Program: year R-1 | R-2 | R-3 | R-4 | R-5 & R-6 | R-7 | R-8

The American Board of Neurological Surgery Primary (written) Examination is taken for self-assessment beginning in Year 02, and is taken for credit later in the training program. Ultimately, a passing grade, for credit, is required for graduation from the UW residency.

Internship

Applicants accepted into the neurological surgery residency are automatically assigned to the surgical internship at UW and need not apply separately for it (one must register for the general match, however, to formally accept this position). The first year of residency is spent as an intern in the General Surgery program at the UW. Six (6) months of this year are spent on surgical rotations, including general surgery, burns/plastics, cardiothoracic surgery, emergency/trauma medicine, and orthopaedics and sports medicine. There are two months (2) spent in neurosurgery rotations, one at UWMC and one at HMC. One month is devoted to learning neuro-ICU medicine, under the tutelage of neuro-critical care faculty. The remaining three months are spent on Neurology rotations under the supervision of Neurologists at CHRMC and HMC.

During this R-1 year, the resident is under the supervision and educational guidance of the General Surgery Department and Program Director, except while on the Neurology or Neurosurgery rotations. However, it is also during this time that the R-1 Neurosurgery designated residents are welcomed into our Neurological Surgery Department. They attend all the monthly Chairman meetings, as time permits, at which time the formal mentorship process begins.

UWMC/HMC Junior Residency

During the second clinical year, the resident serves as the junior resident on the Neurological Surgery service at the University of Washington Hospital Medical Center (UWMC) and Harborview Medical Center (HMC). The rotation is split with 4 months each at UWMC, HMC/TBI and HMC/Vascular/Elective.

At UWMC, the resident cares for patients with primary and metastatic brain tumors, pituitary tumors, skull base abnormalities, medically intractable epilepsy with brain mapping, complex spinal pathologies including spinal cord tumors, peripheral nerve lesions, and complex pain and spasticity problems. The rotation at UWMC is unique in that residents receive mentoring by each Faculty member at UWMC, on an individual basis, for each surgical procedure and outpatient encounter.

At HMC, the Department has organized the program into two services: 1) the Trauma /Spine Service and 2) The Vascular/Elective Service (aneurysms, brain tumors, epilepsy, radiosurgery and deep brain stimulation). The second year resident spends 4 months on each Service. The R-2 resident will assist in running each of the two clinical services with the aid and mentoring of the Chief Resident and Faculty assigned to each service. The R-2 gains tremendous experience in the operative and non-operative management of head and spinal cord trauma, as well as intracranial hemorrhage of all etiologies. During this period he/she learns the management and evaluation skills required to correctly assess and triage patients arriving in a busy emergency department. The R-2’s interpersonal skills are honed under stressful situations, and his or her knowledge base grows exponentially by interacting with the Chief Resident and Faculty many times a day.

The R-2 year is a carefully mentored/supervised year in the operating room and in the clinics. The foundation for the 6 areas of ACGME endorsed competency is laid so that basic technical skills, neuroscience knowledge, judgment and professionalism are fostered.

HMC Senior Junior Residency and CHRMC Chief Residency

The HMC experience as a "Senior Junior" resident is basically operating all day, every day. This is when residents start spending most of their time in the operating room learning elective and trauma spine cases, crash craniotomies, and other intermediate neurosurgical procedures. The HMC R3 supervises the intern and R2 on the service as well.

The second six months are spent at Children's Hospital & Regional Medical Center (CHRMC) as Chief Resident on the pediatric neurosurgery service. In addition to managing the busy clinical service and supervising three nurse practitioners, the chief resident operates 4-5 days/week with the exception of Wednesday academic and clinic day. The chief resident is thus responsible for the administration of the service and reports to the full-time faculty members at CHRMC. The full spectrum of pediatric neurosurgery is encountered on this rotation, including brain and spinal cord tumors, surgical epilepsy, spinal dysraphism, vascular malformations, spacticity, craniofacial abnormalities, neonatal hemorrhage, hydrocephalus, trauma, spine deformities, and other congenital malformations.

International Neurosurgery

The resident and Program Director write the Neurological Surgery RRC each year to obtain permission prospectively to include this as a non-ACGME clinical elective. St. George's Medical School in London is the location for the R-4 year resident's clinical rotation. The year is spent as a Registrar and Senior Registrar (Chief Resident) on the Atkinson Morley (AMH) Neurosurgery Service under the auspices of Professor Anthony Bell and his academic colleagues. All aspects of adult neurosurgery are covered, including spinal instrumentation.

Approximately 180-210 major cranial and spinal operations are performed while a Registrar in Great Britain. Due to the work week and vacation regulations of the UK's medical care system, residents are able to travel throughout Europe and Asia and gain mentorship from other internationally renowned neurosurgeons.

In 2003, our Department performed a critical 20-year review of this experience by past graduates of the Residency Program. The analysis revealed that this remains the single most unique educational residency experience from a resident perspective. It is one which the resident would not have pursued, had they not matriculated at the UW. It was often cited as a major reason for ranking the UW so highly in the Neurosurgery match. Lastly, the residents cite the ability to learn a practice system different from their own and apply this knowledge to their practice in the USA, as one of the many reasons for their clinical success.

Academic Duties - Research Years

The R-5 and R-6 years are devoted to research and the investigative process. Since the implementation of the ACGME resident work hours guidelines, there is scheduled on-call clinical responsibility. This occurs in the form of an initial exposure to the role of Chief Resident or substitution at night for a junior resident. This call enables the resident to maintain “clinical touch” while being gradually exposed to the role of the Chief. It is often during these years that the resident accomplishes the 2-month Elective Neuropathology rotation and 1-month Neuro-radiology rotation or interventional Neuro-radiology elective.

A new procedure has been implemented to ensure a worthwhile research endeavor is pursued. Professor George Ojemann, Director of Research in the Department of Neurological Surgery and PI on the NIH Training Grant, meets with each of the residents and reviews their research interests and goals. A research committee consisting of basic scientists and clinical investigators is also available as a resource and often interviews each resident. The resident then receives approval for his/her research program from Dr. Ojemann. The goal of these years is to develop the skills to be an independent investigator in any scientific field applicable to neurosurgery. This goal encourages residents to advance our field by solving problems that affect our patients, in a methodical and scientifically sound fashion.

As part of their academic training, residents are encouraged to apply for various research awards and grants, present their work at local, national, and international meetings, and prepare manuscripts on clinical and research work. The resident is encouraged to prepare a grant during or prior to the first year of research so that the second year can be funded by an extramural source. The resident is mentored by dedicated basic scientists, funded clinical investigators or Neurosurgery faculty mentor who review their proposals in detail and provide guidance. The NIH Training Grant is often a source of extramural funding for resident research and projects.

Junior Chief Residency UWMC/HMC

Each resident has 12 months of “mandatory” elective clinical time. However, with the advent of the ACGME resident work hours guidelines, this elective time has taken on a more formal appearance in order to assure compliance. This year remains a very rich clinical experience with extensive operating duties. The goal is to add subspecialty skill in Trauma, Tumor, Epilepsy and Spine. It exists to gain new skills in areas such as spine instrumentation, brain mapping, skull base anatomy, and trauma surgery/management. Currently, the resident spends one six-month period running the Spine/Trauma Service at HMC and a six-month rotation as the Junior Chief Resident UWMC with duties in the skull base laboratory.

At HMC the resident is responsible for the inpatient, emergency and operative care of approximately 1,000 patients a year. As the second Chief Resident at HMC, the resident has major responsibilities in running not only the Spine/Trauma Service but covering the Chief Resident of the Vascular/elective Service when he/she is off call every other night. Thus, during this period of time, the Spine/Trauma Chief Resident will often be involved in the surgical care of vascular (aneurysm and AVM) and tumor patients as well as spine and trauma patients. The administrative and training duties during this 6-month period include mentoring the junior resident in the proper inpatient and emergency room care of patients with spine fractures and intracranial hematoma/injury.

A second six-month elective time has been transformed into a unique training experience as the Junior Chief at UWMC. This is performed at the discretion of the UWMC Service Chief and Program Director. Therefore, the rotation may include any of the following focused training: skull base surgery, neuro-interventional radiology, neuro-oncology, minimally invasive spine procedures, pain procedures and surgical epilepsy. During this period the UWMC Junior Chief spends time in the Skull Base laboratory refining his/her anatomical and surgical skills in preparation for skull base and vascular neurosurgery rotation as a Chief Resident.

Chief Residency

The residency culminates in the R-8 year, as each R-8 resident serves 12 months as the Chief Resident; i.e., six months at UWMC and six months at HMC. The Chief Resident is responsible for coordinating the operative schedule, mentoring junior residents and supervising the clinical activities on the respective Neurosurgery Services. He/she is responsible for all inpatient care, emergency care, consultations, surgical admissions and operations of the respective services. At the end of each 6-month rotation the Chief Resident is expected to develop the advanced psychomotor skills and mature interpersonal skills to manage the broad spectrum of patient diseases cared for at each hospital. Specifically, the Chief Resident will be capable of evaluating and managing patients with the entire spectrum of brain tumors, epileptic foci, skull base lesions, aneurysms, vascular malformations, extracranial vascular disease, movement disorders, intracranial hematoma, traumatic brain and spine injury, infections, congenital anomalies, hydrocephalus, surgically correctible pain issues, peripheral nerve problems, and spine fractures/diseases/deformities.

This is the year that all 6 competencies are planned to coalesce so that a successful Neurosurgeon with great technical skills, compassion and a broad knowledge base is produced. This Neurosurgeon should show leadership potential and scientific investigative potential.

year R-1 | R-2 | R-3 | R-4 | R-5 & R-6 | R-7 | R-8

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