OHSU

Curriculum

The Oregon Health & Science University Neurosurgery Residency Training Program utilizes the inpatient and outpatient facilities and operative suites of the University Hospital (UHS), Doernbecher Children's Hospital (DCH), and the Veterans Administration Medical Center (VAMC).

Outpatient clinics are held at the University complex and at the Center for Health & Healing (CHH) located on the banks of the Willamette River.  The Portland Aerial Tram provides express transportation between the University Hospital and CHH (3 minutes). The average daily bed occupancy of the services is 50 to 60. Approximately 2600 surgical procedures are performed annually.

Faculty

There is a full-time faculty of 23 including: 11 neurosurgeons, 3 neurointensivists 6 neurosurgery instructors, an endocrinologist, 2 neuropsychologists, 3 research faculty, a surgical navigation specialist, an editor and a medical illustrator. The faculty are constantly available.

Program Goals

The goals of the program are to provide:
1. Comprehensive clinical neurosurgical training.
2. Basic science and clinical research training.
3. Excellent and cutting edge neurosurgical care of patients.

By accomplishing these goals, we hope to produce trainees who can successfully pursue careers in neurological surgery with the skills necessary to provide leadership and creativity in scientific, educational, regulatory and leadership settings. Overall, the program is designed with graduated responsibility and supervision at each level of training.

Program Prerequisites

Prerequisite to appointment is expected completion of a medical degree at an accredited U.S. medical school or the equivalent, with evidence of excellent academic and clinical performance, plus successful completion of the USMLE examination series or equivalent. The 'internship' (PGY1) through 'Chief Residency' (PGY7) years are completed at Oregon Health & Science University. Oregon Health & Science University and the Department of Neurological Surgery are committed to representing diversity in the selection of residency trainees.

Resident Appointments and Mid-Level Provider Support

There are 14 residents in training with two appointed each year. Also assigned to the program are a surgical intern, 6 physician assistants, 2 nurse practitioners, nurse clinical specialists, and several research nurses and assistants.

Intern (PGY1):
The Internship consists of:

  • Six months of training in neurosurgical critical care. Interns work and study in the dedicated OHSU Neurosciences Intensive Care Unit, with an associated formal didactic curriculum, plus training in neurosurgical and critical care based procedures.
  • Three months of neurology (6 weeks adult, 4 weeks pediatric, 2 weeks neuro-ophthalmology).
  • One month of emergency medicine.
  • One month of pediatric surgery.
  • One month of vascular surgery.

Junior Resident (PGY2):

The junior resident is initially assigned to the Neurosurgery Service of the University Hospital. Half the year focuses on emergency neurosurgery and the operative and medical management of neurotrauma. During the other half year, the resident concentrates on inpatient management and basic elective neurosurgical operations, including lumbar and cervical laminectomy, discectomy, pain and peripheral nerve surgery, and craniotomy. Second year residents are supervised and mentored by their chief residents and receive direct operative mentorship from faculty during both halves of the year. Junior residents also have the opportunity to teach rotating interns and students.

Educational Objectives. This rotation introduces the first year neurosurgery resident (R2) to:

  • The management of neurosurgical patients in the critical care and peri-operative environments, focusing on the principles of pathophysiology.
  • The treatment of major central nervous system injury, including brain and spinal column.
  • Academic neurosurgery and the associated enterprises of interdisciplinary care, outcomes tracking and reporting, technological and management advances, and professionalism.

Basic Clinical Neuroscience Year (PGY3):

The third neurosurgery year is spent in the clinical and basic sciences, including 6 months in Neuroradiology (with 6 weeks of endovascular neurosurgery), and 6 months of Neuropathology. Residents also pursue a half-time, year-long basic research project, which often becomes the basis of their full-time research project in the PGY-6 year. Finally, residents participate in the weekly Human Investigation Program (HIP) lectures courses and associated projects, providing significant grounding in evidence-based medicine, statistics, literature analysis, and human study design.

1. Neuroradiology: The rotation is divided into two principal components: diagnostic imaging (20 weeks, halftime with neuroscience) and endovascular neurosurgery (6 weeks full time).

Educational Objectives: To provide a formal introduction into neuroradiology and a basis for further development during clinical consultation and Neuroradiology/Neurosurgery conferences.

Diagnostic imaging:

  • To gain a basic understanding of the various MRI and CT parameters, including T1 and T2 weighting, gradient echo, and MR angiography.
  • To gain a basic understanding of the clinical use of more advanced techniques such as diffusion weighted imaging and MR spectroscopy.
  • To have experience with CT imaging of the brain and spine, CT angiography, and to understand the clinical use of these techniques.
  • To gain knowledge about the indications for and contraindications to more invasive techniques, such as CT myelography and angiography.

Angiography:

  • To observe and participate as an assistant in diagnostic angiography and interventional neuro-angiography procedures.
  • To become familiar with vascular anatomy of the groin and facile with arterial access.
  • To become familiar with post-puncture hemostatic techniques.
  • To learn indications for, contraindications to and complications of neuro-angiography and management of critically ill patients during angiographic procedures.

2. Neuropathology: Neuropathology is a constant feature of each neurosurgery clinical rotation. Pathology for tumor and other complex cases is reviewed in interdisciplinary and management conferences, including the Adult and Pediatric Neurological Oncology Tumor Boards.

Educational Objectives: To provide a formal introduction to the appropriate handling of surgical specimens in preparation for pathological analysis, principles of oncological and non-oncological gross and microscopic pathology, and the presentation of pathological material in case review, conference and academic settings.


Senior Resident (PGY4):

The forth year resident has two, 6-month rotations, one at the Veterans Administration Medical Center (VAMC) and the other at Doernbecher Children’s Hospital (DCH), providing experience in the management of two very distinct patient groups throughout their continuum of care.

1. Veterans Administration Medical Center (VAMC): The resident is responsible for all patient care activities at the VAMC and supervises a physician assistant and rotating medical students. The resident performs more advanced surgical procedures, including cervical laminectomy, craniotomy for brain tumor, cranioplasty, carotid endarterectomy and functional neurosurgery.
Educational Objectives:

  • To exercise the role of chief resident on a small neurosurgical service and to make independent decisions regarding patient care under appropriate supervision.
  • To observe and be part of comprehensive pre- and post-operative longitudinal care of all patients on the service, including clinical care, complication management and follow-up.
  • To observe and work within a governmental managed care environment.

2. Doernbecher Children’s Hospital (Pediatric Neurosurgery): The resident is responsible for all clinical and operative care on the DCH Pediatric Neurological Surgery Service, working with two surgical faculty and two pediatric nurse practitioners. Included are both routine pediatric neurosurgical procedures (tethered spinal cord, Chiari malformation, hydrocephalus, spasticity etc.) and also complex and challenging microsurgical and endoscopic surgery (midline brain tumors, AVMs, epilepsy monitoring and resection, third ventriculostomy, etc.). Both general pediatric neurosurgery and specialty clinics (craniofacial, tumor and spina bifida) are available, as well as special programs and conferences for pediatric CNS tumor and surgical epilepsy management.

Educational Objectives:

  • To obtain the knowledge and communication skills to work effectively with childrens’ families in coordinating treatment and postoperative care.
  • To learn effective interdisciplinary, team based care, including PT, OT, and Child Life, and to understand the programs available to developmentally or physically challenged children.
  • To function as Chief resident of a busy multiple attending and midlevel provider neurosurgical service.
  • To master pediatric neurological examination, medical management, and operative positioning within each principal age group (premature infant, term infant, toddler, child, adolescent).
  • To understand the incidence, pathophysiology and prognosis of CNS diseases in children.

Senior Resident (PGY5): The senior year is devoted in 3-month blocks to senior residency on the two University Hospital adult neurosurgical services.

University Hospital - Green Senior Resident (R5): The Green Senior Neurosurgery Resident rotation is devoted to the diagnosis of complex diseases and surgical management of the adult spine, on the inter-service management of neurotrauma patients, providing a critical experience in systems-based, interdisciplinary care. The resident participates in complex cranial procedures related to functional neurosurgery, including functional and frameless stereotaxis, intracranial monitoring and epilepsy surgery. Exceptional resources are available to understand the role of computers, electrophysiological monitoring and imaging in the operating room. This rotation also introduces the opportunity for the resident to act in a supervisory and teaching role for junior residents and interns on the Green Neurosurgery team.

University Hospital - Gold Senior Resident (R5): The Gold Senior Neurosurgery Resident rotation is devoted to the diagnosis and treatment of complex CNS diseases, the surgical management of adult cerebrovascular disease, neuro-oncology, neuro-endocrinology and skull base surgery. The skull base surgery experience on the Gold Service provides exposure to interdisciplinary patient management and operative management by the neurosurgery and otology/skull base (otolaryngology) teams.
The resident, with attending staff, approves and facilitates all patient admissions, discharges, transfers and operative procedures. The resident performs and assists with complex surgical procedures and performs many primary neurosurgical consultations with faculty review.

Educational Objectives:

  • To learn to facilitate all patient admissions, discharges, transfers and operative procedures for large and busy University services.
  • To perform and assists with complex surgical procedures.
  • To perform primary neurosurgical consultations.
  • To participate in important supervisory and decision-making roles in the early management of neurosurgical emergencies.
  • To experience the supervisory and teaching roles of junior residents and interns.
  • To learn how to perform in a professional manner and to strengthen communication skills.

Research Year (PGY6):

The 6th year is devoted to a required basic science laboratory experience involving an hypothesis-driven basic science research project. The goal is to establish a foundation for an academic or other innovative neurosurgical career. Residents may pursue their work in an appropriately mentored environment in any OHSU science laboratory and residents are encouraged to look beyond the Department for projects most suitable for their intellectual and career interests if appropriate. Residents continue to attend neurosurgical didactic conferences and other major Department events during their research. There is no call duty or vacation coverage during this year.

Educational Objectives:

  • To encourage research and academic achievement on a level with the excellence clinical training.
  • To develop career interests complementary to clinical training and qualifications for assumption of creative and leadership responsibilities along with complementary clinical interests and competency.

Chief Resident (PGY7):

Green Chief Resident (Administrative Chief): The Green Chief resident serves as a nexus for management and communication of a complex interdisciplinary surgical department, with practical emphasis on systems based practice, communication and professionalism skills. In this 6-month rotation, the resident supervises the educational and quality management activities of the service, and assigns duty schedules and operative cases for residents on the Green service. The resident performs complex posterior fossa procedures for tumor and microvascular decompression, complex spine reconstruction, tumor and vascular malformation operations, mesial temporal resections for epilepsy, intracranial monitoring, etc. The Green Chief resident is also the administrative chief resident for the Department of Neurological Surgery during that rotation.
Gold Chief Resident: This 6-month rotation is focused on neurovascular surgery (aneurysm, AVM, cavernous malformation, carotid endarterectomy, cerebral vascular bypass), surgical neuro-oncology (primary and metastatic brain tumors, meningiomas) and skull base surgery (acoustic neuroma, pituitary adenoma and skull base neoplasms), and complex spinal surgery. This Chief resident assigns duty schedules and operative cases for residents on the Gold service and directs all resident activities and duty assignments.

Educational Objectives:

  • To provide experience as the administrative resident for the OHSU Neurosurgical Residency Program.
  • To offer experience in the triage of emergency care, surgical priorities, and organization of resident, operative and support resources for the Department’s day to day clinical activities.
  • To offer experience as a teacher-in-training.
  • To make supervised independent decisions about key clinical care issues (admission, discharge, care setting transfer, operation).
  • To achieve competency in the most complex range of neurosurgical procedures including difficult tumors, cortical resection, posterior fossa lesions, and spinal reconstruction.

Outpatient experience is concentrated in the following rotations:

OHSU Junior Resident: The junior residents attend a faculty staffed and resident directed neurosurgical outpatient clinic on Wednesdays. They are responsible for initial consultation, operative decision-making and post-operative follow-up of all clinic patients and participate in the operative management of these patients, depending on appropriate match between training and case level.

Doernbecher Senior Resident: The Senior resident sees all new clinic consultations, manages in-hospital care, and sees patients back in definitive post-operative clinic follow-up, with supervision by the attending surgeon.

VA Medical Center Senior Resident: The VA Senior Resident is responsible for all clinic consultations, inpatient care, and post-operative follow-up on the service, with assistance from a physician’s assistant and supervision by faculty.

OHSU Gold Senior Resident: The Gold Senior Resident is responsible for new and follow-up clinic evaluations of skull base/neuro-oncology and neuro-vascular patients, with assistance from a physician’s assistant and supervision by faculty.

OHSU Green Senior Resident: The Green Senior Resident supervises the work of the junior residents in a faculty staffed and resident directed neurosurgical outpatient clinic, which is held weekly in the University Hospital as a means of developing independent clinical decision making ability, and fostering teaching skills development.

Teaching Conferences

Formal teaching conferences are held daily, (schedule).

Outpatient Clinics

The outpatient clinics in each institution also constitute a major teaching venue since attendance is mandatory for the faculty and the residents. Outpatient clinics are held every day at the Center for Health & Healing, a faculty staffed and resident directed neurosurgical outpatient clinic is held on Wednesdays and a weekly outpatient clinic is held at the Portland VAMC.

Summary

Training in neurological surgery is rigorous and demanding. The residency training program in neurological surgery at OHSU is devoted to high standards in the practice of neurosurgery, patient care, resident education and research.

Information/Inquiries

If you have questions about your application or the process for application, please address those to:

Heidi Waldo
Program Coordinator
503 494-6207

If you have further questions concerning the program, please address those to:

Nathan R. Selden, M.D., Ph.D., F.A.A.P., F.A.C.S.
Mario and Edith Campagna Professorship of Pediatric Neurological Surgery
Vice Chairman for Education
Residency Program Director
Department of Neurological Surgery, CH8N
Oregon Health & Science University
3303 SW Bond Avenue
Portland, OR 97239