Program Description

DESCRIPTION OF THE NEUROSURGICAL RESIDENCY TRAINING PROGRAM

NEW JERSEY MEDICAL SCHOOL - NEUROLOGICAL INSTITUTE OF NEW JERSEY

DEPARTMENT OF NEUROLGOICAL SURGERY

The neurosurgical residency training program housestaff allotment has been increased from one resident per year to 1.5 residents (alternating annually between one and two residents) per year. This increase in the housestaff has increased the flexibility in the program. As such, we currently offer the opportunity to pursue a dedicated year of basic science research (usually performed during the PGY4 year) or a year of subspecialized advanced training (typically completed at the PGY5 or higher level of training). Either the research work or the advanced subspecialization training can be performed at UMDNJ-New Jersey Medical School or at outside institutions. If an outside institution is to be utilized, permission must be obtained from the American Board of Neurological Surgeons prior to the experience in order to receive credit for this work. Presently, we have our residents declare during their PGY2 year (or the beginning of their PGY3 year) whether they would prefer a research experience or an advanced clinical subspecialization year. Depending on the individual interests of the residents involved, we provide flexibility to accommodate those interests.

PGY1 

The first year of training has been infolded to fit under the control of the Department if Neurological Surgery. A formal internship in general surgery is no longer required. In the first year, the resident has a varied experience in the surgical specialties. Rotations are designed to teach independence in problem solving and to learn basic principles of surgical care and critical care. Experience is gained by rotations in general surgery, the intensive care units, the emergency room, and on the neurosurgical service. In addition, the first year resident will complete four months of rotations on the neurology service. During these rotations on the adult, pediatric, and stroke neurology services, the PGY1 resident will be directly supervised by the neurology service and will be responsible for learning sophisticated aspects of the neurological exam and fundamental aspects of electromyography (EMG) and electroencephalography (EEG). By the end of the first year, the neurosurgical resident will have developed familiarity with critical care management of intensive care unit patients, an understanding of basic surgical principles common to general surgical, trauma, and neurosurgical patients, and have acquired a general understanding of neurologic disorders which would be amenable to both operative and non-operative treatments.

PGY2

The second year of neurosurgical training will take place at University Hospital . The resident will be trained in the assessment of the neurological exam and the accurate diagnosis of the more common neurological problems. During this year, the junior resident will learn to perform progressively complex minor cases including uncomplicated laminectomies and craniotomies for extra-axial trauma. Residents will also learn to set up and position cases under direct supervision . The junior resident will have significant floor responsibilities both in direct care and in the supervision of the neurosurgical subinterns. He or she will also have significant responsibility for the management of cases in the intensive care unit. The PGY2 will become proficient with the placement and use of all monitoring methodologies including intracranial pressure (ICP) monitors, external ventricular drains (EVD), and transcranial Doppler monitoring. Reconstruction and interpretation of CT-angiograms is regularly performed and the second year resident will become proficient in evaluating patients with cerebrovascular disorders.

The PGY2 resident will be responsible for most non-neurosurgical medical decisions. Continual assistance is provided in these decisions by the senior resident neurosurgical housestaff as well as by the responsible neurosurgical attending physician; however, emphasis is placed on developing independent thought processes. In the clinics, they will do the preliminary work-up on their cases, and will see these patients sequentially over time once a given patient is identified as theirs. Treatment plans will be reviewed with the chief neurosurgical resident. Faculty supervision is provided weekly in the outpatient clinics which serve as an excellent venue for teaching the full spectrum of management of neurosurgical disorders. .

PGY-3

In the third year of training, the resident will rotate onto neuropathology and neuroradiology over three months. These rotations will include a formal neuropathology review course which focuses on formal didactic training in the interpretation of a broad spectrum of pathologies. Furthermore, neuropathology will include daily reading of neurosurgical specimens under the direction of the neuropathology staff. During neuroradiology, the resident will participate actively in diagnostic angiography as well as interventional endovascular procedures with both the radiology and neurosurgical attending staff. Daily neuroradiology reading will be assigned along with participation in the neuroradiology conferences. Neuroradiologic procedures, including myelography and CT-guided biopsies, are a significant part of the procedural learning. The resident will be responsible for preparing material for weekly neurosurgical conferences.

Additional time will be spent on the general neurosurgical service as a senior junior resident. During this time, the third year resident will have increasing responsibility in both the operating room and the critical care management of the intensive care unit patients. PGY3 residents will be expected to perform routine cranial surgeries for the treatment of trauma as well as an assortment of other elective cranial surgeries. The degree of involvement will vary based on the experience of the resident and the complexity of the surgery. Spine surgery training is a major portion of the third year experience. Routine spine surgeries will be performed by the PGY3 resident and experience will be gained on complex spinal reconstructions. Once again, the degree of involvement on a given case will depend on the comfort and experience of the individual resident and on the complexity of the spinal procedure. Operative experience will also be gained in the surgical treatment of peripheral nerve disorders. During the third year, the resident will help teach the junior residents the performance of routine bedside procedures, such as ICP monitor placement and EVD placement, as well as overseeing the management of the NICU patients. At all times, direct chain of command will continue through the chief resident and the attending physician for all complex management decisions.

PGY4

The fourth year is a research experience. During this year, the PGY4 resident will work in the neurosurgery/neurophysiology laboratories. Residents will learn basic neurophysiological and neurochemical laboratory techniques and gain experience with the operating and neurochemical laboratory techniques. Valuable experience with the operating microscope is taught during this year. The residents will achieve an understanding of the rigors of basic science and the complexities of the scientific method. Residents with particular interest in the neurosciences will be encouraged to devise and independently use research projects outside of the formal residency training time period. Both basic science and clinical faculty will assist the residents in construction of projects and grants for carrying out these plans of interest. Residents with a particular research interest may use this time to work in a laboratory outside of UMDNJ. This rotation would be carefully evaluated to ensure that it is comparable to the research opportunity offered in the parent institution. During this rotation, the resident is still required to cover night call at University Hospital .

PGY5

During the fifth year, the resident will begin their senior resident rotations. During the next three years, night call responsibilities will be shared among the senior residents for the University Hospital service. Routine in-house calls will be managed by junior resident staff. All OR cases will continue to be directly supervised by attending physicians.

The resident will have the opportunity to spend a prolonged period of time in an area of subspecialization. This is typically a six month commitment to one of the neurosurgical subspecialties. During this time, the PGY5 will commit a significant portion of time to reading and concentrating on a discreet area of expertise. Residents in this year are strongly encouraged to be involved in clinical projects, with the mentoring of one of the staff neurosurgeons, which will culminate in national presentations and peer-reviewed journal article publications. The opportunity to spend this time at outside institutions is possible and is reviewed on an individual basis. Night call responsibility during this year continues at University Hospital .

A three month rotation in the fifth year will be spent at Hackensack University Medical Center , a major adult affiliate institution and special resource hospital for spinal neurosurgery. The resident will function as the chief resident during this rotation. At this level, the resident should be comfortable managing most elective neurosurgical situations, with supervision as needed, and emergent situations with progressively distant supervision. Independent decision making in both clinics and the operating room will be emphasized. A three month period of time will also be spent on the neurosurgical service as a senior resident. This rotation is geared toward a heavy operating experience with the goal of increasing operative familiarity with the more complex neurosurgical cases.

PGY6

The first six months of the sixth year will be spent at Hackensack University Medical Center . The PGY6 resident will function as the chief resident on this rotation. At this level, the resident will be expected to demonstrate the skills necessary to be an independent operator. Faculty supervision will, of course, continue. The resident should be able to undertake all facets of adult and pediatric neurosurgical care including the pre- and post- operative care and surgical management. A three month rotation at University Hospital , as the acting chief resident, is a major part of the sixth year of training. The acting chief resident will be responsible for all the assorted activities of running the neurosurgical service. This experience is designed to give the PGY6 resident the opportunity to develop the skills which will be required in the chief resident year. In both the operating room and outside the operating suite, the acting chief resident will have full chief resident responsibilities. The final three months of the sixth year of training will be spent on the neurosurgical service as a senior resident. During this time, the senior resident will work on developing operative skills while learning the nuances of running the neurosurgical service from the chief resident. This rotation is heavily weighted toward performing major neurosurgical operations in preparation for the chief residency year.

PGY7

During their chief resident year, the PGY7 resident will function with broad latitude in decision making. The chief resident at University Hospital will be responsible for administering resident rotations, the scheduling of cases at University Hospital , the Neurosurgical conferences, and the management of the neurosurgical clinics. The chief resident will have the option to undertake the operative management of particularly interesting or difficult cases. During this year, the chief resident will work predominantly on challenging cases such as intracranial tumors, aneurysms and AVMs, intricate pediatric cases, brachial plexus surgeries, intradural spinal cord tumors, and complex spinal reconstructive procedures. The chief resident year is divided between University Hospital and Hackensack University Medical Center with the majority of the year spent at University Hospital . At the completion of the chief residency year, it is expected that the resident should be a polished clinician and surgeon.