Neurosurgery Rotation

Neurosurgical ward: T5 and T6, Jim Pattison Pavilion South Tower, VGH. Consists of 40 ward beds plus an eight bed neurosurgical intensive care unit (T5A).

Resident Ward Rounds: 0615-0735 Mon. to Fri 0800-0900 Sat. and Sun.

Round is conducted with the nursing staff. The priorities are to see all patients in the ICU, all immediate postoperative cases, and to attend to nursing concerns for the day. Those residents preparing to be in the operating room should be there by 0745 hours

Objectives

During the rotation on the neurosurgical service students and junior residents should learn:

  1. Examination, diagnostics and management of the unconscious patient.
  2. Management of acute head injuries; acute and chronic intracranial hematomas.
  3. Recognition and primary management of subarachnoid hemorrhage and brain tumors.
  4. Recognition and management of spinal cord compression.
  5. Diagnosis and management of cervical and lumbar complications of degenerative disc disease.
  6. Causes, pathophysiology and management of increased intracranial pressure.
  7. Assessment and management of seizure disorders.
  8. Management of common electrolyte abnormalities in Neurosurgical patients.
  9. Basic technical skills in the OR which include:
    • familiarity with the procedure
    • knowledge of surgical anatomy
    • skill in use of basic instruments
    • some practical experience

During the rotation, all residents should fulfill the Royal College’s CanMEDS Competencies.

COMMUNICATOR:

  • Establish therapeutic relationships with patients and families.
  • Conduct, document and present history and physical exam.
  • Document operative and progress notes.
  • Perform/communicate discharge summaries appropriately
  • With appropriate supervision discuss relevant information with patients and family.
  • With appropriate supervision obtain consent for surgery
  • Share and present information with other health care providers

COLLABORATOR:

  • Work/collaborate effectively in an interdisciplinary team
  • Consult appropriately
  • Be able to work with other healthcare providers and paramedical personnel on multiple levels
  • Take part in educational activities and teaching
  • Be able to share workload and duties appropriately
  • Be able to listen and respond appropriately to concerns of other health care providers

MANAGER:

  • Effectively utilize and allocate finite resources
  • Manage own time, education and personal life for a balanced lifestyle
  • Work effectively and efficiently
  • Triage patients being able to identify neurosurgical emergencies that require prompt and immediate management.
  • To have working knowledge and be able to manage the complete care of patients on the Neurosurgical ward.
  • To be able to delegate effectively
  • To be able to share and assign surgical cases appropriately

HEALTH ADVOCATE:

  • Recognize and respond to determinants of health in patients.
  • Respond in appropriate timely manner to these issues.
  • Contribute to overall patient well-being and outcome
  • Facilitate return of patient to community/alternate care
  • Be able to identify and provide community care/resources to support patients

SCHOLAR:

  • Participate in weekly rounds/educational activities and journal club.
  • Identify and seek out personal learning needs
  • Apply principles of critical appraisal to medical information
  • Facilitate patients, student and peer learning.
  • Contribute to development of new knowledge
  • Acquire knowledge in research methods and statistics.
  • Be involved in research projects/presentations supervised by faculty

PROFESSIONAL:

  • To foster collegial relationships with staff and residents, neuroscience nurses and other allied health professionals
  • To develop through observation and practical experience professional tactics for effective, honest discussion with patients and families with respect to challenging issues including delivery of grave diagnoses, withdrawal of care and disclosure of medical error.
  • Exhibit appropriate professional behaviors in practice, including honesty, integrity, commitment, compassion, timeliness, respect and altruism
  • Show appropriate respect for opinions of other health care providers
  • 5)Be able to appraise and identify own limits with respect to knowledge and patient care, and when to ask for assistance and consult effectively.
  • Understand and have a working knowledge of ethics in context of clinical care

Resources

  1. “Neurological Examination” – Smith, Kline and French “Examination and Management of the Neurologic Patient.”
  2. “Essentials of Neurosurgery” – Andrew Kaye
  3. “Diagnosis of Stupor and Coma” – Plum and Posener
  4. “The Handbook of Neurosurgery” – Mark S. Greenberg
  5. “Resident Survival Guide” – updated regularly by the Chief resident Spine rotation