Year One
The focus of the NS-1 year is the acquisition of knowledge and skills fundamental to becoming a neurosurgeon. The NS-1 year consists of 4 rotations in Critical Care, Neurology, Neurosurgery and Trauma. Starting in the 2008-2009 academic year the NS-1 neurosurgery rotation has been increased from 3 months to 6 months. The NS1 resident assists the NS-2 resident and is responsible for seeing patients admitted to the clinical service. While the NS-1 is not given the same amount of responsibility as the NS-2 resident, their experiences are intended to expose them to fundamentals of neurosurgery and systems-based practice. The NS-1 resident is allowed to perform basic neurosurgical procedures under the direct supervision of senior residents and/or attendings as assigned by the Chief resident.
Three months of the NS-1 year are spent rotating on the neurology residency service; exposing the NS-1 to the fundamentals of neurology, including evaluation, diagnosis and creating treatment plans for neurological patients. Six-weeks are spent learning to evaluate, diagnose and care for trauma patients. An additional six-week rotation to the surgical critical care unit exposes residents to the management of post operative neurosurgical patients. In addition, the NS-1 residents attend department conferences.
Year Two
The NS-2 is a busy clinical year during which the resident works under the close supervision of the chief residents. The NS-2 makes ICU rounds each morning with the chief residents; and is assigned a single service covering three to five attending physicians’ floor patients along with a nurse practitioner. While on junior call, and under the direct supervision of an in-house senior resident, the NS-2 is responsible for all emergency room, trauma-bay and inpatient neurosurgical consultations; for coordinating patient transfers with outside physicians, and managing all critical issues involving neurosurgical inpatients.
The NS-2 is assigned to operative cases each morning by the chief residents and, like all residents, must attend and participate in daily teaching rounds with Drs. Sonntag or Spetzler; bi-monthly Journal Club; monthly patient presentations at Morbidity and Mortality Conferences; and a topic presentations at the weekly Neurosurgical Teaching Rounds.
Year Three
The NS-3 resident experience includes three-month clinical rotations on the pediatric, cerebrovascular and endovascular neurosurgery services. The NS-3 is assigned daily operative cases by the chief residents, including spinal decompression and fusions, brain tumors and trauma. The NS-3 also directly supervises the NS-2 and the medical students rotating onto the service while taking in-house call, and is responsible for attending all conferences and teaching rounds as previously described.
The NS-3 pediatric resident is responsible for the care and management of all pediatric inpatients. During this rotation, the NS-3 performs all pediatric surgeries; attends 1-2 pediatric neurosurgery clinics each month; and presents at monthly pediatric neurosciences grand rounds. The rotation is primarily under the supervision of Dr. Harold Rekate, Section Chief of the Division of Pediatric Neurosurgery, but the resident works with all attendings who care for children.
The cerebrovascular rotation is an opportunity for the NS-3 to work closely with Dr. Robert Spetzler, Department chairman and Director of the BNI. The resident attends clinic, makes rounds and runs teaching conference with Dr. Spetzler, and, under the chief residents’ supervision, is primarily responsible for his patients. This is universally considered a very busy and extremely rewarding rotation.
During the endovascular rotation, the NS-3, along with 2 BNI endovascular fellows, is responsible for all inpatient rounding, operative cases, and office clinic of endovascular patients. As the BNI now has 3 dedicated endovascular neurosurgeons – Drs. Cameron McDougal, Felipe Albuquerque and David Fiorello – this is a rich and robust experience with exposure to a variety of head and spinal column vascular pathology including aneurysms, strokes, AVM’s, AV fistulae, vaso-occlusive disease and tumors.
Year Four
Eight months of the NS-4 year is spent on the clinical neurosurgery service. The chief residents assign cases of increasing complexity, including spinal fusions, brain tumors and neuroendoscopy. In addition, the NS-4 is responsible for senior call and attending all conferences and teaching rounds as previously described.
During the resident's first four months of independent research, the NS-4 is expected to familiarize himself/herself with all projects currently in progress in the neurosurgical laboratory. Active participation in at least two ongoing laboratory protocols is expected while he/she plans, designs and writes a research protocol with a plan for funding and presentation to the appropriate institutional review board. These activities come under the direct supervision of the Principle Investigator, Director of the Neurosurgical Research Laboratory, of ongoing projects and potential co-investigators for the resident's own research project.
Year Five
The fifth-year resident is assigned to six months on the clinical neurosurgery service and to six months research/electives unless the required endovascular rotation has not been completed. The surgical cases assigned to the NS-5 include complex spinal fusions and tumors; skull-base tumors; epilepsy surgery and vascular cases. The NS-5 participates in all conferences and teaching rounds as previously described, and takes 1-2 in-house senior calls each month.
While the residency program does not mandate a minimum number of publications in peer review journals, evidence of scholarly activity is evaluated at the resident's bi-annual evaluation session. Further opportunities for collaborative, basic science research, as well as co-investigator opportunities for clinical research abound.
Year Six
The sixth-year neurosurgical resident is expected to further enhance and polish surgical skills but primarily is dedicated to develop and further implement research projects. While participating in all clinical and research conferences, the resident attends the Neuroscience Seminar held by the Division of Neurobiology. Maturation in clinical decision skills and scholarly activities are reviewed with a focus toward preparation for the Chief Resident Year. To this end, the entire year is left open for the NS-6 to structure, either at the BNI or away, and there are no operative or call responsibilities assigned.
Year Seven
During these 12 months, the resident serves as the Chief of the Clinical Service for Neurological Surgery. As an essential part of the educational program, the Chief has full responsibility for patient management and supervision of house staff officers and medical students/rotators on the service. The chief residents round each weekday morning with the NS-1&2’s and share at-home call, which includes rounding with the on-call residents on the weekend mornings. The operative experience of a BNI chief resident is unparalleled, and the year is the extremely rewarding culmination of 7 years of Neurosurgical training.
