The Department of Neurological Surgery offers a six-year (PGY 2-7) residency program that is internationally renowned as a training ground for exceptional neurosurgeons. Accredited by the Accreditation Council on Graduate Medical Education, the program accepts three residents a year.

Residency training at the Department of Neurological Surgery begins after completion of a one-year internship that includes a nine-month surgical specialty internship and three months on neurology. Junior residents then embark on a clinical experience consisting of rotations on the pediatric service as well as the adult microvascular, neurotrauma, spine, vascular, and stereotactic services.

This first year strongly emphasizes basic operative technique and clinical decision making. Routinely, junior residents are assigned to an operating room three to four days a week, and most residents participate in more than 250 cases during their first year. The bulk of the cases are trauma and other craniotomies, routine spinal procedures, pediatric neurosurgery, and spinal fluid diversion procedures. Clinical judgment is enhanced by spending one day a week in the outpatient office.

The second year of neurosurgical training comprises rotations on the endovascular and neuroradiology, neuropathology, and image-guided surgery services. During this time, residents maximize their non-clinical hours with supplemental reading and clinical reviews in preparation for a practice run of the written board exam in the spring. Formal training in stereotactic radiosurgery and movement disorder surgery is obtained during this year. In their third year, PGY-4 residents return to the clinical service as senior residents and continue their operative experience. Increasingly difficult procedures are assigned to senior residents and consist mainly of complex spinal procedures with instrumentation, craniotomies for intra-axial tumors and meningiomas, and posterior fossa surgery.

Residents spend 18 to 24 months of PGY-5 and 6 conducting clinical or basic science research on focused projects. They work under the aegis of an experienced, full-time basic science investigator, who may or may not be a member of the neurosurgery department faculty; collaboration with established basic science investigators is encouraged. During these non-clinical years, past residents have pursued a subspecialty focus or a Master’s degree in neuroscience, business, or public health, all residents complete the written board requirement during this time. An innovative new program offers selected residents the opportunity to participate in a 12- to 18-month “intra-residency fellowship” that will provide intensive training in a clinical field (e.g., vascular, spinal, image-guided neurosurgery) or a comprehensive clinical or basic science research environment. During this time, a four-month rotation as chief resident of the integrated Veterans Administration Hospital service is performed.

After completing their research training, PGY-7 trainees return as chief residents on the clinical service. On average, chief residents perform 400 to 500 major cases including the clipping of aneurysms, skull base procedures, complex spine surgery, and posterior fossa procedures. Their responsibilities also include overseeing the clinical service and instructing the other residents. At the completion of the chief year, residents ordinarily have performed more than 1,000 neurosurgical procedures in which they were primarily involved. 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 Club (four per year)
• Patient Care Conference (weekly)
• Pediatric Neurosurgical Conference (twice weekly)
• Pituitary Conference (quarterly)
• Residents’ Conference
• Neuroanatomy and Neurophysiology Basic Science Conference (weekly)
• Spine Conference
• Image-Guided Service Conference (weekly)
• Visiting Professor Series

The chief residents present the weekly patient care conference. Each resident also presents two 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. In the recent academic year, more than 20 peer-reviewed journal articles were published by residents. 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, 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. Almost 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. Each academic year ends with a gala farewell celebration.

For a detailed information on the Neurosurgery Department, please visit our Overview section.