Neurological Surgery Residency Training Program
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Rotation, Objectives, Curriculum
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Rotations and Objectives and Curriculum for MCG Neurosurgery Residents Training (by year and rotation)

PGY 1

The resident will earn basic surgical techniques and patient management. Critical care skills will be emphasized.

Primary Clinical Skills Performance Based Objectives:
The resident will demonstrate mastery of the following skills:

1. History and Physical differential diagnosis
2. Central line venous access
3. Route: Subclavian, Jugular
4. A line
5. Arterial blood gas-femoral, radial
6. Chest tube
7. Lumbar Puncture
8. Skin suture
9. Open/close simple incision or biopsy (1 or 2 layers)
10. ACLS/ATLS certification
11. Reading EKG, chest x-ray

During this time period, the resident will be assigned to 3 months of neurology at MCGH&C. Assignments are usually on a consult service where the resident gains practice in the identification and emergent treatment of a number of neurological diseases and syndromes. A part of the assignment may be on a neurology inpatient service where the resident may assist in the therapy of patients assigned to the Neurology service. Disorders encountered may include seizures, movement disorders, headaches, neuromuscular disorders, strokes and other syndromes of primary concern to the neurologist.

The Medical College of Georgia has an extremely active Neurodiagnostic Unit including EMG, EEG and evoked potential. The Stroke team is internationally known. World-class faculty in epilepsy, dementia and neuromuscular disorders also enhance the residents' experience.

Neurology Goal:
Demonstrate an understanding of the neurological examination, diagnostic neurological testing, and neurological diseases and their treatment.

PGY 2 - NS 1

Neurosurgical Goals:
The resident will learn basic Neurosurgical patient evaluation and management including fundamental skills of surgery which may include but is not limited to those listed in the curriculum. The resident will also participate in epilepsy and functional Neurosurgical cases with exposure to stereotactic techniques.

Neurosurgical Based Performance Objectives:
Fundamental Neurosurgery Skills ­ Competence during 18 months of Neurosurgical Residency

1. Familiarity with operating microscope
2. Burrholes
3. Ventriculostomy/ICP monitor
4. Open/close lumbar laminectomy
5. Open/close diskectomy
6. Open/close cervical laminectomy
7. Open/close anterior cervical fusion
8. Open/close craniotomy
9. Third ventriculostomy
10. Intraventricular endoscopy
11. Cranial reconstruction for congenital and acquired deformities
12. Nerve biopsy
13. Carpal Tunnel Release
14. Craniotomy for subdural/epidural hematoma
15. Craniotomy for tumor-superficial/supratentorial
16. ACDF
17. Laminectomy diskectomy, lumbar, complete
18. Cervical laminectomy/laminoplasty
19. Frameless stereotaxic techniques
20. Ulnar transposition
21. Critical care skills- management of:
     - Traumatic Brain Injury
     - Subarachnoid hemorrhage
     - Pre-op/Post-op patients

PGY 3 - NS II

The third year resident will study Neuroradiology, Neuropathology and will develop skills in Pediatric Neurosurgery, building on basic skills acquired the past 2 years.

Neuroradiology Goals:
Residents will master essentials of neuroradiology including features of relevant disorders including:

1. Congenital lesion
2. Infectious disease
3. Inflammatory conditions
4. Vascular disorders
5. Traumatic lesions
6. Metabolic disorder
7. Demyelinating disease
8. Dementias and degenerative disease
9. Benign and malignant neoplasia

Neuroradiology Performance Based Objectives:

1. Demonstrate the ability to interpret accurately the radiographic studies of trauma patients.
2. Demonstrate the ability to interpret accurately carotid and vertebral angiograms.
3. Demonstrate the ability to interpret accurately spinal angiograms.
4. Demonstrate the ability to interpret accurately spinal myelograms and postmyelogram CT scans.
5. Demonstrated the ability to interpret accurately cranial and spinal CT scans and MR images of non-traumatic lesions.

Neuropathology Goals:
During the 3-month rotation, residents will learn gross and histopathological features of relevant disorders including:

1. Congenital lesion
2. Infectious disease
3. Inflammatory conditions
4. Vascular disorders
5. Traumatic lesions
6. Metabolic disorder
7. Demyelinating disease
8. Dementias and degenerative disease
9. Benign and malignant neoplasia

Neuropathology Performance Based Objectives:

1. Demonstrate the ability to order appropriate laboratory tests of CSF, gross and microscopic specimens.
2. Demonstrate the ability to recognize and understand the clinical pathological significance of the disorder listed in goals.

Pediatric Goals:
Demonstrate an understanding of the anatomy, physiology, pathophysiology, and presentation of diseases in children that a neurosurgeon may be called on to diagnose and treat. Demonstrate the ability to formulate and implement a diagnostic and treatment plan for these diseases.

Pediatric Performance Based Objectives:

1. Perform a complete history, physical examination, and assessment on newborns, infants and children.
2. Interpret the results of the physical examination, and laboratory and radiological studies to arrive at a differential diagnosis.
3. Perform subdural, intraventricular, and lumbar punctures in children.
4. Perform a shunt tap.
5. Perform a twist drill or burr hole for subdural, parenchymal, or ventricular access or as part of a craniotomy.
6. Perform a craniotomy or craniectomy for evacuation of a subdural or epidural lesion.
7. Perform a craniectomy as part of a skull biopsy.
8. Perform craniotomy for elevation of a depressed skull fracture.
9. Place a ventriculoperitoneal, jugular, or pleural shunt.
10. Revise a ventriculoperitoneal, jugular, or pleural shunt.
11. Perform a cranioplasty with artificial material or homologous material.
12. Perform a laminectomy in a patient with normal spinal anatomy.
13. Position a patient for intracranial or intraspinal surgery.
14. Demonstrate an ability to open and close cranial and spinal wounds including dural opening and repair.
15. Complete a sagittal synostectomy.
16. Close an open spinal or cranial neural tube defect.
17. Repair an intracranial encephalocele.
18. Make the opening for a complex craniofacial repair.
19. Perform the exposure for supratentorial and infratentorial lesions (excluding pineal, suprasellar, and intraventricular locations).
20. Perform the exposure for spinal exploration in a patient with abnormal spinal anatomy or reoperation.
21. Evacuate an intraparenchymal hematoma.
22. Accomplish an endoscopic third ventriculostomy in uncomplicated settings.
23. Apply and use frameless or framed stereotactic modalities for lesion location and shunt placement.
24. Accomplish repair of a Chiari malformation.
25. Accomplish an uncomplicated detethering procedures.
26. Perform a cranial vault expansion.
27. Perform placement of baclofen-type pumps.
28. Perform spinal fusion without instrumentation.
29. Apply a vagal nerve stimulator.
30. Perform exposure for a suprasellar, pineal, and intraventricular lesion (including orbitofrontal, transcallosal, and supracerebellar).
31. Remove uncomplicated posterior fossa and supratentorial lesions.
32. Repair complex tethered cords (e.g., lipomyelomeningocele, retethering, and diastematomyelia).
33. Accomplish exposure for intradural spinal neoplasms.
34. Use an endoscope to communicate trapped CSF spaces.
35. Remove an intracranial vascular malformation less than 3 cm in size and in noneloquent brain.
36. Perform the placement of grids for seizure monitoring.
37. Perform a rhizotomy for spasticity.
38. Perform a temporal lobectomy in an uncomplicated patient.
39. Perform a stereotactic biopsy of a supratentorial lesion.
40. Perform a spinal fusion using instrumentation.
41. Accomplish endoscopic third ventriculostomy in uncomplicated settings.
42. Assist with complex craniofacial surgery.
43. Assist with a vascular procedure for moyamoya disease.

PGY 4 - NS-III

Research Goals:
The Neurosurgery research rotation enables the resident to undertake an investigational project of a basic science, translational or clinical nature. The goal of this rotation is that the resident will design a research project, conduct the research subsequently and present the results of these effects.

Research Based Performance Objectives:

1. Demonstrate critical analysis and preparation of basic science or clinical literature.
2. Understand fundamental approaches to experimental design and statistical analysis.
3. Understand research techniques and methods that would be applicable to the residents' future practice.
4. Experience interactions with basic scientists and multidisciplinary research teams.

PGY 5 - NS-IV

The research year concludes during the NS IV year. During the final 18 months the resident becomes the chief of the VA service to prepare for the NS V chief year at MCG as described under NS II.

PGY 6 - NS V

The chief resident will have major primary responsibility for patient management with faculty supervision. The chief resident will also have administrative responsibility, as designed by the program director. At the conclusion of the final year, the resident will demonstrate:

• Technical excellence in all area of neurosurgery
• Appropriate judgment in all area of surgical and non-surgical skills
• Commitment to the well being of their patients
• Commitment to life long learning and self-improvement, the graduate will become board certified.

At the conclusion of the final year, the resident will demonstrate achievement of these objectives to the satisfaction of the program director and involved faculty. This achievement will be reflected in each resident's formal evaluations.

Advanced Neurosurgical Skills Performance Based Objectives:
Competence developed during the last 12-18 months of Neurosurgery
The resident will competently perform:

1. Craniotomy for functional Neurosurgery and epilepsy
2. Stereotactic procedures including tumor biopsy
3. Cervical spine anterior plates and screws
4. Lumbar spinal instrumentation - Anterior/Posterior
5. Complex spine Thoracic ­ Anterior/Posterior with instrumentation
6. Carotid Endarterectomy
7. Pituitary surgery ­ transphenoidal
8. Aneurysms, simple
9. Posterior fossa tumors
10. Extra axial tumors (cranial and spine)
11. Major nerve neuropathy
12. Brachial plexus

Additional Procedures/Options:

1. Complex aneurysms
2. Cranial base approaches and procedures
3. Cerebral and spinal cord AVM's

Questions and Comments to Bill Hamilton 

 June 06, 2005

Department of Neurosurgery  |  Medical College of Georgia