• Neuro-Oncology
• Neurovascular
• Pediatrics
• Spine
• Functional/Stereotactic
• VA
• Research

The duties of the residents in each year
Duties have been listed by area in terms of the educational curriculum of the Program

Neuro-Oncology

The neuro-oncology curriculum is based on knowledge and performance objectives divided into junior, senior and chief resident sections. Learning is intended to be cumulative with increasing responsibility over the period of training.

Junior Resident  (PGY 2, 3)

Knowledge Objectives

1. Understand the epidemiology, natural history, common locations and incidence of primary brain tumors including hereditary syndromes.
2. Understand the basics of tumor biology including proliferation, invasiveness and vascluarization.
3. Describe the important MRI and CT findings for the differential diagnosis of primary brain tumors.
4. Understand the principle histological findings that characterize different gliomas and the criteria for astrocytoma grading.
5. List the common metastatic tumors that are found in the CNS according to their frequency.
6. Describe the more common locations and characteristics of meningiomas.
7. Understand the orientation of cranial nerves entering the cavernous sinus, internal auditory canal and jugular fossa.
8. Describe the origin of craniopharyngiomas and Rathke’s cleft cyst.
9. Understand the clinical presentations for pituitary tumors including hormonally active and inactive lesions.
10. Describe the appropriate use of medications for brain tumor surgery including steroids, mannitol, antibiotics and hormone replacement.
11. Become familiar with hospital-based information systems utilized for patient care.

Performance Objectives

1. Demonstrate competency in performing a history and physical examination on a patient with a brain tumor.
2. Prioritize the findings on the history and physical exam and communicate these with senior residents and faculty.
3. Maintain professional conduct with staff, families and other residents.
4. Understand the salient features on MRI and CT that differentiate between primary and metastatic brain tumors as well as intra-axial and extra-axial lesions.
5. Understand the variations in patient positioning for brain tumor surgery.
6. Demonstrate competency in opening and closing craniotomies as well as placing lumbar drains and intracranial pressure monitors including ventriculostomy.
7. Assist in performing stereotactic brain biopsies.
8. Write clear informative notes in the patient’s chart that reflect important clinical priorities.

Senior Resident (PGY 6)

Knowledge Objectives

1. Describe the appropriate preoperative workup for a patient with a primary brain tumor or a metastatic brain tumor.
2. Understand the common clinical signs and symptoms of a patient with a brain tumor and how they influence the differential diagnosis.
3. Describe the important clinical signs and symptoms for patients that require emergency intervention for a brain tumor.
4. Explain the rationale for selection of an operative approach for supratentorial and posterior fossa tumors.
5. Demonstrate the external landmarks used for intracranial surgery including the pterion, asterion, and inion and how to localize the superior sagittal sinus, transverse sinus and sigmoid sinus.
6. Describe the operative approaches for tumors of the lateral and third ventricles.
7. Understand the appropriate preoperative imaging studies for tumor surgery and demonstrate understanding of interpretation of these studies
8. Understand the techniques utilized for intraoperative brain relaxation.
9. Describe the appropriate postoperative management of a patient after supratentorial and posterior fossa tumor surgery including the relative risk factors and how to minimize complications and the appropriate use of adjuvant therapy.
10. Understand the signs and symptoms of meningeal carcinomatosis.
11. Understand the indications for stereotactic brain biopsy vs. resection for a brain tumor and how to select an optimal target for biopsy.

Performance Objectives

1. Assist in the operative resection of intra-axial and extra-axial brain tumors.
2. Perform stereotactic brain biopsies.
3. Demonstrate facility with the use of surgical instruments including the operating microscope.
4. Demonstrate the ability to identify the interface between the tumor and the brain and how to use this for tumor resection.
5. Demonstrate the ability to properly identify anatomic landmarks, primary motor, sensory and language regions of the brain, cranial nerves and major arterial and venous structures.
6. Show how to minimize and control intraoperative bleeding from the tumor and how to achieve brain relaxation.
7. Maintain a record of surgical experience with brain tumors and utilize this experience to improve patient outcome.

Chief Resident (PGY 7)

Knowledge Objectives

1. Discuss the appropriate use of intraoperative techniques for SSEP and motor and speech mapping.
2. Describe the techniques for establishing surgical goals for patients with brain tumors.
3. Establish treatment plans for patients with brain tumors including the criteria for selecting patients for surgery vs. radiosurgery.
4. Understand the surgical options for accessing tumors in the CPA and suprasellar region.
5. Illustrate the various options for skull base surgery including tumors of the anterior fossa, middle fossa and posterior fossa.’
6. Describe the risk factors for and techniques used to treat CSF leaks.
7. Describe the common genetic mutations associated with gliomas and how they relate to treatment and prognosis.
8. Describe the relative risk of morbidity and mortality for low-grade and anaplastic gliomas.
9. Describe the significant factors that influence the risk of transformation from a low-grade to a high-grade glioma.
10. Understand the appropriate role of arteriography, endovascular embolization and carotid occlusion in the management of brain tumors.
11. Demonstrate competency in educating junior and senior residents about surgical treatment of brain tumors.
12. Demonstrate competency in communicating with brain tumor patients and their families.

Performance Objectives

1. Demonstrate the capability to function independently in all aspects of brain tumor surgery, including supratentorial and infratentorial, intra-axial and extra-axial tumors.
2. Demonstrate knowledge of how normal anatomical structures are displaced by tumors and how this impacts on surgical treatment.
3. Carry out complex treatment plans for complicated brain tumor patients, including an understanding of contingency options when surgical problems arise.
4. Demonstrate competency as first assistant in resection of skull base tumors.
5. Establish management strategies that provide compassionate but efficient care for brain tumor patients.
6. Show the ability to teach junior residents appropriate surgical techniques.
7. Demonstrate appropriate postoperative care of brain tumor patients including the appropriate use of consultation from Radiation Oncology and Medical Oncology.
8. Communicate effectively regarding treatment and anticipated outcome with patients and their families including end of life care.
9. Interact with other physicians and residents in a professional manner.

Neurovascular Resident Educational Objectives

Pediatric Neurosurgery

Curriculum

Pediatric Neurosurgery is an integral part of all clinical rotations at Yale with the senior resident having the most prominent role in this area.  Pediatric case account for approximately 20% of the operative case volume of the Department and >30% of the inpatient service.  While Dr. Duncan is the Chief of Pediatric Neurosurgery a considerable number of the Epilepsy cases are in children.  When Dr. Duncan is away the General Neursurgery Attending covers Pediatrics according to the Call Schedule.  Eileen Ogle is the P.A.-C for Pediatrics. 

The three irreverent rules for pediatrics are, the mother is always right, it’s always the shunt (Itzak’s Rule), you’re better off learning how to talk to pediatricians than memorizing Harriet Lane, and if you or I annoy a pediatrician we’ll all pay for it for three months.

The goals for junior residents are, learn to take appropriate histories with emphasis on development and recognition of the critical role of mechanism of injury whenever non-accidental injury is potential, learn age appropriate interactions with children including establishing rapport, history, expected skills across development, and examinations, learn the necessity for close monitoring and reevaluation in the infant or child with a central nervous system disorder, begin to understand the differences in physiology across age groups in the young and the influence of neurosurgical interventions on them, begin to understand the spectrum of central nervous system diseases and disorders in the young which are extensive and complex begin to master an approach to frequently presenting problems including hydrocephalus, trauma, IVH in the premature infant, raised intracranial problems, congenital spinal anomalies, craniosynostosis, develop and understanding of the laboratory studies required to evaluate infants an children develop an understanding of the diagnostic imaging for them as well. learn to tell and write a clear, succinct summary for consults, inpatients and progress, engage the pediatricians in the care of our pediatric patients – you will both learn a great deal,
look at everything yourself, do your own examinations, our system works  lot better if we don’t propagate each other’s errors report anything to the attending without delay – believe it or not – attendings can be helpful and contribute to your education and even occasionally make a difference in care, and, enjoy the kids – they’re nice people.

Finally, you need to have a clear goal to write and publish; not just in pediatrics but pediatrics provides an excellent forum to consider.  Many of the cases you see will be sufficiently unusual to merit reporting and our colleagues in neuroradiology, neuropathology, neuro-oncology, pediatrics, plastics and pediatric surgery are delighted to help.  Additionally, trauma has one of the finest longitudinal databases in the institution.  

The goals for Senior Residents are quite simply to run the pediatric service.

In order to do this along with Chief Resident coverage, other case assignments, teaching, managing NICU patients – all within 88 hours – requires a great deal of knowledge, thoughtful efficiency and help.

[by Michael Stoffman, M.D.]

Attend clinic and  evaluate children with history/physical exam. Review imaging and formulate plan with Dr. Duncan.

Review pediatric neurosurgery consults with Junior residents and assess children where appropriate.

Daily rounds in Newborn Special Care Unit, Pediatric ICU and pediatric wards. Interact with nurses, pediatricians, pediatric intensivists and surgeons regarding patients. Each patient discussed with Dr. Duncan at least once daily.

Review patients to be presented at monthly Morbidity and Mortality conference.

Increasing responsibility in surgery for pediatric patients including preoperative assessment, positioning, exposure, operation, closure for following procedures:

1. CSF diversion – VP, VA, ventriculopleural, shunts etc.
2. Cranioplasty for craniosynostosis
3. Craniotomy for trauma including skull fractures, epidural and subdural hematoma, intracerebral hemorrhage
4. Closure of myelomeningocele
5. Surgical management of lipomeningocele, tethered cord, Dandy Walker malformation, arachnoid cysts
6. Suboccipital craniotomy for Chiari Malformations and associated syrinx
7. Craniotomy for posterior fossa  and supratentorial tumor
8. Endoscopic surgery including endoscopic third ventriculostomy, fenestration, cyst resection
9. Closed and open reduction of atlantoaxial rotatory subluxation and cervical subluxation
10.  Halo application
11.  Surgical management of cervical, thoracic and lumbar spine fractures

SPINE
Spine surgery residency competency

Junior resident

From a clinical standpoint the junior level resident is expected to assess in an effective fashion clinical signs and symptoms associated with spinal disorders.  This clinical assessment incorporates the history, neurological examination and the formulation of appropriate diagnostic modalities necessary to diagnose and treat patients with spinal ailments. Through comprehensive lectures focusing on the anatomy, radiology and biomechanics of the spine the JR will acquire the basic knowledge to achieve the aforementioned goals. In-services will expose the JR to the multitude of spinal instrumentations and their appropriate utilization, spinal orthotics, and placement of halos.   In addition, the JR will be responsible in conjunction with the chief resident and the ICU team to coordinate and implement a comprehensive treatment plan for patients suffering from spinal cord injury beginning from ER management to traction, close reduction, and cardiopulmonary stabilization. 

The operating room experience will consist of a gradual process understanding the basic surgical anatomy while performing lumbar and cervical discectomies and laminectomies.  This step is critical since the majority of these patients have severely distorted anatomy from extensive arthritic changes.  By the end of the rotation it is expected that the JR is able to perform a non instrumented decompressive procedure with minimal supervision as a stepping stool for the VA rotation.

Research Experience

he research experience is tailored by the individual resident.  There are many resources available for the residents that explore many aspects of spine (biomechanics) and spinal cord injury related research.   There is a close collaboration between the neuroscience community and the department of orthopedics enabling the resident to choose from a wide variety of research topics.  Under the supervision of a laboratory mentor a focused and realistic proposal is formulated with the expectation for publication in peer review journals and presentations at national meetings. 

Senior/Chief Resident

The SR is primarily responsible for managing the pediatric service.  There is considerable amount of opportunity during this year to be involved in all aspects of spine related disorders.  In conjunction with the orthopedic department the SR is encouraged to participate in deformity spine cases in order to obtain a better appreciation of the physio-biomechanical forces required for corrective surgery.  This knowledge acquisition translates directly to the application of corrective forces involved in degenerative scoliosis that is becoming more predominant in our patient population as well as in metastatic lesions and traumatic injuries.  The SR will become more verse in managing complex craniovertebtral junction abnormalities, including degenerative, congenital, acquired (traumatic or postoperative), and metastatic lesions.  By the end of the rotation it is expected that the SR can effectively diagnose, formulate and implement a comprehensive treatment plan that is clinically sound and meets the expectations of the spine program. 

With these skills in place the chief resident is responsible for administrating effectively and facilitating the care of patients with spinal disorders.  The CR is fully independent in coordinating the aforementioned goals and is responsible for tailoring their training to meet their needs and enhance their clinical experience.  The CR is the primary source for guidance to all the residents under the direct supervision of the spine attending. 

Outline - Spine surgery expectations
Junior:    Anatomy:  Radiological evaluation, Neuro examinations, Management of spinal cord injury
                                Surgical:  Laminectomy lumbar, Discectomy cervical and lumbar

Assistant resident:  Biomechanics
VA clinic:Assess patients effectively and develop a plan
Follow up with multidisciplinary approaches to spine
Basic principles of instrumentation and biomechanical construction
Research:  Laboratory options, Presentations in meetings
Senior:  Pediatric spine care;,Craniovertebral junction instrumentation, Master all aspects of instrumentation, 360 approaches in the spine
Chief: All aspect of care and surgery

Functional/Stereotactic

The faculty members involved in functional neurosurgery at Yale include Drs. de Lotbiniere, Chiang, King, Spencer and Vives. The Epilepsy Surgery Program is a well-developed, separate clinical program and is described elsewhere. In addition, there is substantial representation in the Gamma-Knife Program, especially in the treatment of trigeminal neuralgia.

The remainder of this program consists of interventions designed to treat several different entities. These include movement disorders, peripheral nerve injury, trigeminal neuralgia, psychiatric disorders, spasticity and pain. Because of the varied nature of these problems, as well as the relative infrequency of any one particular type of patient, these cases are seen in each individual physician’s clinic. The expected goals of educational development for junior, mid-level and senior residents for movement disorders, peripheral nerve surgery and trigeminal neuralgia are outlined below. The educational goals for the potpourri of other disorders follow a similar pattern.

Junior Residents

Movement Disorders – Identify and distinguish the major types of movement disorders, including Parkinson’s disease, essential tremor and dystonia. Develop a working knowledge of the medical management of each of these disorders. Develop an understanding of the differential diagnosis and possible confounding causes of syndromes similar to these. Perform physical examination of a patient with movement disorders. This is accomplished by a combination of clinical neurosurgery and clinical neurology rotations as well as direct didactic discussions.

Trigeminal Neuralgia – Identify the pain syndrome of trigeminal and distinguish it from other causes of facial pain. Develop a working knowledge of the medical management of this disorder. Develop an understanding of the differential diagnosis and possible confounding causes of syndromes similar to these. Perform physical examination of a patient with movement disorders. This is accomplished by a combination of clinical neurosurgery and clinical neurology rotations as well as direct didactic discussions.

Peripheral Nerve Surgery – Identify the major types of peripheral nerve disorders including trauma, entrapment, neoplastic and systemic disorders. Develop a working knowledge of the non-surgical management of these disorders. Perform physical examination of a patient with peripheral nerve disorders. Develop knowledge of the surgical anatomy involved in carpal tunnel surgery, sural nerve biopsy and sural nerve harvest and assist or act as primary surgeon in these cases.  This is accomplished by a combination of clinical neurosurgery rotations as well as direct didactic discussions. This is supplemented by direct operating room supervision of the care of patients with these disorders.

Mid-Level Residents

Movement Disorders – Building upon the foundation established above, further understand the selection of different targets within the extrapyramidal motor system that can be targeted for surgical intervention. Understand the role of ablative surgery with thermal/radiofrequency lesions and stereotactic radiosurgery and distinguish these from deep brain stimulation (DBS). Develop an understanding of the anatomy and surgical techniques utilized for the stereotactic placement of lesions and DBS electrodes.  This is accomplished by a combination of clinical neurosurgery rotations, direct didactic discussions and direct participation in the operative care of patients with movement disorders at an assistive or primary surgeon level.

Trigeminal Neuralgia – Midlevel residents are expected to further their understanding of the selection of different surgical modalities for the treatment of trigeminal neuralgia, including thermorhizolysis, stereotactic radiosurgery and microvascular decompression. Develop a working knowledge of the surgical anatomy and techniques for thermorhizolysis and stereotactic radiosurgery for trigeminal neuralgia.  This is accomplished by a combination of clinical neurosurgery rotations, direct didactic discussions and direct participation in the operative care of patients with trigeminal neuralgia at an assistive or primary surgeon level.

Peripheral Nerve Surgery – Utilizing the concepts established above, further understand the surgical selection and operative management of brachial plexus injury patients, patients with entrapment neuropathies other that carpal tunnel, patients with reflex sympathetic dystrophy and peripheral neuromas.
This is accomplished by a combination of clinical neurosurgery rotations, direct didactic discussions and direct participation in the operative care of patients with peripheral nerve disorders at an assistive or primary surgeon level.

Senior Residents

Movement Disorders – Using the base of knowledge thus far established, further understand the nuances of placement of lesions and electrodes. Develop an understanding of the electrophysiologic placement of subthalamic nucleus electrodes. Understand the steps to identify incorrectly placed electrodes and correct their placement intraoperatively.  This is accomplished by a combination of clinical neurosurgery rotations, direct didactic discussions and direct participation in the operative care of patients with movement disorders at an assistive or primary surgeon level.

Trigeminal Neuralgia –Further understand the options for surgical failures with trigeminal neuralgia. Develop a working knowledge of the surgical anatomy and techniques for microvascular decompression for different cranial neuralgias.
This is accomplished by a combination of clinical neurosurgery rotations, direct didactic discussions and direct participation in the operative care of patients with trigeminal neuralgia at an assistive or primary surgeon level.

Peripheral Nerve Surgery – Further understand the surgical problems, complications and failures of nerve transfer for brachial plexus injury and the indications for other surgical nerve grafting procedures (i.e. hypoglossal to facial transfers).  This is accomplished by a combination of clinical neurosurgery rotations, direct didactic discussions and direct participation in the operative care of patients with peripheral nerve disorders at an assistive or primary surgeon level.

Framed and Frameless Stereotaxy

The theory and practice of the use of the CRW, Leksell and frameless stereotaxy systems are taught throughout residency. These include cases where this technology is utilized for functional neurosurgery as well as for neoplasm biopsy, stereotactic craniotomy and for the placement of diagnostic electrodes for epilepsy surgery. The methods of registration and the sources of error with the use of these devices are discussed throughout residency.

Research

The department is actively engaged in academic research in the field of functional neurosurgery. In addition to the many basic science areas of research in epilepsy, there is current NIH funding for the development of novel techniques for intraoperative navigation (5R01EB000473-04) and for the use of viral vectors encoding hGDNF for the treatment of Parkinson’s disease (5U01NS046028-02).

VA Resident and Patient Care Guidelines

Patient Care

The VA resident has the primary responsibility during their rotation for VA inpatients, consults, the ED, OR, and clinics. These responsibilities include direct patient care, documentation, and helping to coordinate the VA cross-coverage by other residents. The attendings will not micro-manage the patients. Residents must be proactive and take the initiative to solve patient care problems.

The VA resident must check in daily with the VA neurosurgery attending on call to update them about the service.
To promote continuity of patient care when the VA neurosurgery resident is not in-house and to provide an opportunity for the neurology residents to learn about neurosurgical patients, diseases, and care, all non-ICU and non-stepdown neurosurgery patients (i.e. “neurosurgery floor patients”) will be admitted to the neurology service under the auspices of the neurology attending, and will be cared for jointly by the neurosurgery and neurology services.

Daily weekday joint neurology/neurosurgery rounds on neurosurgery floor patients will be coordinated by the VA neurosurgery resident and the neurology chief resident.

The neurology service will write daily progress notes on neurosurgery floor patients, including on weekends.

The VA neurosurgery resident will write daily progress notes on all neurosurgery floor patients except when the neurosurgery floor patients have been signed out to the neurology service. Neurosurgery floor patients are signed out to neurology under the following circumstances:
Nights – when the VA neurosurgery resident is off duty to fulfill mandatory work hour restrictions

Weekends - when the VA neurosurgery resident is off duty to fulfill mandatory work hour restrictions

Vacation time – when the VA neurosurgery resident is on vacation

Scientific meetings – when the VA neurosurgery resident is in attendance at a scientific meeting (usually AANS in the Spring and CSN in the Fall) or when the neurosurgical training program is shorthanded during national meetings and in-house resident resources are concentrated at Yale

The VA neurosurgery resident should independently review all tests and studies obtained on neurosurgery floor patients.

The VA neurosurgery resident and neurology team will implement the daily care plan together.

Neurology residents will take “1st call” for patient-care issues on neurosurgery floor patients

The neurology resident will confer with the VA neurosurgery resident for all issue of substance. Any issues that cannot be satisfactorily resolved by phone consultation must be resolved by the VA neurosurgery resident at the bedside.

If the VA neurosurgery resident has signed out the service for the night, weekend, meeting, or vacation time off, the neurosurgery Chief resident (or a resident specifically designated by the chief resident) will provide phone consultation and bedside consultation for all VA neurosurgery patients, as needed.

All neurosurgery patients in the ICU or stepdown unit will be on the neurosurgery service.

Daily neurosurgery ICU rounds will be coordinated by the VA neurosurgery resident

A neurosurgery resident will round on and write notes on neurosurgery ICU and stepdown patients every day of the week. On weekends when the VA resident is taking two days off, or during VA neurosurgery resident meeting or vacation time, this will require the neurosurgery Chief resident (or their designee) to round on the VA ICU and stepdown patients and write notes.
Upon transfer out of the ICU or stepdown unit to the floor, patients will be placed on the neurology service.

Some neurosurgery floor patients may not require daily rounds or notes:

Patients without active medical problems who remain hospitalized for social reasons (e.g., receiving outpatient RT at Yale + no transportation from home available = they remain at the VA for 3 weeks) can be administratively “transferred” to “intermediate care” status. Intermediate care patients only periodic require notes and “chart checks”.

Similarly, patients can be sent out on pass overnight or over the weekend (e.g., depart Friday afternoon after RT, return Monday morning before RT). No notes are required while patients are out on pass.

All new VA neurosurgery consults must be seen and documented by a neurosurgery resident. “Phone triaging” of inpatient or ER consults is not acceptable.  During times when the VA resident is scheduled to be off, if the neurosurgery chief resident is not available to see an ER consult in a timely fashion, the Chief resident may decide to enlist the assistance of the VA neurology resident after discussion with the on-call attending.

VA rules stipulate that only residents who have spent time on a neurosurgery rotation at the VA can provide care to VA patients. Thus, neurosurgery residents who have not yet rotated through the VA cannot see consults or provide care for inpatients.

Dr. Chiang and Dr. King will alternate coverage of call, clinic, inpatient care, consults, and OR staffing approximately every two weeks. Consult the VA call schedule to determine the current VA attending on call.

The neurosurgery attending physician is responsible for supervising the care of VA neurosurgery patients, and must be kept “in the loop” about significant clinical events.

When admitting patients to the VA on the neurosurgery service, the VA attending of record must be “in town”. If this is not the case, then the patient should be admitted under the VA on call attending, and transferred to another attending latter, as indicated.

Promptly notify the VA attending on call of any admissions to their service, regardless of the hour.

Attendings should be immediately notified of any significant clinical events that happen to their patients (e.g., change in neuro status, hemodynamic instability, transfer to ICU, etc.).

Notify Dr. King promptly if a patient that he is covering dies, regardless of the hour, even if the patient is DNR and the death was “expected.” Dr Chiang should be notified immediately for any emergencies.   All non-emergent events require notification prior to 8am the next morning.

Non-emergency surgical treatment plans must be formulated under the guidance of an attending at least 24 hours before the scheduled time of surgery. The vA resident must meet face to face with the attending to discuss the impending surgery. To facilitate the discussion, the resident must bring to the meeting:
Hard copies of neuroimages
Printouts of relevant CPRS neurosurgery notes

The VA has strict guidelines for documentation of resident supervision. Residents and attendings will have to work together to ensure that these guidelines are met to fulfill our responsibilities to trainees and patients. The primary form of documentation is attending notes and co-signatures of resident notes (details below).

Call coverage

The VA resident has primary on-call responsibility for the VA. This includes neurosurgery inpatient coverage, inpatient consults, ER consults, and will periodically require returning to the VA after hours for issues that cannot be satisfactorily resolved via telephone or by the neurology resident.

Dr. King will be responsible for recording and distributing the VA call schedule each month. A written or email copy of the monthly VA call schedule will be distributed to the VA resident, VA page operator, Yale page operator, Yale answering service, neurosurgery Chief resident(s), neurology Chief resident, Dr. Duncan, Dr. Chiang, and Dr. King.

The VA resident call schedule will be integrated with the Yale call schedule, in consultation with the neurosurgery Chief resident(s). For each day of the month, the schedule will list the names and beeper numbers for the following:

1st call – VA beeper, usually carried by the VA neurosurgery resident (could be Yale neurosurgery on call resident during 24 hours off each week, or designated neurosurgery cross-covering resident or Yale neurosurgery on call resident when VA resident is away at meetings or vacation)

1st backup call – Yale neurosurgery on call resident (or Chief resident if Yale resident is 1st call)

2nd backup call – Yale neurosurgery Chief resident

3rd backup – VA neurosurgery attending on-call

Any proposed deviation from the publicized VA call schedule must be approved by the VA neurosurgery on call attending and needs to be communicated to both the neurosurgery and neurology chief residents.

Research

The research rotation extends from PGY 2.5 -4.5 and can include a variety of different approaches that will advance the scholarly/academic interests of the resident.  In planning the activities to be pursued during this period, the residents consult closely with Dr. Charles Greer during PGY 1- 2.5 who will help to direct them to appropriate resources, advise on the development of grant proposals and provide approval for the final project.  Also, during PGY 1 or 2 the resident usually attends the RUNN course at the MBL in Woods Hole for a national update on research issues in neurosurgery.  Prior to beginning the research rotation the residents may also attend the annual Yale Neuroscience Retreat where they have the opportunity to meet and talk with many of Yale’s resident  neuroscientists over the course of a long weekend. This experience is also pivotal in helping them to refine their research interests.  Residents will also meet with Dr. Greer, and additional faculty he may designate, at 6 month intervals during the research rotation to help evaluate progress and address any obstacles the resident may encounter.

At the completion of the formal research rotation there is also a 6 month elective period (PGY 4.5 – 5.0) that the resident may use to complete a project, finish manuscripts or transition back to fulltime clinical training.

During the full 24 month research rotation the resident engages in full-time research, or its scholarly equivalent, similar to that being performed by a postdoctoral fellow. The resident pursues an individually tailored research or academic program, under the guidance of the  faculty head/mentor.  The goal of this time is, naturally, to address a series of well defined hypotheses culminating in the publication of a paper or in the acquisition of new academic skills or scholarly achievements that will advance and complement the clinical career of the resident.  However,  a more subtle objective is instilling in the residents the fundamental skills of experimental design and hypothesis testing that can be utilized as they pursue independent academic careers at the completion of their residency program.

Because the pursuit of scholarly activity usually requires grant support, residents are expected to pursue several mechanisms that can support their research/scholarly efforts.  These may include, but are not limited to, grant applications to NSF, NIH, NNAS, or other focused foundations.

During this period the residents may also choose to pursue teaching opportunities in any of several courses that are required for medical students during their first two years of training. These may include, but are not limited to, Structure and Function of the Nervous System, Gross Anatomy, Histology, and Cell Biology.

The research facilities in the Department of Neurosurgery are extensive.  There are 8 Ph.D. members of the faculty that are conducting basic science programs as well as the basic science and clinical science laboratories directed by members of the clinical faculty.  Collectively, neurosurgery presently occupies approximately 7,000 square feet of wetlab laboratory space.  Among the group use facilities are electron microscopes, confocal microscopes, infrared microscopes, tissue culture facilities and laboratories fully equipped for molecular biology and electrophysiological analyses of in vitro, slice and whole animal preparations.  In addition, a recently developed collaborative program includes the availability of a fully equipped MRI functional imaging laboratory.  Each of the laboratories is independently funded through extramural resources that include NIH, NSF and a variety of special interest foundations.

In addition to the basic science faculty, the Department of  Neurosurgery is further enriched by 6-8 Ph.D.s conducting postdoctoral studies, 2-4 Ph.D. candidates conducting thesis research and annually, 3-4 medical students conducting thesis research. In addition, a technical staff of 6 provides specialized assistance in a number of tasks ranging from small animal surgery to molecular biology.

It is also important to emphasize that the neuroscience community at Yale in extensive and that the Department of Neurosurgery and our training programs are full participants in all aspects of that community.  In the past, residents have performed research with members of the Department of Neurobiology as well as in the Department of Biology.  These  collaborative programs with other departments and faculty have been driven by the special interests of the resident.  The ability to interact outside the boundaries of the Department of Neurosurgery emphasizes the highly interactive and exceptionally rich atmosphere in which our residents are being trained.

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Last modified: August 31, 2006 (jj)