The Neurosurgical Residency Program at Yale-New Haven Hospital is a seven-year program under the direction of the Department of Neurosurgery. Dr. Murat Günel is the department chair, and Dr. Charles Duncan is program director for the residency.
The Neurosurgical Residency Program gives residents a broad neurosurgical background. It exposes them to subspecialty neurosurgery and gives them a chance to engage in basic and clinical research.
Appointments to the program are for one year with advancement based on performance. Residents are evaluated continuously by the faculty and senior residents in accordance with the General Competencies. The department expects residents to contribute to their own education through active interaction with faculty. Faculty evaluations are based on residents’ performance in seminars, on the wards, in the OR, in clinics and in the laboratory.
The epilepsy surgery program offers a flexible experience in the diagnostic and therapeutic approaches to medically intractable seizures. A single position for six months to one year is available either following completion of neurosurgical training or embedded within the residency. A Yale-New Haven Hospital resident may elect to concentrate within this specialty for six months to one year and, if choosing this path, may combine clinical experience with ongoing research related to epilepsy.
For individuals choosing the one-year course, either during or following neurosurgery training, the year begins in July and the first three months are spent in Neurology. Here the fellow works with the medical epileptologists attending outpatient clinics, evaluating patients for the surgical program, learning about the appropriate selection of anticonvulsants, and studying both scalp and intracranial electroencephalography. The surgical fellow rotates with the neurology fellows supervising the audiovisual monitoring (AVEEG) of Phase-1 patients (24-hour scalp monitoring selection for surgical candidacy) and caring for the patients undergoing chronic intracranial study (Phase 3). The fellow is supervised in the AVEEG monitoring suite by an epileptology faculty and is then responsible for presenting these patients at the weekly Monday epilepsy surgery conference. The next nine months are then spent in the surgical arm of the program where they take part in both diagnostic and therapeutic surgical procedures. There is a close interaction with the other residents who also take part in the surgical procedures assuming the role of assistant or primary surgeon, depending on year of training and ability. The fellow is expected to carry out at least one clinical research project during this year, attend twice weekly clinics, present at monthly Journal Club, and at the end of the year prepare an abstract for the yearly meeting of the American Epilepsy Society.
An infolded fellowship in endovascular neurosurgery is available through the Neurovascular Section. Furthermore, opportunities for further developing Cerebrovascular and skull base microsurgical skills is also available through the Cerebrovascular/Skull Base microsurgical dissection laboratory through the Neurovascular Section.
Section Specific Programs
Stereotactic and Functional Neurosurgery Program
The stereotactic and functional neurosurgery program directly contributes to the education of medical students and residents through teaching at the medical school level and during the course of training of residents in neurosurgery. The aim is to educate students at the various levels of their training in the ability to recognize the needs of patients with disabling conditions such as Parkinson's disease, spasticity, and chronic pain disorders. In addition, the ability to understand the fundamental neuro-anatomy and neuro-physiology is taught through a series of lectures and by participation in the variety of disorders which fall under the heading of stereotactic and functional neurosurgery.
Neurovascular Surgery Program
Program participates in regular lectures to rotating medical students in neuroscience clerkship, addressing topics of stupor and coma, central nervous system injury, intracranial pressure, acute ischemic stroke and acute hemorrhagic stroke.
In addition, the Neurovascular Surgery Program at Yale has developed written curriculum objectives for resident training at the junior, assistant resident and senior resident level in cerebrovascular disease and neuro-critical care. These include specific knowledge-based objectives, as well as technical skills which must be achieved at every level of training. This curriculum was integrated in the neurosurgical residency training program at Yale during the current year, and has been used as a model for developing similar curricula at the national level, under the sponsorship of the Cerebrovascular Section of the American Association of Neurological Surgeons and the Congress of Neurological Surgeons. It is anticipated that these neurosurgical residency curriculum guidelines will form the basis of a multidisciplinary broad curriculum endorsed by national organizations.
The Program participates in a number of educational activities throughout the state. We are represented in the Connecticut Trauma Committee and in the local affiliate of the American Heart Association, and participate in their regular public information and regional scientific fora. Faculty from the Neurovascular Surgery Program present regular lectures at various community hospitals in Connecticut. Research Progress Interaction with Other Departments.
The department is used for medical student teaching by the Yale School of Medicine. During their laboratory experience residents participate in the neuroanatomy course as lecturer and laboratory supervisor. In this course the neurosurgery resident acts both as teacher and student. This role has been extremely well received and according to the medical student reviews accounts for much of the enthusiasm for neurosurgery. One to 4 students will be on the clinical service at one time.
Third year medical students have a four week Clinical Neurosciences Rotation with a choice of adult neurology, pediatric neurology, neurosurgery or outpatient experience. The student who chooses neurosurgery works closely with the residents and attendings as an integral member of the team. Fourth year medical students may elect a subinternship in neurosurgery and similarly be an integral part of the service. There is a surgical intern on the neurosurgery service at YNHH at essentially all times. The residents have responsibility for teaching these students and interns. These interactions with students are an important guide to mentoring for the residents. There is a noon conference each Friday where the medical students present selected educational cases. The residents prepare the students and question them during the conference. Similarly, students present at other general conferences and chief’s rounds.
Each year a number of students complete their medical school thesis in the Department and a number of others will do shorter projects as well.
Residents teaching residents is an important aspect to neurosurgical education. The faculty makes every effort possible to assure this is well supervised and appropriate. Some of the best-received teaching conferences are those were resident present topics to their peers. Additionally, the residents have an opportunity to teach general surgery, neurology, and pediatric house staff about surgical diseases of the nervous system.
VA Connecticut Healthcare System (VACHS)
The VA Neurosurgery program contributes to the education of neurosurgery residents and medical students. Neurosurgery residents rotate for 6 months on the VA neurosurgery service early in their training, where they participate in and take graduated responsibility for the entire process of neurosurgical care. Under attending supervision, residents see patients in consultation, determine appropriate neurosurgical management, supervise preoperative clearance of medical issues, play a major role in the OR, provide post-operative care, and observe the outcomes of care in follow-up clinic visits.
Medical students can take a combined VA neurology-neurosurgery rotation where they split time between the VA neurosurgery and neurology services. While on the neurosurgery portion of their rotation, medical students help evaluate patients in neurosurgery clinic, participate in surgeries, and assist with perioperative care.