Neurosurgery Residency Training

Physicians participating in the Neurological Surgery Residency Program at Cedars-Sinai Medical Center will receive the minimum following training over a seven-year period:

  • 2 months of general surgery in PGY1 year
  • 60 months of clinical neurosurgery
  • 3 months of neurology
  • 3 months of electives
  • 12 months of basic science and laboratory research
  • 12 months as chief resident

Each year of the training is described below.

Year 1 (PGY 1)

During the PGY-1 year, the resident rotates on two months of general surgery (trauma service and general surgery intensive care unit), three months of neurology, two months of neuro-intensive care unit, one month of radiology, and four months on the neurological surgery service.

During the month on the trauma service, the resident attends all trauma surgery-related conferences and learns the acute, ICU and subacute care of multiple trauma patients. This includes morbidity and mortality conference, and general surgery didactic conferences.  During the month of general surgery critical care, residents participate in the ICU care of surgical patients and participate in daily rounds, didactic lectures, and conferences in the Department of Surgery.

The resident will rotation on the neurology service for three months where the resident will learn the subtleties of neurological examination, and care of a variety of neurological conditions. During this time, the resident participate in the neurology subspecialty clinics of stroke, movement disorders, neuro-infectious disease, neuro-oncology, neuro-inflammatory, and neuro-muscular and participate in daily rounds, didactic lectures and conferences in the Department of Neurology.   

One month will be spend with the neuro-radiologists reading scans such as x-rays, MRIs and CTs to demonstrate an understanding of neuro-radiological imaging as it specifically relates to neurosurgical patients.  During this month, the resident will participate in imaging related conferences. 

For the last six months of the PGY-1 year, the intern rotates on the neurosurgery and neurosciences intensive care service.  They are exposed to the care of the full spectrum of neurosurgical patients.  They see patients in the emergency room and consultations on the patient floors if the more senior residents are not immediately available.  They review the consults with the appropriate resident on each subspecialty service or chief resident, before staffing the consult with the appropriate attending.  They also participate in the  neuroscience intensive care rounds and conferences. They continue to attend all Department of Neurosurgery didactic lectures, clinical conferences and teaching rounds.

During this year, the resident is expected to attain a set of objectives and essential skills. For a description of these skills, click here

Year 2 (PGY 2)

The academic teaching service at Cedars-Sinai is subdivided into three separate rotations: Gold, White and Blue services.  The attendings on the Blue service primarily focus on neurosurgical oncology, and functional neurosurgery (Drs. Black, Chu, Yu, Mamelak, Patil and King).  The attendings on the Gold service primarily focus on pediatrics and vascular (Drs. Schievink, Alexander and Danielpour).  The White service attendings make up the spine service (Drs. Johnson and Baron).  During the PGY2 through PGY6 years, the residents rotate through each of these services as junior and senior residents. 

The PGY2 spends the first six months as the neuro-critical care and neuro-consult resident, followed by three months on the spine service and then three months on the vascular/pediatric service. They acquire a total of 12 months of clinical neurosurgery experience during this time. 

The typical day for the PGY2 on the neuro-critical care and neuro-consult service starts with pre-rounds in the intensive care unit at about 5am.  Rounds in the morning start at 6 am in the neuroscience intensive care unit.  The imaging studies from the previous night are reviewed with the team lead by the chief resident.  Formal rounds are made on all the patients on the neuro-ICU service and a tentative plan of care is reached.  The residents round on the floor patients and then review and create plan of care with the chief resident. After rounds, the residents on the subspecialty rotations head to the OR or respective outpatient clinics while the PGY2 resident completes any outstanding clinical responsibilities with the help of the physicians assistant and nurse practitioner.  At about 8:00am, the junior resident meets with the neuro- ICU team (made up of a neurointensivist and a nurse practitioner) for neuro-ICU rounds.  Any recommendations in proposed plan of care are discussed with the attending of record after rounds.  The resident also attends the neuro-ICU journal club once a month and neuro-ICU didactic teaching conference once a week.  The consult resident is available for consultations from the emergency room and other inpatient services.  He attends all didactic lectures, and conferences in the Department of Neurosurgery.

During the second six months of PGY2 year, the resident rotates through two subspecialty services: White and Gold services.  The typical day for the residents involves rounding with the rest of the team and then followed by reviewing the patients with the attendings on his/her rotation.  The resident then heads to either the operating room or the outpatient clinics to meet their assigned attending and their patients. The resident on the White service is expected to attend Spine Conference twice a month, in addition to the rest of the didactic conferences.  On the Gold rotation, the resident is required to attend the weekly Neurovascular Conference in addition to the standing didactic conferences.  On both rotations they are expected to attend faculty outpatient specialty clinics as assigned by the Chief Resident. 12 months of required clinical neurosurgery occur during the PGY2 year.

During this year, the resident is expected to attain a set of objectives and essential skills. For a description of these skills, click here

Year 3 (PGY 3)

During the PGY3 year, the resident rotates for three months at Childrens Hospital of Los Angeles (CHLA) under  the direct supervision of Drs. Gordon McComb and Mark Krieger.  On a typical day at CHLA, the resident start rounds with the attendings at approximately 6:30 am, followed by discussion of patient care with the pediatric teams involved in the care of the patients and then heads to the operating rooms.  The person on-call for the day sees non-emergent consults in between cases.  Sign-out rounds occur in the afternoon.  The residents take home call, but may go back into the hospital for consults or emergency cases during the evening.  The residents attend neurosurgery morbidity and mortality conference and series of didactic lectures (every Friday morning) at University of Southern California.  They also attend tumor board, a combined neurosciences case presentations at CHLA. 

The remainder of the 9 months is spent on the clinical neurosurgery services at Cedars-Sinai on subspecialty rotations.  12 months of required clinical neurosurgery occur during the PGY3 year.

During this year, the resident is expected to attain a set of objectives and essential skills. For a description of these skills, click here

Year 4 (PGY 4)

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

The PGY-4 resident rotates through all of 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.  During the PGY-4 year, 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 proposal, which is typically expected to be 10 to 20 pages in length, is evaluated by the educational committee and subspecialty faculty. If approved, the proposal will be the basis of their research year.  There are nine months of clinical neurosurgery and three months of electives during the PGY-4 year.  The PGY-4 is expected to participate in the faculty outpatient clinics at least twice a week as well as the resident clinic.  The PGY-4 continues to attend all of 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. For a description of these skills, click here

Year 5 (PGY5) - Research Rotation

The PGY-5 year of training is dedicated to the pursuit of an appropriate research project as well as attainment of the skills necessary for a successful academic career.  The PGY-5 resident spends the entire year on research.  During this year they will participate in a formal didactic set of lectures and conferences at CSMC as part of the biomedical sciences curriculum developed for PhD students.  This includes a series of didactic lectures, seminars, and classic course work that provides instruction in biostatistics, grant writing, and the basics of clinical trial design.  The resident will also have the opportunity, if interested, to participate in seminars at UCLA and CSMC focusing on clinical trial design.  Furthermore, residents will continue to accrue knowledge of the basic and clinical neurosciences relevant to their research project and the practice of neurological surgery. They will apply knowledge of study designs and statistical methods to their own research and to their review of the literature. The resident will be asked on occasion to provide call coverage for residents who are on vacation.  He or she will not be responsible for any other clinical activities during this time.

During this year, the resident is expected to attain a set of objectives and essential skills. For a description of these skills, click here.

PGY 6 - Senior Resident Rotation

The PGY-6 resident is considered the senior resident.  They will rotate on the subspecialty services with six months on the Blue (tumor/functional) service, and the remainder of the time on the Gold and White services.  In this year, the resident takes backup home call on some weekends to relieve the chief resident.  During this year, the senior resident first assists on more complicated tumor, pediatric, vascular and/or spine cases that are not covered by a chief resident.

During this year, the resident is expected to attain a set of objectives and essential skills. For a description of these skills, click here

PGY 7 - Chief Resident Rotation

The PGY-7 year is the chief resident year.  

The chief resident is primarily responsible for the academic teaching service, operative case scheduling, assignment of duties to residents and medical students, and plays a major role in the development of didactic lectures on Academic Day.  The chief resident is in direct communication with the attending neurosurgeons, but is responsible for the majority of patient management, and may designate authority and liability as necessary and appropriate to lower level residents.  The chief resident is aware of the progress of the residents, and along with the attending neurosurgeons, is responsible for the supervision of each operative case, encouraging and allowing participation as assistants in increasingly more difficult cases, and as surgeons in simple cases.  The chief resident is given preference for selection of operative cases.  The Chief Resident’s clinical experience includes performing the majority of the complex surgeries on the neurosurgical service.  These include craniotomies for tumors and vascular disorders, spinal procedures for degenerative, vascular and neoplastic spinal diseases and complex neurointerventional procedures. The Chief Resident performs these surgical procedures supervised by an attending surgeon in a progressive fashion.

The Chief Resident also serves as a resource for the on-call resident for emergent and non-emergent patient care issues along with the attending surgeon on-call.  The Chief Resident’s administrative responsibilities include supervision and organization of the weekly teaching conferences and coordination of quality assurance and other clinically related conferences. Other responsibilities include supervision of the junior residents, overseeing the daily activities of the residents’ schedule and assignments under the direction of the Program Director, and overseeing the Chief Resident Outpatient Clinic where he or she will evaluate patients, order appropriate studies and provide follow-up care.  The residents, including the chief resident, are at all times supervised by faculty of the academic teaching service.

During this year, the resident is expected to attain a set of objectives and essential skills. For a description of these skills, click here

Evaluations

The program director meets with residents bi-annually on clinical rotations individually to review their progress, evaluation and publications.