Description of Rotation or Educational Experience

This is a one month rotation for the acute care surgical resident. Exposure to neurosurgical patients and their diseases will occur at University Medical Center. Residents will acquire a fundamental knowledge base in the basic principles of neurosurgery, along with the recognition and surgical treatment of diseases and disorders of the central and peripheral nervous system.

Patient Care

Goal

Residents must be able to provide patient care that is compassionate, appropriate, and effective for the treatment of health problems and the promotion of health. Residents are expected to:

Competencies

• Perform and document pertinent history, physical findings, and radiological findings in a multitrauma patient
• Identify and manage elevated intracranial pressures.
• Differentiate central from peripheral nervous system injuries
• Insert intracranial pressure monitoring devices including ventriculostomy catheters and electronic (fiber optic or miniaturized strain gauge) devices
• Intepret plain x-rays, dynamic x-rays, myelograms, CT scans and MR scans of patients with spinal disorders.
• Demonstrate the ability to place and manage cranial traction devices for reduction and immobilization of the unstable cervical spine.
• Demonstrate the ability to perform transthoracic, thoracoabdominal, retroperitoneal, and transabdominal approaches to the thoracic and lumbar spine.

Objectives

• Insert intracranial pressure monitors
• Drainage of subdural fluid collections
• Assist craniotomies
• Assist cervical traction
• Assist placement of halo vest
• Thoracolumbar spinal exposures

Medical Knowledge

Goal

Residents must demonstrate knowledge of established and evolving biomedical, clinical, epidemiological, and social-behavioral sciences, as well as the application of this knowledge to patient care. Residents are expected to:

Competencies

• Determine an initial choice for intravenous fluids for a newly admitted ICU patients with the following diagnoses, clinical condition, electrolyte and volume status
• Head injury
• Stroke
• Tumor
• Infection
• Hydrocephalic
• List the mechanisms of action and potential complications of commonly used pressors and hypotensive agents.
• Discuss indications, pharmacologic mechanism, duration of action, and effect on the neurological examination for sedative, paralytic, and analgesic agents commonly used in the ICU.
• Discuss the pathophysiology and management of coagulopathy after head injury
• Describe the basic principles of nutritional management in neurosurgical critical care.
• Explain the treatment of posttraumatic seizures.
• Outline the basic principles of ICU management of patients with spinal cord injury.
• Describe a systematic approach to the examination of the peripheral nervous system
• Define brain death and discuss methods of making such a diagnosis.

Objectives

• Complete reading of the Brain Trauma Foundation Guidelines for the Management of (Adult) Severe Traumatic Brain Injury
• Complete reading of the Brain Trauma Foundation Guidelines for the Acute Medical Management of Severe Traumatic Brain Injury in Infants, Children and Adolescents
• Provide a lecture directed at medical students and junior surgical resident on the above topics.

Practice- Based Learning and Improvement

Goal

Residents must demonstrate the ability to investigate and evaluate their care of patients, to appraise and assimilate scientific evidence, and to continuously improve patient care based on constant self-evaluation and life long learning. Residents are expected to develop skills and habits to be able to :

Competencies

• Systematically analyze practice, using quality improvement methods, and implement changes with the goal of practice improvement
• Use information technology to optimize learning
• Participate in the education of patients, families, students, residents and other health professionals, as documented by evaluations of a resident’s teaching abilities by faculty and/or learners

Objectives

• Create a PowerPoint slide show to be inserted into a resident databank for lectures on neurosurgical topics.
• Provide real-time ongoing feedback to the Head-Trauma protocol.

Systems Based Practice

Goal

Residents must demonstrate an awareness of and responsiveness to the larger context and system of health care, as well as the ability to call effectively on other resources in the system to provide optimal health care. Residents are expected to:

Competencies

• Coordinate patient care within the health care system relevant to their clinical specialty
• Work in interprofessional teams to enhance patient safety and improve patient care quality

Objectives

• Participate in Department of Trauma meetings and Peer-reviews to examine system relevant deficiencies.
• Work as liaison between the neurosurgical service and the primary trauma service.

Professionalism

Goal

Residents must demonstrate a commitment to carrying out professional responsibilities and an adherence to ethical principles. Residents are expected to demonstrate:

Competencies

• Compassion, integrity, and respect for others
• Sensitivity and responsiveness to a diverse patient population, including but not limited to diversity in gender, age, culture, race, religion, disabilities, and sexual orientation

Objectives

• Create and execute a questionnaire to survey cultural opinions on brain death and dying.

Interpersonal and Communication Skills

Goal

Residents must demonstrate interpersonal and communication skills that result in the effective exchange of information and teaming with patients, their families, and professional associates. Residents are expected to:

Competencies

• Communicate effectively with physicians, other health professionals, and health related agencies
• Maintain comprehensive, timely, and legible medical records

Objectives

• Complete all outstanding medical records upon termination of rotation.
• Obtain satisfactory or above ratings on a nursing and physician filled evaluation in the category of communication.

Teaching Methods

• Attendance of all lectures, conferences and quality improvement meetings.
• Review of assigned reading materials
• Attending preceptorship

Assessment Method (residents)

• Focused observation by faculty staff
• 360 degree evaluation by faculty at end of rotation through e-value system.
• Case log review with program director

Assessment Method (Program Evaluation)

• Using e-value system, rotation is assessed on several qualities including but not limited to value, accessibility, and relevance to practice.
• Outcome on national standardized exams.

Level of Supervision

• Residents are under direct or indirect supervision by faculty staff at all times.

Educational Resources

Brain Trauma Foundation Guidelines.