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 Accreditation Council on Graduate Medical Education, the program accepts three/four residents (alternating) per year.

Residency training at the department begins after completion of a one-year internship that includes a nine-month surgical specialty internship (including four months of neurosurgery) 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. Numerous physician assistants and nurse practitioners provide support in the outpatient clinics and wards.

The second year of neurosurgical training comprises rotations on the vascular (endovascular and exovascular), neuropathology, and image-guided surgery services (radiosurgery functional, neurooncology). 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 (ABNS) in the spring. Formal training in stereotactic radiosurgery, movement disorder surgery and neuro-oncologic 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.

This two year block provides career development for residents, either in an area of advanced clinical training or investigation. The resident can participate in basic science or clinical investigation on any topic that will foster their career and will be of benefit to neurosurgery. The University of Pittsburgh provides an array of faculty mentors and opportunities for research in neurosurgery, orthopedic surgery, neurology, neuroscience, psychiatry, physical medicine and rehabilitation, neuroradiology, neuropathology, bioengineering, public health, and regenerative medicine (McGowan Institute). Investigations can be funded from numerous sources including the Walter Copeland Fund of the Department (administered by the Pittsburgh Foundation). Our residents have competed successfully for AANS, CNS, and ACS grants as well as others. The resident is expected to write numerous scientific papers and learn the principles of investigation while supervised by selected faculty. Residents also have the opportunity to obtain post-graduate degrees (MS, MPH or PhD) if appropriate.

In addition, during the first twelve-month block, the resident spends four months as senior/chief resident at the Veteran’s Administration (VA) Hospital on the adult neurosurgical service and attends clinics and procedures at UPMC Shadyside as appropriate. The VA rotation is fully integrated with the UPMC adult rotations (same faculty, back-up-on-call coverage, same conferences). This rotation focuses on spinal neurosurgery, pain procedures, peripheral nerve surgery, and cranial procedures. The attending neurosurgeons at the Veteran’s Administration Hospital supervise the resident during that rotation. Attendance at conferences is mandatory and neurosurgical knowledge is gauged during this time. The residents take the written examination of the American Board of Neurological Surgery (for credit), most often in the PGY-5 year. A four month elective in surgical neuro-oncology is also available during this time at UPMC Shadyside.

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)
• Cerebral Angiography (twice monthly)
• 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 (weekly)
• Neuroanatomy and Neurophysiology Basic Science Conference
  (January - March; weekly)
• 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. A 2010 article in the Journal of Neurosurgery listed the University of Pittsburgh number one in published scholarly output.

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. According to a 2011 article in the Journal of Neurosurgery, more academic neurosurgeons completed training at the University of Pittsburgh than at any other institution.

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