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Sunnybrook Hospital Objectives PGY5

Rotation-Specific Objectives for Neurosurgical Residents on Neurosurgical Services:
PGY5 Rotation at Sunnybrook

Sunnybrook Health Science Centre
The Sunnybrook neurosurgery service is the busiest level 1 adult neurotrauma service in Canada. Accordingly, residents receive outstanding training here in the management of the patient with head/spinal injuries and neurocritical care. In addition, the Sunnybrook neurosurgery service features multidisciplinary programs in spinal disorders, acoustic neuroma surgery, peripheral nerve surgery, and stereotactic radiosurgery for AVMs and cerebral tumors.

Residents typically rotate as junior (PGY1-3) and then as Intermediate (PGY5) residents at SHSC for periods up to 6 months. Throughout their rotations at SHSC, 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 PGY5 resident will be able to:

  • Demonstrate understanding of the main acquired adult neurosurgical disorders requiring neurosurgical attention including infectious diseases, head and spinal cord injury, brain tumours, stroke, vascular malformations, and degenerative diseases of the brain and spinal cord.
  • Demonstrate an understanding of the indications and contra-indications for common neurosurgical procedures.
  • Demonstrate an intimate and precise 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 diagnostic and imaging studies used to investigate the patient with a neurosurgical disorders including EEG, EMG, CT, MRI, ultrasound, Cerebral Angiography, ICP monitoring, intra-operative neurophysiologic monitoring, and frameless stereotaxy via intra-operative navigation

CLINICAL SKILLS: At the completion of their rotation, the PGY5 resident will be able to:

  • Obtain a detailed history and carry out a detailed neurological examination in the patient in order to provide a comprehensive differential diagnosis and localization of diseases affecting the central nervous system.
  • Order and interpret appropriate general diagnostic tests (hematology, x-ray, chemistry, etc.) for the satisfactory management of patients.
  • Provide ongoing, high quality, post-operative neurological assessment and care, including neuro-intensive care, to the neurosurgical patient
  • Interpret neuroradiological examinations in the neurosurgical patient.
  • Recognize critically ill neurosurgical patients and independently provide basic and advanced care, seeking help when appropriate.

TECHNICAL SKILLS: At the completion of their rotation, the PGY5 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:

  • Burr holes for drainage of subdural hematomas
  • Ventriculostomy
  • Insertion of ICP monitor
  • Craniotomy for traumatic depressed skull fracture, skull base fracture, epidural hematoma, subdural hematoma, intracerebral hematoma, and lobectomy
  • Application of Halo ring and the use of cervical spinal traction
  • Craniotomy for trauma, tumour, epilepsy, and stroke
  • Utilization of image guidance (neuronavigation)
  • Application and utilization of framed stereotaxy
  • Posterior fossa decompression for Chiari malformation
  • Cranioplasty
  • Neck dissection appropriate to carotid endarterectomy, and tracheostomy
  • VP shunt insertion and revision
  • Laminectomy, decompression and fusion of spinal fracture with instrumentation as required
  • Laminectomy for cervical and lumbar degenerative disc disease
  • Laminectomy for epidural metastatic disease and other spinal tumors
  • Repair CSF leak
  • Exposure and decompression of median and ulnar nerves for neuropathy

 

At the completion of their rotation, the PGY5 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:

  • Supratentorial craniotomy for removal of glioma, meningioma and other tumors
  • Posterior fossa craniotomy for tumour removal
  • Transphenoidal pituitary tumor resection
  • Clipping of intracranial artery aneurysms
  • Excision of arteriovenous and cavernous malformations
  • Laminectomy, decompression and fusion of spinal fractures in the cervical, thoracic and lumbar regions with instrumentation as required
  • Exposure of the brachial plexus with sural nerve grafting
  • Radiosurgery for arteriovenous malformations and tumours
  • Posterior fossa craniotomy for acoustic schwannoma, trigeminal neuralgia and hemifacial spasm
  • Endoscopic third ventriculostomy

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 most 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 resident and/or staff member(s).
  • Supervise junior resident trainees who might rotate through service.

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 rounds.
  • Engage in academic projects with a view to presentation at national/international meetings and publication.
  • 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