St. Michael's Hospital or Toronto Western Hospital Objectives PGY1

Rotation-Specific Objectives for Neurosurgical Residents on Neurosurgical Services:
PGY1 Rotation at Toronto Western Hospital or St. Michael’s Hospital

Toronto Western Hospital
The Neurosurgery service at the Toronto Western Hospital (TWH) is the largest in Canada. This service distinguishes itself by providing tertiary and quarternary neurosurgical care to patients with complex neurosurgical conditions affecting the brain and spine. Unique features of the Neurosurgery service at TWH include a combined neurosurgical and orthopedic spinal program, multidisciplinary programs for patients with AVMs and aneurysms, movement disorders and degenerative brain diseases, brain tumors, and epilepsy. Other areas of expertise and focus include intra-operative navigation and imaging, awake craniotomy for brain tumors with cortical mapping, endovascular therapy for aneurysms and AVMs, and stereotactic radiosurgery for tumors and vascular malformations using the Gamma Knife unit.

Residents typically rotate as junior (PGY1-3) and then as Chief (PGY5-6) residents at TWH for periods up to 6 months. Throughout their rotations at TWH, residents learn a wide variety of procedures to care for patients with complex neurosurgical conditions.

St Michael's Hospital
The Neurosurgery service at the St Michael's Hospital (SMH) is a busy inner urban practice with an active Level 1 Adult Trauma program. This service distinguishes itself by providing neurosurgical care to patients with complex skull base lesions including pituitary tumours, complex neurovascular care including endovascular care performed by neurosurgeons, and combined neurosurgery and orthopedic spinal care for patients with spinal disease. The patients served by SMH often come from an under-privileged background and residents learn to identify and activate appropriate community resources to help these individuals.

Residents typically rotate as junior (PGY1-3) and then as Chief (PGY5-6) residents at SMH for periods up to 6 months. Throughout their rotations at SMH, residents learn a wide variety of procedures to care for patients with various neurosurgical conditions.

MEDICAL EXPERT

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

• Demonstrate an understanding of the main acquired adult neurosurgical, including infectious diseases, head and spinal cord injury, brain tumours, stroke, vascular malformations, and degenerative diseases of the brain and spinal cord.
• Demonstrate a basic knowledge of the anatomy of the central and peripheral nervous systems, including the spine and skull
• Understand the indications for and appropriately order common diagnostic studies, including EEG, EMG, CT, MRI, and ultrasound.
• Demonstrate an understanding of the spectrum of neurosurgical procedures that are available for the treatment of the patient with 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 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.
• Recognize and manage common perioperative medical issues common in neurosurgical patients (i.e. seizures, cerebral salt wasting, SIADH, cerebral vasospasm).
• Provide basic post-operative care to the neurosurgical patient.
• Recognize common post-operative complications.
• Identify major pathology and important anatomy on CT and MRI.

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:

• 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
• Application of stereotactic frame and use of frameless stereotaxyLumbar puncture
• Lumbar drain

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, under supervision:

• Supratentorial craniotomy
• Posterior fossa craniotomy
• Cervical dissection for carotid endarterectomy and anterior cervical fusion
• Posterior cervical, thoracic and lumbar spinal exposures for trauma and degenerative diseases.
• Placement of VP shunts

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 the Chief 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