Curriculum/Schedule

University of Cincinnati Medical Center (UCMC)

University of Cincinnati Medical Center Neurosurgery Service - Intern, PGY-1

The neurosurgery Intern will be exposed to the breadth of inpatient neurosurgical practice at a tertiary referral center and the sole level-I trauma center for over 2-million residents of the Cincinnati Metro Area. Clinically, the neurosurgery intern is exposed to and ultimately assumes graded responsibility for the UCMC neurosurgery service along with the Junior Resident. This includes the evaluation and treatment of neurosurgical ICU patients; post-operative spine and cranial inpatients; neurotrauma patients; inpatient consultations; and both UCMC ER and outside hospital consultations. The intern will be exposed to overnight call through a small number of “buddy” calls with more senior residents during their time on the service. Operatively, the neurosurgery intern is expected to become adept at the spectrum of bedside neurosurgical procedures. In the operating room, the intern will assist with and learn to perform basic elective neurosurgical procedures as well as emergent procedures for cranial trauma. The neurosurgery intern will also be expected to participate in outpatient clinics to gain exposure to preoperative and postoperative neurosurgical care in the ambulatory setting.

University of Cincinnati Medical Center Neurocritical Care Service - Intern, PGY-1

During time with the UCMC Neurocritical Care Service, the resident learns to identify which patients warrant an ICU level of care and is introduced to the principles of critical care management with a focus on neurological disorders. General critical care medicine is also emphasized with concepts of cardio-pulmonary, fluid and electrolytes, infectious, hematologic and nutritional management addressed as an integral part of patient care. Recognition of the need for consultation with other clinical subspecialists is also emphasized along with disposition planning for transfer/discharge from the NSICU.

Procedurally, the neurosurgery resident will be taught common critical care procedures: airway management including non-invasive management, intubation, and bronchoscopy; placement of central venous lines, arterial lines, and other advanced vascular access; and continued experience with invasive intracranial monitoring devices and other bedside neurosurgical procedures. The nature of the NSICU is such that it provides the opportunity for the residents to experience multiple difficult psychosocial situations. The ability to deal with these situations effectively will be honed, reviewed, and emphasized throughout the rotation.

University of Cincinnati Medical Center Neurosurgery Service– Junior Resident, PGY-2

The junior resident is primarily responsible for the UCMC Neurosurgery Service under the direction and direct supervision of the Chief Resident and faculty. Central to this responsibility is the evaluation and management of all referrals, consultations, postoperative inpatients, neurotrauma consultations/inpatients, and neurosurgical ICU admissions/inpatients. The junior resident will participate in inpatient care from initial evaluation and admission to discharge and placement. The junior resident plays a significant role in teaching, supervising, and mentoring the neurosurgery intern. Ideally this will lead to shared responsibility for the service between the PGY-1 and PGY-2, freeing the latter for greater time in the OR. The junior resident will perform all bedside neurosurgical procedures independently. In the operating room, the junior resident will be exposed to a variety of the most common neurosurgical procedures, including emergent procedures for trauma.

The junior resident will spend 6 months on the Dunsker service (spine & neurotrauma patients) and 6 months on the Tew service (cranial patients). He/she will take approximately 6 calls per month on service.

University of Cincinnati Medical Center Neurosurgery Service, PGY 3-5

After completing the junior resident rotations, the PGY3-5 rotation on the UCMC Neurosurgery Service is primarily concerned with exposure to and increasing involvement performing the breadth of operative procedures. Due to the procedures commonly performed at UCMC, an emphasis is placed on cranial neurosurgery with additional endovascular, spine, functional, trauma, and CSF diversion procedures. The more junior resident will spend much of their time one-on-one with faculty, scrubbed with a Chief Resident on complex cranial/spinal cases, or scrubbed with the junior resident to guide them through more basic operative procedures. The PGY-5 may rotate on service as part of a clinical elective or to gain further exposure to specific cranial procedures. The PGY-3 takes roughly 6 calls per month on service; the PGY-4 takes roughly 4 calls per month on service; the PGY-5 takes roughly 3 calls per month on service.

University of Cincinnati Medical Center Neurosurgery Service – Chief Resident, PGY-6

The Chief Resident rotations enable residents to bring all of their previous training to bear as they prepare to graduate and enter the independent practice of neurosurgery. Residents mature as clinicians, surgeons, leaders, and administrators by honing their skills to ultimately provide the highest level of medical care in an efficient, effective, and compassionate manner. The Chief Resident year demands proficiency in the complete management of all neurosurgical problems with emphasis on sharpening their technical skills, in both cranial and spinal surgery, as they prepare to assume the role of independent practitioners. Call is shared between two Chiefs and they serve as backup for each other during times when they have to be away from the service for conferences, job interviews and vacation time, etc.

Ultimate authority of running the UCMC Neurosurgery Service is vested in the Chief Resident. As the leaders of the resident team, the Chief Residents must demonstrate their developed managerial, administrative, and leadership skills both clinically and academically to effectively guide and instruct the resident team, physician assistants, nurse practitioners, medical students, and all allied healthcare providers. The Chief Residents assume the major teaching role for other members of the service. The Chief Resident rotation is the culmination of six years of postgraduate training in neurological surgery designed to allow maturation in all aspects of their neurosurgical skill set and assure residents can apply their clinical skills, surgical skills, and medical knowledge base to pursue a career in academics, private practice, or a combination of both.

The Chief Resident of the Tew service also services as the Administrative Chief which emphasizes honing the management and teaching skills needed to help others progress in the clinical and operative management of neurosurgical disease. The Administrative Chief is responsible for supervising the junior resident and intern by serving as their immediate point of contact for staffing in-hospital neurosurgery consultations; rounding on consult patients with the junior residents on service; and implementing plans of treatment after appropriate discussion with the faculty involved. The Administrative Chief is responsible for preparing and presenting patient’s complications and deaths at the monthly Morbidity and Mortality Conference. He/she is also responsible for documenting and providing operative statistics for all neurosurgical procedures performed at UCMC.

University of Cincinnati Medical Center Neurosurgery Service – PGY 7

The PGY-7 year provides an opportunity for advanced training in the resident’s area of interest. An enfolded fellowship can be completed in spine or endovascular surgery. Alternatively, a resident may gain additional expertise in multiple sub-specialty rotations including functional, pediatric neurosurgery or neuro-trauma. The year can be designed for transition to private practice if a resident plans to establish or join a small practice.

Cincinnati Children's Hospital Medical Center (CCHMC)

CCHMC Neurosurgery Service, PGY-3

During the CCHMC rotation, the resident’s education and service dedicated to the practice of pediatric neurosurgery service at Cincinnati Children’s Hospital Medical Center, one of the leading children’s hospitals in the nation with a robust national and international referral base. CCHMC also serves as the sole pediatric trauma center for the Cincinnati metropolitan area. The CCHMC resident functions as part of a large team that includes the pediatric neurosurgery fellow, visiting residents from outside institutions, physician’s assistants, nurse practitioners, and the pediatric neurosurgery faculty.

The neurosurgery resident serves as the senior resident on service and co-directs the service with the pediatric neurosurgery fellow. The rotation involves exposure to a wide variety of pediatric neurosurgical issues in children. The resident is expected to encounter all aspects of pediatric neurosurgery, including congenital neurologic disorders, neurooncology, functional neurologic disorders with an emphasis on epilepsy, and neurotrauma. The rotation is intended to maximize the resident’s education and focus on inpatient, outpatient and operative management of pediatric neurosurgery patients. Operative time is spent under the instruction of Drs. Francesco Mangano—Chief of the Division of Pediatric Neurosurgery, Charles Stevenson, Sudhakar Vadivelu, and Jesse Skoch. The rotation also emphasizes participation in attending clinics, including those of non-operative faculty. There is also ample opportunity to become involved in the division’s robust research endeavors. The resident takes approximately 10 home calls; call is divided with any visiting residents and the pediatric neurosurgery fellow. The pediatric neurosurgery fellow and faculty serve as backup while on primary call.

The Christ Hospital

TCH Neurosurgery Service – Senior Resident, PGY-4

The senior resident at the Christ Hospital is responsible for the neurosurgery service. The emphasis is on gaining independence performing the spectrum of general neurosurgical procedures under direct faculty supervision as well as becoming adept at the evaluation of preoperative and postoperative patients in a busy practice setting.  An emphasis is placed on basic and complex spine procedures including minimally invasive techniques and general cranial procedures.  The PGY 4 senior resident is responsible for the administration of the TCH service and takes 8 overnight calls from home.  Once licensed, residents PGY 3-6 may elect to take additional home calls at the discretion of the Chief Resident and faculty.

West Chester Hospital

WCH Neurosurgery Service – PGY-4

The PGY-4 resident at the West Chester Hospital is responsible for the neurosurgery service. The emphasis is on gaining independence performing the spectrum of general neurosurgical procedures under direct faculty supervision as well as becoming adept at the evaluation of preoperative and postoperative patients in a

busy practice setting. An emphasis is placed on basic and complex spine procedures including minimally invasive techniques and neuro-functional procedures. The resident is responsible for the administration of the WCH service and along with the APP and attendings, covers the hospital taking home calls.