences with optional attendance: a. A neuropathology conference is conducted on Wednesdays from 11:00 to 12:00 by the neuropathology faculty.2. Neuropathology. outside speakers participate in this program. A review of all patients referred with neuro-oncologic problems are conducted weekly.
g. This consists of brain cutting or a slide review of current cases. This is a combined conference with the Orthopedic Service. Combined Neurosurgery and Neurology Grand Rounds The combined Neurology/Neurosurgery Grand Rounds are conducted on a weekly basis from 9:00 to 10:00 AM on Wednesdays. A neuro-oncology (neurotumor board) conference is conducted on Wednesdays from 4:00 to 5:00 PM by the medical neurological and neurosurgical neuro-oncology faculty and residents.
. Neuropathology. Pituitary Conference. our medical epileptologists. Neurosurgery. Neuroradiology. and neurosurgeons performing epilepsy surgery. Matsuo and Constantino. Their technical staff. Management plans and assignment of treatment protocols are the most important function of the conference.
d. Multidisciplinary case management conference with Neurology and Neuropsychology (one hour per week). A multidisciplinary conference with Endocrinology. The presentations are made by the medical school faculty on a wide array of subjects of interest to the neurosurgical trainee and faculty. and Radiotherapy (one hour per month). epilepsy fellows. Tumor Conference.
h. as well as our neuropsychologists involved in the management and evaluation of epilepsy patients. c. f. all participate. This is a multi-disciplinary case management conference (one hour per month). Adult Epilepsy Surgery Conference. and our neuropathologist and neuroradiologist.
b. The conference is conducted by Drs. The responsibility for the didactic presentation of these rounds is divided by neurosurgery and neurology. Pediatric Brain Tumor Conference.
e. Once a month it is based on journal articles related to spinal disorders and once a month it is conducted at the Shriners Hospital with an emphasis on scoliosis and deformity surgery (two hours per week). In addition. Spine Conference.
Resident Core Curriculum Vascular Medical management of SAH – R Schmidt Surgical management of supratentorial aneurysms – J MacDonald Surgical management of infratentorial aneurysms I – R Schmidt Surgical management of infratentorial aneurysms II – R Schmidt Cavernous malformations – R Jensen AVM surgery – D Brockmeyer Spinal vascular disease – M Schmidt Ischemic disease – J MacDonald Dural AV fistulae – R Schmidt Guidelines for surgical management of head injury – J MacDonald Cardiogenic shock in neurosurgery – E Skalabrin Critique of ISAT methods and results – J Kestle Management of anterior circulation aneurysms Traumatic vascular injury Tumors Meningiomas Part 1 – R Jensen Meningiomas Part 2 – R Jensen Current management of spinal tumors – M Schmidt Craniopharyngioma – M Walker Intraventricular tumors – D Brockmeyer Posterior fossa tumors – J Kestle Hypothalamic/chiasmatic tumors – M Walker Acoustic neuroma – C Shelton Spinal cord tumors – D Brockmeyer Brain mets – R Jensen Pineal tumors – J Kestle Dermoid/epidermoid/teratoma – R Schmidt Glioma surgery – D Fults Skull base approaches – J MacDonald Pituitary tumors – W Couldwell Neurofibromatosis – A Osborn Anterior skull base reconstruction – P Sharma Radiobiology/radiosurgery – D Shrieve Chemotherapy of CNS tumors part I – D Blumenthal Chemotherapy of CNS tumors part II – D Blumenthal
F Siddiqi Craniofacial disorders and craniosynostosis II . J Balbierz.Brockmeyer Peds topics already covered in other sessions: Pediatric C-spine injuries – D Brockmeyer Craniopharyngioma – M Walker Hypothalamic/chiasmatic tumors – M Walker Surgery for spasticity: rhizotomy – M Walker Pediatric Head Injury – J Kestle Ped Epilepsy Surgery – J Kestle Posterior fossa tumors – J Kestle Trauma Guidelines for surgical management of head injury – J MacDonald Physiology of spinal cord injury – R Schmidt Brain death – R Schmidt GSWs – R Jensen Pediatric C-spine injuries – D Brockmeyer Physiology of spinal cord injury – R Schmidt Pediatric Head Injury – J Kestle Evaluating the unstable spine Occ C1/2 – R Apfelbaum The evolution of cervical plating – R Apfelbaum Management of subaxial C-spine fractures – M Schmidt 19
.F Siddiqi Complicated hydrocephalus – M Walker Slit ventricle syndrome – M Walker Hydrocephalus management and Hx of 3rd ventric – Kestle Neuroembryology for neurosurgeons – G Schoenwolf Arachnoid cyst – J Kestle Chiari malformations .Brockmeyer Spinal deformity – J Smith Pediatric Vascular disease .Functional Epilepsy Hemispherectomy and other Ped Epilepsy Surgery – J Kestle Epilepsy surgery – Temporal – J MacDonald Epilepsy surgery – Extratemporal P House Vagal Nerve Stimulation – R Schmidt The history of movement disorder surgery – W Couldwell Baclofen pump trouble shooting – J Gooch. C Lipscombe. RN DBS for Parkinson’s – P House Surgery for spasticity: Baclofen pumps – J MacDonald Surgery for spasticity: rhizotomy – M Walker Patient selection for epilepsy surgery – T Constantino Neuropsych assessment of neurosurgical patients – G Mooney Peds/Congenital Spinal dysraphism – M Walker Congenital brain malformations – D Brockmeyer Craniofacial disorders and craniosynostosis I .
XI. Most commonly. bone physiology peripheral nerve metastatic disease C. Randy Jensen.XII Radiation safety training – D Tripp Infections Complications of sinus disease – R Orlandi Spine Infection – M Schmidt Miscellaneous Planning your research project – J Kestle Sir W Osler – W Couldwell DVT prophylaxis study – S Browd Medicolegal issues – Dave Williams The anatomy game – J MacDonald/J Kestle Suggestions incidental aneurysms primer on research methodology pathology billing and coding medical economics some practice management topics like contracting. Research All residents are encouraged to carry out clinical research projects during their clinical rotations and are required to carry out a spectrum of basic and clinical research projects during the NS-3 year. etc.VI Cranial nerves V. Clinical research may be done in association with any of the faculty. Kestle. or Dr. The residents are encouraged to submit their work for presentation and publications. this has been in the department's laboratories under the direction of Dr.. they may also work in other departmental or institutional research laboratories. William Couldwell. reimbursement. Dan Fults. Graduate training in clinical trial design and clinical research methods may be done with Dr.IV. 20
.Anatomy Electrophysiology of the subthalamic nucleus – M Hornyak Cranial nerve II Cranial nerves III.X. VII. The following is a list of publications in which a resident of the program was an author or joint author. VIII Cranial nerves IX. They generally work under the supervision of one of the neurosurgical faculty participating in their laboratory projects. Dr.. Depending on their interests.
Rao G. J Neurosurg. Rao G. Neurosurg Focus. discussion 542-4. 2003 May-Jun. Klimo P Jr. Interpositional carotid bypass strategies for the surgical management of aneurysms and tumors of the skull base. Townsend JJ. Fults DW. 2003 Dec. 2003 Mar-Apr. Couldwell WT. Weiss MH. Couldwell WT. Stevens S. Fassett DR. 2003 Aug 15. 2003 Aug 15. Neurosurgery.25(24): 1-4. Couldwell WT. 2003 21
. Kan P.15(2):E10. 2003 Mar. Diffuse large B-cell lymphoma presenting as a sacral tumor. Karawande SV. Kan P. Neoplasia. Neurosurg Focus 14 (3):Article 2. Coffin CM. Kestle JR. Seeding of a cavernous angioma with Mycoplasma hominis: case report. Couldwell WT. 2003 Aug 15. Embolization of sacral tumors. Bacchus K. Ragel B.15(2):E4. 2003 Liu JK. New approaches for the treatment of refractory meningiomas. House P. Stevens EA. Kan P. Lumbosacral ependymomas: a review of the management of intradural and extradural tumors. Gottfried ON. Case report. Apfelbaum RI. Schmidt M. Schmidt MH. 2003 Nov 15. Couldwell WT. Neurosurg Focus 14 (3):Article 3. Conduits for cerebrovascular bypass and lessons learned from the cardiovascular experience. J Neurol Neurosurg Psychiatry. Review.15(2):E12.15(5):E13. Treatment of metastatic spinal epidural disease: a review of the literature. Spinal meningiomas: surgical management and outcome. 2003 Nov 15. Fults DW.99(2):416-20.5(3):198-204. Case report and classification scheme. Rao G. MacDonald J. Rao G.52(3):534-44. Schmidt M. Coexistent cerebral metastasis and cavernous malformation. Jensen RL.6(1):49-52. Schmidt R. Neurosurgery. Inter. 2003 Liu JK. Suprasellar displacement of intracavernous internal carotid artery: case report. Couldwell WT. Nerve sheath tumors involving the sacrum. 2003 Jan. c-Myc enhances sonic hedgehoginduced medulloblastoma formation from nestin-expressing neural progenitors in mice. Spine. Dunn J. Pedone CA. Schmidt MH.74(1):105. Holland EC. MacDonald JD. Neurosurg Focus.53(6):1433-4.53(3):749-52. 2003 June 14(6): Article 2. Gottfried ON. Congenital partial aplasia of the posterior arch of the atlas causing myelopathy: case report and review of the literature. Symptomatic pneumocephalus occurring years after transphenoidal surgery and radiation therapy for an invasive pituitary tumor: a case report and review of the literature.and intraobserver reliability of computed tomography in assessment of thoracic pedicle screw placement.2003 Liu JK. Neurosurg Focus. 2003 Dec 1. Schmidt RH. Carroll K. 2003 Nov 15. Spontaneous hemorrhage associated with a pilomyxoid astrocytoma. Liu JK.10(2):148-58. Pituitary. discussion 1434-5. Cancer Control. Klimo P Jr. Gottfried ON. 2003 Sep. discussion 752-3 Klimo P Jr. Spine. Blumenthal DT. Jensen RL. Neurosurgery. Brodke DS. Gottfried ON. Gottfried ON. Soleau SW. Neurosurg Clin N Am 14:93-107. Extensive experience with dural sinus thrombosis. Neurosurg Focus. Osborn A.15(5):E1. Schmidt MH. Dailey AT. Schmidt MH. Contemp Neurosurg. Soleau SW. Rondina M.28(22):2527-30. 2003 Aug. Neurosurg Focus. 2003. Review. 2003 Jun 15. Quinones-Hinojosa. Surgical approaches to pituitary tumors. Neurosurg Focus. Schmidt MH. Management of spinal meningiomas. Gluf W. Rao G.28(12):E224-8. Report of two cases.
2003 Liu JK. Moscatello AL. Zones of approach for craniofacial resection: minimizing facial incisions for resection of anterior cranial base and paranasal sinus tumors. Pituitary apoplexy: diagnosis and management. Contemp Neurosurg 25 (25):1-12. MacDonald JD. McDermott MW. J Neurosurg 100(2):215224. Brockmeyer DL. Schmidt R. 5th Ed. 2003 Couldwell WT. Weiss MH. Liu JK. Surgical management of posterior petrous meningiomas. Cervical spinal metastasis: reconstruction and stabilization techniques after tumor resection. Weiss MH. 2004 Couldwell WT. O’Neill B. Schmidt MH. 4 (Winn HR. MacDonald JD. von Koch CS. Kestle JR. Gottfried ON. Weiss MH. Primary intraosseous skull base cavernous hemangioma: case report. 2003 Liu JK.. Gottfried ON. Neurosurg Focus 14 (5):Article 11. Vol. 2003 2004 Liu JK. Orlandi RR. Apfelbaum RI. Couldwell WT. AANS Bull 12(4):7-9. Schmidt MH. Couldwell WT. Youman’s GR. Orlandi RR. 2003 Liu JK. Chiles BW III. 2003 Liu JK. Traumatic arteriovenous fistula of the posterior inferior cerebellar artery treated with endovascular coil embolization. Central neurocytoma: A review. Couldwell WT. Couldwell WT. editorial response. 2004 Schmidt MH. Treatment of axis fractures. Anterior reconstruction and stabilization techniques for cervical spinal metastasis. Endoscopic-assisted craniofacial resection of esthesioneuroblastoma: minimizing facial incisions. In Youman's Neurological Surgery. Gottfried ON. Moorthy CR. Decker D. Orlandi RR. Couldwell WT. Contemp Neurosurg 25 (12):1-6. Jensen RL. Apfelbaum RI. Trends in the neurosurgical workforce. Skull Base 13:219-228. Rosenow JM. Orlandi RR. Neurosurg Focus 14 (6):Article 7. Surg Neurol 61(3):255-260. Madan N. Contemp Neurosurg 25 (5):1-8. Philadelphia.Liu JK. 2003 Liu JK. Couldwell WT. Tenner MS. Kestle JR. 2003 Liu JK. Harnsberger HR. Forman S. Hypophysial transposition (hypophysopexy) for radiosurgery of pituitary tumors involving the cavernous sinus: technical note. Chiles BW III. Jensen RL. 2004 Klimo Jr P. 2004 York JE. J Neurosurg 100:161-164. Schmidt MH. Surgical management of aneurysmal bone cysts of the spine. Klimo Jr P. Burger PC. Marked reduction of cerebral vasospasm with lumbar CSF drainage following subarachnoid hemorrhage. Elsevier. Chang SM. 2004. Neurosurg Focus 14 (5):Article 7. Update on treatment modalities for optic nerve sheath meningiomas. Decker D. J Neuro-oncol 66(3):377-384. Neurosurgery 53:1126-1137. Couldwell WT. Schmidt MH. Stevens EA. Couldwell WT. Benzil DL. Schaefer SD. New closure technique for the endonasal transsphenoidal approach: technical note. Couldwell WT. Gottfried ON. Moscatello AL. Neurosurg Focus 15 (5):Article 4. 2003 Liu JK. Chiles BW 3rd. Liu JK. 2003 Liu JK. Popp AJ. 2004 Liu JK. MacDonald JD. pp. Technical note and report of 3 cases. eds. Neurosurg Focus 15 (5):Article 2. 4939-4949. Minim Invasive Neurosurg 46:310-315. 2003 Liu JK.). Apfelbaum RI. Dailey AT. Tenner MS. Zones of exposure in surgical approaches to the anterior cranial base and paranasal sinuses. 209. Efficacy of multiple intraarterial papavarine infusions on cerebral 22
Dougherty WR. Treatment options for trigeminal neuralgia. Walker ML. Fults DW. Holland EC. Couldwell WT. Rabb C. 2004 Schmidt R. Spinal epidural lipomatosis: A review of the etiology and treatment recommendations. Contemp Neurosurg 26:1-8. 2004. Couldwell WT. 2004 Cole CD. Schmidt MH. Liu JK. Klimo Jr P. J Neurosurg 100(5):883-890. J Neurosurg 100(3):414421. Comparison of radiosurgery and surgery for treatment of glomus jugulare tumors. Apfelbaum RI. Gottfried ON. Brockmeyer DL. Kan P. Marcel Dekker. 2004 Gottfried ON. Semin Neurosurg 14(3): 169-185. Hyponatremia in the neurosurgical patient: Diagnosis and management. 2004 Couldwell WT. Pituitary carcinoma: A review of the literature. Apfelbaum RI. 2004 Liu JK. Porous polyethylene implant for cranioplasty and skull base reconstruction. 2004 Kan P. 2004 Fassett DR. SIADH and hyponatremia after spinal surgery. Jensen RL. Neurosurg Focus 16 (4):Article 11. Schmidt MH. classification. MacDonald JD. Neurosurg Focus 16 (4):Article 7. and injuries to the vital nonneural structures of the neck. Brodke DS. Apfelbaum RI. Fukushima T. 2004. Kan P. Semin Spine Surg 16:174-181. Liu JK. Smith ME.circulation time in patients with recurrent cerebral vasospasm. Fassett DR. Complications of ICP monitoring in children with head trauma. Neurosurg Focus 16 (4):Article 2. 2004. 2004 Walker ML. Amini A. Brockmeyer DL. In Complications of pediatric and adult spinal surgery (Vaccaro A. Schmidt MH. J Neurosurg (Pediatrics 2) 101:53-58. Couldwell WT. 2004 Ragel B. Contemporary management of prolactinoma. J Neurosurg 101: 357. Couldwell WT. ed). Marked reduction of cerebral vasospasm with lumbar CSF drainage following subarachnoid hemorrhage: Letter to the Editor. Liu JK. Couldwell WT. Neurosurgery 55:539-550. Soft tissue complications of anterior cervical surgery: dysphagia. Valle LD. Sonic hedgehog and insulin-like growth factor signaling synergize to induce medulloblastoma formation from nestinexpressing neural progenitors in mice. Jensen RL. Schmidt MH. Oncogene 23(36): 6156-62. Brothman AR. 2004 Rao G. 2004 Klimo Jr P. Moscatello AL. 2004. Neurosurg Focus 17(2): E4. New York. Gottfried O. 2004 Liu JK . Gottfried ON. Schaefer SD. with emphasis on the extended approaches: Surgical experience in 105 cases. Pedone CA. Neurosurg Focus 16(3):Clinical Pearl 1. Couldwell WT. Neurosurgical implications of allergic fungal sinusits. 2004 Liu JK. dysphona. Oncologist 9: 188-196. Aneurysmal bone cysts of the spine. surgical anatomy. 217-234. Reiss K. Liu JK. 2004 Liu JK. Metastases to the pituitary gland. Klimo Jr P. Weiss MH. p. Craniopagus twins: embryology. Cole CD. Neurosurg Focus 16 (4):Article 9. 2004 Liu JK. Neurosurg Focus 16 (4):Article 8. Neurosurg Clinics N Amer 15(3):319-334. Surgical management of spinal metastases. 2004 (cover article) Anderson R. and separation. J Neurosurg 100(4):700705. Blumenthal DT. Browd S. Kestle JR. Townsend JJ. Drozd-Borysiuk E. Fassett DR. Oligodendroglioma and juvenile pilocytic astrocytoma presenting as synchronous primary brain tumors: Case report and review of the literature. Pathophysiology of meningiomas. Childs Nerv Syst 20(8-9):554-566. Neurosurg Focus 16 (4):Article 10. 2004. Variations on the standard transsphenoidal approach to the sellar region. 2004 23
. Ragel B. Couldwell WT. Antibiotics in the management of spinal postoperative wound infections.
Hemorrhage from Moya-Moya vessels associated with a cerebral arteriovenous malformation. Schmidt MH. 614-628. Liu JK. 2004. MS Berger MS and MD Prados). pp. Aneurysms of the petrous internal carotid artery: Anatomy. Klimo Jr P. Minimally invasive treatments for metastatic tumors of the spine. Aneurysmal bone cysts of the spine.L. Schloesser P. J Neurosurg 101:869–871. 259-262. Klimo Jr P. W. In Cancer of the Nervous System. 2004 (cover photo) Liu JK. A meta-analysis of surgery compared with conventional radiotherapy for the treatment of metastatic spinal epidural disease. J Neurosurg 102:181-182. Review of Yadav JS. In Clark C (ed): The Cervical Spine. Klimo Jr P. Philadelphia. Fessler RG. Chapter 45. 4th Edition. Kestle JR. Schmidt MH. 4th Edition. Skalabrin EJ. 2nd ed. Nerve sheath tumors of the spine. 2005. 2005 Gottfried ON. Neurooncology 7(1):64-76. Assessing the validity of the Endoscopic Shunt Insertion Trial – Did surgical experience affect the results? J Neurosurg (Pediatrics 2) 101:130–133. Apfelbaum RI. pp. 2004 Browd SR. 2005 Couldwell WT. Embolization of metastatic spinal tumors. Neurosurg Focus 17(4):E1. Lippincott Williams & Wilkins. Amini A. New York. Thompson CJ. 1031-1042. Gottfried ON. Surgical management of cervical spinal metastasis: anterior reconstruction and stabilization techniques. Neurosurg Clinics N Amer 15(4): 391-399. Response to a Letter to the Editor. Contemp Spine Surg 5(11). Macdonald. Schmidt MH. Klimo Jr P. 2004. R. 2004 Klimo Jr P. Clinical trials and evidence-based medicine for metastatic spine disease. Schmidt MH. Dens fractures. eds). B. Tenner MS. Neurosurg Focus 18 (1):EJC1. Brockmeyer DL. Posterior laminoforamintomy. 2005 24
. 2004 Rao G. (Loeffler J and Black PM. Ragel BT. Couldwell WT. Davis GE. 2004 Liu JK. Neurosurg Clinics N Amer 15(4):459-465. 2004 (reprint from Contemp Neurosurg)
2005 Schmidt R. N Engl J Med 351:1493-1501. Dailey AT. In Cerebral Vasospasm: Advances in Research and Treatment. 2004 Binning M. Lippincott Williams & Wilkins. Gottfried ON. Couldwell WT. Saunders. Apfelbaum RI. Kestle JR. Gottfried ON. Apfelbaum RI. 2004 Fassett DR. Wholey MH. 2004 Gluf W. 2004 Klimo Jr P. Couldwell WT. Cavernous hemangioma of the skull with subdural hematoma. Liu JK. Drake JM. Neurosurg Focus 17 (5):E13. Schmidt MH. 2004 Klimo Jr P. Prophylaxis for deep vein thrombosis in neurosurgery: A review of the literature. 2004 Gottfried ON. In Berger MS and Brown eds: Textbook of Neuro-Oncology (ed. Lippincott Williams & Wilkins. Neurosurg Clinics N Amer 15(4):549-564. Cerebral vasospasm is markedly reduced by lumbar cerebrospinal fluid drainage. Schmidt MH. Couldwell WT.Klimo Jr P. Neurosurg Clinics N Amer 15(4):425-435. Philadelphia. 2005 Journal Club. Surgical management of cervical radiculopathy: Part B. 2004. Thieme Medical Publishers. Posterior surgical approaches and outcomes in metastatic spine disease. Philadelphia. Fessler RG. ed. Schmidt MH. Scott AM. Neurosurg Focus 17(4): Clinical Pearl 1. Pleomorphic xanthoastrocytoma (Part 2: Tumor-specific principles). In Clark C (ed): The Cervical Spine. Kestle JR. Schmidt MH. Stevens E. Neurosurg Clinics N Amer 15(4):413-424. Stevens E. pp. etiology and treatment. Kuntz RE. Schloesser PA. et al: Protected carotid-artery stenting versus endarterectomy in high-risk patients. Philadelphia. 2004 Rao G. Thompson CJ. Kestle JR. Chapter 75.
Surgical approaches to spinal schwannomas. Binning ML. Townsend JT. Vaccaro. Percutaneous dilational tracheostomy in neurosurgical patients. Schmidt MH. 307-314. 2005 Liu JK. Hedlund GO. Acta Neurochir (Wien) 147(3): 335-338. Neurosurg Focus 19 (2):E9. Vaccaro. pp. pp. Simon AS. Simeone FA. Neurosurg Focus 18 (6a):E9. 2005 Liu JK. Pingree J. J Neurooncol 71(2):189-193. J Neurosurg (Pediatrics 3) 102:314– 317. Rosenberg WS. Anderson RCE. Thrombosed basilar apex aneurysm presenting as a third ventricular mass and hydrocephalus. 2005 Ragel B. 2005 Gottfried ON. In Spinal Instrumentation: surgical techniques (Kim. Oregon. 2005 Young AL. New York. In Spinal Instrumentation: surgical techniques (Kim. Brockmeyer DL. 2005 Fassett DR. High incidence of tumor dissemination in myxopapillary ependymoma in children. Posterior cervical approach for intrathecal baclofen pump insertion in children with previous spinal fusions: Technical note. Apfelbaum RI. 2005 Rao G. Leone P. Feldstein NA. Expansion of arachnoid cysts in children: Two cases and review of the literature. MacDonald JD. pp. eds). 2005 Liu JK. Cranial base strategies for resection of craniopharyngioma in children. In Progress in Neurological Surgery. Fessler. Kraus KL. Schmidt MH. 2005 Liu JK. Intraventricular tanycytic ependymoma: case report. Neurosurgery 56 (suppl 1): E207. Jensen RL. Gillespie D. 18 (ed. Binning M. Inj Prev 11:97-101. Rao G. Couldwell WT. Arthur A. Trends in the neurosurgical workforce in the United States. 2005 Cole CD. 59-69. Mann CN. Popp AJ. Prescott SM. Rovit RL. 2005 Couldwell WT. Gottfried ON. 2005 Klimo Jr P. Contemporary applications of functional and stereotactic techniques for molecular neurosurgery. New York. 124-145. Assessing automobile head restraint positioning in Portland. Walker ML. Ragel B. Kestle JR. 2005 Gottfried ON. J Neurosurg (Pediatrics 1) 102:59–64. Vaccaro. Apfelbaum RI. House P. Neurocrit Care 2(2):124132. 2005 Liu JK. Kestle JRW. J Neurosurg (Pediatrics 1) 102:119–122. 2005 Liu JK. Ubiquitous expression of cyclooxygenase-2 in meningiomas and decrease in cell growth following in vitro 25
. Distal ventriculoperitoneal shunt failure secondary to Clostridium difficile colitis. Thieme. Brockmeyer DL. Posterior C1-C2 transarticular screw fixation. 2005 Browd S. Cole CD. Neurosurg Focus 18 (5):E4. Gottfried ON. Couldwell WT. Anterior surgical anatomy and approaches to the cervical spine. Regan. 2005 Liu JK. Chiari 1 malformation in patients with FG syndrome. In Spinal Instrumentation: surgical techniques (Kim. Couldwell WT. Diffusion restriction of a spinal arachnoid cyst. 2005. Odontoid screw fixation. Anderson R. Acta Neurochir (Wien) 147(4): 413-417. Ragel B. Su E. Couldwell WT. Apfelbaum RI. pp. Karger. J Neurosurg (Pediatrics 2) 103:148–155. Report of two cases. Schmidt MH. Janson C). Thieme. New York. eds). Titanium cage-assisted polymethylmethacrylate reconstruction for cervical spinal metastasis. New York. 70-80.Fassett DR. Apfelbaum RI. Couldwell WT. Brockmeyer DL. Far-lateral transcondylar approach: surgical technique and its application in neurenteric cysts of the cervicomedullary junction. Neurocrit Care 2(3): 268-273. 2005 Gottfried ON. Rao G. Regan. Walker ML. J Neurosurg (Pediatrics 4) 102:439. vol. Historical perspectives on the diagnosis and treatment of trigeminal neuralgia. Contemp Neurosurg 27(4):1-8. Opitz JM. Hedlund GL.: Thieme. Intraarterial papaverine infusions for the treatment of cerebral vasospasm induced by aneurysmal subarachnoid hemorrhage. Couldwell WT. 2005 Gottfried ON. eds). Frank EH. Walker ML. Liu JK. 2005. J Neurosurg 102:202-208. Freese A. Couldwell WT.
J Neurosurg 103:570–574. Kestle JR. practice survey impact. Kestle JRW. In Min. Harvey Cushing and Oskar Hirsch: Early forefathers of modern transsphenoidal surgery. (Schmidek H and Roberts DW. In Min. Molecular genetics of meningiomas. Peri-insular hemispherotomy. W. 100(2):215-224. CRC Press. Cushing’s first case of transsphenoidal surgery: the launch of the pituitary surgery era. Laws Jr ER. An and L. 2005 Krieger MD. Clark R. Operative Neurosurgical Techniques: Indications. H. 5th ed. Walker ML. Couldwell WT. 2005 Klimo Jr P. Kestle JR. Liu JK. Mayer). Surgery (ed. 2005 Ragel BT. Vrionis FD. Spine 30:2523-2529. 2005 Ragel BT. Liu JK.M. Apfelbaum RI. 2005 Klimo Jr P. 23-29. New York.M. 2005 Klimo Jr P. Surgery (ed. Apfelbaum RI. Microsurgical C1/2 stabilization. Neurosurg Focus 19 (6):E9. H. Efficacy of multiple intraarterial papavarine infusions on cerebral circulation time in patients with recurrent cerebral vasospasm. Thoracoscopic spine surgery in instrumentation and stabilization of the anterior thoracic and lumbar spine. 2005 Liu JK. Springer. 2005 Fassett DR. New York. Schmidt R. Non-communicating spinal extradural arachnoid cyst causing spinal cord compression in a child. Response to Letter to the Editor about Nonfunctioning Pituitary Carcinomas. Cole CD. J Neurosurg 103:1096-1104. Amar AP. Kan P. Gottfried ON. Rao G. 2005 (cover article) Amini A. 2005 (cover article) Cohen-Gadol AA. 2005 Fassett DR. Couldwell WT. 100(3):414-421. Kestle JR. Tenner MS. pp. Neurosurg Focus 19 (5):E9. Metastatic spinal cord compression. Neurosurg Focus 19 (3): E11. 2006. Endoscopic third ventriculostomy in adult patients: A series of 36 patients. Schmidt RH. Osborn A.B. Invasive Spin. J Neurosurg 103(3):508-517. Vocal cord paralysis after anterior cervical spine surgery. Fassett DR. Methods. Rosenow JM. Rathke’s cleft cyst intracystic nodule: A characteristic MRI finding. Lippincott Williams & Wilkins. 2005 Couldwell WT. Jensen RL. Cohen-Gadol AA. Bulletin momentum continues: New editor considers peer review. Surgical management of growth hormone-secreting and prolactin-secreting pituitary adenomas. J Neurosurg (Pediatrics 3) 103:207–212. In Gibbs SR and Verma A: Year Book of Neurology and Neurosurgery 2005. In Gibbs SR and Verma A: Year Book of Neurology and Neurosurgery 2005. J Neurosurg (Pediatrics 3) 103:266–269. Philadelphia. 2005. 2005 Browd S. and Results. Cole CD. Elsevier. 2005. J Neurosurg 2004 Feb. Philadelphia. Couldwell WT. Schmidt MH. Weiss MH. eds). Biomechanical Analysis of a New Concept: An Add-on Dynamic Extension Plate for Adjacent-Level Anterior Cervical Fusion (Presented at the 2004 CSRS Meeting). Chapter XI-33. 2005 Amini A. Kestle JR. 2005 Binning M. 2005. Sherr GT. MacDonald JD. pages 222-223. Philadelphia. MacDonald JD. J Natl Comprehensive Cancer Network 3(5):711-720. pp. Gottfried O. Couldwell WT. New York. Liu JK. Philadelphia. Beisse R. Stevens EA. 26
. Apfelbaum RI. H. 585-588. pages 250-251. In Silbergeld D and Miller J (ed): Epilepsy Surgery: Principles and Controversies. Saunders. Springer. Bachus KN. Marked reduction of cerebral vasospasm with lumbar CSF drainage following subarachnoid hemorrhage. Brodke DS. 2005 Klimo Jr P.treatment with the inhibitor celecoxib: potential therapeutic application. Microsurgical treatment odontoid fractures. J Neurosurg 103:837–840. Jenis). Elsevier. AANS Bulletin. Apfelbaum RI. Neurosurg Focus 19 (6):E4. J Neurosurg March 2004. Schmidt MH. Mayer). Invasive Spin. Chapter 4. Couldwell WT. Madan N. Potentially useful outcome measures for clinical research in pediatric neurosurgery. In Spine Surgery Complications (ed. Liu JK.
Elsevier. In Gibbs SR and Verma A: Year Book of Neurology and Neurosurgery 2005. Salzman KL. 2006 Kan P. Cervical spine clearance after trauma in children. Pediatr Neurol 34(2): 83-92. Janigro). Amirlak B. 2006 Fassett DR. 2006 Rao G. Tuberous Sclerosis — a Syndrome of Incomplete Tumor Suppression. Clark R. Chin SS. Brockmeyer DL. Neurosurgery. Apoptosis in glioma cells: review of the literature. 2005. J Neurosurg 2004 January. Couldwell WT. Can. J. Schaefer SD. 100:161-164. Philadelphia. Viskochil D. 2003 Nov. 2006 Anderson RCE. Hanson K. Neurosurg Focus 20 (2):E7. 2005. New closure technique for the endonasal transsphenoidal approach: technical note. Schmidt MH. 33: 80-85. Moscatello AL. Ragel BT. Molecular. 2006 Gottfried ON. NJ. Neurosurg Focus 20 (2):E5. Brockmeyer DL. Ragel BT. Apfelbaum RI. 2006. genetic.53(5):1126-37. Orlandi RR. 2006 McCall T. Odontoid synchondrosis fractures in children. 2006
. 2006 Fassett DR. Elsevier. Cervical spine deformity associated with resection of spinal cord tumors. Orlandi RR. pages 334335. Decker D. Browd SR. Philadelphia. Totowa.Liu JK. Sci. Chapter 12. and cellular pathogenesis of neurofibromas and surgical implications. Gottfried ON. Validation of a quality-of-life questionnaire for patients with pituitary adenoma. Neurosurg Focus 20 (2):E3. Humana Press. Neurol. Subaxial cervical spine trauma in children: a review. Fassett DR. Neurosurgery 58(1):1-16. McCall T. pages 335336. D. Kestle JRW. Fults DW. In Cell Cycle in the Central Nervous System (ed. Couldwell WT. Couldwell WT. In Gibbs SR and Verma A: Year Book of Neurology and Neurosurgery 2005. Zones of approach for craniofacial resection: minimizing facial incisions for resection of anterior cranial base and paranasal sinus tumors. 2006 McCall T. Couldwell WT. Brockmeyer DL. Liu JK. Cusimano M. Neurosurg Focus 20(1): E3. Fults DW. Weiss MH. Failure of cerebrospinal fluid shunts: Part I: Obstruction and MECHANICAL FAIlure. Kan P. Neurosurg Focus 20 (2):E2.
Couldwell M..D.D. Professor and Chairman of Neurosurgery
Medical School: McGill University 1979-1984 Post Graduate: McGill University 1989-1991 Ph. Ph.D.
William T.D. Neuroimmunology and Molecular Biology Neurosurgery Residency: University of Southern California 1985-1989 Clinical Fellowship: McGill University 1989-1991
Surgical Management of Epilepsy
• • • • •
Surgical Managment of Epilepsy Neuro-oncology Pituitary Tumors Skull base Cerebrovascular neurosurgery
D. University of Toronto 1991-1992 Pediatric Neurosurgery Clinical Interests:
Pediatric Neurosurgery Pediatric Epilepsy Surgery
. Kestle.John R. M.. M.Sc. Residency Program Director Director of Pediatric Neurosurgery Professor of Neurosurgery Primary Childrens Medical Center
Medical School: University of Western Ontario 1980-1984 Residency: University of Toronto 1985-1990 Post Graduate: McMaster University 1987-1989 MSc Epidemiology and Biostatistics Clinical Fellowships: University of Toronto 1991 Peripheral Nerve The Hospital for Sick Children.W.
Ronald I.D. Spine Fellowship Director Professor of Neurosurgery
Medical School: Hahnemann Medical College Residency: Albert Einstein College of Medicine Clinical Interests:
• • •
Cervical Spine Instrumentation Pituitary Disorders Management of Trigeminal Neuralgia
. Apfelbaum. M.
III. Fults.Daniel W. Wake Forest University Research Fellowship: University of North Carolina Clinical and Research Interests:
• • •
Neuro-oncology Molecular Biology of Nervous System Tumors General Neurosurgery
.D. Professor of Neurosurgery
Medical School: University of Texas Southwestern Medical School Residency: Bowman Gray School of Medicine. M.
Professor of Neurosurgery Primary Children’s Medical Center
Medical School: University of Tennessee Residency: Barrow Neurological Institute Clinical Fellowship: The Hospital for Sick Children. University of Toronto Pediatric Neurosurgery Clinical Interests:
General Pediatric Neurosurgery Management of Hydrocephalus
.Marion L. M. Walker.D.
D. Brockmeyer. M. Professor of Neurosurgery Primary Children’s Medical Center
Medical School: Case Western Reserve University Residency: University of Utah Clinical Fellowship: University of Utah
• • •
Pediatric Spine Surgery Pediatric Cerebrovascular Neurosurgery General Pediatric Neurosurgery
D.D Neuroscience Neurosurgery Residency: Loyola University 1993-1998 Clinical Interests:
• • •
Neuro-oncology Intraoperative navigation and cortical mapping of lesions in eloquent brain General Neurosurgery
.Randy L. Associate Professor of Neurosurgery
Medical School: University of Utah 1987-1991 Post Graduate: Loyola University 1993-1998 Ph. Ph. Jensen. M..D.
MacDonald. Chapel Hill Residency: University of Utah Clinical Fellowship: University of Florida
• • • • • •
Cerebrovascular Neurosurgery Functional Neurosurgery o Epilepsy.Joel D. Associate Professor of Neurosurgery
Medical School: University of North Carolina.D. Movement Disorder. General Neurosurgery Organized Neurosurgery Computer-based applications in neurosurgery Complex Spine o Cervical. etc. Thoracic and Lumbar Trauma o Degenerative Disease
Ph..D. Schmidt. Associate Professor of Neurosurgery
Medical School: University of Iowa Post Graduate: University of Iowa
Residency: University of Washington Clinical Interests:
• • • • •
Cerebrovascular Neurosurgery Skull base General Neurosurgery Neurosurgical Intensive Care Neurotrauma
. M.Richard H.D.
D. M.Meic H. Schmidt. Director. San Francisco Neuro-Oncology 2000 to 2001 Spinal Surgery 2001 to 2002
• • • • • • • •
Minimally invasive spine surgery Endoscopic Spinal Surgery Primary and metastatic spine tumors Spinal cord neoplasms Kyphoplasty/Vertebroplasty Radiosurgery Neuro-oncology Complex Brain tumors
. Spinal Oncology Service Huntsman Cancer Institute Assistant Professor of Neurosurgery Adjunct Assistant Professor of Orthopedic Surgery
Medical School: Medical College of Wisconsin 1990 to 1994 Neurosurgery Residency: Medical College of Wisconsin 1994 to 2000 Clinical Fellowships:
• • •
University of California.
. MD Assistant Professor Neurosurgery
Medical School: Washington University School of Medicine 1994-1998 Neurosurgery Residency: Neurosurgery. Parkinson’s Disease.Paul A. House. University of Utah 1998-2004 Clinical Fellowship: University of California San Francisco 2004-2005
Surgical Management of Movement Disorders Surgical Management of Epilepsy
Epilepsy Movement Disorders (Tremor.
Eric Huang. Ph.L.D. M.. Associate Professor of Neurosurgery
Medical School: Fudan University Shanghai Medical College Doctorate: Rutgers University (cell and developmental biology) Postdoctoral Training: Brigham and Women's Hospital-Harvard Medical School Clinical and Research Interests:
• • • •
Molecular mechanisms of hypoxic response Cancer biology Brain tumors Molecular targets
Assistant Professor of Neurosurgery Primary Children’s Medical Center
Medical School: University of Alberta. Edmonton. Clinical Epidemiology. University of Toronto 2005-2006
• • •
Pediatric Neurosurgery Hydrocephalus Clinical Trials
.The Hospital for Sick Children. Canada 1999-2005 Post Graduate: University of Toronto. M. Canada M. 2002-2006 Clinical Fellowships: Pediatric Neurosurgery . Ontario.. Ontario.Jay Riva-Cambrin. Toronto. Toronto. Alberta Canada-1998 Residency: University of Toronto.D.Sc.
MD Assistant Professor Neurosurgery
Medical School: Jefferson Medical College Neurosurgery Residency: University of California. Irvine Medical Center Clinical Fellowship: Barrow Neurological Institute
• • •
Interbody fusion techniques Minimally invasive surgical techniques for both the cervical and lumbar spine Peripheral nerve disorders
. Yonemura.Ken S.
Germany.D.Rudolf W. Adjunct Professor of Neurosurgery
Dr. We are honored to have him join our faculty as Adjunct Professor of Neurosurgery. Beisse will be visiting us periodically from Germany to teach his techniques to our faculty
and residents and to other US spine surgeons.Beisse. This is one of the major regional trauma centers in Germany. Beisse is an excellent surgeon and superb teacher.
Dr. M. Germany Clinical Interests:
• • • • •
Spine Trauma Minimally Invasive Spine Surgery Endoscopic Spinal Surgery Spinal Cord Injury Surgical Intensive Care
. Dr. Germany Residency: Trauma Center Murnau. He is the associate director and head trauma surgeon at the Trauma Center of the Berufsgenossenschaftliche Unfallklinik in Murnau. When licensure is granted. Medical School: University of Erlangen. he also will be available to assist with surgery and consult with colleagues on difficult cases. Beisse is a leading internationally recognized pioneer in thoracolumbar endoscopic spine
stabilization and the developer of the MACS-TL plating system.
OR • Has a full and unrestricted license to practice medicine in a US licensing jurisdiction. Applicant must be a graduate of a US or Canadian medical school accredited by the Liaison Committee on Medical Education (LCME) –OR2. For candidates inquiring about our program via telephone. outlining the application and interview process as well as information about the Neurosurgery faculty and program in general.E. Kestle.utah.edu/som/education/gme/. mail or email. This allows applicants to complete only one application to apply to as many of the participating programs as they select. Applicant must have passed Parts I and II of USMLE prior to the time they begin training. They provide a Central Application Service (CAS) for neurosurgery residencies. Be a graduate of a medical school outside of the US who meets one or more of the following qualifications: • Has a currently valid ECFMG certificate. OR • Is a graduate of a medical school outside the US who has completed a Fifth Pathway Program provided by an LCME-accredited medical school. college and medical school transcripts. Required materials for application include the completed CAS application. The neurosurgery training program at the University of Utah does not accept applications from any source except CAS. All applicants to our program must contact the Neurological Surgery Matching Program directly. 4.
. which standardizes and distributes all application materials. USMLE scores and three letters of recommendation. the program director. Be a graduate of a college of osteopathic medicine in the US accredited by the American Osteopathic Association (AOA) –OR3. which includes a personal statement.
Departmental Policies DEPARTMENT OF NEUROSURGERY UNIVERSITY OF UTAH RESIDENT SELECTION AND REPLACEMENT POLICY Reviewed 2/22/06
RESIDENT SELECTION Eligibility 1. Applicant must be willing to comply with the Health Sciences Center Drug Testing Policy if selected. a packet is sent which contains the GME brochure and a letter from Dr. They are also informed that additional information can be obtained from the departmental website at http://uuhsc.edu/neurosurgery/ as well as the Graduate Medical Education (GME) website at http://uuhsc.utah. 5. Application Process The neurosurgery training program at the University of Utah participates in the National Neurosurgery Matching Program.
race. color. When possible. This also allows us to evaluate. national origin. discuss and rate the applicants in as fair and objective manner as possible. The University of Utah School of Medicine dos not discriminate on the basis of sex. match-ranking lists are completed by the applicants as well as the residency programs. they all meet for lunch and the applicants are then taken on a tour of the clinical and research facilities by two or three of the current residents. disability. The Neurological Surgery Matching Program match occurs approximately two months prior to the general NRMP match. Applicants are provided with information and directions related to this prior to their interview visit.Interview Process From the completed applications. The remaining faculty and residents meet to discuss the match ranking. At the conclusion of the interview process. Applicants are notified whether or not they have been invited for interviews via email. If they are invited for an interview. interviewing between 10-15 candidates each day. By grouping the interviews on a dedicated day we can assure all Resident interviewees have the opportunity to meet most of our faculty and residents and to see our institution in an efficient manner. a group of outstanding applicants are selected to be interviewed by a committee made up of the program director and additional faculty members. age. the interview dates and an overview of the interview process is included in the email. or veteran's status. The following are included in this folder: • • • • • • • • • • • • • • The day’s itinerary A synopsis of each resident and faculty member Faculty and resident publication list An excerpt from our standards of performance Program Description Work hours policy Supervision Policy Moonlighting Policy Leave Policy This Resident Selection Policy Liability coverage policy Stipend memo (previous year's) A copy of the contract they would be expected to sign (previous year's) J1 Visa Acknowledgement form for International Medical Graduates
Applicants interview with all faculty and residents available that day. After interviews are complete. 44
. religion. The interviews are held on two or three designated days. On the interview day applicants receive an information folder. an informal gathering for the applicants and residents is held at a local restaurant the evening before or after the interview day. The match results are available in late January.
the work load and work hours and the impact of having one less resident in the Department. an interview process would be set up with as many faculty available as possible. This may not be on a dedicated Saturday. The other criteria for eligibility and required materials for application are the same as for the resident selection process. the Department will assess the current number of residents.
. as occurs prior to the CAS Neurosurgery Match. Based on these factors. If that is the case. Should an attempt be made to hire a resident during the academic year. a decision will be made as to whether to attempt to hire a resident in the middle of the academic year or to wait until the next application process. it is possible that an active resident will change career plans and leave the program.Resident Replacement Despite the rigorous application and resident selection process.
. generally the neurosurgeon on-call. In addition.DEPARTMENT OF NEUROSURGERY UNIVERSITY OF UTAH SUPERVISION POLICY Reviewed 5-24-06 INTRODUCTION All residents at all levels of the training program are supervised by a faculty neurosurgeon. the attending insures the discharge or transfer of patients is appropriate. Rounds are made daily on inpatients and major diagnostic and treatment decisions are discussed with faculty. Faculty schedules are structured to provide residents with continuous supervision and consultation. major decisions regarding diagnosis and/or care are discussed with the attending. A specific call schedule is published to indicate who is available at any time for these cases. The attending neurosurgeon directs the care of the patient and provides the appropriate level of supervision based on the patient’s condition. To assure that the full spectrum of specialized neurosurgical services can be offered to the patient. On inpatient units All patients that are admitted through the emergency room or are direct admissions from outside institutions or physicians are assigned to a specific faculty neurosurgeon. The activities of the residents are supervised by the neurosurgical attendings. specifically acute subarachnoid hemorrhage. neurovascular problems. complexity of care and experience of the resident being supervised. and thoracolumbar fractures are managed on both an emergent and elective basis by members of the faculty with specific expertise in these areas. Junior residents often discuss patient care issues with chief residents prior to going to the attending. The attending physician meets all inpatients for whom he or she is responsible early in the course of care and documents this in the chart. The attending may choose to countersign or append the residents note. All elective cases are generally admitted to the inpatient service by the neurosurgical faculty. For example. Attending physicians make daily rounds on inpatients. All inpatients are assigned an attending physician who is clearly identified in the patients’ record. Documentation of the supervision is by progress notes entered into the record by the attending neurosurgeon or the resident. the senior resident and the faculty person on-call will contact the appropriate neurosurgeon within the group best prepared to handle this problem and arrange for such care. Faculty and residents are educated to recognize the signs of fatigue and adopt and apply policies to prevent and counteract the potential negative effects. In between rounds. A.
Rev. the outpatients are seen in neurosurgical attending clinics. In this clinic the residents perform the initial evaluation and investigation of patients.
Attached (pages 48-58) is the GME Resident Supervision Policy (Section 7. Documentation from both clinics.B. and in the majority of cases is scrubbed as either the primary surgeon or first assistant. They are then discussed with faculty. reflects the attending with whom the case was reviewed. These requirements assure adequate supervision yet graded responsibility throughout the training period. The neurosurgeons supervise the resident clinic on a rotating basis. the neurosurgical faculty is present within the operating room. 10. attending neurosurgeons see all of the patients in their own clinics. There is also a resident clinic on Wednesdays.
On outpatient services At the UUMC. whether dictated by the resident or the attending. Again. In most cases. Residents are invited to participate if they are available and in those situations they are under direct supervision of the faculty member. The Department of Neurosurgery complies with this policy. Revised January 2006).
. the residents are encouraged to participate and do so under the direct supervision of the neurosurgeon.
In the operating room The specific institution requirements of all the hospitals in our complex require the presence of the surgeon within the institution during all operative procedures. At PCMC.
C. This provides further details. No. 2. Reviewed April 2006.
Summary of Main Points Key principles 1. which includes the principles stated in this document and outlines specific supervision issues distinctive to their training program. Follow local admission guidelines for attending notification. POLICY: Each discipline will be responsible for the development of a policy for its program. 4. Programs are free to adopt these guidelines as appropriate to their specialties. Program directors direct and supervise the program. ii. All supervision situations will be specialty specific. Meet with the patient within 24 hours of admission iii. v.2 Review Date: April 2006 Revision Date: January 2006 I. Attending physician/staff practitioner responsibilities a. Ensures transfer from one inpatient service to another inpatient service is appropriate. Countersign note c. II. 5. An attending physician must be identified for each episode of patient care involving a resident. Outpatient i. b. Emergency Room 48
.Document attending involvement by either an attending note or documentation of attending supervision in the resident progress note. 10 Rev. Resident supervision must be documented. Attending physician is identified in the chart. Attending physician is identified in the chart ii. iv. The attending physician is responsible for the care provided to these assigned patients. 2. vi. Inpatient i. III. Key supervision issues 1. PROCEDURE: Resident Supervision Policy .UNIVERSITY OF UTAH HOSPITALS AND CLINICS
GRADUATE MEDICAL EDUCATION
HOUSESTAFF POLICIES AND PROCEDURES _________________________________________________________ RESIDENT SUPERVISION Section 7 No. The attending physician is responsible for determining the level of supervision required to provide appropriate training and to assure quality of patient care. PURPOSE: To outline guidelines for supervision for postgraduate trainees in the University of Utah Affiliated Training Programs. Ensures discharge is appropriate. Discuss patient with resident during initial visit . Document supervision with progress note by the end of the day following admission. iii. 3.
Education of attending physicians d. 2. Countersign procedure note Sign initial DNR orders and document compliance with local DNR policies
Program director/program coordinator a. Attending physician is identified ii. Discuss with resident doing consultation within 24 hours ii.
i. An attending physician must always be physically present. Implementation and follow-up of policy
. Attending meets with the patient before procedure/surgery iii. Consultation i. Surgery/Procedures i. Documents agreement with surgery/procedures iv. Document supervision of consultation by the end of the next working day. Orientation for residents c.d. Establish and write program specific supervision policy b.
Determination of this level of supervision is a function of the experience and demonstrated competence of the resident and of the complexity of the patients’ health care needs. facilitate the resident’s professional and personal development. Attending physician refers to licensed. surgery. psychiatry. professional competencies. The Attending physician may provide care and supervision only for those clinical activities for which they are privileged. who have been formally credentialed and privileged at the training site. psychiatry. Postgraduate medical education is the process by which clinical and didactic experiences are provided to residents to enable them to acquire those skills. Program Director. It includes the imparting of the practitioner’s knowledge. Graduate Medical Education. pediatrics. The term "residents" refers to individuals who are engaged in a postgraduate training program in medicine (which includes all specialties such as internal medicine. d. c.e.) and for ensuring the program is in compliance with the policies of the respective accrediting and/or certifying body(ies).POLICY FOR SUPERVISION OF POSTGRADUATE TRAINEES AT THE UNIVERSITY OF UTAH AFFILIATED HOSPITALS Salt Lake City. documentation is the written or computer-generated medical record evidence of the interaction between a supervising practitioner and a resident concerning a patient encounter. and attitudes.
. and effective manner. and attitudes by the practitioner to the resident and assuring that the care is delivered in an appropriate.. independent physicians. knowledge. The Program Director is responsible for the quality of the overall affiliated education and training program in a given discipline (i. in accordance with applicable requirements. medicine.) The term "resident" for the purposes of this policy includes individuals in their first year of training typically referred to as "interns" and individuals in advanced postgraduate education programs who are typically referred to as "fellows. h. which are important in the care of patients. Supervising Practitioner must provide an appropriate level of supervision. g. timely. In terms of resident supervision. DEFINITIONS: a. Residents. The purpose of graduate medical education is to provide an organized and integrated educational program providing guidance and supervision of the resident. skills. and an acquisition of detailed factual knowledge in a clinical specialty. and ensure safe and appropriate care for patients. Such control is exercised by observation. pediatrics etc. surgery. Documentation is the written or computer-generated medical record evidence of a patient encounter. consultation and direction. Supervision refers to the dual responsibility that an attending physician has to enhance the knowledge of the resident and to ensure the quality of care delivered to each patient by any resident. Documentation." e. Utah
I. etc. Graduate medical education programs focus on the development of clinical skills. attitudes. Supervision. f. Supervising Practitioner. Attending Physician. This term is synonymous with the “Attending Physician” in medicine.
Rules governing billing and documentation. ability and experience.
b. both for the provision of excellent patient care and for the provision of excellent education and training for future health care professionals The quality of patient care. patient safety.
. there must be clear delineation of responsibilities to ensure that qualified practitioners provide patient care. All programs which include residents within the University of Utah Affiliated Hospital System must be approved by the appropriate the ACGME (Accreditation Council for Graduate Medical Education) or have special approval by the Graduate Medical Education (GME) committee. Incumbent on the clinician educator is the appropriate supervision of the residents as they acquire the skills to practice independently.
g. Institutional Requirements of ACGME state that “[medical] residents must be supervised by teaching staff in such a way that the residents assume progressively increasing responsibility according to their level of education. In a health care system where patient care and the training of health care professionals occur together. and the success of the educational experience are inexorably linked and mutually enhancing.
c. they will be allowed the privilege of increased authority for patient care. Qualified health care professionals with appropriate credentials and privileges provide patient care and provide supervision of residents. whether they are trainees or full-time staff. This policy focuses on resident supervision from the educational perspective. Clinician educators involved in this process must understand the implications of this principle and its impact on the patient and the resident. however. It is recognized that as resident trainees acquire the knowledge and judgment that accrue with experience. This is fundamental. The intent of this policy is to ensure that patients will be cared for by clinicians who are qualified to deliver that care and that this care will be documented appropriately and accurately in the patient record. will inevitably evolve.II. The hospital must comply with the institutional requirements and accreditation standards of the Joint Commission of Accreditation of Healthcare organizations (JCAHO) and other health care accreditation bodies.
d. The principles of good training and educational supervision are not likely to change radically over time. regardless of specialty or discipline.” This process is the underlying educational principal for all graduate medical education. POLICY: a.
and the role of residents within the affiliated training program iv. Ensure that residents are provided the opportunity to contribute to discussions in committees where decisions being made may affect their activities. 52
b.e.) and for ensuring that the program is in compliance with the policies of the respective accrediting or certifying bodies. The Residency Program Director is responsible for the quality of the overall education and training program in a given discipline (i. this includes written evaluations by the residents and interviews with residents. Assess the attending physician’s discharge of supervisory responsibilities. The procedures through which the attending physician provides and document appropriate supervision is outlined below in section 5. ii. Attending physician. Structure training programs consistent with the requirements of the accrediting and certifying bodies (as identified above) and the affiliated sponsoring entity. as individuals. pediatrics. The Associate Dean for Graduate medical education is responsible for establishing local policy to fulfill the requirements of this policy and the applicable accrediting and certifying body requirements. surgery. etc. i. Residency Program Director. the responsible attending physician must continue to maintain a personal involvement in the care of the patient. At a minimum.
. d. Determination of this level of supervision is a function of the experience and demonstrated competence of the resident and of the complexity of the patient’s health care needs. Such communication must be documented in the record.. Associate Dean for Graduate Medical Education. medicine. The attending must provide an appropriate level of supervision. The residents. When a resident is involved in the care of the patient. Each resident is responsible for communicating significant patient care issues to the attending physician. psychiatry. c.RESPONSIBILITIES: a. must be aware of their limitations and not attempt to provide clinical services or do procedures for which they are not trained. Arrange for all residents entering their first rotation to participate in an orientation to policies. Failure to function within graduated levels of responsibility or to communicate significant patient care issues to the responsible attending physician may result in the removal of the resident from patient care activities. Resident. procedures. The attending physician is responsible for and must be personally involved in the care provided to individual patients in inpatient and outpatient settings as well as long-term care and community settings. They must know the graduated level of responsibility described for their level of training and not practice outside of that scope of service. other practitioners and other members of the health care team. iii. The Residency Program Director defines the levels of responsibilities for each year of training by preparing a description of the types of clinical activities residents may perform and those for which residents may act in a teaching capacity.
Pathology and radiology reports must be verified by an attending physician. It is the responsibility of the attending physician to be sure the residents involved in the care of the patient are informed of such delegation and can readily access an attending physician at all times. Fulfillment of such responsibility requires personal involvement with each patient and each resident who is providing care as part of the training experience. . ii. The attending physician will direct the care of the patient and provide the appropriate level of supervision based on the nature of the patient’s condition. The attending physician is expected to fulfill this responsibility. The progress note must be properly signed. Such a delegation will be documented in the patient's record. The attending physician’s progress note will include findings and concurrence with the resident’s initial diagnosis and treatment plan as well as any modifications or additions. This supervision must be personally documented in a progress note no later than the day after admission. Attending physicians are expected to be personally involved in the ongoing care of the patients assigned to them in a manner consistent with the clinical needs of the patient and the graduated level of responsibility of the trainee. ensures that the discharge of the patient from an inpatient service is appropriate and based on the specific circumstances of the patient’s 53
. Attending physicians are responsible for the care provided to each patient. dated. Resident Supervision by the attending physician. The medical record must reflect the degree of involvement of the attending physician. and they must be familiar with each patient for whom they are responsible. in consultation with the resident. the attending physician must meet the patient early in the course of care (within 24 hours of admission including weekends and holidays). The resident note shall include the name of the attending physician with whom the case was discussed as well as a summary of that discussion. Medical. the assigned practitioner. iii. Attending physicians will be responsible for following the admitting procedures required by the institutions at which they are admitting patients is association with resident physicians. Documentation of this supervision will be by progress notes entered into the record by the attending physician or reflected within the resident’s progress note at a frequency appropriate to the patient’s condition. It is recognized that other attending physicians may. in the following manner: i. or in addition to. The attending physician. and timed. be delegated responsibility for the care of a patient and provide supervision instead of. at a minimum. Discharge from Inpatient Status. at times. surgical or mental health services must be rendered under the supervision of the attending physician or be personally furnished by the attending physician. the likelihood of major changes in the management plan. and the experience and judgment of the resident being supervised. PROCEDURES: a. The attending may choose to countersign and add an addendum to the resident note detailing his/her involvement and supervision. the complexity of care. For patients admitted to an inpatient team.III. Each patient will be assigned an attending physician whose name will be clearly identified in the patient's record. or the resident’s description of attending involvement. either by staff physician progress note.
the supervising practitioner must physically meet and examine the patient within 24 hours of admission by the night float to the inpatient service. v. The supervision for new patients should be documented by either independent attending physician note or an addendum to the resident note. Return patients should be seen by or discussed with the attending physician at such a frequency as to ensure that the course of treatment is effective and appropriate. dated. medications. or transferred into an ICU the attending physician must physically meet. An attending physician must be physically present in the clinic area during clinic hours. Unless otherwise specified in the graduated levels of responsibility. For patients admitted to an inpatient service of the medical center. vii. a “night float” resident occasionally provides care before the patient is transferred to an inpatient ward team. This supervision must be documented in the chart via a progress note by the attending physician or the resident’s note and include the name of the attending physician and the nature of the discussion. This supervision must be documented in the record via a note by the attending physician or the resident’s note that indicates the nature of the discussion with the attending physician. this may include physical activity. Intensive Care Units (ICU). The Attending’s co-signature 54
. irrespective of the time the ward team assumes responsibility for the patient. the supervising practitioner for the night float must be clearly designated by local policy. In addition.diagnoses and therapeutic regimen. The attending may choose to countersign and add an addendum to the resident note detailing his/her involvement. In these cases. including Medical. Cardiac and Surgical ICUs. The medical record should reflect the degree of involvement of the attending physician. Night Float Admissions. functional status and follow-up plans. and evaluate the patient as soon as possible. Transfer from One Inpatient Service to Another. diet. All patients to the clinic for which the attending physician is responsible should be supervised by the attending physician. Out Patient clinic. but no later than2 4 hours after admission or transfer. All notes must be signed. iv. New patients should be supervised as dictated by graduated level of responsibility outlined for each discipline. examine. either by staff physician progress note or the resident’s description of attending involvement. The attending physician from the transferring service must be involved in the decision to transfer the patient. new patients must be seen by and evaluated by the attending physician at the time of the patient visit. The attending physician from the receiving service must treat the patient as a new admission and write an independent note or an addendum to the resident’s transfer acceptance note. and timed by the resident. The attending physician. vi. ensures that the transfer of the patient from one inpatient service to another or transfer to a different level of care is appropriate and based on the specific circumstances of the patient’s diagnoses and condition. in consultation with the resident. including weekends and holidays. Evidence of this assurance must be documented by the attending physician countersignature of the discharge summary. For patients admitted to. or Transfer to a Different Level of Care.
The supervision of residents performing consultation will be determined by the graduated levels of responsibility for the resident. Emergency room consultations by residents may be supervised by a specialty attending physician or the emergency room attending physician. After discussion of the case with the discipline specific attending physician. without exception. will function under the supervision of attending physicians. x. Emergency Department. the attending physician will be responsible for supervision of these residents. the specialty specific attending physician does not need to meet directly with the patient.of the resident’s note is an acceptable method for the attending physician to document resident supervision. xi. An emergency department attending physician must be physically present in the emergency department. Unless otherwise stated in the graduated levels of responsibility. The attending may choose to countersign and add an addendum to the resident note detailing his/her involvement. The attending physician is responsible for official consultations on each specialty team. When trainees are involved in consultation services. In such cases where the emergency room attending physician is the principal provider of care for the patient’s emergency room visit. i. The attending physician. All DNR orders must be signed or countersigned by the attending physician. All emergency room consultations by residents should involve the attending physician supervising the resident’s discipline specific specialty consultation activities for which the consultation was requested. ix. b. the resident may receive direct supervision in the emergency room from the emergency room attending physician. Emergency room consultations. Within the scope of the training program. the attending physician must meet with each patient who received consultation by a resident and perform this personal evaluation in a timely manner based on the patient’s condition. Assure all Do Not Resuscitate (DNR) orders are appropriate and assure the supportive documentation for DNR orders are in the patient's medical record. the specialty specific attending physician’s supervision of the consultation should be documented in the medical record by co-signature of the consultation note or be reflected in the resident physician consultation note. The attending physician must document this official consultation supervision by writing a personal progress note or by writing his/her concurrence with the resident consultation note by the close next working day. ensures that the discharge of the patient from the emergency department is appropriate. in consultation with the resident. all residents. A responsible attending physician must be immediately available to the resident in person or by telephone and able to be present within a reasonable period 55
. However. viii. Assignment and Availability of Attending physicians. The patients seen in consultation by residents must be discussed and/or reviewed with the attending physician supervising the consultation within 24 hours of initial consultation by the resident. Each new patient to the emergency department must be seen by or discussed with an attending physician.
g. These guidelines will include the knowledge. The Residency Program Director will define the levels of responsibilities for each year of training by preparing a description of the types of clinical activities residents may perform and those for which residents may act in a teaching capacity. it is the decision of the attending physician as to which activities the resident will be allowed to perform within the context of the assigned levels of responsibility. radiology studies. In addition. Facilities must ensure that their training programs provide appropriate supervision for all residents as well as a duty hour schedule and a work environment that are consistent with proper patient care. Patients followed in more than one clinic will have an identifiable attending physician for each clinic. knowledge. As part of their training program. Attending physicians are responsible for ensuring the coordination of care that is provided to patients. ii. and technical skill. and all applicable program requirements. c. skill. i. Graduated Levels of Responsibility. Ultimately. attitudes. residents are allowed to certify and re-certify certain treatment plans (e. ii. iii. the educational needs of residents.of time (generally considered to be within 30 minutes of contact). and make available "call schedules" indicating the responsible attending physician(s) to be contacted. if needed.. 56
. however. The documentation of the assignment of graduated levels of responsibility will be made available to other staff as appropriate. and be promoted at the time of the annual review. Speech Therapy) as part of their assigned levels of responsibility. These activities are considered part of the normal course of patient care and require no additional documentation on the part of the supervising practitioner over and above standard setting-specific documentation requirements. knowledge. and skills which will be evaluated and must be present for a resident to advance in the training program. In general. Physical Therapy. and therapeutic procedures as part of their assigned levels of responsibility. and judgment. iii. Each training program will be structured to encourage and permit residents to assume increasing levels of responsibility commensurate with their individual progress in experience. it is expected that an appropriately privileged attending physician will be available for supervision during clinic hours. pharmaceuticals. Each discipline will publish. assume increased responsibilities (such as supervision of lower level trainees). residents should be given progressive responsibility for the care of the patient. judgment. In order to ensure patient safety and quality patient care while providing the opportunity for maximizing the educational experience of the resident in the ambulatory setting. residents are allowed to order laboratory studies. The determination of a resident's ability to provide care to patients without a supervisor present or to act in a teaching capacity will be based on documented evaluation of the resident's clinical experience. The overriding consideration must be the safe and effective care of the patient that is the personal responsibility of the attending physician.
Attending physicians will provide appropriate supervision for the patient’s evaluation. shall be permitted to do everything possible to save the life of a patient or to save a patient from serious harm. Attending physicians will be responsible for authorizing the performance of such procedures. Determination of this level of supervision is generally left to the discretion of the attending physician within the context of the previously described levels of responsibility assigned to the individual resident involved. bronchoscopy. but such documentation does not replace the pre-operative documentation required by the surgery attending physician. angiograms. Diagnostic or therapeutic procedures require a high level of expertise in their performance and interpretation. lumbar puncture. e. iii. Supervision of Procedures. and any other procedures where there is the need for informed consent. ii. Anesthesiology) must write their own pre-procedure notes (such as for the administration of anesthesia) as required by JCAHO. wound debridement. This pre-procedural evaluation and note may be done up to 30 days in advance of the surgical procedure. are considered elements of routine and standard patient care. plan for treatment. During the performance of such procedures. Emergency Situation. although invasive by nature. In such situations. Examples are the placing of intravenous and arterial lines. A pre-procedure note may also serve as the admission note if it is written within 1 calendar day of admission by the attending physician with responsibility for continuing care of the inpatient. and drainage of superficial abscesses. Although gaining experience in performing such procedures is an integral part of the education of the resident. routine radiologic studies. i. endoscopy. Other services involved in the patient’s operative care (e. an attending physician will provide an appropriate level of supervision.g. and judgment and under an appropriate level of supervision by attending physicians. and if the notes meet criteria for both admission and pre-operatives notes. NOTE: Excluded from the requirements of this section are procedures that. diagnosis. or to prevent serious impairment of the health of a patient.. and such procedures should only be performed with the explicit approval of the attending physician. This determination is a function of the experience and competence of the resident and of the complexity of the specific case. All applicable JCAHO standards concerning documentation must be done. An "emergency" is defined as a situation where immediate care is necessary to preserve the life of.d. assisted by other clinical personnel as available. any resident. For elective or scheduled procedures. such procedures may be performed only by residents with the required knowledge. Examples include operative procedures performed in the operating suite. skill. thoracentesis. paracentesis. and/or choice of specific procedure to be performed. management decisions and procedures. The 57
. the attending physician must evaluate the patient and write a pre-procedural note or addendum to the resident’s preprocedure note describing the findings.
appropriate attending physician will be contacted and apprized of the situation as soon as possible. The resident will document the nature of that discussion in the patient's record. f. Evaluation of Residents and Supervisors. i. Each resident will be evaluated according to accrediting and certifying body requirements on the basis of clinical judgment, knowledge, technical skills, humanistic qualities, professional attitudes, behavior, and overall ability to manage the care of a patient. Evaluations will occur as indicated by the accrediting or certifying body at the end of the resident's rotation or every six months, whichever is more frequent. Written evaluations will be discussed with the resident. ii. If a resident's performance or conduct is judged to be detrimental to the care of a patient(s) at any time, action will be taken immediately to ensure the safety of the patient(s). iii. At least annually, each resident rotating through the will be given the opportunity to complete a confidential written evaluation of attending physicians and of the quality of the resident’s training. Such evaluations will include the adequacy of clinical supervision by the attending physician. The evaluations will be reviewed by the program director. iv. All written evaluations of residents and attending physicians will be kept on file by the Residency Program Director in an appropriate location and for the required time frame according to the guidelines established by the respective ACGME Residency Review Committee or other accrediting and certifying agencies. g. Monitoring Procedures. i. The goal of monitoring resident supervision is to foster a system-wide environment of peer learning and collaboration among managers, attending physicians and residents. The monitoring process involves the use of existing information, the production of a series of evaluative reports, the accompanying process of public review of key findings, and discussion of policy implications. Monitoring will of the compliance with these procedures will be performed by the program director and as part of the scheduled internal program reviews. ii. The basic foundation for resident supervision ultimately resides in the integrity and good judgment of professionals (attending physicians and residents) working collaboratively in well-designed health care delivery systems. Approval body: Graduate Medical Education Committee Approval date: April 2002 Policy Owner: Graduate Medical Education Historical Information: Review dates: 2/06 Revision dates 1/06 Approval dates: 58
DEPARTMENT OF NEUROSURGERY UNIVERSITY OF UTAH WORK HOURS POLICY Revised 4/13/05
Work hours will be established to conform to the ACGME work hours regulations for all core and subspecialty programs as of July 1, 2003. These regulations are reproduced below: Resident Duty Hours and the Working Environment Providing residents with a sound academic and clinical education must be carefully planned and balanced with concerns for patient safety and resident well-being. Each program must ensure that the learning objectives of the program are not compromised by excessive reliance on residents to fulfill service obligations. Didactic and clinical education must have priority in the allotment of residents' time and energies. Duty hour assignments must recognize that faculty and residents collectively have responsibility for the safety and welfare of patients. 1. Duty Hours a. Duty hours are defined as all clinical and academic activities related to the residency program, i.e., patient care (both inpatient and outpatient), administrative duties related to patient care, the provision for transfer of patient care, time spent in-house during call activities, and scheduled academic activities such as conferences. Duty hours do not include reading and preparation time spent away from the duty site. b. Duty hours must be limited to 80 hours per week, averaged over a four-week period, inclusive of all in-house call activities. c. Residents must be provided with 1 day in 7 free from all educational and clinical responsibilities, averaged over a 4-week period, inclusive of call. One day is defined as one continuous 24-hour period free from all clinical, educational, and administrative activities. d. Adequate time for rest and personal activities must be provided. This should consist of a 10 hour time period provided between all daily duty periods and after in-house call. 2. On-Call Activities The objective of on-call activities is to provide residents with continuity of patient care experiences throughout a 24-hour period. In-house call is defined as those duty hours beyond the normal work day when residents are required to be immediately available in the assigned institution. a. In-house call must occur no more frequently than every third night, averaged over a fourweek period. b. Continuous on-site duty, including in-house call, must not exceed 24 consecutive hours. Residents may remain on duty for up to six additional hours to participate in didactic activities, transfer care of patients, conduct outpatient clinics, and maintain continuity of medical and surgical care as defined in Specialty and Subspecialty Program Requirements. c. No new patients, as defined in Specialty and Subspecialty Program Requirements, may be accepted after 24 hours of continuous duty.
d. At-home call (pager call) is defined as call taken from outside the assigned institution. 1. The frequency of at-home call is not subject to the every third night limitation. However, at-home call must not be so frequent as to preclude rest and reasonable personal time for each resident. Residents taking at-home call must be provided with 1 day in 7 completely free from all educational and clinical responsibilities, averaged over a 4-week period. 2. When residents are called into the hospital from home, the hours residents spend inhouse are counted toward the 80-hour limit. 3. The program director and the faculty must monitor the demands of at-home call in their programs and make scheduling adjustments as necessary to mitigate excessive service demands and/or fatigue. 3. Oversight a. Each program must have written policies and procedures consistent with the Institutional and Program Requirements for resident duty hours and the working environment. These policies must be distributed to the residents and the faculty. Monitoring of duty hours is required with frequency sufficient to ensure an appropriate balance between education and service. b. Back-up support systems must be provided when patient care responsibilities are unusually difficult or prolonged, or if unexpected circumstances create resident fatigue sufficient to jeopardize patient care. 4. Duty Hours Exception An RRC may grant exceptions for up to 10% of the 80-hour limit, to individual programs based on a sound educational rationale. However, prior permission of the institution's GMEC is required. 5. University of Utah Department of Neurosurgery Work Hours Policy The definitions of duty hours and on-call activities as described by the ACGME have been adopted. Compliance with these regulations is monitored on an ongoing basis. Resident work hours are entered into commercially available software and reported every four weeks at the Wednesday Departmental Conference by the Program Director. The Program Director also monitors call schedules to ensure compliance. Particular attention is paid to the at-home call, which is not subject to the one in three restriction. All Department members (faculty and residents) have completed the SAFER Training Program so that they are familiar with the signs and symptoms of fatigue. Should these arise, back up support for clinical care and call responsibilities has been available as needed from residents on research rotations. The Department applied for and was granted a 10% exemption to the 80 hour limit and has therefore been working with an 88 hour work week.
0 May June July Aug Sept PGY 6 Oct PGY 5 Nov PGY 3 Dec Jan PGY 2 Feb ACGME Mar Apr May June
In case of conflicting requests. Residents involved in the National Guard or any other organized reserve branch of the United States Armed Services are entitled to leave of absence not exceeding 15 calendar days or 11 working days per year. For example PGY-2 residents should overlap months. the American Association of Neurological Surgeons. We traditionally try to provide additional time off during the Christmas/New Years holiday season. vacations will be awarded by seniority. The usual vacation will be seven days. who will have 62
. “Academic work” will be considered in the following hierarchy: Residents receiving awards will have priority over residents giving platform presentations.
Meeting Policies Residents are encouraged to submit papers for presentation at both regional and national neurosurgical meetings. If a resident has a talk or poster accepted for the meeting.
D. Requests will be considered in light of the number of people who want to travel. The last date that they will be accepted is one month prior to the date of the meeting. CONFERENCES AND LEAVE Revised 7/26/06 The service will try to be flexible to try to accommodate individual's vacation requests as long as it does not interfere with the proper functioning of the service. the travel request form should be sent to the program director as soon as they have been informed that their work has been accepted. The same applies to talking at courses.DEPARTMENT OF NEUROSURGERY UNIVERSITY OF UTAH VACATION. no vacation should be planned during the time of the Lende Winter Neurosurgery Conference which is held the first week of February every year. and the Congress of Neurological Surgeons annual meetings. To provide for adequate service coverage vacations should not generally be planned at this time. This includes going to meetings that are funded by sources other than the Department. other meetings that should be respected are the Rocky Mountain Neurosurgical Society. but earlier notification would be best. This is leave time and is in addition to annual paid vacation. since that will reduce the ability of other residents to attend these meetings. Specifically. There will be no vacation the last two weeks of June and the first two weeks of July. The maximum consecutive vacation time that can be taken is two weeks but if this is done it should be organized to minimize the impact on the service. residents should not plan vacation during times of meetings. In addition. the relevance of the meeting. however seniority preference only exists at the time of the initial request. In addition. Only one resident may be gone from a service at a time. This applies to any and all time away from the service. A senior resident may not change his vacation time to a time already scheduled by a junior resident. A submitted presentation should be coordinated with one of the faculty staff and a copy of any abstract submitted should be forwarded to the program director. Vacation/conference leave requests should be submitted well prior to the date of departure. the academic work that the resident is doing at the meeting and the cost. The following general rules should be adhered to: 1) All vacation and travel request forms need to be signed by Dr. Kestle.
priority over oral posters. or bereavement. for whatever reason. personal or family need. etc. will be allowed during a given year for a total of 7 weeks of missed training time in a 12-month period (14%). It is anticipated that any resident attending a meeting at departmental expense will participate fully in the meeting. E. Activities such as educational symposiums or professional meetings related to neurosurgical education are not considered leave if they are approved by the program director. 2) Types of Leave Leave will be classified as one of the following: maternity. adoption. Residents (including Chiefs) will not necessarily be reimbursed for attendance at meetings where they are not presenting academic work. a) Maternity: The Department of Neurosurgery feels that maternity leave is important for full recovery of the resident and to assure her ability to work 63
. During a period of leave the resident will continue to receive pay and benefits. Additional time taken either before or after the meeting however will be at the individual's expense and taken as vacation time. An additional 4 weeks of leave. Leave cannot be accumulated from year to year. who will have priority over regular posters. including insurance. Because of the intense nature of neurosurgical training and the major responsibilities every resident has to the patients and the service. The Family Leave Act mandates that employees be granted leave from work for various personal and medical reasons. Residents will be readmitted to the program at the end of the family leave at the same status as when leave commenced. use of leave time must be restricted to significant personal or family needs and for the minimum amount of time needed for these events. Each resident will have a maximum of five weeks off per academic year: three weeks of vacation and a maximum of two weeks time off for attendance at meetings. leave has been determined by the department chairman. Heretofore. Resident staff at the University of Utah are contractually guaranteed 21 days of vacation per year of training. military service. Abuse of leave time may serve as grounds for probation or termination. Any resident who takes an extended leave must meet with the program director about his or her return to determine if they will have to make up time to make up the minimum requirements required by the program and the American Board of Neurological Surgery. Submission of abstracts to meetings outside the Continental United States can only be done with prior approval of the program director and will usually only be considered under exceptional circumstances. 1) Definition Leave is defined as time spent away from clinical or research responsibility on the neurosurgery service during the duration of the residency training program (6 years). major illness. Leave Policy The Neurosurgery Residency Review Committee has no specific policy regarding leave of any kind. Vacation is independent of leave. at the rate specified by hospital policy. paternity.
An example of acceptable reasons for approval might include a family member with a major illness. Adoption: A resident. it is needed for the individual to be fully trained. Per the FMLA. This leave may or may not be paid and make up time may be required. Per the FMLA. spouse. additional unpaid leave is available. No scheduling concessions. without penalty. they do not accrue sick leave. Paternity: A resident is allowed to attend the birth of his children and an additional 2 days paid leave. in the judgment of the program director. Armed Forces are entitled to 15 work days of leave per year. Per the FMLA. Maternity leave of 4 weeks paid leave and vacation time may be taken in conjunction. Military Service: A resident involved in the National Guard or other organized reserve branches of the U. It is strongly suggested that individual arrangements be made during the prenatal period to make up this time. sibling. additional unpaid leave is available.S. Vacation time may be taken in conjunction with adoption leave.e. Vacation time may be taken in conjunction with paternity leave. Unusual Circumstances: Under "unusual” circumstances. The resident may be required to make up the missed training time at the end of the training period without pay. The resident is responsible for arranging for coverage of her normal call assignments during maternity leave.. grandparent or grandchild. Such additional make up time at the end of the residency will be without pay. i. Leave will be granted for the duration of a major medical or psychological illness at the discretion of the program director. a resident may receive up to 7 weeks of paid leave per year. with additional unpaid time if circumstances dictate. additional unpaid leave is available. Individuals with prolonged absences or with repetitive annual absences may require additional make up time at the end of the residency to meet the requirements of board eligibility or if.b)
a complete schedule upon her return. Bereavement: A resident may take up to three working days. Sick pay and insurance benefits will continue for the duration specified by hospital policy. Maternity leave may have to be made up from elective time or at the end of the residency to meet the requirements of the American Board of Neurological Surgery. is entitled to 2 days paid leave for the purpose of adoption. "light duty" can be accommodated. Personal or Family Need: A resident may be granted a 1-week period of leave with the prior approval of the program director. child. This leave is available in the event of death of a parent. to extent Program Director deems reasonable and necessary. parent-in-law. either male or female. and residents should discuss this matter with the Program Director. a resident may be granted leave for an unspecified amount of time with the prior approval of the program director. and residents should discuss this matter with the Program Director. This is paid leave and is in addition to vacation time. brother-in-law.
As specified above. sister-in-law. including vacation. 64
. and residents should discuss this matter with the Program Director. Major Illness: Since residents are considered "temporary” employees by the University Hospital.
Because the Neurosurgery Training Program is time intensive and it is difficult to meet all the requirements in only 88 hours per week. which require residents to work no more than 88 hours per week when averaged over a four week period. The ACGME has instituted work hour regulations. moonlighting is not allowed.DEPARTMENT OF NEUROSURGERY UNIVERSITY OF UTAH MOONLIGHTING POLICY Revised 9/17/04
Moonlighting Policy Neurosurgery residency training is a rigorous full-time educational experience. The ACGME requires that hours spent moonlighting be counted towards the 88 hours. Residents should not be diverted from their primary responsibilities of patient care and learning by engaging in extramural professional activities. We therefore have an 88 hour per week maximum. Military service is not considered moonlighting. The University of Utah Neurosurgery program received approval from the Residency Review Committee for a 10% extension of the work hour limit.
. It is important that residents have time for adequate rest and personal pursuits.
At the request of the pregnant trainee. Such a dose increases the theoretical risk for fetal malformation or tumor development by 0. The trainee should take it upon herself to provide extra radiation protection during the critical weeks by: (a) wearing a maternity lead apron. apprehensions. Antenatal guidelines The greatest radiation risk for the fetus occurs during the first trimester. Fetal exposure can and should be closely monitored. pre-conception Any changes in fluoroscopy schedules to accommodate a resident attempting to become pregnant should not be anticipated. the period of organogenesis. her first trimester schedule can be adjusted so that it does not include angiography or fluoroscopy (to be made up at a later date). Studies suggest an expected nine month fetal dose of only 50 mR for the average radiologist. such adjustments will be considered upon request.105%).DEPARTMENT OF NEUROSURGERY UNIVERSITY OF UTAH PREGNANCY GUIDELINES FOR NEUROSURGERY TRAINEES Revised 9/17/04 The residency program can anticipate that female trainees may have children during training. The Department Medical Physicist has special belly badges that should be worn beneath the apron. For services using extensive under-table fluoroscopy. The maternity lead apron will be kept in the Radiology Chair’s Office and can be checked out upon request. (b) normal precautions of decreasing fluoroscopy time and exposure. The department has available a maternity lead apron (reinforced ventrally. The trainee will be responsible for the safe return of the apron to the Administrative Office. This apron will be kept in the Administrative Office and may be checked out upon request. 1. The planned pregnancy. potential misunderstanding. (c) wearing a belly badge under the lead apron during fluoroscopy. These are inexpensive. By outlining expectations of the pregnant neurosurgery resident. and even discrimination may be averted. The AAWR (American Association of Women in Radiology) suggests that reasonable policies regarding pregnancy be established and presented to all trainees. 2.005% (from the normal population rate of 4. wrap-around style). Data suggest that fluoroscopy and angiography are safe to the fetus when normal radiation safety precautions are taken. The 1994 occupational dose analysis for the residents in our department also suggests that elimination of fluoroscopy at any time during pregnancy cannot be justified on scientific grounds.
. and can be read weekly or on very short notice. The trainee is responsible for the safe return of the lead to the Chair’s Office. re-usable.100% to 4. The NRC allows a fetal dose of up to 500 mR over the nine month gestation period.
The pregnant trainee should recognize the potential disruption in scheduling that her maternity leave will cause.
. is generally minimal and does not impact work attendance.In the healthy radiologist. prenatal sickness morbidity. time to be made up without pay). Serious illness requiring prolonged bed rest will be treated as a recognized leave of absence (leave with pay. Every effort should be made to complete expected service duties during the pre-natal period.
other disciplines. chief residents. STANDARDS OF PERFORMANCE AND DUE PROCESS POLICY Revised 2-22-06 INTRODUCTION Resident performance is evaluated through the residency and advancement to the next level is dependent on satisfactory performance. nurses.e-value. which are based on the six competencies as outlined by the ACGME/Neurosurgery RRC. This consists of discussion of resident performance at weekly faculty meetings and at faculty retreats. This is done on line at https://www. There is a continuous process of resident evaluation through the residency. Structured Evaluations Each resident is formally evaluated by the faculty every three months or at the end of each rotation. nurses and other allied health professionals. often with the input of colleagues. The residents are continuously observed during conferences and on the ward and in the operating room. The resident receives a copy of the evaluation and may discuss it further at any time.
. In addition.
b. The Program Director then meets with each resident individually to review and sign the evaluation. RESIDENT EVALUATION PROCESS The following methods are used to formulate resident evaluations: a. They may be received from Neurosurgical faculty.DEPARTMENT OF NEUROSURGERY UNIVERSITY OF UTAH RESIDENT EVALUATION. These incidents are usually discussed with the resident on an individual basis as they occur. immediate feedback is usually given to the residents regarding their decision making process. In these situations. c. These evaluation forms are reviewed by the Program Director and Chairman. Residents are evaluated by attending neurosurgeons. families or other allied health workers. their skills and their teaching presentations. An assessment of their strengths and weaknesses and recommendations for improvement is developed. input received by the Department from any source relevant to a resident’s performance is considered in their progression through and graduation from the program. Notable Incidents Exceptional resident performance (good and/or bad) is brought to the attention of the Program Director in writing and added to the resident’s file.net/ using the evaluation forms (pages 71-73). Issues arising from such discussions are brought to the resident’s attention when appropriate or incorporated into their structured evaluations.
These are used as the basis for evaluation and for advancement through the residency training program. No. This has been adopted to assure that all actions regarding resident disciplinary action or probation are enacted fairly. 1 (page 76) of the University of Utah Housestaff Policies and Procedures Manual entitled "Academic Probation" will be followed.
STANDARDS OF PERFORMANCE The Department has developed PGY specific standards of performance. 2. but are not limited to. The Department goal is to have residents achieve a score of 70th percentile or higher. They may include. Rev. Specific recommendations from these reviews might include: 1) 2) 3) 4) 5) Suggesting specific corrective actions Requiring repeating some time Requiring special programs such as counseling Placing an individual on academic probation Terminating the individual if prior corrective action and probation have not been successful or immediately if behavior is especially egregious
The resident will be given an opportunity to remediate unsatisfactory performance. Please note that the departmental due process checklist on page 82 is not quite correct in item 7. 5. which were established by consensus among Department members. The policy which is to be applied is stated in Section 7. On the first attempt. They will be advised as to the length of the probationary period and what must be accomplished in order to be removed from probation. the residents may choose to take it for practice or for credit. Section IIA of the Housestaff Manual: "No resident will be dismissed for academic problems without a probationary period. If this is achieved on the first attempt.3. Such extraordinary circumstances are beyond the normal professional behavior expected of all physicians. The policies in Section 7. abusive behavior to patients. the public or other health professionals. pages 6-11.
. Duties of the residents in each year.d. a second attempt is not necessary. The Department pays for the examination.
American Board of Neurological Surgery Written Examination This examination is taken by the residents during or after the PGY-3 year. All residents are required by the American Board of Neurological Surgery to satisfactorily pass this examination for credit. No. substance abuse. theft or abuse of property. UNSATISFACTORY PERFORMANCE Any resident who receives an unsatisfactory rating on a rotation or who otherwise is not performing in a satisfactory fashion as determined by the faculty and program director will be reviewed for corrective action. DUE PROCESS The University of Utah School of Medicine Housestaff Due Process Policy detailed in Section 7 No. unless extraordinary circumstances exist" (emphasis added). dishonesty or insubordination. 5 of The Housestaff Manual will be followed (pages 78-82). They are described in Section A.
6 (page 83).
. RESIDENT GRIEVANCE POLICY See Housestaff Manual Grievance Policy Section 7 No.PROBATION AND DISMISSAL See Housestaff Manual Resident Evaluation Policy Section 7 No. 1 (page 76).
EVALUATION FORM FOR NEUROSURGERY RESIDENTS ON CLINICAL ROTATIONS
Dates of Rotation:
PATIENT CARE: Delivers appropriate and effective patient care Demonstrates compassion toward patients and their families.
Rating 1-5 (1=Poor. 5=Outstanding) 1 1 1 2 2 2 3 3 3 4 4 4 5 5 5
MEDICAL KNOWLEDGE: Knowledge of clinical neurosurgery. Uses current literature to support patient care. Is technically competent in the performance of surgical procedures
Rating 1-5 (1=Poor. 5=Outstanding) 1 1 2 2 3 3 4 4 5 5
PRACTICE-BASED LEARNING AND IMPROVEMENT: Willingness to learn from errors in order to improve patient care.
Rating 1-5 (1=Poor. Decision making ability. 5=Outstanding) 1 1 2 2 3 3 4 4 5 5
Maintains comprehensive. 5=Outstanding) 1 1 2 2 3 3 4 4 5 5
Academic initiative/activity for their level of training
. Sensitive to a diverse patient population. 5=Outstanding) 1 1 1 2 2 2 3 3 3 4 4 4 5 5 5
SYSTEM BASED PRACTICE: Demonstrates knowledge of different practice and delivery systems. 5=Outstanding) 1 1 1 1 2 2 2 2 3 3 3 3 4 4 4 4 5 5 5 5
PROFESSIONALISM: Commitment to professional responsibilities. appropriate and legible medical records. timely.
Rating 1-5 (1=Poor.
Rating 1-5 (1=Poor. With clerical and nursing staff.
Rating 1-5 (1=Poor. With residents/attendings. Adheres to ethical principles. Practices cost effective care.INTERPERSONAL AND COMMUNICATION SKILLS: With patients and families.
List of presentations: Title
List of publications: Title
List of funding applications: Source
Program Director’s Signature________________________________ Date _________________ Resident’s Signature_______________________________________
completed research tasks on time.
was able to present/describe the research so that other residents/faculty can understand it. the resident developed an appropriate plan for the research rotation.
was able to suggest/plan future experiments which will build on the work (s)he is doing.
was able to work well independently.
was aware of the clinical relevance of the research.EVALUATION FORM FOR NEUROSURGERY RESIDENTS ON RESEARCH Name:__________________________________________ PGY Level:_____________________________________________ Evaluator:_______________________________________ Dates of Rotation:_______________________________________ 1 Poor 2 3 Expected Level 4 5 Outstanding
Research Performance During the research rotation.
acquired an in depth knowledge of the literature relevant to the research. 1
Rating 1-5 (see scale above) 2 3 4 5
learned the necessary techniques for the research.
with an overall goal that all residents will pass the examination and become board certified. colleagues and staff b) ability to perform an adequate history and physical c) fund of basic and clinical knowledge to perform adequately at the assigned level in the training specialty. and such progress needs to be monitored. and all evaluations will be directed at that ultimate objective.UNIVERSITY OF UTAH HOSPITALS AND CLINICS GRADUATE MEDICAL EDUCATION HOUSESTAFF POLICIES AND PROCEDURES ______________________________________________________________________ RESIDENT EVALUATION POLICY Section 7 No. It is further expected that residents will be eligible for the specialty board examination (if applicable) upon completion of the training program. where applicable: 1) A definition of clinical competence. PURPOSE: The Graduate Medical Education Committee of the University of Utah School of Medicine has responsibility for the overall academic quality of each of the graduate medical training programs. II. Issuance of an agreement for one year does not imply the resident will complete the training program. and clinical fellows in ACGME accredited training programs). the purpose will be spelled out. and 3) Conditions which warrant academic probation or other remedial action. POLICY: STANDARDS OF PERFORMANCE Each program will have a written set of standards of performance for residents. the training of effective and competent physicians is the goal of each training program. The policy shall spell out the method and frequency of evaluation for residents in the training program. A written copy of these standards will be given to each resident on or before the first day of training in that program. Each program expects a progression of knowledge in the specialty area from beginning to end of training. 1 Rev. towards patients. including at least: a) appropriate behavior by the resident. and the School of Medicine. and a copy will also be filed with the Office of Graduate Medical Education. These standards should include. 2) The conditions for promotion to the next year of training. A part of that quality can be measured by the performance of the residents (a term used to identify interns. In addition to achieving board certification. Agreements for succeeding years of training will be issued only after specified conditions have been met. RENEWAL OF HOUSEOFFICER AGREEMENTS Residents performing satisfactorily may have the resident agreement renewed for the subsequent year. 2 Review Date: February 2005 Revision Date: February 2005 _____________________________________________________________________ I. residents. the program director. 74
. If it is used as a performance measure. If an In-Service examination is given. The resident agreement is renewable annually as agreed among the resident. that will be clearly stated to the residents.
each resident will be evaluated in writing at least monthly. The evaluation committee may make recommendations on corrective action as described below. or at the end of each rotation. In addition to regular contact with supervisors. Each residency program will designate an evaluation committee. This final written evaluation will state whether a resident has successfully completed requirements for board eligibility. 5. That committee must meet at least quarterly to review performance of all residents not progressing satisfactorily. if resident progress is not satisfactory. for whatever reason. Discuss the evaluation with the resident immediately. the program director must: a. This final evaluation should be part of the resident's permanent record maintained by the Office of Graduate Medical Education. and how the resident will be evaluated to determine if the problem has been corrected.
4. with resident representation. and remedial programs must be established by each program. so the problem can be resolved before it is time to renew the agreement for the coming year. whether at the University of Utah School of Medicine or another institution. or list areas of deficiency for board eligibility.
2. For any evaluation of less than satisfactory performance.
c.ACADEMIC EVALUATION 1.
The resident will be allowed to refute in writing any evaluation. Rotations longer than one month should have an interim evaluation. Supervisors are responsible for early detection of problems.
6. and will be available for review by the resident upon request. b. Residents new to a training program need special monitoring during the first six months of the program. Outline in written form and in the discussion any corrective action to be taken to remedy the deficiency. The resident will meet with the program director at the end of each agreement year to review the accumulated written evaluations of the year's performance. A final written evaluation will be done for each resident who completes a program. The written evaluations will be placed in the resident's file. Residents having performance difficulty may need to be placed on a special program immediately. responsible for resident evaluation. That evaluation must include a review of the resident's performance during the final period of training and should verify that the resident has demonstrated sufficient professional ability to practice competently and independently. Notify the program evaluation committee of the unsatisfactory evaluation. or changes to another program. which will be placed in the resident's file along with the evaluation.
substance abuse.. Such corrective actions can include repeating a rotation(s). The decision of a program not to renew an agreement shall be made by the chair after consultation with the program director. the evaluation committee. which might include special supervision.e. The Director of Graduate Medical Education should be notified at this time. a special program. At the time the houseofficer is removed from probation. Virtually all actions of a houseofficer in connection with the performance of duties relate to the suitability of the houseofficer as a medical practitioner. or termination. when possible. 1992 76
. 3) Not offer an agreement for the coming year. i. or insubordination. abusive behavior to patients. or the department chair. theft or abuse of property. and what must be accomplished in order for the resident to be removed from probation. if previous corrective action has not been successful. Usually that clause will refer to continuing problems of the kind that resulted in the first probationary period. tardiness or unexcused absences. 2) Offer a houseofficer agreement for the next agreement year. the resident can request review of his case by the program evaluation committee. will be considered as part of the comprehensive academic evaluation. Approval body: Graduate Medical Education Committee Approval date: February 2005 Policy Owner: Graduate Medical Education Historical Information: Review dates: February 2005 Revision dates February 2005 Approval dates: January 6. Any decision to not renew shall be made and communicated in writing to the houseofficer no later than four months prior to the end of the agreement year. the program has the option to: 1) Allow the resident to complete the remainder of the training year. Each program will designate who has authority for instigating corrective action. the public. the probationary period will not extend past the end of the current agreement year. If the resident and the program director cannot agree on the terms of remediation.ACADEMIC PROBATION Any resident who receives an unsatisfactory rating on any rotation or who is otherwise not performing in a satisfactory fashion. in which case the program has the option of extending the probationary period into the next agreement year. but that extension shall not exceed three months. repeating a year. The resident should have an opportunity to remediate unsatisfactory performance. or academic probation in addition to any of the above. will be considered invalid until the resident has fulfilled the probationary requirements and been removed from probation. Any houseofficer agreement which may have been issued by a program for a subsequent year. or other health professionals. Therefore issues of integrity. should be reviewed for corrective action. The program will determine the length of the probationary period. in the opinion of the program or as defined by the program standards of performance. unless the agreement year ends within three months. Houseofficer agreements offered for a subsequent year may contain a written clause stating conditions under which the agreement may be terminated immediately. In general. the program director.
EVALUATION POLICY CHECKLIST 1. Write departmental standards of performance. Send a copy to the Office of Graduate Medical Education. Set up a procedure whereby all housestaff receive these standards at the start of their training, and updates if revisions are made. Do a written evaluation of each houseofficer at least monthly and put in resident's file. Do interim evaluations if rotation is longer than one month and performance is not satisfactory. Set up a program evaluation committee to meet quarterly to review performance. Monitor housestaff new to the program very carefully for at least six months. If performance is unsatisfactory: a. b. c. 7. Discuss immediately with resident. Outline in discussion and in writing any corrective action to be taken, and what will determine if the problem has been corrected. Notify program evaluation committee of unsatisfactory evaluation.
4. 5. 6.
Do not renew a resident agreement for a subsequent training year without a satisfactory performance review. Resident must be given four months’ notice of contract nonrenewal. Meet with the resident at least once a year to review performance. Upon completion of training, send a final written evaluation of the resident's performance to the Office of Graduate Medical Education.
__________________________________________________________________________________________ SCHOOL OF MEDICINE HOUSESTAFF DUE PROCESS POLICY Section 7 No. 5 Rev. 2 Review Date: February 1, 1992 Revision Date: February 1, 1992 I. PURPOSE
To assure fairness in all evaluations the Graduate Medical Education Committee has adopted Standards of Review for actions that may affect the status of the resident. All residents will receive a copy in the orientation packet of the institution's Standards of Review at the start of training, as well as in the Housestaff Manual. Any resident being disciplined or put on probation, or otherwise affected by the policy will receive a second copy of the policy in the mail, from the Director of Graduate Medical Education (DGME). The policy will be sent with a cover letter as soon as the DGME is notified of the problem by the program director. II. POLICY A. All programs will follow the University of Utah School of Medicine Resident Evaluation Policy. Standards (as spelled out by the institution and each individual program) not met will be considered to be academic problems. No resident will be dismissed for academic problems without a probationary period, unless extraordinary circumstances exist. No resident will be dismissed without consultation with the Director of Graduate Medical Education to make sure that appropriate evaluation, documentation, and probationary procedures have been followed. B. A resident's pay will stop at the time of termination by the program. If the decision is later reversed by the appeals process, back pay may be awarded as part of that decision. An appeal of any decision in this process must be made in writing to the DGME within one week of receipt of the written decision, unless other arrangements have been made.
THE RESIDENT: A. Will be notified in writing by the program director of any negative evaluations which may affect his or her standing or progress in the training program. Has a right to appeal the evaluation if the resident feels he/she has been evaluated unfairly. The resident is allowed to appropriately address the questions of performance before various committees within the department or School of Medicine as specified by the policy below. Academic evaluations during a rotation and the assignment of a rating at the conclusion of a rotation are provided by the course director(s) and will be sustained unless found to be arbitrary, capricious, or not based on established criteria. The unsatisfactory rating may result in interruption of the normal sequence of rotations.
C. Has a right to provide additional or explanatory information to the body considering an appeal, as that body is receiving information. If the appeals body has requested the resident to provide or expand upon that information in person, he/she will be excused from committee deliberations after presenting his/her information. D. Has a right to be accompanied by a faculty member or another resident to act as advocate during any personal appearance at an appeal procedure. A summary of proceedings will be made available to the resident. The resident may take notes at the meeting. The resident will be informed, by the program director or the DGME: 1. of the decision of each committee or appeals body. This will be followed by written notification of the decision, at which time the time starts for the next level of appeal. Notification should contain information on the next level of appeal, if the resident is so inclined. The department will be sent a copy of the decision of each committee as well. that at each level of appeal, the party making the appeal, whether it be the resident, program director, or hospital, is responsible for providing evidence to convince the committee or appeals body to reverse the decision being appealed.
THE PROGRAM: May appeal any decision made by any body subsequent to the decision of the program Grievance Committee, by filing a written appeal with the DGME, as per the above resident procedures, substituting the word "program" for "resident".
This committee will reach a decision no longer than 30 days after receiving an appeal.
. They may ratify. two faculty members. and one resident. Any party dissatisfied with the decision of this committee may appeal for: B. with an advocate. V. reverse. and will be referred to the civil authorities where appropriate. comprised equally of housestaff and faculty. review by the Dean. Violations of law and other such behavior which do not bear directly on performance or suitability as a physician are considered disciplinary problems. The Vice President will make a decision no longer than 14 days after receiving an appeal.
Time limits as established above may be extended by mutual agreement between the DGME and the aggrieved party. review by the Program Grievance Committee. or make a new decision. The Dean will make a decision no longer than 14 days after receiving an appeal.
III. The resident may appear before this committee to testify on his/her behalf. review by the Vice President of Health Sciences who may ratify. review by the School of Medicine Housestaff Grievance Committee. that individual shall be replaced for purposes of this particular appeal. may appeal for: A. School of Medicine. or make a new decision. and if that is the case. reverse. Any party dissatisfied with the decision of the Dean may appeal for: D. However. Informal
The Office of Graduate Medical Education will try to facilitate informal discussions to resolve differences. which shall be made up of a program director. he/she will not rule on a case but merely pass it on to the Vice President after review. Appeals at every level may result in hearings where the parties will be afforded ample opportunity to present their case and to introduce relevant information. or make a new decision. This committee will take into consideration the resident's overall performance when arriving at a decision. Any party dissatisfied with the decision of this committee may appeal for: C. Usually. Appeals may be for any action considered to be arbitrary. This will be the final step in the appeal process. Time limits refer to working days. or not in keeping with previously announced criteria.
IV. or any party dissatisfied with a decision of the program evaluation committee. the Dean may ratify. Members of the committee should be broadly representative of the program faculty and residents.INSTITUTIONAL DUE PROCESS PROCEDURES I. No member of the committee shall be a member of the resident's department. Formal
Any houseofficer. reverse. who will review to be sure procedures have been followed. as previously specified. This committee will reach a decision no longer than 30 days after receiving an appeal. capricious. II.
Approved by: Graduate Medical Education Committee January 6. 1992
9. No resident may be dismissed without a period of corrective action.DEPARTMENTAL DUE PROCESS CHECKLIST FOR HOUSESTAFF 1. 5. or whose contracts are not renewed as expected. comprised equally of housestaff and faculty and broadly representative of faculty and residents.
4.D. The resident has a right to provide additional or explanatory information to the Program Grievance Committee. or for cause. The resident has a right to appeal any evaluation on the basis that it is arbitrary.
7. The resident has a right to be accompanied by a faculty member or another resident to act as advocate during any appeal procedure. The resident may take notes at the meeting. Rev. Set up a Program Grievance Committee. as outlined in the School of Medicine Housestaff Due Process Policy (Section 7. No. Establish program criteria pursuant to the University of Utah School of Medicine Resident Evaluation Policy.
. 2) before the resident may appeal to the School of Medicine Housestaff Grievance Committee.
6. 8. or probation.. will be reported to the Utah Physician Licensing Board. A letter will be written by the Dean stating "_____________________________________. or Director of Graduate Medical Education. or not based on an established criteria. of the decision of each committee or appeals body. All the above steps must be followed. The resident will be informed by the program director. was dismissed (did not have his/her contract renewed) from (name of training program) at the University of Utah School of Medicine on (date). Notify a resident in writing of any negative evaluations which might affect his or her standing or progress in the program.
REPORTING POLICY All residents dismissed from a training program." Approved by: Graduate Medical Education Committee January 6.
a University attorney will also be invited. but may be closed to the public at any time if the evidence reasonably requires or involves a discussion of the character.______________________________________________________________ SCHOOL OF MEDICINE HOUSESTAFF GRIEVANCE COMMITTEE HEARING GUIDELINES Section 7 No. professional competence. Each of the parties will be permitted to bring a representative to the hearing who shall function in an advisory capacity only. Formal rules of evidence are not applicable. they are not formal trials. 1992 _______________________________________________________________ If the due process procedure results in a hearing.
4. Hearings will be held only after timely notice to all parties. these guidelines are to be followed: 1. or present written evidence or testimony. the advisor shall not address the Committee or question witnesses. together with any other documents relied upon by the Committee in reaching its decision. 11. Each of the parties will be allowed to submit questions to the Chair. When invited to a hearing. each of the parties will be permitted to examine all documents introduced at the hearing. or physical or mental health of an individual.
8. inappropriate. to be put to the other if determined to be significant and helpful in the Chair's sole discretion. The presentation of information by either party may be limited by the Chair if it is determined to be irrelevant.
10. January 6.
9. or generally of little use in contributing to a fair and expeditious resolution of the issues. 2. Hearings are in the nature of informal.
Approved by: Graduate Medical Education Committee. 1 Review Date: February 1. Cross-examination of one side by the other will not be permitted.
7. repetitious. Hearings will be open to all parties.
6. Unless called as a witness. however. Any questions about committee rules or procedures should be directed to the Chair. Each of the parties will be permitted to testify and comment on the issues at the hearing. 5. Committee deliberations after a hearing will be private. 1992 83
. adjudicative proceedings. 6 Rev. 3. If the resident's advocate is an attorney. 1992 Revision Date: February 1.
Medical Records 1. 2004 Revision Date:
.Other rules and guidelines A.
Attire Neurosurgery has adopted the Graduate Medical Education Professional Attire Guidelines UNIVERSITY OF UTAH HOSPITALS AND CLINICS GRADUATE MEDICAL EDUCATION HOUSESTAFF POLICIES AND PROCEDURES PROFESSIONAL ATTIRE GUIDELINES Section 07 No. 0 Review Date: August 2. The resident assigned to the case will be responsible for entering the appropriate data in the Op Coder computer program in the operating room and generating an operative note for the chart from that program. General 1. 2. Residents are expected to answer all pages promptly. Every patient going to surgery will have their history reviewed and be examined by the most senior resident who is scrubbing on the procedure. If this is done by the intern or medical student it will be reviewed by the appropriate neurosurgery resident and any additions that are necessary appended to it. B. staff and fellow residents. Every patient admitted to the hospital will have a history and physical recorded on the medical record. Residents are required to follow the procedures and meet the standards and requirements detailed in the University of Utah Housestaff Policies and Procedures Manual unless otherwise specified in this document. This includes the timely preparation of both discharge summaries and operative dictations as well as timely correction of any oversights that have occurred.
6. with the need to make up suspended time to complete the residency.
2. Residents with an excessive number of incomplete charts will not be allowed to scrub in surgery until these charts are completed.
3. 12 Rev. For small procedures done outside the operating room under local anesthesia only.
5. Residents are at all times expected to exhibit appropriate and professional behavior towards patients.
C. Residents are expected to adhere to the medical record policy of the institution. Hospital policy requires orders to be rewritten after any procedure done in the operating room regardless of the anesthetic. Accumulation of undictated reports or summaries will result in suspension. a "resume all previous orders" order can be written.
use of instruments. and appropriate. These guidelines apply to each work day. Style: No tank or halter tops. Artificial nails do not allow for proper hand hygiene. or on the following rotations only unless otherwise delineated by departmental policy: Emergency room. Scrubs: Scrubs should not be worn outside of the hospital premises. LDS or VAMC). Jewelry: Should not be functionally restrictive or excessive. Hair: Mustaches. including days with no patient care responsibilities. Scrubs may be worn in the operating room. Hands: Fingernails must be clean and short to allow for proper hand hygiene. It is the purpose of this policy to provide general guidelines to assist each department or specialty in developing its own dress code policy to meet its specific needs. it is recommended that a coat with name tag be worn over the scrubs. No shorts. Jeans are discouraged. Shoes: Footwear must be clean. Dress guidelines for residents assist in achieving this goal while also acknowledging individual desires for diversity and self-expression. and the public at all training sites. and comply with JCAHO standards where applicable. No sweatshirts or shirts with messages. Maternity clothes are not exempt from these guidelines. and beards must be clean and well trimmed. Specific Standards: Name Tags: Proper identification as required by each training site must be worn and clearly displayed at all times while on duty. and must be clean and neat. midriffs or tube tops. In patient care areas. lettering or logos (except UUMC. AO. White coats: White coats are recommended. It is recognized that each department or specialty may have requirements which are more specific or less rigorous than the guidelines outlined herein. staff. Scrubs are expected to be clean and pressed. If wearing scrubs outside the operating area. Policy Resident appearance and conduct should at all times reflect the dignity and standards of the medical profession. Fragrance: No strong colognes or perfumes as patients may be sensitive to strong fragrances. it is recommended that a clean white coat be worn over the scrubs. A tie is recommended for men on weekdays and recommended on weekends unless described as optional in the specific department policy. hair longer than chin length. and all ICUs. prevent glove puncture and injury to the patient.
.Purpose To present a professional appearance to patients. in good condition. Following are guidelines for professional attire. Open-toed shoes and sandals are not recommended in patient care areas for safety reasons. delivery areas. Residents with long hair who render patient care should wear hair tied back to avoid interfering with performance of procedures or coming into contact with the patient.
Drug Testing 1. if unable to contact him. anxiety. pager 339-7113 or email at lhaas@dfpm. 2. E.edu. 4. These guidelines will be the official policy of this department as well (pages 66-67). All patients at University Hospital and Primary Children's Medical Center are private patients and have an attending surgeon. The attending staff should be notified of any patient of theirs who is admitted to the hospital or transferred to or from the service. Nose piercings which have religious significance are acceptable. The University of Utah Housestaff well-being program is available to provide assistance and appropriate professional referral to assist housestaff in dealing with depression. See Section 7 No. Any major treatment decisions should be coordinated with the attending staff as well.5 of The Housestaff Manual for detail. Random drug testing will be carried out at the VA Hospital as part of the federal mandate to maintain drug-free government work places. This service is confidential. Leonard Haas.
. or marital and family conflicts. Resident/Staff Communications The attending neurosurgeon should be notified as expeditiously as possible of any significant worsening in the patient's condition. D. he/she may be asked to return home to change into more appropriate attire. with the exception of ears.D. There should be no visible tattoos.
G. contact any other staff surgeon. Ph. Repeat violations will result in a letter being placed in the resident’s permanent file.
Additional Items 1. No patient will be taken to surgery unless the attending surgeon is either in house or immediately available except in the case of a life-threatening situation in which the most senior resident available may proceed while the support staff attempts to notify the attending surgeon or. addressing deficiencies in the professionalism competency portion of training.Piercings/ Tatoos: There should be no visible body piercings. substance abuse. 86
2. as well as those found in the University Hospital Professional Image Standard 1-6. is in charge of student counseling and can be reached at 581-7914. A positive drug test will adversely affect an individual's ability to remain in the neurosurgical residency program. F. Special Consideration for Pregnant Residents Regarding Radiologic Exposure The Department of Radiology has very reasonable guidelines based on the American Association of Women in Radiology (AAWR) recommendations. Departments should write a department-specific policy which may deviate from this policy as long as it adheres to these basic guidelines.utah. Violation: If a resident is in violation of his/her department’s guidelines. Residents should notify the program director or department chair if at any time they feel they are not getting regularly scheduled time off or feel that their educational experience is suffering from a service load that has been given to them.
They provide assistance in the care and management of inpatients and outpatients. secretarial. The funds generated will be distributed in a fashion that best meets the educational needs of all of the residents. In addition. They take care of scheduling of imaging and follow-up appointments and answer patient and family questions. Industry support will be welcomed and encouraged in this form. Residents are. At PCMC.
. receive books. In addition. Both hospitals have an on-call room available adjacent to the clinical areas. any offers of industry support for residents should go through the Program Director and should be in the form of an unrestricted educational grant to the Department. Since the Department is responsible for the education of the residents and since some of these items are related to the educational process. or other such items at the expense of industry.
In view of the ADVAMED regulations recently introduced. Hospital dictation is easily available from any telephone in the hospital. These arrangements were sometimes made on an individual basis between a resident and industry and in the past there was little oversight of the process from the Department. the same hospital. Therefore. The location of imaging studies for surgical procedures is facilitated by a digital imaging system. a Department policy regarding interactions between the residents and industry has been discussed and developed by the Education Committee. UUMC has all of the usual support services including phlebotomists. Outpatient clinical personnel are provided by both the hospital and department.
Resident Support At UUMC. The clinical nurse specialist is in charge of the clinics and deals with calls from outside physicians and patients. The nurse practitioner assists with the care and management of inpatients and functions similar to an intern or junior resident.3. the Department now evaluates the appropriateness of these items in light of the rest of the educational process. There is a nurse practitioner and a clinical nurse specialist. invited to attend conferences. surgical loupes. and (b) a media technician who develops and catalogues their slide/video presentations for meetings and conferences.
F. there is a nurse specialist assigned for every two attending surgeons. This is available in NCC as well. there is a neurosurgery library in the office area of the adult division at UUMC and in the office area at PCMC. and administrative support is available. the department provides full secretarial and administrative support to the residents. They are also involved in clinical research studies for the appropriate attending. The Department has two support staff that are instrumental in resident academic productivity: a) a medical editor who assists the residents with manuscript development and submission. She also performs surgical scheduling. They provide an especially valuable interface with patients and families. on occasion. Both hospitals provide a food allowance for residents on call and both hospitals have a medical library on site.
The evaluations are completed anonymously by residents.
. Evaluation of Residents Described in Department Policies (page 68). reviewed by the program director and department chair.G. Correction of any serious problem is monitored by the program director and chairman. 2. and discussed with the individual faculty members.
Evaluation 1. Evaluation of Faculty The residents are asked to evaluate the faculty using a standard on-line questionnaire (page 89) at the end of each rotation.
patients 12345 COMMENTS: H) Please rate the faculty member as a speaker using the rating scale as follows: 1=Outstanding 2=Very Good 3=Satisfactory 4=Fair 5=Poor 1.EVALUATION FORM (to be completed by neurosurgical residents) Name of Faculty Member Dates Rate from 1 to 5 (1 is outstanding and 5 is poor) A) Teaching ability 12345 COMMENTS:
B) Clinical ability and respect as a role model 12345 COMMENTS:
Interest in the residents' educational experience 12345 COMMENTS:
D) Operating room technical ability 12345 COMMENTS:
Willingness to teach in the OR through supervising residents surgery 12345 COMMENTS:
Encourages residents to be involved in research projects 12345 COMMENTS:
G) Ability to get along with peers. Quality of handout or syllabus material for these conferences 9. residents. Were objectives clearly defined 3. Was material covered appropriate for your needs 7. Quality of audiovisual material 10. ability to make material interesting 8. Was relevance of the material to medicine made clear 5. students. nurses. Clarity of presentation/explanations 4. Pace of presentation COMMENTS: GENERAL COMMENTS: GREATEST STRENGTH OF FACULTY MEMBER: GREATEST WEAKNESS OF FACULTY MEMBER:
. Degree to which conference enhanced your understanding of subject 6. Organization and preparation 2. Speaker's enthusiasm.
During the year.net/. Each year the ACGME asks that 70% or more of our residents complete an online survey.3. research. teaching sessions. The other asks them to rate the conferences (attached). feedback is solicited from the residents during their quarterly meeting with the program director Resident surveys. in addition to evaluating the faculty. Program Director and Associate Program Director have a retreat with all the residents and interns. The program director (Dr. At the end of each academic year. Once or twice each academic year the Chair. including clinical rotations. faculty. and anything else that they felt was a concern.
3. call.e-value. Resident retreats. An open discussion of issues related to the residency is held.
C. Feedback to residents from faculty has increased in frequency and the results of the evaluations are available at any time on line at https://www. 2. Our compliance is usually very high and the results are provided to us in a summary format.
D. Review of residency. The program director administers confidential surveys to all the residents.
Evaluation of the Program The following methods are used to evaluate the residency program: A. One asks general questions about the program. Because of the small number of residents (and the almost one-to-one ratio of faculty to residents) and the close working relationship among the group. A nurse practitioner and physician assistant were hired to help with the inpatient service at the UUMC. the residents conduct a review of the residency (which focuses on the preceding year). There are no faculty present at the meeting. The chief residents summarize the evaluation and submit it in writing to the department – it is distributed to all faculty members and discussed at the weekly faculty meeting.
E. a number of changes have been made over the past few years: 1. Kestle) meets with every resident to review their progress but also to get their feedback on the program. informal feedback is received from the residents on a regular basis. 4. this is probably our best method of feedback.
As a result of the above evaluation processes. Informal feedback. The PGY-specific expectations have been developed and distributed to all of the residents. Attendance at Grand Rounds and PCMC Trauma Conference have been made optional. Problems are identified quickly and addressed as they arise. In addition. Meetings with the program director.
Strongly disagree 1 Hospital support services are sufficient to help me care for my inpatients The caseload on the wards is about right The average number of work-ups on call days is reasonable There is enough clerical/administrative support provided by the program The workload is generally excessive on the wards I get timely and appropriate feedback from faculty I receive sufficient counseling from faculty to help with career planning Full time faculty contribute to a great extent to the teaching I’ve received I have enough personal support from faculty I receive enough instruction on what is expected of me in each level of training I have far too little leisure time There are too many difficult patient management problems on the service I often feel stressed out or depressed I often feel tired and overworked I rarely have time to read
Strongly agree 5
Please evaluate the following conferences. If you have not attended a particular one enough to have an opinion pls check “can’t evaluate”. Pls add comments on back – especially constructive ones if you think a conference has low value.
Waste of time 1 Wed am first hour Wed am 2nd hour Grand Rounds (Wed am third hour) M+M Wed evening journal club PCMC – Fri am radiology case conference (0800-0900) PCMC – epilepsy conference (Fri 0700) PCMC – trauma conference (Fri 0700) PCMC tumor board Sat am case conference UU Spine conference (Tues 5:30) UU tumor board (Wed 3 pm) UU epilepsy UU pituitary conference
Extremely valuable 5
The operative data for the 2003-2004 academic year indicate that there were 1. there are often three or four ORs running simultaneously. One fellow is accepted from the orthopaedic discipline and one from the neurosurgery discipline annually. Pediatric Neurosurgery Fellow The Pediatric Neurosurgery Fellow is appointed for one year and is based exclusively at Primary Children’s Medical Center. The fellowship is primarily clinical. In the OR. B.H. involved in opening and/or closing only). Our two 93
. we believe there is adequate clinical work at various levels of complexity for resident training and that the fellow does not interfere with the resident experience. with the fellow being a full-time member of the housestaff on the Pediatric Service. The person on call each day (whether it is the resident or the fellow) stays out of the operating room to cover the emergency department.D. when there is a complex or unique pediatric case. On rare occasions. Ph. In addition they are encouraged to engage in scholarly activity and have an opportunity to participate in research projects in both departments and in the Orthopaedic Biomechanics Laboratory under the direction of Kent Backus. with the volume of material on our services. all cases are directly supervised by attending pediatric neurosurgeons with graded responsibility to the fellow. they would be scheduled out of the operating room that day.. The division of operative cases on the service is primarily based on the call schedule. and outpatient clinics. Spine Fellow The Spine Fellowship Program at the University of Utah is a joint fellowship sponsored by the Spine Sections of both the Neurosurgery and Orthopaedic Departments. This means the case was done primarily by the attending and fellow. the senior resident and/or fellow may be in the operating room even though. One fellow is accepted per academic year and he or she works closely with the two Neurosurgery residents rotating at PCMC. The Pediatric Fellow has completed neurosurgical residency training prior to the fellowship. The fellow will spend one half year on each service. according to the call schedule.e. One hundred sixty-two of these did not have the resident in a significant role. Call and clinical duties are shared equally by the fellow and the two residents (one-in-three call from home). and junior resident according to the complexity of the case and their surgical ability. the fellow is able to obtain training in pediatric neurosurgery without interfering with the resident training experience. Regular joint conferences are held involving spine surgeons from both departments.041 major procedures performed at PCMC. The chief residents have their choices of cases on which to scrub. However. Based on these numbers. The remaining 879 cases were performed with significant resident participation. The neurosurgery portion of our program is a resident-centric one and fellows are advised of this prior to their accepting a position. or by the attending and residents with the resident having a minor role (i. Fellows are selected by the appropriate department and should have completed residency training. The chief residents will usually pick the cases that interest or challenge them the most when there is the opportunity to do so. Because of the large surgical volume of pediatric cases.
Fellowships A. inpatient service. senior resident.
complex aneurysms located at the cranial base.chiefs in 2003-2004 for example. neither was available. so the fellows have the opportunity to scrub on most cases.
. intraoperative participation. there has been a good acceptance of the casesharing concept necessary to preserve resident experience. and postoperative management of patients with skull base lesions including complex tumors at the base of the skull. This helps round out the experience. the anatomical skull base laboratory provided by the Department of Neurosurgery is available for correlative anatomical studies and the developments and refinements in skull base approaches. The operative statistics support the fact that the fellow is not impinging on the training opportunities for the resident. and head and neck cancer (along with the ENT Division). were planning careers in functional and epileptic surgery and cerebrovascular surgery. Dr. The fellow is also expected to do be involved in a retrospective analysis and also a prospective study in the various disease processes that involve the cranial base.
C. but had the opportunity to scrub on all types of cases during their chief year. sometimes as first assistant and other times as second. Our junior residents scrubbed on 176 spine cases. The material in the Department of Neurosurgery exceeds the ability of senior resident involvement in all cases. Involvement of the fellow will not interfere with neurosurgical resident training. The fellow will participate in the clinical diagnosis. The fellow is expected to present papers at national and international meetings. In 2003-2004. The fellow will also be involved with teaching of residents at all levels and he/she will participate in the skull base conference where cases are presented for discussion and management with ENT and Neuroradiology. pre-operative assessment. Skull-Base Fellow The Skull-Base Fellow is appointed for one to two years. In addition. as well as textbooks. Two hundred three of these were done by one of the two chief residents and 198 by the two spine fellows. Paul House and Dr. 480 spine cases were done. Adam Arthur. as well as prepare publications in the peer-reviewed journals. During the orthopaedic portion of the year there are not always senior orthopaedic residents. respectively. For 79 cases. With this balance.
Operative data for one of the chief residents.I. 2003-2004
Intracerebral Hematoma. This information is to be reported separately: by senior clinical year. "Assistant" refers to surgeon acting as an assistant. "Surgeon" refers to primary responsibility.and post-operative care). Head Trauma Nonsurgical Management Decompressive Craniotomy Depressed Skull Fracture Gunshot/ Penetrating Wound Hematoma. Craniotomy Other than Trauma Abscess Aneurysm AVM Epilepsy (diagnostic/ therapeutic) Hematoma Metastatic Tumor Primary Tumor Other Subtotal 2. Attach additional pages as necessary. Count only those cases in which the resident had a significant decision making role (including pre.RESIDENCY REVIEW COMMITTEE FOR NEUROLOGICAL SURGERY OPERATIVE EXPERIENCE FOR RESIDENTS
Supply the number of cases for the most recently graduating resident representing his/her entire neurosurgery experience. Subdural Other Subtotal 29 4 8 1 0 2 16 13 73 24 2 7 1 0 1 16 10 61 53 6 15 2 0 3 32 23 134 6 0 0 55 65 168 5 17 8 12 6 0 0 61 68 167 3 17 6 6 12 0 0 116 133 335 8 34 14 18
SENIOR CLINICAL YEAR
OTHER CLINICAL YEARS
TOTAL EXPERIENCE ALL YEARS
. and by all other clinical years. Combined surgical statistics from ALL institutions in which the resident served are to be included on this one form and not broken down into separate institutions. Patients up to 16 years of age inclusive are considered pediatric cases. Epidural Hematoma. should be explained in the "Other" section found on page 7 of this log. Resident's Name: ___________________ ______ Log Covering Period from: __________ to__________ Resident Signature ________________________________________ Major Procedures – Adult (17+ Years) 1. Procedures listed as "Other".
RESIDENCY REVIEW COMMITTEE FOR NEUROLOGICAL SURGERY OPERATIVE EXPERIENCE FOR RESIDENTS
Major Procedures – Adult (17+ Years) 3. Transphenoidal Procedures Pituitary Tumor Other 13 0 13 10 0 10 23 0 23
SENIOR CLINICAL YEAR
OTHER CLINICAL YEARS
TOTAL EXPERIENCE ALL YEARS
Subtotal 4. Occlusive Vascular Surgery Bypass Endarterectomy Other
1 1 0 2
1 1 0 2
2 2 0 4
Subtotal 5. Spinal Surgery Cervical Disc & Spondylosis with: Bone Graft Instrumentation Both Neither Metastatic Tumor with: Bone Graft Instrumentation Both
0 0 47 6
0 0 80 13
0 0 127 19
0 0 0 0
0 0 0 0
0 0 0 0
RESIDENCY REVIEW COMMITTEE FOR NEUROLOGICAL SURGERY OPERATIVE EXPERIENCE FOR RESIDENTS
Major Procedures – Adult (17+ Years) Spinal Surgery (Continued) Primary Tumor with: Bone Graft Instrumentation Both Neither Trauma with: Bone Graft Instrumentation Both Neither Other Subtotal 6. Peripheral Nerve Entrapment Release Neurolysis Neurorrhaphy Sympathectomy Transposition Tumor Other Subtotal
SENIOR CLINICAL YEAR
OTHER CLINICAL YEARS
TOTAL EXPERIENCE ALL YEARS
0 0 0 6
0 0 0 9
0 0 0 15
0 0 9 0 37 105
1 2 6 0 93 204
1 2 15 0 130 309
1 0 1 0 0 2 0 4
7 1 0 3 0 1 0 12
8 1 1 3 0 3 0 16
RESIDENCY REVIEW COMMITTEE FOR NEUROLOGICAL SURGERY OPERATIVE EXPERIENCE FOR RESIDENTS
Major Procedures – Adult (17+ Years) 7. CSF Shunting Procedures 9
Initial/ Revision Other Subtotal 9. Miscellaneous Other
23 3 35
24 2 61
33 5 96
. Stereotaxic Surgery Cardotomy Thalamotomy/ Pallidotomy 0 18 9 4 31 0 0 0 42 2 2 46 0 0 0 60 11 6 77 0 0
SENIOR CLINICAL YEAR
OTHER CLINICAL YEARS
TOTAL EXPERIENCE ALL YEARS
Trigeminal Tumor Biopsy Other Subtotal 8.
7. 2. 4. Brain Trauma Brain Tumor Craniofacial Reconstruction Craniosynostosis Peripheral Nerve Shunt Procedure (Initial / Revision) Spinal Dysraphism Spinal Trauma with: Bone Graft Instrumentation Both Neither 9. 8. Spinal tumor with: Bone Graft Instrumentation Both Neither 10. 5. 3. Other Subtotal 0 0 0 0 1 5 0 0 0 0 1 0 SURGEON 1 1 0 0 0 1 49 ASSISTANT
OTHER CLINICAL YEARS SURGEON 19 33 4 16 0 74 4 ASSISTANT
TOTAL EXPERIENCE ALL YEARS SURGEON 20 34 4 16 0 50 4 75 ASSISTANT
0 0 0 0
0 0 0 0
0 0 0 5 60 264
0 0 0 5 61 269
GRAND TOTAL: MAJOR PROCEDURES ADULT PEDIATRIC 442 5 598 264 1. 6.040 269
.RESIDENCY REVIEW COMMITTEE FOR NEUROLOGICAL SURGERY OPERATIVE EXPERIENCE FOR RESIDENTS
SENIOR CLINICAL YEAR Major Procedures-Pediatric (Through 16 yrs) 1.
*American Board of Neurological Surgeons
The Primary Examination III. A candidate must then have successfully completed an internship and neurosurgical residency training in programs accredited by the Accreditation Council for Graduate Medical Education (ACGME). l997. Application requirements B. and the American College of Surgeons (ACS). The RRC consists of six neurosurgeon members. This portion of the year may not include more that 6 weeks of neurosurgery. the American Hospital Association (AHA). the American Medical Association (AMA). each applicant must be a graduate of a medical school acceptable to the Board. ABNS Board Certification A.12 months B. two representatives each from the ABNS. Training in Neurological Surgery To be eligible for certification by the American Board of Neurological Surgery (ABNS).
. thereby satisfying the ABNS requirement for neurology training. A. The remaining 6 months should include other fundamental clinical skills considered appropriate by the neurosurgical training program director. This requirement may be satisfied by training for one or more years in an ACGME accredited general surgery program in the United States. the AMA. Neurosurgical training programs in the United States are reviewed and accredited by the Residency Review Committee for Neurological Surgery (RRC) under authority delegated to it by the ACGME. Qualified individuals interested in ABNS certification should contact the Board office. The ABNS does not accredit training programs. An exception applies for residents from Canadian neurosurgical programs who began training before July 16.60 months minimum C.I. the Association of American Medical Colleges (AAMC). Neurological Surgery Residency . This year of training is preferably taken prior to beginning neurosurgical residency and must be completed prior to beginning the third year of residency training. The ACGME is sponsored by the American Board of Medical Specialists (ABMS).12 months Twelve months must be devoted to acquiring adequate knowledge in fundamental clinical skills. Up to 3 months of neurology may be included. The training may likewise be acquired during the course of training in an ACGME accredited neurosurgical residency program. and the Council of Medical Specialty Societies (CMSS). Fundamental Clinical Skills – Internship Year . Fundamental Clinical Skills – Internship Year . Special Considerations D. Program Director's Endorsement II. Oral examination
I. Training in Neurological Surgery A. Such training must include at least 6 months in surgical disciplines other than neurosurgery.
60 months minimum Each resident must complete a minimum of 60 months of training as a full-time resident in an ACGME accredited neurosurgical training program. Program Directors must request credit and receive approval in writing from the ABNS in advance if training is to be undertaken outside the parent program. Training in clinical neurosurgery must be progressive and not obtained during repeated short periods in a number of institutions. As senior resident. (1) At least 36 months must be devoted to core clinical neurosurgery with progressive responsibility culminating in 12 months as senior-most resident. Some of the time might be dedicated to additional neurology or subspecialty neurosurgical training. or residents may get started through communications with their program director. Special Considerations Modification of the above requirements to fulfill specific training goals may be formulated for an individual resident. At least 24 months of training in core clinical neurosurgery must be obtained in one institution. (4) An individual’s training is not complete and a Program Director’s endorsement cannot be provided until the Primary Examination has been passed for credit toward certification. (2) A minimum of 3 months must be devoted to clinical neurology. Trainees are required to record the operative procedures performed during their residency. C. as well as administrative responsibilities. Up to 3 months of this training may be acquired during the 12 months of training in fundamental clinical skills. the trainee shall have major or primary responsibility for patient management. Such training shall not count toward fulfilling the requirements for certification unless credit is specifically requested by the resident's program director in writing and approved by the Board in advance. Six months are recommended. and/or other disciplines related to the nervous system. but 3 months are required. or spine or endovascular surgery. Neurological Surgery Residency . however. The ABNS furnishes passwords and ID numbers to gain access to this program. The ABNS prefers that this record be provided to the via the web-based NeuroLog database logging system available to all residents and Program Directors.B. doing neurology during the internship year does not shorten the requirement for 60 months of residency training thereafter. (3) The remaining 21 to 24 months (see 2 above) must be devoted to aspects of the basic or clinical neurological sciences. for instance pediatric neurosurgery. This period must be taken as a full-time assigned resident in a neurology residency program accredited by the ACGME. as designated and deemed appropriate by the program director.
. which may include neuropathology. Training other than as an appointed resident in an ACGME accredited neurosurgical training program shall not be considered as fulfilling the ABNS requirements unless specifically requested by the Program Director and approved by the Board in advance of such training. Trainees are expected to acquire basic knowledge and skills in each of these disciplines. neuroradiology. and research.
An individual’s training is not complete and a Program Director’s endorsement cannot be provided until the Examination has been passed for credit. (3) Has passing of the Primary Examination for credit. the ABNS must receive the written consent from the Program Directors of both programs. Applications must be filed with the ABNS by mid-December. and other relevant disciplines deemed suitable and appropriate by the Board. the ABNS requires a statement from his or her program director to the effect that the candidate: (1) Has fulfilled the professional training requirements of the Board. Program Director's Endorsement Prior to acceptance of a candidate for oral examination. usually the last Saturday in March. neuroradiology. neurology. neuropharmacology. neurosurgery. (4) Is recommended by his or her program director as being professionally competent for the independent practice of neurological surgery and suitable for consideration by the Board for certification. This examination is prepared by the ABNS and includes material on fundamental clinical skills. The Program Director receiving the resident is responsible for ascertaining that any prior training may count toward completion of residency. neuroanatomy. at most ACGME accredited neurosurgical training programs. The Primary Examination is given once each year. has had substantially more than the prerequisite training in general surgery. the ABNS may at its discretion consider and give retroactive credit to a trainee who. medical neurology. (2) Has performance satisfactorily in the program has been satisfactory. or basic neurological sciences in institutions acceptable to the Board.
. along with notification of the type and amount of training to be allowed in the transfer.On a Program Director’s recommendation. before entering an accredited neurosurgical residency program. II. critical care. neuropathology. The Primary Examination Each applicant for certification must first successfully pass the Primary Examination for credit toward certification. D. Should a resident transfer from one accredited neurosurgical training program to another. as determined by his or her Program Director. The Primary Examination is open to all residents in ACGME-accredited neurosurgical training programs and to neurosurgeons who have successfully completed such training. Residents may take it either for credit toward certification or self-assessment. neurobiology.
Each candidate must be scheduled for oral examination within five years of completing training.III. To re-enter the process. A completed application includes the application form. A candidate who fails to apply to the ABNS in time to be scheduled for oral examination within 5-years of completion of training is no longer considered to be within the certification process. Letters of recommendation and hospital privileges will be requested. Post-graduate fellowships do not extend this window of opportunity but are counted within the interval to complete the process. After re-passing. have it reviewed and approved. the ABNS sends application packets outlining the requirements for continuing the process to become a certified Diplomate. the candidate must re-take and pass the Primary Examination. hospital release. otherwise. Six to twelve months may be required for the entire application to be reviewed and approved by the various ABNS Committees and full Board. the oldest case cannot be more than two years old at the time of review. and at least one year of practice data. The ABNS will not schedule a candidate for oral examination until all requirements have been fulfilled and approved by the Directors. (2) Practice Data Requirements Each applicant for ABNS Certification must submit a list of all operative and nonoperative in-patients for whom he or she was the responsible physician or surgeon during a period of 12 consecutive months. If the case log includes less than 100 operative cases. (1) Application Form Application forms are available from the ABNS office or may be printed from this website. appropriate fee. business agreement. ABNS Board Certification A. and take the oral examination. Candidates for certification must complete and file accurate applications with the Board. This process should ideally be completed within 3 years of completing residency training. the candidate has 3 years to submit an application as outlined above. copies of licenses. applications should be filled out and sent to the ABNS office as soon as possible after completion of residency and logging of twelve months of practice data.
. with at least 3 months of follow-up. The list does not include out-patients or consultations in which the applicant did not assume primary responsibility for patient’s care. with oldest case not more than two years old at the time of review. Application Requirements As neurosurgical residents complete training. In order to comply with this five-year rule. Data collection should begin shortly after the applicant begins practice and sent to the Board as soon as 12 months have been accumulated. he or she will no longer be considered actively involved in the certification process. it must continue until 100 cases have been collected for analysis. Again. together with the required supporting documents.
forms and an example can be requested from the Board office or printed from this website. the candidate will be scheduled for the oral examination. and results of diagnostic tests. B. the examination covers all of neurosurgery. must be approved by the ABNS and the applicant scheduled for oral examination within 3-years after passing the Primary Examination. province or country where the applicant practices is a requirement for oral examination and issuance of an ABNS Certificate.
. An applicant who fails to apply to the ABNS in time to be scheduled for oral examination within the 5-year time frame will not be scheduled for oral examination until he or she has again passed the Primary Examination for credit and thereby returned to the certification process. including symptoms. At least 2 of these must be neurosurgeons who practice in the applicant's community.The list of cases shall include all information as determined by the Board. Oral Examination Once an application has been reviewed and approved by the Credentials Committee and received a favorable review by the full Board at a regularly scheduled meeting. however. The ABNS expects applicants to record their data in the web-based NeuroLog database system. findings. and outcome of surgical and medical diseases of the nervous system. as well as in all hospitals where the applicant has practiced since the completion of neurosurgical training. If the application is not completed within 5-years of the candidate’s completion of training. along with an updated application. The new request. (5) Hospital Privileges Each applicant must have unencumbered and unrestricted hospital staff privileges for neurosurgical practice in all hospitals in which he or she cares for patients. (4) Licensure A currently valid license to practice medicine in the state. Such license must be unrestricted and unencumbered by proceedings which threaten its continuance. The oral examination lasts 3-hours and covers the diagnosis. Privileges must be unrestricted in respect to the hospital's usual requirements for a neurosurgeon and be unencumbered by any official hospital proceeding that threatens the continuation of such privileges. Work up. Such candidates must then submit a request for oral examination accompanied by the then applicable fee. questions from all aspects of the discipline must be answered. (3) Letters of Recommendation The applicant shall supply names and addresses of 3 or more physicians with whom he or she has had professional contact to attest to the quality of his or her professional conduct. The primary thrust relates to clinical practice via a case history format. management. and at least one must be an ABNS Diplomate. he or she shall no longer be considered to be actively involved in the certification process. Notwithstanding the growing tendency toward subspecialization.
Such candidates must then submit new information and the applicable fee as requested by the Board. TX 77303 (713) 441-6015 FAX: (713) 794-0207
firstname.lastname@example.org. The candidate has 3-years in which to take the oral examination a second time. both available from the ABNS office. if indicated. and management are evaluated with attention given to relevant anatomy. If an individual fails to obtain a passing score on the oral examination the first time.edu
Ms. including passing the oral examination. as well as descriptions of how operations should be performed. Suite 2139 Houston. The examination is structured to focus on problems which neurosurgeons may expect to encounter and manage in general practice. In the event that the individual fails again or the 3-year time frame lapses. The Office address is: 6550 Fannin Street. Rules and Regulations. and Code of Ethics. Monday through Friday.
. The applicant will again have 3-years to be complete the certification process.
Additional Information Detailed information about all aspects of the American Board of Neurological Surgery and the certification process is available in the Booklet of Information and the Bylaws. and physiological mechanisms. Sanderson and her staff are available in the office from 9am to 5pm. he or she may apply for re-examination. thereby returning to the certification process. pathology. he or she must re-pass the Primary Examination for credit.differential diagnosis.
ACGME* Neurosurgery Program Requirements
*Accreditation Council for Graduate Medical Education
by each specialty. and rehabilitation) of disorders of the central. and vertebral column. critical care. I. B. and autonomic nervous systems. peripheral. instrumentation. including skull base. disorders of the spinal cord.ACGME COMMON PROGRAM REQUIREMENTS APPEAR IN BOLD
Program Requirements for Residency Education in Neurological Surgery Preface The program requirements set forth here are to be considered common to all specialties. evaluation. prevention. disorders of the pituitary gland. including the surgical and endovascular treatment of disorders of the intracranial and extracranial vasculature supplying the brain and spinal cord. diagnosis. As such. nonsurgical and stereotactic radiosurgical treatment of adult and pediatric patients with disorders of the nervous system: disorders of the brain. and disorders of the cranial and spinal nerves throughout their distribution. the evaluation and treatment of pathological processes that modify the function or activity of the nervous system. and their blood supply. meninges. The training program in neurological surgery must include a minimum of 1 year of training in Accreditation Council for Graduate Medical Education (ACGME) accredited program in general surgery or at least 1 year of a program accredited for the acquisition of fundamental clinical skills as defined below. Definition of Discipline Neurological surgery is a discipline of medicine and that specialty of surgery which provides the operative and nonoperative management (ie. meninges. Introduction A. neurological surgery encompasses the surgical. or endovascular techniques. including those that may require treatment by fusion. treatment. where indicated and individually. Duration and Scope of Education 1. This training should be completed prior to the third year of neurological surgery training. including their supporting structures and vascular supply. including the hypophysis: and the operative and nonoperative management of pain. and are complete only when supplemented.
plan. should be spent in the study of the basic sciences. (2) 3 months of training in an ACGME accredited neurology training program preferably included in the PGY1-year.
In order to meet the goals of the PGY-1 Year there must be: (1) At least 6 months of structured educational experience in surgery. multiple organ system trauma. The remaining period of time. intra-. and emergency/multisystem trauma care.
. or other appropriate subject matter related to the neurosciences as agreed on by individual residents and the
4. Gain experience in the care of critically ill surgical and medical patients Participate in the pre-. Be involved in the care of patients with surgical and medical emergencies. in addition to the year of acquisition of fundamental clinical skills.
The neurosurgery program director is responsible for the design. The program director should consider training in adult and pediatric operative surgery. neuroradiology.
3. neuropathology. surgical critical care. attitudes and skills needed to formulate principles and assess.2. and post-operative care of surgical patients Develop basic surgical skills
(5) b. and initiate treatment of patients with surgical and medical problems. and oversight of a PGY-1 year that will prepare residents for education in neurological surgery. (3) No more than 3 months of neurological surgery. not devoted to clinical neurology and neurosurgery. This year must include resident participation in clinical and didactic activities that will give them the opportunity to: (1) Develop the knowledge.
The neurological surgery training program is 60 months in duration. and nervous system injuries and diseases. a. as approved by the neurosurgery program director. and must provide 36 months of clinical neurological surgery at the sponsoring institution or one of its approved participating institutions. implementation.
] 5. [Note: The program director should consult the American Board of Neurological Surgery for certification requirements concerning any training conducted outside the approved institutions of the program. unless they have previously had a minimum of 1 year of formal residency training in an accredited neurology training program.
Accreditation Guidelines 1.
6. each resident must be notified in writing of the length of training. Prior to entry into the program. Any training added to the accredited residency must be based on a clear educational rationale and must not interfere with the education and training of the residents enrolled in the program. The program must provide the residents with experience in direct and progressively responsible patient management as they advance through training.
C. The chief resident must have major or primary responsibility for patient management with faculty supervision. There must be a 12-month period of time as chief resident on the clinical service of neurological surgery in the sponsoring institution or its approved participating institutions. an educational program in neurological surgery must be in substantial compliance with both the Program
2. A block of training of 3 months minimum in an ACGME-accredited neurology training program must be arranged for all residents. Training programs in neurological surgery are accredited by the Residency Review Committee (RRC) by authority of the ACGME. The prescribed length of training for a particular resident may not be changed without mutual agreement during his or her program unless there is a break in his or her training or the resident requires remedial training.
The specific portion of the clinical training that constitutes the 12 months of chief residency must be specifically designated as the chief residency experience and must be identified at the time of program review. The chief resident should also have administrative responsibility as designated by the program director. a. A list of accredited training programs in neurological surgery is published annually in the Graduate Medical Education Directory. To be accredited by the ACGME. 8.
. This training may be taken during the year of fundamental clinical skills.program director.
A participating institution functions as a separate neurological surgical service with a local training director under the direction of the program director and should be sufficiently close to the sponsoring institution to ensure peer interaction and regular attendance at joint conferences and other activities. as described in the Institutional Requirements. and formal evaluation of residents.
3. and hospitals. as specified later in this document. a. Appropriate exceptions may be considered for special resource hospitals (eg. pediatrics. The sponsoring institution for an educational program in neurological surgery must be in a single geographic location.
A. specify the duration and content of the educational experience. The program director must demonstrate to the RRC that the clinical service operates as a single unit in the assignment of residents and their faculty supervisors. c. including timely appointment of a permanent department or division chairperson of Neurological Surgery. supervision.Requirements for Residency Education in Neurological Surgery and the Institutional Requirements of the Essentials of Accredited Residencies in Graduate Medical Education.
. Sponsoring Institution One sponsoring institution must assume ultimate responsibility for the program. Programs must be able to demonstrate their compliance with these requirements at the time of their site visit and subsequent review by the RRC. and this responsibility extends to resident assignments at all participating institutions. and state the policies and procedures that will govern resident education during the assignment.
II. specify their responsibilities for teaching.
An integrated institution must function as a single neurological surgery service with the sponsoring institution. the formulation of call schedules. Appropriate institutions include medical schools. The institution must demonstrate commitment to the program in terms of financial and academic support. and the convening of teaching conferences and related educational activities.
b. trauma). a.
3. The program director. In the event of a change of either program director or department chair. Program Director 1. The program director must be certified in the specialty by the American Board of Neurological Surgery. The program director must be appointed in good standing and based at the primary teaching site.
c. the program must be site-visited within 2 years. and for the establishment and maintenance of a stable educational environment. and experience to conduct the program. together with the faculty is responsible for the general administration of the program. 1. counseling. The person designated with this authority is accountable for the operation of the program.)
b. and advancement of residents (in accordance with institutional and departmental policies and procedures) and the maintenance of records related to program accreditation. (Certain federal programs are exempted. selection. the program director should promptly notify the executive director of the Residency Review Committee (RRC) through the Web Accreditation Data System of the Accreditation Council for Graduate Medical Education (ACGME). The program director must possess the requisite specialty expertise. Program Personnel and Resources
A. When a change in chairmanship occurs within an accredited neurological surgery training program. as well as documented educational and administrative abilities. There must be a single program director responsible for the program. including those activities related to the recruitment.III. instruction. B. The program director shall be licensed to practice medicine in the state where the institution that sponsors the program is located. evaluation. Qualifications of the program director are as follows: a. Adequate lengths of appointment for both the program director and faculty are essential to maintaining such an appropriate continuity of leadership. supervision.
. or possess qualifications judged to be acceptable by the RRC.
and retention of the number and types of neurological
. This includes selecting and supervising the faculty and other program personnel at each participating institution. The program director must ensure the implementation of fair policies. as established by the sponsoring institution and in compliance with the Institutional Requirements.
c. the RRC may determine that a site visit is necessary. grievance procedures. The program director must oversee and organize the activities of the educational program in all institutions that participate in the program. Such changes. as well as updating annually both program and resident records through the ACGME’s Accreditation Data System. The program director is responsible for preparing an accurate statistical and narrative description of the program as requested by the RRC. the addition or deletion of any institutional rotation
On review of a proposal for any such major change in a program. include: 1) the addition or deletion of a participating institution to which residents rotate a change in the format of the educational program (including fellowships within the program) a change in the approved resident complement of the program for those specialties that approve resident complement. for example. and due process.
Responsibilities of the program director are as follows: a. compilation. appointing a local site director. The program director must seek the prior approval of the RRC for any changes in the program that may significantly alter the educational experience of the residents.4. and monitoring appropriate resident supervision at all participating institutions.
The program director is responsible for the annual collection.
there must be a sufficient number of faculty with documented qualifications to instruct and supervise adequately all residents in the program. including mental or emotional conditions inhibiting performance or learning and drug. participation in scholarly activities.
Qualifications of the physician faculty are as follows:
. Training situations that consistently produce undesirable stress on residents must be evaluated and modified. They must demonstrate a strong interest in the education of residents. f. These records must be accurately maintained by the program director.
g. At each participating institution. This information must be provided in the format and form specified by the RRC. This record must include all of the procedures in which the neurological surgery resident was either resident surgeon or assistant and must be signed by both the resident and the program director as a statement of its accuracy. and must support the goals and objectives of the educational program of which they are a member. Annually.
b. must devote sufficient time to the educational program to fulfill their supervisory and teaching responsibilities. Program directors and teaching staff should be sensitive to the need for timely provision of confidential counseling and psychological support services to residents. The program director must monitor resident stress. a.or alcohol-related dysfunction. The faculty. 3. the program director must ensure the compilation of a comprehensive record of the number and type of operative procedures performed by each resident completing the program. There should be a minimum faculty of three neurological surgeons
2. Neurological surgery faculty participation in undergraduate medical education is desirable.
C. furthermore.surgery operative procedures performed in all institutions and facilities utilized in the clinical education of residents.
Faculty 1. a commitment to their own continuing medical education. This information must be provided in the format specified by the RRC.
and an in-depth understanding of basic mechanisms of normal and abnormal states and the application of current knowledge to practice. as evidenced by the publication or presentation of. the staff as a whole must demonstrate broad involvement in scholarly activity. and the provision of support for residents’ participation.
The responsibility for establishing and maintaining an environment of inquiry and scholarship rests with the faculty.
Complementary to the above scholarship is the regular participation of the teaching staff in clinical discussions. as appropriate. for example. as evidenced by peer-reviewed funding or by publication of original research in a peerreviewed journal. the scholarship of discovery. and an active research component must be included in each program. Qualifications of the nonphysician faculty are as follows: a. the scholarship of application.
. 5. While not all members of a teaching staff must be investigators.
b. or national professional and scientific society meetings. as well as documented educational and administrative abilities and experience in their field.
c. and research conferences in a manner that promotes a spirit of inquiry and scholarship (e. regional. case reports or clinical series at local. in scholarly activities. The physician faculty who are neurological surgeons must be certified in the specialty by.g. rounds.a. journal clubs. The physician faculty must be appointed in good standing to the staff of an institution participating in the program. the American Board of Neurological Surgery or possess qualifications judged to be acceptable by the RRC. the offering of guidance and technical support for residents involved in research such as research design and statistical analysis. as evidenced by review articles or chapters in textbooks.
b. Scholarship is defined as the following: a..
4. or be in the certification process of. the scholarship of dissemination. Nonphysician faculty must be appropriately qualified in their field.
The physician faculty must possess the requisite specialty expertise and competence in clinical care and teaching abilities.
. and office space for training purposes in the regular preoperative evaluation and postoperative follow-up for cases for which the resident has responsibility. technical. neurological surgery beds should be on a unit designated for the care of neurosurgery patients.g.
Other Program Personnel Additional necessary professional. sufficient laboratory space and equipment.
2. There should be space and support personnel for research identifiable in the neurological surgery division or department. and some activity should be ongoing in this area. Inpatient facilities a. Clinical and/or basic research opportunities should be available to the neurological surgery resident with appropriate faculty supervision. clinic.
b. support personnel. Inpatient facilities available for training programs in neurological surgery should be geographically identifiable and have an adequate number of beds. 1. Similarly.
Nonphysician faculty must possess appropriate institutional appointments.
Facilities and Resources The program must ensure that adequate resources (e.. and clerical personnel must be provided to support the program.
Research Facilities a. The presence of a neurological surgery operating room with microsurgical capabilities and an intensive care unit specifically for the care of neurological surgery patients is desirable to a training program. computer and statistical consultation services) are available.
Outpatient Facilities Residents must have available appropriate outpatient facilities. as are other units for specialized neurological surgery care. and proper equipment to ensure quality education and excellence in patient care.
the quality and volume of patients and related clinical material available for education). b.4.
Resident Appointments A. Eligibility Criteria The program must comply with the criteria for resident eligibility as specified in the Institutional Requirements. On-site libraries and/or collections of texts and journals must be readily available during nights and weekends. faculty-resident ratio. There must be access to an on-site library or to a collection of appropriate texts and journals in each institution participating in a residency program. This individual must be responsible for the education of the residents and also will supervise the educational activities of other neurological surgeons relating to resident education in that institution. institutional funding.
Library a. The training director in neurological surgery at each participating institution must have major clinical responsibilities at that institution.
. The training director shall be a qualified neurological surgeon appointed by and responsible to the program director in each geographically separate institution. Training Directors at Participating Institutions a.g. Number and Quality of Residents The RRC will approve the number of residents based upon established written criteria that include the adequacy of resources for resident education (e. These appointments will generally be for a 1-year period and can be renewable to ensure continuity of leadership.
c. Appropriate exceptions may be considered for special resource hospitals. and the quality of faculty teaching. Library services should include the electronic retrieval of information from medical databases.. b. Residents must have ready access to a major medical library.
d.1. e. and the number of graduates passing these written and oral examinations Facilities
g. number of graduates who take written and oral examinations of the American Board of Neurological Surgery. The program must provide the RRC with an explanation for the excess complement and its plan for resolution to normal complement.
Resident Transfers To determine the appropriate level of education for residents who are transferring from another residency program. A program director is required 119
. except as provided below. Presence of a faculty of national stature in neurological surgery Quality of the educational program Quality of clinical care Total number and distribution of cases Quality of clinical and basic research Quality of residents trained by the program. b. as determined by the RRC. 4.
The number of residents at each year of training in a given program. A new resident may be appointed to fill a vacancy providing there is no adverse impact on the existing resident staff.
The RRC will review the selection process of residents and seek evidence that the program evaluates the progression of the residents during training. a program may be authorized to enroll more than one resident per year. Where there is demonstrated excellence in providing educational experience for the residents. In determining the size of a resident complement. including numbers of residents starting and finishing the program. shall not exceed the number approved by the most recent accreditation review of that program. c. The ability to do so does not depend on any multiplication of the minimum requirements as established by the Program Requirements for Residency Education in Neurological Surgery. the program director must receive written verification of previous educational experiences and a statement regarding the performance evaluation of the transferring resident prior to their acceptance into the program.
One of the measures of a training program is the quality of residents chosen and the ability of the program to ensure a steady increase in the resident's knowledge and skills. the RRC will consider the following: a.
2. The appointment of fellows and other specialty residents or students must not dilute or detract from the educational opportunities available to regularly appointed residents.
. Documentation must be provided describing the fellowship's relationship to and impact on the residency. Goals and Objectives The program must possess a written statement that outlines its educational goals with respect to the knowledge. Format The program design and sequencing of educational experiences will be approved by the RRC as part of the review process. If fellows so appointed will. and neuropathology must be an integral part of the training program designed for the education of the neurological surgery residents. including surgical endovascular neuroradiology. and neuropathologists. and must be reviewed with residents prior to their assignments. Program Design 1. This statement must be distributed to residents and faculty. Educational experience in neuroradiology.
A. Programs must notify the RRC when they sponsor or participate in any clinical fellowship taking place within institutions participating in the program. All educational components of a residency program should be related to program goals.
3. 3. Such experience should be under the direction of qualified neuroradiologists and preferably endovascular neurosurgeons.to provide verification of residency education for residents who may leave the program prior to completion of their education. This notification must occur before the commencement of such training and at each subsequent review of the program. detract from the education of the regularly appointed residents.
2. Appointment of Fellows and Other Students 1. and other attributes of residents for each major assignment and for each level of the program. in the judgment of the RRC. C. the accreditation status of the program may be adversely affected.
Specialty Curriculum The program must possess a well-organized and effective curriculum. There should be clinical resources for the education of neurological surgery residents in anesthesiology.
Residents Scholarly Activities Each program must provide an opportunity for residents to participate in research or other scholarly activities.
D. general surgery. and provide educational experiences as needed in order for their residents to demonstrate the following:
. it is unlikely that a program can mount an adequate educational experience for neurological surgery residents without approved training programs in related fields. and residents must participate actively in such scholarly activities.
b. pathology. orthopedics. and psychiatry. Recognizing the nature of the specialty of neurological surgery. and attitudes required. Related Disciplines a. pediatrics.
C. A lack of such resources will adversely affect the accreditation status of the neurological surgery program. otolaryngology. endocrinology. emergency medicine. both didactic and clinical.
The residency program must require its residents to obtain competence in the six areas listed below to the level expected of a new practitioner. skills.
B. Toward this end. and radiology. critical care. behaviors. Clinically oriented training programs in the sponsoring institution of the neurological surgery program should include accredited training programs in neurology.4. programs must define the specific knowledge. internal medicine. The curriculum must also provide residents with progressive responsibility for patient management. 6.
The program must provide opportunities for experience and instruction in the basic neurosciences Resident participation in undergraduate medical education is desirable. ophthalmology.
Gather and understand essential patient information in a timely manner.
Prioritize and stabilize multiple patients simultaneously.
Competently perform neurosurgical operative procedures. At a minimum residents are expected to:
g. and effective for the treatment of health programs and the promotion of health with specific reference to neurosurgical conditions.
Counsel and educate patients and families.
patient care that is compassionate.
Provide health care services aimed at preventing health problems and maintaining health.
Implement an effective plan of management.
Generate an appropriate differential diagnosis.
Work with health care professionals to provide patientfocused care.
Medical Knowledge: Residents must demonstrate knowledge about established and evolving biomedical, clinical, and cognate sciences, with specific reference to basic and clinical neurosciences, as well as the application of this knowledge to patience care. Among other things, residents are expected to:
a. Generate a differential diagnosis and properly sequence critical actions for patient care, including management complications, morbidity and mortality.
b. Synthesize and properly utilize acquired patient data.
c. Identify neurosurgical emergencies.
d. Know how to access current medical information.
e. Understand how to treat neurosurgical conditions.
Incorporate evidence-based principles
Practice-based learning and improvement that involves the investigation and evaluation of care for their patients, the appraisal and assimilation of scientific evidence, and improvements in patient care. At a minimum, residents are expected to:
Analyze and assess their practice experience and perform practice-based improvement.
Locate, appraise and utilize scientific evidence related to their patients’ health problems.
Apply knowledge of study design and statistical methods to critically appraise the medical literature.
Utilize information technology to enhance their education and improve patient care.
Facilitate the learning of students and other health care professionals.
Residents must be able to demonstrate interpersonal and communication skills that result in the effective exchange of information and collaboration with patients, their families, and other health professionals. At a minimum, residents are expected to:
Develop an effective therapeutic relationship with patients and their families, with respect for diversity and cultural, ethnic, spiritual, emotional, and age-specific differences.
Demonstrate effective participation in and leadership of the health care team.
Develop effective written communication skills.
Maintain relevant and legible medical records
Effectively communicate with out-of hospital personnel as well as non-medical personnel.
c. emotional state. adherence to ethical principles.
5. as manifested through a commitment to carrying out professional responsibilities. At a minimum.
Strengthen listening and non-verbal communication skills.g.
Discuss death honestly. and gender/ethnicity issues. sensitively.
Treat patients/family/staff/ paraprofessional personnel with respect.
Demonstrate sensitivity to patient’s pain.
Professionalism. residents are expected to:
a. patiently. and compassionately.
Involve patients in medical decisions
h. and sensitivity to patients of diverse backgrounds.
g.f. even temperament
h. providers. At a minimum.
i. residents are expected to:
Exhibit self-awareness and knowledge of limits. 127
. as well as the ability to call effectively on other resources in the system to provide optimal health care.
Respond to the comments of other team members. and peers openly and responsibly. families. access. as manifested by actions that demonstrate an awareness of and responsiveness to the larger context and system of health care.
Understand different medical practice models and delivery systems and how to best utilize them to care for the individual patient. and evaluate the effectiveness of the resources. patients. and systems necessary to provide optimal neurosurgical care. appropriately utilize.
The entire surgical experience of the most recently graduating resident(s) must be submitted each time the program has its periodic review.
D. A program must demonstrate to the satisfaction of the RRC that it has both the volume of patients under neurological care and the breadth and depth of academic support to ensure that it has the capability of providing excellent neurological surgery training to residents.
Clinical Components A current. 1. Understand principles of and advance practices for patient safety at the institutional and individual level. Under some circumstances.
b. e. 2.
. Patient Requirements There shall be sufficient patients admitted each year to ensure that the resident participates in the care of patients suffering from the full spectrum of neurosurgical diseases. This participation must include substantial experience in the management (including critical care) and surgical care of adult and pediatric patients and should include the full spectrum of neurosurgical disorders.
Advocate. a. well-organized.c. coordinate.
Practice cost-effective health care and resource allocation that does not compromise quality of care. the program may be required to include data for a period of up to 3 years prior to the date of the submitted program information forms for accreditation or reaccreditation.
d. The former must be substantiated in part by a compilation of annual institutional operative data and resident operative data (including that from residents rotating on the service from other programs) provided in a fashion prescribed by the RRC. and facilitate patient care. written plan for rotation of residents among the various services and institutions involved must be maintained and must be available to the residents and faculty.
neoplasms. stereotaxic surgery. extracranial carotid artery surgery. No affiliated hospital in the training program should be a component of a training program unless there are a minimum of 100 major neurological surgery procedures per year distributed appropriately among the spectrum of cases as described in paragraph e. transsphenoidal and stereotaxic surgery (including radiosurgery).
d. It also is understood that the educational requirements of the resident must be considered at all times. An exception may be made if a hospital offers special clinical resources. For instance. spinal. pain management. and peripheral nerve surgical procedures and should represent a well-balanced spectrum of neurological surgery in both adults and children.c. Under appropriate supervision.
f. above. Consonant with their skills and level of experience..
Residents must have opportunities to evaluate patients referred for elective surgery in an outpatient environment. this experience should include obtaining a complete history.g. or pediatric neurological surgery. there should be a minimum of 500 major neurological surgery procedures per year per finishing resident.
The profile of clinical experience reported to the RRC must be limited to that utilized in the resident's educational program. trauma. conducting an examination. extracranial. e. ordering (if necessary) and interpreting diagnostic studies. The presence within a given training program of this neurological surgery workload and the distribution of the surgical experience are equally important. residents should be actively involved in preoperative decision making and subsequent operative procedures under the supervision of the attending physician who has ultimate responsibility for the patient. recognizing
. and arriving independently at a diagnosis and plan of management. and spinal procedures of a sufficient number and variety using modern techniques. It must be understood that achievement of this minimum number of clinical procedures will not ensure accreditation of a training program. the cases should be appropriately distributed among cranial. Within the total clinical facilities available to the training program. that significantly augment the resources of the training program. and assignment to a clinical service that limits or precludes educational opportunities will be adversely considered in evaluation of the program. This spectrum should include craniotomies for trauma. and vascular malformations. aneurysms. Residents should similarly be actively involved in postsurgical care and follow-up evaluation of their patients to develop skills in assessing postoperative recovery.
Didactic Components There must be a well-coordinated schedule of teaching conferences. learn to evaluate research findings.
Resident Duty Hours and the Working Environment Providing residents with a sound didactic and clinical education must be carefully planned and balanced with concerns for patient safety and resident well-being. Residents must be provided with rapid. and document adequate supervision of residents at all times. Preoperative interview and examination of patients already scheduled for a surgical procedure will not satisfy these requirements. Other Required Educational Components Graduate medical education must take place in an environment of inquiry and scholarship in which residents participate in the development of new knowledge. direct. E. and developing the physician-patient relationship. and develop habits of inquiry as a continuing professional responsibility. Such guidelines must be communicated to all members of the program staff. rounds. Duty hour assignments must recognize that faculty and residents collectively have responsibility for the safety and welfare of patients. Each program must ensure that the learning objectives of the program are not compromised by excessive reliance on residents to fulfill service obligations. communicating with referring physicians. G. reliable systems for communicating with supervising faculty. A conference attendance record for both residents and faculty must be maintained.
VI. Supervision of Residents 1. Didactic and clinical education must have priority in the allotment of residents’ time and energy. Faculty schedules must be structured to provide residents with continuous supervision and consultation.
2. All patient care must be supervised by qualified faculty through explicit written descriptions of supervisory lines of responsibility for the care of patients. and other educational activities in which both the neurological surgery faculty and the residents participate. The program director must ensure. A.and treating complications. Conferences must be coordinated among institutions in a training program to facilitate attendance by a majority of staff and residents.
This continuity of care must take precedence-without regard to the time of day. time spent in-house during call activities.
2. averaged over a 4-week period.. inclusive of all in-house call activities. d. educational.
Faculty and residents must be educated to recognize the signs of fatigue. Duty hours must be limited to 80 hours per week. responsible. patient care (both inpatient and outpatient). or on-call schedules. Attending physicians or supervising residents with appropriate experience for the severity and complexity of the patient's condition must be available at all times on site.
. At the same time. Residents must be provided with 1 day in 7 free from all educational and clinical responsibilities.
Duty Hours 1. as practiced by qualified neurological surgeons. the complexity of the patient's illness. and the risk of the operative procedures. and scheduled activities such as conferences. and responsive physician dedicated to delivering effective and appropriate care. administrative duties relative to patient care.
4. Progressive Responsibility Resident participation in and responsibility for operative procedures embracing the entire neurosurgical spectrum should increase progressively throughout the training period. Duty hours do not include reading and preparation time spent away from the duty site.e. and administrative duties. day of the week. alert. their technical skill. Duty hours are defined as all clinical and academic activities related to the residency program.3. the provision for transfer of patient care. The responsibility or independence given to residents in patient care should depend on their knowledge. Continuity of Care Graduate training in neurological surgery requires a commitment to continuity of patient care. and adopt and apply policies to prevent and counteract its potential negative effects.
B. patients have a right to expect a healthy. One day is defined as 1 continuous 24-hour period free from all clinical. number of hours already worked. i. their experience. averaged over a four-week period. e. inclusive of call.
4. Support services must be such that the resident does not spend an inordinate amount of time in noneducational activities that can be discharged properly by other personnel. In-house call is defined as those duty hours beyond the normal work day. Residents taking at-home call must be provided with 1 day in 7 completely free from all educational and clinical responsibilities. including in-house call.
On-call Activities The objective of on-call activities is to provide residents with continuity of patient care experiences throughout a 24-hour period.
C. Residents may remain on duty for up to 6 additional hours to participate in didactic activities. This should consist of a 10-hour time period provided between all daily duty periods and after in-house call. 4. lounge. must not be so frequent as to preclude rest and reasonable personal time for each resident. 1. when residents are required to be immediately available in the assigned institution. and food facilities.
2. while ensuring that undue stress and fatigue among residents are avoided. In-house call must occur no more frequently than every third night. At-home call (or pager call) is defined as a call taken from outside the assigned institution. At-home call. transfer care of patients. Continuous on-site duty. It is his or her responsibility to ensure assignment of appropriate in-hospital duty hours so that residents are not required to perform excessively difficult or prolonged duties regularly.
6. The program director must establish an environment that is optimal for both resident education and patient care.
5. conduct outpatient clinics. however.
. averaged over a 4-week period. No new patients may be accepted after 24 hours of continuous duty.
Adequate time for rest and personal activities must be provided. averaged over a 4-week period. a. During duty hours residents must be provided with adequate sleeping. The frequency of at-home call is not subject to the every-thirdnight limitation. and maintain continuity of medical and surgical care. must not exceed 24 consecutive hours.
is required. cii. in compliance with the ACGME Institutional Requirements. Duty hours must be monitored with a frequency sufficient to ensure an appropriate balance between education and service. or if unexpected circumstances create resident fatigue sufficient to jeopardize patient care. Back-up support systems must be provided when patient care responsibilities are unusually difficult or prolonged.
Moonlighting 1. This refers to the practice of internal moonlighting.
c. Duty Hours Exceptions
When residents are called into the hospital from home. The program director must comply with the sponsoring institution’s written policies and procedures regarding moonlighting.
An RRC may grant exceptions for up to 10% of the 80-hour limit to individual programs based on a sound educational rationale. Any hours a resident works for compensation at the sponsoring institution or any of the sponsor’s primary clinical sites must be considered part of the 80-hour weekly limit on duty hours. These policies must be distributed to the residents and the faculty. Each program must have written policies and procedures consistent with the Institutional and Program Requirements for resident duty hours and the working environment.
Oversight 1.b. and make scheduling adjustments as necessary to mitigate excessive service demands and/or fatigue. the program director must ensure that moonlighting does not interfere with the ability of the resident to achieve the goals and objectives of the educational program.
. however. the hours residents spend in-house are counted toward the 80-hour limit. The program director and the faculty must monitor the demands of at-home call in their programs.
3. Because residency education is a full-time endeavor. Prior permission of the institution’s GMEC.
and should verify that the resident has demonstrated sufficient professional ability to practice competently and independently. to achieve progressive improvements in residents’ competence and performance. The evaluations should include a review of their teaching abilities. and other professional staff.
Final Evaluation The program director must provide a final evaluation for each resident who completes the program. clinical knowledge. including evaluation by faculty.
Faculty The performance of the faculty must be evaluated by the program no less frequently than at the midpoint of the accreditation cycle.VII. and for utilizing the results to improve resident performance. Assessment should include the use of methods that produce an accurate assessment of residents’ competence in patient care. interpersonal and communication skills. In addition. Resident 1. Assessment should include the use of assessment results. medical knowledge. patients. Such evaluations are to be communicated to each resident in a timely manner. Formative Evaluation The faculty must evaluate in a timely manner the residents whom they supervise.
b. The final evaluation must be part of the resident’s permanent record maintained by the institution.
c. self. practice-based learning and improvement. and maintained in a record that is accessible to each resident.
2. peers. and
. Assessment should include the regular and timely performance feedback to residents that includes at least semiannual written evaluations. the residency program must demonstrate that it has an effective mechanism for assessing resident performance throughout the program. and systems-based practice. and again prior to the next site visit. a. This evaluation must include a review of the resident’s performance during the final period of education.
Evaluation A. professionalism. commitment to the educational program.
In the evaluation process.
.scholarly activities. Representative program personnel (i. the group must take into consideration written comments from the faculty. Written evaluations by residents should be utilized in this process.e. and the quality of supervision of residents. This group must conduct a formal documented meeting at least annually for this purpose. The results of these evaluations must be documented. the contribution of each institution participating in the program. Performance of program graduates on the certification examination should be used as one measure of evaluating program effectiveness.. representative faculty. and the residents’ confidential written evaluations. the financial and administrative support of the program. at least the program director. the volume and variety of patients available to the program for educational purposes. The teaching staff should periodically evaluate the utilization of the resources available to the program. the quality of the curriculum and the extent to which the educational goals have been met by residents must be assessed. the program rotations and conferences must be evaluated by both residents and faculty. This evaluation must include annual written confidential evaluations by residents. and one resident) must be organized to review program goals and objectives. C. The program should maintain a process for using assessment results together with other program evaluation results to improve the residency program. At least annually. and the effectiveness with which they are achieved. the most recent report of the GMEC of the sponsoring institution.
The program should use resident performance and outcome assessment in its evaluation of the educational effectiveness of the residency program. the performance of members of the teaching staff. In particular. Program The educational effectiveness of a program must be evaluated at least annually in a systematic manner. which should be approved by the faculty and documented in the minutes of the meeting. the group should prepare an explicit plan of action. If deficiencies are found.
Performance on Examination One measure of the quality of a program is the participation in and performance of its graduates on the examinations of the American Board of Neurological Surgery. experimental projects along sound educational principles are encouraged. IL 60610. 515 N State St/Ste 2000. All residents must pass the ABNS primary examination before completing the program. and utilization of program evaluations. Certification Requirements Residents who plan to seek certification by the American Board of Neurological Surgery should communicate with the office of the board regarding the full requirements for certification. The sponsoring institution and program are jointly responsible for the quality of education offered to residents for the duration of such a project. The number of residents completing training and taking and passing the certification examinations will be part of the RRC’s evaluation of the program. Experimentation and Innovation Since responsible innovation and experimentation are essential to improving professional education. as well as accurate and timely provision of program-related information to the RRC will be monitored as part of the overall review of the residency program.
The process. and must include the educational rationale and method of evaluation. maintenance.
ACGME: June 2005 Effective Date: January 2006
. Requests for experimentation or innovative projects that may deviate from the program requirements must be approved in advance by the RRC. Chicago. Requests regarding evaluation of educational programs in neurological surgery and all related program inquiries should be addressed to the Executive Director of the Residency Review Committee for Neurological Surgery. B. The current address of this office is published in each edition of the Graduate Medical Education Directory.D. IX. Board Certification A.