Goals

Objectives

Progression

Patient Care

  Evaluation
  Planning
  Treatment
 
 

Become proficient in the comprehensive neurosurgical history and physical examination.  Interpret diagnostic imaging studies with neuroradiology fellows and attendings.  Perform initial stabilization and management of critically ill ICU and emergency room patients.  Develop basic operative technical and intraoperative decision making skills.  Perform twice daily rounds and sequentially follow patient progression from admission through treatment until hospital discharge.
Develop outpatient clinic and decision-making skills.

Progress is expected in critical patient evaluation, assessment of laboratory values, interpretation of diagnostic imaging, treatment alternatives and basic operative skills.
Residents are expected to take an increasingly active role in interpreting complex patient presentations, and planning for their care, as well as executing established plans independently.

Tools:  Senior resident feedback, Bi-annual evaluations with residency director, Surgery Biopsy Tool, event reporter

Medical Knowledge

Standard texts

Literature searches

Participate in daily teaching by senior residents during work rounds (case directed learning)
Read standard neurosurgery texts and landmark articles
Present at required weekly teaching conferences and incorporate current literature reviews
Sit for the neurosurgery board examination each year

Progress is expected in knowledge of medical literature as demonstrated in teaching rounds, conferences, primary examinations and patient care.

Tools:  Primary Examination for self assessment, resident presentations

Practice Based Learning & Improvement

  Portfolio
  Outcome

Track procedures, operations, and outcomes in a centralized database.  Conduct frequent interactive presentations before the faculty and senior residents.  Learn operating skills through constant attending and senior resident feedback during procedures.  Plan research activities and write grant applications.

Conference presentations designed to increase a resident’s depth of knowledge in critical topics will be regularly assigned.  These items along with publications, grant applications and reviews will be  added to the residents portfolios

Residents are expected to assume an increasingly active role in the operating room and in designing patient care plans.

An expanding base of knowledge is expected and the critical elements of this experience will be securely preserved for the residents.

Tools:  Conference presentations, Portfolio updates, publications

Interpersonal  & Communication Skills

  Rounds
  Sign out
  Conferences

Foster communication between all members of the patient care team by sitting at the center of complex interpersonal relationships
Manage relationships with patients, families, attendings and all levels of hospital staff
Present clinical data at daily work rounds, conduct weekly formal presentations for attendings, and present research findings at departmental grand rounds each year
Residents will work effectively in this complex environment of patients, families, and multiple levels of health care professionals.
Residents will effectively present cases in rounds and other venues, e.g., presenting case or clinical change to attending. They will present and receive critical information upon arrival and departure for duty hours.  They will prepare and present regularly at major departmental teaching conferences.

Residents are expected to improve interpersonal skills through constant introspective assessment, web-based modules, and management feedback.  Residents are further expected to learn to manage interns as they would their junior team during senior residency.
While training is provided by the institution in sexual harassment, diversity, and HIPPA, respect and humanistic interactions with patients are essential.  Effective communication is critical to learning and patient safety.

Tools:  360 degree evaluations, event reporter, Press-Ganey, patient questionnaires

Professionalism

Maintain a professional demeanor under stressful circumstances during clinical, research and educational activities.
This will be a critical theme in most interactions in this institution additionally conferences and lectures will periodically address ethics as the major topic.

Performance and progress will be noted on frequent evaluations.

Tools:  Bi-annual evaluations, 360 degree evaluations, event reporter, patient questionnaires

Systems-Based Practice

Junior residents are monitored as a part of ongoing systems-based practice initiatives
Senior residents and attendings mentor junior residents with their broader perspective of system-based practice

Residents are expected to appreciate the value of system-based practice and learn to study, improve, and contribute to the system.

Tools:  Bi-annual evaluations, 360 degree evaluations

Progressive responsibility:  As with all medical and surgical training, neurosurgical residency is built on junior residents slowly assuming small degrees of increasing responsibility as they demonstrate broader and deeper skill sets.  Intrinsic to this model of education is mentorship.  At the junior resident level this mentorship translates into a lifelong relationship with one’s chief and senior residents who most closely and frequently supervise early education.  Junior residents are critical to the successful functioning of our busy service; they must quickly learn to integrate substantial knowledge with new clinical skills while navigating the complex environment of a large academic teaching hospital.  Residents learn to effectively communicate relevant portions of clinical situations by first discussing cases with senior residents;  they function as extensions of their more senior counterparts by collecting data, synthesizing information and proposing solutions.  Two junior residents at Yale-New Haven Hospital work in concert with each other by splitting these clinical, educational, and operative activities. 
There follows in 3-month blocks rotations based at the WHVAMC and YNHH.  For this year there is a weekly continuity clinic, a day weekly at the Gamma Knife Center while at the VA, and Increased operative and non-operative patient care responsibility.  Major conference presentations are largely the responsibility of the resident assigned to YNHH but the resident at the VA attends all conferences at YNHH.  Residents in this interval will also develop research plans, prepare grant applications, and read for the primary examination.  Further detail is provided in sections below.
Teaching is a critical component of progress throughout the Program for all levels.  Students provide feedback through *EValue.