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The Neurosurgery Residency Program at the University of Nebraska was approved in July 1993 and began training neurosurgery residents in July 1994. The program is five years in duration after the required one year of preliminary surgery training. We are a 2-1 program. Two residents are resident every other year and the preliminary year is spent at UNMC. The resident will be exposed to the private as well as the academic practice of modern neurosurgery through rotations at the Nebraska Methodist Hospital and Children's Memorial Hospital in addition to the Nebraska Medical Center. The program is five years in length pending satisfactory completion of requirements. Forty-five months are spent on the neurosurgery service, twelve months of this as Chief Resident. Fifteen months are spent learning basic information in neurology, neuroanatomy, neurophysiology, neuropathology, neuroradiology and clinical electives. While at UNMC, call will be every fourth night. As the senior resident at Methodist/Children's, call will be every other night. The Chief Resident will act as every night back-up. The section participates in several conferences and residents will be expected to contribute to the success of these learning opportunities. The conferences include: Tumor Board Conference, held twice monthly, Grand Rounds every other Wednesday, Neuroradiology conference every Tuesday, Morbidity & Mortality conference and Journal Club every month. Resident performance will be evaluated every six months with written reviews and meetings with the program director. Evaluation is based on the ACGME and American Board of Neurological Surgery criteria. The resident will be provided with a copy of the evaluation. Unsatisfactory performance will result in probation with specific guidelines for improvement and review. Residents will be allowed to take the written portion of the Neurosurgical Board Exam during the NS-1 and NS-2 years for self-evaluation and in the NS-3 year, for credit. A yearly stipend is provided to purchase books or to attend meetings, courses or other related activities. The neurosurgery offices are located in the University Hospital with clinical facilities housed in a newly constructed Outpatient Care Center. The Methodist/Children's complex is located 10 minutes from the Nebraska Medical Center. EDUCATIONAL PROGRAM GOALS AND OBJECTIVES NS-1 Year The NS-1 year is divided equally at the Nebraska Medical Center and Methodist/Children’s Complex with six consecutive months at each site. The resident will participate in the pre-operative and post-operative evaluation and care of patients at both sites. The resident will learn how to perform a history and physical neurologic examination, order appropriate tests and follow-up with the results, schedule admissions and surgery, perform patient teaching, perform daily care and make appropriate notes, discharge planning and follow-up with the patient after discharge. The residents will be expected to scrub with the faculty in the operating room and perform the surgical procedures for which they are qualified, depending upon their level of technical ability and educational background. The resident will be expected to evaluate emergency room patients and provide evaluation and medical and surgical care.At all stages of training, residents’ clinical activities are monitored and supervised by faculty to ensure appropriate, safe, timely, and cost-effective care. At the same time, our faculty understands the need for residents to develop their independence so they will become capable, independent neurosurgical practitioners. We accomplish this goal by providing our residents, at each level of training, progressively greater freedom in evaluating and managing patients within the limits of their medical knowledge and technical expertise as judged by the supervising faculty. Junior residents work at all times under the direct supervision of their "senior consultants", including the faculty, the Senior Resident, and the Chief Resident. During the initial phase of junior level training, they will report frequently to their senior consultants. As they demonstrate competency in the evaluation and management of neurosurgical patients, particularly with more common, less critical disorders, they are given greater latitude and independence for the primary assessment (including ordering of diagnostic tests). They are encouraged to develop a management plan but are expected to present their plan to their senior supervisor(s) prior to initiating treatment. In the operating room, they will learn to perform minor cases as first surgeon and will learn to assist with major cases. The goals of the NS-1 year include developing fundamental knowledge of the inpatient and outpatient delivery of care to include consults, new and return visits by patients, proper documentation and dictating of information to meet the requirements of the hospital, insurance companies, and referral of patients as required, and basic neurosurgical skills. Global evaluation of resident performance will be performed by the neurosurgery faculty and support staff ("360 degree evaluation") at the conclusion of each 6 month rotation. The NSY-1 resident will take the written examination of the American Board of Neurological Surgery (ABNS) for self-assessment. Residents will also complete a "self-assessment" and formal evaluation of the program and the faculty (see Appendix for sample evaluation forms) annually. Educational Goals and Objectives of Training Year NS-1 Patient Care Goal: provide appropriate and compassionate care to a broad range of patients and in a variety of healthcare settings. Specific Objectives:
Assessment: observation by faculty, Senior and Chief Residents Medical Knowledge Goal: to demonstrate knowledge of basic neurosurgical disorders and treatments Specific objectives:
Assessment: Written examination of American Board of Neurological Surgery Practice-Based Learning and Improvement Goal: to learn to investigate and evaluate the care of patients, acquire and assimilate scientific evidence, and analyze practices in order to improve patient care Specific objectives:
Assessment: observation by faculty, Senior, and Chief Residents Interpersonal and Communication Skills Goal: to develop skills that result in the effective exchange of information with patients, families, and other healthcare providers Specific objectives:
Assessment: observation by faculty, Senior, and Chief Residents; 360 degree evaluation including support staff Professionalism Goal: to demonstrate a commitment to carrying out professional responsibilities and adhere to ethical principles. Specific objectives:
Assessment: observation by faculty, Senior, and Chief Residents; 360 degree evaluation including support staff System-Based Practice Goal: to demonstrate awareness of the larger context of healthcare and call effectively on other resources in the system to provide optimal healthcare Specific objectives:
Assessment: observation by faculty, Senior, and Chief Residents; 360 degree evaluation including support staff NS-2 Year The NS-2 year is divided into three rotations. Two months will be spent on the Pain Service, five months on neurosurgery at the Nebraska Medical Center, and five months on the pediatric neurosurgery service at Children’s Hospital. The purpose of the NS-2 year is to build on knowledge and skills obtained during the NS-1 year in particular by assuming greater responsibility for patient care (NMC service) and by gaining more in-depth knowledge and skills of the subspecialty area of pediatric neurosurgery and pain. During this year, residents will demonstrate greater independence and responsibility for inpatient and outpatient care, including evaluation and decision-making. Residents at this level are expected to evaluate patients in the inpatient and outpatient settings, establish a differential diagnosis, identify appropriate diagnostic tests, and develop a treatment plan. They may implement non-critical aspects of the evaluation but are expected to report in a timely fashion to Senior and/or Chief Residents and faculty. Residents will refine their abilities to perform the neurosurgical history and physical examinations. Additionally, residents will improve knowledge of indications and interpretation of laboratory and imaging studies, apply complex diagnostic and patient-management skills, including participation in inpatient and outpatient settings, establish and implement effective patient care plans, counsel patients on the risks, goals, limits and alternatives to neurosurgical procedures, perform selected surgical procedures under direct supervision, focusing on spinal neurosurgery (e.g., lumbar and cervical laminectomies, lumbar discectomy, anterior cervical discectomy with and without fusion), assist in major surgical procedures, and perform portions of the procedure that are appropriate to the resident's level of training under guidance, and practice critical care skills as required for inpatient neurosurgery. Global evaluation of resident performance will be performed by the neurosurgery faculty and support staff ("360 degree evaluation") at the conclusion of the neurosurgery rotations. Evaluation of resident performance in non-neurosurgery rotations will be provided by faculty supervising the resident in those rotations. The NSY-2 resident will take the written examination of the American Board of Neurological Surgery (ABNS) for self-assessment. Residents will provide evaluations of faculty in non-neurosurgery rotations following conclusion of those rotations and will complete a "self-assessment" and formal evaluation of the neurosurgery program and faculty (see Appendix for sample forms) annually. Educational Goals and Objectives of Training Year NS-2 PAIN SERVICE The Pain Service rotation will provide neurosurgery residents with medical cognitive and psychomotor skills relevant to the diagnosis and management of acute and chronic pain disorders, especially those relevant to the neurosurgical population (e.g., back pain). Residents should develop an understanding of the epidemiology, pathophysiology, evaluation, and management of such disorders as spinal pain problems and neuropathic pain disorders (e.g., complex regional pain syndrome). Management strategies including various classes of pharmacologic agents (opioid and non-opioid), interventional, non-interventional, and alternative/complementary treatments will be introduced. Residents will be given a global assessment by the Pain Service faculty at the conclusion of the rotation. Patient Care Goal: provide appropriate and compassionate care to patients with common pain disorders related to neurosurgery. Specific Objectives:
Assessment: observation by faculty Medical Knowledge Goal: to acquire and apply knowledge of basic pain disorders and treatments for the management of pain Specific objectives:
Assessment: Written examination of American Board of Neurological Surgery and observation by faculty Practice-Based Learning and Improvement Goal: to learn to investigate and evaluate the care of patients, acquire and assimilate scientific evidence, and analyze practices in order to improve patient care Specific objectives:
Assessment: observation by faculty Interpersonal and Communication Skills Goal: to develop skills that result in the effective exchange of information with patients, families, and other healthcare providers Specific objectives:
Assessment: observation by faculty Professionalism Goal: to demonstrate a commitment to carrying out professional responsibilities and adhere to ethical principles. Specific objectives:
Assessment: observation by faculty System-Based Practice Goal: to demonstrate awareness of the larger context of healthcare and call effectively on other resources in the system to provide optimal healthcare Specific objectives:
Assessment: observation by faculty PEDIATRIC NEUROSURGERY The NS-2 pediatric neurosurgery rotation will provide the resident with the basic cognitive and psychomotor skills of fundamental importance to this subspecialty area. Special attention will be directed toward promoting understanding of the common pediatric neurosurgical disorders including pathogenesis, evaluation, and management. During this rotation, residents will assume greater responsibility for patient evaluation, formulating a diagnostic and treatment plan, and implementing the plan (under the supervision of the attending physician).Global evaluation of resident performance will be conducted at the conclusion of the rotation by faculty and support staff. Performance will be gauged also by the written ABNS examination. Patient Care Goal: provide appropriate, timely, cost-effective and compassionate care to pediatric patients Specific objectives:
Assessment: observation by faculty, Senior, and Chief Resident Medical Knowledge Goal: to acquire and demonstrate knowledge of basic pediatric neurosurgery disorders and apply this knowledge to patient care Specific objectives:
Assessment: observation by faculty and Senior and Chief Residents; ABNS written examination Practice-based Learning and Improvement Goal: to learn to evaluate and improve the quality of patient care using self-reflection, self-directed learning, critical analysis of practice patterns and outcomes Specific objectives:
Assessment: observation by faculty and Senior and Chief Residents Interpersonal and Communication Skills Goal: demonstrate an ability to communicate effectively with pediatric patients and their families, work in a consultative fashion with other healthcare providers, and work as a member of the healthcare team Specific objectives:
Assessment: observation by faculty and Senior and Chief Resident; 360 degree evaluation by support staff Professionalism Goal: to demonstrate respect, compassion, and integrity Specific objectives:
Assessment: observation by faculty, Senior, and Chief Resident; 360 degree evaluation by support staff Systems Based Practice Goal: to learn and demonstrate awareness of and responsiveness to the larger context and system of healthcare and call effectively upon other resources in the system to provide optimal healthcare Specific objectives:
Assessment: observation by faculty, Senior, and Chief Resident; 360 degree evaluation NEUROSURGERY UNMC This rotation will allow the resident to increase knowledge and build on skills learned during the NS-1 year. Residents will be given a greater degree of responsibility in managing patients in the inpatient and outpatient settings. The outpatient experience will include the evaluation of new and return patients. Particular emphasis will be given in the outpatient experience to participating in the preoperative evaluation of patients as well as postoperative follow-up. During midlevel years, when the residents have built a reasonable fund of neurosurgical knowledge and skills, they are expected to conduct a thorough evaluation of the patient, develop a differential diagnosis, formulate a care plan to include ordering of diagnostic tests, interpret test results, and guide the execution of the treatment plan. The midlevel resident may initiate non-critical aspects of the treatment plan. At this level of training, the midlevel resident may also assume some limited responsibility for oversight of the junior level residents (for common, non-critical disorders). In the operating room, the midlevel resident will work collaboratively with the faculty surgeon on minor and major cases such that as the year progresses the midlevel resident will increasingly be the primary surgeon for non-complex surgical procedures (e.g., spinal surgeries, shunts, pain procedures). At this level, residents will be expected to report to their supervising residents and faculty, particularly prior to implementing treatment, but as they become more versant with patient management may be granted greater autonomy to initiate treatment of non-critical problems. Global evaluation of resident cognitive and technical performance will be conducted by faculty and support staff (as part of the 360 degree assessment) at the conclusion of the rotation and by the ABNS written examination. Patient Care Goal: to develop residents’ ability to combine medical knowledge and clinical judgment to promote decision-making skills while providing high quality, compassionate, and cost-effective patient care. Specific objectives:
Assessment: observation by faculty, Senior and Chief Residents Medical Knowledge Goal: demonstrate understanding of basic anatomy and physiology pertaining to normal and abnormal function of the nervous system as it relates to neurosurgical disorders Specific objectives:
Practice-Based Learning and Improvement Goal: demonstrate an ability to learn and improve skills from self-evaluation and critical self-analysis Specific objectives: As part of annual evaluation, identify strengths and weakness, note areas for improvement, and determine how to improve those weaknesses Participate in grand rounds and morbidity and mortality conferences to identify areas of insufficient knowledge or skills; determine how to improve those areas Locate, appraise and assimilate evidence from scientific studies related to common neurosurgical problems and apply this information to patient care, with emphasis on spinal and pediatric neurosurgery Assessment: observation by faculty, Senior and Chief Residents; annual self-assessment Interpersonal and Communication Skills Goal: to develop the resident’s ability to work as a member of the healthcare team; to educate patients and families regarding medical disorders, and to communicate effectively with medical colleagues Specific objectives:
Assessment: observation by faculty, Senior, and Chief Residents; review of medical records deficiency reports (e.g., delinquency reports); 360 degree evaluation by faculty and support staff Professionalism Goal: demonstrate a commitment to carrying our professional responsibilities and adhere to ethical principles. Specific objectives:
Assessment: observation by faculty, Senior, and Chief Residents; 360 degree assessment by faculty and support staff Systems-Based Practice Goal: to understand systems of healthcare and serve as an advocate for quality patient care and assist patients in dealing with system complexities, especially in an outpatient setting Specific objectives:
Assessment: observation by faculty, Senior and Chief Residents NS-3 Year The NS-3 year will be devoted to increasing residents’ cognitive and psychomotor skills in disciplines related to the practice of neurological surgery. Rotations include neuroradiology (1 month), neuropathology (1 month), vascular/cerebrovascular (3 months), and basic or clinical research (7 months). The goal is to provide the resident with a foundation of knowledge in supporting disciplines that will further his/her clinical skills, ability to critically evaluate research activities and publications, and foster an understanding of research technique. Residents will be expected to pass the ABNS written examination (for credit) during the NS-3 year in preparation to assuming Senior Resident duties at Methodist/Children’s Hospitals during the NS-4 year. Global evaluation of resident performance will be performed by the neurosurgery faculty and support staff ("360 degree evaluation") following the neurosurgery research rotation. Evaluation of resident performance on non-neurosurgery rotations will be provided by faculty overseeing the residents in those rotations. Residents will evaluate faculty of non-neurosurgery rotations at the conclusion of those rotations and will complete a "self-assessment" and formal evaluation of the neurosurgery program and faculty (see Appendix for sample forms) annually. Educational Goals and Objectives of Training Year NS-3 NEURORADIOLOGY The NS-3 neuroradiology rotation will be one month but may be extended one additional month to run concurrently with neuropathology with the consent of the supervising faculty in these two programs. This rotation will provide the resident with knowledge regarding the indications, appropriate applications, and interpretation of a variety of diagnostic radiographic studies relevant to the evaluation and management of neurological disorders including cranial and spinal plain radiographs, CT, MRI, myelography, nuclear medicine studies, and arteriography. Residents will review and interpret these studies under the guidance of faculty neuroradiologists. The residents are encouraged during this rotation to write a clinical paper with the faculty in neuroradiology. As part of their neuroradiology training, residents will attend the AFIP Neuroradiology Course during the NS-3 year. Evaluation of resident performance will be provided by the supervising faculty at the conclusion of the rotation and by the ABNS written examination. Patient Care Goal: to develop residents’ ability to combine medical knowledge and clinical judgment to promote diagnostic and decision-making skills. Specific objectives:
Assessment: observation by faculty Medical Knowledge Goal: demonstrate understanding of basic anatomy and physiology pertaining to normal and abnormal function of the nervous system as it relates to neurosurgical disorders Specific objectives:
Practice-Based Learning and Improvement Goal: demonstrate an ability to learn and improve skills from self-evaluation and critical self-analysis Specific objectives:
Assessment: observation by faculty; annual self-assessment Interpersonal and Communication Skills Goal: to develop the resident’s ability to work as a member of the healthcare team and to communicate effectively with medical colleagues Specific objectives:
Assessment: observation by faculty; 360 degree evaluation by faculty and support staff Professionalism Goal: demonstrate a commitment to carrying our professional responsibilities and adhere to ethical principles. Specific objectives:
Assessment: observation by faculty; 360 degree assessment by faculty and support staff Systems-Based Practice Goal: to understand the appropriate ordering of radiographic diagnostic studies with attention toward cost-effectiveness and appropriate healthcare utilization Specific objectives:
Assessment: observation by faculty NEUROPATHOLOGY The NS-3 neuropathology rotation will be one month but may be extended one additional month to run concurrently with neuroradiology with the consent of the supervising faculty in these two programs. This rotation will provide the resident with knowledge regarding the histopathological studies used in neuropathology and histopathological characteristics of neurological disorders, including structural/anatomic/histological abnormalities of the skull, brain, spine, spinal cord, peripheral nerve, meninges and other supporting structures of the central nervous system, and muscle. Residents will review and interpret neuropathology studies under the guidance of faculty neuroradiologists. The residents are encouraged during this rotation to write a clinical paper with the faculty in neuroradiology. As part of neuropathology training, residents will attend the AFIP Neuropathology Course during the NS-3 year. Evaluation of resident performance will be provided by the supervising faculty at the conclusion of the rotation and by the ABNS written examination. Patient Care Goal: to establish an understanding of the normal histology and abnormal histopathological characteristics of disorders of the skull, brain, spine, spinal cord, peripheral nerve, meninges and other supporting structures of the central nervous system, and muscle to allow the resident to understand the pathophysiology of neurosurgical disorders to allow appropriate diagnostic and therapeutic intervention Specific objectives:
Assessment: observation by faculty; ABNS written examination Medical Knowledge Goal: Establish a foundation of knowledge regarding the normal histology and abnormal histopathological characteristics of disorders of the skull, brain, spine, spinal cord, peripheral nerve, meninges and other supporting structures of the central nervous system, and muscle Specific objectives:
Assessment: observation by faculty; ABNS written examination Practice-based Learning and Improvement Goal: to improve the residents’ skills in self-assessment and critical analysis of practice patterns and outcomes to improve patient care Specific objectives:
Assessment: observation by faculty; resident’s annual self-assessment Interpersonal and Communication Skills Goal: to develop the resident’s ability to work as a member of the healthcare team and to communicate effectively with medical colleagues Specific objectives:
Assessment: observation by faculty; 360 degree evaluation by faculty and support staff Professionalism Goal: demonstrate a commitment to carrying our professional responsibilities and adhere to ethical principles. Specific objectives:
Assessment: observation by faculty; 360 degree assessment by faculty and support staff Systems-Based Practice Goal: to understand the appropriate ordering of diagnostic studies with attention toward cost-effectiveness and appropriate healthcare utilization Specific objectives:
Assessment: observation by faculty VASCULAR SURGERY The NS-3 resident will participate in a three month vascular surgery rotation at Methodist Hospital. The purpose of this rotation is to provide the resident with a comprehensive understanding of vascular disorders, particularly carotid and vertebral occlusive disease, its evaluation, and management. During this time, the resident is expected to engage in a variety of inpatient activities related to vascular surgery, including interventional and non-interventional treatments, preoperative evaluation, surgical care, and postoperative management. Evaluation of resident performance will be provided at the conclusion of the rotation by the supervising faculty. Patient Care Goal: to learn how to evaluate, treat, and manage patients with vascular disease (especially carotid and vertebral occlusive disease) non-operatively and operatively, pre- and post-surgery Specific objectives:
Assessment: observation by faculty Medical Knowledge Goal: to understand the epidemiology, presentation, evaluation and diagnosis, and operative and non-operative treatment of vascular disorders Specific objectives:
Practice-based Learning and Improvement Goal: to improve the residents’ skills in self-assessment and critical analysis of practice patterns and outcomes to improve patient care Specific objectives:
Assessment: observation by faculty; resident’s annual self-assessment Interpersonal and Communication Skills Goal: to develop the resident’s ability to work as a member of the healthcare team and to communicate effectively with medical colleagues Specific objectives:
Assessment: observation by faculty; 360 degree evaluation by faculty and support staff Professionalism Goal: demonstrate a commitment to carrying our professional responsibilities and adhere to ethical principles. Specific objectives:
Assessment: observation by faculty; 360 degree assessment by faculty and support staff Systems-Based Practice Goal: to understand the appropriate evaluation, diagnostic testing, and treatment of vascular abnormalities with attention toward cost-effectiveness and appropriate healthcare utilization Specific objectives:
Assessment: observation by faculty RESEARCH EXPERIENCE During the NS-3 year, residents will have 7 months dedicated to research. Projects involving laboratory research or clinical research at UNMC, other University of Nebraska campuses, or away from the UN campus may be available. Inter-departmental, collaborative research is supported. During the first three years of residency training, neurosurgery residents should consider their research interests and begin to explore research options. Residents will be expected to have identified a research project and mentor by Spring of the NS-2 year and take preliminary steps that will allow them to start their research project promptly at the beginning of the research rotation. Research projects should be discussed and approved with the Program Director for the purpose of ensuring that the project is appropriate and will provide a good research experience; this discussion should take place well before final arrangements for the research project are made to ensure the project is appropriate and that is can start and conclude in a timely manner. A wide variety of resources are available for support of resident research. These resources include those of the basic science faculty of the Section of Neurosurgery and the University of Nebraska College of Medicine in neuroanatomy, neurophysiology, neuropharmacology, neuropathology, and neuroradiology. Projects outside these domains may also be appropriate (e.g., epidemiologic studies). Reasonable financial support will be available for the resident. During this rotation, residents should become knowledgeable about research design and development as well as statistical analysis as it relates to evaluation of research data. Knowledge in the methods of obtaining funding for research should also be obtained. Residents in this track should learn to critically evaluate clinical and bench research projects. Residents in the research rotation will learn to prepare clinical and bench research information for oral and printed presentation. Residents in the research year may help teach the basic neuroscience curriculum to the University of Nebraska medical students and rotating residents. Residents will be evaluated at the conclusion of their research rotation (see Appendix for sample form). Patient Care Goal: to understand how to apply bench and clinical research data in the care of patients Specific objectives:
Assessment: observation by faculty/research mentor Medical Knowledge Goal: develop in-depth knowledge of research topic subject matter Specific objectives:
Assessment: observation by faculty/research mentor Practice-Based Learning and Improvement Goal: learn to evaluate critically research goals and progress, use evaluation to improve the research design/implementation, educate others about research results Specific objectives:
Assessment: observation by faculty/research mentor Interpersonal and Communication Skills Goal: learn to communicate effectively with research staff; learn to disseminate research findings to peers and other appropriate audiences Specific objectives:
Assessment: observation by faculty/research mentor Professionalism Goal: develop respect for the importance of activities of basic and clinical research personnel Specific objectives:
Assessment: observation by faculty/research mentor System-Based Practice Goal: understand the role of basic and clinical research in the advancement of clinical practice Specific objectives:
Assessment: observation by faculty/research mentor NS-4 Year The NS-4 year will be spent entirely at the Methodist and Children’s Hospital with the individual serving as Senior Resident. The resident is expected to participate in patient care in the inpatient setting, the operating room, and emergency room. The senior resident will be responsible for the evaluation of new and follow-up patients, including consults, and will provide coverage of the emergency rooms at these institutions in collaboration with faculty neurosurgeons. The resident will operate on standard neurosurgical procedures up to and including major craniotomies and complex spinal surgery under the direction of the faculty. The Senior Resident will assume administrative and clinical oversight of junior residents working on the neurosurgery service at theses hospitals, including assigning clinical duties and establishing the call schedule. The Senior Resident will also be involved in quality improvement and teaching. This will include preparation and presentation of the morbidity and mortality conferences, grand rounds, and the neuro-oncologic tumor planning conferences. During the NS-4 year, the Senior Resident should assimilate the knowledge and skills learned in the preceding years of training, improve clinical judgment, and refine technical skills with the goal of developing progressively greater independence and autonomy with respect to patient care. In the NS-4 year, the resident will be expected to evaluate patients independently (under supervision of faculty and the Chief Resident), order and interpret appropriate diagnostic tests, and formulate a treatment plan. The Senior Resident may implement the treatment plan for non-critical issues but is expected to report to faculty in a timely manner. The Senior Resident will be expected to participate in as many operative procedures as possible and with special attention to gaining exposure to a wide variety of cases, including complex spine, tumor, skull base, vascular, and peripheral nerve. The Senior Resident should serve as primary surgeon for all procedures for which s/he is qualified. As the year progresses, attention should be given toward participating in more complex cases and toward assuming progressively greater degrees of function as the primary surgeon. The Senior Resident is expected to work collaboratively with other members of the healthcare team, request and respond to consults in a timely and professional manner, and draw on the resources of the broader healthcare system as needed to provide optimal care to the patients. The Senior Resident is expected to increase the depth and breadth of knowledge of neurosurgical disorders and their management and apply this information to the care of patients. The Senior Resident should educate patients and their families regarding their medical disorders, be able to explain options for treatment and the relative advantages of each approach, and work with the patients to develop the treatment plan that is appropriate. The Senior Resident is expected at all times to maintain a professional demeanor and serve as a good role model for junior residents and students. Global evaluation of resident performance will be performed by the neurosurgery faculty and support staff ("360 degree evaluation") each 6 months. Residents will also 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-4 Patient Care Goal: develop clinical judgment and technical skills appropriate for senior level neurosurgical resident Specific objectives:
Assessment: observation by faculty Medical Knowledge Goal: demonstrate knowledge of simple and complex neurosurgical disorders and their management Specific objectives:
Assessment: observation by faculty Practice-Based Learning and Improvement Goal: demonstrate an ability to evaluate and improve patient care through self-evaluation, self-learning, and review of scientific evidence Specific objectives: Organize, prepare, and present cases at morbidity and mortality conferences and grand rounds, including critical appraisal of causes of morbidity and mortality Assess current knowledge related to neurosurgical disorders treated on the neurosurgery service, conduct literature search and review critically, present results to faculty, residents, and students; apply finding to improve patient care Instruct junior residents and medical students regarding neurosurgical diseases Assessment: observation by faculty Interpersonal and Communication Skills Goal: demonstrate effective of information between physicians and patients and among members of the healthcare team Specific objectives: Demonstrate an ability to communicate effectively with patients and families from a variety of socioeconomic and cultural backgrounds Demonstrate an ability to work, as the Neurosurgery Senior Resident, as the team leader, organizing and coordinating activities of the team Maintain accurate, timely, and legible medical records Initiate and respond professionally to requests for consultations with other physicians and healthcare providers Assessment: observation by faculty; 360 degree assessment Professionalism Goal: demonstrate commitment to professional responsibility and integrity Specific objectives: Demonstrate sensitivity to patients' culture, age, gender, and disabilities Demonstrate integrity and a commitment to patients that supersedes self-interest, serving as primary neurosurgeon and taking "ownership" of your patients and their well-being Participate meaningfully in multidisciplinary conferences, serving as the primary representative of neurosurgical practice Assessment: observation by faculty; 360 degree evaluation System-Based Practice Goal: develop an understanding of types of medical practices and demonstrate the ability to use a variety of healthcare resources to provide optimal patient care Specific objectives:
Assessment: observation by faculty; 360 degree evaluation
NS-5 Year 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:
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: Demonstrate through patient care and educational conferences an advanced knowledge of anatomy, physiology, pharmacology, and pathophysiology related to all aspects of neurosurgery Demonstrate through patient care and educational conferences familiarity with classical and contemporary neurosurgical literature appropriate for an independent surgeon capable of life-long learning 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:
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:
Assessment: observation by faculty; 360 degree assessment Professionalism Goal: demonstrate commitment to professional responsibilities and high moral and ethical standards Specific objectives:
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:
2008-2009 Residents
Mark Robinson, MD: Chief Resident Resident (HOVI)
Guy Music, MD: Senior Resident (HOV)
Hendrik Klopper, MD: HOIV
Meysam Kebriaei, MD: HOIII
Scott Boswell, MD: HOII
RESIDENCY APPLICANT INFORMATION Applications must be processed through the Electronic Residency Application Service (ERAS). The interview dates for the Section of
Neurosurgery at the University of Nebraska Medical Center are as
follows:
Once applications have been received and interviews conducted, rank order lists are then submitted to the National Resident Matching Program (NRMP). The following links will provide you with more in-depth information about the neurosurgery program at the University of Nebraska Medical Center.
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