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XI. Goals and Objectives
XI. Goals and Objectives
Resident Training Program Policies and Procedures 2012-2013 (PDF)
MSIII | MSIV | NS1 Surgical Intern | NS1 | NS2/UCLA Junior | NS3 | NS4 | NS5 | NSR | NS5-7
UCLA DEPARTMENT OF NEUROSURGERY
THIRD YEAR STUDENT ROTATION GUIDELINES
GOALS OF CLINICAL ROTATION:
The overall goal of this rotation is to introduce the principles of evaluation and treatment of the patient with nervous system dysfunction who might need surgical intervention. During this brief week, a glimpse of the work that neurosurgeons do will be learned so that, in the future, patients who might need neurosurgical intervention will be identified with greater ease. In general, the activities listed below are those in which you will be participating
- Rounds with residents and attendings and daily management of neurosurgical inpatients
- Outpatient clinic with attending neurosurgeons
- Evaluation of ER neurosurgical patients or inpatients requiring neurosurgical consultation
- Operating room activity
Skills in the following areas will be gained:
Comprehensive evaluation of the patient with nervous system disease, including patient history and neurological examination. At least two full H&Ps on patients admitted to the neurosurgical service or undergoing consultation by the neurosurgery service should be done. The H&P should be co-signed by a resident and placed in the chart.
Evaluation of neurosurgical patients in the outpatient clinic. It is expected that at least one new patient is seen independently and presented to the attending neurosurgeon. Following the presentation, a detailed H&P (clinic note) should be written and submitted for review by the attending. The five areas to be covered for patients who might need neurosurgical intervention will be (1) Intracranial Tumor, (2) Cerebrovascular, (3) Spine, (4) Functional/Epilepsy, and (5) General Neurosurgery.
Neurosurgical diagnostic aids. Exposure to imaging techniques will include CT, MRI, and angiogram. Exposure to ICU monitoring will include ICP, CPP, and SJO?.
Treatment of neurosurgical disorders. Basic principles of neurosurgical management will be covered, including neurosurgical emergencies. This will include some exposure to operating room procedures.
UCLA DEPARTMENT OF NEUROSURGERY FOURTH YEAR MEDICAL STUDENT CLERKSHIP
NS362.01 NEUROSURGERY
Location: CHS and Santa Monica UCLA Spine Center Revised: 8/10/11
COURSE CHAIR:
Neil Martin, M.D., FAANS, Chairman and Residency Program Director
SUPPORTING FACULTY:
Drs. Batzdorf, Bergsneider, DeSalles, Edelman, Frazee, Gonzalez, Fried, Holly, Hovda, Lazareff, Liau, Lu, Mathern, McBride, Pouratian, Shafa, Vespa, Yang, Ausman, Malkasian
STUDENT COORDINATOR:
Colleen Bruton (310) 794-7362
E-MAIL: cbruton@mednet.ucla.edu
REPORT TO:
Chief Resident, Neuroradiology Rounding Room - 1617 RRUMC Conference Room, 5:15am
Colleen Bruton's Office, Neurosurgery Education Suite. 17-384 Semel, 10:00am.
COURSE OBJECTIVES (in order of importance)
1. Acquisition of knowledge of neurosurgical conditions expanded beyond the core clerkship exposure.
2. Improvement in the assessment of neurosurgical problems.
3. Development of understanding of surgical treatment of neurological disease, including pain.
4. Development of judgment of selection of operative treatment.
5. Familiarity with diagnostic armamentarium.
6. Understanding of risks and complications of neurosurgical procedures.
7. Training in pre- and post-operative care with emphasis upon common problems.
8. Preparation of short scientific presentations, both written and oral.
PREREQUISITES: (Optional) Medicine, Surgery
AVAILABLE FOR EXTERNS: Yes STUDENTS / PERIOD: max 3 min 1
DURATION: 3 weeks (Course may be extended to four weeks with Course Chair approval to meet home school requirements if it does not prevent another student from rotating).
2011-2012 ROTATIONS BEGIN WEEKS:
By Arrangement 2,5,8,9,13,15,18,22
DESCRIPTION: Introduce the principles of evaluation and treatment of the patient with nervous system dysfunction who might need surgical intervention. The activities include rounds with residents and faculty and daily management of neurosurgical inpatients, outpatient clinics with attending neurosurgeons, evaluation of ER neurosurgical patients or inpatients requiring neurosurgical consultation, and
operating room activity.
STUDENT EXPERIENCES
COMMON PROBLEMS/DISEASES
1. Spinal degenerative joint disease
2. Intracranial masses
3. Pain problems
4. CNS trauma
5. Congenital defects
6. Hydrocephalus
7. Intracranial vascular disease
8. Movement Disorders
CLOSE CONTACT WITH:
X FULL-TIME FACULTY
X CLINICAL FACULTY
X FELLOWS
X RESIDENTS
X INTERNS
X OTHER: Nurse practitioners
Inpatient 70%
Outpatient 30%
APPROXIMATE # OF PATIENTS EVALUATED EACH WEEK BY STUDENT: 4 - 5
TOTAL # OF PATIENTS EVALUATED EACH WEEK BY ENTIRE SERVICE: 44+
TYPICAL WEEKLY SCHEDULE
ON-CALL SCHEDULE & WEEKEND ACTIVITIES:
*M & M conf. 4th Wed of every month, B124 RRUMC; ***Neurosurgery Grand Rounds - Wed. Case Presentations, 6238 RRUMC; Wed. ICU Rounds.
ADDITIONAL COMMENTS AND OTHER SPECIAL REQUIREMENTS: On call every fourth (4th) day. Saturday and Sunday Rounds are 6:15 - 7:00a.m.and 6:00 - 7:30 p.m.
CURRICULUM FOR NEUROSURGERY EXTERNSHIP
PROPOSED REVISION: JULY 1, 2008
Welcome to UCLA Neurosurgery.
The UCLA Department of Neurological Surgery curriculum for 4th year medical students is designed to provide the medical student with general competency regarding indications for and general principles of surgical therapy for neurological disease. The goals and objectives listed below are covered over a 4-week rotation through a series of conferences, clinics, operating room experiences, and interactions with neurosurgery attendings, residents, and patients.
GOALS AND OBJECTIVES (AS SUGGESTED BY THE CNS):
o General Skills Topics
o The Neurological Examination
o Evaluate patient's mental status and speech.
o Examine the cranial nerves.
o Examine central and peripheral sensory function.
o Examine motor function.
o Examine cranial and peripheral reflexes.
o Examine cerebellar function and gait.
o Fundamentals of Neuro-Imaging
o Recognize spine fractures and dislocations.
o Differentiate on computerized images between blood, air, fat, CSF, and bone.
o Recognize specific disease entities listed below such as epidural, subdural, intracranial hematoma, subarachnoid hemorrhage, brain tumors, and hydrocephalus.
o Intracranial hypertension
o Understand the pathophysiology of elevated intracranial pressure, cerebral perfusion and the influence of blood pressure, blood gases, and fluid and electrolyte balance.
o Recognize the clinical manifestations of acute brain herniation including the Cushing reflex, midbrain effects and vital signs.
o Understand the impact of focal mass lesions, structural shifts and their consequences.
o Intracranial Disease
o Diagnosis and Management of Head Trauma
o Understand and assign the Glasgow Coma Score.
o Recognize the presentation of brain herniation syndromes in the setting of trauma.
o Initiate management of elevated intracranial pressure in head trauma.
o Recognize and initiate management of concussion, brain contusion and diffuse axonal injury.
o Recognize and initiate management of acute subdural and epidural hematoma, including surgical indications.
o Recognize and initiate management of penetrating trauma including gunshot wounds.
o Recognize and understand the principles of management of open, closed and basilar skull fractures, including cerebrospinal fluid leak, and chronic subdural hematoma (in children and adults).
o Diagnosis and Management of Brain Tumor and Abscess
o Know the relative incidence and location of the major types of primary and secondary brain tumors.
o Understand the general clinical manifestations (focal deficit and irritations, mass effect; supratentorial vs. infratentorial) of brain tumors.
o Recognize specific syndromes: extra-axial (cerebellopontine, pituitary, frontal....) and intra-axial, in brain tumor presentation.
o Review the diagnostic tools that are currently used for evaluation (laboratory tests, radiology, biopsy).
o Understand broad treatment strategies (surgery, radiosurgery, radiation, and chemotherapy) in the treatment of tumors.
o Recognize the clinical manifestations of abscess and focal infections due to local spread, hematogenous disease associated with immune deficiency, and how they differ from the mimic tumors.
o Understand the general principles in the treatment of abscess and focal intracranial infections.
o Diagnosis and Management of Headaches
o Know the major causes of intracranial hemorrhage: vascolopathy in the aged (hypertension and amyloidosis), aneurysm, vascular malformation, tumor and coagolopathy.
o Recognize the symptoms and signs of subarachnoid, cerebral and cerebellar hemorrhage.
o Apply diagnostic tools in evaluation of acute headache (CT and MRI, role of lumbar puncture).
o Understand the natural history and broad treatment strategies (surgery, radiosurgery, interventional radiology as well as treatment of vasospasm) of intracranial aneurysms and vascular malformations.
o Differentiate the symptomatology of migraine, cluster, and tension headache and sinusitis headache.
o Diagnosis and Management of Ischemic Cerebrovascular Disease
o Recognize the symptoms and signs of anterior and posterior circulation ischemia emphasizing carotid disease and contrasting it with hemorrhagic stroke.
o Differentiate among the types of ischemic stroke: embolic, hemodynamic, lacunar.
o Categorize etiologic factors of brain ischemia including atherosclerosis, cardiac disease, arterial dissection, fibromuscular dysplasia, vascolitis, venous thrombosis and hematologic disease.
o Understand the treatment options in ischemic disease and their indications, including medical management, risk factor modification and surgical therapy.
o Diagnose and monitor carotid occlusive disease using noninvasive methods and understand indications for angiography and carotid endarterectomy.
o Spinal disease
o Diagnosis and Management of Spinal Cord Injury
o The emergency room diagnosis and interpretation of radiologic studies in spinal trauma.
o Initiate acute management of spinal cord injury including immobilization, steroids and systemic measures.
o Understand the definition and subsequent management principles of the unstable spine.
o Understand management principles in spinal cord injury including indications for decompressive surgery and treatment of the medical complications associated with cord injury (skin, bladder, bowel movement, respiratory).
o Diagnosis and Management of Nontraumatic Neck and Back Problems
o Diagnose and understand the natural history and management principles of whiplash and soft tissue injury.
o Recognize the broad categories of spinal pain and radicolopathy:
o The signs and symptoms (including cauda equina syndrome).
o Their common causes, their diagnosis and their management (cervical and lumbar disc herniation, osteoarthritic disease, spondylolisthesis).
o Their differential diagnosis and management (including metastatic disease and primary spinal tumors).
o Recognize the broad categories of myelopathy:
o The signs and symptoms (including comparison of acute and chronic spinal cord injury).
o The common causes, their diagnosis and their management (cervical and lumbar disc herniation and osteoarthritic disease).
o Differential diagnosis and management (including transverse myelopathy, metastatic disease and primary spinal tumors).
o Peripheral nerve disease
o Diagnosis and Management of Peripheral Nerve Injury and Entrapment
o Diagnose traumatic nerve injury (laceration, stretch and compression) and understand indications and general strategies of treatment.
o Recognize the signs and symptoms of common nerve entrapment (carpal tunnel syndrome, ulnar nerve entrapment, thoracic outlet syndrome and meralgia paresthetica), their etiology, conservative management strategies and indications for surgical intervention.
o Other common neurosurgical problems
o Diagnosis and Management of Hydrocephalus and Spinal Dysraphism
o Recognize the symptoms and signs of hydrocephalus in children.
o Recognize the symptoms and signs of hydrocephalus in adults.
o Understand common etiologies of hydrocephalus in children and dolts, and differentiate between communicating and obstructive hydrocephalus.
o Understand treatment strategies for hydrocephalus.
o Recognize common syndromes of spinal dysraphism, their neurologic manifestations and broad principles of management.
o Diagnosis and Management of Surgically Treatable Pain Problems, Movement Disorders and Epilepsy
o Recognize the features of trigeminal and glossopharyngeal neuralgia, causalgia and cancer pain, indications for surgical referral and the spectrum of surgical therapeutic options.
o Recognize movement disorders amenable to surgical intervention, including Parkinson's disease, dystonia, spasticity, and hemifacial spasm, indications for surgical referral and the spectrum of surgical therapeutic options.
o Understand the general classification of seizure disorders, definition of intractable epilepsy, and the broad categories of surgical intervention for epilepsy including invasive electrodes, resective and disconnective surgery.
ACHIEVING THE GOALS AND OBJECTIVES
The goals and objectives of the medical student program are achieved in the 4 week rotation by exposure to neurosurgery patients in the clinical care setting, weekly departmental conferences, neurosurgery clinics, overnight call, and operating room experience.
1. Clinical service
There are four clinical neurosurgery services offered by UCLA Neurosurgery. These busy four services offer different perspectives on the spectrum of neurosurgical care.
- Westwood (Ronald Reagan Medical Center) Campus
oAttendings: Martin, Frazee, Ausman, Gonzalez, Bergsneider, Liau, Edelman, Holly, Batzdorf, Mathern, Lazareff, Shafa, Becker, Fried, McBride, DeSalles, Lu, and Yang.
oResidents: 1 Chief, 2 Seniors, 3 Juniors, and 2 Interns
oExperience: Busy tertiary care referral center. All areas of neurosurgery are well represented. - Santa Monica Campus oAttendings: Holly, McBride, Lu
oResidents: 1 Senior
oExperience: Mainly spine (traumatic, degenerative, tumor), combination of complex referral cases and community practice - West Los Angeles VA Campus oAttendings: Frazee, DeSalles, Gonzalez
oResidents: 1 Chief, 1 Intern
oExperience: Complex and community spine (mainly degenerative), functional (DBS) cases, variety of intracranial cases - Harbor-UCLA Campus oAttendings: McBride,. Ausman, Duong, Shafa
oResidents: 1 Chief, 1 Senior, and 2 Interns
oExperience: Traumatic head and spine injuries, complex intracranial and spine cases; significant resident autonomy
2. Weekly Departmental Conferences
Neurosurgical conferences are held daily every Wednesday.
a)Case presentations are held every other week, where interesting cases are presented and reviewed.
b)Journal Club is held once a month on Education Day. The student is expected to critique and present an assigned article.
c)Morbidity and Mortality conference is held once a month.
d)Board Review is held every other Wednesday and involves a detailed review of a board topic.
e)Neuropathology conference is held once a month on Education Day,
f)Surgical Science conference is held once a month on Education Day,
g)Basic science conference is held once a month on Education Day,
h)A Surgical Symposium is held once a month and involves a presentation by an expert in his/her field reviewing current controversies or evolving science.
3. Neurosurgery Clinics
Students are expected to participate in the clinics at each campus visited. Colleen Bruton can assist with coordination and schedules. At clinic the student will be assigned patients to interview, examine and present. They will be assessed on clinical history and physical examination performance.
4. Emergency call
To obtain exposure to acute neurosurgical conditions it is expected that the student take call on the same schedule as his/her junior resident mentor. This typically involved a "q3" call arrangement.
5. Operating room experience
Daily operating room attendance is essential and guidance as to which surgeries to attend should be obtained from the senior/chief residents. All surgeries concerning patients for whom the student is responsible should be attended. Level of participation in the surgery is up to the attending present but the student should ALWAYS be prepared to be scrubbed in.
SCHEDULING AND LOGISTICAL INFORMATION
At the Westwood (RRMC) Campus, rounds begin at 0530 during the week and at 0700 on the weekends. The Chief resident should be contact prior to starting the rotation to receive reporting instructions.
At the Santa Monica Campus, the senior resident should be contact prior to starting the rotation to receive reporting instructions.
At the VA Campus, the chief resident should be contact prior to starting the rotation to receive reporting instructions.
At the Harbor Campus, rounds begin at 0630 during the week and at 0700 on the weekends. The meeting location is on the sixth floor Neurosurgery office. Page Jonathan Negus, NP, at 310-501-2701 prior to starting the rotation to receive reporting instructions.
Scrub attire is appropriate for daily work rounds. Business attire is requested when reporting to the clinics.
TIPS/RECOMMENDATIONS
Professional attitude and enthusiasm are hallmarks of an exceptional student. Be punctual, and be prepared for full days of work.
EFFORT. EFFORT. EFFORT. The Neurosurgical externship at UCLA can be rigorous and tiring. But this is exceeded by its potential to be rewarding and informing.
Thank you, and good luck. We look forward to seeing you on the service.
NS1 NEUROSURGERY GENERAL INTERN ROTATION Updated: August 1, 2006
ROTATION: NEUROSURGERY
ROTATION DIRECTOR: Marvin Bergsneider, M.D.
NEUROSURGERY CHAIRMAN: Neil Martin, M.D., FAANS
SITES: Ronald Reagan UCLA Medical Center
VA Greater Los Angeles Healthcare System
GOALS: To provide trainees an opportunity to participate in the perioperative and operative aspects of neurosurgery.
LEVEL OF TRAINEE: R1
ASSESSMENT:
Monitoring of the accomplishment of the stated objectives will be performed using the following methods:
1. Global Rating: end of rotation evaluation of resident performance to assess the resident's demonstration of Core Competencies with respect to the stated objectives by faculty, other team resident members, students, and nursing staff.
2. Case Logs: auditing of operative cases pertinent to the specialty in the Surgical Operative Log.
3. Written Examination: performance on the annual ABSITE examination. Patient Survey: performance will be assessed by patient surveys administered though the rotation.
DESCRIPTION OF THE ROTATION:
The Neurosurgery rotation of 1 month in the R1 year.
1. All rotating will be part of the Neurosurgery team and responsible for the care of the Neurosurgery patients.
2. The surgery residents will provide in-patient care including routine admissions and critical care of patients.
4. Residents will further participate in surgical operations needed on these patients under direct supervision by the surgical faculty.
5. The rotating residents will participate in all Department of Surgery educational conferences and didactic presentations.
6. Residents are expected to actively participate and present at the weekly Neurosurgery Conference.
R1 RESIDENT
COMPETENCY BASED LEARNING OBJECTIVES
Patient Care:
7. Perform a complete and thorough history and physical examination, with emphasis in elements unique to neurosurgery patients.
8. Initiate the laboratory evaluation and any other initial diagnostic studies with an understanding of the tests to be ordered.
9. Make informed decisions about diagnostic and therapeutic interventions on neurosurgery patients with the guidance of senior residents and faculty.
10. Be proficient in the preoperative preparation of the patients for neurosurgery and routine postoperative care.
11. Understand basic pathophysiology of neurosurgical disorders.
12. Understand basic pathophysiology of neurosurgical disease under the guidance of the senior residents and attending physicians.
13. Understand the basic indications for common radiological and interventional studies used in the care of neurosurgery patients such as CT scan and MRI.
14. Demonstrate the ability to effectively set priorities and coordinate the care of neurosurgery patients.
Medical Knowledge:
1. Demonstrate an understanding of a comprehensive neurological evaluation including an accurate history and physical examination.
2. Demonstrate a working knowledge of the role of the following diagnostic modalities in the evaluation of patients with neurosurgical problems:
a) plain skull radiographs
b) plain spine radiographs
c) CT scan of head or spine
d) MRI
e) cerebral angiography
3. Discuss the management of head injuries to include:
a) selection, prioritizing, and performance of resuscitation efforts
b) analyzing components and results of baseline neurological examination to determine and evaluate changes in patient neurological status
c) treatment of a scalp wound
d) initial treatment of compound depressed skull fractures
e) management of increased intracranial pressure
f) recognition of cerebral herniation syndromes
g) initiation, management, and interpretation of intracranial pressure monitoring
h) recognition and initial management of post-traumatic intracranial hemorrhage
4. Discuss the management of cervical and lumbar disc disease including:
a) conservative management (traction, rest, physical therapy, analgesic medications)
b) selection and usefulness of radiologic modalities (plain spine films, CT, MRI, myelography)
c) indications for surgical management
5. Discuss the description and diagnosis of intracranial and intraspinal mass lesions (neoplasm, abscess, hematoma) including:
a) signs and symptoms of intracranial and intraspinal mass lesions
b) pathophysiology of intracranial and intraspinal abscess
c) pathophysiology of spontaneous intracranial and intraspinal hemorrhage
d) pathophysiology of hydrocephalus
6. Demonstrate an understanding of the critical issues associated with closed head injury including:
a) coma
b) brain swelling
c) increased intracranial pressure
d) ICP monitoring
e) cerebral perfusion
f) hyperventilation
g) diuretic use
7. Demonstrate an understanding of the critical issues associated with spinal cord injury including:
a) recognition of neurological deficit from cord and/or root injury at various levels
b) spinal stabilization including the use of tongs or halo
c) pathophysiological responses in the acute quadriplegic or paraplegic patient
d) respiratory problems
e) use of corticosteroids
e. urinary bladder dysfunction
8. Demonstrate the ability to recognize and manage the following problems commonly encountered in neurosurgical patients:
a) hyponatremia
b) water intoxication
c) SIADH
d) hypopituitarism
e) hypoadrenalism
9. Understand the clinical definition of brain death.
10. Demonstrate an understanding of the importance of early referral of head and spinal cord injury patients to rehabilitation services and the potential impact upon long-term prognosis.
11. Perform neurological history and examination of patients at various levels of consciousness.
12. Assist during neurosurgical procedures, gaining exposure to:
a) craniotomy, laminectomy
b) neurosurgical hemostasis
c) protection of neural tissues
d) repair/replacement of dura and bone
13. Perform limited neurosurgical procedures under appropriate supervision:
a) diagnostic lumbar puncture
b) insertion of ICP monitor
c) repair of scalp lacerations
d) application and management of skeletal traction by tongs or halo
Practice Based Learning:
o Develop a personal program of self-study and professional growth with guidance from the teaching staff and senior residents. An understanding of the etiology, pathogenesis, pathophysiology, diagnosis and management of neurosurgical disorders will allow for sound surgical judgment, which relies on knowledge, rational thinking and the surgical literature.
o Utilize current literature resources to obtain up-to-date in information in the neurosurgical patients and practice evidence-based medicine.
o Participate in teaching and organization of the educational weekly neurosurgery conference.
o Participate in activities of the Department of Surgery (including all teaching conferences) and assume responsibility for teaching and supervision of subordinate surgical house staff, and medical students.
o Participate in the Department Morbidity & Mortality conference and utilize information to further improve patient care.
o Participate in daily teaching rounds and be able to present patients in an organized and complete fashion
Professionalism:
o Practice compassionate patient care maintaining the highest moral and ethical values with a professional attitude.
o Demonstrate understanding of the needs and feelings of others, including the patient's family members, allied health care personnel (nurses, clerical staff, etc.), fellow residents, and medical students.
o Communicate and collaborate effectively in a team of health care providers
o Demonstrate respect, compassion and integrity in the care of neurosurgery patients on a daily basis
o Demonstrate mature and educated approach to Ethical issues commonly encountered in a neurosurgery setting.
o Show sensitivity to patients culture, age, gender and disabilities
o Recognize and appropriately handle sensitive cases of abuse
o Be self-aware and have knowledge of professional limits by practicing on-going medical education and self-improvement.
o Be accountable to profession in their actions and decisions.
o Understand the legal implications of the declaration of brain death.
Interpersonal Relationships And Communication:
o Create and sustain a therapeutic and ethically sound relationship with patients and patient families
o Work effectively with other members of the medical team including allied health care personnel (nurses, clerical staff, etc.), fellow residents, and medical students.
o Maintain professional interactions with other health care providers and hospital staff
Systems Based Practice:
o Understand how the health care organization affects surgical practice of neurosurgical practice.
o Demonstrate cost effective health care.
o Be able to coordinate care including discharge planning, social service, rehabilitation, and long term care.
o Follow established practices, procedures, and policies of the Department of Surgery and integrated and affiliated hospitals.
o Maintain complete of medical records operative notes staff sheets and notes, patient database cards and other patient care related documentation in a timely, accurate and succinct manner.
REFERENCES:
Greenberg, MS. Handbook of Neurosurgery. 6th ed. New York: Thieme Medical Publishers, 2006.
Black, Peter, Neurosurgery - An Introductory Text; New York, Oxford University Press, 1995
TYPICAL WEEK *:
- *Each intern is encouraged to scrub into a neurosurgical OR case at least twice per week.
- ** Wednesdays: Interns have mandatory Department of Surgery conferences in the morning. Interns are encouraged to attend the 5pm Neurosurgery conferences including ICU Monitoring (first Wed), Board Preparation Lectures (second and fourth Wednesdays), and Symposia/Grand Rounds Lecture (third Wednesday).
UCLA Neurology Elective Rotation (NS1)
Goals and Objectives
Rotation Director: Alon Avidan. M.D.
Assessment:
1. The resident will be given a verbal assessment of their accomplishment of the core competencies on a weekly basis (During Friday rounds).
2. The resident will undergo a formal written evaluation of their performance of the core competencies at the conclusion of the rotation.
3. The resident will be expected to keep up their time log for the rotation.
Description of the Rotation:
The UCLA neurology rotation is three months during the NS2 clinical year. At RRUCLA, residents work in teams of two PGY2 residents and a senior (PGY4) Chief resident with the supervision of a rotating attending faculty Neurologist. There are usually 1-2 rotating third year medical students. The team cares for primary Neurology patients that are concentrated on 6 North but may be in other locations in the hospital based on bed availability. In addition, this team provides formal neurologic consultation for patients from other medical services within the hospital. The resident team develops diagnostic and therapeutic management plans for these patients in collaboration with the attending. Regular learning occurs throughout the process of patient assessment and management. There are also more structured regularly scheduled teaching conferences.
1. The rotating resident functions part of the neurology consult team.
2. The rotating resident participates in the provision of in-patient care, inpatient consultations, and emergency room consultations.
3. The rotating resident will function as part of the stroke response team and learn the essentials of initial evaluation and treatment of ischemic stroke.
4. The rotating resident will expand their knowledge base on the full spectrum of surgical and non-surgical neurological diseases.
5. The rotating resident will learn to broaden their differentials diagnosis based on patients presenting symptoms. The will also learn the necessary work for the common and uncommon neurological disease.
6. The residents will participate in morning rounds and the formulation of care plans.
7. Resident learns the range of differential diagnosis associated with non operative neurological diseases.
8. The rotating resident attends the once monthly education day held at UCLA Westwood.
Competency Based Learning Objectives
Patient Care:
1. Perform a thorough history and physical examination, with a focus on aspects pertinent to patient's specific disorder in the full spectrum of neurological diseases.
2. Demonstrate an understanding of the patho-physiology of cranial, spinal, peripheral nerve as well as pediatric disorders.
3. Further learn the indications for ordering diagnostic imaging and electrophysiological studies such as CT, MRI, angiograms, myelogram, EEG, EMG and NCS in non-surgical neurological diseases.
4. Develop competence in reading and interpreting radiological studies such as MRI, CT, myelography, angiography, and plain radiography.
5. Understand the role of non-operative therapeutic treatment strategies for the full spectrum of cranial, spinal and peripheral nerve disorders.
6. Develop an understanding the appropriate management of patients with Central nervous system infections.
7. Understand the informed consent process, importance of documentation, and patient expectation management.
8. Participate and provide leadership patient care and follow-up in the outpatient clinic.
Medical Knowledge:
1. Develop the ability to follow and care for a specified group of patients
2. Develop the ability to evaluate newly admitted patients and present to neurology faculty
3. Develop familiarity with the technical aspect of performing EMG, EEG, and nerve conduction studies
4. Develop an knowledge base about the basic pathology of all types of neurology patients specifically Multiple Sclerosis, movement disorders, seizure clinic patients
5. Learn to identify neuralgic condition warranting a further work up by a neurologist.
6. Learn electrodiagnostics --- EMG, EEG and NCS testing.
Practice Based Learning
1. Understand the current medical literature and evidence-based medicine in the treatment of neurological patients.
2. Lead in the literature search for question that may arise regarding patient care.
3. Participate in teaching rounds and present patient in a succinct and organized fashion.
Interpersonal and Communication Skills
1. Establish a healthy doctor - patient relationship with patients and their families.
2. Work effectively with other members of the medical team: doctors, residents, fellows, nurses, and allied health personnel.
3. Maintain timely, comprehensive, accurate, and legible medical records.
4. Understand the importance of keeping referring physicians apprised of the status of their patients.
5. Identify any concerns with the health of fellow residents, staff, or allied health personnel.
Professionalism
1. Provide compassionate patient care and maintain moral and ethical standards.
2. Demonstrate sensitivity to patient's religion, culture, race, age, and gender, disabilities, and sexual orientation.
3. Adhere to patient confidentiality and scientific integrity.
4. Identify deficiencies in self or peer performance and suggest strategies for improvement.
5. Understand professional and personal limitations.
6. Be accountable for decisions and actions.
7. Provide team leadership and set a standard of excellence to be emulated by junior level residents and medical students.
Systems Based Practice
1. Improve throughput in both the outpatient and inpatient settings.
2. Understand optimal use of information technology
Recommended Resources:
1) Hospitalist Neurology (Blue Books of Practical Neurology, Vol 19); edited by Martin
Samuels, MD
2) Neurology in Clinical Practice, 2nd Edition; edited by Walter G. Bradley, DM, FRCP
and Robert B. Daroff, MD, et. al.
3) Principles of Neurology, 6th Edition; Raymond Adams, Maurice Victor, Alan Ropper
4) Merritts Textbook of Neurology
5) Neurological Differential Diagnosis, 3rd Edition; John Phillip Patten
6) Localization in Clinical Neurology; 3rd Edition: Paul W. Brazis, MD, Joseph C.
Masdeu, MD, and Jose Biller, MD
7) Diagnostic Neuroradiology, Anne G. Osborn, MD, FACR
8) Computer access to internet sources with available links:
Pub Med, Medline, Harrison's On Line, MD Consult, STAT
Biomedical Library
CHS/UCLA Junior Resident Neurosurgery Rotation
Goals and Objectives
UPDATED: July 1 2008
ROTATION: Junior resident neurosurgery rotation, NS2
ROTATION DIRECTORS: Neil Martin M.D.
SITES: UCLA Medial Center
Overview:
This rotation serves as the core teaching for the residents to learn the care of neurosurgical patients. The resident evaluates patients presenting with all varieties of neurosurgical pathologies: spine, cranial and peripheral nerves. Under the supervision of the attending physicians, senior residents and the neurocritical care team, the junior resident learns to develop a plan of care for the neurosurgical patients.
Goals:
1. To develop the diagnostic skills to evaluate accurately the status of a neurosurgical patient.
2. To develop the diagnostic skills in the interpretation of basic findings on CT scan and MRI that could lead to acute patient deterioration.
3. To recognize neurosurgical emergencies
4. To recognize complications from neurosurgical procedures or treatments.
5. To relay the findings and patient's condition to the attending physician in an organized fashion
6. To develop a plan of care for the neurosurgical patients under the supervision of the attending physician.
7. To learn the techniques of neurosurgical procedures: ventriculostomy, lumbar drain, central line placement.
8. To acquire the skills to perform the initial steps during a neurosurgical operation.
Assessment:
1. The resident will be given a verbal assessment of their accomplishment of the core competencies at the mid-point of the rotation.
2. The resident will undergo a formal written evaluation of their performance of the core competencies at the conclusion of the rotation.
3. The resident case logs will be audited by the rotation director and/or program director at the end of the rotation.
4. The resident case presentations and journal article presentations will be evaluated throughout the duration of the rotation.
Description of the Rotation:
The junior resident neurosurgery rotation is 12 months during the R2 clinical year.
1. The rotating resident will be part of the team that includes the attending neurosurgeons, the neurocritical care attendings and fellows, the senior residents, the inpatient nursing staff, the inpatient nurse practitioners, surgical staff, physician assistant(s) and supporting staff.
2. The rotating resident will provide in-patient care of neurosurgical patients including Critical Care and ward patient care, pre-operative and post-operative patient evaluation and care, inpatient and emergency room consultations.
3. Residents will participate in inpatient surgical cases under the direct supervision of the attending staff. These include but are not limited to:
a. Shunt placement/revision
b. Chiari decompression
c. Myelomeningocoele repair
d. Pediatric tumor resection
e. Traumatic epidural/subdural evacuation
f. Intraparenchymal hematoma evacuation
g. Elevation/repair of skull fractures
h. Hemicraniectomy for trauma/stroke
i. Traumatic spine injury surgery
j. Supratentorial and infratentorial Craniotomy for tumor/vascular approaches
k. Endonasal/Transsphenoidal resection of tumor/masses
l. Endoscopic surgeries (e.g. endoscopic third ventriculostomy, endoscopic transsphenoidal tumor resection).
m. Deep Brain Stimulator (DBS) lead placement
n. Vagal Nerve stimulator (VNS) placement
o. DBS or VNS generator replacement
p. Epilepsy surgery (corticectomy, temporal lobectomy, hemispherectomy)
q. Craniosynostosis repair
r. Cranioplasty
s. Abscess aspiration, brain biopsy
t. Subdural/intraparenchymal/intraventricular intracranial pressure monitor or ventriculostomy placement
u. Lumbar laminectomy/fusion
v. Cervical/thoracic posterior laminectomy/fusion
w. Anterior cervical diskectomy and fusion (ACDF)
x. Spinal exposure for intradural lesions (e.g. tumors/vascular malformations)
y. Peripheral nerve decompression/repair
z. Peripheral nerve tumor resection
4. Residents will participate in inpatient and emergency room bedside procedures including arterial catheterization, central line placement, swan-ganz catheter placement, chest tube placement, lumbar punctures, lumbar drain placements, non-invasive (i.e. programming) and invasive (i.e. {"shunt tap{", externalization of shunt, intrathecal injections) shunt evaluation, frontal and occipital ventriculostomy placement, intraparenchymal intracranial pressure monitor placement, subdural drain placement. Cisternography and myelography. HALO orthosis placement. NG tube, Dobhoff tube and complicated foley placement.
5. Each resident is required to perform each of the above under the supervision of an attending physician or senior resident for at least the first 5 attempts for each procedure. Subsequently, the residents may perform the above procedures independently if approved by the senior and chief residents and attending staff.
6. The residents will evaluate and participate in the clinical decision making of inpatient and emergency room consultations
7. The residents will evaluate and participate in the clinical decision making of urgent and long-term trauma patient care.
8. The resident will attend the weekly Neurosurgery education lectures including education day lectures, quality assurance meetings, case presentations, board review lectures and team meeting.
9. The residents are each expected to prepare a case presentation once every three months.
Competency Based Learning Objectives
Patient Care:
1. Perform a thorough history and physical examination, focusing on the neurological and neurosurgical pathology.
2. Understand the pathophysiology of neurosurgical diseases including but not limited to:
a) Intracranial pressure monitoring and management
b) Head and spine trauma management
c) Intracranial mass diagnosis and treatment
d) Spinal dysraphism evaluation and treatment
3. Understand the indications for ordering diagnostic studies such as Plain radiography, CT, MRI, myelograms and angiograms.
4. Acquire the ability to competently read and interpret radiological studies such as MRI, CT, and angiography.
5. Understand the role of non-operative therapeutic treatment strategies including ventriculostomy placement and HALO application.
6. Understand the indications for, and timing of intervention for patients with various neurological and neurosurgical disorders
7. Understand the informed consent process, importance of documentation, and preoperative patient expectation management.
Medical Knowledge:
1. Understand the location and function of spinal and cranial anatomy in the setting of developmental pathology, tumors and trauma.
2. Describe the etiologies of various neurosurgical pathology including but not limited to: intracranial hemorrhage, trauma, tumor, hydrocephalus, and infection.
3. Differentiate between common clinical findings seen in neurological and neurosurgical conditions.
4. Learn the Brainlab software used for planning imaging guided surgeries. Learn to register the Brainlab equipment intraoperatively.
5. Gain confidence in the performance of surgical procedures as described above.
6. Understand proper patient positioning and level localization for the above-mentioned procedures.
Practice Based Learning
1. Understand the current medical literature and evidence-based medicine in the treatment of patients with head or spine trauma, intracranial hemorrhage, intracranial mass lesions, and developmental abnormalities.
2. Participate and present at the weekly neurological educational conferences including board preparation lectures, case presentations, and ICU rounds.
3. Attend the mandatory UCLA Neurosurgery Education Day.
4. Participate in teaching rounds and present patient in a succinct, organized fashion.
UCLA Neurosurgery Functional/Stereotactic Radiosurgery Rotation (NS3)
Goals and Objectives
Rotation Director: Antionio A. F. DeSalles, M.D., Ph.D.
Assessment:
1. The resident will be given a verbal assessment of their accomplishment of the core competencies at the mid-point of the rotation.
2. The resident will undergo a formal written evaluation of their performance of the core competencies at the conclusion of the rotation.
3. The resident case logs will be audited by the rotation director and/or program director at the end of the rotation.
4. The resident case presentations, journal article presentations, grants proposal, and manuscript submissions will be evaluated throughout the duration of the rotation.
Description of the Rotation:
The Radiosurgery/Functional Neurosurgery rotation is three (3) months usually during the NS2 year.
1. The rotating resident will be part of the team that includes the attending neurosurgeon (Dr. Antionio DeSalles), the radiation oncologist and fellows, the neurophysicist the neurophysiologist and supporting staff.
2. The rotating resident will provide in-patient care including post-operative ward and ICU patients and inpatient consultations.
3. Residents will participate in in-patient and outpatient surgical cases under the direct supervision of the attending staff.
4. The residents will evaluate and participate in the clinical decision making of patients in the outpatient clinic.
5. The resident will attend and present at the weekly Functional Neurosurgery research meeting and Radiosurgery meeting that is held during the academic calendar year.
6. The resident will attend the once monthly education day held at UCLA Westwood.
7. The resident will attend and participate in the Radiosurgery Tutorial lectures that occur approximately 6 times yearly.
Competency Based Learning Objectives
Patient Care:
1. Perform a thorough history and physical examination, with a focus on aspects pertinent to patients with functional and pain disorders as well as intracranial and spinal lesions requiring radiosurgery/radiotherapy.
2. Understand the pathophysiology of functional disorders.
3. Understand the indications for ordering diagnostic studies such as Audiograms, MRI modalities including Diffusion Tensor Imaging and Functional MRI imaging and angiograms.
4. Acquire the ability to competently read and interpret radiological studies such as MRI, CT, and angiography.
5. Understand the role of non-operative therapeutic treatment strategies.
6. Understand the indications for, and timing of intervention for patients with various neurological and neurosurgical disorders
7. Understand the indications, limitations, benefits, and alternatives of Deep Brain Stimulator surgeries.
8. Understand and implement the treatment plan for patients suffering from chronic pain.
9. Understand the informed consent process, importance of documentation, and preoperative patient expectation management.
10. Participate in patient postoperative care and follow-up in the outpatient clinic.
Medical Knowledge:
1. Understand the location and function of spinal and cranial anatomy, particularly of the cerebello-pontine angle (CPA), the sellar/parasellar region, the thalamus, midbrain and basal ganglia.
2. Describe the different etiologies of Parkinson's disease, essential tremor, dystonia.
3. Differentiate between common clinical findings seen in trigeminal neuralgia and other facial pain syndromes.
4. Understand the different modalities of medical and surgical therapy for trigeminal neuralgia.
5. Understand the causes and treatments of patients suffering from chronic pain syndromes / reflex sympathetic dystrophy
6. Understand the concept of radiosurgery and fractionated radiotherapy in the treatment of malignant and benign tumors as well as neuropathies.
7. Discuss the clinical and radiographical factors that impact the treatment plan for patients with metastatic brain and spinal disease.
8. Explain the risks and indications for radiosurgery and radiotherapy for CPA lesions, supratentorial lesions, sellar/parasellar lesions, spinal lesions, and trigeminal neuralgia.
9. Describe the anatomical landmarks used for various deep brain syndrome targets with relation to the specific nervous circuits and gross anatomy.
10. Learn the Brainlab/iPlan software used for planning radiosurgery and radiotherapy for cranial and spinal lesions.
11. Learn the Brainlab stereotaxy software used for planning and performing deep brain stimulation surgeries.
12. Gain confidence in the performance of surgical procedures such as:
a) Deep Brain Stimulator (DBS) placement
b) DBS lead and generator placement
c) DBS Battery replacement
d) DBS generator programming/reprogramming
e) Cortical stimulator placement
f) Cortical stimulator programming
g) Foramen Ovale stereotactic procedures (trigeminal nerve rhizotomy / ablation, meckel's cave mass biopsy)
h) Percutaneous stereotactic rhizotomy
i) DREZ rhizotomy
13. Understand proper patient positioning and level localization for the above-mentioned procedures.
Practice Based Learning
1. Understand the current medical literature and evidence-based medicine in the treatment of functional and radiosurgery patients.
2. Participate and present at the weekly Functional Surgery and Radiosurgery conferences.
3. Attend the mandatory UCLA Neurosurgery Education Day.
4. Participate in teaching rounds and present patient in a succinct, organized fashion.
Interpersonal and Communication Skills
1. Establish a healthy doctor - patient relationship with patients and their families.
2. Work effectively with other members of the medical team: doctors, residents, fellows, nurses, and allied health personnel.
3. Maintain timely, comprehensive, accurate, and legible medical records.
4. Understand the importance of keeping referring physicians apprised of the status of their patients.
5. Identify any concerns with the health of fellow residents, staff, or allied health personnel.
Professionalism
1. Provide compassionate patient care and maintain moral and ethical standards.
2. Demonstrate sensitivity to patient's religion, culture, race, age, and gender, disabilities, and sexual orientation.
3. Adhere to patient confidentiality and scientific integrity.
4. Identify deficiencies in self or peer performance
5. Understand professional and personal limitations.
6. Be accountable for decisions and actions.
Systems Based Practice
1. Understand effective health care cost strategies as it relates to spinal surgery: implant costs, hospitalization time, etc.
2. Demonstrate coordination of multiple disciplines in the treatment of spinal patients: physical therapy, rehabilitation, discharge planning.
3. Improve throughput in both the outpatient and inpatient settings.
4. Understand optimal use of information technology.
5. Understand all rules regarding patient safety in the operating room such as the "time-out" period.
6. Adhere to the requirements of the eighty-eight hour workweek.
UCLA Neuropathology Rotation (NS3)
Goals and Objectives
Rotation Director: Harry V. Vinters, M.D.
Assessment:
1. The resident will be given a verbal assessment of their accomplishment of the core competencies at the mid-point of the rotation.
2. The resident will undergo a formal written evaluation of their performance of the core competencies at the conclusion of the rotation.
3. The resident will be evaluated after giving a short presentation regarding an area of neuropathology interest at the conclusion of the rotation.
Description of the Rotation:
The neuropathology rotation is two (2) months during either the NS2 clinical year.
1. The rotating resident will be part of the neuropathology unit that includes 3 attending neuropathologists, one fellow, one rotating pathology resident, and one or two other elective rotators.
2. The rotating resident will review all slides submitted for diagnosis, including frozen sections, permanent sections, and immunohistochemical preparations.
3. Residents will participate neuropathology sign-out sessions.
4. The residents will participate in neuropathology conferences, autopsies, and brain-cutting sessions.
5. The resident will be expected to read a short neuropathology introductory text.
6. The resident will attend all neurosurgery education conferences each Wednesday at Westwood-UCLA.
7. The resident is responsible for giving a neuropathology lecture on a topic of his/her choice at the conclusion of the rotation.
Competency Based Learning Objectives
Patient Care:
1. Understand the intraoperative preparation necessary for certain neuropathologic specimens.
2. Understand how use information provided by the neuropathologists in a patent care setting.
3. Understand the molecular and physiological nature of neurological disease.
4. Understand the importance of effective, accurate documentation.
Medical Knowledge:
1. Understand the normal CNS histology and be able to identify cellular characteristics under the microscope.
2. Understand the principles of neuropathology, including different staining techniques and the role of immunohistochemistry.
3. Understand the limitations of frozen section as it relates to intraoperative diagnosis.
4. Understand the role of electron microscopy.
5. Identify micrographic features of neurologic disease, including tumors, demyelinating disease, degenerative disease, infection/inflammation, and vascular disease.
6. Understand the processes involved in peripheral nerve and muscle pathologic diagnosis.
7. Gain experience being able to describe microscopic findings in a clear, precise manner.
8. Gain experience with autopsy and brain cutting.
9. Identify neurological disease in gross surgical and autopsy specimens, with attention paid to radiological correlates.
Practice Based Learning
1. Understand topics in the current literature in neuropathology.
2. Participate in the weekly neuropathology conferences, including brain-cutting sessions.
3. Attend the mandatory UCLA Neurosurgery Education Day and all educational conferences.
4. Participate in neuropathology sign-out sessions.
Interpersonal and Communication Skills
1. Understand the importance of accurate and precise communication of pathology results to referring physicians.
2. Work effectively with other members of the neuropathology team and members of the pathology laboratory.
3. Understand the importance of timely result reporting.
4. Identify any concerns with the health of fellow residents, staff, or allied health personnel.
Professionalism
1. Maintain moral and ethical standards.
2. Adhere to patient confidentiality and scientific integrity.
3. Identify deficiencies in self or peer performance
4. Understand professional and personal limitations.
5. Be accountable for decisions and actions.
Systems Based Practice
1. Understand effective health care cost strategies as it relates to neuropathology.
2. Demonstrate coordination of pathology with the clinical disciplines.
3. Understand optimal use of information technology.
4. Adhere to the requirements of the eighty hour work week.
UCLA NEUROSURGERY RESIDENCY PROGRAM
ROTATION GOALS AND OBJECTIVES
UPDATED: February 17, 2008
ROTATION: Neurointerventional Surgery, NS3
ROTATION DIRECTOR: Nestor R. Gonzalez, M.D.
SITES: UCLA Medial Center/Veterans Administration Greater Los Angeles
OVERVIEW:
The role of minimally invasive procedures guided under fluoroscopic control has radically changed the practice of vascular neurosurgery in the last two decades. Multiple clinical studies and the continuous creativity of leaders in endovascular techniques have allowed the establishment of well defined therapeutic strategies using interventional neuroradiology techniques for the management of cerebrovascular disease.
This rotation, offered to the neurosurgery residents for a period of 6 months, allows the neurosurgical trainees to be actively involved in the practice of this vital portion of the management of neurovascular problems, with exposure to the complete range of endovascular and surgical neurovascular interventions performed at UCLA Medical Center and Veterans Administration Greater Los Angeles Hospital under the supervision of well-recognized faculty with expertise in the filed.
The inclusion of this model of education to neurosurgical residents recognizes the relevance of minimally invasive, catheter-based procedures in the management of neurovascular pathologies, and allows the trainees to be prepared for a competitive role in the pursue of formal fellowships to obtain formal training in this subspecialty.
GOALS:
1. To develop understanding of the indications, techniques and possible benefits and complications of the minimally invasive, targeted interventional neuroradiology treatments.
2. To develop a knowledge base of the decision-making process for performing guided imaging interventional radiology versus open surgical procedures for specific pathologic processes.
3. To acquire diagnostic skills in the interpretation of cerebral and spinal angiograms, and the ability to determine differential diagnosis with their clinical and surgical implications.
4. To recognize the different endovascular treatment options for neurological conditions and identify their advantages and disadvantages in the management of cerebrovascular diseases.
5. To develop skills in the interpretation of angiography.
6. To develop skills in the handling of vascular catheters, guiding wires, and microcatheters, and microwires.
7. To develop the ability to comprehend and critically analyze current literature in endovascular procedures.
LEVEL OF TRAINEE: NS3
ASSESSMENT:
Monitoring of the accomplishment of the stated objectives will be performed using the following methods:
1. Global Rating: end of rotation evaluation of resident performance to assess the resident's demonstration of Core Competencies with respect to the stated objectives by faculty, other team resident members, students, and nursing staff.
2. Case Logs: auditing of interventional cases in the Surgical Operative Log.
3. Patient Survey: performance will be assessed by patient surveys administered through rotation.
DESCRIPTION OF THE ROTATION:
The Neurointerventional Surgery rotation includes two (2) months during NS2 year at UCLA MC, and 4 months during NS4/5 year at VA GLA.
1. All rotating will be part of the Interventional Neuroradiology/ Neurointerventional Surgery team.
2. The neurosurgery residents will provide in-patient and out-patient care including routine admissions of endovascularly treated patients, critical care of patients, and attending the endovascular clinic.
3. Residents will further participate in endovascular procedures needed on these patients under direct supervision by the interventional neuroradiologist faculty.
4. The rotating residents will participate in all educational conferences and didactic presentations.
5. Residents are expected to actively participate and present at the monthly Endovascular Conference.
NS2
COMPETENCY BASED LEARNING OBJECTIVES
Patient Care:
1. Perform a complete and thorough history and physical examination with emphasis in elements unique to endovascular patients.
2. Initiate the laboratory evaluation and any other initial diagnostic studies with an understanding of the tests to be ordered.
3. Make informed decisions about diagnostic and therapeutic intervention on endovascular patients with the guidance of interventional neuroradiologist faculty.
4. Be proficient in the preoperative preparation of the patients for endovascular and routine postoperative care.
5. Understand basic pathophysiology of cerebrovascular disease.
6. Understand the basic indications for common radiological and interventional studies used in the care of neurological patients such as angiography, CTA, MRA, functional tests such as WADA tests.
7. Demonstrate the ability to effectively set priorities and coordinate the care of endovascular patients.
8. Physical Examination:
a. To understand the significance of observational signs in cerebrovascular pathologies, such as attention span, posture, neglectias, etc.
b. To detect and evaluate peripheral and carotid pulses, bruits. To evaluate aces pathways for endovascular procedures.
c. To interpret physical findings of a detailed neurological exam, understand how they contribute to the diagnosis, recognize their limitations, and be aware of other diseases that might mimic the findings.
Medical Knowledge:
Aneurysmal Disease
1. To understand the incidence and prevalence of aneurysmal disease
2. To understand the natural history of intracranial aneurysms.
3. To understand the current concepts on genetic distribution of the disease.
4. To understand the roles of angiography, CT, and MRI/MRA in screening and in planning treatment.
5. To understand the indications of surgical repair versus endovascular treatment and the factors which contribute to treatment decision- making.
6. To understand the natural history of treated and untreated lesions.
7. To understand the rationale for use of assisted endovascular techniques such as balloon assisted coiling or stent placement, and to recognize the therapeutic implications of such technique in the clinical course of patients with intracranial aneurysms.
Cerebrovascular Ischemic Disease:
1. To describe the anatomy of the arch, great vessels, and intracranial arteries.
2. To understand the different etiologies of carotid disease.
a. Atherosclerosis
b. Fibromuscular dysplasia
c. Traumatic occlusion
d. Acute dissection
3. To define hemispheric, non-hemispheric, and non-specific symptoms of stroke.
4. To differentiate among transient ischemic attach (TIA), reversible ischemic neurologic deficit (RIND), stroke in evolution and completed stroke.
5. To describe the arterial and neurological examination and their importance in caring for patients with carotid artery disease.
6. To describe the relationship between carotid artery atherosclerosis and the clinical syndrome of vertebro-basilar insufficiency.
7. To describe the appropriate evaluation for patients with each of the above clinical presentations including the role of Duplex scans, CT scans, MRA, and conventional angiography.
8. To discuss the non-surgical and surgical treatment of acute ischemic syndromes including stroke.
9. To be able to discuss the potential role of endovascular treatment for ischemic disease.
Venous Thrombotic Disease
1. To understand the classic triad of stasis, hypercoagulable state and vein wall damage leading to venous thrombosis.
2. To understand other risk factors such as malignancy, hormonal variations, and obesity.
3. To be familiar with the known hepercoagulable status including anticardiolipin/antiphospholipid antibodies, lupus anticoagulant, protein C, and protein S deficiency, antithrombin III deficiency, hyperfibrinogenemia, plasminogen deficiency, factor V Leiden mutation (activated protein C resistance), heparin induced thrombocytopenia, and their role in both venous thrombotic and arterial ischemic disease.
4. To be familiar with the signs, symptoms and non-invasive and invasive tests currently used in the diagnosis of dural sinus thrombosis.
5. To describe the management of dural sinus thrombosis and intracranial venous hypertension including heparin treatment and the role of endovascular techniques.
6. To recognize the importance of monitoring platelet counts during heparin therapy, and the diagnosis and treatment of heparin induced thrombosis.
Vascular Malformations
1. To understand the incidence and prevalence of vascular malformations.
2. To differentiate the angioarchitectural characteristics between arteriovenous malformations, arteriovenous fistulas, cavernous angiomas and venous angiomas, and to identify the therapeutic implications of these differences.
3. To understand the natural history of each of these lesions.
4. To understand the current concepts on genetic factors of vascular malformations and cavernous angiomas.
5. To understand the roles of angiography, CT, and MRI/MRA in screening and in planning treatment.
6. To understand the indications of surgical repair and or endovascular treatment and the factors which contribute to treatment decision- making.
7. To understand the natural history of treated and untreated lesions.
8. To understand the rationale for use of combined techniques in the management of arteriovenous malformations and fistulas.
Vascular Tumors
1. To recognize the angiographic characteristics of intracranial tumor vascular supply and their therapeutic implications.
2. To understand the role of preoperative tumor embolization and the common endovascular techniques used for this purpose.
3. To recognize potential complications of tumor embolization and strategies for their prevention.
Vascular Access
1. To know the arterial and venous anatomy involved in the commonly used places for endovascular access.
2. To understand the techniques used to obtain arterial and venous access.
3. To understand the methods used to obtain hemostasis of the arteriotomy site.
Complications of Endovascular Therapy
1. To recognize the clinical manifestations of pseudo aneurysm following arteriography, percutaneous transluminal angioplasty, and bypass grafting.
2. To recognize and understand the therapeutic interventions for procedural aneurysm or AVM rupture.
3. To recognize and understand the therapeutic interventions for post-angioplasty hyperperfusion.
4. To recognize and understand the rationale for medical therapeutic strategies during embolic or ischemic endovascular procedural complications.
Practice-Based Learning:
1. Develop a personal program of self-study and professional growth with guidance from the teaching staff and senior fellows. An understanding of the etiology, pathogenesis, pathophysiology, diagnosis, and management of endovascular disorders will allow for sound surgical and endovascular judgment, which relies on knowledge, rational thinking, and pathophysiology knowledge.
2. Utilize current literature resources to obtain up-to-date in information in the cerebrovascular patients and practice evidence-based medicine.
3. Participate in teaching and organization of the educational weekly conferences.
4. Participate in activities of the Division of Interventional Neuroradiology (including teaching conferences) and assume responsibility for teaching and supervision of subordinate house staff and medical students.
5. Participate in the Division of Neurosurgery and Interventional Neuroradiology Morbidity and Mortality conference and utilize information to further improve patient care.
6. Participate in daily teaching rounds and be able to present patients in an organized and complete fashion.
Professionalism:
1. Practice compassionate patient care maintaining the highest moral and ethical values with a professional attitude.
2. Demonstrate understanding of the needs and feelings of others, including the patient's family members, allied health are personnel (nurses, clerical staff, etc.), fellow residents, and medical students.
3. Communicate and collaborate effectively in a team of health care providers.
4. Demonstrate respect, compassion and integrity in the care of endovascular patients on a daily basis.
5. Demonstrate mature and educated approach to ethical issues commonly encountered in a neurovascular surgery setting.
6. Show sensitivity to patient's culture, age, gender, and disabilities.
7. Be self-aware and have knowledge of professional limits by practicing on-going medical education and self-improvement.
8. Be accountable to profession in their actions and decisions.
Interpersonal Relationships and Communications:
1. Create and sustain a therapeutic and ethically sound relationship with patients and patient families.
2. Work effectively with other members of the medical team including allied health care personnel (nurses, clerical staff, etc.), fellow trainees, and medical students.
3. Maintain professional interactions with other health care providers and hospital staff.
System-Based Practice:
1. Understand how the health care organization affects practice of endovascular procedures.
2. Demonstrate cost effective health care.
3. Follow established practices, procedures, and policies of the Divisions of Neurosurgery and Interventional Neuroradiology and integrated and affiliated hospitals.
Maintain complete medical records, operative and procedural notes, staff sheets and notes, patient database cards and other patient care related documentation in a timely, accurate, and succinct manner.
Neuroradiology Elective Rotation, NS3
Goals and Objectives
Rotation Directors: Noriko Salamon, M.D. - UCLA
Gasser Hathout, Susan El-Saden, M.D. - V.A.
Assessment:
1. The resident will be given a verbal assessment of their accomplishment of the core competencies at the mid-point of the rotation.
2. The resident will undergo a formal written evaluation of their performance of the core competencies at the conclusion of the rotation.
3. The resident will be expected to keep their duty hours up to date.
Description of the Rotation:
The neuro-radiology rotation is three (3) months during the NS2 clinical year.
1. The rotating resident will be part of the neuroradiology team that includes 2 attending neuroradiology, one fellow, one rotating radiology resident, and one or two other elective rotators.
2. The rotating resident will participate in the reading of all modalities neuro-imaging performed at UCLA Westwood, or the VA hospital depending on the site of the rotation.
3. The resident will be expected to build on their fundamental knowledge in interpretation of imaging studies.
4. The resident will attend all neurosurgery education conferences each Wednesday at Westwood-UCLA.
Competency Based Learning Objectives
Patient Care:
1. Understand the process involved in getting imaging studies for patients including the necessary labs needed.
2. Understand how to use information provided by the neuroradiologist in a patent care setting.
3. Understand the how clearly explain the risks of each imaging studies to patients.
4. Understand the ways to allay and manage patient's anxiety about various studies such as MRI.
5. Understand the importance of effective, timely, and accurate documentation.
6. Understand the kind of information in patient's medical history is helpful to radiologist during interpretation of imaging studies.
Medical Knowledge:
1. Further solidify their understanding of normal CNS structures on imaging studies.
2. Learn of the consistently differentiate between pathology in the epidural, subdural, subarachnoid and intra-perynchymal lesions.
3. Learn how to effectively interpret lesions on MRI, CT, plain X-rays, and angiography.
4. Understand the principles and physics behind the different types of imaging studies
Understand the advantages and disadvantages of the different types of imaging studies as they relate to different CNS pathologies.
6. Learn the appropriate and cost effective sequence for ordering imaging studies.
7. Understand emerging technologies for better in imaging and their relationship to neurological diseases.
Practice Based Learning
1. Understand topics in the current literature in neuroradiology.
2. Participate in the weekly neuroradiology conferences
3. Attend the mandatory UCLA Neurosurgery Education Day and all educational conferences.
4. Participate in imaging reading sessions.
Interpersonal and Communication Skills
1. Understand the importance of accurate and precise communication of radiology results to referring physicians.
2. Work effectively with other members of the neuro-radiology team and technician
3. Understand the importance of timely result reporting.
4. Identify any concerns with the health of fellow residents, staff, or allied health personnel.
Professionalism
1. Maintain moral and ethical standards.
2. Adhere to patient confidentiality and scientific integrity.
3. Identify deficiencies in self or peer performance
4. Understand professional and personal limitations.
5. Be accountable for decisions and actions.
Systems Based Practice
1. Understand effective health care cost strategies as it relates to neuroradiology.
2. Demonstrate coordination of radiology with the clinical disciplines.
3. Understand optimal use of information technology.
4. Adhere to the requirements of the eighty hour work week.
Harbor UCLA Senior Rotation, NS4
Goals and Objectives
Rotation Director: Duncan McBride M.D.
Assessment:
1. The resident will be given a verbal assessment of their accomplishment of the core competencies on a weekly basis (During Friday rounds).
2. The resident will undergo a formal written evaluation of their performance of the core competencies at the conclusion of the rotation.
3. The resident will be expected to keep up their case log for the rotation.
Description of the Rotation:
The Harbor UCLA senior rotation is four (4) months during the NS3 clinical years.
1. The rotating senior resident will be part of the General neurosurgery team that includes five attending neurosurgeons, one chief resident, two general surgery interns, two physician assistants, and one nurse practitioner.
2. The rotating resident will provide in-patient care including critical ICU care, standard ward care of preoperative and postoperative patients, inpatient consultations, and emergency room consultations (Level on trauma center).
3. Residents will participate in surgical cases under the direct supervision of the attending staff and chief resident.
4. As a continuation of what he/she learned during their junior year, resident is expected to learn the more complex surgical approaches and the logic behind choosing one approach over the other.
5. Resident is expected to gain confidence in the management of both operative and non-operative neurosurgical trauma.
6. Resident is responsible for teaching bedside procedures to interns and physician assistants.
7. The resident also serves as the first call for overnight consults and perform invasive procedures such as ventriculostomies when warranted after discussion with chief resident and attending.
8. The residents learn to evaluate and participate in the clinical decision making of outpatients with neurosurgical diseases during clinic.
9. The resident will attend and present at the weekly multi-disciplinary conference where patient conditions are discussed and reviewed. The medical disciplines involved often are internal medicine, pathology, radiology, pediatrics and neurology, although other disciplines often join.
10. The resident also participates in trauma conference with the General surgery team.
11. The resident will attend the once monthly education day held at UCLA Westwood.
12. The resident in conjunction with the chief resident is responsible for keeping the Harbor UCLA Quality Assurance database current.
Competency Based Learning Objectives
Patient Care:
1. Perform a thorough history and physical examination, with a focus on aspects pertinent to patient's specific disorder in the full spectrum of neurological diseases.
2. Understand the patho-physiology of cranial and spinal as well as pediatric disorders.
3. Understand the indications for ordering diagnostic electrophysiological studies such as CT, MRI, angiograms, myelogram, EEG, EMG and NCS.
4. Demonstrate the ability to competently read and interpret radiological studies such as MRI, CT, myelography, angiography, and plain radiography.
5. Understand the role of non-operative therapeutic treatment strategies for the full spectrum of cranial, spinal and peripheral nerve disorders.
6. Understand the indications for, and timing of surgery for patients with neurological disorders.
7. Understand and implement the treatment plan for spinal patients suffering from chronic pain.
8. Understand and solidify their knowledge of the principles involved in the management of patients with traumatic brain and spinal cord injury.
9. Understand the management of patients with subarachnoid hemorrhage,
10. Understand the indices of and management of vasospasm.
11. Understand the management of ventilated patients.
12. Understand the appropriate management of patients with Central nervous system infections.
13. Understand the informed consent process, importance of documentation, and preoperative patient expectation management.
14. Participate in patient postoperative care and follow-up in the outpatient clinic.
Medical Knowledge:
1. Understand the location and function of spinal anatomical structures as they pertained to surgical procedures
2. Identify and understand the management of perioperative surgical complications
3. Learn the performance of a wide range of neurosurgical procedures:
a. Cranial
i. Standard craniotomy for resection of malignant and non malignant tumors.
ii. Pterional craniotomy for clipping of anterior circulation aneurysms
iii. Orbitozygomatic craniotomy
iv. Retrosigmoid approach to CP angle tumors
v. Translabyrinthine approach for acoustic scwhanommas
vi. Suboccipital craniectomy for treatment of Chiari malformations
vii. EDAS
viii. Microvascular decompression for treatment of trigeminal neuralgia
ix. Transnasal transsphenoidal surgery.
x. Repair of myelomeningocele.
xi. Treatment of the full spectrum of hydrocephalus
xii. Craniotomy if SDH, EDH and ICH.
xiii. Endoscopic third ventriculostomies
xiv. Pre-operative and Intra-operative use of image guidance technology.
b. Spinal
i. anterior cervical discectomy and fusion
ii. posterior cervical foraminotomy
iii. posterior cervical fusion
iv. laminoplasty
v. cervical laminectomy
vi. thoracic discectomy
vii. thoracic fusion
viii. lumbar microdiscectomy
ix. lumbar laminectomy
x. lumbar fusion
xi. arthroplasty
xii. interspinous spacer placement
xiii. Chiari decompression
xiv. spinal cord tumor resection
xv. tethered cord surgery
xvi. surgery for Syringomyelia
xvii. minimally invasive decompression and fusion
4. Understand proper patient positioning and level localization for cranial and spine procedures.
Practice Based Learning
1. Understand the current medical literature and evidence-based medicine in the treatment of neurosurgical patients.
2. Participate and present at the weekly joint Harbor neurosurgery conference.
3. Attend the mandatory UCLA Neurosurgery Education Day.
4. Maintain the Harbor QA database.
5. Participate in teaching rounds and present patient in a succinct, organized fashion.
6.The resident will attend and present at the weekly multi-disciplinary conference where patient conditions are discussed and reviewed. The medical disciplines involved often are internal medicine, pathology, radiology, pediatrics and neurology, although other disciplines often join.
7.The resident also participates in trauma conference with the General surgery team.
Interpersonal and Communication Skills
1. Establish a healthy doctor - patient relationship with patients and their families.
2. Work effectively with other members of the medical team: doctors, residents, fellows, nurses, and allied health personnel.
3. Maintain timely, comprehensive, accurate, and legible medical records.
4. Understand the importance of keeping referring physicians apprised of the status of their patients.
5. Identify any concerns with the health of fellow residents, staff, or allied health personnel.
Professionalism
1. Provide compassionate patient care and maintain moral and ethical standards.
2. Demonstrate sensitivity to patient's religion, culture, race, age, and gender, disabilities, and sexual orientation.
3. Adhere to patient confidentiality and scientific integrity.
4. Identify deficiencies in self or peer performance
5. Understand professional and personal limitations.
6. Be accountable for decisions and actions.
7. Provide leadership and set a standard of excellence to be emulated by junior level residents
Systems Based Practice
1. Understand effective health care cost strategies as it relates to neurosurgery
2. Demonstrate coordination of multiple disciplines in the treatment of neurosurgical patients: physical therapy, rehabilitation, discharge planning, .
3. Improve throughput in both the outpatient and inpatient settings.
4. Understand optimal use of information technology.
5. Understand all rules regarding patient safety in the operating room such as the "time-out" period.
6. Adhere to the requirements of the eighty hour work week.
UCLA Senior Rotation, NS4
Goals and Objectives
Rotation Directors: Neil Martin M.D, Marvin Bergsneider MD
Assessment:
1. The resident will be given a verbal assessment of their accomplishment of the core competencies at the end of the rotation.
2. The resident will undergo a formal written evaluation of their performance of the core competencies at the conclusion of the rotation.
3. The resident will be expected to keep up their case log for the rotation.
Description of the Rotation:
The UCLA Westwood senior resident rotation is 4 months during the R4 or R5 clinical years
1. The senior resident will be part of the General neurosurgery team that includes one chief resident, one "super" senior resident, a senior resident, three junior residents, two general surgery interns, one physician assistant, two nurse practitioners and rotation medical students. The team is directly supervised by one or more attending neurosurgery clinical faculty.
2. Furthermore the neurosurgical team works very closely with the neurocritical care team to provided the best care possible to patients on the service. The neurocritical care team consists of two neuro-intensivists, two clinical fellows and two nurse practitioners.
3. The senior resident plays a significant role in the formulation of patient treatment plans during morning and afternoon rounds.
4. The rotating senior resident provides in-patient care including critical ICU care, standard ward care of preoperative and postoperative patients, inpatient consultations, and emergency room consultations (Level one trauma center).
5. The senior resident participates in and leads surgical cases under the direct supervision of the attending staff.
6. The senior resident is expected to develop confidence in performing the more complex surgical approaches and understand the logic behind choosing one approach over the other.
7. In conjunction with attending surgeon and the chief resident, the senior resident is expected to teach the junior residents the performance of such surgical approaches.
8. The senor resident is expected to have confidence in the management of both operative and non-operative neurosurgical trauma and to be able to teach the senior resident as well as the junior residents.
9. The resident also serves as the second call for overnight consults.
10. The senior resident takes the leadership role in evaluating and participates in the clinical decision making of inpatient consults.neurology, although other disciplines often join the meeting.
11. The resident will attend the once monthly education day held at UCLA Westwood.
12. The resident in conjunction with the chief resident is responsible for keeping the UCLA Westwood Quality Assurance database current.
Competency Based Learning Objectives
Patient Care:
1. Perform a thorough history and physical examination, with a focus on aspects pertinent to a patient's specific disorder in the full spectrum of neurological diseases. Actively participate in teaching the junior residents how to conduct a comprehensive patient history and physical examination.
2. Understand the patho-physiology of cranial and spinal as well as pediatric disorders.
3. Demonstrate competency in identifying the indications for ordering diagnostic imaging and electrophysiological studies such as CT, MRI, angiograms, myelogram, EEG, EMG and NCS.
4. Demonstrate the ability to competently read and interpret radiological studies such as MRI, CT, myelography, angiography, and plain radiography.
5. Understand the role of non-operative therapeutic treatment strategies for the full spectrum of cranial, spinal and peripheral nerve disorders.
6. Demonstrate an understanding of the indications for, and timing of surgery for patients with neurological disorders.
7. Understand and implement the treatment plan for spinal patients suffering from chronic pain.
8. Demonstrate a solid knowledge of the principles involved in the management of patients with traumatic brain and spinal cord injury.
9. Understand the management of patients with subarachnoid hemorrhage,
10. Understand the indices and management of vasospasm.
11. Demonstrate competence in the management of ventilated patients.
12. Understand the appropriate management of patients with central nervous system infections.
13. Understand the informed consent process, importance of documentation, and preoperative patient expectation management.
14. Participate in patient postoperative care.
Medical Knowledge:
1. Understand the location and function of anatomical structures as they pertained to surgical procedures
2. Identify and understand the management of perioperative surgical complications.
3. Gain experience in the performance of a wide range of neurosurgical procedures such as:
a. Cranial
i. Standard craniotomy for resection of malignant and non malignant tumors.
ii. Pterional craniotomy for clipping of anterior circulation aneurysms
iii. Orbitozygomatic craniotomy
iv. Retrosigmoid approach to CP angle tumors
v. Translabyrinthine approach for acoustic scwhanommas
vi. Suboccipital craniectomy for treatment of Chiari malformations
vii. EDAS
viii. EC/IC Bypass surgery
ix. Microvascular decompression for treatment of trigeminal neuralgia
x. Transnasal transsphenoidal surgery.
xi. Repair of myelomeningocele
xii. Treatment of the full spectrum of the types of hydrocephalus
xiii. Craniotomy if SDH, EDH and ICH
xiv. Endoscopic third ventriculostomies
xv. Pre-operative and Intra-operative use of image guidance technology.
b. Spinal
i. anterior cervical discectomy and fusion
ii. posterior cervical foraminotomy
iii. posterior cervical fusion
iv. laminoplasty
v. cervical laminectomy
vi. thoracic discectomy
vii. thoracic fusion
viii. lumbar microdiscectomy
ix. lumbar laminectomy
x. lumbar fusion
xi. arthroplasty
xii. interspinous spacer placement
xiii. Chiari decompression
xiv. spinal cord tumor resection
xv. tethered cord surgery
xvi. surgery for Syringomyelia
xvii. minimally invasive decompression and fusion
4. Senior resident is expected to learn and refine their knowledge of proper patient positioning and level localization for cranial and spine procedures.
5. The senior resident is expected to participate in teaching the junior residents the proper safety procedure for patient positioning.
Practice Based Learning
1. Understand the current medical literature and evidence-based medicine in the treatment of neurosurgical patients.
2. Attend the mandatory UCLA Neurosurgery Education Day.
4. The senior resident is expected to continually appraise the current literature and apply it to bedside patient care
5.The senior resident helps in the preparation of the weekly clinical case presentation and board preparation lectures.
6 The senior resident plays a significant role in performing literature search on questions that arise in the context of patient care.
Interpersonal and Communication Skills
1. Establish a healthy doctor - patient relationship with patients and their families.
2. Work effectively with other members of the medical team: doctors, residents, fellows, nurses, and allied health personnel.
3. Maintain timely, comprehensive, accurate, and legible medical records.
4. Understand the importance of keeping referring physicians apprised of the status of their patients.
5. Identify any concerns with the health of fellow residents, staff, or allied health
personnel.
6. The senior resident plays a significant role in resolving conflicts that may arise by identifying the root cause of the problem and coming up with solution. Furthermore, the senior resident is expected to facilitate the implementation of preventive measures to avoid the repeat of such conflict.
Professionalism
1. Provide compassionate patient care and maintain moral and ethical standards.
2. Demonstrate sensitivity to patient's religion, culture, race, age, and gender, disabilities, and sexual orientation.
3. Adhere to patient confidentiality and scientific integrity.
4. Identify deficiencies in self or peer performance
5. Understand professional and personal limitations.
6. Be accountable for decisions and actions.
7. Provide leadership and set a standard of excellence to be emulated by junior level residents
Systems Based Practice
1. Understand effective health care cost strategies as it relates to neurosurgery
2. Demonstrate coordination of multiple disciplines in the treatment of neurosurgical patients: physical therapy, rehabilitation, discharge planning,
3. Improve throughput in both the outpatient and inpatient settings.
4. Understand optimal use of information technology.
5. Understand all rules regarding patient safety in the operating room such as the "time-out" period.
6. Adhere to the requirements of the eighty hour work week.
Santa Monica Neurosurgery Spine Rotation, NS5
Goals and Objectives
Rotation Directors: Langston Holly, M.D. and Larry Khoo, M.D.
Assessment:
1. The resident will be given a verbal assessment of their accomplishment of the core competencies at the mid-point of the rotation.
2. The resident will undergo a formal written evaluation of their performance of the core competencies at the conclusion of the rotation.
3. The resident case logs will be audited by the rotation director and/or program director at the end of the rotation.
Description of the Rotation:
The Santa Monica Spine rotation is 4 months during either the R4 or R5 clinical years.
1. The rotating resident will be part of the spine surgery team that includes 3 attending spine surgeons, one fellow, one physician assistant, and one nurse practitioner.
2. The rotating resident will provide in-patient care including critical ICU care, standard ward care of preoperative and postoperative patients, inpatient consultations, and emergency room consultations.
3. Residents will participate in in-patient and outpatient surgical cases under the direct supervision of the attending staff.
4. The residents will evaluate and participate in the clinical decision making of patients with spinal disorders in the outpatient clinic.
5. The resident will attend and present at the weekly Santa Monica Spine Conference that is held during the academic calendar year.
6. The resident will attend the once monthly education day held at UCLA Westwood.
7. The resident is responsible for maintaining the Santa Monica Quality Assurance database in conjunction with the supervising attending.
Competency Based Learning Objectives
Patient Care:
1. Perform a thorough history and physical examination, with a focus on aspects pertinent to patients with disorders of the spine and peripheral nervous system.
2. Understand the pathophysiology of spinal disorders and apply basic spinal biomechanics.
3. Understand the indications for ordering diagnostic electrophysiological studies such as EMG and NCS, and appropriate imaging studies.
4. Acquire the ability to competently read and interpret spinal radiological studies such as MRI, CT, myelography, angiography, and plain radiography.
5. Understand the role of non-operative therapeutic treatment strategies such as physical therapy, bracing, oral medications, and injections.
6. Understand the indications for, and timing of surgery for patients with spinal disorders.
7. Understand the indications, limitations, benefits, and alternatives of minimally invasive spine surgery.
8. Understand and implement the treatment plan for spinal patients suffering from chronic pain.
9. Understand the informed consent process, importance of documentation, and preoperative patient expectation management.
10. Participate in patient postoperative care and follow-up in the outpatient clinic.
Medical Knowledge:
1. Understand the location and function of spinal anatomical structures:
a) Vertebral body
b) Intervertebral disc
c) Facet complex
d) Pedicle
e) Pars interarticularis
f) Lamina/spinous process
g) Foramen transversarium
h) Spinal ligaments: anterior longitudinal ligament, posterior longitudinal ligament, ligamentum flavum, interspinous ligament, transverse ligament, alar ligament, and apical ligament
i) Transverse process
2. Describe the different etiologies of spondylolisthesis
3. Differentiate between common clinical findings seen in radiculopathy and peripheral nerve disorders
4. Understand the distinguishing features between neurogenic claudication and vascular claudication.
5. Understand the causes and treatments of patients suffering from various forms of myelopathy.
6. Describe basic spinal biomechanics principles such as Denis three-column rule of instability and the Rule of Spence.
7. Discuss the clinical and radiographical factors that impact the treatment plan for patients with metastatic spinal disease.
8. Explain the risks and indications for spinal procedures such as artificial disc placement, spinal fusion, dynamic stabilization, and intervertebral spacer placement.
9. Understand the rationale for the use of translational, rotational, and/or static anterior cervical plates.
10. Understand the basics of bone biology and the role of osteobiologics:
a). osteoinductive agents
b). osteoconductive agents
c). osteogenic agents
d). bone growth stimulators
11. Describe the anatomical landmarks required for placement of thoracic/lumbar pedicle screws and cervical lateral mass and atlantoaxial screws.
12. Identify and understand the management of perioperative surgical complications.
13. Gain confidence in the performance of spinal surgical procedures such as:
j) anterior cervical discectomy and fusion
k) posterior cervical foraminotomy
l) posterior cervical fusion
m) laminoplasty
n) cervical laminectomy
o) thoracic discectomy
p) thoracic fusion
q) lumbar microdiscectomy
r) lumbar laminectomy
s) lumbar fusion
t) arthroplasty
u) interspinous spacer placement
v) Chiari decompression
w) spinal cord tumor resection
x) tethered cord surgery
y) surgery for Syringomyelia
z) minimally invasive decompression and fusion
14. Understand proper patient positioning and level localization for the above-mentioned procedures.
Practice Based Learning
1. Understand the current medical literature and evidence-based medicine in the treatment of spinal patients.
2. Participate and present at the weekly joint Santa Monica Neurosurgery Spine conference.
3. Attend the mandatory UCLA Neurosurgery Education Day.
4. Maintain the Santa Monica QA database.
5. Participate in teaching rounds and present patient in a succinct, organized fashion.
Interpersonal and Communication Skills
1. Establish a healthy doctor - patient relationship with patients and their families.
2. Work effectively with other members of the medical team: doctors, residents, fellows, nurses, and allied health personnel.
3. Maintain timely, comprehensive, accurate, and legible medical records.
4. Understand the importance of keeping referring physicians apprised of the status of their patients.
5. Identify any concerns with the health of fellow residents, staff, or allied health personnel.
Professionalism
1. Provide compassionate patient care and maintain moral and ethical standards.
2. Demonstrate sensitivity to patient's religion, culture, race, age, and gender, disabilities, and sexual orientation.
3. Adhere to patient confidentiality and scientific integrity.
4. Identify deficiencies in self or peer performance
5. Understand professional and personal limitations.
6. Be accountable for decisions and actions.
Systems Based Practice
1. Understand effective health care cost strategies as it relates to spinal surgery: implant costs, hospitalization time, etc.
2. Demonstrate coordination of multiple disciplines in the treatment of spinal patients: physical therapy, rehabilitation, discharge planning.
3. Improve throughput in both the outpatient and inpatient settings.
4. Understand optimal use of information technology.
5. Understand all rules regarding patient safety in the operating room such as the "time-out" period.
6. Adhere to the requirements of the eighty hour work week.
Research Year, NSR
Goals and Objectives
Rotation Director: David Hovda, Ph.D.
RESEARCH: In the third year of residency training each resident is to begin exploring research opportunities during the first elective period. A faculty member initially counsels the resident who also is invited to discuss ideas with the program director. The resident is to identify a mentor and a research area for training and, ultimately, independent work. The mentor and research training area (both must be approved by the program director) may be in one of the neurosurgical research laboratories or in other non-neurosurgical research programs.
GOALS:
1. Learn basic scientific approach and techniques
2. Write a research proposal in NIH format. Learn grant writing skills
3. Complete a defined research project
4. Present the research findings at a UCLA Neurosurgical conference, and at a regional or national meeting.
5. Submit research findings for manuscript publication(s)
ADVANCED RESEARCH: At this stage of residency training (NS4/5), the resident can take full advantage of the microsurgical laboratory or one of several research laboratories in the Division of Neurosurgery under the supervision of a member of the neurosurgery faculty or the Brain Research Institute. The resources of the UCLA School of Medicine, Brain Research Institute, Neuropsychiatric Institute, and the Department of Graduate Schools of UCLA are available and provide a broad source of training in the basic, as well as clinical neurosciences. The resident will perform a multiple of dissections of human cadavers and practice micro dissection and anastomosis in rats using surgical microscopes. To enhance their learning, residents are to take advantage of videotapes of various operations performed by faculty. These videotapes are available in the laboratory. The NS3 is eligible to take the written national neurosurgical board exam this year for credit and is expected to pass.
It is important that your research proposal be submitted to, and approved by, the research committee before you start. This process generally takes a number of weeks. Before you start, we expect you to have Human Subject Protection Committee (or Animal Research Committee) approval. And to have arranged research funding, or at least applied for it.
Research facilities
UCLA Medical Center is the primary site for neuroscience research. State-of-the-art laboratories provide multi-discipline approaches to research in all neurosurgical disease. The N.I.H. supports investigating brain injury in both the clinical and laboratory settings. Several clinical trials supplemented by innovative lab research have been performed. In addition, there are ongoing projects in subarachnoid hemorrhage, ischemia, and transvenous retro perfusion. Clinical studies in cerebral microdialysis during Phase II monitoring of epilepsy patients are being performed as well as seminal studies in hippocampal cellular physiology. Laboratories for skull base dissection and spinal research provide the residents with laboratory experience in various approaches. Animals are also available to develop microvascular techniques with the aid of an operative microscope. The Brain Research Institute is a multidisciplinary research institute interested in normal and pathologic brain development and function. With a well-developed research plan, opportunities exist for residents to collaborate with the BRI or virtually any department in the university for their research time.
The Giannini Family Foundation invites promising, young postdoctoral investigators in the early stages of their careers to apply to the Medical Research Fellowship Program. The fellowship program supports innovative medical research in the basic sciences and applied fields. The medical research should lead to a better understanding of the diagnosis, management or prevention of disease and contribution to the alleviation of human suffering. Fellowship is open to US citizens & permanent alien resident. The award will be paid in a progressive stipend.
Veterans Administration Chief Resident Rotation, NS5-7
Goals and Objectives
Rotation Director: John Frazee. M.D.
Assessment:
1. The resident will be given a verbal assessment of their accomplishment of the core competencies on a weekly basis.
2. The resident will undergo a formal written evaluation of their performance of the core competencies at the conclusion of the rotation.
3.The resident will be expected to keep up their case log for the rotation.
Description of the Rotation:
The VA chief rotation is four (4) months during the NS5 clinical year. It is the first of the chief rotations.
The rotating chief resident will be part of the General neurosurgery team that includes three attending neurosurgeons, one general surgery intern and one nurse practitioner.
The rotating chief resident will lead in the provision of in-patient care including critical ICU care, standard ward care of preoperative and postoperative patients, inpatient consultations, and emergency room consultations.
The chief residents will participate and lead in surgical cases under the direct supervision of the attending staff.
As a continuation of what he/she has learned during their junior and senior years, the chief resident is expected to confidently perform more complex surgical approaches and understand the logic behind choosing one approach over the other.
While the amount of trauma is minimal, the resident is expected to demonstrate confidence in the management of both operative and non-operative neurosurgical trauma.
The chief resident is responsible for teaching bedside procedures to interns.
The chief resident also serves as the first call for overnight consults and performs invasive procedures such as ventriculostomies when warranted after discussion with the attending neurosurgeon.
The chief resident leads the evaluation and the clinical decision making of outpatients with neurosurgical diseases during clinic (twice a week).
The chief resident attends the once monthly education day held at UCLA Westwood.
The chief resident attends the weekly educational conference at UCLA Westwood campus.
The chief resident is responsible for keeping the VA hospital Quality Assurance database current.
Understand the socioeconomic, sociopolitical, psychosocial and medical issues pertinent to the VA patient population.
Competency Based Learning Objectives
Patient Care:
1. Perform a thorough history and physical examination, with a focus on aspects pertinent to patient's specific disorder in the full spectrum of neurological diseases.
2. Demonstrate an understanding of the patho-physiology of cranial, spinal, peripheral nerve as well as pediatric disorders.
3. Demonstrate an understanding of the indications for ordering diagnostic imaging and electrophysiological studies such as CT, MRI, angiograms, myelogram, EEG, EMG and NCS.
4. Demonstrate competence in reading and interpreting radiological studies such as MRI, CT, myelography, angiography, and plain radiography.
5. Understand the role of non-operative therapeutic treatment strategies for the full spectrum of cranial, spinal and peripheral nerve disorders.
6. Understand the indications for, and timing of surgery for patients with neurological disorders.
7. Understand and implement the treatment plan for spinal patients suffering from chronic pain.
8. Understand and solidify their knowledge of the principles involved in the management of patients with traumatic brain and spinal cord injury.
9. Demonstrate competence in the management of patients with subarachnoid hemorrhage,
10. Understand the indices of and management of vasospasm.
11. Show competence the management of ventilated patients.
12. Understand the appropriate management of patients with Central nervous system infections.
13. Understand the informed consent process, importance of documentation, and preoperative patient expectation management.
14. Participate and provide leadership postoperative patient care and follow-up in the outpatient clinic.
Medical Knowledge:
1. Understand the location and function of spinal anatomical structures as they pertained to surgical procedures.
2. Identify and understand the management of peril-operative surgical complications
3. Show confidence in the performance of a wide range of neurosurgical procedures:
4. While a great deal of case done at the VA are spine base, the chief resident is expected to burnish their skill level in the performance of the following procedures:
a. Cranial
i. Standard craniotomy for resection of malignant and nonmalignant tumors.
ii. Pterional craniotomy for clipping of anterior circulation aneurysms.
iii. Orbitozygomatic craniotomy and its variations.
iv. Retrosigmoid approach to CP angle tumors
v. Translabyrinthine approach for acoustic scwhanommas
vi. Suboccipital craniectomy for treatment of Chiari malformation
vii. Microvascular decompression for treatment of trigeminal neuralgia
viii. Transnasal transsphenoidal surgery. (microscopic and endoscopic approach
ix. Repair of myelomeningocele
x. Treatment of the full spectrum of hydrocephalus
xi. Craniotomy and craniectomy for SDH, EDH and ICH
xii. Endoscopic third ventriculostomies
xiii. Pre-operative and Intra-operative use of image guidance technology.
b. Spinal
i. anterior cervical diskectomy and fusion
ii. posterior cervical foraminotomy
iii. posterior cervical fusion
iv. laminoplasty
v. cervical laminectomy
vi. thoracic discectomy
vii. thoracic fusion
viii. lumbar microdiscectomy
ix. lumbar laminectomy
x. lumbar fusion
xi. arthroplasty
xii. interspinous spacer placement
xiii. Chiari decompression
xiv. spinal cord tumor resection
xv. tethered cord surgery
xvi. surgery for Syringomyelia
xvii. minimally invasive decompression and fusion
xviii. Cervical corpectomies
5. Understand proper patient positioning and level localization for cranial and spine procedures.
6. Demonstrate the ability to use intra-operative fluoroscopy.
Practice Based Learning
1. Understand the current medical literature and evidence-based medicine in the treatment of neurosurgical patients.
2. Lead in the literature search for question that may arise regarding patient care.
3. Attend the mandatory UCLA Neurosurgery Education Day.
4. Maintain the VA QA database.
5. Participate in teaching rounds and present patient in a succinct, organized fashion. .
Interpersonal and Communication Skills
1. Establish a healthy doctor - patient relationship with patients and their families.
2. Work effectively with other members of the medical team: doctors, residents, fellows, nurses, and allied health personnel.
3. Maintain timely, comprehensive, accurate, and legible medical records.
4. Understand the importance of keeping referring physicians apprised of the status of their patients.
5. Identify any concerns with the health of fellow residents, staff, or allied health personnel.
6. The chief resident assumes a leadership role in resolving conflicts that may arise by identifying the root cause of the problem and coming up with solutions. Furthermore, the chief resident is expected to facilitate the implementation of preventive measures to avoid the repeat of such conflict.
Professionalism
1. Provide compassionate patient care and maintain moral and ethical standards.
2. Demonstrate sensitivity to patient's religion, culture, race, age, and gender, disabilities, and sexual orientation.
3. Adhere to patient confidentiality and scientific integrity.
4. Identify deficiencies in self or peer performance and suggest strategies for improvement.
5. Understand professional and personal limitations.
6. Be accountable for decisions and actions.
7. Provide team leadership and set a standard of excellence to be emulated by junior level residents.
Systems Based Practice
1. Understand effective health care cost strategies as it relates to neurosurgery
2. Demonstrate coordination of multiple disciplines in the treatment of neurosurgical patients: physical therapy, rehabilitation, discharge planning,
3. Improve throughput in both the outpatient and inpatient settings.
4. Understand optimal use of information technology.
5. Understand all rules regarding patient safety in the operating room such as the "time-out" period.
6. Adhere to the requirements of the eighty-hour workweek.
Harbor UCLA Chief Rotation, NS5-7
Goals and Objectives
Rotation Director: Duncan McBride M.D.
Assessment:
1. The resident will be given a verbal assessment of their accomplishment of the core competencies on a weekly basis (During Friday rounds).
2. The resident will undergo a formal written evaluation of their performance of the core competencies at the conclusion of the rotation.
3.The resident will be expected to keep up their case log for the rotation.
Description of the Rotation:
The Harbor UCLA chief rotation is four (4) months during the NS5 clinical year.
The rotating chief resident will be part of the General neurosurgery team that includes five attending neurosurgeons, one senior resident, two general surgery interns, two physician assistants, and one nurse practitioner.
The rotating chief resident will lead in the provision of in-patient care including critical ICU care, standard ward care of preoperative and postoperative patients, inpatient consultations, and emergency room consultations (Level on trauma center).
The chief residents will participate and lead in surgical cases under the direct supervision of the attending staff.
As a continuation of what he/she has learned during their junior and senior years, the chief resident is expected to confidently perform more complex surgical approaches and understand the logic behind choosing one approach over the other.
Resident is expected to demonstrate confidence in the management of both operative and non-operative neurosurgical trauma.
The chief resident is responsible for teaching bedside procedures to interns and physician assistants.
The chief resident also serves as the second call for overnight consults and performs invasive procedures such as ventriculostomies when warranted after discussion with the attending neurosurgeon.
The chief resident leads the evaluation and the clinical decision making of outpatients with neurosurgical diseases during clinic.
The chief resident and presents at the weekly multi-disciplinary conference where patient conditions are discussed and reviewed. The medical disciplines involved often are internal medicine, pathology, radiology, pediatrics and neurology, although other disciplines often join.
The resident also participates in trauma conference with the General surgery team.
The chief resident attends the once monthly education day held at UCLA Westwood.
The chief resident in conjunction with the senior resident are responsible for keeping the Harbor UCLA Quality Assurance database current.
Competency Based Learning Objectives
Patient Care:
1. Perform a thorough history and physical examination, with a focus on aspects pertinent to patient's specific disorder in the full spectrum of neurological diseases.
2. Demonstrate an understanding of the patho-physiology of cranial, spinal, peripheral nerve as well as pediatric disorders.
3. Demonstrate an understanding of the indications for ordering diagnostic imaging and electrophysiological studies such as CT, MRI, angiograms, myelogram, EEG, EMG and NCS.
4. Demonstrate competence in reading and interpreting radiological studies such as MRI, CT, myelography, angiography, and plain radiography.
5. Understand the role of non-operative therapeutic treatment strategies for the full spectrum of cranial, spinal and peripheral nerve disorders.
6. Understand the indications for, and timing of surgery for patients with neurological disorders.
7. Understand and implement the treatment plan for spinal patients suffering from chronic pain.
8. Understand and solidify their knowledge of the principles involved in the management of patients with traumatic brain and spinal cord injury.
9. Demonstrate competence in the management of patients with subarachnoid hemorrhage,
10. Understand the indices of and management of vasospasm.
11. Show competence the management of ventilated patients.
12. Understand the appropriate management of patients with Central nervous system infections.
13. Understand the informed consent process, importance of documentation, and preoperative patient expectation management.
14. Participate and provide leadership in patient postoperative care and follow-up in the outpatient clinic.
Medical Knowledge:
1. Understand the location and function of spinal anatomical structures as they pertained to surgical procedures.
2. Identify and understand the management of peril-operative surgical complications
3. Show confidence in the performance of a wide range of neurosurgical procedures:
a. Cranial
i. Standard craniotomy for resection of malignant and nonmalignant tumors.
ii. Pterional craniotomy for clipping of anterior circulation aneurysms.
iii. Orbitozygomatic craniotomy and its variations.
iv. Retrosigmoid approach to CP angle tumors
v. Translabyrinthine approach for acoustic scwhanommas
vi. Suboccipital craniectomy for treatment of Chiari malformation
vii. Microvascular decompression for treatment of trigeminal neuralgia
viii. Transnasal transsphenoidal surgery. (microscopic and endoscopic approach
ix. Repair of myelomeningocele
x. Treatment of the full spectrum of hydrocephalus
xi. Craniotomy and craniectomy for SDH, EDH and ICH
xii. Endoscopic third ventriculostomies
xiii. Pre-operative and Intra-operative use of image guidance technology.
b. Spinal
i. anterior cervical diskectomy and fusion
ii. posterior cervical foraminotomy
iii. posterior cervical fusion
iv. laminoplasty
v. cervical laminectomy
vi. thoracic discectomy
vii. thoracic fusion
viii. lumbar microdiscectomy
ix. lumbar laminectomy
x. lumbar fusion
xi. arthroplasty
xii. interspinous spacer placement
xiii. Chiari decompression
xiv. spinal cord tumor resection
xv. tethered cord surgery
xvi. surgery for Syringomyelia
xvii. minimally invasive decompression and fusion
xviii. Cervical corpectomies
7. Understand proper patient positioning and level localization for cranial and spine procedures.
Practice Based Learning
1. Understand the current medical literature and evidence-based medicine in the treatment of neurosurgical patients.
2. Participate and present at the weekly joint Harbor neurosurgery conference.
3. Attend the mandatory UCLA Neurosurgery Education Day.
4. Maintain the Harbor QA database.
5. Participate in teaching rounds and present patient in a succinct, organized fashion.
6.The resident will attend and present at the weekly multi-disciplinary conference where patient conditions are discussed and reviewed. The medical disciplines involved often are internal medicine, pathology, radiology, pediatrics and neurology, although other disciplines often join.
7.The resident also participates in trauma conference with the General surgery team.
Interpersonal and Communication Skills
1. Establish a healthy doctor - patient relationship with patients and their families.
2. Work effectively with other members of the medical team: doctors, residents, fellows, nurses, and allied health personnel.
3. Maintain timely, comprehensive, accurate, and legible medical records.
4. Understand the importance of keeping referring physicians apprised of the status of their patients.
5. Identify any concerns with the health of fellow residents, staff, or allied health personnel.
6. The chief resident assumes a leadership role in resolving conflicts that may arise by identifying the root cause of the problem and coming up with solution. Furthermore, the chief resident is expected to facilitate the implementation of preventive measures to avoid the repeat of such conflict
Professionalism
1. Provide compassionate patient care and maintain moral and ethical standards.
2. Demonstrate sensitivity to patient's religion, culture, race, age, and gender, disabilities, and sexual orientation.
3. Adhere to patient confidentiality and scientific integrity.
4. Identify deficiencies in self or peer performance and suggest strategies for improvement.
5. Understand professional and personal limitations.
6. Be accountable for decisions and actions.
7. Provide leadership and set a standard of excellence to be emulated by junior level residents.
Systems Based Practice
1. Understand effective health care cost strategies as it relates to neurosurgery
2. Demonstrate coordination of multiple disciplines in the treatment of neurosurgical patients: physical therapy, rehabilitation, discharge planning, .
3. Improve throughput in both the outpatient and inpatient settings.
4. Understand optimal use of information technology.
5. Understand all rules regarding patient safety in the operating room such as the "time-out" period.
6. Adhere to the requirements of the eighty hour work week
UCLA Chief Resident Rotation, NS5-7
Goals and Objectives
Rotation Directors: Neil Martin M.D, Marvin Bergsneider MD
Assessment:
1. The resident will be given a verbal assessment of their accomplishment of the core competencies on a weekly basis (During Friday rounds).
2. The resident will undergo a formal written evaluation of their performance of the core competencies at the conclusion of the rotation.
3. The resident will be expected to keep up their case log for the rotation.
Description of the Rotation:
The UCLA Westwood Chief resident rotation is four (4) months during the R6 or R7 clinical years and immediately follows the Harbor UCLA chief rotation.
1. The rotating chief resident will be part of the General neurosurgery team that includes the chief resident, two senior residents, three junior residents, two general surgery interns, one physician assistant, two nurse practitioners and rotation medical students
2. Furthermore the chief resident as the leader of the neurosurgical team works very closely with the neurocritical care team to provide the best care possible to patients on the service. The neurocritical care team consists of two neuro-intensivists, two clinical fellows and two nurse practitioners.
3. The chief resident provides leadership in the formulation of patient treatment plans during morning and afternoon rounds.
4. The rotating chief resident will provide in-patient care including critical ICU care, standard ward care of preoperative and postoperative patients, inpatient consultations, and emergency room consultations (Level on trauma center).
5. The chief resident participates in and leads surgical cases under the direct supervision of the attending staff.
6. The chief resident is expected to have confidence in performing the more complex surgical approaches and the logic behind choosing one approach over the other.
7. In conjunction with attending surgeon, the chief resident is expected to teach the senior and junior residents the performance of such surgical approaches.
8. The Chief resident is expected to have confidence in the management of both operative and non-operative neurosurgical trauma and to be able to teach the senior resident as well as the junior residents.
9. The resident also serves as the second call for overnight consults.
10. The Chief resident takes the leadership role in evaluating and participates in the clinical decision making of inpatients consults. neurology, although other disciplines often join the meeting.
11. The resident will attend the once monthly education day held at UCLA Westwood.
12. The chief resident is responsible for keeping the UCLA Westwood Quality Assurance database current.
Competency Based Learning Objectives
Patient Care:
1. Perform a thorough history and physical examination, with a focus on aspects pertinent to patient's specific disorder in the full spectrum of neurological diseases. Activity participate in teaching junior resident how to conduct a comprehensive patient history and physical examination.
2. Understand the patho-physiology of cranial and spinal as well as pediatric disorders.
3. Demonstrate competency in identifying the indications for ordering diagnostic imaging and electrophysiological studies such as CT, MRI, angiograms, myelogram, EEG, EMG and NCS.
4. Demonstrate the ability to competently read and interpret radiological studies such as MRI, CT, myelography, angiography, and plain radiography.
5. Understand the role of non-operative therapeutic treatment strategies for the full spectrum of cranial, spinal and peripheral nerve disorders.
6. Demonstrate an understanding of the indications for, and timing of surgery for patients with neurological disorders.
7. Understand and implement the treatment plan for spinal patients suffering from chronic pain.
8. Demonstrate a solid knowledge of the principles involved in the management of patients with traumatic brain and spinal cord injury.
9. Understand the management of patients with subarachnoid hemorrhage,
10. Understand the indices and management of vasospasm.
11. Demonstrate competence in the management of ventilated patients.
12. Understand the appropriate management of patients with central nervous system infections.
13. Understand the informed consent process, importance of documentation, and preoperative patient expectation management.
14. Participate in patient postoperative care.
Medical Knowledge:
1) Understand the location and function of anatomical structures as they pertained to surgical procedures
2) Identify and understand the management of perioperative surgical complications
3) Master the performance of a wide range of neurosurgical procedures such as:
a Cranial
i) Standard craniotomy for resection of malignant and nonmalignant tumors.
ii) Pterional craniotomy for clipping of anterior circulation aneurysms.
iii) Orbitozygomatic craniotomy and its variations.
iv) Retrosigmoid approach to CP angle tumors
v) Translabyrinthine approach for acoustic scwhanommas
vi) Suboccipital craniectomy for treatment of Chiari malformation
vii) Microvascular decompression for treatment of trigeminal neuralgia
viii) Transnasal transsphenoidal surgery. (microscopic and endoscopic approach)
ix) Repair of myelomeningocele
x) Treatment of the full spectrum of hydrocephalus
xi) Craniotomy and craniectomy for SDH, EDH and ICH
xii) Endoscopic third ventriculostomies
xiii) Pre-operative and Intra-operative use of image guidance technology.
b Spinal
i) anterior cervical diskectomy and fusion
ii) posterior cervical foraminotomy
iii) posterior cervical fusion
iv) laminoplasty
v) cervical laminectomy
vi) thoracic discectomy
vii) thoracic fusion
viii) lumbar microdiscectomy
ix) lumbar laminectomy
x) lumbar fusion
xi) arthroplasty
xii) interspinous spacer placement
xiii) Chiari decompression
xiv) spinal cord tumor resection
xv) tethered cord surgery
xvi) surgery for Syringomyelia
xvii) minimally invasive decompression and fusion
xviii) Cervical corpectomies
4) Chief resident is expected to have knowledge of proper patient positioning and level localization for cranial and spine procedures.
5) Chief resident is expected to participate in teaching the junior residents proper safety procedure for patient positioning.
Practice Based Learning
1. Understand the current medical literature and evidence-based medicine in the treatment of neurosurgical patients.
2. Attend the mandatory UCLA Neurosurgery Education Day.
3. Maintain the UCLA Westwood QA database.
4. The chief resident is expected to continually appraise the current literature and apply it to bedside patient care
5.The chief resident is heavily involved in the preparation of the weekly clinical case presentation and board preparation lectures.
6 The chief resident takes a leading role in performing literature search on questions that arise in the context of patient care.
Interpersonal and Communication Skills
1. Establish a healthy doctor - patient relationship with patients and their families.
2. Work effectively with other members of the medical team: doctors, residents, fellows, nurses, and allied health personnel.
3. Maintain timely, comprehensive, accurate, and legible medical records.
4. Understand the importance of keeping referring physicians apprised of the status of their patients.
5. Identify any concerns with the health of fellow residents, staff, or allied health
personnel.
6. The chief resident assumes a leadership role in resolving conflicts that may arise by identifying the root cause of the problem and coming up with solution. Furthermore, the chief resident is expected to facilitate the implementation of preventive measures to avoid the repeat of such conflict.
Professionalism
1. Provide compassionate patient care and maintain moral and ethical standards.
2. Demonstrate sensitivity to patient's religion, culture, race, age, and gender, disabilities, and sexual orientation.
3. Adhere to patient confidentiality and scientific integrity.
4. Identify deficiencies in self or peer performance
5. Understand professional and personal limitations.
6. Be accountable for decisions and actions.
7. Provide leadership and set a standard of excellence to be emulated by junior level residents
Systems Based Practice
1. Understand effective health care cost strategies as it relates to neurosurgery
2. Demonstrate coordination of multiple disciplines in the treatment of neurosurgical patients: physical therapy, rehabilitation, discharge planning, .
3. Improve throughput in both the outpatient and inpatient settings.
4. Understand optimal use of information technology.
5. Understand all rules regarding patient safety in the operating room such as the "time-out" period.
6. Adhere to the requirements of the eighty hour work week
