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Training Program
The Neurosurgery Residency Training Program at The George Washington University is committed to the education of medical students and residents. The Neurosurgical Residency is a 5 year program designed to train physicians in the clinical practice of neurosurgery, including the operative and non-operative management of disorders of the nervous system, and to mentor young physicians in the science of neurosurgery. The program is structured to prepare the resident for the science and practice of neurosurgery as defined by the American Board of Neurological Surgery.
The Neurosurgery Residency Program at The George Washington University strives to combine training, education, and research to produce a well-rounded experience for its graduates.
The training component consists of the clinical practice of neurosurgery which encompasses the out-patient evaluation of patients with neurological disorders, the in-patient management of critically ill neurosurgical patients, and the operative treatment of diseases of the nervous system. The training program consists of four hospital sites. These sites provide both outpatient and in-patient clinical experience. The hospitals making up the core of this training program are The George Washington University Hospital (GWUH) under the direction of Anthony Caputy, MD, the Inova Fairfax hospital (IFX) under the direction of Anthony Caputy, MD, James Ecklund,MD, and James Leiphart, MD, the Children’s Hospital National Medical Center (CHNMC) under the direction of Robert Keating, MD, and the National Institute of Health (NIH) under the direction of Russell Lonser, MD, and John Heiss, MD.
The educational component of the Residency Program in Neurosurgery is structured around a didactic core curriculum as outlined below. Participation in these conferences is mandatory.
Each resident is expected to pursue clinical or basic research projects, as part of the research component of the residency program. The resident may elect to do a fellowship year at the NIH in a rotation outside of the 5 year training program commitment.The first resident in Neurosurgery at George Washington University was Jonathon O. Williams in 1940. Since that time over 100 Neurosurgeons have finished the program.
The current Neurosurgery training program at GWU is a 6-year program following internship. The clinical neurosurgical services are centered at George Washington University Hospital (GWU), Inova Fairfax Hospital (IFX), The National Institutes of Health (NIH), and the Childrens National Medical Center (CNMC). Standing electives exist in Neurology, Neuropathology, Neuroradiology, and in the Ammerman Microsurgical Laboratory. Other electives to expand or diversify training are also encouraged. Below is a schedule of training based on each year of time spent in the department. However there is flexibility in the schedule to accommodate individual interests and career goals.
PGY 2-NS1, first year neurosurgery resident
The first neurosurgical year is the foundation of all subsequent training. The rapid acquisition of a fund of didactic information as well as basic clinical skills is essential. The first neurosurgical-training year involves a significant amount of non surgical time involved with patient care and didactic lectures. In addition, there is the initial exposure to the operating room and surgical techniques. The resident will participate in outpatient clinics.
The NS-I resident is involved in the day-to-day management of the inpatient service including the management of critically ill ICU or trauma patients. This resident has the primary day-to-day responsibility for the care of the in-house, pre and postoperative patients. The resident manages the patients in the ICU, and under the direction of the chief resident and the Neurosurgery attendings. This resident also acts a liaison between the Neurosurgery Service and the other services that are involved in the care of the Neurosurgery patients. The resident will have frequent interactions with the neuro-intensivist and is directly involved with the multidisciplinary discharge planning rounds.
The resident is charged with gathering information and organizing patient care data.
The NS-I resident must rapidly develop confidence in the basic physical examination and details of the neurologic exam. He/she must collect information on the patients and be able to prioritize the implementation of therapies based on each patient's severity of care, and level of need. The resident must be able to anticipate potential complications and respond in a timely and effective manner to any complication. The resident is closely supervised and must present the gathered information to the chief resident or the attending, who will confirm his / her diagnosis and will support or amend his / her management plans.
This resident year exposes the resident to the outpatient evaluation of neurosurgical patients and the inpatient evaluation of consultations both on the non-neurosurgery service and on the emergency room patients.
The resident will become familiar with the practice of neurosurgery and begin to develop professional and communication skills as he/she learns to evaluate, instruct, or counsel the patient and the patient's family. The resident will develop a sense of continuity from the preoperative to the postoperative follow-up. He/ she will begin to define outcomes, and to develop evidence-based techniques to help improve patient outcomes. The first-year resident will participate in operative neurosurgical procedures in order to develop a familiarity with the techniques of operative neurosurgery. He /she will often serve as a second assistant to the chief resident or the attending neurosurgeons. As the resident becomes more experienced, he/she will become the primary resident on basic cranial or spinal procedures under the direct supervision of the attending.
PGY3-NS2, second year neurosurgery resident
In this second neurosurgical year, the clinical and surgical skills developed in the first year are refined and improved upon by greater exposure to more complicated neurosurgical cases.
The resident will participate in outpatient clinics.
To solidify the resident's knowledge, he/she will have a greater role in the medical student teaching. Research interest should be identified and plans for a project during the research year should be initiated.
This year will solidify the patient management skills acquired in the first neurosurgical year. The resident in this year should be fully adept at developing a differential diagnosis, interpreting laboratory and imaging data, developing a well defined and organized action plan for each patient's care. The ability to anticipate, identify, and act on neurosurgical emergencies or complications should be second nature to this resident. This resident should be able to assess and organize all patient information and to use evidence-based principles to formulate sound treatment plans that improve patient outcome.
The resident should be able to identify personal strength and limitations with the attendings' input and supervision. He / she should be able to set learning and improvement goals by incorporating new data from the literature and outcome data into the daily care of the patients.
In this year the resident has a more senior role and should have firmly established his/her position as a member of the Neurosurgery team and should develop an effective and collegial working relationship with the other clinical services including the ICU, Emergency Room, Nursing and Social Services. Outpatient activities are required, and the resident should keep precise patient records, and keep current and accurate dictations.
In this year, the resident takes a great role in the education of the patients, the patient's families, medical students and other health professionals.
The resident becomes more active in organizing the conferences and journal club topics. He/she develops a greater understanding of the impact of evidence-based practice on outcome and learns to critically evaluate the medical literature. An understanding of study designed and statistical methods are necessary. The resident in this year through the participation in the multidisciplinary rounds and structured hospital committees begins to understand the larger healthcare issues including risk benefit analysis, cost awareness and limitations of resources. The resident will evaluate the patient's options and alternatives, discussing them with the attending; and then formulate the safest most effective treatment plan for each individual patient.
In addition to increased patient care and administrative responsibilities, the resident in this year progresses in the operating room. This resident is given more primary surgical responsibility and has exposure to more complicated neurosurgical cases. Under the supervision of the attending faculty member, the resident should become familiar with degenerative spine surgery and cranial and spinal trauma surgery, tumor surgery, and nonsurgical management of neurosurgical disease and trauma.
PGY-4 year: Research Year
After two clinical years in Neurosurgery, the resident now embarks on a research year. The resident is expected to pursue a clinical or basic science project and may elect to do this at the National Institutes of Health (NIH). The resident develops a research protocol and pursues a formal basic lab investigation under the faculty members at the Surgical Neurology Branch of the NINDS at the National Institutes of Health.
In addition the resident becomes involved in the outpatient service at the NINDS, and the associated clinical research protocols. The resident develops a more complete understanding of study design and statistical methods (practice based learning and improvement). This enhances the resident's educational experience allowing him/her to develop a more critical method of analyzing the medical literature and applying that learning to patient care.
PGY5-NS3, third year neurosurgery resident
This third year neurosurgical resident will refine his/her clinical and surgical skills. This involves a rotation at the National Institute of Health.
The resident in the Neurosurgery-3year has completed two years of clinical core work and one year outside the five-year program requirements doing research at the NIH. The first six months of the year are spent on a clinical elective at the National Institutes of Health. The resident is exposed to the outpatient and inpatient management of complex neurosurgical disease processes. A protocol driven format allows the resident to experience the processes of going from basic laboratory design to clinical protocol and thereby observing the outcome of this activity. Specialized surgeries are done at the Surgical Neurology Branch at the National Institute of Health including tumor surgeries, surgery for Von Hippel-Lindau, syringomyelia, epilepsy and movement disorder surgery.
Following that six-month rotation, the resident has elective time on neuroradiology/interventional neuroradiology and may pursue elective work in the Ammerman Microneurosurgical Lab or on a clinical pathology rotation in Neuropathology with Dr. Robert Jones.
Neuroradiological presentations are incorporated in the weekly academic conferences.
A three month rotation for residents as an elective in interventional neuroradiology is available under the supervision of Dr. Christopher Putman at Inova Fairfax Hospital (IFX). At the George Washington University, angiography and interventional cases are being integrated within the service as a whole with the cases being assigned daily, as are the cases in the operating room. These cases are under the direction of Dr. Vivek Deshmukh. Dr. Deshmukh is a full time faculty member at George Washington University and at Inova Fairfax Hospital, he has subspecialty clinical interest in cerebrovascular surgery and interventional endovascular neurosurgery. The residents participate both in the interpretation of neurodiagnostic studies, and in specialized procedures (interventional radiology). They also present case-review studies in the Radiology and Neurosurgery Department.
During this year the resident has senior level service responsibility at the NIH, and night call responsibility .
PGY6-NS4, fourth year Neurosurgery resident
This fourth year Neurosurgery resident serves at a senior level resident at Inova Fairfax Hospital. On this rotation, he/she assumes the highest level of responsibility functioning as a chief resident at that hospital. It is at Inova Fairfax that he has exposure to a large number of spinal and cranial trauma cases and vascular neurosurgical patients. In addition there is a large inpatient pediatric service. There is a high degree of multispecialty interaction among the various services including the trauma surgeons, intensivist, neuroradiologist, neurologist and interventional neuroradiology and vascular and endovascular neurosurgery. The resident must hone his/her communication skills to effectively educate the patients and the patient's family members. Also, this resident must maintain ongoing communications with other physicians and health professionals caring for the neurosurgery patients. The Fairfax community is a large, diverse and multicultural. English is often not the primary language of the patients admitted to the hospital. The resident must become sensitive to the diverse culture and become cognizant of the various systems in play within the hospital and the community to work effectively with other agencies to coordinate the patient's care within the health system. He must be the patient's advocate practicing effective and resource-efficient care across the various systems to care for each individual patient. He will have administrative duties to coordinate the junior residents' surgical and outpatient activities. He will supervise the junior residents' management of the inpatients, operative and the postoperative patients.
This NS4 resident will coordinate the educational activities for this service providing the support to the faculty moderators for the various clinical teaching conferences. Although, he has senior status and supervises and directs the care on the service, he will maintain a close communication with attending faculty and remain under their supervision. He will achieve the highest level of responsibility in the operating room under direct supervision of an attending faculty member. For the second six months, this resident will have a clinical elective experience at the Children's National Medical Center (CNMC). While there, he will be exposed to a wide variety of pediatric cases including trauma, tumors of the brain and spine, seizure surgery, CSF diversion, and spinal dysraphism. The resident will be under the direct supervision of the attending faculty for all outpatient, inpatient, and surgical activities. The resident must become sensitive to the special needs of the pediatric population and the needs of the patients' parents and family, and demonstrate compassion. The resident will have responsibility for the clinical service and gather the information data for review by the attending faculty. The attending faculty will directly supervise the resident’s patient care activities. As a resident's clinical judgment and clinical skill mature, the level of clinical responsibility, and the intensity of the operative experience will be expanded by the supervising faculty.
PGY7-NS5, fifth Neurosurgical year
The chief resident year encompasses the highest degree of independence and the most responsibility. The chief resident is responsible for the smooth function of the inpatient service. The chief resident will maintain an outpatient clinic with continuous responsibly for the patients seen in that clinic. The chief resident has administrative duties for running the clinical service and coordinating portions of the educational program. The chief resident will have responsibility for educational matters including grand rounds, visiting professor conferences, and journal club. The chief resident is responsible for maintaining an accurate log of the statistics for the service including admissions, consults, surgical procedures, discharges, and mortality and morbidity. The chief resident also directs the other residents in the education of the medical students.
The chief resident has the highest level of responsibility for managing the Neurosurgery Service and is second to the attending faculty for the patient's care.
The chief resident progressively assumes more independence in the diagnoses and management of neurosurgical diseases.
The chief resident is a role model for the more junior residents and students.
The chief resident conducts daily work rounds on all neurosurgical patients. These rounds are separate from the other attending or teaching rounds. The chief resident supervises the pre- and post-operative care of the neurosurgery patients and assigns the junior residents' duties. In the operating room, the chief resident acts as a primary surgeon and the first assistant to the attendings, or as primary surgeon giving instructions to more junior level residents. The chief resident directs the immediate postoperative care in the ICU.
The chief resident is a primary backup to the on-call resident. In that role, the chief resident reviews all admissions and consults. He/ she makes decisions, with attending input, regarding patient management for both elective and non-elective cases.
The chief resident also has primary outpatient responsibility in a continuity clinic. The chief resident makes the initial evaluation, organizes the workup, and determines the plan, and directs the ongoing care of the patients. The chief resident's administrative responsibilities include compiling patient statistics, and presenting selective cases at the monthly Mortality and Morbidity Conference. In addition, the chief resident assists attending in the teaching and in the evaluation of the medical students and in directing journal club assignments and organizes selective teaching conferences.
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