Pediatric Neurosurgery Rotation

Pediatric Neurosurgery cases are treated at the BC Childrens’ Hospital. Residents rotate through this service for a period of 6 months in their mid to senior years and are the sole resident on service. Residents are involved in all aspects of the management and treatment of the Pediatric neurosurgical patient.

Objectives

The following are the learning objectives for the rotation:

  1. Discuss the embryologic principles and developments which relate specifically to congenital malformations of the nervous system.
  2. Demonstrate a knowledge and understanding of the anatomical and physiologic specifics in the neonate, infant and child, which have application to neurosurgery.
  3. Discuss the management parameters of the following specific pediatric conditions:
    • congenital and developmental abnormalities of the skull, meninges, brain, spine, spinal cord, and peripheral nerves.
    • neoplasms
    • craniocerebral trauma
    • vascular malformations and anomalies
    • midline developmental abnormalities
    • hydrocephalus and increased intracranial pressure
    • epilepsy
  4. Demonstrate a knowledge of the principles of cranial reconstructive surgery and the management of craniosynostosis and related conditions.

COMMUNICATOR:

  • Establish therapeutic relationships with patients and their parents
  • Obtain and synthesize appropriate history from parents/patients.
  • Listen effectively and interpret non-verbal speech.
  • Develop keen sense of observation when assessing very young patients.
  • 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 pediatric patients.
  • Respond in appropriate timely manner to these issues.
  • Be aware and be able to recognize victim of child abuse.
  • Be able to institute appropriate measures when possible abuse is identified.
  • 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.
  • Complete a pediatric research project supervised by faculty during the rotation

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 parents and patients 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
  • 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.

Academic Rounds

The pediatric neurosurgical resident is required to attend Neuroscience Grand Rounds, Case Presentation, Professor’s Rounds, Correlative Rounds and the 512/513 Postgraduate Seminar at VGH.

The academic responsibilities also include attendance at the following rounds, while assigned to the pediatric neurosurgery service:

  1. Pediatric Outpatient Clinic: The resident attends an outpatient pediatric neurosurgery clinic in association with the attending staff.
  2. Pediatric Neuroradiology Rounds: This weekly teaching session is run by the Pediatric Neuroradiologists.
  3. Pediatric Epilepsy Conference or Clinic: A multidisciplinary conference to discuss patients potentially requiring surgical treatment for epilepsy. This conference alternates with a clinic, where patients are assessed prior to and after surgery for epilepsy. This is held every 2 weeks.
  4. Spinal Cord Clinic: This is a multidisciplinary clinic for children with myelomeningocele and other spinal cord abnormalities. The neurosurgical attending staff and resident will attend the clinic to perform neurosurgical follow up assessments of these patients.
  5. Oncology Case Discussions: The resident will attend this round when any neuro-oncology patient is being presented. This occurs approximately twice per month.
  6. Neuro-Oncology Clinic: A multidisciplinary clinic for brain tumour patients, conducted once per month.
  7. Pediatric Neurosurgery Ambulatory Clinic: The resident will conduct an office clinic with one of the staff, when there is no Neuro-oncology Clinic.
  8. Pediatric Journal Club: Hosted by one of the attending faculty on an approximately monthly basis throughout the academic year. A relevant topic is selected, and papers assigned to each resident for review and discussion. These papers are pre-circulated and the residents are expected to attend the Journal Club having reviewed the papers to be discussed.