 |
|
| Neurosurgery residency at University of Wisconsin Hospital
and Clinics is a 7 year program. We accept two residents per year. The PG–1 year consists of acquiring fundamental clinical skills in Neurosurgery, Critical Care, and General Surgery.
This is followed by
a combination of Clinical Neurosurgery (4 years),
Neurology/Path/Radiology/Elective (1 year) and Research
(1 year). For tabular details of our rotations in 2009-2010 see Table 1. For a summary of time spent in each rotation see Table 2 . For a written description of each rotation see the paragraphs after Table 3 . |
| |
| Conferences include the Distinguished Lecturer Series, where world–renowned educators,
such as Albert Rhoton, Jr., M.D. (middle), meet and exchange ideas with residents. Distinguished Lecturer Series |
| Overview of Neurosurgical Training Years PGY–1 through PGY–7 |
| Table 2. Rotations — Total Length | ||||
| Rotation | Site | Total Time | ||
| Fundamental Clinical Skills = PGY-1 | UWH & VAH | 12 Months | ||
| Junior Resident | UWH & Meriter Hospitals | 15 Months | ||
| Neurology | UWH & VAH | 3 Months | ||
| Neuroradiology & Neuropathology | UWH & VAH | 6 Months | ||
| Research | UWH & UW Campus | 12 Months | ||
| Senior Resident and Elective | UWH & VAH | 24 Months | ||
| Chief Resident | UWH & VAH | 12 Months | ||
| Total Residency Period | 7 Years | |||
| Table 3. Approximate Call Schedule | ||||
| Rotation | Night / Weekend Call Schedule | |||
| Junior Resident (UWH) | In–house primary call every 4-5 days for UWH / VAH. | |||
| Junior Resident (Meriter) | No in–house call. Primary call from home all weekday nights and 2 out of 4 weekends. Calls back average 5 per month. | |||
| Neuropathology / Radiology | In–house primary call every 4-5 days for UWH / VAH. Daytime weekday hours in Neuropathology / Radiology are usually protected from clinical duty. | |||
| Research | In–house primary call every 4-5 days for UWH / VAH. Daytime weekday hours in research are usually protected from clinical duty. | |||
| Senior Resident(s), and Elective Quarter | No primary call. Backup call from home 10 days a month for UWH / VAH. | |||
| Chief Resident(s) | No primary call. Backup call from home 10 days a month for UWH / VAH. | |||
| PGY-1 Resident — UW Hospital — Fundamental Clinic Skills — 12 months |
|
Each first year resident is matched with a neurosurgical faculty mentor and spends 6 months on clinical neurosurgery, 4½ months on ICU/Emergency care and 1½ months on Plastics. This year the resident obtains fundamental medical knowledge and patient care skills needed to serve as the foundation for neurosurgical training. Particular emphasis is placed on obtaining critical care skills. For that reason our first year residents are assigned early on to a 6-week general surgery night float rotation and 6 weeks in the Neurosurgery ICU. These rotations provide them a rapid introduction to UW Hospital emergency personnel (ER, OR, laboratory and radiology) and their services. Our first year curriculum also includes time spent in the general adult ICU, pediatric ICU, and neuroanesthesia. In subsequent training years our residents are expected to enhance these critical care skills by providing all primary critical care management for neurosurgical patients in our hospital’s ICUs. Finally, a 6 week rotation on Plastics provides an introduction to vascularized skin/muscle flaps and establishes good habits in learning to close tissues. |
| PGY-2 — Junior Resident — UW Hospital — 12 months |
This year is spent entirely at UW Hospital where our residents become fully immersed in clinical neurosurgery. From the start of this year our residents are exposed to subspecialty neurosurgical practice. This means that out of a 4 quarter year they spend 1 quarter each in pediatric neurosurgery, spine, and cranial tumor/vascular work ( Table 1, please see next paragraph for 4th quarter). The benefits of subspecialty practice are several: a close working relationship with 2-3 faculty, more efficient acquisition of clinical responsibility and more effective continuity of care experience. The fourth quarter is spent in neuroradiology. The Department of Neurosurgery and the neuroradiology section of the Department of Radiology maintain a close working relationship. Neuroradiologists are adjunct faculty of our department and a fellowship trained neurosurgeon, Dr. David Niemann, is co-director of a joint endovascular training program. The other co-director is Dr. Beverly Aagaard-Kienitz a neuroradiologist. The timing of the 3-month Neuroradiology rotation to the PG-2 year indicates the importance we place on early acquisition of interpretive neuroradiology skills in CT and MRI. In addition, this resident assists in diagnostic cerebral angiography and observes endovascular interventional techniques. By the end of the neuroradiology quarter, the resident should be able to perform diagnostic cerebral angiography of uncomplicated patients with supervision. |
| PGY-3 — Junior Resident — Meriter Hospital — 6 months |
| The Meriter Hospital Resident is stationed at our affiliated institution, located 10 minutes from University Hospital. This institution is a private 450–bed hospital. UW programs in high–risk obstetrics, perinatal medicine and neonatal intensive care are located at Meriter. The Meriter rotation provides our residents with two unique learning opportunities: a community practice experience in neurosurgery and an experience in neonatal neurosurgical care. |
| PGY-3 — Neurology / Pathology — UW Hospital — 6 months |
Neurology training lasts three months. A special program has been designed for neurosurgery residents which centers on neurologic issues most valuable for the neurosurgery trainee: stroke, movement disorders, epilepsy, and electrodiagnostic testing. This critical segment of training is deliberately saved for the PG-3 year. By that time the resident has clinically matured, understands the value of neurological training, and can promptly put it to use. |
 |
| Neuropathologist and expert teacher, Dr. Shahriar Salamat, at brain cutting. |
| PGY-4 & 5 — Research |
| Research is an integral part of the neurosurgery residency and is
fully funded. The program fosters an investigational emphasis at all levels of training
through research time, research conferences, research mentoring, clinical and basic
research, and the journal club. The resident can choose from among projects offered by
our own faculty or from among 125 other University faculty members (affiliated
with other departments) who work in the field of neuroscience in Madison. The communication of research findings through publications and attendance at national meetings is strongly encouraged. The Department
of Neurological Surgery itself has a long history of important neurosurgical research
contributions. In 1955, for example, our department first introduced hyperosmotic agents into clinical
neurosurgery in the treatment of intracranial hypertension. Our current areas of research include: • Vascular Biology Molecular Biology of Stroke Neuroprotection and Neurogenesis in Stroke Induction of Carotid Atherosclerosis Ischemic Preconditioning in Stroke • Molecular Biology of Brain Tumor Stem Cells • Animal Models of Brain Tumors Caused By Implanted Tumor Progenetor Cells • Stereotaxic and Minimally Invasive Methods in Spine Surgery • New Treatments for Spinal Cord Injury • Folate in CNS Regeneration and Repair • CSF Flow Imaging in Chiari Malformation • Microsurgical Neuroanatomy Relevant to Neurosurgery (see anatomy lab photo) • Treatment of Neuropathic Pain Following Spinal Cord Injury (see photo) • Stem cell transplantation for treatment of CNS Diseases |
 |
| Resident Dr. Sharad Rajpal in the spinal cord injury lab. |
| PGY-5 & 6 — Senior Resident |
| A Senior Resident is stationed at the Middleton Veterans Administration Hospital and also at the UW Hospital. These two hospitals are physically joined, have a single neurosurgical faculty, and function as a single unit. While at the VA, the senior resident is responsible for seeing all out patients and urgent care patients, identifying patients needing admission, formulating the evaluation strategy, reviewing findings with the staff neurosurgeon, and making recommendations regarding surgical and nonsurgical management. Although the senior resident's principal responsibility is to care for veterans hospital patients, he/she also has responsibilities at UW Hospital seeing inpatient consultations, assisting in and performing operations and taking night call. The senior resident works closely with the chief resident and acts as chief resident when taking call. |
 |
| Dr. M. Baskaya (cerebrovascular staff, standing) and resident Dr. Moftakhar in the anatomy lab, examining a colored latex perfused brain. The lab contains two workstations with two operative microscopes, head holders, drills, camera, TV monitor, and DVD recording equipment. Latex perfused brains are prepared in our own department. |
| PGY-6 — Elective Rotation |
| The innovative idea of having an elective rotation, which could function as a mini–fellowship, was put into operation in 2001. We scheduled this rotation for the PGY–6 year. It has been a hit. By that time many residents are seriously weighing the pros and cons of subspecialty interest. The elective rotation allows them to spend a trial period immersed in one subspecialty. Alternatively, some residents opt to spend this time in further research. In either instance, the format is designed on a case by case basis. |
| Chief Resident |
| During the seventh year, the trainee becomes the Chief Resident in neurological surgery at UW Hospital. He/she is responsible for patient care, under the direct supervision of the attending staff. The resident sees patients in the outpatient clinic and participates in diagnostic and therapeutic decision–making for inpatients. In a typical year the chief will be the primary surgeon working with an attending on approximately 400 major cases (system–wide there are currently over 2500 cases per year). The chief resident has administrative supervision of the junior house staff and is expected to participate in their teaching. The resident is responsible to the attending staff and chief of service for the smooth operation of the neurosurgical service. Together with the attending staff, all residents participate in teaching medical students assigned to neurosurgery. |
| Special Features of our Program |
| Endovascular Neurosurgery At UW Hospital, interventional radiology is managed by two fellowship trained co-directors, one from Radiology (Dr. Beverly Kienitz), the other from Neurosurgery (Dr. David Niemann.) This arrangement reflects the close working ties which exist between the two Departments. For neurosurgery residents in the PGY-2 and PGY-4 years, this means that they have introductory training in angiography and transcather interventional procedures. In the PGY-6 year our resident may also elect to have a three month endovascular minifellowship for additional training. During academic year 2007-2008, 125 endovascular thereputic procedures and 132 additional diagnostic angiograms were perform by our faculty often with the participation of neurosurgery residents. 
|
| Dr. David Niemann (faculty neurosurgeon, who is also fellowship trained in endovascular), and resident neurosurgeon Dr. Brandon Rocque (far left) at work in our interventional neuroradiology suite. We provide a full spectrum of endovascular procedures for treating aneurysm, AVM, and occlusive disease. |
| Duty Hours and Education Our training program is designed to educate residents with minimal dilution from non–educational tasks. Although we have been granted 88 hour work week status, no resident time is used for patient support services such as filling out request forms, phlebotomy, IV insertion, laboratory services or patient escort. No resident time is used for radiological film retrieval since online retrieval is commonly available. No time is spent responding to routine patient telephone inquiries, setting up outpatient appointments, or setting up routine admissions. Our department employs nurses and nurse practitioners for these purposes.
Spectrum of Surgical Training Residents receive training in the full spectrum of general neurosurgical problems. In addition they receive an excellent background in cerebrovascular and endovascular surgery, image guided cerebral and spinal surgery, skull based surgery, epilepsy surgery, pediatric surgery, a wide range of spine cases including complex stabilization, and stereotaxic procedures to control movement disorders. An innovative aspect of our program is the mini–fellowship that is built into the PG–6 year as an Elective Rotation. Combined UW Hospital and VA Facilities The William S Middleton Veteran’s Administration Hospital and the UW Hospital are physically joined. The neurosurgical faculty is the same for both hospitals and the two neurosurgical services function as a single unit. UW Hospital serves as a level one trauma and spinal cord injury center as well as a state–designated tertiary care center for nontraumatic disease. It has two Med Flight helicopters. In combination, the VA and UW hospitals have multiple in–house MRI facilities, multiple CT scanners, a positron emission tomographic scanner, a 133X3 cerebral blood flow laboratory, state–of–the–art neurovascular and MRA facilities, and stand at the forefront in the development of MRI spectroscopy, functional MRI, 3–D and perfusion / diffusion imaging. |
 |
| Med Flight arriving at UW Hospital. In this photograph, the VA Hospital (left) connects to the UW Hospital (right) just to the left of the helicopter tail. (Click the photo to enlarge.) |
 |
Home | Residency Program | Description |
| Last update: 8/5/09 |
