SickKids Objectives

Rotation-Specific Objectives for Neurosurgical Residents on Neurosurgical Services:
Pediatrics Rotation at Hospital for Sick Children

The Hospital for Sick Children
The Hospital for Sick Children (HSC) is Canada's premier pediatric tertiary care neurosurgical program and comprises a level 1 pediatric trauma program, a national craniofacial surgery program, and multidisciplinary programs for epilepsy surgery, spinal dysraphism, neuro-oncology, and cerebrovascular neurosurgery.

Residents generally do 3-6 month rotations at the Hospital for Sick Children learning the nuances of pediatric neurosurgery, and becoming familiar with technical procedures to treat children with neurosurgical disorders.

MEDICAL EXPERT

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

• Demonstrate a comprehensive knowledge of neuroembryogenesis, and the disorders that arise in pediatric neurosurgical patients as a result of disturbed neuroembryological patterns such as myelomeningocele, lipomyelomeningocele, tethered cord, Chiari malformation, Dandy Walker, and encephalocele.
• Demonstrate knowledge of developmental milestones that are acquired throughout childhood that can be affected by pediatric neurosurgical conditions.
• Demonstrate a thorough understanding of the formation and circulation of the cerebrospinal fluid (CSF), and disease processes that can arise from disturbed CSF flow (hydrocephalus).
• Demonstrate an awareness of the basic principles of clinical genetics, and the genetic disorders that can affect the nervous system such as neurofibromatosis, tuberous sclerosis, and Sturge Weber.
• Demonstrate a thorough understanding of the main acquired pediatric neurosurgical disorders that will present in childhood including infectious diseases, pediatric head and spinal cord injury, brain tumours, stroke, vascular malformations, and epilepsy.
• Demonstrate familiarity with and understanding of diagnostic imaging studies used to investigate children with pediatric neurosurgical disorders including EEG, EMG, CT, MRI, MEG, and ultrasound.
• Demonstrate an understanding of the neurosurgical procedures that are available for the treatment of the child with pediatric neurosurgical disease.

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

• Obtain a detailed history and perform a neurological examination of the pediatric patient in order to provide a differential diagnosis and localization of diseases affecting the central nervous system.
• Recognize critically ill neurosurgical pediatric patients and independently provide basic care, seeking help when appropriate.
• Provide post-operative care to the pediatric neurosurgical patient.
• Recognize and manage common post-operative complications.
• Interpret neuroradiological examinations in the pediatric neurosurgical patient and be able to provide a differential diagnosis.

TECHNICAL SKILLS: At the completion of their rotation, the 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 without supervision:

• Subdural tap
• Burr holes for drainage of subdural hematomas
• Ventriculostomy
• VP shunt insertion and revision
• Insertion ICP monitor
• Excision skull lesions
• Craniotomy for trauma, tumour, epilepsy, and stroke
• Posterior fossa decompression for Chiari malformation
• Laminectomy for tethered cord and spinal cord tumours.
• Cranioplasty
• Manage common complications of the above procedures.

At the completion of their rotation, the resident will be able to will have demonstrated an understanding of neurosurgical anatomy, and the technical ability to satisfactorily and safely perform the following procedures, under supervision, including appropriate patient positioning and incision marking:

• Endoscopic third ventriculostomy
• Endoscopy for cyst fenestration and septostomy
• Sagittal craniectomy for sagittal synostosis
• Repair simple myelomeningocele and encephalocele
• Posterior fossa craniotomy for tumor removal
• Lobectomy, cortical resection, hemispherectomy, and corpus callosotomy for seizures
• Placement of subdural grid and depth electrodes for epilepsy
• Vagal nerve stimulator implantation
• Supratentorial craniotomy for removal of intracerebral hematoma, tumor, and abscess
• Complex craniofacial repairs for coronal, lambdoid, and multiple suture synostoses in conjunction with the craniofacial surgeons
• Repair of complex congenital malformations such as lipomyelmeningocele, myelomeningocele, disastematomyelia, and neurenteric cyst.

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 pediatric 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
• Communicate effectively with nursing managers and administrators, when necessary. 

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.
• Delegate responsibilities where and when appropriate.
• Manage the complete care of a group of patients on the service under the direction of the Chief fellow 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.
• Recognize risk factors for child maltreatment and institute appropriate resources and protective mechanisms

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 rounds.
• Engages in academic projects with a view to presentation at national/international meetings and publication.
• Understand the principles of evidence-based medicine as applied to neurosurgery, including basic concepts of randomized trials, meta-analyses, and economic evaluations.
• Effectively teach other members of the medical team.

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