PGY 2
The academic teaching service at Cedars-Sinai is divided into three separate rotations: Gold, White and Blue. The attending physicians on the Blue rotation focus primarily on neurosurgical oncology and functional neurosurgery (Black, Chu, Yu, Mamelak, Patil and King). The attending physicians on the Gold rotation focus primarily on pediatrics and vascular (Schievink, Alexander and Danielpour). The White rotation attending physicians make up the spine service (Johnson and Baron). From PGY-2 through PGY-6, the residents rotate through each of these services as junior and senior residents.
During PGY-2, the resident spends the first six months in neurocritical care and neuroconsult, followed by three months on the spine service and then three months on the vascular/pediatric service. The resident acquires 12 months of clinical neurosurgery experience during this time.
A typical PGY-2 day on the neurocritical care and neuroconsult service starts with pre-rounds in the intensive care unit at 5 a.m. Rounds start at 6 a.m. in the neuroscience intensive care unit. Imaging studies from the previous night are reviewed with the team led by the chief resident. Formal rounds are made to all the patients on the neuro-ICU service, and residents then create and review a tentative plan of care with the chief resident. After rounds, residents on the subspecialty rotations head to the operating room or respective outpatient clinics, while the PGY-2 resident completes any outstanding clinical responsibilities with the help of the physician assistant and nurse practitioner. At 8 a.m. 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 physician 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, and attends all didactic lectures, and conferences in the Department of Neurosurgery.
During the second six months of PGY-2, the resident rotates through two subspecialty rotations: White and Gold. The typical day involves rounding with the rest of the team, followed by reviewing the patients with the attending physicians on the rotation. The resident then heads to either the operating room or the outpatient clinics to meet the assigned attending physician and the attending's patients.
The resident on the White rotation is expected to attend the Spine Conference weekly, 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, the resident is expected to attend faculty outpatient specialty clinics as assigned by the chief resident.
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 comprehensive neurosurgery history and do a physical examination
- Understand when to order presurgical laboratory studies and imaging and what the results of such studies mean in the context of treatment
- Develop and implement appropriate care plans in consultation with the chief resident or attending surgeon
- Counsel patients on the risks, goals, limits and alternatives to both simple and more complex neurosurgical procedures, supervised by the chief resident or attending surgeon
- Perform selected surgical procedures (e.g., ventriculostomies, VP shunt placement, simple craniotomies) under direct supervision of chief resident or faculty
- Assist in major surgical procedures and perform, under supervision, portions of such procedures that are appropriate for his or her level of training.
- Work with other health care professionals on the neurosurgery team and health care professionals from other disciplines who are involved in a patient's care
Medical Knowledge
The resident will develop the ability to:
- Perform above the 10th percentile on the American Board of Neurological Surgery primary examination
- Demonstrate a solid foundation of knowledge of anatomy, physiology and pharmacology related to inpatient neurosurgery patients
- Correctly interpret basic laboratory and radiological studies
- Demonstrate increasing familiarity with classic and current aspects of the neurosurgical literature
- Demonstrate a foundation for clinical neurosurgery problem-solving and decision-making
Practice-Based Learning and Improvement
The resident will develop the ability to:
- Demonstrate an ongoing and improving ability to learn from errors
- Locate, appraise and assimilate evidence from scientific studies related to common neurosurgical problems
Interpersonal and Communication Skills
The resident will develop the ability to:
- Provide compassionate care, as determined by patients, families, colleagues and auxiliary health professionals in wards and outpatient settings
- Work effectively as a member of a healthcare team
- Communicate effectively with other healthcare professionals on consulting services
Professionalism
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 meetings
Systems-Based Practice
The resident will develop the ability to:
- Advocate for quality patient care and assist patients in dealing with system complexities
- Practice cost-effective health care and resource allocation by using evidence-based medical practice that does not compromise quality of care
Have Questions or Need Help?
Contact us if you have questions or would like to learn more about the Neurological Surgery Residency Program at Cedars-Sinai.
Cedars-Sinai Department of Neurosurgery
127 S. San Vicente Blvd., Suite A6600
Los Angeles, CA 90048