Neurological Surgery Residency Program Curriculum

The Intern (PGY-1) year consists of the following rotations:

• Neurosurgery (6 months)
• 1 Month Rotations in Related Specialties (3 months)
• Critical Care (3 months)

The first year is structured to expose the intern to various services to develop skills in general inpatient management and gain an understanding of the function and daily operations of those services in addition to the operations and functions of UofL Hospital. Under the guidance of related departments, interns will spend one month in neuro-oncology, one month in neuroradiology and one month in neuro-otology. In addition, a three-month rotation in critical care is required, where the resident will develop skills in general inpatient management, gain an understanding of the function and daily operations of the service and acquire skills in specific areas that are pertinent to neurosurgical practice. The remaining six months are spent on the neurosurgical service. During this time, the intern will also learn bedside procedures including external ventricular drain and lumbar drain placement.

The second year is spent at UofL Hospital as the junior resident on services including trauma, neuro-oncology and vascular/endovascular. The PGY-2 year offers intense exposure to inpatient management, especially of acutely ill patients, including emergency inpatient consults. Junior residents are supervised by the chief resident and receive direct operative mentorship from faculty throughout the PGY-2 year. During this time, residents should be able to perform all bedside procedures and will participate in surgery for patients they have worked up.

The third year is structured as a clinical neuroscience year, which includes three months in pediatric neurosurgery at Norton Children's Hospital, where the PGY-3 will typically be the sole neurosurgery resident on service. The resident will also spend three months with neuro-oncology and three months with endovascular at UofL Hospital, serving as the mid-level resident. The final three-month rotation is with the UofL Hospital trauma service, where the senior resident is the upper-level resident. These rotations aid the resident’s transition to acting as an independently functioning, chief-level resident. At intervals throughout this year, the resident will work with a faculty mentor to choose and plan a research project, developing a formal research proposal to be pursued in the upcoming PGY-4 year devoted to research.

The fourth year is devoted to intense research. There are no formal daytime clinical responsibilities and greatly reduced night call expectations. The resident will work with a faculty research mentor throughout the year. The PGY-4 resident is expected to pass the American Board of Neurological Surgery Preliminary Exam for self-assessment prior to their PGY-4 year and will be expected to pass for credit during the PGY-4 year.  

Beginning in the fifth year, the senior residents serve as the senior-most resident team member on service. They will spend the year on complex and minimally-invasive spine, neuro-oncology, vascular/endovascular neurosurgery and functional services. There is a focus on surgical technical skill development as well as management decision-making during this fifth year.  

During the sixth year, residents become chief residents of the program. The year is intensely focused on operative and management skills, including leading the team and supervising the resident's interaction with other services. Academic and administrative responsibilities are divided and managed between the two PGY-6 residents. Each PGY-6 resident will typically serve as academic and administrative chief in rotations of six months. They will interact as needed to optimize the overall functioning of the service. 

The administrative chief's duties include the primary responsibility of the day-to-day operation of the UofL Hospital and Jewish Hospital service, dividing up the resident workload as equitably as possible. They will assume the highest clinical and operative duties as well as a significant amount of administrative duties including day-to-day operations of the neurosurgical clinical services, supervision of the junior and senior residents as well as rotating residents and medical students and assignments of residents to the operating rooms and other procedures. With oversight by the program director, the chief resident also assigns resident coverage for the clinics, in-house call and vacation schedules.

The PGY-6 year will also provide an opportunity to fine-tune operative skills and provide oversight for the entire management of the patient population on the service, utilizing the consultative opportunities provided by the attending staff and allied clinical services.   

Chief residents will be able to assume total care of any patient with any neurosurgical problem and establish the foundation of a career in either academic or community-based practice. In addition, the PGY-6 will be able to do the following: counsel and educate patients and their families; use technology to support their own education; facilitate the learning of students and other health care professionals; work effectively with others as the leader of a health care team; demonstrate sensitivity and responsiveness to patients' culture, age, gender and disabilities; and assist patients in dealing with health care system complexities.

The academic chief's responsibilities include:

• Coordination of Didactics:
  • Topic selection and scheduling in conjunction with faculty oversight
  • Assignment of presentations to residents
• Teaching/coordination assistance with cadaver labs
• New intern/resident integration
  • Bedside teaching/mentoring to help new residents become familiar with routines and standards of the neurosurgery service in the various locations we staff
  • Didactic presentations to familiarize residents with knowledge and concepts critical to effective participation in the service
• Encouragement of academic engagement
  • Maintaining a list of available courses and conferences and encouraging resident attendance/participation throughout their training
  • Coordinating with the administrative chief to facilitate resident participation in conferences and courses and presentation of research/results of academic productivity
• Logistical support and availability for senior residents
  • Participation in the senior call pool as needed to prevent excessive strain on senior residents
  • Maintain availability to staff emergent/major cases when chief/senior residents are unavailable

Upon the completion of the PGY-6 year, the resident should be able to manage the full spectrum of neurological disease and understand the mechanisms of supervision at every level of resident education.

During the seventh year, each resident is given the opportunity to round out their education, developing skills valuable to their upcoming practice. Residents planning to stay in academic practice may choose to include time to develop teaching skills and grant writing skills related to an area of thematic research. Some may choose to devote this year to an enfolded fellowship in a subspecialty. Thus, each PGY-7 year will vary based on the interests and plans of the resident. By February of PGY-6, each resident should create a proposal that details where their professional interests lie and a 12-month schedule that meets those interests. The program director and faculty members will meet with each resident to create a plan that supports these interests and prepares the resident for upcoming success as an independent practitioner.