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 "Senior-Junior" PGY-3 resident should expand their knowledge of cerebrovascular disease through a 1-month rotation with the Division of Vascular Surgery along with exposure to our neuroendovascular team. During the remainder of the PGY-3 year is spent on the neurosurgery service where the resident is expected to continue to progress in their ability to independently evaluate and manage inpatients, but also to hone their skill at outpatient evaluation and management.
Passing the American Board of Neurological Surgery examination for practice is expected at this stage. Participation in national meetings and educational conferences is encouraged. Our third year traditionally will attend the Chicago Review Course and/or the Armed Forces Neuropathology and Neuroradiology Review Course.
After successful completion of the three junior resident years, the PGY-4 year is spent in Houston in two separate rotations. First, a six-month experience at the Texas Children's Hospital under the supervision of Dr. Thomas G Luerssen where our residents fully integrate with Baylor residents and staff during this experience. Following this rotation, the PGY-4 will rotate at the Methodist Neurological Institute Neurosurgery Department under the supervision of Dr Robert G. Grossman MD and Dr David Baskin MD. The Methodist Hospital rotation primarily serves to augment the resident experience in stereotactic, functional, and epilepsy neurosurgery. Given the volume and breadth of cases at Methodist, the resident is also exposed to a wide variety of complex spine, skull base and vascular cases. This rotation serves as an outstanding opportunity for the resident to function in a high volume, well supervised environment and allows them to continue to mature in their surgical judgment and operative skill. The primary goal, however, is to give them the requisite experience in functional and seizure surgery.
The PGY-5 resident rotation is spent at MD Anderson Cancer Center under the supervision of Jeffrey Weinberg MD. The goal of the MD Anderson rotation is to expose the resident to a broad spectrum of oncologic disease in the setting of a large and internationally renowned institution. The resident is expected to function as a member of the neurosurgical team on this very busy service and interact with a variety of fellows and residents from other institutions. They are expected to take progressive responsibility for patient management as deemed appropriate by their supervising faculty. The rotation exposes the resident to the full spectrum of neurosurgical oncology, including malignant brain tumors, skull base pathology, pituitary tumors, benign brain tumors, primary and metastatic tumors of the spine, and peripheral nerve tumors and disorders. The over arching goal is for the resident to continue to develop in their ability to independently diagnosis and treat patients with neurosurgical oncologic problems.
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 division 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 PGY7 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 during 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.