Services > Neurosurgery > Residency > Loma Linda University Med Center Neurosurgery Residency Goals

Goals and Objectives For Training Levels

NS-1 (PGY-2) | NS-2 (PGY-3) | NS-3& 4 (PGY-4 & 5) | NS-5 (PGY-6)

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These goals and objectives are designed to serve as general guideline for technical capabilities and responsibilities for neurosurgical residents at Loma Linda University Medical Center as they progress through the residency training program. There is significant variability in technical proficiency between residents and in the amount of time necessary for each resident to learn the technical skills listed. It is the program director's decision, based on daily observation and evaluations from the other faculty, as to whether each trainee has attained the necessary skills to proceed to the next level of training or to complete the training program.


NS-1/PGYII Neurosurgical Resident Goals & Objectives

PGY-II neurosurgical residents will evaluate and provide care for patients in the surgical ward, surgical clinics, operating room, intensive care units and in the emergency department under the supervision of more senior residents and attending surgeons. PGY-II neurosurgical residents begin to supervise PGY-I neurosurgical residents in addition to medical students and other trainees in these settings, with the assistance of PGY-III, IV, V, and VI residents, and attending surgeons. PGY-II neurosurgical residents are given increasing responsibility for patient care that is based on training and demonstrated ability. It is recognized that specific experience and knowledge of each surgical resident may be different.

PGY-II neurosurgical residents will:

  1. Obtain and record detailed historical information from patients and families and verify the information gathered by PGY-1 residents under their supervision.
  2. Perform and record detailed physical examinations on their patients and verify the physical examinations done by the PGY-1 residents under their supervision.
  3. Discuss with their supervising resident and/or attending surgeon the history and physical examinations and use this to define a diagnostic and therapeutic plan.
  4. Write orders for patient care including diagnostic studies and therapies based on the above plan. They will verify the orders for patient care written by PGY-1 residents under their supervision.
  5. Record daily progress notes in the patient record. Modifications of the diagnostic and therapeutic plan based on further examination of the patient and discussion with supervising residents and/or attending surgeons will be recorded in these progress notes and patient care orders.
  6. The PGY-II neurosurgical residents will discuss as appropriate the diagnoses and diagnostic and therapeutic plan with other professionals involved in the patient care (i.e. nursing, physical therapy, social work, consulting physicians, etc.) and the patient and/or family.
  7. The PGY-II neurosurgical resident is expected to demonstrate increasing levels of competence in performing the procedures essential for the practice of neurosurgery. They will supervise simple procedures of PGY-I residents as defined previously.
  8. Life-sustaining procedures may be initiated and performed, as necessary, by PGY-II neurosurgical resident in circumstances where direct supervision by the supervising resident is not immediately available.
  9. Discharge planning, writing of prescriptions, and discharge from inpatient or outpatient care is done by PGY-II neurosurgical residents under the supervision of the PGY-IV, V, or VI resident and/or attending surgeon.
  10. Dictation of medical records will be done by the PGY-II neurosurgical residents in accordance with hospital guidelines.
  11. The PGY-II neurosurgical resident will be actively involved with teaching, directing, and supervising PGY-I neurosurgical residents, medical students, and physician assistant students.
  12. Hospital and department policies define hours of duty, on-call responsibility and availability, procedures for illness or absences, dress codes, and professional behavior, patient confidentiality, and safety procedures.
  13. The PGY-II neurosurgical resident is expected to fully participate in the teaching program including teaching conferences, attending rounds, interdisciplinary care conferences, and other defined teaching conferences. It is expected that PGY-II neurosurgical residents will be self-directed learners, including learning outside of the structured education program.
  14. PGY-II resident will receive specific timely evaluations of performance at the end of each quarter from supervising residents and attending surgeons. Annually a 360 evaluation will be conducted. Evaluation will be constructive and directed at assisting the process of graduated learning. More frequent evaluation should be expected whenever problems in performance are identified. Summary evaluation is conducted by the program director.
  15. Competence during the year is assured by direct observation by supervising residents and attending physicians, including review of verbal presentation, physical examination, and written notes in patient records. These observations are used for the formal evaluations noted above.
  16. The PGY-II resident is encouraged to participate as primary surgeon or first assistant as his/her operative skills improve. At the end of the first academic year, the PGY-II resident is expected to demonstrate with relative ease the ability to perform posterior exposures for cervical and lumbar disc surgery, placement of ventriculoperitoneal shunts, placement of burr holes for drainage or biopsy, completion of craniotomy bone flaps, and require minimal assistance in completion of uncomplicated lumbar discectomies. In addition, the PGY-II resident will have removed one or more simple brain tumors as primary surgeon. The program director evaluates the PGY-II resident at the end of the first year of training and advances the resident into the second year of training if appropriate.

Elective Procedures for PGY-II Neurosurgical Residents without Supervision by an Attending Surgeon

Insert peripheral intravenous catheters
Insert urinary bladder catheters
Insert nasogastric tubes
Lumbar puncture

Suture uncomplicated wounds

Insert central intravenous catheters

Insert pulmonary artery catheters

Insert peripheral arterial lines

Thoracentesis

Insert chest tube

Change central venous catheters over a wire

Halo ring placement

ICP monitor placement

Twist drill drainage of subdural fluid collection

Emergency Procedures without Supervision

Defibrillate the heart

Endotracheal intubation in a life-threatening situation

Elective Procedures with Supervision by a PGY-IV or V Resident

Incision, debridement, and drainage of soft tissue infections
Burr hole placement
Ventriculoperitoneal shunt placement/revision


Elective Procedures with Attending Surgeons Present

Procedure

Resident Level

Excision of Cutaneous Lesion

1-6

Excision of Subcutaneous Mass

1-6

Incision, debridement, and drainage of soft tissue infections

1-6

Burr hole placement

1-6

Lumbar discectomy/foraminotomy

2-6

Craniotomy for trauma or simple tumors

2-6

Simple or Stereotactic brain biopsy

2-6

 


NS-2/PGY-III Neurosurgical Resident Goals & Objectives

 

PGY-III neurosurgical residents will evaluate and provide care for patients in the surgical ward, surgical clinics, operating room, intensive care units, and in the emergency department under the supervision of more senior residents and attending surgeons. PGY-III neurosurgical residents supervise PGY-I and II neurosurgical residents in addition to medical students and other trainees in these settings, with the assistance of PGY-IV, V, and VI residents, and attending surgeons. PGY-III neurosurgical residents are given increasing responsibility for patient care that is based on training and demonstrated ability but otherwise the year is very similar to the PGY-II year in terms of clinical rotations and responsibilities. It is recognized that specific experience and knowledge of each surgical resident may be different.

PGY-III neurosurgical residents will:

  1. Obtain and record detailed historical information from patients and families and verify the information gathered by PGY-1 residents under their supervision.
  2. Perform and record detailed physical examinations on their patients and verify the physical examinations done by the PGY-1 residents under their supervision.
  3. Discuss with their supervising resident and/or attending surgeon the history and physical examinations and use this to define a diagnostic and therapeutic plan.
  4. Write orders for patient care including diagnostic studies and therapies based on the above plan. They will verify the orders for patient care written by PGY-1 residents under their supervision.
  5. Record daily progress notes in the patient record. Modifications of the diagnostic and therapeutic plan, based on urther examination of the patient and discussion with supervising residents and/or attending surgeons, will be recorded in these progress notes and patient-care orders.
  6. The PGY-III neurosurgical residents will discuss as appropriate the diagnoses and diagnostic and therapeutic plan with other professionals involved in the patient care (i.e. nursing, physical therapy, social work, consulting physicians, etc.) and the patient and/or family.
  7. The PGY-III neurosurgical resident is expected to demonstrate increasing levels of competence in performing the procedures essential for the practice of neurosurgery. They will supervise simple procedures of PGY-I residents as defined previously.
  8. Life-sustaining procedures may be initiated and performed, as necessary, by PGY-III neurosurgical resident in circumstances where direct supervision by the supervising resident is not immediately available.
  9. Discharge planning, writing of prescriptions, and discharge from inpatient or outpatient care is done by PGY-III neurosurgical residents under the supervision of the PGY-IV, V, or VI resident and/or attending surgeon.
  10. Dictation of medical records will be done by the PGY-III neurosurgical residents in accordance with hospital guidelines.
  11. The PGY-III neurosurgical resident will be actively involved with teaching, directing, and supervising PGY-I neurosurgical residents, medical students and physician assistant students.
  12. Hospital and department policies define hours of duty, on-call responsibility and availability, procedures for illness or absences, dress codes and professional behavior, patient confidentiality, and safety procedures.
  13. The PGY-III neurosurgical resident is expected to fully participate in the teaching program including teaching conferences, attending rounds, interdisciplinary care conferences, and other defined teaching conferences. It is expected that PGY-III neurosurgical residents will be self-directed learners, including learning outside of the structured education program.
  14. PGY-III residents will receive specific timely evaluations of performance at the end of each quarter from supervising residents and attending surgeons. Annually, a 360 evaluation will be conducted. Evaluation will be constructive and directed at assisting the process of graduated learning. More frequent evaluation should be expected whenever problems in performance are identified. Summary evaluation is conducted by the program director.
  15. Competence during the year is assured by direct observation by supervising residents and attending physicians, including review of verbal presentation, physical examination, and written notes in patient records. These observations are used for the formal evaluations noted above.
  16. The PGY-III resident is assigned in a similar fashion to the PGY-II resident, with increasing responsibility as her/his technical skills improve. At the end of the second year of neurosurgical training, the PGY-III resident is expected to be able to complete cervical and lumbar discectomies, perform simple instrumentation--cervical plating, perform uncomplicated craniotomies for supratentorial tumors or trauma, and perform posterior fossa exposures.

Elective Procedures for PGY-III Neurosurgical Residents without supervision by an Attending Surgeon

Insert peripheral Intravenous catheters

Insert urinary bladder catheters

Insert nasogastric tubes

Lumbar puncture

Suture uncomplicated wounds

Insert central intravenous catheters

Insert pulmonary artery catheters

Insert peripheral arterial lines

Thoracentesis

Insert chest tube

Change central venous catheters over a wire

Halo ring placement

ICP monitor placement

Twist drill drainage of subdural fluid collection

Emergency Procedures without Supervision

Defibrillate the heart

Endotracheal intubation in a life-threatening situation

Elective Procedures with Supervision by a PGY-IV or V Resident or Attending Surgeon

Incision, debridement, and drainage of soft tissue infections

Burr hole placement

Ventriculoperitoneal shunt placement/revision

Elective Procedures with Attending Surgeons Present


Procedure

Resident Level

Excision of Cutaneous Lesion

1-6

Excision of Subcutaneous Mass

1-6

Incision, debridement, and drainage of soft tissue infections

1-6

Burr hole placement

1-6

Lumbar discectomy/foraminotomy

2-6

Craniotomy for trauma or simple tumors

2-6

Simple or stereotactic brain biopsy

2-6

Posterior fossa craniotomy/craniectomy

3-6

Craniotomy for aneurysm or AVM

3-6

 


NS-3/PGY-IV and NS-4/PGY–V Neurourgery Resident Goals &Objectives

PGY-IV and -V neurosurgical residents spend the majority of their time in the laboratory but also provide direct patient care throughout the hospital and supervising other residents, medical students, and physician assistants under the direct guidance of attending surgeons. PGY-IV and -V neurosurgical residents will also have some administrative responsibilities including arrangement of teaching conferences.

PGY-IV and -V neurosurgical residents will:

  1. Obtain and record detailed historical information from patients and families and verify the information gathered by physicians under their supervision.
  2. Perform and record detailed physical examinations on their patients and verify the physical examinations done by the physicians under their supervision.
  3. Discuss with their fellow and/or attending the history and physical examinations and will use this to define a diagnostic and therapeutic plan. They will assist the physicians under their supervision in defining a diagnostic and therapeutic plan.
  4. Write orders for patient care including diagnostic studies and therapies based on the above plan. They will verify the orders for patient care written by physicians under their supervision.
  5. Record daily progress notes in the patient record. Modifications of the diagnostic and therapeutic plan, based on further examination of the patient and discussion with attending surgeons will be recorded in these progress notes and patient care orders.
  6. PGY-IV and -V neurosurgical surgery residents will discuss as appropriate the diagnoses and diagnostic and therapeutic plan with other professionals involved in the patient care (i.e. nursing, social work, etc.) and the patient and/or family.
  7. PGY-IV and -V neurosurgical residents are expected to demonstrate increasing levels of competence in performing the procedures essential for the practice of surgery. They will supervise simple procedures.
  8. Discharge planning, writing of prescriptions, and discharge from inpatient or outpatient care is done by PGY-IV and -V neurosurgical residents under the supervision of the attending surgeon.
  9. Dictation of medical records will be done by the PGY-IV and -V neurosurgical residents in accordance with hospital guidelines.
  10. The PGY-IV and -V neurosurgical resident will be actively involved with teaching, directing and supervising PGY-I, II, and III Surgery Residents, medical students and physician assistant students. They will participate in the evaluation of these individuals. They will occasionally be asked to assume the responsibilities of the PGY-VI (Chief) residents when these residents are unavailable.
  11. The PGY-IV and -V neurosurgical resident is expected to fully participate in the teaching program including teaching conferences, attending rounds, interdisciplinary care conferences and other defined teaching conferences. It is expected that PGY-IV and -V neurosurgical resident will be self-directed learners, including learning outside of the structured education program.
  12. PGY-IV and -V neurosurgical residents will receive specific timely evaluations of performance at the end of each quarter from attendings. Annually, a 360 evaluation will be conducted. Evaluation will be constructive and directed at assisting the process of graduated learning. More frequent evaluation should be expected whenever problems in performance are identified. Summary evaluation is conducted by the program director with input from all the institutions on an annual basis.
  13. Competence during the year is assured by direct observation by fellows and attending physicians including review of verbal presentation, physical examination, and written notes in patient records. These observations are used for the formal evaluations noted above.
  14. PGY-IV and PGY-V neurosurgical residents are strongly encouraged to spend these two years doing laboratory and clinical research, either on- or off-campus. It should be noted that the resident is encouraged to do research within the division of neurosurgery at Loma Linda, but the experience is tailored to the educational wishes and needs of the individual resident as developed by the program director and the resident. During these years, the resident is expected to participate as fully as possible in the academic conferences and continue to be on call as first-call resident every fourth night. The required three months of neurology is also completed during these years and is composed of a mix of outpatient and inpatient experiences. The laboratory/research resident is also assigned teaching responsibility on our academic day--one day per week--to the ambulatory junior medical students assigned to our service. This includes a one two-hour session with two to four medical students teaching techniques involved in reading and interpreting MR scans, CT scans, and other radiographic materials. The students are encouraged to use this opportunity to have any clinical or patient-care questions answered. The time the PGY-IV and PGY-V resident spends outside of his/her research/laboratory commitment is approximately 25 percent.

Elective Procedures for PGY-IV & V Neurosurgical Residents without Supervision

All PGY I, II and III elective procedures without supervision

Emergency Procedures without Supervision

Defibrillate the heart

Emergency tracheostomy

Emergency cricothyroidotomy

Evacuation of soft tissue infection, abscess or hematoma

Elective Procedures with Attending Surgeons Present


Procedure

Resident Level

Excision of Cutaneous Lesion

1-6

Excision of Subcutaneous Mass

1-6

Incision debridement, and drainage of soft tissue infections

1-6

Burr Hole placement

1-6

Lumbar discectomy/foraminotomy

2-6

Craniotomy for trauma or simple tumors

2-6

Simple of Stereotactic brain biopsy

2-6

Posterior fossa craniotomy/craniotomy

3-6

Craniotomy for aneurysm or AVM

3-6

Complicated brain tumors

4-6

Pediatric brain tumors

4-6

Spinal cord tumors

4-6

Complex spine tumors

4-6

 


NS-5/PGY-VI (chief) Neurosurgical Resident Goals & Objectives

PGY-VI (chief) neurosurgical residents spend the majority of their time providing direct patient care and supervising other residents, medical students, and physician assistants under the direct guidance of attending surgeons. PGY-VI (chief) neurosurgical residents will also have some administrative responsibilities including posting of the operative schedule and bed control in the intensive care unit and surgical ward. In addition, they will make out the resident call schedule.

PGY-VI (chief) neurosurgical residents will:

  1. Obtain and record detailed historical information from patients and families and verify the information gathered by physicians under their supervision.
  2. Perform and record detailed physical examinations on their patients and verify the physical examinations done by the physicians under their supervision.
  3. Discuss with their fellow and/or attending the history and physical examinations and will use this to define a diagnostic and therapeutic plan. They will assist the physicians under their supervision in defining a diagnostic and therapeutic plan.
  4. Write orders for patient care including diagnostic studies and therapies based on the above plan. They will verify the orders for patient care written by physicians under their supervision.
  5. Record daily progress notes in the patient record. Modifications of the diagnostic and therapeutic plan, based on further examination of the patient and discussion with attending surgeons, will be recorded in these progress notes and patient care orders.
  6. PGY-VI (chief) neurosurgical residents will discuss as appropriate the diagnoses and diagnostic and therapeutic plan with other professionals involved in the patient care (i.e. nursing, social work, etc.) and the patient and/or family.
  7. The PGY-VI (chief) neurosurgical residents are expected to demonstrate increasing levels of competence in performing the procedures essential for the practice of surgery. They will supervise simple procedures.
  8. Discharge planning, writing of prescriptions, and discharge from inpatient or outpatient care is done by PGY-VI (chief) neurosurgical residents under the supervision of the attending surgeon.
  9. The PGY-VI (chief) neurosurgical residents in accordance with hospital guidelines will do dictation of medical records.
  10. The PGY-VI (chief) neurosurgical residents will be actively involved with teaching, directing, and supervising PGY-I, II, and III neurosurgical residents, medical students, and physician assistant students. They will participate in the evaluation of these individuals.
  11. The PGY-VI (chief) neurosurgical resident is expected to fully participate in the teaching program including teaching conferences, attending rounds, interdisciplinary care conferences, and other defined teaching conferences. It is expected that PGY-VI neurosurgical residents will be self-directed learners, including learning outside of the structured education program.
  12. PGY-VI (chief) neurosurgical residents will receive specific timely evaluations of performance at the end of each quarter from attendings. Annually, a 360 evaluation is conducted. Evaluation will be constructive and directed at assisting the process of graduated learning. More frequent evaluation should be expected whenever problems in performance are identified. The program director conducts summary evaluation and suitability for board examination, with input from all the institutions at the end of the PGY-VI year.
  13. Competence during the year is assured by direct observation by fellows and attending physicians, including review of verbal presentation, physical examination, and written notes in patient records. These observations are used for the formal evaluations noted above.
  14. PGY-VI (chief) neurosurgical residents coordinate the operative schedule and are given preference for selection of cases acting as primary surgeon according to level of skill and interest.
  15. PGY-VI (chief) neurosurgical resident is on call as back up every night with the exception of two 24-hour periods within a two week period--contiguous or non-contiguous--when the chief resident is relieved of all hospital duty and responsibility. This time is typically taken contiguously every other weekend. It should be noted that this call is not in-house, and care is taken to ensure that the maximum 80-hour workweek is not exceeded.

Elective Procedures for PGY-VI (chief) neurosurgical residents without supervision

All PGY I, II, and III elective procedures without supervision

Emergency Procedures without Supervision

Defibrillate the heart

Emergency tracheostomy

Emergency cricothyroidotomy

Evacuation of soft tissue infection, abscess, or hematoma

Elective Procedures with Attending Surgeons Present

Procedure

Resident Level

Excision of cutaneous lesion

1-6

Excision of subcutaneous mass

1-6

Incision debridement, and drainage of soft tissue infections

1-6

Burr Hole placement

1-6

Lumbar discectomy/foraminotomy

2-6

Craniotomy for trauma or simple tumors

2-6

Simple of stereotactic brain biopsy

2-6

Posterior fossa craniotomy/craniotomy

3-6

Craniotomy for aneurysm or AVM

3-6

Complicated brain tumors

4-6

Pediatric brain tumors

4-6

Spinal cord tumors

4-6

Complex spine tumors

4-6