PGY-1
During the PGY 1 year the resident spends six months on the neurosurgical service taking care of patients on the neurosurgical floor and getting early exposure to the operating room Residents learn the following in their first year:
- Preoperative medical work-up for neurosurgical patients
- Postoperative care & critical care management of the neurosurgical patient
- Complex socioeconomic factors related to disposition
In addition to inpatient care, the resident is expected to become comfortable in operating room. Under the supervision of faculty and senior residents, the PGY-1 resident will be expected to become proficient with the following:
- Positioning & Equipment Setup
- Standard opening & closing of cranial & spinal procedures
- Basic operative technique
- Ventriculostomy Placement
- Intracranial Pressure Monitor Placement
- Lumbar Drain Placement
PGY 1 residents take "buddy call" with the PGY 2 and 3 residents and, in a graduated fashion, learn the structure, organization, and work-up necessary for being the independent on-call resident.
Off-service rotations
The remainder of the PGY 1 year is spent on off service rotations providing exposure to services that work closely with the neurosurgical service, cultivating a deeper understanding and appreciation for the overall care of the patients that we manage.
These include:
- Trauma surgery
- Stroke neurology
- Neuroendovascular Surgery (working in the angiography suite with Neurosurgery/Neurology/Radiology)
- Neuro-otology (exposure to lateral skull base approaches)
- Neuro-ophthalmology
- Surgical-Neurological ICU
PGY-2 and PGY-3 (18 months on inpatient service)
During the PGY 2 and 3 years, residents are fully integrated into the neurosurgical service and assume the role of “junior resident,” including primary call responsibility, graduated autonomy in the operating room, and management of the inpatient service.
Junior resident call is a 24-hour in-house call that, on average, is taken every 4 days. During the on-call period, the resident is responsible for every aspect of the neurosurgical service, allowing the resident to develop extensive knowledge and experience caring for critically ill patients on our service
Resident responsibilities
This includes the following responsibilities:
- Knowing the neurologic exam and plan for every patient on the neurosurgical service
- Reviewing the imaging studies acquired on such patients
- Evaluating patients postoperatively
- Seeing new consults in the emergency room
Promptly to any questions/pages regarding any patient on the neurosurgery service
During this time, each resident is also assigned to a primary service, with each rotation consisting of a 6-month block.
These include:
- Intensive Care Unit (ICU) patients
- Pediatric Neurosurgical patients
- Neurosurgery consultation patients
In the operating room, the junior resident continues to advance their operative skills, gaining progressive autonomy in increasingly complex procedures under the supervision of the attending neurosurgeon. This includes exposure to vascular neurosurgery, neuro-oncology, epilepsy surgery, complex spine surgery, and functional neurosurgery, peripheral nerve surgery, and endovascular neurosurgery.
PGY-3 – 6 months on Continuity of Care (CoC) rotation
During this 6-month rotation the resident begins to transition into a more senior resident role with an independent block with two faculty, Hiroyuki Oya, MD, PhD, and Satoshi Yamaguchi, MD, PhD.
The resident will be paired with these faculty in a “mentorship model” in which they follow their patients from clinic, to the operating room, and to follow-up.
During this time, the resident spends two days a week in the clinic with these faculty evaluating patients and then is able to follow these patients through their entire interaction with the neurosurgical service.
This time allows the resident to gain further experience in the following areas.
- Outpatient evaluation of neurosurgical disease
- Patient History & Physical
- Imaging assessment
- Formulating a surgical plan & discuss management strategies
- Ongoing evaluation & management of neurosurgical patients
- Review procedures and consent information with patients
- Perform operate procedures with faculty oversight
- Round on and manage postoperative patients
- Patient follow-up in clinic after discharge
This rotation has been invaluable to the education of the neurosurgical resident in allowing them to gain a greater appreciation of the entire scope of patient care as they move toward independent practice, from outpatient evaluation, surgical intervention, and follow-up care. Focused mentorship during this time also allows the resident to gain autonomy in patient management as well as in the operating room, allowing significant advancement in operative skill.
PGY-4 and PGY-5 – 2 years of research time
After completion of the junior resident years, the transition to senior residency begins with two years of dedicated research time.
During the initial three years, it is expected that the resident has explored research opportunities and begun working with neurosurgical faculty and colleagues in both the clinical and basic science realms to establish a collaborative research plan.
The goal during this two-year period is to allow the resident dedicated time to be immersed in rigorous scientific research and acquire the skills necessary for a lifelong career as an academic surgeon scientist. Time should be spent executing experiments, analyzing data, and preparing manuscripts for publication.
Clinical responsibilities
Clinical obligations during this time are limited, with the resident covering “chief call” on average 1 of 4 weekends. This involves rounding with the team that weekend and taking home call while supervising the in-house junior resident on call.
All operative procedures during this call period are performed by the resident on “chief call” in conjunction with the attending on call.
PGY-6 - Chief Year
The chief residency year is divided into two six-month blocks during which the chief resident is assigned half of the neurosurgical service based on faculty member. The chief acts as the primary physician responsible for managing all aspects of neurosurgical patient care.
Responsibilities of the chief resident include:
- Rounding on all patients
- Formulating care plans, even for the most complex neurosurgical patients
- Formulating operative plans
- Overseeing the care provided by junior residents
- Providing operative coverage for elective and emergent cases daily
- Alternating call every other day to direct care of new consults
Upon completion of this year under the supervision of the neurosurgical faculty, the chief resident should be prepared to practice and operate independently as they transition independent practice.
PGY-7 – Transition to Practice
During the PGY-7 year, the resident spends six months at the University of Iowa where they will see patients in their own clinic and to formulate clinical and operative plans independently. These patients will be staffed with a supervising faculty member who ultimately is responsible for the case, however it is the expectation that the PGY-7 resident acts as the treating physician.
Buddy call
In addition to the elective outpatient service, the resident also will take "buddy" faculty call to further the transition to practice experience, allowing for independent decision making regarding operative management. Moreover, the PGY 7 resident is available to operate on any of the elective patients on the operative schedule to allow the trainee to further hone their operative skills in an independent, but mentored environment.
Off-site rotation
The other six months of the PGY-7 year is designed to allow the resident additional training in their field of choice. This is frequently done off site at another institution, however if desired the resident may also stay at the University of Iowa and work with any of the faculty in a one-on-one fashion to continue to develop skills of interest.
These experiences are typically arranged independently by the resident prior to their chief year with the guidance of faculty. During this period, the resident is provided with a living expense stipend in addition to their current salary and benefits to offset the cost, allowing the pursuit of additional training in their subspecialty area of focus.
Overall, this has been an invaluable experience during this final year, allowing for significant professional and personal growth.