Transition to Discipline Level (Block 1 of Neurosurgery Service)
MEDICAL EXPERT:
- Perform a focused history on patients with neurosurgical presentation
- Perform a focused physical examination on patients with neurosurgical presentation
- Recognize neurosurgical emergencies and solicit appropriate assistance
- Develop familiarity with the operating room environment, which includes:
- Proficiency with the surgical scrub and gowning procedures
- Familiarity with the sterile field and techniques
- Preparing of the operating room for the surgical procedure
- Balance microscope
- Prepare and utilize pin fixation
- Familiarity with basic surgical instruments
COLLABORATOR:
- Work/collaborate effectively as a member of the interdisciplinary care team on the neurosurgical service, fostering a positive team environment
- Work with other healthcare providers and paramedical personnel on multiple levels in the management of neurosurgical patients
- Demonstrate a safe and accurate written and/or verbal handover of patient issues to colleagues
- Share the workload and duties appropriately with other members of the resident team
- Listen and respond appropriately to concerns of other health care providers
LEADER:
- Manage own time, education and personal life to ensure balanced lifestyle
- Effectively utilize and allocate finite resources using an evidence informed approach
- Triage patients, being able to identify neurosurgical emergencies that require prompt and immediate management
HEALTH ADVOCATE:
- Facilitate improvements in the underlying determinants of health in neurosurgical patients in an integrated fashion during care delivery
SCHOLAR:
- Identify and seek out personal learning needs related to cases encountered on the neurosurgical service
- Facilitate patient, student and peer learning
PROFESSIONAL:
- Foster collegial relationships with staff and residents, neuroscience nurses and other allied health professionals
- 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.
Resources
- “Neurological Examination” – Smith, Kline and French “Examination and Management of the Neurologic Patient.”
- “Principles of Neurological Surgery” – Richard G. Ellenbogen, Laligam N. Sekhar and Neil Kitchen
- “Diagnosis of Stupor and Coma” – Plum and Posener
- “The Handbook of Neurosurgery” – Mark S. Greenberg
- “Resident Survival Guide” – updated regularly by the Chief resident Spine rotation
Foundation Level (PGY 1-2)
MEDICAL EXPERT:
- Complete neurological examination of the unconscious and conscious patient.
- Develop understanding of neuro-anatomical localization based on clinical presentation
- Initiate diagnostics and management of the unconscious patient.
- Initiate management of acute head injuries, acute and chronic intracranial hematomas.
- Recognize and initiate initial management of patients with subarachnoid hemorrhage.
- Recognize and initiate initial management of patients with intra-axial and extra-axial brain tumors.
- Recognize and initiate initial management of patients with spinal cord compression.
- Diagnosis and management of cervical and lumbar complications of degenerative disc disease.
- Manage increased intracranial pressure and understand the underlying causes and their pathophysiology.
- Provide initial assessment and management of seizure disorders.
- Manage common electrolyte abnormalities in Neurosurgical patients.
- Basic technical skills in the operating room which include:
- Familiarity with the procedure being performed
- Knowledge of surgical anatomy
- Skill in use of basic surgical instruments including using the operating microscope
- Skill in registering and utilizing intraoperative neuro-navigation
- Perform burrhole drainage of chronic subdural hematoma
- Perform the technical skill of a supratentorial craniotomy
- Insertion of lumbar CSF drains
- Insertion of external ventricular drains and ICP monitors
COMMUNICATOR:
- Establish therapeutic relationships with patients and their families in the clinic, emergency room and on the neurosurgical inpatient units.
- Communicate effectively with patients and families in order to obtain through, focused histories during patient care encounters
- Present neurosurgical consultations including detailed history, physical exam and findings of investigations to senior residents and attending staff.
- Document neurosurgical consultations including history, physical examination, findings of investigations and outline of the management plan (both written and dictated as appropriate).
- Document operative and progress notes in the patient chart for patients on the neurosurgical service.
- Perform/communicate discharge summaries appropriately for patients being discharged from the neurosurgical service
- Update patients and family relevant information regarding their neurosurgical condition and management plan with appropriate supervision
- Obtain consent for basic neurosurgical procedures with appropriate supervision (e.g. burrhole drainage of subdural hematoma, insertion of external ventricular drain, craniotomy for evacuation of hematoma).
COLLABORATOR:
- Work/collaborate effectively as a member of the interdisciplinary care team on the neurosurgical service, fostering a positive team environment
- Consult other medical and surgical specialities appropriately in the care of the neurosurgical patients
- Work with other healthcare providers and paramedical personnel on multiple levels in the management of neurosurgical patients
- Demonstrate a safe and accurate written and/or verbal handover of patient issues to colleagues
- Share the workload and duties appropriately with other members of the resident team
- Listen and respond appropriately to concerns of other health care providers
LEADER:
- Manage own time, education and personal life to ensure balance lifestyle
- Effectively utilize and allocate finite resources using an evidence informed approach
- Triage patients being able to identify neurosurgical emergencies that require prompt and immediate management
- Have working knowledge and be able to manage the complete care of patients on the Neurosurgical ward.
- Bring forward potential patient safety incidents with a goal of enhancing the system of care on the neurosurgical service
- Contribute to the goals of continuous quality improvement by participating in morbidity and mortality review
HEALTH ADVOCATE:
- Recognize and respond to determinants of health in neurosurgical patients including the role of smoking in cerebrovascular disease
- Facilitate improvements in the underlying determinants of health in neurosurgical patients in an integrated fashion during care delivery
- Facilitate return of patient to community/alternate care environments in collaboration with the multidisciplinary care team and advocate for access to resources to
- Identify and provide community care/resources to support patients during their medical journey
SCHOLAR:
- Actively participate in weekly rounds/educational activities and journal club.
- Identify and seek out personal learning needs related to cases encountered on the neurosurgical service
- Apply principles of critical appraisal to medical information
- Facilitate patient, student and peer learning
- Acquire knowledge in research methods and statistics.
- Be involved in research projects/presentations supervised by faculty in order to contribute to development of new knowledge in neurosurgery
PROFESSIONAL:
- Foster collegial relationships with staff and residents, neuroscience nurses and other allied health professionals
- 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
- 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 neurosurgical care delivery.
Resources:
- “Neurological Examination” ‑ Smith, Kline and French “Examination and Management of the Neurologic Patient.”
- “Principles of Neurological Surgery” – Richard G. Ellenbogen, Laligam N. Sekhar and Neil Kitchen
- “Diagnosis of Stupor and Coma” ‑ Plum and Posener
- “The Handbook of Neurosurgery” ‑ Mark S. Greenberg
- “Resident Survival Guide” – updated regularly by the Chief resident
Expectations of the rotation:
- Maintain a logbook of all surgical procedures (including insertion of lumbar drains and ICP monitors)
- Attend both Stereotactic radiosurgery rounds and neuro-oncology tumour board at least once per month
- Attend VGH combined Epilepsy rounds and stroke rounds at least once per month
Junior Core Level (PGY 3-4)
MEDICAL EXPERT:
- Develop management plan and provide definitive medical management of patients with subarachnoid hemorrhage
- Develop management plan and provide definitive medical management of patients with traumatic brain Injury
- Provide surgical management of patients with closed head injury
- Craniotomy and evacuation of hematoma
- Elevation of depressed skull fracture
- Develop management plan and provide definitive medical management of patients with raised intracranial pressure
- Develop management plan and provide definitive medical management of patients with intracerebral hemorrhage
- Develop management plan and provide definitive medical management of patients experiencing complications of neurosurgical conditions including:
- Neurological deterioration (e.g. Seizure, new focal deficit)
- Infections (e.g. meningitis, abscess)
- CSF leak
- Post-operative hematoma
- Vasopasm
- Assess and manage patients presenting with intracranial infections
- Assess and manage patients with hydrocephalus and shunt related issues including technical skills of shunt insertion and endoscopic third ventriculostomy
- Assess and manage patients with Chiari malformation including technical skills of Chiari decompression
- Assess and manage patients with arachnoid cysts including technical skills of cyst fenestration
- Assess and manage patients with trigeminal neuralgia and other neurovascular compression syndromes
- Assess and manage patients with disorders of the peripheral nervous system (e.g. entrapment neuropathies, trauma, nerve sheath tumours) including technical skills of common peripheral nerve decompression (carpal tunnel release and ulnar nerve decompression)
- Assess and manage patients with intracranial and spinal vascular lesions including, aneurysms, vascular malformations, cavernous malformation, dural arteriovenous fistula and carotid stenosis
- Assess and manage patients with intra-axial primary and secondary brain tumours including technical skills of tumour resection
- Assess and manage patients with pituitary adenomas and other simple sellar pathology
- Assess and manage patients with extra-axial convexity tumours including technical skills of tumour resection
- Technical skills in the OR, which include:
- Completion of technical skills of a convexity craniotomy including dural opening and closure
- Completion of technical skills of a pterional craniotomy including dural opening and closure
- Completion of technical skills of a posterior fossa craniotomy including dural opening and closure
- Application of a stereotactic frame
- Completion of a stereotactic biopsy (frame based of frameless stereotaxy)
- Completion of a sural nerve and/or muscle biopsy
- Detailed knowledge of relevant surgical anatomy
- Skill in use of surgical instruments including using the operating microscope
- Skill in registering and utilizing intraoperative neuro-navigation
COMMUNICATOR:
- Establish therapeutic relationships with patients and their families in the clinic, emergency room and on the neurosurgical inpatient units.
- Present and document the neurosurgical consultations including detailed history, physical exam and findings of investigations and management plan.
- Document operative reports in the medical record for patients on the neurosurgical service
- Perform/communicate discharge summaries appropriately for patients being discharged from the neurosurgical service
- Communicate effectively with patient and their families in emotionally charged situations including breaking bad news, discussing prognosis, disclosing adverse events and addressing complaints
- Obtain consent for neurosurgical procedures with appropriate supervision
COLLABORATOR:
- Work/collaborate effectively as a member of the interdisciplinary care team on the neurosurgical service
- Consult other medical and surgical specialities appropriately in the care of the neurosurgical patients
- Work with other healthcare providers and paramedical personnel on multiple levels in the management of neurosurgical patients
- Actively participate in educational activities and teaching
- Share the workload and duties appropriately with other members of the resident team
- Listen and respond appropriately to concerns of other health care providers
LEADER:
- Contribute to and actively participate in quality improvement initiatives on the neurosurgical service
- Work effectively and efficiently
- Effectively utilize and allocate finite healthcare resources
- Triage patients effectively, including 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.
- Delegate effectively and appropriately
HEALTH ADVOCATE:
- Recognize and respond to determinants of health in patients with neurosurgical diagnoses.
- 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:
- Develop and execute scholarly projects in the field of neurosurgery, basic neuroscience and/or medical education
- Participate in weekly rounds/educational activities and journal club.
- Present educational content to other residents and medical students
- Identify and seek out personal learning needs related to cases encountered on the neurosurgical service
- Apply principles of critical appraisal to medical information
- Facilitate patient, student and peer learning
- Acquire knowledge in research methods and statistics.
PROFESSIONAL:
- Foster collegial relationships with staff and residents, neuroscience nurses and other allied health professionals
- 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
- 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
Expectations of the rotation:
- Maintain a logbook of all surgical procedures (including insertion of lumbar drains and ICP monitors)
- Attend both Stereotactic radiosurgery rounds and neuro-oncology tumour board at least once per month
- Attend VGH combined Epilepsy rounds and stroke rounds at least once per month
Senior Core Level (PGY 5-6)
MEDICAL EXPERT:
- Assess and manage patients with subarachnoid hemorrhage including participation in decision making regarding surgery vs endovascular intervention for aneurysms and performing microsurgical treatment of intracranial aneurysms
- Develop management plan and provide definitive medical management of patients with intracerebral hemorrhage including technical skills of evacuation of an intracerebral hemorrhage with management of any associated vascular malformation or hemorrhagic tumour
- Assess and manage patients with intracranial and spinal vascular lesions including, aneurysms, vascular malformations, cavernous malformation, dural arteriovenous fistula and carotid stenosis including technical skills of carotid endarterectomy
- Assess and manage patients with trigeminal neuralgia and other neurovascular compression syndromes including technical skills of microvascular decompression and percutaneous rhizotomy
- Assess and manage patients with disorders of the peripheral nervous system (e.g. entrapment neuropathies, trauma, nerve sheath tumours) including technical skills of resection of peripheral nerve tumours
- Assess and manage patients with intra-axial primary and secondary brain tumours including technical skills of tumour resection including those located in eloquent areas
- Assess and manage patients with intraventricular tumours including technical skills of tumour resection
- Assess and manage patients with pineal region tumours including technical skills of tumour resection
- Assess and manage patients with skull base tumours including technical skills of tumour resection
- Assess and manage patients with pituitary adenomas and other complex sellar pathology including technical skills of transphenoidal surgery for tumour resection
- Assess candidacy for advanced functional procedures and determine appropriate management plan for patients with movement disorders
- Assess candidacy for surgical management and determine appropriate management plan for patients with epilepsy
- Assess candidacy for advanced functional procedures and determine appropriate management plan for patients with chronic pain
- Assess candidacy for advanced functional procedures and determine appropriate management plan for patients with spasticity
COMMUNICATOR:
- Establish therapeutic relationships with patients and their families in the clinic, emergency room and on the neurosurgical inpatient units.
- Document operative and progress notes in the patient chart for patients on the neurosurgical service.
- Effectively communicate management plans for neurosurgical patients with patient care coordinators and allied health team
- Update patients and family relevant information regarding their neurosurgical condition and management plan
- Obtain consent for complex neurosurgical procedures
- Prepare and present patient case vignettes at neurosurgical correlative rounds
COLLABORATOR:
- Work/collaborate effectively as a member of the interdisciplinary care team on the neurosurgical service
- Consult other medical and surgical specialities appropriately in the care of the neurosurgical patients
- Work with other healthcare providers and paramedical personnel on multiple levels in the management of neurosurgical patients
- Actively participate in educational activities and teaching
- Share the workload and duties appropriately with other members of the resident team
- Listen and respond appropriately to concerns of other health care providers
LEADER:
- Manage the neurosurgical inpatient service
- Delegate appropriate tasks and responsibilities to team members
- Organize and present educational rounds (corelative rounds etc.)
- Organize resident call schedule for neurosurgery service (abide by contract and university policies and accommodate requests when able)
- Lead a quality improvement initiative on the neurosurgical service
- Effectively utilize and allocate finite healthcare resources
- To have working knowledge and be able to manage the complete care of patients on the Neurosurgical ward.
HEALTH ADVOCATE:
- Recognize and respond to determinants of health in neurosurgical patients.
- 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:
- Develop and execute scholarly projects in the field of neurosurgery, basic neuroscience and/or medical education
- Provide teaching to junior learners on the neurosurgery team (bedside and other informal teaching)
- Facilitate and coordinate resident roles in weekly rounds/educational activities and journal club.
- Identify and seek out personal learning needs related to cases encountered on the neurosurgical service
- Apply principles of critical appraisal to medical information
- Facilitate patient, student and peer learning
- Contribute to development of new knowledge
- Acquire knowledge in research methods and statistics.
PROFESSIONAL:
- Foster collegial relationships with staff and residents, neuroscience nurses and other allied health professionals
- Develop 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
- 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
Expectations of the rotation:
- Maintain a logbook of all surgical procedures (including insertion of lumbar drains and ICP monitors)
- Present cases at both Stereotactic radiosurgery rounds and neuro-oncology tumour board during rotation
Transition to Practice Level (PGY6 – Final Rotation)
MEDICAL EXPERT:
- Efficiently and effectively manage an outpatient clinic environment
- Triage office referrals – Prioritize patients based on the urgency of clinical presentations
- Contribute to office scheduling
- Review imaging and laboratory results and act on the results accordingly
- Coordinate, organize and execute outpatient and inpatient surgical bookings
- Contributing surgical expertise to interprofessional neurosurgery teams (e.g. BCCA neuro-oncology tumour board, Epilepsy rounds, BCCA Stereotactic Radiosurgery Rounds)
COMMUNICATOR:
- Communicate effectively with clinic and operating room staff in the coordination of patient bookings
- Establish therapeutic relationships with patients and their families in the clinic, emergency room and on the neurosurgical inpatient units.
- Update patients and family relevant information regarding their neurosurgical condition and management plan
COLLABORATOR:
- Work/collaborate effectively as a member of the interdisciplinary care team in the running of the neurosurgical inpatient and outpatient service
- Work with other specialists in multidisciplinary conferences to achieve consensus in recommendations for complex cases
LEADER:
- Demonstrate leadership skills in the operating room
- Integrate supervisory and teaching responsibilities into the overall management of the clinical service
- Delegate appropriate tasks and responsibilities to team members
- Effectively utilize and allocate finite resources
- Allocate health care resources for optimal patient care
HEALTH ADVOCATE:
- Facilitate return of patient to community/alternate care working with physiatry colleagues
SCHOLAR:
- Provide junior learners with opportunities for appropriate clinical responsibility
- Provide junior learners with feedback to enhance learning and performance
- Integrate best evidence and clinical expertise in recommendations made regarding cases presented to multidisciplinary care conferences
PROFESSIONAL:
- Exhibit exemplary professional behaviour at all times
- Intervene when behaviours toward colleagues and/or learners undermine a respectful environment
Expectations of the rotation:
- Maintain a logbook of all surgical procedures (including insertion of lumbar drains and ICP monitors)
- Present cases at both Stereotactic radiosurgery rounds and neuro-oncology tumour board during rotation