PGY-4 Year

Educational Program: PGY-4

The PGY-4 year builds on preceding years’ activities by providing residents with a foundation of knowledge in supporting disciplines that will further clinical skills and ability to critically evaluate and manage patients. PGY-4 rotations will include operative neurosurgery at UNMC and the VA Medical Center as well as additional clinical neurosciences experience. PGY-4 residents will take the written examination of the American Board of Neurological Surgery for self-assessment and are expected to pass. To facilitate success, and as part of neuroradiology and neuropathology training, PGY-4 residents typically attend the INOVA Washington Neuroradiology/ Dr. Kenneth M. Earle Memorial Neuropathology Review Course. Global evaluation of resident performance will be performed by the neurosurgery faculty and support staff (“360 degree evaluation”) following the neurosurgery research rotation.

Operative neurosurgery rotations at UNMC (including night float) and the VA will build on prior year’s rotations. Residents will be given increasingly greater autonomy in patient evaluation/management and more primary roles in operative procedures within their limits of knowledge and skills (as judged by faculty).

The operative neurosurgery rotation at the VA Medical Center allows resident to assume a greater role in the primary evaluation and operative and non-operative care of patients. Equally important, the VA offers opportunity for longitudinal care, continuity-of-care, and systems-based practice experiences that will help residents gain greater appreciation for these facets of healthcare delivery and will help them transition from junior resident to senior resident. The VA population includes a large number of patients with spinal and/or peripheral nerve abnormalities, which constitute “bread and butter” neurosurgery, and complements the more subspecialized services that are provided at the other training sites. The resident will participate in the comprehensive delivery of operative and non-operative care of neurosurgery patients, including evaluation and management of inpatients and outpatients (new and return), perioperative and operative care, and coordination of care including proper communication with other healthcare providers and referring entities. The resident will be expected to develop his/her skills in history and physical/neurologic examinations, selection and ordering of diagnostic tests, interpretation and follow-up of test results, inpatient care, discharge planning, and follow-up after discharge. Experience in the outpatient clinic and continuity of care will be important. The resident will be expected to scrub with the faculty in the operating room and perform the surgical procedures or portions of procedures for which s/he is qualified based upon technical ability and knowledge. The VA resident, as an intermediate or senior level house officer, will be granted relatively greater independence in patient evaluation and management, commensurate with their knowledge and skills, but will be monitored and supervised closely by faculty to ensure appropriate, safe, high-quality, and cost-effective patient care.