Educational Objectives of Foundation Level (PGY 1-2)
MEDICAL EXPERT:
- Completion of the neurological examination of the patient with spinal pathology.
- Develop understanding of neuro-anatomical localization based on clinical presentation
- Initiate diagnostics and management of the patient with spinal pathology
- Develop an understanding of principles of biomechanics and balance in spinal pathology and spine surgery
- Diagnosis and management of cervical and lumbar complications of degenerative disc disease.
- Manage common complications of spine surgery and spinal cord injury
- Basic technical skills in the OR 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 exposure of the midline subaxial spinal column and wound closure
- Apply external spinal fixation and traction devices
COMMUNICATOR:
- Establish therapeutic relationships with patients and their families in the clinic, emergency room and on the spine inpatient units.
- Communicate effectively with patients and families in order to obtain through, focused histories during patient care encounters
- Present consultations including detailed history, physical exam and findings of investigations to senior residents and attending staff.
- Document 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 spine service.
- Perform/communicate discharge summaries appropriately for patients being discharged from the spine service
- Update patients and family relevant information regarding their spinal condition and management plan with appropriate supervision
- Obtain consent for basic spine surgical procedures with appropriate supervision (e.g. anterior cervical discectomy and fusion, lumbar discectomy, lumbar laminectomy, ORIF for spinal fracture).
COLLABORATOR:
- Work/collaborate effectively as a member of the interdisciplinary care team on the spine service, fostering a positive team environment
- Consult other medical and surgical specialities appropriately in the care of the spine patients
- Work with other healthcare providers and paramedical personnel on multiple levels in the management of spine 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 spine ward.
- Bring forward potential patient safety incidents with a goal of enhancing the system of care on the spine 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 spine patients including intravenous drug abuse and spinal infections
- Facilitate improvements in the underlying determinants of health in spine 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
- Identify and provide community care/resources to support patients during their medical journey
SCHOLAR:
- Actively participate in weekly rounds/educational activities
- Identify and seek out personal learning needs related to cases encountered on the spine 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
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 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
Expectations of the rotation:
- Maintain a logbook of all surgical procedures (including insertion of lumbar drains)
Resource:
- “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
- “The Handbook of Neurosurgery” ‑ Mark S. Greenberg
Educational Objectives of Core Level (PGY 3-6)
MEDICAL EXPERT:
- Describe the embryology and anatomy of the spine and spinal cord
- Initiate diagnostics and management of the patient with spinal pathology
- Develop a deeper understanding of principles of biomechanics and balance in spinal pathology and spine surgery
- Assess and manage patients with degenerative spinal conditions
- Assess and manage patients with neoplastic spinal conditions
- Assess and manage patients with congenital spinal conditions
- Assess and manage patients with spinal deformity
- Assess and manage patients presenting with traumatic spinal injuries including
- Assessment and classification spinal cord injury
- Assessment and classification of bony and ligamentous injuries including determination of the mechanical stability of an injury
- Manage spine injuries with appropriate surgical and/or non-surgical strategies
- Manage the impacts of injury on the other organ systems (cardiovascular, respiratory, urologic)
- Assess and manage patients presenting with cauda equina syndrome
- Assess and manage patients presenting with spinal cord compression (including infectious and neoplastic causes)
- Assess and manage patients with spinal vascular lesions (e.g dural arteriovenous fistula)
- Assess and manage patients presenting with spinal infections (spinal epidural abscess, osteomyelitis-discitis)
- Assess and manage patients with Chiari malformation including technical skills of chiari decompression
- Assess and manage patients with synringomyelia including technical skills of synrinx-shunt insertion
- 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
- Manage common complications of spine surgery and spinal cord injury
- Technical skills in the OR including:
- Knowledge of surgical anatomy
- Skill in use of surgical instruments including using the operating microscope
- Skill in registering and utilizing intraoperative neuro-navigation
- Perform a lumbar laminectomy
- Perform a posterior cervical or thoracic decompression
- Perform a lumbar discectomy
- Perform exposure of the anterior cervical spine
- Perform anterior cervical decompression
- Perform spinal instrumentation throughout the spinal axis (posterior subaxial cervical, posterior thoraco-lumbar, occipito-cervical and anterior cervical)
- Perform surgical management of intrsdural spinal pathology including vascular lesions, intra-medullary and extramedulallary spinal tumours
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 spine consultations including detailed history, physical exam and findings of investigations to spine fellows and attending staff.
- Document operative and progress notes in the patient chart for patients on the spine service.
- Effectively communicate management plans for spine patients with patient care coordinators and allied health team
- Update patients and family relevant information regarding their spine condition and management plan
- Obtain consent for spine surgical procedures
COLLABORATOR:
- Work/collaborate effectively as a member of the interdisciplinary care team on the spine service, fostering a positive team environment
- Consult other medical and surgical specialities appropriately in the care of the spine 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
- Actively participate in educational activities and teaching including
- Share the workload and duties appropriately with other members of the resident team
- Listen and respond appropriately to concerns of other health care providers
- Work with other healthcare providers and paramedical personnel on multiple levels in the management of spine patients
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, including being able to identify spine emergencies that require prompt and immediate management
- Have working knowledge and be able to manage the complete care of patients on the spine ward.
- Bring forward potential patient safety incidents with a goal of enhancing the system of care on the spine 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 spine patients including intravenous drug abuse and spinal infections
- Facilitate improvements in the underlying determinants of health in spine 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
- Identify and provide community care/resources to support patients during their medical journey
SCHOLAR:
- Develop and execute scholarly projects in the field of neurosurgery, basic neuroscience and/or medical education
- Provide teaching to junior learners on the spine surgery team (bedside and other informal teaching)
- Identify and seek out personal learning needs related to cases encountered on the spine 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 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