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CLINICAL
ROTATIONS
West
Junior This
rotation is generally the trainee's initial exposure to clinical neurosurgery.
He/she is introduced to the fundamentals of managing the neurosurgical patient.
The trainee shares clinical responsibilities with the East Senior Resident caring
for patients under the direct supervision of the responsible Staff neurosurgeon.
The trainee is expected to acquire the skills necessary to manage uncomplicated
emergencies, participate in pre- and post-operative patient care, and evaluate
straightforward outpatient neurosurgical problems. North
Junior The
trainee assists the recently graduated Junior Staff neurosurgeon (during the latter's
period of extended training), learning fundamental diagnostic and operative skills
and taking part in the daily care of patients assigned to this team. There is
emphasis on the fundamentals of emergency management of the neurosurgical patient,
including head trauma and triage. Simple invasive ward procedures and basic operative
techniques are learned. Clinical responsibilities, including Emergency Ward coverage,
are carried out under the supervision of the North Attending neurosurgeon and
other MGH Staff including Senior Residents. The trainee is expected to acquire
the clinical skills associated with these responsibilities and to demonstrate
competency in performing simple operative procedures including burr hole placement,
ventriculostomy, and craniectomy. East
Junior The
trainee shares clinical responsibilities with the East Senior Resident caring
for patients under the direct supervision of the responsible Staff neurosurgeon.
There is particular emphasis on vascular, functional, and pediatric neurosurgery
during this rotation. In this context he/she is expected to acquire additional
expertise in the non-operative management of such cases. Operative competence
by the end of this rotation should include satisfactory performance of supratentorial
and infratentorial brain exposures by craniotomy and uncomplicated spinal exposures. Spine This
rotation provides a concentrated, systematic exposure to the management of spinal
disorders. The resident is principally under the supervision of our senior spine
specialists, Drs. Borges and Coumans, assisting in the operative and outpatient
care of his patients. The resident is expected to attain competence in the performance
of more complex spinal procedures at all levels of the spine including anterior
exposures, fusions, and simple instrumentation. In addition, he/she is expected
to demonstrate proficiency in the pre- and post-operative care of such patients
and in the outpatient evaluation of more difficult spinal problems, including
the complications of surgery. East
Senior The
trainee at this level is now able to assume a larger role in operative and non-operative
management of more complex clinical problems under the supervision of Visiting
Staff neurosurgeons on the East Team. The trainee works closely with his/her East
Jr. counterpart, overseeing their clinical activities, thereby playing an important
teaching role. As the East senior, the trainee works most closely with Dr. Ogilvy
(vascular), but also works with Drs. Butler (pediatric), Carter (tumor), and Eskandar
(functional and peripheral nerve). Operative experience is extensive with a special
emphasis on vascular problems including aneurysms, arteriovenous malformations,
and occlusive cerebrovascular disease. In addition, there is considerable exposure
to functional neurosurgery including deep brain stimulation for movement disorders,
epilepsy surgery, and the surgical management of trigeminal neuralgia. The trainee
is expected to demonstrate competence in the performance of the foregoing procedures,
in addition to management of the patient pre- and post-operatively. He/she should
be familiar with recognition and treatment of acute subarachnoid hemorrhage and
cerebral vasospasm. West
Senior [Chief Resident] The
responsibilities of this rotation include increasing experience in the management
of complex tumors and spinal disorders. At this point in the Chief Residency the
trainee works with other members of the Visiting Staff including Drs. Barker and
Curry (tumor), and Drs. Coumans and Borges (spine and peripheral nerve). There
is a special emphasis on technically difficult tumors of the skull base, including
vestibular schwannomas, for which the trainee works especially with Dr. Barker.
In addition, there is an increasing opportunity to perform complex spinal instrumentation,
spinal tumor surgery, and peripheral nerve surgery. The operative cases are typically
of a complex and sophisticated nature, commensurate with the resident's level
of progress. At this level and beyond, there is considerable responsibility for
teaching of other residents and supervision of their clinical activities. The
West Chief Resident is responsible for managing the call schedule and assigning
case to the various residents. In addition, the West Chief Resident is an important
resource for the other residents.
Chief Resident
for the Chief of Service The
trainee now works under the direct supervision of the Chief of Service, Dr. Robert
Martuza, assisting in the care of his patients. During this period, the residents
participate in Dr. Martuza’s clinic for one day of the week, thereby gaining
considerable experience in the outpatient clinical setting. The cases represent
a range of complex skull base tumors, meningiomas, and intraspinal tumors. In
addition, the residents work with Dr. Swearingen in the management of pituitary
tumors and master the details of the transsphenoidal approach. During this period,
the Chief Resident gains considerable experience in managing outpatients in a
busy academic clinical practice, and in making decisions regarding complex neurosurgical
cases. This is also an opportunity for the Chief Resident to spend time with the
Chief of Service and to obtain guidance regarding career planning following the
completion of training. The resident is expected to demonstrate competence in
the independent management of this entire range of neurosurgical disorders, including
the satisfactory performance of operative procedures as well as management of
relevant complications and pre- and post-operative care. |
