The major responsibility for the learning aspects of the training program rests with the resident. Their objective is to become an independent, competent neurosurgeon. Their responsibilities are to develop and practice the skills of self-learning which will lead to independence from their teachers.
The accumulation of knowledge in both basic and clinical sciences is the responsibility of the trainee. The resident should plan to study in a disciplined fashion, outlining for themselves topics and appropriate material to review, spread comprehensively over the period of their training. This should include a study of basic textbooks, a review of the classical literature, review of articles on major topics, and current journal reviews.
The cognitive skills of analysis and problem-solving, clinical judgment and decision-making are learned through the development of a careful system of analysis. It is suggested that each resident develop a system which takes into consideration:
- The anatomical diagnosis
- A clinical diagnosis
- The indications and alternatives for confirmatory investigation, the expected results, and interpretation of same
- A careful analysis of the differential diagnosis
- A provisional diagnosis
- A statement of the natural history of the condition
- A critical analysis of the treatment alternatives
- A plan for action.
Technical skills are learned under supervision and practiced repetitively to perfection. The aspects of operating skills include:
- Cognitive Aspects: The resident comes to the operating room prepared with an operative plan. They know the surgical anatomy and on the basis of readings or previous experience condenses the operation into definable steps. Areas of difficulty are anticipated and acceptable end results are defined. Problems are recognized, possible solutions analyzed and becomes proficient at dealing with the technical difficulties and problems.
- Psychomotor Aspects: A superior resident is dexterous and uses sharp dissection precisely. Each step is followed in sequence and proceeds confidently. Instruments are selected and used correctly. A good three dimensional perception, in and out of the wound, and under magnification is developed. The use of visual feedback is learned. Actions are time and motion efficient.
- Affective Aspects: The resident is confident and secure and maintains performance in the face of frustration, technical difficulties, and disagreement. The resident incorporates suggestions into his actions. The resident involves assistants in the case and is polite and professional with the operating room staff.
Patient-relational skills are learned from day to day interaction. It is suggested that in discussing patients’ illnesses with them, that the resident develop a specific pattern which would include:
- A clear statement of the diagnosis
- A natural history of the disease and prognosis
- The recommended treatment and influence on natural history
- The expected results
- The risks, both general and specific, involved in the treatment;
- Consideration of the patient as a person in crisis seeking help; the physician must respect the patient‘s anxiety, questions, dignity, and hopes.
The resident’s knowledge-base, cognitive, technical and patient-relational skills are continuously monitored, evaluated, critiqued and upgraded in both formal and informal feedback throughout the residency. This is accomplished by the structure of the residency program (rounds, didactic sessions, journal club, etc.), feedback form nursing and the guidance of the attending staff (one to one interactions with staff in the operating rooms and around patient management).