This rotation introduces the first-year neurosurgery resident to the management of neurosurgical patients in the critical care and perioperative environments. It is at this time the resident is evaluated with respect to progression of responsibility from direct supervision to indirect supervision (with direct supervision available). The rotation also focuses on the principles of pathophysiology and treatment of major central nervous system injury, including brain, spinal cord, and spinal column. This rotation is the resident's introduction to academic neurosurgery and the associated enterprises of interdisciplinary care (systems-based practice), outcomes tracking and reporting (practice-based learning), technological and management advances, and the role of the neurosurgeon in these advances.
Trauma neurosurgery is a critical and fundamental aspect of neurosurgical care and training. Traumatic brain injury is an acute surgical problem requiring rapid assessment, aggressive treatment, and an intimate knowledge of the physiology, anatomy, and critical care of the nervous system and all other organ systems, which are often also affected in the traumatized patient.
The care of trauma patients also involves communicating with family members experiencing a dramatic, unexpected, and profoundly disruptive life event. The junior resident plays an important role, with attending surgeon participation and supervision, in the intensive communication needs of these families, providing an opportunity to learn and practice critical professionalism and communication skills.
This rotation also introduces the first-year neurosurgery resident to the inpatient management of neurosurgical patients as well as to the principles of basic neurosurgical procedures including craniotomy and straightforward approaches to the spine. The rotation focuses on the complex, interdisciplinary environment of hospital-based, modern neurosurgical practice. Thus, the junior resident is instructed in principles of systems-based practice, including the management of neurosurgical patients, and working on care teams involving mid-level providers (NPs and PAs). The junior resident also learns the principles of longitudinal care, discharge planning and outpatient communication and the recognition and management of late neurosurgical complications.
Operative experience is directed towards basic neurosurgical procedures such as simple craniotomy, posterior (dorsal) approaches to the (principally lumbar) spine and CSF diversion procedures.
The junior resident will be responsible for the basic functions of the neurosurgical ICU and ward service and urgent daytime neurosurgery consultation in the emergency department and hospital. The chief resident will supervise the junior resident and report directly to attending surgeons.
The junior resident will assess neurosurgical patients and will organize this data for presentation to the chief resident and attending during morning rounds and to the resident and call team during afternoon rounds. The junior resident will report to the chief resident and neurosurgery attendings.
The main teaching hospitals during the PGY-2 year are OUMC, OCH, and the VA hospital. The junior resident will gain an exposure to outpatient management of neurosurgical and spine patients and will attend the Department of Neurosurgery teaching conferences. The junior resident will perform ICU-based neurosurgical procedures (see above) with initial supervision under the departmental procedures certification policy, and then independently with back-up from senior residents and faculty. The junior resident will also participate (with appropriate back-up coverage for the ICU) in trauma and other emergency procedures (hematoma evacuation, decompressive craniotomy, etc.) on ICU patients.
The junior resident will also be expected to perform clinically driven, case-based study (i.e. performing literature searches on topics relevant to active patients in the ICU).
The junior resident will observe, participate in and, as appropriate, perform family updates, care discussions, end-of-life discussions, brain death evaluations and organ donation referrals (within institutional guidelines regarding brain death and conflict of interest).
The neurosurgical attending makes daily rounds with the junior resident, if available.