Sunnybrook Intermediate Objectives
Rotation-Specific Objectives for Neurosurgical Residents on Neurosurgical Services: Intermediate Rotation at Sunnybrook Health Sciences Centre
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:
Sunnybrook Health Sciences Centre
Neurosurgery residents typically rotate at the Sunnybrook Health Sciences Centre at a junior (PGY1-2) and intermediate level (PGY3-4) for a 6-month period. The Sunnybrook neurosurgery service is the busiest level 1 adult neurotrauma service in Canada. Accordingly, residents receive outstanding training here in the management of the patient with head/spinal injuries and neurocritical care. In addition, the Sunnybrook neurosurgery service features multidisciplinary programs in spinal disorders, acoustic neuroma surgery, peripheral nerve surgery, and stereotactic radiosurgery for AVMs and cerebral tumors.
At the completion of their rotations at Sunnybrook, the intermediate level neurosurgery resident will function effectively as a:
MEDICAL EXPERT/CLINICAL DECISION MAKER
- Admit patients, record their medical history and physical examination in clinic ward environment, and formulate diagnostic and treatment plans.
- 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 with a faculty member at least one half day per week.
At the completion of their neurosurgical rotations at Sunnybrook, the intermediate level resident will have demonstrated the following:
- An understanding of the main acquired adult neurosurgical disorders requiring neurosurgical attention including infectious diseases, head and spinal cord injury, brain tumours, stroke, vascular malformations, and degenerative diseases of the brain and spinal cord.
- An intimate and precise knowledge of the anatomy of the central and peripheral nervous systems, including the spine and skull, and a working basic knowledge of the other disciplines including physiology, pathology, endocrinology, and neuropsychology.
- Familiarity with and understanding of diagnostic and imaging studies used to investigate the patient with a neurosurgical disorders including EEG, EMG, CT, MRI, ultrasound, Cerebral Angiography, ICP monitoring, intra-operative neurophysiologic monitoring, and frameless stereotaxy via intra-operative navigation
- An understanding of the spectrum of neurosurgical procedures that are available for the treatment of the patient with neurosurgical disease.
- The ability to obtain a detailed history and carry out a detailed neurological examination in the patient 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 neurosurgical patient
- The ability to interpret neuroradiological examinations in the neurosurgical patient.
At the completion of their Sunnybrook 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:
- Burr holes for drainage of subdural hematomas and empyemas
- Insertion of ICP monitor
- Craniotomy for traumatic depressed skull fracture, skull base fracture, epidural hematoma, subdural hematoma, intracerebral hematoma, and lobectomy
- Application of Halo ring and the use of cervical spinal traction
- Craniotomy for trauma, tumour, epilepsy, and stroke
- Utilization of image guidance (neuronavigation)
- Application and utilization of framed stereotaxy
- Posterior fossa decompression for Chiari malformation
- Neck dissection appropriate to carotid endarterectomy, and tracheostomy
- VP shunt insertion and revision
- Laminectomy, decompression and fusion of cervical spinal fracture with instrumentation as required
- Laminectomy for cervical and lumbar degenerative disc disease
- Laminectomy for epidural metastatic disease and other spinal tumors
- Repair CSF leak
- Exposure and decompression of median and ulnar nerves for neuropathy
Under the supervision of the staff neurosurgeon, the neurosurgical resident at the intermediate level at the Sunnybrook will assist in the completion of the following procedures:
- Supratentorial craniotomy for removal of glioma, meningioma and other tumors
- Posterior fossa craniotomy for tumour removal
- Transphenoidal pituitary tumor resection
- Clipping of intracranial artery aneurysms
- Excision of arteriovenous and cavernous malformations
- Laminectomy, decompression and fusion of spinal fractures in the cervical, thoracic and lumbar regions with instrumentation as required
- Exposure of the brachial plexus with sural nerve grafting
- Radiosurgery for arteriovenous malformations and tumours
- Posterior fossa craniotomy for acoustic schwannoma, trigeminal neuralgia and hemifacial spasm
- Endoscopic third ventriculostomy
At the completion of their rotations in neurosurgery, the intermediate level neurosurgery resident at Sunnybrook 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
At the end of their intermediate level rotation at Sunnybrook, residents will be able to:
- 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.
During their rotations at Sunnybrook, 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 including allied health professionals.
During their adult neurosurgery rotations at Sunnybrook, intermediate level 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 all aspects of patient care and developing improved healthcare delivery strategies.
- 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.
During their neurosurgical rotations, intermediate level residents at Sunnybrook will:
- Utilize resources effectively to balance patient care, learning needs, and outside activities.
- Allocate finite health care resources wisely.
- Work effectively and efficiently at Sunnybrook Health Sciences Centre.
- Utilize information technology (eg. searching medical databases) to optimize patient care, life-long learning and other activities.
- During their neurosurgical rotations, intermediate level residents at Sunnybrook will:
- Learn time management for clinical activity, learning needs and family and recreational activities.
- Learn to function efficiently and effectively at Sunnybrook so as to optimize the application of existing resources and shared assets (such as beds, OR time, certain equipment etc.).
- 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.
- Supervise junior resident trainees who inconsistently rotate through service.
During their adult neurosurgical rotations at Sunnybrook, intermediate level residents will:
- Identify the important determinants of health affecting patients.
- Contribute effectively to improved health of patients and communities.
- Recognize and respond to those issues where advocacy is appropriate.
During their Sunnybrook neurosurgery rotations, intermediate level residents will:
- Identify the important determinants of health that affect their patients, with an emphasis on factors leading to head trauma.
- Council patients and families on modifiable determinants of health as they relate to their condition.
- 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 including interacting with the media via frequently televised trauma programs.
During their adult neurosurgery rotations at Sunnybrook, 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.
During their neurosurgery rotations at Sunnybrook, 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.
During their adult neurosurgery rotations, intermediate level residents at Sunnybrook 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.
During their neurosurgery resident rotations, intermediate level residents at Sunnybrook 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; and appropriate conduct when dealing with fellow health professionals and other non-medical personnel.
- 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.
- Handle any conflicts with other health professionals, patients, families, or others in a manor appropriate to a physician.