Year Four (PGY-4)

The PGY-4 resident spends three months of elective time on the required neuroradiology and neuropathology electives, in addition to rotations of their choosing (radiosurgery, epilepsy, neuromonitoring/EEG, etc.). The neuropathology and neuroradiology rotations run concomitantly during a two-month period so that the resident has an additional month of chosen electives.

The PG 4 resident rotates through all the clinical services. The resident gains more in-depth knowledge of the care of neurosurgical patients and is expected to participate as a first assist in most complex neurosurgical cases. The resident also develops an area of primary interest and is expected to formulate a plan for the research year with appropriate mentorship. The resident then writes a formal proposal, including a hypothesis, goals and research design. The educational committee and subspecialty faculty evaluate the proposal, which is expected to be 10 to 20 pages in length. If approved, the proposal will be the basis of the resident's research year.

There are nine months of clinical neurosurgery and three months of electives during PGY-4. The resident is expected to participate in the faculty outpatient clinics at least twice a week, as well as the resident clinic, while continuing to attend all the didactic lectures, clinical conferences and teaching rounds in the Department of Neurosurgery.

During this year, the resident is expected to attain a set of objectives and essential skills:

Patient Care

The resident will develop the ability to:

  • Take and document a neurosurgery history and do a physical examination, with emphasis on spinal, pediatric and complex neurosurgical disorders
  • Know what laboratory and imaging studies should be ordered when and be able to interpret the results as relates to neurosurgery
  • Apply complex diagnostic and patient-management skills, including participation in busy outpatient neurosurgical clinics
  • Establish and implement effective patient-care plans
  • Counsel patients on the risks, goals, limits and alternatives to neurosurgical procedures
  • Perform selected surgical procedures under direct supervision, focusing on spinal neurosurgery (e.g., lumbar and cervical laminectomies, lumbar discectomy, anterior cervical discectomy with and without fusion)
  • Assist in major surgical procedures, and perform portions of the procedure that are appropriate to the resident's level of training, under guidance
  • Practice critical-care skills as required for inpatient neurosurgery

Medical Knowledge

The resident will develop the ability to:

  • Perform above the 15th percentile on the ABNS primary examination for self-assessment
  • Demonstrate a solid foundation of knowledge of anatomy, physiology and pharmacology related to inpatient neurosurgery patients
  • Demonstrate an increasing familiarity with the neurosurgical literature, particularly as relates to spinal and pediatric neurosurgery and critical care issues
  • Accurately do clinical evaluations, including correctly interpret ting basic and advanced laboratory and radiological studies
  • Teach and mentor PGY-1 to PGY-3 residents and medical students

Practice-Based Learning and Improvement

The resident will develop the ability to:

  • Demonstrate an improving ability to learn from errors
  • Construct and implement educational goals for instruction in different elective fields (e.g., neuropathology, radiosurgery, neuro-oncology)
  • Develop fundamental research skills that can be used to develop a fundable basic-science research proposal
  • Locate, appraise and assimilate evidence from scientific studies related to common neurosurgical problems, with emphasis on spinal and pediatric neurosurgery
  • Identify areas of neurosurgical practice where current knowledge is inaccurate or inadequate and participate in clinical studies to improve the general fund of neurosurgical knowledge

Interpersonal and Communication Skills

The resident will develop the ability to:

  • Provide compassionate care
  • Work effectively as a member of a healthcare team, particularly in outpatient specialty clinics
  • Participate meaningfully in multidisciplinary conferences focused on specific neurosurgical fields


The resident will develop the ability to:

  • Demonstrate sensitivity and responsiveness to patients' culture, age, gender and disabilities
  • Demonstrate integrity and a commitment to patients that supersedes self-interest
  • Participate meaningfully in ongoing professional development by submitting research for peer review to journals and national professional meetings

Systems-Based Practice

The resident will develop the ability to:

  • Advocate for quality patient care and assist patients in dealing with system complexities, especially in an outpatient setting
  • Use evidence-based medical practice to provide cost-effective health care and resource allocation that does not compromise quality of care
  • Understand practice management issues, such as patient processing, evaluation and management coding, procedural terminology, documentation of services rendered and other reimbursement process-related issues in outpatient clinic setting
  • Demonstrate an understanding of practice types and opportunities, healthcare delivery systems and medical economics