Neurosurgery Training by Year
Each academic year begins on July 1. That marks the official start date for PGY-1 residents and the graduation date for PGY-7 residents. Residents progress to the next PGY on that date as well. Expand the tabs below for a year-by-year breakdown of the residency program.
- 6 months neurological surgery: Rounding, operating, and participating in neurosurgery call.
- 3 months neurology: No call requirement, except there is participation in weekend rounding (weekend assist).
- 6 weeks trauma: q4 trauma call.
- 6 weeks critical care: No call requirement, except there is participation in weekend rounding (weekend assist).
- All PGY-1 residents participate in the intern boot camp run by the senior neurosurgery residents. This will introduce you to the basics of managing neurosurgical patients and procedures.
- To make ICU rounding easier for on-call residents, we have implimented an off-service intern to help as a weekend assist. During the 18 weeks of off-service time, interns participate in 12 total weekends of assist. As described above, it occurs during neurology and critical care rotations. The weekend assist consists of ICU and floor rounding. Residents generally finish by 11:00 AM. During the off-service time, we ensure that residents have sufficient days off and meet ACGME hour requirements. For the current group of interns, 6 weekends are consecutive with one weekday off per week, and 12 weeks will be every other weekend. Residents always have at least 4 days off per month.
- USMLE Step 2 CK and CS must be completed before July 1 of PGY-1. USMLE Step 3 must be completed July 1 of PGY-2.
- Junior residents at Barrow, together with chief residents, form the core of our neurosurgical service. PGY-2 residents are responsible for covering primary call, which entails fielding consults from our ER, trauma room, as well as outside hospitals. This exposes our residents to nearly every situation faced by a practicing neurosurgeon.
- Juniors are also responsible for rounding on ICU patients, where they learn the fundamentals of neurocritical care and postoperative management.
- This intense year quickly elevates your fundamental clinical skills to a high level, where basic and even complex neurocritical care becomes second nature.
- The call requirement is q6 primary call. The number of consults per call ranges from about 10 to 25 per 24-hour period. The on-call junior resident also performs 1-2 operative procedures—EVDs, subdural drains, halos, etc.—per call. In total, on-call juniors place over 500 EVDs each year and approximately 200 subdural drains. Our residents are treated as a neurosurgeons, not labor, during call and normal on-service time. Residents are not involved in placing IVs, A-lines, CT transport, or prepping patients for procedures unless they indicate a desire to do so.
- During PGY-2, residents spend three months on the neuroendocrine service under the supervisions of Dr. Andrew Little and Dr. William White. During this period, they will:
- Learn the details of perioperative care of pituitary patients, especially in regards to syndromes of endocrine dysfunction and deficiency.
- Begin mastery of transnasal procedures and techniques.
- Be closely involved in monthly neuroendocrine conferences.
- Become proficient in the management of these often complex patients.
- During rounding, our residents communicate directly with our in-house critical care physicians and internal medicine attending physicians, not other residents. As well, for management of our floor-status patients, we have 6 nurse practitioners, with 1-2 on weekends, to assist while our residents are operating.
- PGY-2 residents typically perform about 250-300 operative cases, typically involving skill-building cases such as
- CSF shunt placements
- Lumbar laminectomies
- Deep brain stimulation placement
- Intrathecal pumps
- It is not uncommon for more complex cases, including brain tumors and cervical fusions, to become available to PGY-2 residents as a first assist. Equally important, PGY-2 residents have opportunities to double-scrub with more senior residents on complex cases. This provides opportunities to see once-in-a-lifetime cases, as well as directly model surgical techniques from other residents.
The PGY-3 year is broken down into four different services:
- 3 months Dr. Lawton’s service
- 3 months pediatric neurosurgery
- 3 months endovascular neurosurgery
- 3 months general service
- During time on Dr. Lawton’s service, residents are fully responsible for the clinical operations of the chairman. It is a high-intensity experience with superb vascular and skull base exposure wherein residents learn the subtleties of patient management that makes for successful practice. You will learn to manage effectively the various elements of a busy private practice, including:
- running an outpatient clinic
- overseeing the care of ICU and floor patients
- reviewing all radiographic images for consultation
- post-operative follow-up
- managing patient phone calls and patient inquiries
- ensuring that operative cases are scheduled correctly
For three months, residents rotate at Barrow Neurological Institute (BNI) to work with neurosurgeons in a dedicated pediatric hospital:
Residents on pediatric neurosurgical service will gain exposure to:
- cranial and spinal tumors
- synostosis reconstructions
- pediatric trauma
- endoscopic procedures
- Chiari malformations
- spine dysraphism including tethered cord and myelomeningocele
- brachial plexus repair/reconstruction,
- CSF diversion
With only one resident on service at a time, our resident is able to choose the cases of their interest, which means that CSF diversion cases comprise 10-15% of their case volume.
The call schedule at PCH is different than that at Barrow, with q2 home call with an average of 2-4 consults, which may sometimes be managed through the staff at the hospital. There are great support services at PCH, including two nurse practitioners and one physician assistant. As at Barrow, residents on pediatric service at PCH serve as neurosurgeons, not support staff.
Working with our two endovascular fellows, and under the supervision of Dr. Felipe C. Albuquerque and Dr. Andrew Ducruet, our residents learn to perform angiography, from establishing arterial access to navigating complex aortic arches and third order vessels. By the end of the rotation, most residents have performed 100 diagnostic and interventional procedures and are capable of completing a 4-vessel angiogram.
Residents on endovascular service manage post-op, ICU, and floor patients, and gain experience with complications associated with endovascular neurosurgery.
General Neurosurgery Service
There are also three months of general neurosurgical service, during which residents progressively ascend through cases of increasing complexities.
As a PGY-3, residents are expected to master:
- anterior cervical fusions
- lumbar decompression
- simple cranial cases
- neurotrauma cases
There is increasing exposure to:
- spinal deformity correction
- complex cranial tumors
- other microsurgical procedures, like Chiari decompression
The senior operative years at Barrow provide a wealth of advanced oncologic, vascular, and spinal cases. This includes:
- skull base approaches
- eloquent tumor resections
- carotid endarterectomies
- spinal deformities
- microvascular decompressions
- epilepsy surgeries
- occasional cerebrovascular cases.
At this point in training, residents are able to choose increasingly complex cases that facilitate transition to independence upon graduation.
Three months during the fourth year is dedicated to learning the management of spinal disorders. This includes:
- routine out-patient clinic
- review of films
- selection of the best of Dr. Uribe’s cases
There are six months of elective specialization and research during PGY-5, which is covered in a separate section.
The sixth year is dedicated to research and pursuit of elective rotations.
Chief residency at Barrow is a mixture of operative freedom and complexity as well as ultimate responsibility.
Chief neurosurgery residents select the best cases every day, which routinely include:
- complex tumors
- skull base approaches
Chiefs are also responsible for the operation of the clinical service, which entails:
- case assignments
- ICU rounds every morning with juniors
- developing the rules and procedures by which other residents care for patients
During this time, our residents are expected to master complex cases as they take the final steps toward becoming an attending neurosurgeon.