The PGY-1 or "Internship" spent at UTMB John Sealy Hospital is designed to provide the trainee with a broad background in surgical principles and care of the surgical patient. Six months of this year is spent on the neurosurgery service as an integral member of the team. Apprenticeship in basic procedures (ventriculostomy, ICP monitor and central line placements) is important in this first year. The resident is expected to gain understanding of the management of diseases affecting all organ systems and not just those commonly seen in neurosurgical patients. They are expected to become proficient in the management of ICU issues related to airway management, ventilator management, IV access, monitors of cardiac function, management of cardiac dysfunction and arrhythmias, pulmonary dysfunction, issues related to bowel dysfunction and nutrition, pressor management.
This rotation is also meant to serve as an introduction to the coordination required between services in the management of the critically ill surgical patient. This goes along with exposure to the operating room, and the intern may expect to be involved in at least 150 cases this first year. Three months are spent in one month intervals on various rotations including trauma, critical care, plastic surgery and other surgical subspecialties as determined by the Program Director. The remaining three months are spent on the neurology service. The resident is expected to become familiar with electrophysiological tests including but not limited to electromyography, nerve conduction velocity, electroencephalography, somatosensory evoked potentials, motor evoked potentials, cortical mapping, brainstem auditory evoked potentials, visual evoked potentials, facial nerve monitoring, electronystagmograms, and urodynamic studies.
The PGY-2 or "Junior Resident" year spent at UTMB John Sealy Hospital serves for consolidation of knowledge and acquisition of procedure fundamentals as well as neurocritical care and neurotrauma emergencies management. Operating room responsibility is increased and approximately 200 cases per year while on service. This rotation continues to serve as an introduction to the preoperative, operative, and postoperative care of the neurosurgical patient. The resident is expected to progress in their ability to independently evaluate patients, develop a differential diagnosis, proceed with special studies and tests, and then formulate and carry out a treatment plan.
As the neurosurgery service at UTMB is a unified service, the resident will be exposed to a wide array of neurosurgical diseases. The PGY-2 resident will gain increasing responsibility for the care and management of neurosurgical ICU patients. They serve as the primary resident responsible for the floor and the ICU. Additionally, this resident will be the primary liaison between the emergency department and the neurosurgery service, and will serve as the first responder to neurosurgical emergencies. They are also expected to develop their own project in the field of practice based learning and improvement.
In this third year of training spent at UTMB John Sealy Hospital, the "Mid-Level Resident" PGY-3. Resident will spend their first 6 months on Neurosurgery at Galveston Campus with focused on increased OR exposure and Autonomy (~200-250 Cases). The next 6 months will be experienced at Texas Children's Hospital (TCH), under the supervision of Dr. Howard Weiner where our residents fully integrate with Baylor residents and staff during this experience. Resident is expected to lead simple spine cases (ACDF, Laminectomy) and assist Senior residents on more complex procedures including complex spine craniotomies (non-eloquent glioma, metastasis, trauma).
Passing the American Board of Neurological Surgery Primary examination for practice is expected at this stage. Participation in national meetings and educational conferences is encouraged.
After successful completion of the three junior resident years, the PGY-4 year is spent back in Galveston. This year can be spent on research (basic science or clinically focused research) or on an enfolded clinical year (Spine, Vascular, or General). For residents interested in a CAST-accredited fellowship, option may be available to complete elective year in the final year of training stead.
The PGY-5 resident is the "Senior Resident" and spends 12 months on clinical service on Galveston Campus. Resident is expected to lead moderate complexity cases (thoracolumbar fusion, standard craniotomies) and assist in higher complexity cases (skull base tumor, spinal deformity, aneurysm clipping).
The PGY-6 resident is the "Chief Resident" at UTMB, and he/she coordinates the function of the service as a whole. During this year, the chief will acquire full administrative, clinical and operative responsibilities within the department with faculty supervision. The Chief Resident is also responsible for all weekly educational conferences, call schedules and distribution of daily operative cases for junior residents.
The PGY-7 year serves as the "Transition to Practice" year, wherein the trainee functions in a monitored and mentored environment as a Clinical Instructor, with virtually complete autonomy. We have found this transition year particularly assists residents in acquisition of full operative autonomy and responsibility as well as knowledge of administrative concepts that are extremely relevant to any neurosurgical practice.