Year Three (PGY-3)

During PGY-3, the resident rotates for three months at Children's Hospital of Los Angeles under the direct supervision of Mark Krieger, MD. On a typical day at Children's Hospital, the resident starts rounds with the attending physicians at approximately 6:30 a.m., participates in the discussion with pediatric teams involved in patient care and then heads to the operating rooms. The person on call for the day sees non-emergent consults between cases. Sign-out rounds occur in the afternoon. During the evening, the resident takes home call but may go back into the hospital for consults or emergency cases. The resident attends the neurosurgery morbidity and mortality conference and the series of didactic lectures (every Friday morning) at the University of Southern California, Los Angeles. The resident also attends the tumor board, a combined neurosciences case presentation at Children's Hospital.

The remainder of the nine months is spent on subspecialty rotations in clinical neurosurgery services at Cedars-Sinai. 12 months of required clinical neurosurgery occur during PGY-3.

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 they relate 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
  • 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 it 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

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 an outpatient clinic setting
  • Demonstrate an understanding of practice types and opportunities, healthcare delivery systems and medical economics