Intern (PGY1) Responsibilities

The Intern year consists training in a variety of specialties. Interns spend time with the Department of Surgery and the Department of Otolaryngology, as well as rotating through various specialties, gaining insight and knowledge about those medical specialties that tie into Neurosurgery. 

Interns rotate through: 

• Training in neurosurgical critical care. Interns work and study in the dedicated OHSU Neuroscience Intensive Care Unit, with an associated formal didactic curriculum, plus training in neurosurgical and critical care based procedures.
• Neurology (adult, pediatric, electrophysiology, and neuro-ophthalmology).
• Interventional neuroradiology.
• Pediatric neurosurgery.
• Adult neurosurgery.
• Anesthesiology
• Neuro-Ophthalmology
• Endovascular
• Trauma (General Surgery)
• Otolaryngology

Junior Resident (PGY2-3) Responsibilities

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 with the 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. 

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:

• Neuroradiology
  • 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.
• Neuropathology
• Basic science introductory experience
• Human investigations courses (or equivalent)

Senior Resident (PGY4) Responsibilities

In the first year of the senior resident rotations there are three, 4-month rotations, one at the Portland Veterans Administration Medical Center (PVAMC), one at Doernbecher Children’s Hospital (DCH), and the third at Hillsboro Medical Center (HMC). The three rotations provide experience in the management of very distinct patient groups throughout their continuum of care. 

Portland Veterans Administration Medical Center (PVAMC): The resident is responsible for all patient care activities at the PVAMC 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.

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.

Hillsboro Medical Center (HMC, formerly Tuality): The resident is responsible for patient care activities at Hillsboro Medical Center Neurosurgery and works with two surgeons in this community-based healthcare system. The resident performs more advanced surgical procedures, including spine surgeries and complex cranial procedures.

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 community-based healthcare environment.
• To obtain the knowledge and communication skills necessary to advocate for patients and to participate in the healthcare team. 

Research Year (PGY5) Responsibilities

During the 5th year, a 12-month block is devoted to research experience. Often, this is a basic science laboratory experience involving an hypothesis-driven basic science research project or a clinical 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.

If a resident's focus is not in basic science research, there are also many opportunities for doing clinical research, quality improvement projects, or a combination of projects. Residents will present a proposal to the Program Director the year prior (at least) to their research year that describes their goals and objectives for their research year. 

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.

Senior Resident (PGY6) Responsibilities

The second senior resident year rotation is devoted to blocks on the two University Hospital adult neurosurgical services.

University Hospital - Green Senior Resident: 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: 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.

University Hospital - Cobalt Senior Resident: The Cobalt Senior Neurosurgery Resident rotation is devoted to the diagnosis and treatment of complex spine diseases, the surgical management of spine disease and disorders, and spine surgery. The spine surgery experience on the Cobalt Service provides exposure to interdisciplinary patient management and operative management by the neurosurgery and spine 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.

Chief (PGY7) Responsibilities

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 4-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. 

Gold Chief Resident: This 4-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.

Cobalt Chief Resident: The Cobalt Chief Neurosurgery Resident 4-month rotation is devoted to the diagnosis and treatment of complex spine diseases, the surgical management of spine disease and disorders, and spine surgery. The spine surgery experience on the Cobalt Service provides exposure to interdisciplinary patient management and operative management by the neurosurgery and spine 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.

The Chief residents work together to assign duty schedules and operative cases for residents on the services and directs all resident activities and duty assignments, as well as being responsible for monthly M&M conferences and patient presentations.

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.

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.