Welcome to Tulane University Medical Center Department of Neurological Surgery

TULANE UNIVERSITY HEALTH

SCIENCES CENTER

SCHOOL OF MEDICINE

DEPARTMENT OF NEUROSURGERY

RESIDENCY PROGRAM HANDBOOK

2002-2003

I. INTRODUCTION

A. DEFINITION AND DESCRIPTION OF THE SPECIALTY

Neurological Surgery is a discipline of medicine that provides the operative management and nonoperative management (i.e. prevention, diagnosis, evaluation, treatment, critical care, and rehabilitation) of disorders that affect the central, peripheral, and autonomic nervous systems, including their supporting structures, and vascular supply and the operative and nonoperative management of pain. As such, neurological surgery encompasses the treatment of adult and pediatric patients with disorders of the nervous system; disorders of the brain, meninges, skull, and their blood supply, including the extracranial carotid and vertebral arteries; disorders of the pituitary gland; disorders of the spinal cord, meninges, and vertebral column and disorders of the cranial and spinal nerves throughout their distributions.

B. DURATION AND SCOPE OF EDUCATION

The neurological surgery-training program is 72 months in duration. The program is diversified and well balanced, including clinical neurosursgery, basic sciences, neuroradiology, neuropathology, and other subject matter related to the neurosciences, tailored to the specific needs of the resident with approval from the program director. There are 36 months of clinical neurosurgical surgery rotations and 24 months of neurology, neuropathology, neuroradiology, basic science / elective rotations, and a research year.

C. ADMISSION PREREQUISITE

Applicants for Neurological Surgery Residency must have graduated from an accredited Medical School in the United States . Candidates from Foreign and U.S. Territory School of Medicine will be reviewed on an individual basis. They must be able to obtain a Louisiana Medical license, and must complete a first year surgical rotation. We participate in the San Francisco Matching Central Application Service.

II. INSTITUTIONAL ORGANIZATION

A. SPONSORING INSTITUTION

Medical Center of Louisiana at New Orleans

Charity and University Campuses

B. PARTICIPATING INSTITUTIONS

1. INTEGRATED INSTITUTION

A. Veterans Administration Medical Center

2.. AFFILIATED INSTITUTION

A. Tulane University Hospital & Clinic

3. SPECIAL RESOURCE HOSPITAL

A. Barrow Neurological Institute-St. Joseph Hospital and Medical Center

III. EDUCATIONAL PROGRAM

A. EDUCATIONAL GOALS AND OBJECTIVES

The goal of the Tulane Neurosurgery Residency Training Program is to provide an outstanding educational experience for the training and education of neurological surgery residents encompassing the six general competencies in the areas of:

Patient care
Medical knowledge
Practice-based learning and improvement
Interpersonal and communication skills
Professionalism
Systems-based practice

Our educational objective is to produce highly competent, compassionate, and well rounded neurosurgeons who are proficient in the above 6 competencies. In each of the above competencies the residents must be able to demonstrate the following in each competency:

· Patient Care that is compassionate, appropriate, and effective for the treatment of health problems and the promotion of health.

· Medical Knowledge about established and evolving biomedical, clinical, and cognate sciences and the application of this knowledge to patient care.

· Practice-Based Learning and Improvement that involves investigation and evaluation of their own patient care, appraisal and assimilation of scientific evidence, and improvements in patient care.

· Interpersonal and Communication Skills that result in effective information exchange and teaming with patients, their families, and other health professionals.

· Professionalism, as manifested through a commitment to carrying out professional responsibilities, adherence to ethical principles, and sensitivity to a diverse patient population.

· Systems-Based Practice, as manifested by actions that demonstrate an awareness of and responsiveness to the larger context and system of health care and the ability to effectively call on system resources to provide care that is of optimal value.

The Neurological Surgery Department is dedicated to the principles of teaching, research and excellence in patent care. We, the faculty of the Neurological Surgery Department, are totally committed to and have dedicated our educational, financial and human resources in order to accomplish our educational objectives. In order to accomplish these objectives the residents will be exposed to the operative and non-operative management of adult and pediatric patients with disorders that affect the central, peripheral, and autonomic nervous system, including their supporting structures and vascular supply and the operative and non-operative management of pain. As such, the training will encompass the treatment of adult and pediatric patients with disorders of the nervous system; disorders of the brain, meninges, skull, and their blood supply, including the extracranial carotid and vertebral arteries; disorders of the pituitary gland; disorders of the spinal cord, meninges, and vertebral column and disorders of the cranial and spinal nerves throughout their distributions.

We are committed to the advancement of knowledge and the science of neurological surgery through our research endeavors and are dedicated to the improvement of medical practice and standards of care through our clinical work.

B. CLINICAL RESPONSIBILITIES

Any questions a resident has regarding the program should be directed to the Chief Resident, Program Coordinator or the Program Director. The residents are required to maintain their medical licenses in good standing and provide a copy of the license to the neurosurgery academic office as soon as they receive it from the Louisiana State Board of Medical Examiners. No resident will be allowed to take vacation in July, March, December or June (exceptions may only be made by the program director). All requests for vacation should be made in writing to the senior resident, who is responsible for maintaining the on-call and leave schedules. Hospital handbooks are available in the academic office for the use of all residents. Dress code will be followed as defined by the particular service through which the resident is rotating and as dictated by the neurosurgery training program.

PATIENT AND STAFF RELATIONSHIPS

The success of the department is directly dependent upon the satisfaction of both patients and referring physicians. All patients are to be treated with compassion, courtesy, and consideration. Their questions are to be answered fully and in, as much as possible, an unhurried fashion. Rounds are to be conducted in a professional fashion. No one is to drink or eat during rounds.

Nurses and residents, and other personnel are to be treated with courtesy and respect. A record of repeated disruptive behavior, ineffectual relationships with patients, nurses, residents, or other personnel is grounds for disciplinary action

ROUNDS

TMC -Rounds are conducted twice daily and weekend mornings. All patients have to be seen prior to going to the OR the morning of surgery. Repeated tardiness for rounds is grounds for disciplinary action.

Medical Center of LA at New Orleans (MCLNO)- Rounds are conducted by the chief resident twice daily and once daily on weekends. The rounds will be attended by the junior resident, rotating residents and students. All patients will be seen prior to going to the OR the morning of surgery.

VAMC - Rounds are conducted in accordance to the Director of the service. Attendings will round independently or with the resident on the service depending on OR or conference schedules.

CONSULTS

All consults must be responded to in a timely manner. E.R. and ICU patients should be seen immediately for true emergencies, and within 30 minutes for more routine requests. Non-ICU patients should be seen within 4-6 hours after request.

CHARTS AND MEDICAL RECORDS

All new admissions will have complete H&P’s legibly written or dictated within 24 hours. Progress notes are entered daily into the charts in the SOAP format. Preoperative and operative notes must be entered for all surgical cases on the same day as surgery. Post-operative notes must also be written. The operative reports must be dictated within 24 hours of surgery. Discharge summaries must be dictated the same day of discharge.

Clinical privileges will be suspended if medical records and charts are not completed in a timely manner. Please consult the hospitals’ handbooks for their specific rules and regulations regarding this matter.

SURGICAL LOG

All residents must maintain an accurate and up-to-date summary or log of all monthly surgical data beginning with the first year of training as required by the ABNS and the RRC. The monthly statistics from each hospital and the ABNS data from each resident must be turned into the program director’s office on Monday of the week of the City Wide Conference (second Saturday of each month). The residents are responsible for keeping track of all admissions, consultations, surgical cases (major and minor procedures), diagnostic and interventional neuroradiology cases.

CALL

1. Working hours are defined from 0700 to 1700, Monday through Friday: all other hours will be call hours. However, the resident on each service is expected to finish his/her daily responsibilities for that service prior to turning the service over to the call team.

2. The resident on call should be notified during call hours.

3. The resident on each service should be promptly informed of all new admissions or consultations occurring during call hours by 0700 the next working day.

4. Please make requests for specific days off by the 5th of the preceding month so that the call schedule can be done in a timely manner.

MOONLIGHTING

Moonlighting is not permitted under any circumstances and will lead to disciplinary action.

FACULTY SUPERVISION

All surgical cases must be presented at the Friday after noon staffing conference. Interesting surgical or nonsurgical cases are also presented at this conference. In addition to this staffing conference, the supervision of residents is coordinated by the full-time faculty so that each attending will have a day of staffing for VAMC and MCLNO hospitals for that week. The attending staff dedicates this entire day to educating and supervising the residents and does not have any additional clinical responsibilities anywhere else (i.e. surgeries or clinics). The attending is responsible for supervising all surgical cases in the O.R., staffing all new admissions, consults, making rounds, attending all teaching conferences for that day and supervising all clinics. The residents are encouraged to seek out different medical opinions regarding a case, but should avoid the appearance of “shopping around” for the “right” endorsement or medical opinion. Clinical staff are also available for supervising surgical cases at all hospitals.

EDUCATIONAL COMPOSITION AND SPECIALIZATION

FULLTIME FACULTY

DONALD E. RICHARDSON, MD,FACS

Professor and Program Chairman.

Pain, movement disorders, stereotaxy, functional neurosurgery.

JOHN WALSH, Ph.D., MD,FACS

Professor and Chief of Pediatric Neurosurgery.

Pediatric Neurosurgery,functional, stereotacxy and Gamma Knife Radiosurgery.

CLINICAL FACULTY

STEVEN N. BAILEY, M.D.

Clinical Assistant Professor

Certified, American Board of Neurological Surgeons

BRADLEY J. BARTHOLOMEW, M.D.

Clinical Associate Professor of Neurogurery

Director of Conferences and Journal Club

Certified, American Board of Neurological Surgeon

JOHN R. CLIFFORD , M.D

Clinical Assistant Professor of Neurosurgery

Certified, American Board of Neurological Surgeons

Fellow, American College of Surgeons

FRANK CULICCHIA , M.D.

Clinical Assistant Professor of Neurosurgery

Certified, American Board of Neurological Surgeons

DZUNG H. DINH, M.D., MBA, FACS

Clinical Associate Professor

Certified, American Board of Neurological Surgeons

DONALD DOOLEY, M.D.

Clinical Professor

Director, Neurosurgery Service Veterans Administration Hospital

Certified, American Board of Neurological Surgeons

JOSEPH M. EPPS, M.D.

Clinical Professor of Neurosurgery

Assistant Director, Neurosurgery Service, Veterans Administration Hospital, Certified, American Board of Neurological Surgeons

THOMAS B. FLYNN, M.D.

Certified, American Board of Neurological Surgery

Fellow, American College of Surgeons

Clinical Assistant Professor of Neurosurgery

BRYANT G. GEORGE, M.D.

Clinical Assistant Professor of Neurosurgery

Certified, American Board of Neurological Surgery

ALLEN JOSEPH, M.D.

Clinical Assistant Professor of Neurosurgery

Certified, American Board of Neurological Surgery

Fellow, American College of Surgeons

CHRISTOPHER MASCOTT, MD,F(R)CS

Clinical Assistant Professor

Certified, American Board of Neurological Surgeons

JOSEPH M. NADELL, M.D.

Clinical Professor of Neurosurgery/Pediatrics

Certified, American Board of Neurological Surgery

Fellow, American College of Surgeons

JOHN PATTON, M.D.

Clinical Assistant Professor of Neurosurgery

Certified, American Board of Radiology

THOMAS PERONE, M.D.

Clinical Assistant Professor of Neurosurgery

Certified, American Board of Neurological Surgery

Fellow, American College of Surgeons

JUAN CARLOS PISARELLO, M.D.

Clinical Associate Professor of Neurosurgery

Chief of Neurosurgery, VAMC

Local Training Director for Residency training program at

VAMC

ANNE H. SHOLES, M.D.

Clinical Assistant Professor of Neurosurgery

JOHN R. TOMPKINS, M.D.

Clinical Instructor of Neurosurgery

RELATED DISCIPLINE FACULTY

There are faculty from other departments who are directly involved with or participate in the training, educating and supervising our residents.

RONALD AMADEE, MD.

Professor and Chairman of ENT,

Adjunct Professor of Neurosurgery

Neuro-otology, skull base

GERALD GIANOLI, MD.

Assistant Professor Otolaryngology.

Neuro-otology, Skull base.

MARTA MARTINEZ , Ph.D.

Assistant Professor of Bioengineering.

JOHN N. JOSLYN, M.D.

Associate Professor of Radiology

Neuroradiology

M.B. BHATTACHARJEE, MBBS, M.D., MRCPath

Assistant Professor of Pathology

CURTIS L. SUTTON, M.D.

Assistant Professor of Radiology

Neuroradiology

ROBERT L. HEWITT, M.D.

Professor and Interim Chairman

Department of Surgery

Vascular surgery

DONALD L. AKERS, M.D.

Associate Professor of Surgery

Vascular surgery

LEON A. WEISBERG, M.D.

Professor and Section Chief

Department of Psychiatry and Neurology

ANNE L. FOUNDAS, M.D.

Associate Professor

Department of Psychiatry and Neurology

DEBRA G. ELLIOTT, M.D.

Assistant Professor

Department of Psychiatry and Neurology

JOSEPH T. WEBER, Ph.D.

Professor

Department of Anatomy

NORMAN R. KREISMAN, Ph.D.

Associate Professor

Department of Physiology

HECTOR LEBLANC, M.D.

Professor

Department of Pathology/Neuropathology

C. CLINICAL COMPONENTS

REQUIRED ROTATIONS:

FIRST YEAR PGY-2 NS 1:

The PGY-2 resident is assigned to the Neurosurgery Service at Tulane Medical Center for the entire year (12 months of clinical neurological surgery). He/she is appointed to this service directly under the supervision of the Chairman and full time faculty. THE PGY-5 resident is also assigned to this service and services as senior resident. He/she participates with the PGY-5 in the work-up of each patient admitted to the service, including pre-operative, operative, postoperative and nonsurgical care. With the PGY-5, he/she conducts a pre-operative clinic for patients who are scheduled for the surgery for the coming week. He/she with the PGY-5 assists the faculty on surgical procedures performed on this service. Rounds are made twice daily and at least once on weekend. Both residents are directly involved in the management of all hospital patients including critical care patients. They answer all consults for the service and see all daytime emergency room consults. They compile and present the Tulane neurosurgery statistics at the weekly staffing conference and the monthly CityWide M&M conference.

While on this rotation, the residents may attend outpatient neurosurgery clinics at the Medical Center of LA at New Orleans (Charity Hospital Campus) and at the V.A. Hospital. The residents will take call for VAMC, Medical Center of LA at New Orleans (MCLNO) and TMC every fourth or fifth night. At the end of the first year, the resident should understand the basic pathophysiology of different neurological and neurosurgical disorders. Technical competency is required in the placement of ventriculostomy, insertion of ICP monitor, application of halo and tongs, craniotomies for blunt or penetrating traumatic injury to head and spine, and stereotactic biopsies. The PGY-2 resident is expected to be proficient in all simple surgical approaches to the spine for laminectomy and anterior cervical discetomy, understand the basics of spinal fusion, instrumentation and various management approaches for head and spine disorders. He/she should be able to perform some pediatric procedures, such as shunt or reservoir placement, simple repair of myelomeningocele. The resident is required to attend all neurosurgery-teaching conferences. The first year resident may attend the annual Louisiana State Neurosurgical Society Meeting or other regional and national meetings deemed appropriate by the Program Director. The resident may take the American Board of Neurological Surgeons written exam for self-assessment. Individual resident statistics must be turned in on a monthly basis and failure to do so may result in disciplinary action.

Minimum competency requirements for PGY2-TMC

At the end of the first six months the PGY2 at TMC should be able to perform the following:

1. Ventriculostomy

2. ICP Monitor

3. Exposure for anterior cervical discectomy

4. Exposure for lumbar discectomy

5. Carpal tunnel release

6. Craniotomy exposure for head trauma