The junior resident (R2) 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. Junior 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.
The junior resident year (R3) is also focus on the clinical and basic sciences, including Neuroradiology (with endovascular neurosurgery), and Neuropathology. PGY3 residents have three rotations during the year, which mimic the PGY4 rotations. During the VA and DCH rotations, the PGY3 resident is the junior resident on the service and participates in the overnight call schedule withthe PGY2 residents. During the third rotation, the PGY3 residents have a Fundamentals rotation, which is an opportunity to begin working on the research that will be done during the PGY5/6 year. Finally, residents have the opportunity to 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.
Educational Objectives. These training years introduce the neurosurgery resident to:
- The management and consultation 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.
- Elective Cases
- A staggered shift schedule
Junior residents are also introduced to fundamentals such as:
- 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.
- 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.
- Diagnostic imaging:
- Basic science introductory experience
- Human investigations courses (or equivalent)