NS-5 Year

Educational Program Goals and Objectives  

The NS-5 year will be spent at the Nebraska Medical Center as Chief Resident. The goal of the Chief year is to transition the resident from trainee (early in the year) to independent practitioner (by completion of the Chief year) by refining technical skills and clinical judgment. This will be accomplished by promoting the Chief Resident’s independence and autonomy in directing patient care. By the conclusion of the year, the Chief resident will be expected to demonstrate independence and competency in the evaluation, diagnosis, and management of the full spectrum of surgical and non-surgical neurosurgical disorders in the inpatient and outpatient settings. The Chief Resident will oversee the inpatient service, including surgical and non-surgical patients. The Chief Resident will be expected to operate as primary surgeon on most cases. The Chief Resident will also have administrative responsibilities (with the guidance of the Section Chief) for oversight and assignment of duties to junior residents, establishing the resident call schedule, vacation and coverage schedules, and educational programming (including organization and presentation of grand rounds and morbidity and mortality conferences) and will participate in the educational mission of the University by teaching junior residents, students, ancillary healthcare providers, and other groups (e.g., patient support groups) from time to time. Global evaluation of resident performance will be performed by the neurosurgery faculty and support staff ("360 degree evaluation") each 6 months. Residents will complete a "self-assessment" and formal evaluation of the program and the faculty (see Appendix for sample forms) annually.   

Educational Goals and Objectives of Training Year NS-5   

Patient Care   

Goal: function independently in the evaluation and management of neurosurgery patients with awareness of patient and family needs   

Specific objectives:   

  1. Gather essential information about all neurosurgical patients, either directly or by managing more junior residents
  2. Understand indications for, order appropriately, and interpret laboratory and imaging studies relevant to neurosurgical care
  3. Devise comprehensive patient care plans at the level of an independent neurosurgeon, drawing on the wide range of healthcare resources appropriate for patient care, under appropriate supervision from attending surgeons
  4. Implement effective patient-care plans, assuming the role of primary leader on the neurosurgery service, under appropriate supervision of attending surgeons
  5. Counsel patients on the risks, goals, limits, alternatives, and expected outcomes of neurosurgical treatments (operative and non-operative) to facilitate their participation in medical decision-making
  6. Perform all major neurosurgical procedures at an independent level, under appropriate supervision of an attending surgeon
  7. Demonstrate respect for patients’ socioeconomic and cultural backgrounds, their privacy, and their autonomy   

Assessment: observation by faculty   

Medical Knowledge   

Goal: demonstrate a comprehensive understanding of basic and clinical science evidence, including evidence-based guidelines, and apply to patient care   

Specific objectives:   
  1. Demonstrate through patient care and educational conferences an advanced knowledge of anatomy, physiology, pharmacology, and pathophysiology related to all aspects of neurosurgery
  2. Demonstrate through patient care and educational conferences familiarity with classical and contemporary neurosurgical literature appropriate for an independent surgeon capable of life-long learning 
  3. Use evidence-based guidelines to develop patient care plans   

Assessment: observation by faculty   

Practice-Based Learning and Improvement   

Goal: demonstrate ability to evaluate patient care, outcomes, and improve care by self-assessment and self-directed learning   

Specific objectives:   

  1. Identify deficiencies in knowledge through self-assessment of patient care
  2. Use information technology (e.g., PubMed, Ovid) to identify, obtain, and review literature pertaining to neurosurgical care for the purposes of improving deficiencies in knowledge, and apply this information to improve patient care
  3. Participate in educational programs that improve cognitive or psychomotor skills
  4. Organize and prepare cases for morbidity and mortality conference and grand rounds, including critical analysis of causes of complications, review of pertinent literature, and critical introspection into approaches to minimizing risk of similar complication
  5. Evaluate operational aspects of the neurosurgery service and recommend changes that might improve quality, efficiency, or cost-effectiveness of patient care
  6. Guide more junior residents in all aspects of patient care, provide constructive criticism and education to improve their neurosurgical skills; foster in them an appreciation for neurosurgery and respect for patients   

Assessment: observation by faculty; 360 degree evaluation   

Interpersonal and Communication Skills  

Goal: communicate effectively with patients, families, and members of the healthcare team   

Specific objectives:   

  1. Communicate effectively and respectfully with patients and families regarding healthcare
  2. Interact efficiently, effectively, and respectfully with a variety of healthcare personnel, support staff, regulatory agencies, and payors in the pursuit of optimal patient care
  3. Demonstrate leadership skills in the management of more junior residents
  4. Assist the Program Director in overseeing the academic and clinical growth and development of junior residents
  5. Maintain accurate and timely medical records   

Assessment: observation by faculty; 360 degree assessment   

Professionalism  

Goal: demonstrate commitment to professional responsibilities and high moral and ethical standards   

Specific objectives:   

  1. Demonstrate sensitivity and responsiveness to patients' culture, age, gender and disabilities
  2. Demonstrate integrity and a commitment to patients that supersedes self interest, serving as primary neurosurgeon, and taking "ownership" of patients
  3. Respect and protect patients’ privacy and autonomy; involve patients and families in decision making to the greatest extent possible
  4. Serve as a role model for junior residents regarding integrity, honesty, and ethical standards   

Assessment: observation by faculty; 360 degree assessment   

Systems-Based Practice   

Goal: demonstrate awareness of and responsiveness to the larger context and system of healthcare; identify and use resources in the system to provide optimal patient care; identify and correct problems and errors in the system   

Specific objectives:   

  1. Demonstrate an understanding of practice opportunities, practice types, health care delivery systems, and medical economics at a level that is expected of an independent neurosurgeon
  2. Advocate high-quality patient care and assist patients and the responsible junior residents in dealing with system complexities and contradictions
  3. Guide junior residents in the practice of cost-effective health care and resource allocation through evidence-based medical practice that does not compromise quality of care
  4. Understand practice management issues such as patient processing, evaluation and management coding, procedural terminology, documentation of services rendered, and other reimbursement process related issues in both inpatient and outpatient settings, serving as the primary provider of care
  5. Participate in quality improvement initiatives such as morbidity and mortality conferences or hospital or clinic-based initiatives