CURRICULUM

PGY-I: Combined Surgery / Clinical Neurosciences Internship

In complete fulfillment of ABNS requirements for training in general care, Neurology and Allied Clinical Neurosciences, this year combines a variety of clinical rotations including Neurosurgery, Endovascular Neurosurgery, Neurology, MICU, NeuroICU, Stereotactic Radiosurgery, Neuroradiology, and Neuropathology.

During this year the resident acquires expertise in the diagnosis and treatment of general medical, neurosurgical, and neurological diseases and conditions. The resident learns to manage a busy clinical service of neurosurgery floor patients efficiently. This includes obtaining a medical history, performing a physical exam, ordering appropriate tests, interpreting test results, performing daily care, writing accurate and concise daily notes, discharge planning and dictating discharge summaries. The resident builds a fund of knowledge in general medicine and neurosurgery.

PGY-II: Junior Resident at SHC

The PGYII year is spent in clinical Neurosurgery working with the Chief Residents, Senior Residents, and interns rotating as the night float, day consult and operative resident. The PGY-II resident joins clinical neurosurgical faculty in the initial assessment, operative treatment and postoperative care of patients. Subspecialty clinics in which the resident conducts preoperative assessment and postoperative follow-up include cerebrovascular, tumor, spine/peripheral nerve, pediatric, functional (epilepsy, pain, movement disorders) and general neurosurgery.

In the day consult and night float rotations, the resident becomes familiar with the diagnosis, surgery, and both preoperative/postoperative care of patients with neurosurgical problems. This includes ICU care of critically ill patients, emergency management of neurosurgical conditions and neurosurgical consultations. Emphasis is placed on improvement of communication skills for relating to patients and families and on issues of medical ethics.

As the operative PGY2, the resident acquires familiarity with the basic principles of operative neurosurgical technique, including patient positioning, surgical exposure and surgical closure. The resident also acquires proficiency in performing minor procedures (lumbar puncture, lumbar drain, ventriculostomy, muscle/nerve biopsy, and halo placement); craniotomy for trauma, tumor, hematoma, and abscess; basic cervical and lumbar spinal surgery; peripheral nerve surgery; and stereotactic biopsy.

PGY-III: Junior Resident at VA, LPCH and SCVMC

The PGYIII year is divided between the VA, LPCH and SCVMC in which they are the primary resident for all neurosurgical care by acting as patients’ primary neurosurgeon during inpatient, outpatient, and consultative care. The resident evaluates all consults, works up all new cases for admissions, participates in all operations as primary surgeon or first assistant, and directs postoperative care.

At the, VA Palo Alto Health Care, emphasis is in general neurosurgery, particularly that required by the degenerative diseases commonly encountered in the veteran population.

At the Santa Clara Valley Medical Center, the area's main county hospital, SCVMC offers full exposure to the breath of neurosurgery as well as in-depth experience in neurosurgical trauma.

At Lucile Packard Children’s Hospital, the resident acquires more advanced diagnostic and patient management skills relevant to diseases of infants and children. The resident understands the unique conditions and the special considerations required to treat neurosurgical diseases in children and infants.

During this year, the resident should actively pursue clinical research interests, submit abstracts regarding this research to regional and national meetings, and present clinical data at local, regional and national conferences. The resident is also expected to expand basic knowledge of neuroscience, neurology and neurosurgery, and to take the Written Neurosurgical Boards for self-assessment.

PGY-IV: Basic/Clinical Research

Clinical or basic science research may be performed in the Neurosurgical Research Laboratories, another laboratory at Stanford or, in special cases, a laboratory at another institution or in industry. Some may choose to pursue an advanced degree such as a PhD, MBA, or MPH during this time. The resident is large protected from clinical responsibilities.

In clinical or basic science research, the resident develops academic skills, including critical review of existing literature, hypothesis driven research, creative and rigorous experimental design, precise performance of procedures, interpretation of data, synthesis of experimental results with existing literature, and preparation of reports for publication, grants, and presentation at regional and national meetings.

PGY-V: Basic/Clinical Research or Senior Resident

During PGY-5, the resident may continue their clinical/basic science research or complete a non-post residency enfolded fellowship such as the Neurocritical Care fellowship focusing on developing expertise at the interface of neurology, neurosurgery, and critical care.

If a resident plans to pursue a post residency fellowship, the resident may move up to a senior resident in their PGY-5 with the Program Director’s approval ensuring the resident’s milestone evaluations are in good standing.

PGY-VI: NS-6 Senior Resident at SHC and Kaiser Redwood City

During this year the resident is expected to become proficient in the outpatient and inpatient diagnosis and management of neurosurgical diseases, including those in the subspecialty areas of vascular, tumor, spine/peripheral nerve, pediatric, functional and general neurosurgery. The resident should demonstrate proficiency in supervision of junior residents, interns and medical students and in communication with patients, families, colleagues, and staff. The resident is expected to develop microsurgical operative skills, including those for aneurysms, vascular malformations, epilepsy, microvascular decompression, brain tumors, transsphenoidal procedures, spinal tumors, spinal dysraphism, carotid endarterectomy, sympathectomy, functional neurosurgery, craniofacial reconstruction, craniosynostosis repair, and complex spine surgery.

PGY-VII: NS-7 Chief Resident at SHC and LPCH

This final year as Chief resident in Neurosurgery is spent primarily at SHC. The Chief Residents cooperatively lead the entire resident team and manage the neurosurgical service at SHC and LPCH. The chief residents lead daily patient rounds in the ICU and on the ward. Under direct faculty supervision, the Chief Residents perform the vast majority of the difficult operative procedures carried out at SHC. Challenging cases are sufficiently numerous to provide intensive surgical and peri-operative management experience to all Chief Residents. The Chief Residents also assist in organizing weekly Neurosurgery Grand Rounds and supervising the junior residents, the medical students and sub-interns in the operating room and on the wards.

The resident further hones comprehensive neurosurgical operative skills, including microscopic surgery for difficult aneurysms, vascular malformation, tumors, epilepsy and pituitary lesions; carotid endarterectomies and vascular reconstructive procedures, including EC-IC bypass; complex spinal reconstruction; and pediatric neurosurgical procedures. At the conclusion of the PGY-VII year the neurosurgical resident should be fully qualified to join the neurosurgical faculty at an academic institution or an active private practice group.