Neurosurgery Residency Curriculum

PGY-1: Neurosciences, Critical Care, and Neurosurgery

The PGY-1 year will consist of three months of critical care including rotations with the anesthesia surgical critical care service and the neuroscience critical care service. The PGY-1 resident will also spend three one month blocks on neuro-pathology, neuro-radiology, and a neurology subspecialty service. The remaining six months will be spent on the neurosurgery service. The PGY-1 resident will contribute to the call pool once a minimum number of procedures is achieved.

PGY-2: Junior Resident

The PGY-2 resident is the junior neurosurgery resident at SLUH. The PGY-2 resident provides assistance with the daily patient care for the inpatient neurosurgery service, including pre- and post-operative care. He or she provides neurosurgical consultation services to the emergency room and inpatient services. The PGY-2 resident also assists in the operating room and covers call at SLUH and CGCH.

PGY-3: Subspecialty and Community Hospital Electives

PGY-3 year is spent on elective rotations designed to develop the specific interests of the resident, in addition to rotating on neurosurgical services at community hospitals designated as official sites of the residency program. Rotations available include complex spine, endovascular, radiation oncology, movement disorder, peripheral nerve, neuro-oncology, neuro-ophthalmology, as well as other potential for self designed electives.

Our residency program is affiliated with SSM St. Mary’s Hospital, Mercy Hospital St. Louis, and SSM DePaul Hospital as sites to experience a more private setting for neurosurgical care. Available elective away rotations include a 3-month spine and networked health rotation at SSM St. Mary’s Hospital and SSM Health DePaul Hospital and a 3-month cranial and spine rotation at Mercy Hospital St. Louis.

PGY-4: Pediatric and Adult Neurosurgery

The PGY-4 year is spent primarily at CGCH as the resident focused on the pediatric service. During this rotation this resident participates in pediatric cases and clinics. There is also continued adult neurosurgery exposure during this time based on call and case coverage needs. During this year it is expected for the PGY-4 to develop more advanced surgical skill and autonomy while being exposed to the breadth of pediatric neurosurgical care.

PGY-5: Research Year

PGY-5 is designated as the research year. The resident’s primary responsibility is participating in basic science or clinical research in a project that has been approved by the Chair and Program Director. Both clinical and basic science opportunities are available but it is expected that the resident develops a plan for this time based on their specific interests. This resident is expected to attend clinical conferences and to be available for call duty.

PGY-6: Senior Neurosurgery Resident

During the PGY-6 year, the resident is assigned to the neurosurgery service at SLUH as the senior neurosurgical resident. During this portion of their training, the resident should become more active in the operating room but again serves as backup to the more junior hospital staff. Subspecialty focus can be planned into this year on the neurosurgical service with the aim of honing future career goals.

PGY-7: Chief Resident

The PGY-7 resident is designated as the Chief Resident of the neurosurgery service spanning both SLUH and CGH. During this 12 month period, the resident should play a primary role in taking care of all neurosurgical patients on the inpatient service and serve as primary surgeon in both routine and complex neurosurgical operations. The Chief Resident is expected to perform as a leader of the neurosurgery service with teaching, administrative duties and clinical roles.

Faculty have either a half or full day clinic once a week. Each attending has a clinical nurse who is responsible for scheduling outpatient tests, follow-up appointments, and other preoperative or postoperative studies. Clinic coverage is not required by residents, but encouraged. The role of the resident is to perform a thorough history and physical examination on new patients, a focused history and exam on follow-up patients, review any and all imaging studies with the attending physician, and generate a management plan.

The pediatric neurosurgery clinic is held at SSM Health Cardinal Glennon Children's Hospital on the ground floor in the outpatient area. The pediatric resident will cover half a day in the clinic each week. Each clinic is also staffed with a clinical nurse as well as a pediatric nurse practitioner. There are also monthly separate pediatric multidisciplinary clinics that involve neurosurgery, including myelomeningocele and brain tumor clinics that are staffed by residents when they are not in the operating room.

In-house call is covered by junior residents nightly with the chief resident or subspecialty chief resident as senior level backup. During vacation time for on service residents, the off service resident is available to cover in-house call as well as the daily service responsibilities. One night of call per week is to be covered by a physician extender to allow maximum resident attendance at didactic sessions.

The neurosurgical service at Saint Louis University is heavily dependent upon computer technology. Both of the main hospitals use EPIC for electronic health records throughout the system in both the inpatient and outpatient environment. Residents utilize a written hand off system as well as in-person rounds to communicate patient care tasks and concerns with the call team.

The neurosurgery attendings rotate on the general neurosurgery call schedule, with designations of subspecialty call including vascular, pediatrics, and spine. When a resident is on call, he or she will field all ER calls, floor consultations, and ICU and floor nurse calls both at SSM Health Cardinal Glennon Children's Hospital and SSM Health Saint Louis University Hospital.

When the service is consulted, the on-call attending and backup resident are notified. For any inpatient management question, the back-up resident is available either over the phone or for direct supervision as needed. Any operative cases are staffed by the backup senior resident, the on-call resident when able and, of course, the attending on call. Neurosurgical bedside procedures are performed by the resident on-call or the senior backup resident as necessary.

Spine call is shared with the orthopaedic service. On average, neurosurgery takes one in three weeks of spine call throughout the year.

Journal Club: This conference is held to both review new literature as well as discuss historical papers that have impacted neurosurgical care over time. Residents are assigned a paper to read in detail and present to the group with the aim of familiarizing the resident with critical evaluation of scientific papers as well as learning the scientific basis for neurosurgical treatments employed today.

Patient Care Conference: During this conference, interesting cases are discussed and teaching points are made. This educational experience often includes reviewing imaging in the form of conventional radiographs and/or intraoperative video or photography. It also provides a forum for faculty and residents to collaborate and discuss difficult or perplexing cases.

Resident Teaching Conference: This conference consists of didactic sessions given by neurosurgical residents and reviewed by faculty on various anatomic, radiographic and operative topics. This curriculum is designed to cover the breadth of neurosurgery over a 2 year timeframe.

Fetal Care Conference: This is a lunch conference held on Thursdays to review all active patients followed by the Fetal Care Institute at Cardinal Glennon. This includes all specialties and discusses the prenatal and expected postnatal care of patients with congenital and neonatal complex medical problems.

Pediatric Tumor Board: This is a weekly conference hosted by pediatric oncology on Thursday mornings to discuss care of any pediatric oncology patient. Neurosurgical patients are discussed here as needed with oncology, neurosurgery, pathology, radiation oncology, social work, and palliative care attendance as well as any additional surgical subspecialties that are involved.

Spine Conference: This is a weekly conference held on Monday mornings to discuss spine cases being performed that week by both neurosurgery and orthopedic spine. Patients presented either have upcoming surgeries or are presented as interesting or challenging cases where input from both subspecialties is encouraged.

Grand Rounds: At least once per month, faculty speakers from within the division, across multidisciplinary lines, and from other institutions are invited to present to the faculty, residents, and medical students on a topic of their choice.

Morbidity and Mortality Conference (M&M): This conference consists of case presentations by the chief resident from the previous month’s complications and/or deaths.

Epilepsy Conference: Adult and pediatric epilepsy conferences are held on a monthly and as needed basis for the multidisciplinary discussion of care for complex epilepsy patients likely to require surgical care. This is held in conjunction with neurology, neuropsychology, radiology, and neurosurgery.

Movement Disorders Conference: This is hosted by Drs. Richard Bucholz and Pratap Chand, the movement disorders specialist. Potential surgical candidates are presented, often with videographic data.

Neuropathology Conference: This conference is hosted by neuropathologist Miguel Guzman, M.D. The curriculum consists of a comprehensive review of pathologies of the central nervous system.

Neurosurgery Tumor Board: This is a multidisciplinary conference and often includes presentations from neurology, oncology, radiology, radiation oncology, pathology and neurosurgery. The cases are introduced by neurosurgery residents. SSM Health Cardinal Glennon Children's Hospital also hosts its own Tumor Board but is not restricted to CNS pathology.

Psychosurgery Conference: Overlapping neurosurgical and psychiatric cases and topics are discussed. Residents and faculty from neurosurgery and psychiatry are present.

Radiation Oncology Conference: This conference is hosted by John Dombrowski, M.D., chair of Radiation Medicine. The curriculum includes radiation oncology and basic physics as it relates to tumors of the central nervous system and the late effects of radiation on the central nervous system

Resident Meeting: The resident meeting is hosted by Jeroen Coppens, M.D., the program director and Joanna Kemp, M.D., the associate program director. During this meeting, a predetermined agenda regarding resident concerns and updates are discussed.

Resident Research Conference: Resident ongoing research projects are presented and discussed with Dr. Coppens.

Spine Trauma Conference: In this monthly conference, meetings are held on the 4th Wednesday evening of the month and dinner is provided. All spine trauma cases are recorded and presented at this conference with discussion about all aspects of care. This is attended by orthopedics, neurosurgery, trauma, radiology, rehab and therapy services, and emergency medicine both from within and outside the institution.