Neurotrauma / Critical Care Objectives

Rotation-Specific Objectives for Neurosurgical Residents on NTICU:
PGY1 Rotation at Sunnybrook or St. Michael’s Hospital

The Neurosurgery services at SMH and SHSC are both associated with busy active Level 1 Adult Trauma programs, in addition to very busy non-trauma neurosurgical practices. During their PGY1 Neurotrauma/Neurocritical Care rotation, residents are primarily assigned to the neurosurgery team at the hospital, but their focus is on the management of, and teaching around, the critically ill patients in the CCU.

MEDICAL EXPERT

KNOWLEDGE: At the completion of their rotation, the PGY1 resident will be able to:

• Demonstrate an understanding of the main acquired critical illnesses in adults requiring neurosurgical attention including infectious diseases, head and spinal cord injury, brain tumours, stroke, and vascular malformations.
• Demonstrate a basic knowledge of the anatomy of the central and peripheral nervous systems, including the spine and skull, and a working basic knowledge of the other disciplines including physiology, pathology, endocrinology, and neuropsychology.
• Demonstrate an understanding of the spectrum of neurosurgical procedures that are available for the treatment of the patient with critical neurosurgical disease.
• Demonstrate familiarity with basic ventilator orders for most patients
• Demonstrate awareness of the ethical principles pertinent to critically ill patients especially end of life care, and issues around withdrawing and withholding life support.
• Demonstrate familiarity with airway management and indications for intubation.
• Demonstrate familiarity with use inotropes and vasopressors

CLINICAL SKILLS: At the completion of their rotation, the PGY1 resident will be able to:

• Obtain a detailed history and perform a neurological examination of the patient in order to provide a differential diagnosis and localization of diseases affecting the central nervous system.
• Recognize critically ill neurosurgical patients and initiate basic care, seeking help when appropriate.
• Accurately interpret appropriate general diagnostic tests (hematology, x-ray, chemistry, etc.) for the satisfactory management of patients.
• Provide basic post-operative care to the neurosurgical patient.
• Recognize common post-operative complications.
• Identify major pathology and important anatomy on CT and MRI.
• Demonstrate understanding of central line and arterial line indications and insertion technique
• Understands principles of ACLS and can apply them in a patient resuscitation.

TECHNICAL SKILLS: At the completion of their rotation, the PGY1 resident will be able to will have demonstrated a basic understanding of neurosurgical anatomy, and the technical ability to satisfactorily and safely perform the following procedures:

• Burr holes for drainage of subdural hematomas
• External ventricular drain
• Insertion of ICP monitor
• Application of Halo ring and the use of cervical spinal traction
• Lumbar puncture
• Lumbar drain

At the completion of their rotation, the PGY1 resident will be able to will have demonstrated a basic understanding of neurosurgical anatomy, and the technical ability to satisfactorily and safely perform the following procedures, under supervision:

• Supratentorial craniotomy
• Posterior fossa craniotomy

COMMUNICATOR: At the completion of their rotation, the resident will be able to:

• Prepare written documentation regarding patient interactions in a timely and accurate fashion, including, consultations, progress notes, discharge notes, and operative notes.
• Obtain informed consent for common neurosurgical procedures, including full disclosure of relevant indications, risks, benefits, and alternatives.
• Establish communication with the patient and family that supports a trusting and open relationship.
• Respond appropriately to patients, families, and colleagues, who express anger, hostility, or a complaint.
• Communicate in a clear, concise and collegial manner with other health care professionals.
• Communicate to a group of peers or allied health personnel in a clear and understandable way at weekly conferences.  

COLLABORATOR: At the completion of their rotation, the resident will be able to:

• Effectively and respectfully collaborate with other physicians, health care professionals, and community agencies to contribute effectively to interdisciplinary team activities.
• Listen to concerns expressed by others providing care and assist in resolving these concerns if appropriate.

LEADER: At the completion of their rotation, the resident will be able to:

• Demonstrate time management for clinical activity, learning needs and personal activities.
• Prioritize clinical activities in a manner to optimize patient care and the functioning of the clinical service.
• Triage patients and identify neurosurgical emergencies that require prompt and immediate management including evaluating appropriate diagnostic and imaging modalities and plan for operative treatment.
• Manage the complete care of a group of patients on the service under the direction of a senior resident and/or staff member(s).

HEALTH ADVOCATE: At the completion of their rotation, the resident will be able to:

• Identify the important determinants of health that affect their patients.
• Support the health of patients/families by providing appropriate referrals, support and information on health maintenance, as well as community/home resources.
• Intervene on behalf of patients or the community with respect to the social, economic and biologic factors that may impact on the patients’ health.
• Effectively advocates for practices that enhance health and well-being.
• Demonstrate sensitivity to the needs of patients and their families as they are affected by age, gender, cultural and ethnic perspectives.

SCHOLAR: At the completion of their rotation, the resident will be able to:

• Maintain and enhance professional activities through ongoing learning.
• Critically evaluate medical information and its sources, apply this appropriately to practice and communicate this at weekly Neurosurgery and Neuroscience rounds.
• Engage in academic projects with a view to presentation at national/international meetings and publication.

PROFESSIONAL: At the completion of their rotation, the resident will be able to:

• Deliver the high quality care with integrity, honesty and compassion.
• Fulfill medical, legal, ethical and professional obligations of the specialist.
• Meet deadlines, be punctual, monitor patients, and provide follow-up.
• Demonstrate an understanding of the principles of ethics and apply these in clinical situations.
• Demonstrate self-assessment, seek and accept advice when necessary.
• Maintain and complete a procedural case log that accurately reflects the resident’s surgical experience