From the Program Director
Dear Future Neurosurgeons,
Building one of the top neurosurgical training programs in the world was a vision, defined over 30 years ago, that launched the Barrow Neurological Institute from being a regional center of excellence to the world-renowned institution it is today.
Patient care and resident education remain two core principles that drive us. The goal of this residency program is to structure an environment that will prepare you to be leaders in our field while sowing a lifelong zest for the practice of this extraordinary discipline.
The program is home to a team of 28 outstanding residents, and there is an esprit de corps among this team that is unique. This camaraderie fuels the thrill of training to become the best neurosurgeon you can be.
With eleven dedicated neurosurgical operating rooms and two neuro-endovascular suites, over 7,000 neurosurgical procedures are performed annually at the Barrow. This provides a foundation for resident education, ensuring ample exposure to the whole range of neurosurgical cases, from brain to spine, from simple to complex.
Graduated autonomy is a principle of resident education that is a prerequisite to graduating the best operative neurosurgeons. Through direct observation and feedback from faculty and peers, Barrow residents will build upon the surgical fundamentals to master some of the most technically demanding surgical skills.
Residency is a form of apprenticeship, and the Barrow is where the craft of neurosurgery is at its finest. Barrow is a masters’ program: the camaraderie, surgical volume, and structured autonomy are enjoyed in the setting of mentorship by leading surgeons in each of the neurosurgical subspecialties.
The global visibility of any program derives in large part from peer-reviewed publications, and the impact of the innovations in the operating room is made through writing. A published paper lasts forever, and the Barrow will equip you with the resources to further an academic footprint as a resident and to cultivate a subspecialty interest.
The Barrow is an amazing place to train, and resident selection is instrumental to our mission. We look forward to meeting you!
Francisco Ponce, MD
Director, Barrow Neurosurgery Residency Program
Important Application Dates
- September 2021:
Applicants may begin submitting applications to residency programs at 9:00 AM EST.
- October 2021:
Residency programs may begin reviewing applications and MSPEs are released to residency programs at 9:00 AM EST.
Thank you for your interest in the Neurosurgery Residency Program at Barrow Neurological Institute.
We accept four PGY-1 residents per year through the Electronic Residency Application Service/National Resident Matching Program only. All of our PGY 2-7 positions are currently filled.
Key Dates for 2021
September 2021: Applicants may begin submitting applications to residency programs at 9:00 AM EST.
October 2021: Residency programs may begin reviewing applications and MSPEs are released to residency programs at 9:00 AM EST.
Please include the following items in your ERAS application:
- Common application form
- Personal statement
- Medical school transcript
- Medical Student Performance Evaluation (MSPE)
- Letters of recommendation (maximum of four)
- United States Medical Licensing Examination (USMLE) transcript
- Education Commission for Foreign Medical Graduates (ECFMG) status report (if applicable)
International medical graduates must be able to obtain an ECFMG certificate and J-1 Visa. We do not sponsor visas.
Applicants are evaluated based on multiple criteria, including (but not limited to): personal statement, grades, research experience, USMLE scores, letters of recommendation, and extracurricular pursuits. Applicants will receive notification of their interview status in mid-October.
Interviews take two full days and are typically held between November and January. Applicants will need to arrive the day before their interview and are expected to be on campus until approximately 5:00 PM on the second interview day.
Learn More on How to Apply to the Neurosurgery Residency Program
If you would like more information about Barrow Neurological Institute or have any questions about the residency program not covered here, contact Cristina Parker at Cristina.Parker@DignityHealth.org
Attn: Cristina Parker
Barrow Neurological Institute at
St. Joseph’s Hospital and Medical Center
350 W. Thomas Road
Phoenix, Arizona 85013
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. 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
PGY 4 & 5
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.
PGY-7 Chief Year
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.
There is a wealth of clinical conferences at Barrow, including multidisciplinary clinical rounds, basic science rounds, and teaching rounds.
For residents, the most important of these opportunities are the teaching rounds held by Dr. Michael Lawton and Dr. Nader Sanai. Commonly referred to as film rounds, this teaching conference represents the ultimate commitment to resident education and have been the way Barrow neurosurgery residents have finished their day for more than 20 years. Film rounds consist of inquisitive discussion combined with film review. Questions of diagnosis, anatomy, treatment options, and outcomes are posed to residents, similar to how the ABNS oral boards are performed.
In addition to film rounds, the department’s regularly scheduled conferences include:
- tumor board
- morbidity and mortality
- journal club
- board review
- neuropathology brain cutting
- neurosurgery clinical conferences
- neuroscience grand rounds
2020 Neurosurgery Sub-Internship Application Process
The COVID-19 crisis has created an unusual climate for all of us. In appreciating how this situation affects you as a sub-I applicant, it is important to understand that the administrative infrastructure at Barrow is different other neurosurgical programs in that we have historically relied upon our local affiliate, Creighton University School of Medicine, for credentialing, background checks, drug testing, etc.
You may have heard that Creighton has temporarily delayed accepting visiting student applications due to COVID-19. In light of this, we have begun taking applications directly. To apply, please submit your medical school transcript, school photo, letters of reference, CV, and step one score report to Marinela.Mrizi@DignityHealth.org by April 30, 2020.
This will allow us to review your academic application promptly and provide you a more timely notification regarding academic acceptance, waitlist, or deferral. The credentialing process, when it is permitted to occur, then becomes a formality. Please do not hesitate to reach out to Marinela at the email listed above if you have additional questions.
2020 Sub-Internship Application Requirements
Due Date: April 30, 2020
Materials Required: Medical school transcript, photo, letters of reference, curriculum vitae, step 1 scores
Send To: Marinela.Mrizi@DignityHealth.org
About the Neurosurgery Sub-Internship at Barrow
The essence of the Barrow experience is technical mastery and surgical excellence. As such, the majority of your time here will be spent in the operating room learning surgical fundamentals.
Neurosurgery Residency Program
The neurosurgical service at Barrow is a single service, with one pool of residents independently operating every day in a dedicated 11-room neurosurgical operative suite that contains cutting-edge, state-of-the-art equipment. During the PGY-3 year, residents separately cover both the endovascular and pediatric services.
Locations and Facilities
Endovascular procedures are performed in our radiology department, where we have two additional neurosurgery-dedicated suites. Our pediatrics service is located at Barrow Neurological Institute at Phoenix Children’s Hospital. You will also likely spend time in Barrow Brain and Spine, our outpatient clinic.
The goal of the sub-internship experience at Barrow is to prepare you for residency and to provide you with a very transparent look at our training program. During your time here, you will have exposure to our subspecialty services, clinics, and operating theaters as well as interact on daily basis with our residents, faculty and staff members.
Neurosurgery Sub-Internship Responsibilities
Your primary responsibility while on service is to learn the surgical fundamentals that will form the foundation of your skills and decision making as a surgeon. With the exception of conferences, afternoon teaching rounds, and clinic, you are expected to be scrubbed in on cases daily.
We make every effort to extend the opportunity to each sub-intern to rotate through 1-3 subspecialty clinics. Scheduling conflicts happen for a variety of reasons, but are typically due to emergency cases.
All neurosurgery sub-interns are required to attend regularly scheduled conferences and to give a 10-minute talk at a conference during their time here.
If you would like to practice suturing before you start your sub-internship, Ethicon offers free practice kits to medical students.