Curriculum

The goal of our residency training program is to provide exemplary instruction pertaining to patient care, medical knowledge, practice-based learning, interpersonal and communication skills, professionalism, systems-based practice, and ethical behavior that will allow residents to deliver high quality neurosurgical care.  We are dedicated to assist our trainees in reaching these goals.

Educational Program: Year One

The PGY-1 year consists of rotations through a variety of inpatient and outpatient clinical services that are intended to provide a foundation of knowledge and skills that will promote success in neurosurgery residency. Specific attention will be paid to surgical principles, emergency evaluation and management, basic patient care skills, and clinical neuroscience (e.g., neurocritical care, neurology). Rotations are based at Nebraska Medicine, Nebraska Methodist Hospital, and Children’s Hospital. Upon completion of the initial year of training, the resident will have developed a broad base of knowledge and basic technical skills applicable to neurological surgery.

During this year, residents will develop their skills in performing history and physical examinations, including comprehensive neurological examinations, ordering appropriate tests and follow-up, participate in patient education, perform daily patient care and notes, participate in discharge planning, and follow-up with patients after discharge as needed. On surgical rotations, residents will participate in the pre-operative and post-operative evaluation and care of patients. The residents will be expected to participate in surgical procedures at a level commensurate with their background and skills.

At all stages of training, residents’ clinical activities are monitored and supervised by faculty to ensure appropriate, safe, timely, and cost-effective care. At the same time, residents need to develop their independence so they will become capable, independent neurosurgical practitioners. We accomplish this goal by providing our residents, at each level of training, progressively greater freedom in evaluating and managing patients within the limits of their medical knowledge and technical expertise as judged by the supervising faculty. Junior residents are not, at their level of experience, accomplished diagnosticians or technicians. Therefore, junior residents work at all times under the supervision of their “senior consultants”, including the faculty, the Senior Resident, and the Chief Resident. During the first year of training, in particular, residents are expected to report frequently to their senior consultants. As they demonstrate competency in the evaluation and management of neurosurgical patients, particularly with more common, less critical disorders, they are given greater latitude and independence. They are encouraged to develop a management plan but are expected to present their plan to their senior supervisor(s) prior to initiating treatment. In the operating room, they will learn to perform minor cases as lead surgeon and will learn to assist with major cases. Patient safety and quality of care are top priorities for us, so residents at all levels of training should never hesitate to call their senior consultants if they have questions regarding patient care.

Educational Program: Year Two

The PGY-2 year is spent at Nebraska Medicine and Methodist on rotations intended to allow residents to further develop basic patient care skills as well as neurosurgery knowledge and skills (including rotations on related services such as neuroradiology, neuro-oncology, and epilepsy). On the neurosurgery service the resident will participate in the pre-operative and post-operative evaluation and care of patients. The resident will refine skills in ordering appropriate tests and follow-up with the results, schedule admissions and surgery, perform patient teaching, perform daily care and make appropriate notes, discharge planning and follow-up with the patient after discharge. The residents will be expected to scrub with the faculty in the operating room and perform the surgical procedures for which they are qualified, depending upon their level of technical ability and educational background. The resident will be expected to evaluate emergency room patients and provide evaluation and medical and surgical care.

At all stages of training, residents’ clinical activities are monitored and supervised by faculty to ensure appropriate, safe, timely, and cost-effective care. At the same time, our faculty understands the need for residents to develop their independence so they will become capable, independent neurosurgical practitioners. We accomplish this goal by providing our residents, at each level of training, progressively greater freedom in evaluating and managing patients within the limits of their medical knowledge and technical expertise as judged by the supervising faculty. Junior residents work at all times under the direct supervision of their "senior consultants", including the faculty, the Senior Resident, and the Chief Resident. During the initial phase of junior level training, they will report frequently to their senior consultants. As they demonstrate competency in the evaluation and management of neurosurgical patients, particularly with more common, less critical disorders, they are given greater latitude and independence for the primary assessment (including ordering of diagnostic tests). They are encouraged to develop a management plan but are expected to present their plan to their senior supervisor(s) prior to initiating treatment. In the operating room, they will learn to perform minor cases as first surgeon and will learn to assist with major cases.

The goals of the PGY-2 year include developing fundamental knowledge of the inpatient and outpatient delivery of care to include consults, new and return visits by patients, proper documentation and dictating of information to meet the requirements of the hospital, insurance companies, and referral of patients as required, and basic neurosurgical skills. The PGY-2 resident will take the written examination of the American Board of Neurological Surgery (ABNS) for self-assessment and the ABNS Neuroanatomy Exam.

Educational Program: Year Three

The PGY-3 year includes adult neurosurgery rotations and clinical neurosciences. The purpose of the PGY-3 year is to build on knowledge and skills obtained during the PGY-2 year in particular by assuming greater responsibility for patient care and by gaining more in-depth knowledge and skills of the subspecialty areas of pediatric neurosurgery and pain.

During this year, residents will demonstrate greater independence and responsibility for inpatient and outpatient care, including evaluation and decision-making. Residents at this level are expected to evaluate patients in the inpatient and outpatient settings, establish a differential diagnosis, identify appropriate diagnostic tests, and develop a treatment plan. They may implement non-critical aspects of the evaluation but are expected to report in a timely fashion to Senior and/or Chief Residents and faculty. Residents will refine their abilities to perform the neurosurgical history and physical examinations.

The PGY-3 resident will continue to improve knowledge of indications and interpretation of laboratory and imaging studies, apply complex diagnostic and patient-management skills, including participation in inpatient and outpatient settings, establish and implement effective patient care plans, counsel patients on the risks, goals, limits and alternatives to neurosurgical procedures, perform selected surgical procedures under direct supervision, focusing on spinal neurosurgery (e.g., lumbar and cervical laminectomies, lumbar discectomy, anterior cervical discectomy with and without fusion), assist in major surgical procedures, and perform portions of the procedure that are appropriate to the resident's level of training under guidance, and practice critical care skills as required for inpatient neurosurgery. The PGY-3 resident will take the written examination of the American Board of Neurological Surgery (ABNS) for self-assessment.

Educational Program: Year Four

The PGY-4 year builds on preceding years’ activities by providing residents with a foundation of knowledge in supporting disciplines that will further clinical skills and ability to critically evaluate and manage patients. PGY-4 rotations will include operative neurosurgery at UNMC as well as additional clinical neurosciences experience. PGY-4 residents will take the written examination of the American Board of Neurological Surgery for self-assessment and are expected to pass. To facilitate success, and as part of neuroradiology and neuropathology training, PGY-4 residents typically attend the INOVA Washington Neuroradiology/ Dr. Kenneth M. Earle Memorial Neuropathology Review Course. Global evaluation of resident performance will be performed by the neurosurgery faculty and support staff (“360 degree evaluation”) following the neurosurgery research rotation.

Operative neurosurgery rotations at UNMC (including night float) will build on prior year’s rotations. Residents will be given increasingly greater autonomy in patient evaluation/management and more primary roles in operative procedures within their limits of knowledge and skills (as judged by faculty).

The resident will be expected to develop his/her skills in history and physical/neurologic examinations, selection and ordering of diagnostic tests, interpretation and follow-up of test results, inpatient care, discharge planning, and follow-up after discharge. Experience in the outpatient clinic and continuity of care will be important. The resident will be expected to scrub with the faculty in the operating room and perform the surgical procedures or portions of procedures for which s/he is qualified based upon technical ability and knowledge.

Educational Program: Year Five

The PGY-5 year will be devoted to providing the opportunity to develop an understanding of the research process and to provide a dedicated opportunity to become academically productive. The over-arching goal is to acquaint residents with research processes and techniques, allow them to engage actively in meaningful research, and publish and present. Residents are expected to publish research results in peer-reviewed journals.
During this rotation, residents should become knowledgeable about research design and development as well as statistical analysis, and research funding. Residents in this track should learn to critically evaluate clinical and bench research projects. Residents are expected to present their research.
During the PGY-5 year, residents will have 12 months dedicated to research. Projects involving laboratory research or clinical research at UNMC or at other University of Nebraska campuses. Inter-departmental, collaborative research is supported and encouraged. During the first several years of residency training, neurosurgery residents should consider their research interests and begin to explore research options. Residents will be expected to have identified a research project and mentor by Spring prior to the research year and take preliminary steps that will allow them to start their research project promptly at the beginning of the research rotation. Research projects should be discussed and approved with the Program Director or their faculty mentor for the purpose of ensuring that the project is appropriate and will provide a good research experience; this discussion should take place well before final arrangements for the research project are made. Resources are available within the clinical and basic science faculty of the Department of Neurosurgery and the University of Nebraska College of Medicine in neuroanatomy, neurophysiology, neuropharmacology, neuropathology, and neuroradiology. Projects outside these domains may also be appropriate (e.g., studies through the College of Public Health or Pharmacy). Reasonable financial support will be available for the resident.
Residents will be expected to pass the ABNS written examination (for credit) during the PGY-5 year.

Educational Program: Year Six

The PGY-6 year will be spent at Methodist/Children’s Hospitals as Chief Resident and at Nebraska Medicine as Senior Resident. The resident is expected to participate in patient care in the inpatient setting, the operating room, and emergency room. The resident will be responsible for the evaluation of new and follow-up patients, including consults, and will provide coverage of the emergency rooms at these institutions in collaboration with faculty neurosurgeons. The resident will operate on standard neurosurgical procedures up to and including major craniotomies and complex spinal surgery. The Chief Resident will assume administrative and clinical oversight of junior residents working on the neurosurgery service at his/her hospitals, including assigning clinical duties and establishing the call schedule. As Chief Resident, he/she will also be involved in quality improvement projects and teaching. This will include preparation and presentation of the patient safety & quality improvement (morbidity and mortality) conference, case conference grand rounds, and the neuro-oncologic tumor planning conferences.

During this year, residents should assimilate the knowledge and skills learned in the preceding years of training, improve clinical judgment, and refine technical skills with the goal of developing progressively greater independence and autonomy with respect to patient care. In the PGY-6 year, the resident will be expected to evaluate patients independently (under supervision of faculty), order and interpret appropriate diagnostic tests, and formulate a treatment plan. The Chief Resident may implement the treatment plan for non-critical issues but is expected to report to faculty in a timely manner. The resident will be expected to participate in as many operative procedures as possible and with special attention to gaining exposure to a wide variety of cases, including complex spine, tumor, skull base, vascular, and peripheral nerve. The resident should serve as primary surgeon for all procedures for which he/she is qualified. The resident is expected to work collaboratively with other members of the healthcare team, request and respond to consults in a timely and professional manner, and draw on the resources of the broader healthcare system as needed to provide optimal care to the patients. The resident is expected to increase the depth and breadth of knowledge of neurosurgical disorders and their management and apply this information to the care of patients. The resident should educate patients and their families regarding their medical disorders, be able to explain options for treatment and the relative advantages of each approach, and work with the patients to develop the treatment plan that is appropriate.

Educational Program: Year Seven

The PGY-7 year will be divided equally as Chief Resident and Senior Resident at the Nebraska Medical Center. The goal of the Chief year is to transition the resident from trainee (early in the year) to independent practitioner (by completion of the Chief year) by refining technical skills and clinical judgment. This will be accomplished by promoting the Chief/Senior Resident’s independence and autonomy in directing patient care. By the conclusion of the year, the Chief/Senior resident will be expected to demonstrate independence and competency in the evaluation, diagnosis, and management of the full spectrum of surgical and non-surgical neurosurgical disorders in the inpatient and outpatient settings. The Chief Resident will oversee the inpatient service, including surgical and non-surgical patients. The Chief/Senior Resident will be expected to operate as primary surgeon on most cases. The Chief/Senior Resident will report directly to the responsible staff physician, but is expected to implement non-emergent aspects of patient care independent of direct faculty supervision. The Chief/Senior Resident may implement emergent therapies (e.g., ventriculostomies) as needed for appropriate patient care prior to communicating with the responsible staff physician.

The Chief Resident will also have administrative responsibilities (with the guidance of the Department Chair/Program Director) for oversight and assignment of duties to junior residents, establishing the resident call schedule, vacation and coverage schedules, and educational programming (including organization and presentation of patient safety and quality improvement [morbidity and mortality conferences] and case conference) and will participate in the educational mission of the University by teaching junior residents, students, ancillary healthcare providers, and other groups (e.g., patient support groups) from time to time.

Resident Conferences:

A calendar is published monthly from the Department of Neurosurgery which details all conferences, their dates, times and locations. Residents are encouraged to attend all conferences.

Our conferences include:

• Neurosurgical weekly staffing conference at Nebraska Medicine
• Neuropathological/Brain Cutting at Nebraska Medicine twice a month
• Neuro-Oncology Tumor Board Conference weekly at Nebraska Medicine
• Neurologic Tumor Board Conference at Methodist/Children's monthly
• Neurosurgery Grand Rounds monthly at Nebraska Medicine
• Neurosurgery Case Conference monthly at Nebraska Medicine
• Neurosurgery Patient Safety & Quality Improvement Conference monthly at Nebraska Medicine
• Neurosurgery Special Topics Conference monthly at Nebraska Medicine
• Neuroradiology/Neuroanatomy Conference weekly at Nebraska Medicine
• Neuroscience Research Seminars TBA at Nebraska Medicine
• Neurosurgery Residency Competency Conference held on the fifth Wednesday of the month at Nebraska Medicine

The residents are provided semi-annual visiting professorships at Nebraska Medicine in the spring and Methodist in the fall each year.