Residency training at the department begins with the first-year experience. PGY-1 residents who enter the field as novices in neurosurgery will spend three months on the neurosurgical services, three months on critical care medical services (trauma, neuro, surgical ICU), two months on neurology, and one month on trauma and emergency room services This year continues to evolve as we optimize the introductory experience in neurosurgery. It is designed to optimize performance for the next year, when full integration into patient care teams is accomplished.
The PGY-2 year represents an in-depth introductory year to clinical neurosurgery and emphasizes critical care, 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 at UPMC Mercy, three months on the pediatric service (Children’s Hospital of Pittsburgh of UPMC) 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 tissue oxygenation monitors. Initial case experience includes the selection and identification of patients who will undergo craniotomy, routine spinal procedures and trauma cases.
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 and in the outpatient clinics.
The PGY-3 year emphasizes clinical experience in vascular neurosurgery (an initial introduction to endovascular and exovascular techniques), neuropathology and image-guided surgery (including stereotactic radiosurgery and functional neurosurgery) and neuro-oncology 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, pain surgery and neuro-oncological surgery are obtained during this year. Each Fall PGY-3 residents also attend the annual Research Update in Neuroscience for Neurosurgeons (RUNN) course at Woods Hole, Mass. This course provides an update on exciting developments in neuroscience and is intended to catalyze residents to pursue neuroscience basic or clinical research.
In the PGY-4 year, senior residents in neurological surgery will gain additional critical 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 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 nine months on the adult service and three months as senior resident on the pediatric service. Typically a senior resident participates in between 400 and 500 cases per year.
The PGY-5 block provides a total of nine months months of focused career development opportunities for senior residents. During this time, residents will spend three months as the chief resident at the VA Pittsburgh Healthcare System where they will gain additional surgical and service management skills. During this time residents take the ABNS training exam for credit. All residents must pass the exam in order to graduate. The departmental target goal is a performance on the written boards at or above the 50th percentile.
The remaining time is flexibly designed for residents to actively pursue clinical or research-focused subspecialty training, along with investigations 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 block: the Clinical Investigator Path and the Surgeon Scientist Investigator Path:
Clinical Investigator Path:
The clinical investigator path includes an 18-month period of time during the PGY-5 and PGY-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 four to 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 (American Association of Neurological Surgeons), CNS (Congress of Neurological Surgeons) 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. 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 after they complete the residency training in order to complete such an advanced degree. All residents are expected to present their work at one or more national scientific meetings. During their 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 of Regenerative Medicine). Research may be funded from numerous sources, including the Walter Copeland Fund of the department (which is administered by The Pittsburgh Foundation). Residents in the department’s program have competed successfully for AANS, CNS and American College of Surgeons 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-6 residents return to the service as residents on the clinical services at UPMC Presbyterian, UPMC Shadyside, UPMC Mercy, and in selected cases at UPMC Children’s Hospital of Pittsburgh. Coverage responsibilities include chief of the cranial service, the spinal service and the trauma service. On average, chief residents perform 400-500 major cases during PGY-6, 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 their completion of the chief year, residents often have performed more than 1500 neurosurgical procedures as monitored by the ACGME online Accreditation Data System (ADS) database.
Completing the case log requirements and skill set acquisition in the PGY-6 year allows residents to pursue subspeciality clinical or research training in their last year of clinical neurosurgery before final graduation in June. Selected infolded fellowship opportunities exist in spine (CAST approved), skull base, endovascular (CAST approved), and stereotactic-functional (CAST approved) training. For selected residents pursuing the surgeon scientist pathway, further research opportunities as well as mentoring for grant submission can be pursued.
Residents in this program have a particularly unique experience in microneurosurgery, pediatric, endoscopic, and image-guided neurosurgery including radiosurgery. 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 conference:
- Multidisciplinary Brain Tumor Board (weekly)
- Chairman’s Conference (twice monthly)
- Faculty Teaching Conference (weekly)
- Image-Guided/Radiosurgery Conference (weekly)
- Written Boards Preparation Conference Patient Care Conference (weekly)
- Patient Care Conference (weekly)
- Pediatric Neurosurgical Conference (twice weekly)
- Pituitary Conference (quarterly)
- Skull Base Conference (weekly)
- Residents’ Conference (weekly)
- Spine 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. Six University of Pittsburgh 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. At each annual meeting, residents and faculty often receive named awards for their abstract presentations.
Given the extensive experience in microneurosurgery, skull base surgery, endovascular surgery, endoscopic surgery, and image-guided neurosurgery, many residents no longer require post residency fellowships and entered directly into academic or private practice. Residents who want to have a career focus in pediatric neurosurgery obtain prestigious 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 percent have clinical affiliations with academic institutions.