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PGY 4 - Mid-level Residents


  1. Rotate 12 months in clinical neurosurgery.        
  2. One day per week devoted to teaching in the outpatient clinics.             
  3. Attend the Woods Hole RUNN course.
  4. Take call with senior and/or chief resident and the attending staff backup.
  5. Attend all mandatory conferences and lectures.
  6. Prepare lectures for journal club, ethics, spine, and morbidity and mortality conferences.
  7. Attend scheduled outpatient clinics with assigned faculty.
  8. Take SANS online self assessment examination.
  9. Review AANS/SNS online courses and complete the assessment exams.
  10. Maintain case log through ACGME site and provide all required documentation for resident portfolio.
  11. Take written neurosurgical boards for credit (if necessary).


Reading List, Supplemental Reading

The following AANS/SNS online sessions are expected to be completed during the summer months:

  1. The Biology of Traumatic Brain Injury
  2. Evaluation of the Patient with a Neuroendocrine Disorder
  3. Evaluation of Cerebral Blood Flow
  4. Neuroanesthesia:  Risk Evaluation and Management
  5. Medical Malpractice Claims:  How to Stay in the Operating Room and Out of the Court Room
  6. Self Evaluation
  7. Gender Issues and Cultural Competency in Neurosurgery
  8. Patient Research: Your Obligation to the Patient


Goals and Objectives

The objective of the neurosurgical rotation during the NS4 year is to further expand and enhance the skills and competencies learned from the previous year during the neuroradiology, neuro-ophthalmology, neuropathology and pediatric rotations. This year is devoted solely to clinical neurosurgery. The resident will begin to be involved with supervising and teaching responsibilities in addition to expanding their surgical experience.


Medical Knowledge:  The resident will be able to:

  • Expand knowledge base in neuroanatomy, neurophysiology, neuropharmacology and basic neurosciences by attending the Woods Hole RUNN course.
  • Begin to teach and mentor lower level residents in critical care, operative skills, patient work-up, and evaluation and management skills.
  • Demonstrate the ability to evaluate the medical literature in journal clubs.
  • Attempt to pass the neurosurgical written board exam.
  • Assume an increasingly active role in didactic conference preparations and discussions.

Utilizing:        Written board exam


                        Oral exam

                        Bi-annual evaluations and competencies

                        Skull base lab workshops

Patient Care and Assessment:  The resident will be able to:

  • Accurately interpret complex laboratory and imaging tests.
  • Provide and direct clear and concise inpatient and outpatient treatment plans.
  • Demonstrate competency in the performance of mid-level surgical procedures (spine and cranial) appropriate to the level of training (there are specific core clinical knowledge requirements).

Utilizing:        Observed Exam: clinics/operating room

                        Patient survey:  post-exam/feedback cards

                        Bi-annual exam: procedures

Practice-Based Learning:  The resident will be able to:

  • Perform a clinical or basic science research project appropriate for presentation at a national scientific meeting and for subsequent publication.
  • Demonstrate sound habits of personal scholarship and scientific inquiry.
  • Demonstrate on ongoing and improving ability to learn from errors.

Utilizing:         Journal club with statistics

                        Set new goals/evaluate old goals

                        Yearly scholarship logs


                        Case logs

System-Based Practice:  The residents will be able to:

  • Demonstrate an understanding of practice opportunities, practice types, healthcare delivery systems and medical/socioeconomics.
  • Maintain log of all procedures performed utilizing ACGME case log system.

Utilizing:        QI Team projects

                        Formal lectures

Interpersonal and Communication Skills:  The resident will be able to:

  • Demonstrate a high level of interpersonal communication skills with patients and staff.

Utilizing:        Observed exam

                        Patient survey

                        Feedback cards

Professionalism:  The resident will be able to:

  • Demonstrate a high level of professionalism at all times with administrative faculty and nursing staff.

Utilizing:        Project professionalism/ AMA Virtual Mentor

                        360-degree evaluation

                        Feedback cards


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