Curriculum

Overview and rationale
The longitudinal curriculum will allow residents to develop an integrated approach to the conduct of their profession. During the rotations, the full spectrum of multifaceted care of a particular patient’s problems will be emphasized.

Core competencies

Medical knowledge
The residents will develop their knowledge in the established basic science, clinical, epidemiologic, evidence-based, and social sciences as these pertain to the care of their patients. In addition, the resident will learn to critically evaluate the emerging literature as it pertains to the above-mentioned disciplines. A particular emphasis will be to develop the resident’s knowledge in the process of assessing the advantages and limitations of evidence-based literature, and clinical practice guideline development and application. Throughout the training program, written summative evaluations of medical knowledge will be done at the end of each rotation. The “Self-Assessment in Neurological Surgery” online examination will be used for this purpose.

Patient care
The resident will provide timely, compassionate, effective, and efficient patient care with a continuous emphasis on patient safety and quality. She/he will continue to develop history and physical exam skills and time management skills, specifically the ability to appreciate medical urgencies and prioritize time accordingly. She/he will use information gleaned from the history and physical as well as testing modalities to formulate and execute effective and efficient treatment plans.

Communication and interpersonal skills
The resident will communicate with patients, families, peers, physician staff, and allied health professionals, taking into account variable healthcare literacy, while utilizing methods learned through healthcare literacy training. She/he will be able to discuss pertinent issues with a wide segment of the population she/he serves, to include various socio-economic strata. Residents will learn how to access services for interpretation for non-English speaking patients. Timely completion of medical records will be expected.

Professionalism
Each resident will maintain the highest standards of integrity. She/he will communicate to patients, families, and co-workers with respect and appropriate sensitivity at all times. Appropriate and expected care will be provided to all regardless of gender, age, sexual orientation, culture, race, creed, or religion.

Residents will be trained to self-monitor their behavior and identify personal stress. They will be trained to identify stress and impairment in peers and colleagues and to intervene appropriately. Residents will be expected to complete assigned tasks in a timely fashion.

System-based practice
The residents will enroll in the Geisinger curriculum, a 52-week course incorporating a longitudinal curriculum beginning in the first year. The curriculum covers the following:

  • Quality principles and practice of healthcare delivery, self-assessment performance in practice, peer evaluation, and Root Cause Analysis (RCA) methodology
  • Evidence-based medicine: critical questions, protocol development, medical statistics and research skills
  • Communication skills: EHR, clinician-patient, collegiality, consultative services and health literacy
  • Accessing data across the healthcare system: EHR, registries, bundles, Clinical Decision Intelligence System (CDIS), ProvenCare, Health Navigator, Transitions in Care, Inter-Disciplinary Teams (IDT), Advanced Medical Home, and rehabilitation

Practice-based learning and improvement
The resident will continuously evaluate, adjust and modify his/her approach to gaining the six core competencies by utilizing feedback from instructors, peers, and system tools. He or she will learn to utilize self-evaluation methods and tools to adjust practices based upon emerging medical and scientific evidence. The resident will learn to set educational goals and objectives and make a plan for their completion. The resident will learn to give and receive constructive criticism and make an action plan based on same. The resident will learn and be able to demonstrate acquisition of skills to maintain life-long learning, such as ability to critically appraise the literature, glean knowledge from peer presentations of research and continuing medical education, and arrival at conclusions through multi-disciplinary discussion.

The Neurological Surgery Milestone Project
This joint initiative of the Accreditation Council for Graduate Medical Education and The American Board of Neurological Surgery delineates a methodology for use in the evaluation of resident physicians in the context of their participation in ACGME-accredited residency or fellowship programs. The milestones provide a framework for the assessment of the development of the resident physician in key dimensions of the elements of physician competency in a specialty or subspecialty. These milestones will be employed in assessment of the residents throughout the continuum of training.

Curriculum overview

Yearly breakdown

  • PGY-1: Fundamentals of neurosurgery
  • PGY-2: Junior rotations
  • PGY-3: Junior rotations
  • PGY-4: Research/directed training
  • PGY-5: Senior rotations
  • PGY-6: Senior rotations
  • PGY-7: Chief year

PGY-1 Curriculum overview
The PGY-1 year will be dedicated to establishing a solid foundation and competency in the underpinnings of neurological surgery, including critical care, neurology, neuroanatomy, neuropathology, neuroradiology, anesthesiology, and the related surgical subspecialties of orthopaedic surgery, ophthalmology, otolaryngology, and plastic surgery.  General neurosurgical foundations will also be established, including training in focused neurological examinations, differential diagnosis, and basic neurosurgical and intensive care unit procedures.

This year will fulfill the 2013 ACGME Neurosurgery Residency program requirements IV.A.6.b).(1) and (2). These include the six months of required structural education in general patient care and three months of basic clinical neuroscience education. Three months of critical care education applicable to the neurosurgical patient will be provided during this year, commensurate with requirement.

Geisinger curriculum
Geisinger's curriculum is a longitudinal curriculum beginning in the first year that covers quality concepts, communication skills, evidence-based medicine, data access across the health care system, and transitions in care.
Introduction to neurosurgery and critical care
Introduction to neurosurgery is designed to orient residents to Geisinger Health System's Department of Neurosciences and to the Department of Neurosurgery, as well as to introduce basic concepts in cognitive and procedural aspects of neurosurgical management, including outpatient, inpatient, procedural, operative. Special emphasis is on the critical care of neurosurgical patients.

Neurology
The neurology rotation serves to fulfill the training requirement of three months experience in clinical neurology, and to provide a firm foundation for neurological differential diagnosis, neurophysiological testing, and neuroanatomical localization, as well as neurological disease management.

Neuroanatomy, neurophysiology, neuropathology, neuroradiology, and neuropharmacology
This rotation serves to fulfill basic requirements for instruction in these fields, as well as to provide the foundation for further learning throughout the training program and beyond.

Surgical subspecialties
Exposure to other surgical specialties with whom neurosurgeons often work and whose clinical areas of expertise sometimes overlaps with neurosurgery will add to the residents’ understanding of biomechanics, neuroophthalmology, neurootology, and principles of tissue handling, as well greatly enhance the residents’ understanding of surgical and diagnostic techniques employed in neurosurgery. A firm grasp of neuroanesthesiology techniques is also critical to the safe and effective practice of neurosurgery, and residents will also have opportunity to attain intubation and line insertion skills with broader practice applicability.

PGY-2 curriculum overview
The goal of the PGY-2 curriculum is to train the resident in the basics of neurosurgical care in the fields of pediatric, spine, peripheral nerve, neurotrauma, neurocritical care, and neurooncology, which formulate the bases of most neurosurgical practices. In addition, the resident will be introduced to functional neurosurgery, with an emphasis on pain and basics of movement disorders. The residents will perform pre-operative evaluations, and care for operated patients through the post-operative period. They will assist in surgery and be allowed to participate in surgery in a well-supervised, graduated fashion, taking into account their technical abilities. They will perform a variety of bedside procedures and become proficient in basics of critical care management of neurosurgical patients.  They will learn to formulate differential diagnoses and treatment plans.

Rotations

  • Pediatric and functional neurosurgery
  • Spine and peripheral nerve surgery
  • Neurooncology I
  • Neurotrauma and neurocritical care I

Faculty responsibilities for this training year include

  • Will allow residents to accompany them in the clinic at appointed times
  • Will teach the residents fundamentals of outpatient neurosurgical evaluation and focused examination during their appointed sessions
  • Will allow residents to scrub in surgery on appointed cases
  • Will teach the residents fundamentals of patient positioning, opening, closing, and allow them to perform these functions according to their level of ability
  • Will allow residents to accompany them on teaching rounds on appointed days
  • Will discuss with the residents the pertinent historical and physical findings, diagnostic and treatment modalities, and potential complications and outcomes of those patients seen on rounds
  • Will monitor residents for signs of stress or sleep deprivation and follow-up accordingly

PGY-3 curriculum overview
The goal of the PGY-3 curriculum is to train the resident in more advanced neurosurgical care in the fields of spine, peripheral nerve, and neurooncology, and to provide experience in epilepsy and neurovascular surgery. Residents will acquire diagnostic angiography and basic endovascular skills during this year, and build upon those skills through the remainder of the training program.

The residents will perform pre-operative evaluations, and care for operated patients through the post-operative period. They will assist in surgery and be allowed to participate in surgery in a well-supervised, graduated fashion, taking into account their technical abilities.

They will perform a variety of bedside procedures and become more proficient in basics of critical care management of neurosurgical patients. They will learn to formulate differential diagnoses and treatment plans.

Rotations

  • Spine and peripheral nerve surgery II
  • Neurooncology II
  • Endovascular and vascular neurosurgery
  • Epilepsy surgery

Faculty responsibilities for this training year include

  • Will allow residents to accompany them in the clinic at appointed times
  • Will teach the residents more advanced concepts in outpatient neurosurgical evaluation and focused examination during their appointed sessions
  • Will allow residents to scrub in surgery on appointed cases
  • Will teach the residents more advanced surgical techniques in accordance with the resident’s abilities
  • Will allow residents to accompany them on teaching rounds on appointed days and spend time teaching key concepts regarding the disease processes and surgical care of the patients seen
  • Will discuss with the residents the pertinent historical and physical findings, diagnostic and treatment modalities, and potential complications and outcomes of those patients seen on rounds
  • Will monitor residents for signs of stress or sleep deprivation and follow-up accordingly

PGY-4 curriculum overview
While research and other academic pursuits are encouraged and residents are expected to participate in these activities throughout the training program, this year serves as an opportunity for more focused work. The fourth year will be dedicated to study of a clinical or basic science research topic of the resident’s choice, with input from the department director, the program director, and the resident’s faculty advisor.

Preparation for this year will begin at the start of the PGY-3 year, so as to maximize the time available to the resident. Faculty members are expected to mentor the residents through these decision-making processes.

Alternatives to clinical or basic science research may include pursuit of a focused advanced degree in a related healthcare field, such as public health, epidemiology, etc., but must be approved by both the department director and the program director.

Funding for activities during this year will need to be ascertained well in advance.

Finally, residents will be expected to perform reading and other assignments pursuant to the socioeconomic curriculum.

The resident will take the ABNS written primary examination for credit if not previously passed, and will take the examination annually until successfully completed. The training program cannot be successfully completed unless the primary examination is passed and residents will not be allowed to become chief resident until the examination has been successfully completed.

The PGY-4 residents will be free of in-house call responsibilities, so that they will be able to concentrate their efforts on their designated program.

PGY-5 curriculum overview
The goal of the PGY-5 curriculum is to provide the resident with progressively more responsibility in patient care and the operating room, and function at a higher level. There are two rotations for elective neurosurgery to gain experience in an area of interest, or to provide experience that may be lacking up to this point. The other two rotations in functional neurosurgery and neurotrauma and critical care provide opportunities to act as a senior resident with respect to teaching of lower level residents.

Rotations

  • Elective
  • Functional neurosurgery
  • Neurotrauma and neurocritical care

Faculty responsibilities for this training year include

  • Will allow residents to accompany them in the clinic at appointed times and to see patients independently in clinic, presenting their findings to the attendings.
  • Will teach the residents more advanced concepts in outpatient neurosurgical decision-making
  • Will allow residents to scrub in surgery on appointed cases
  • Will teach the residents more advanced surgical techniques in accordance with the resident’s abilities
  • Will allow residents to accompany them on teaching rounds on appointed days and spend time teaching key concepts regarding the disease processes and surgical care of the patients seen
  • Will discuss with the residents the pertinent historical and physical findings, diagnostic and treatment modalities, and potential complications and outcomes of those patients seen on rounds
  • Will monitor residents for signs of stress or sleep deprivation and follow-up accordingly

PGY-6 curriculum overview
The goal of the PGY-6 curriculum is to provide the resident with progressively more responsibility in patient care and the operating room, and function at a higher level in preparation for the chief resident year, performing more complex procedures. This year provides further opportunities to act as a senior resident with respect to teaching of lower level residents.

Rotations

  • Complex spinal surgery
  • Pediatric and endoscopic neurosurgery
  • Skull base and endoscopic neurosurgery
  • Vascular and endovascular neurosurgery

Faculty responsibilities for this training year include

  • Will allow residents to accompany them in the clinic at appointed times and to see patients independently in clinic, presenting their findings to the attendings.
  • Will teach the residents more advanced concepts in outpatient neurosurgical decision-making
  • Will allow residents to scrub in surgery on appointed cases
  • Will teach the residents more advanced surgical techniques in accordance with the resident’s abilities
  • Will allow residents to accompany them on teaching rounds on appointed days and spend time teaching key concepts regarding the disease processes and surgical care of the patients seen
  • Will discuss with the residents the pertinent historical and physical findings, diagnostic and treatment modalities, and potential complications and outcomes of those patients seen on rounds
  • Will monitor residents for signs of stress or sleep deprivation and follow-up accordingly

PGY-7 curriculum overview
The purpose of the chief resident year is to help the resident transition to practice by providing opportunities to independently evaluate patients, discuss and make decisions regarding surgery with patients, properly execute surgical treatment and post-operative care, perform independent in-hospital consultations for emergency treatments and operations, and perform administrative duties relevant to neurosurgery in the clinical practice and hospital environments. The senior resident will assimilate knowledge gleaned during previous years, regarding clinical treatment and socioeconomic aspects of the practice of neurosurgery. The senior resident will understand how to evaluate practice opportunities and the ramifications of multiple parameters on a clinical neurosurgical practice, whether in the private or academic sector. While the goal of this year is to allow the resident to practice independently as much as possible, activities will still be educational and under the appropriate supervision of neurosurgical faculty.

Didactics/conferences

Weekly

  • Epilepsy conference
  • Spinal case conference
  • Tumor board
  • Cerebrovascular conference

Weekly/rotating on departmental education day

  • Chief resident case conference
  • Neuroradiology case conference
  • Neuropathology
  • Neuroanatomy and surgical anatomy
  • Research didactics and review

Monthly

  • Morbidity & mortality review
  • Grand rounds
  • Journal club