SickKids Objectives

Rotation-Specific Objectives for Neurosurgical Residents on Neurosurgical Services: The Hospital for Sick Children

During their residency training, neurosurgery residents will perform at least 36 months (42 months for those beginning after June 30, 2010) on clinical neurosurgical services within the teaching hospitals of the University of Toronto. These hospitals include: The Hospital for Sick Children, The Toronto Western Hospital, Sunnybrook Health Sciences Centre, and St Michael's Hospital. While there are many similarities between the neurosurgical services at each of these hospitals, there are understandably areas of expertise, which differ at each hospital. These are accounted in the following descriptions of rotation-specific objectives for neurosurgical residents on neurosurgical services:

The Hospital for Sick Children 
The Hospital for Sick Children (Sick Kids) is Canada's premier pediatric tertiary care neurosurgical program and comprises a level 1 pediatric trauma program, a national craniofacial surgery program, and multidisciplinary programs for epilepsy surgery, spinal dysraphism, neuro-oncology, and cerebrovascular neurosurgery. 

Residents generally do 3-6 month rotations at the Hospital for Sick Children learning the nuances of pediatric neurosurgery, and becoming familiar with technical procedures to treat children with neurosurgical disorders. Residents usually come at an intermediate level of training, as PGY-3's and -4's.

SPECIFIC OBJECTIVES:

At the completion of the rotation in pediatric neurosurgery at The Hospital for Sick Children, the intermediate level neurosurgery resident will function effectively as a:

MEDICAL EXPERT/CLINICAL DECISION MAKER

General Requirements

  • Admit patients, record their medical history and physical examination in clinic and ward environment.
  • Assist in the operating room or operate as the principal surgeon under supervision of the attending surgeon or chief clinical fellow.
  • Consult on patients on medical wards, ICUs, outpatient clinics, and emergency department.
  • Make rounds in the various hospital units as assigned, order appropriate medications, tests and other forms of therapy required for continued care, plan discharge with nurse clinicians and charge nurse and write a daily progress note in the chart where appropriate.
  • Attend clinic at least one half day per week with a faculty member.
  • Become familiar with the care of children between birth and age 18 years.

Specific Requirements

At the completion of the rotation in pediatric neurosurgery at the Hospital for Sick Children, the intermediate level resident will have demonstrated the following:

KNOWLEDGE

  • A comprehensive knowledge of neuroembryogenesis, and the disorders that arise in pediatric neurosurgical patients as a result of disturbed neuroembryological patterns such as myelomeningocele, lipomyelomeningocele, tethered cord, Chiari malformation, Dandy Walker, and encephalocele.
  • An intimate knowledge of developmental milestones that are acquired throughout childhood that can be affected by pediatric neurosurgical conditions.
  • A thorough understanding of the formation and circulation of the cerebrospinal fluid (CSF), and disease processes that can arise from disturbed CSF flow (hydrocephalus).
  • An awareness of the basic principles of clinical genetics, and the genetic disorders that can affect the nervous system such as neurofibromatosis, tuberous sclerosis, and Sturge Weber.
  • A thorough understanding of the main acquired pediatric neurosurgical disorders that will present in childhood including infectious diseases, pediatric head and spinal cord injury, brain tumours, stroke, vascular malformations, and epilepsy.
  • Familiarity with and understanding of diagnostic imaging studies used to investigate children with pediatric neurosurgical disorders including EEG, EMG, CT, MRI, MEG, and ultrasound.
  • An understanding of the neurosurgical procedures that are available for the treatment of the child with pediatric neurosurgical disease.

CLINICAL SKILLS

  • The ability to obtain a detailed history and carry out a detailed neurological examination in the child of all ages in order to provide a comprehensive differential diagnosis and localization of diseases affecting the central nervous system.
  • The demonstration of skills in ordering and interpreting appropriate general diagnostic tests (hematology, x-ray, chemistry, etc.) for the satisfactory management of patients.
  • The provision of ongoing, high quality, post-operative neurological assessment and care, including neuro-intensive care, to the pediatric neurosurgical patient
  • The ability to interpret neuroradiological examinations in the pediatric neurosurgical patient.

TECHNICAL SKILLS

At the completion of their pediatric neurosurgical rotation, the neurosurgical residents must have demonstrated a thorough understanding of the surgical anatomy, and the technical ability to satisfactorily and safely perform the following procedures:

  • Subdural tap
  • Burr holes for drainage of subdural hematomas and empyemas
  • Ventriculostomy
  • VP shunt insertion and revision
  • Insertion ICP monitor
  • Excision skull lesions
  • Craniotomy for trauma, tumour, epilepsy, and stroke
  • Posterior fossa decompression for Chiari malformation
  • Laminectomy for tethered cordand spinal cord tumours.
  • Sagittal craniectomy for sagittal synostosis
  • Repair simple myelomeningocele and encephalocele
  • Cranioplasty

Under the supervision of the staff neurosurgeon or chief clinical fellow, the neurosurgical resident at the intermediate level at the Hospital for Sick Children will assist in the completion of the following procedures:

  • Endoscopic third ventriculostomy
  • Endoscopy for cyst fenestration and septostomy
  • Posterior fossa craniotomy for tumor removal
  • Lobectomy, cortical resection, hemispherectomy, and corpus callosotomy for seizures
  • Placement of subdural grid and depth electrodes for epilepsy
  • Vagal nerve stimulator implantation
  • Supratentorial craniotomy for removal of intracerebral hematoma, tumor, and abscess
  • Complex craniofacial repairs for coronal, lambdoid, and multiple suture synostoses in conjunction with the craniofacial surgeons
  • Repair of complex congenital malformations such as lipomyelmeningocele, myelomeningocele, disastematomyelia, and neurenteric cyst.

COMMUNICATOR:

General Requirements

The rotation for intermediate level residents at the Hospital for Sick Children in pediatric neurosurgery is the only opportunity for neurosurgical residents to take care of children from birth to age 18 years. As such, at the completion of their rotations in pediatric neurosurgery, the intermediate level neurosurgery resident will:

  • Establish therapeutic relationships with the patients and their parents
  • Obtain and synthesize relevant history from patients/families/communities
  • Listen effectively
  • Discuss appropriate information with patients/families and the health care team

Specific Requirements

  • Document appropriate histories, physical examinations, and progress notes.
  • Establish communication with the patient and family that supports a trusting and open relationship.
  • Provide information to the patient and family that supports the patient's participation in decision-making.
  • Respond appropriately to patients, families, and colleagues, who express anger, hostility, or a complaint.
  • Share information with other healthcare providers that supports teamwork and effective care planning and provision in an expeditious manner.
  • Be sensitive to the needs of patients and their families as they are affected by age, gender, cultural and ethnic perspectives.
  • Be able to communicate in a clear, concise and collegial manner with referring physicians.
  • Be able to present data to a group of peers or allied health personnel in a clear and understandable way at weekly neurosurgery and neuroscience conferences.
  • Learn the avenues of communication with institutional managers and administrators to be able to clearly express the needs of his/her service.
  • Prepare written documentation regarding patient consultations in a timely and accurate fashion.

COLLABORATOR:

General Requirements

During their pediatric neurosurgery rotation at the Hospital for Sick Children, neurosurgery residents at an intermediate level of training will learn to:

  • Consult effectively with other physicians and health care professionals.
  • Contribute effectively to other interdisciplinary team activities.

Specific Requirements

During their pediatric neurosurgery rotations, residents will:

  • Learn to communicate with other physicians and health care professionals to contribute effectively to interdisciplinary team activities to improve patient care in the management of surgical disorders that benefit from such approaches.
  • Be able to collaborate with allied health care personnel in developing public education tools.
  • Be able to work with healthcare governance at all levels.
  • Contribute administrative skills to the physician team, including direction.
  • Be able to delegate responsibilities where and when appropriate.
  • Listen to concerns expressed by others providing care and assist in resolving these concerns if appropriate.

MANAGER:

General Requirements

During their pediatric neurosurgical rotations, intermediate level residents will:

  • Utilize resources effectively to balance patient care, learning needs, and outside activities.
  • Allocate finite health care resources wisely.
  • Work effectively and efficiently at SickKids.
  • Utilize information technology (eg. searching medical databases) to optimize patient care, life-long learning and other activities.

Specific Requirements

During their pediatric neurosurgical rotations, intermediate level residents will:

  • Learn time management for clinical activity, learning needs and family and recreational activities.
  • Learn to function efficiently and effectively at SickKids so as to optimize the application of existing resources.
  • Learn to interact with the larger community to preserve and secure adequate resources for the provision of excellent care.
  • Utilize current information technology for optimal patient care and for personal life-long learning.

HEALTH ADVOCATE:

General Requirements

During their pediatric neurosurgical rotations, intermediate level residents will:

  • Utilize resources effectively to balance patient care, learning needs, and outside activities.
  • Allocate finite health care resources wisely.
  • Work effectively and efficiently at SickKids.
  • Utilize information technology (eg. searching medical databases) to optimize patient care, life-long learning and other activities.

Specific Requirements

During their pediatric neurosurgery rotations, intermediate level residents will:

  • Identify the important determinants of health that affect their patients.
  • Contribute effectively to injury prevention, health maintenance and health enhancement programs in the community.
  • Be effective advocates of practices that enhance health and well-being
  • Recognize risk factors for child maltreatment and institute appropriate resources and protective mechanisms

SCHOLAR:

General Requirements

During their pediatric neurosurgery rotations, intermediate level residents will:

  • Develop, implement and monitor a personal continuing education strategy.
  • Critically appraise sources of medical information.
  • Facilitate learning of patients, house staff/students and other health professionals.

Specific Requirements

During their pediatric neurosurgery rotations, intermediate level residents will:

  • Acquire current techniques to appraise sources of medical information and develop, implement and monitor a personal education strategy so as to become life-long learners.
  • Acquire a sufficient awareness of the scientific method, including the principles of epidemiology, in order to critically analyse the literature for continuing medical education and investigation.
  • Learn to facilitate the learning of patients, medical colleagues, both junior and senior, and other health care professionals.
  • Make presentations at various times at weekly Neurosurgery and Neuroscience rounds
  • Prepare cases for discussion at monthly morbidity and mortality founds
  • Review topics for discussion at didactic teaching rounds.
  • Undertake one or more clinical research projects leading to a presentation and/or publication as supervised by the faculty.
  • Understand the principles of evidence-based medicine as applied to neurosurgery, including basic concepts of randomized trials, meta-analyses, and economic evaluations

PROFESSIONAL:

General Requirements

During their pediatric neurosurgery rotations, intermediate level residents will:

  • Deliver highest quality care with integrity, honesty and compassion.
  • Exhibit appropriate personal and interpersonal professional behaviors.
  • Practice medicine ethically consistent with obligations of a physician.

Specific Requirements

During their neurosurgery resident rotations, intermediate level residents will:

  • Have a thorough appreciation of the necessity for methods of quality assurance in the delivery of health care.
  • Learn to deliver the highest quality care with integrity, honesty and compassion, and understand the importance of bio-ethical issues in the delivery of health care.
  • Have the deportment of a professional including the demonstration of a sincere, caring attitude in dealing with patients.
  • Fulfill medical, legal, and professional obligations of the specialist.
  • Meet deadlines, be punctual, monitor patients, and provide follow-up.
  • Understand the principles of ethics and apply these in clinical situations.
  • Demonstrate self-assessment, seek and accept advice when necessary.
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