The PGY-6 (vice-chief) and PGY-7 (chief) years are capstone years for neurosurgical residents. Residents gain the knowledge and technical skill to ready them for independent clinical practice. The vice-chief or chief resident assigns duty schedules and operative cases for residents on the service and makes (or delegates to the PGY4-5 resident) the making of the call and vacation schedules for all residents in the Department.

The vice-chief and chief residents supervise the educational activities of the service, including case presentations by senior and junior residents at conferences. The chief resident participates in the triage of emergent add on cases and the distribution of consults to the appropriate on-call and subspecialty staff surgeons. The chief resident supervises and serves as a resource between staff rounds for junior and senior resident evaluations of consult patients and other acute clinical problems, serving as a teacher and formulating definitive care plans for final review with the attending staff before implementation of major decisions.The chief resident serves as a nexus for management and communication of a complex interdisciplinary surgical department, with practical emphasis on systems-based practice, communication, and professionalism skills.

There will be a rotation at Mercy Hospital in a community neurosurgery setting. At Mercy Hospital, the PGY-6 resident is the chief resident at this high-volume training site and is responsible to management of neurosurgical patients on the ward and in the ICU. The resident will provide consultative services to colleagues in the hospital and attending outpatient clinics with a supervising attending. The resident at Mercy Hospital will assist or lead surgeries under the tutelage of an attending neurosurgeon.

The chief resident performs complex intracranial and spinal neurosurgical operations under attending supervision and collaborates with the attending surgeon.

The chief resident will have primary responsibility for management of all patients of OUMC Adult Tower (and at times, Oklahoma Children’s Hospital), including leading work rounds in the ICU, formulation of care plans for ICU and ward patients, supervising the ordering of imaging studies by the resident team, and making key medical and surgical management decisions (with consent and supervision of attending neurosurgeon).

The chief resident is expected to mentor the more junior residents on the service, and review anatomy, pathophysiology, and principles of treatment in the context of the specific patients present on the service.

The chief resident will participate in and perform surgical procedures under the supervision of the neurosurgery faculty as listed above. The resident will be expected to prepare for surgical cases by review of the patient's record and surgical literature pertinent to indications, technical details of the procedure, complications and peri-operative management and will review this information with faculty at the time of the procedure.

The chief resident will attend all Department of Neurosurgery didactic conferences and will present patients from the service at work and educational conferences. The chief resident will participate in the non-clinical competency projects.

The chief resident will also be expected to perform clinically driven, case-based study (i.e. performing literature searches on topics relevant to upcoming surgical patients). 

• Describe the appropriate surgical positioning, external plus skull surface landmarks, scalp incision and craniotomy flap planning for the following intracranial approaches:
  • Orbitozygomatic
    • Trans-sylvian
    • Sub frontal, subtemporal ("Half and half'
  • Fronto-orbital
    • Suprasellar
    • Trans-lamina terminalis 

• Anterior interhemispheric
  • Transcallosal, interforniceal
  • Transcallosal, transforaminal
  • Transcallosal, transchoroidal 
• Subtemporal
  • Intradural
  • Extradural
• Posterior interhemispheric
  • Trans-splenial 
• Occipital interhemispheric
  • Transtentorial

• Supracerebellar, infratentorial
• Retrosigmoid
• Suboccipital
• Transcortical transventricular 
  • Frontal
  • Trigone
  • Temporal
• Temporal bone
  • Translabyrinthine
  • Transcochlear
  • Middle fossa
• Far lateral craniocervical junction 
• Jugular foramen
• Trans-sphenoidal
• Trans-maxillary

• Describe the intra-operative management of severe cerebral edema with brain herniation 
• Describe techniques for intra-operative ventricular and/or subarachnoid CSF drainage (routine and
• Describe the prevention and management of intra-operative venous air embolism.
• Describe the intra-operative management of coagulopathy and massive transfusion.
• Describe the 3-dimensional anatomy of the mesial temporal lobe and indicate in stepwise fashion the technique for trans-cortical, trans-ventricular amygdalohippocampectomy and for anterior temporal lobectomy.
• Describe the principles of scalp vascular supply in skin flap planning and reconstruction.
• Define the options for complex spinal reconstruction in patients with tumor, trauma, inflammatory or degenerative deformity.
• Describe the anatomy of the brain, spine, peripheral nerves, and the bony coverings of each, particularly as they relate to diagnosis, surgical approaches, and treatment of neurosurgical diseases.
• Describe the pathophysiology of degenerative spinal disorders.
• Describe the pathophysiology of primary and metastatic spinal column tumors and spinal cord tumors.
• Describe the pathophysiology and classification system of spinal vascular malformations. Describe the pathophysiology of spinal instability and accurately utilize the AO spinal instability schema. Describe the literature on the classification of spinal instability.
• Describe the evidence related to treatment of spinal cord injury and timing of surgical intervention.
• Describe the pathophysiology of spinal column infections and combined surgical and medical management principles.
• Describe the pathophysiology and best medical management for trigeminal neuralgia and other forms of facial pain.
• Describe the principles of functional stereotaxy using CT or MR and intra-operative physiology.
• Discuss the pathophysiology and clinical presentation of phantom-limb, meralgia paresthetica, anesthesia dolorosa, chronic radiculopathy, etc.
• Discuss the cranial nerve and vascular anatomy of the posterior fossa
• Describe the pathophysiology, classification (typological, anatomical and surgical grade) and bleeding risk of arteriovenous malformations.
• Describe the pathophysiology of carotid stenosis, TIA, RIND, amaurosis fugax, stroke, reperfusion syndrome, and chronic cerebral ischemia.
• Identify threshold levels for flow-related cerebral ischemia in gray and white matter for electrical dysfunction and irreversible neuronal death and describe the various available methodologies for measuring or clinically estimating cerebral blood flow.
• Describe the pathophysiology of neoplastic diseases of the nervous system and its coverings.
• Describe the differential diagnosis of skull base tumors presenting in various locations/compartments and the associated clinical presentations (with particular attention to associated cranial nerve deficits).
• Cite current evidence-based literature as it relates to neurosurgical diseases and accurately classify evidence quality.
• Describe the physiology and pathophysiology of the hypothalamic-pituitary endocrine axis and the associated diagnostic findings in pituitary tumor patients and patients with other sellar and supra­sellar lesions.
• Describe the intra-operative management of coagulopathy and massive transfusion.
• Describe the decision process in tumor resection limits based on age of patient, pathological tumor type, location relative to cranial base neurovascular structures (e.g. cavernous sinus), and expressed medical wishes of patient/family.
• Define diagnostic procedures (contrast and tracer based plus axial and reconstructed imaging) for the diagnosis of cranial/skull base CSF leak.
• Define interdisciplinary approaches to intracranial and extracranial (trans-sinus endoscopic) and CSF diversion methods for treating cranial base CSF leaks due to trauma or surgery.
• Formulate treatment plans for cranial and spinal surgery patients utilizing the best available evidence-based studies
• Demonstrate the ability to perform the following surgical procedures with Faculty supervision: 
  • Micro vascular decompression
  • Amygdalohippocampectomy
  • Anterior temporal lobectomy
  • Craniotomy for cortical mapping/monitoring
  • Complex thoracolumbar reconstruction
    • Anterior (transcavitary)
    • Posterior
    • Posterolateral
    • Endoscopic
    • Combined
    • Complex craniocervical reconstruction
    • Posterior
    • Transoral
    • Submental
  • Anterior Cervical Discectomy and Fusion
  • Posterior Subaxial Cervical Instrumentation and Fusion
  • Posterior Thoracic Instrumentation and fusion
  • Posterior Lumbar Decompression, Instrumentation, and Fusion
  • Anterior Thoracolumbar Fusion
  • Craniotomy for epilepsy, intracranial hemorrhage, or trauma. The senior resident should be able to master the approach to these lesions and begin to master the critical surgical portion of these procedures.
  • Posterior fossa decompression for Chiari malformation
  • Frame based and frameless stereotaxy for biopsy, tumor resection, functional implants,etc.
  • Anterior circulation giant aneurysm clipping, clip reconstruction and aneurysmorrhaphy
  • Posterior circulation aneurysm clipping
  • Supratentorial A VM 
  • Posterior fossa A VM
  • Acoustic neuroma resection
  • Medial sphenoid wing/cavernous sinus meningioma resection
  • Olfactory groove meningioma resection
  • Clival/foramen magnum meningioma resection
  • Eloquent glioma monitoring and resection 
• Demonstrate the ability to recognize and treat complications related to neurosurgical diseases and procedures. 
• Demonstrate an understanding of indications for surgical intervention for neurological diseases. 
• ·Provide in-patient neurosurgical consultation under supervision of faculty. 
• Independently manage neurosurgical emergencies with neurosurgical faculty backup. ·       
• Effectively manage scarce medical resources by efficient triage of operating room time, equipment and service personnel, particularly in the management of emergency surgical cases and timely consultation for neurosurgical patients in the emergency department.

• Interact with other health care professionals in a respectful manner.
• Serve as an effective leader and supervisor of the resident team and co-leader of mid-level providers.
• Reliably and efficiently lead daily rounds.
• Participate with the direction of the Chairman, Program Director, and senior faculty in interviews for appropriate post-residency fellowship training or practice.
• Effectively manage disputes and controversy arising from implementation of the resident call and vacation schedules.
• Demonstrate comportment and leadership skills that command the respect of and sets example for junior team members (residents and interns).
• Provide effective clinical teaching to junior members of the care/educational team.
• Evaluate rotating students and interns including assignment of provisional grades (with review by the Program Director)
• Demonstrate care and compassion for neurosurgical patients and their families
• Demonstrate respect for patients and colleagues from diverse cultural, ethnic and religious backgrounds
• Demonstrate honesty in all professional interactions
• Demonstrate dress, grooming and comportment consistent with institutional guidelines and earning confidence and respect from supervisors, peer1l and patient families
• Comply with all GME and Departmental regulations regarding duty hour restrictions and report personal schedule in timely and accurate fashion
• Accurately self-report fatigue in situations that may compromise safety and/or patient care 

• Supervise junior residents and interns in management of patients.
• Demonstrate ability to resolve conflicts with patients, families, and other health care providers.
• Manage and cooperate with the nursing and support staff to obtain the best care for patients while building teamwork, responsibility, and enthusiasm.
• Serve as a first responder and sounding board for interpersonal disputes or disagreement and conflict resolution within the resident team, with disclosure and advice from neurosurgical faculty as appropriate.
• Communicate effectively with other members of the neurosurgery team.