Resident Expectations

Patient Care

  • Perform a competent and comprehensive neurological evaluation including relevant history and detailed neurological examination.
  • Adapt the evaluation to pertinent positives and negatives related to traumatic brain injury, spinal injury, and ischemic and hemorrhagic stroke.
  • Perform comprehensive systemic assessment in relation to these same clinical entities.
  • Recognize the need for diagnostic studies and their prioritization in relation to common presentations of trauma, hemorrhagic and ischemic stroke. 
  • Recognize the need for laboratory studies related to multi-system homeostasis and other clinical assessment of these entities.
  • Recognize the common expected clinical course of patients with traumatic brain injury, spinal injury, ischemic and hemorrhagic stroke.
  • Recognize phases of illness with common systemic and neurologic complications (including periods of vulnerability to respiratory, hemodynamic, cardiac and other common complications).
  • Recognize specifically the clinical course of anticipated edema following traumatic brain injury, spinal injury and stroke, and its general principles of management.
  • Recognize specifically the time course and management principles of vasospasm following subarachnoid hemorrhage.
  • Specific rapid assessment of patients during neurologic emergencies, and the priorities of airway, hemodynamic, and neurologic resuscitation.
  • Recognize the indications and timing of operative intervention for traumatic brain injury, spinal injury, and hemorrhagic and ischemic stroke.
  • Initiate appropriate pre-operative testing for emergency surgical intervention.
  • Interpret pre-operative diagnostic studies and relation to common emergent and elective surgical interventions for trauma and stroke.
  • Understand and apply assessment and intervention paradigms for abnormal respiratory function, cardiac and hemodynamic function, and elevated intracranial pressure.
  • Understand and apply protocols for barbiturate induced coma, including timing of intervention and management of therapy and its common complications.
  • Understand principles of periprocedure management following catheter angiography and common endovascular procedures for treatment of aneurysm, vascular malformation, and therapeutic carotid occlusion.
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  • Recognize guidelines and controversies related to management protocols in patient assessment and care objectives achieved as an Assistant Resident.
  • Mature prioritization of clinical assessment of simultaneous problems in the same or different patients.
  • Prioritize timing and urgency of surgical intervention for traumatic brain injury, spinal injury and stroke.
  • Recognize the impact of systemic conditions on prioritization and timing of surgical intervention.
  • Interpret and act upon changes in patient assessment related to systemic and neurologic function.
  • Apply patient care protocols related to peri-procedure management after catheter and endovascular procedures.
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  • Develop mature clinical judgement related to the spectrum of clinical problems of traumatic brain injury, spinal injury, hemorrhagic and ischemic stroke.
  • Develop independent plans of patient assessment and care related to these entities, including prioritization.
  • Supervision of the housestaff and medical student team in daily patient assessment and care.
  • Mature understanding of the literature and controversies related to patient assessment and care in traumatic brain injury, spinal injury and stroke.
  • Teaching of fundamental objectives to housestaff and assignment of responsibilities to achieve their respective educational objectives in this area.
  • Understand indications for, and controversies related to endovascular catheter procedures and their indications, peri-procedure management and follow-up.
  • Implement and supervise patient care protocols related to these procedures.
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Diagnostic Skills

  • Recognize the principles, indications, and interpretation of normal and common pathologic findings on x-rays of the cervical, thoracic and lumbar spine, skull and chest.
  • Recognize adequate and inadequate x-ray studies and common pathologic abnormalities on these respective x-rays, in association with trauma, stroke, and common complications in the intensive care unit.
  • Understand the fundamentals of tomographic computerized imaging (CT and MRI), normal findings, general localization of pathology in relation to neuro-anatomic structures and vascular structures, and the appearance of pathologic findings in association with trauma and stroke.
  • Recognize the indications for non-invasive vascular imaging with ultrasound, MRA, and CT contrast studies, the emergency use of these modalities and their common interpretation, and limitations of non-invasive vascular imaging.
  • Interpret carotid ultrasound and transcranial doppler diagnostic findings in the setting of trauma, stroke, and clinical vasospasm.
  • Understand the indications for catheter angiography, its general principles (including anatomic vascular access) and the broad interpretation of angiographic findings in ischemic and hemorrhagic cerebrovascular disease.
  • Correlate the location of focal cranial and spinal pathology to the region of the neuraxis, and ability to localize this region using anatomic landmarks, x-ray, and stereotactic guidance.
  • Perform routine lumbar puncture, and tapping of reservoirs and shunts (at least five each).
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  • Understand and apply detail to protocols of spinal clearance and acute neuroimaging in trauma. Clear patients with multiple trauma and correlate diagnostic finding with neurologic assessment.
  • Prioritize diagnostic interventions including particular choice and sequence of diagnostic studies in the setting of traumatic brain injury, spinal injury, and common syndromes of ischemic and hemorrhagic stroke.
  • Mature interpretation of diagnostic studies in relation to type of pathology, choice of surgical approach and intraoperative localization.
  • Mature interpretation of non-invasive and invasive vascular imaging including degrees of stenosis, level of pathology, types and location of intracranial aneurysms, and types of vascular malformations.
  • Supervise and perform more difficult spinal taps, fluoroscopic guided access, and localization marking of intracranial and spinal targets.
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  • Mature and detailed under-standing of indications, principles, and interpretation of the full spectrum of neurodiagnostic armamentarium.
  • Understand guidelines, protocols and literature controversies related to diagnostic imaging in trauma and cerebrovascular disease.
  • Apply evolving techniques and new modalities to the patient care protocols and education of the housestaff and medical student team at their respective level of educational objectives.
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Technical & Surgical Skills

  • Perform placement of arterial catheters, central venous catheters, pulmonary artery catheters, and burr hole/twist –drill ventricular catheter placement, including indications, landmarks, performance of the procedure (supervised at least five, unsupervised at least five) and post-procedure verification of placement accuracy and application of the devices to the patient care plan.
  • Assist in image guided placement of intra-hematoma catheters (at least three).
  • Volu-metric assessment of intracranial hematoma and ventricular size in relation to catheter placement and drainage.
  • Understand surgical anatomy and principles of exposure of the cervical carotid artery.
  • Assist in opening and exposure of cervical carotid artery (at least three cases).
  • Perform opening and exposure of cervical carotid artery (at least three cases) with supervision.
  • Understand principles of pterional craniotomy including layers of the scalp, management of temporalis muscle, placement of burr holes, and planning of craniotomy flap.
  • Assistance in pterional craniotomy for vascular pathology (at least five cases) and performance of pterional craniotomy for vascular pathology (at least five cases) with supervision.
  • Understand principles of surgical localization and craniotomy flap planning for vascular malformations and non-pterional craniotomy approaches to vascular structures.
  • Assist in non-pterional craniotomy approaches to vascular pathology (at least five cases).
  • Understand principles of acute spinal stabilization and traction-realignment in the setting of trauma and instability, including indications and potential complications.
  • See spinal objectives for additional technical/surgical objectives related to spinal pathology.
  • Understand principles of planning and timing of craniotomy and burr hole drainage for intracranial hematoma.
  • Performance of evacuation procedure of intracranial hematoma (assisting at least three cases, performance with supervision at least five cases).
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  • Performance of routine and complicated burr hole and twist drill procedures for drainage of ventricles and intracranial hematomas (at least ten cases).
  • Exposure of the cervical carotid artery for endarterectomy or proximal control (at least five cases) and performance of plaque removal during carotid endarterectomy (at least three cases).
  • Assisting in complete carotid endarterectomy procedure and arteriotomy closure (at least five cases).
  • Mature understanding of the planning and performance of pterional craniotomy for intracranial vascular pathology.
  • Performance of pterional craniotomy (at least five cases), and splitting of Sylvian fissure and microsurgical exposure of basal cisterns (at least five cases).
  • Performance of surgical approach to vascular structures via non-pterional craniotomy (at least five cases) with supervision, and excision of embolized or simple vascular pathology (at least three cases).
  • Supervision of Assistant Residents in burr hole and simple evacuation procedures for intra-cranial hematoma.
  • Performance of burr holes and simple procedures for evacuation of intra-cranial hematoma (at least five cases).
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  • Mature understanding of surgical strategies and approaches to common and rare vascular pathologies.
  • Understanding and applying principles of intraoperative anesthetic management, proximal and distal control, temporary clip placement with brain protection, and intra-operative localization mapping as applied to vascular pathology.
  • Application of these principles in actual surgical procedures (at least ten cases).
  • Planning and execution of pterional craniotomy for common vascular pathology (at least ten cases).
  • Splitting of Sylvian fissure and microsurgical exposure of basal cisterns for vascular pathology (at least ten cases).
  • Microsurgical exposure and clipping of intracranial berry aneurysm (at least ten cases) with supervision.
  • Planning and execution of non-pterional craniotomy approaches to less common or more complex intracranial vascular pathologies.
  • Execution of craniotomy plan and exposure of vascular lesion (at least five cases).
  • Excision of simple or well embolized vascular malformation (at least three cases).
  • Assistance in microsurgical management of more complex cerebrovascular procedures (at least ten cases).
  • Planning and execution of craniotomy and burr hole plans, including indications, pre-operative and intraoperative localization, and execution of the surgical plan for evacuation of intracranial hematomas (at least ten cases).
  • Supervision of other housestaff in meeting surgical objectives at their respective levels (including assignment of cases).
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Administrative & Teaching

  • Participate in the teaching of nurses and medical students regarding all educational objectives outlined above.
  • Participate in teaching conferences, presentation of cases, and writing of case reports.
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  • Increased teaching responsibility to medical students, interns and assistant residents in their various educational objectives.
  • Supervision of more junior housestaff in performance of technical/surgical objectives at their respective levels.
  • Assistance in the organization of clinical and teaching rounds and conferences, and presentation of cases.
  • Preparation of topic reviews in lecture and manuscript formats, including literature summary and references.
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  • Full administrative supervision of the neuro-ICU service, including patient care, identification of cases for database, morbidity/mortality identification and discussion, and supervision of medical student and housestaff team in every aspect of patient care.
  • Organize and administer teaching conferences.
  • Mature participation in specialty conferences.
  • Assign responsibilities to assistant residents and residents with the aim of fulfilling respective educational objectives.
  • Prepare original contributions to patient care protocols and/or the neurosurgical literature based on accumulated experience with clinical and educational material on the service.
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