The Department of Neurological Surgery offers a seven-year (PGY 1-7) residency program that is internationally renowned as a training ground for exceptional neurosurgeons. Accredited by the UPMC Graduate Medical Education Council as well as the Accreditation Council on Graduate Medical Education (ACGME), the program is currently approved to train 25 residents. The goal of the program is to provide exceptional clinical and scientific education to top-notch graduates of medical schools who wish to be leaders in the field of neurological surgery in the United States. Our program focuses training to maximize medical knowledge, build patient care skills, provide for practice based and systems based learning. We stress professionalism and interpersonal and communication skills and rely heavily on both inpatient and outpatient use of informatics.
The University of Pittsburgh Department of Neurological Surgery was founded more than 75 years ago with a strong commitment to patient care, education and research. Today, our department is the largest neurosurgical academic provider in the United States performing almost 8,000 procedures annually at our academic hospitals and more than 11,000 systemwide.
A recent study published in the Journal of Neurosurgery showed that our department ranked first in academic output in top-tier specialty journals among all departments of neurosurgery across the United States and Canada. Another Journal of Neurosurgery article showed that our department ranked as the most productive residency program in the nation in terms of graduates remaining and contributing in academic neurosurgery. Still another article, published in informaHealthcare, showed that our stereotactic research effort was the most productive in the world.
Seventy-five years at the forefront of neurosurgical care have demonstrated that we are a proven international leader in patient care, research and training.
Residency training at the department begins with the first year experience. PGY-1 residents who enter the field as novices in neurosurgery will spend a total of six months on the clinical neurosurgical service as well as three months on the clinical Neurology Service. First-year residents also will gain clinical experience on various surgical subspecialties which often include ear, nose, and throat, surgical subspecialties, critical care medicine, and the emergency room.
The PGY-2 year represents an in depth introductory year to clinical neurosurgery and emphasizes basic operative techniques and initial clinical decision making. The department emphasizes the importance of the flow of information and communication between residents, senior residents, and responsible faculty. PGY-2 residents routinely spend a block of three months on the cranial service, three months on the spine service, three months on the pediatric service, and three months on the trauma service. Most junior residents participate in more than 250 neurosurgical procedures during their first year. PGY-2 residents will complete basic training in many procedures such as lumbar puncture, external ventricular drain placement, intracranial pressure monitor insertions, and placement of cerebral blood flow technologies such as Licox monitors. Initial case experience includes the selection and identification of patients who will undergo craniotomy, routine spinal procedures, and trauma cases. In addition to nine months at UPMC Presbyterian, each PGY-2 resident will spend a period of three months on the pediatric neurosurgical service at Children’s Hospital of Pittsburgh of UPMC. Clinical judgment is enhanced by spending an average of one day per week in the physician outpatient office. Numerous midlevel providers including physician assistants and nurse practitioners provide support both on the hospital floors as well as in the outpatient clinics.
The PGY-3 year emphasizes clinical experience in vascular neurosurgery (an initial introduction to both endovascular as well as exovascular techniques), neuropathology, and image-guided surgery (including radiosurgery, functional neurosurgery, and neuro-oncology). Residents will also spend 3 months on the neurooncology service at UPMC Shadyside. During the PGY-3 year, residents have a greater opportunity to consolidate their knowledge and to maximize supplemental reading and clinical reviews in preparation for a practice run of the written board examination (American Board of Neurological Surgery). This test is taken for practice in March of the PGY-3 year. Attendance at a training course in stereotactic radiosurgery as well as initial experience in movement disorder and pain surgery as well as neuro-oncological surgery are obtained during this year. All residents also attend the annual RUNN course at Woods Hole, MA. This course provides an annual exciting update on the future of neuroscience and is intended to catalyze residents to pursue neuroscience basic or clinical research.
In the PGY-4 years, senior residents in neurological surgery will gain additional experience in multiple cranial and spinal cases in order to reach the next set of milestones in their education. Consolidation of medical knowledge, enhanced patient care skills, and intense practice based learning will occur in this year. PGY-4 residents spend a significant portion of their time in the neurosurgical operating room. Increasingly difficult procedures are assigned to senior residents and include complex spinal procedures with instrumentation, craniotomies for intra-axial tumors, meningiomas, and posterior fossa surgery. Residents spend eight to nine months on the adult service and three to four months as senior resident on the pediatric service.
The PGY-5 and PGY-6 blocks provides a total of 18- 24 months of focused career development opportunities for senior residents. During this time, residents will spend between three and four months as the chief resident at the Veterans Affairs Pittsburgh Healthcare System where they will gain additional surgical as well as service management skills.
The remaining block of time is designed for residents to actively pursue research-focused subspeciality training, and clinical investigation on topics that will eventually foster their subsequent career and provide benefit to the future course of neurosurgery. There are two paths for trainees in the PGY-5 and 6 year:
Clinical Investigator Path:
The clinical investigator path includes an 18-month period of time during the PGY-5 and 6 year for focused subspecialty training. Residents must identify a primary mentor during the PGY-4 year. The resident in this path must have identified a clinical subspecialty focus that will supplement career development and submit an internal funding grant request (Copeland Grant) on a clinical topic. The resident must complete and submit six publications in peer-reviewed journals during this interval of time. Residents also will participate in the Clinical and Translational Science Institute (CTSI) Seminar Series. Residents are expected to present at the AANS, CNS, or subsection meetings relative to their clinical or scientific work.
Surgeon Scientist Investigator Path:
During this interval of time, residents have between 18-20 months to further develop an academic research career, working in a functional and dedicated laboratory. Residents must identify a primary mentor during their PGY-4 year. They are expected to submit a Copeland Grant during their PGY-4 year on their research topic of choice. Residents in this path are able to submit for a national grant using existing mechanisms from the AANS, CNS, foundations, or industry. Our residents are expected to submit four to six peer-reviewed journal articles during this time. Residents also will have the opportunity to gain a master of science degree but must begin this process one year in advance. Selected residents who wish to obtain a PhD will be fully evaluated for this opportunity but must dedicate additional blocks of training time to complete such an advanced degree. All residents are expected to present their work at one or more national scientific meetings. During this PGY-6 year, residents are freed from responsibility from both outpatient and operating room coverage, except for elective and approved moonlighting performed on the UPMC Presbyterian neurological surgery service.
The University of Pittsburgh provides a wide spectrum of faculty mentors and opportunities for research in neurosurgery, neurology, neuroscience, psychiatry, physical medicine and rehabilitation, neuro-imaging, neuropathology, bioengineering, public health, and regenerative medicine (McGowan Institute). Research may be funded from numerous sources including the Walter Copeland Fund of the department (which is administered by the Pittsburgh Foundation). Residents in our program have competed successfully for AANS, CNS, and American College of Surgeon grants. All residents are expected to write scientific papers and to supplement this with additional book chapters. Residents are expected to learn the principals of investigation under the supervision of faculty mentors.
Residents at all levels are expected to attend the departmental teaching conferences which are mandatory. Neurosurgical knowledge is gauged by performance on written boards as well as by semi-annual written evaluations and meetings. Each year a promotion to the next level of training is determined by the departmental competency review committee.
PGY-7 residents return to the service as chief residents on the clinical service at UPMC Presbyterian. Coverage responsibilities include chief of the cranial service, the spinal service, and the trauma service. On average, chief residents perform 400-500 major cases such as clipping of aneurysms, skull-based tumors, complex spine surgery, and posterior fossa surgery. As future practitioners of neurosurgery, they also learn responsibilities of clinical oversight of the service that they are leading. They serve as primary instructors to the younger residents. By the time of the completion of the chief year, residents often have performed more than 1200 neurosurgical procedures as monitored by the ACGME online ADS data base.
Residents in this program have a particularly unique experience in microneurosurgery, pediatric, endoscopic, and image-guided neurosurgery. In addition to daily teaching rounds, led by individual members of the department faculty, the department holds a series of weekly resident conferences and review lectures to discuss specific neurosurgical concepts, techniques, problems, and solutions. Both faculty and residents are regular participants in these programs, many of which include formal didactic presentations. The training program includes the following faculty/resident conferences:
- Brain Tumor Conference (weekly)
- Chairman’s Conference (twice monthly)
- Faculty Teaching Conference (weekly)
- Journal Clubs (four per year)
- Patient Care Conference (weekly)
- Pediatric Neurosurgical Conference (twice weekly)
- Pituitary Conference (quarterly)
- Residents’ Conference (weekly)
- Neuroanatomy and Neurophysiology Basic Science Conference
(January - March; weekly)
- Image-Guided Service Conference (weekly)
- Visiting Professor Series (four to six per year)
The chief residents present the weekly patient care conference. Each resident also presents one or more annual 30-minute lectures on basic neurosurgical topics or recent research. To teach the skills required for the oral boards, several conferences use a board-simulated approach to presented cases. At least four times per year, an internationally known neurosurgeon serves as a lecturer and visiting professor. The visiting professor also reviews interesting cases with the residents and attends a journal club.
Trainees have been extremely productive during their clinical and non-clinical years. They commonly have five to 10 publications in refereed journals and multiple presentations at national meetings by the completion of their residency.
Since 1980, residents in the department have been awarded three Congress of Neurological Surgeons Preuss Awards for brain tumor research, two CNS clinical fellowships, American College of Surgeons research scholarships, the CNS Margot Anderson Foundation Fellowship in Brain Restoration Research, and two CNS Wilder Penfield Clinical Investigation Fellowships. Five residents have received the Van Wagenen Fellowship, a prestigious award given annually by the American Association of Neurological Surgeons to a North American neurosurgical resident who is graduating that year.
Given the extensive experience in microneurosurgery, skull base surgery, endoscopic surgery, pediatrics, and image-guided neurosurgery, many residents have foregone fellowships and entered directly into academic or private practice. Others have obtained competitive fellowships at other institutions prior to beginning their neurosurgical careers.
Although the program’s focus is on training academic neurosurgeons interested in clinical and basic science research, it has produced many outstanding private practice neurosurgeons as well. Half of the department’s graduates in the last 25 years serve as full-time academic faculty members, and 25% have clinical affiliations with academic institutions.