Clerkship Rotation Description

Summary

Service Description

The Adult Neurosurgery service at VGH contains about 30-50 patients.  There are usually two or three neurosurgery residents and often one core rotating resident.  Patients are in the NICU T5A, the main ICU (2) JPPN, and the wards T6A & B. The service cares for patients with acute craniocerebral injuries, brain tumours, cerebrovascular disorders (aneurysms, AVMs and occlusive diseases), and a wide variety of other general and subspecialty Neurosurgical conditions.  Some degenerative spine patients (secondary care level) are on this service. The Combined Spine Program (Orthopaedics and Neurosurgery) is a separate service with focus on all levels of spine care including the acute spinal cord injury unit. Rotations on Neurosurgery offer good exposure to neurological diagnosis with opportunity to improve neurological diagnostic skills during exposure to a large and diverse group of patients.  Secondary objectives are Neuro-imaging, CT-MRI interpretation; exposure to perioperative management problems of airway, fluid and electrolytes, and intracranial pressure.

The service day (Adult) begins with rounds at 0615-0745 hrs.  ORs run four days/week. Students spend 1 or 2 days of their week with their assigned preceptor in office/clinic situations and other times assessing patients on wards emergency or in OR. Students with special interest in spine should request that they be assigned a preceptor in Combined Spine Program for at least one of their two weeks.

On your arrival to start your Neurosurgery rotation, you should present at the main ICU (opposite bed 14), Jim Pattison Pavilion South T2 Floor at 0615 hours.  If you have not already done so, pick up your package and pager from the neurosurgery secretary, Ms. Sachiyo Kaneko, in the Department of Surgery, Room 3100, Jim Pattison Pavilion North, 3rd Floor after 0830 hours.

The neurosurgical ward is located on T5 and T6, Jim Pattison Pavilion South Tower, and consists  of 40 ward beds plus an eight bed neurosurgical intensive care unit (T5A).  At present, the ventilated patients are managed in the general intensive care unit, and there are a limited number of off‑service consultations and patients. The service works in close association with Neurology, Neuroradiology, Occupational and Physiotherapy, and Nursing.  Resident Ward Rounds are conducted Monday to Friday beginning at 0615 hours to 0730 hours. Saturday and Sunday 0800 to 0900 hours. Rounds is conducted with the nursing staff. The priorities are to see all patients in the NICU, all immediate postoperative cases, and to attend to nursing concerns for the day.  Those students preparing to be in the operating room should be there by 0745 hours.

Thursday is academic day with Neurosurgery Grand Rounds at 0800-1000 hrs, including Professor’s Rounds, Correlative Rounds, and Resident Seminar Series.

An attending neurosurgical staff man is present on duty at all times.  If acute emergencies arise, and the man on call cannot be contacted immediately, then in a life and death situation, attempts should be made to contact any of the neurosurgeons. It is the policy not to require students to take first call in Emergency due to complexity and severity  of the acute illnesses.  However, opportunity should be made available for them to take calls with residents throughout the days and on some nights. Each attending staff makes rounds on his patients at some time throughout the day, but because of the nature of clinical practice, this may not occur at a regular time.  Residents should take the opportunity to go on round with attending staff, and to use this opportunity to ask questions and draw out an exchange of ideas.

At present, Dr. Zwimpfer is assigning medical students to a preceptor on a weekly basis.  If there are any problems during the time on neurosurgical service, medical students should contact Dr. T. J. Zwimpfer.