The neurosurgical resident begins his/her training from the PGY1 level with the Department of Neurosurgery. The year is divided into two six-month blocks. One block is assigned to expose the resident to other surgical and non-surgical disciplines. Rotations may vary from year to year but are currently assigned as follows in one-month rotations: 1) Neurosurgery; 2) Critical Care; 3)Neurology; 4)Surgical ICU; 5) Anesthesia. The second six month block is assigned to the neurosurgical service at University Hospital and includes exposure to the assigned to the consultation service, ward service and the operating room. The resident is expected to participate in all educational conferences and to take the American Board of Neurological Surgery primary written exam for non-credit only. The resident is expected to participate in outpatient clinics of the neurosurgical faculty and the Chief Resident’s clinic.
The second year is divided into two six month blocks. The first six months are spent as a junior resident on the neurosurgery service at UHS. During this year, the resident begins to learn protocols for preoperative evaluation, surgical set-up and begins to assist in selected cases. As the resident progresses he/she is given the appropriate operative responsibilities.
The second six month block consists of resident service at the St. Luke’s Baptist Hospital. The resident works closely with the site’s program director and first assists in all surgical cases and attends all clinics. The resident is responsible for the preoperative work-up and preparation of the patients as well as all postoperative management. The resident is expected to attend all educational conferences and to take the American Board of Neurological Surgery primary written examination for self-evaluation.
The first six months of the third postgraduate year are spent at the University Hospital where the experience is solely concentrated to the introduction of the management of the pediatric neurosurgical patient. The Pediatric Neurosurgery Service is staffed by one Board Certified Pediatric Neurosurgeon, who manage the entire gamut of neurosurgical pediatric problems and diseases. During these six months, the resident works closely with the faculty and is responsible for first call duties while abiding to the 80 hour work week guidelines. The resident is responsible for the preoperative evaluation and preparation of the patients as well as the postoperative care of all neurosurgical in-patients. The resident attends to all of the outpatient clinics and responds to emergency neurosurgical consults.
The last six months residents rotate at Methodist Hospital the residents will have an opportunity to participate in a larger number of surgical cases, to include more cases in the areas of aneurysm surgery, transsphenoidal procedures, metastatic brain tumors, and advanced spine surgery with complex instrumentation. This is an excellent opportunity for our residents to participate in a private practice experience, while remaining in a controlled educational setting. Not only will they have a substantive clinical experience, and operative experience, they will also have the first-hand exposure to a private practice business model, increasing their systems-based learning objectives.
The fourth year is divided into two six month blocks. The resident will spend 6 months on a Neuro endovascular Rotation at University Hospital and St. Luke’s Hospital. The residents work closely with the cerebrovascular neurosurgeons. This rotation is designed to enhance the experience with endovascular neurosurgery. Case content includes diagnostic cerebral angiography, stoke assessment, and interventional angiography for the endovascular treatment of aneurysms, avm’s, fistula, vasospasm, stroke, and tumor embolization.
The second half of this year is spent at the North Central Baptist. This site allows continued trauma experience, as it is a level III trauma center. It also provides additional experience with pediatric patients by having a dedicated children’s emergency center and a level III neonatal intensive care unit. With a resident assigned to this site, they are afforded the opportunity to manage patients on an in-patient service as well as attend adult and pediatric outpatient clinics. The resident is assisted by a dedicated physician’s assistant during the week and will share in covering call with the other neurosurgical residents rotating within the Baptist system. Three department staff have scheduled operative days during the week on site and the resident will be able to assist in their surgical cases (particularly spine and pediatric). This site also provides additional exposure to a private health care setting.
In addition to increasing levels of responsibility, the resident works closely with the Chief Resident in managing the service. He/she is expected to partake increasing levels of educational activities of the junior residents, rotating residents and medical students. At this stage, the resident begins to prepare for the upcoming research year and should formulate a reasonable and achievable research plan.
The PGY5 year is designated as the primary research year. Beginning in year NS4, potential areas of interests are begun to be defined and explored with the resident. The resident will have several options from which to pick an area of concentrated basic science research: cerebral neuroprotection, mechanisms of injury during perfusion and reperfusion and ischemia, systemic hyperthermia and it’s effects on cerebral function microcirculation and autoregulation, pial window model for study of traumatic brain injury, brain tumor cell cultures, spinal cord injury, craniofacial research including genetic analysis of craniosynostosis, exploration of neuroprotective signaling, mitochondrial response to stress and neurodegenerative conditions, neurorestorative potential of stem cells, stroke, and Freidreich’s Ataxia and gp120 induced neuronal signaling. Under the direction of Drs. Papanastassiou and Naomi Sayre, a project is chosen and a 12 month time line is selected for the culmination of this project. It is expected that the resident will become the principal author of at least one publication in the area of research chosen by the resident. The overall goal is to expose the resident to mechanisms of neuro-degeneration and become familiar with techniques of molecular biology, genetics, cell culture and pial window, insight into academic drug development, spinal cord injury model (NYU), stroke model in mice and generation, induction and grafting of stem cells. By working closely with Dr. Sayre, the resident will gain a greater insight into the rigorous, technical and statistical aspects of scientific research. Opportunity will be given to residents to attend national meetings such as the RUNN course and attend a specialty meeting in their area of research.
During the first six months of the NS6 year, the resident is assigned as Senior Resident to the San Antonio Military Medical Center (SAMMC) Hospital. The resident is expected to be the primary surgeon in the majority of the cases and to play a major role in the management of the out-patient clinics. Increasing levels of autonomy and responsibility during this rotation, help prepare the resident for his/her Chief Resident year.
The second six months are spent as Senior Resident at the St. Luke’s Hospital. Likewise, he/she is expected to perform and be the primary surgeon in complex neurosurgical procedures.
During the PGY7 year, the resident is assigned the duties of Chief Resident at both the UHS and VA Hospital. The Chief Resident’s duties include the overall clinical and administrative services at both institutions. The Chief Resident works closely with the faculty in the selection, scheduling, and execution of operative neurosurgical cases. His/her administrative duties include the management of the resident on-call schedule, vacation schedule, conference, and national meeting resident attendance. The Chief Resident leads the daily rounds with the junior residents, PAs, nurses, and rotating interns and/or medical students on a daily basis and establishes the management parameters and the plans for inpatient and consultative neurosurgical service.
Policy on Resident Selection and Appointment
As per ACGME Institutional Requirements, applicants for residency training at UTHSCSA must meet one of the following qualifications:
- Graduate of medical school in the U.S. and Canada accredited by the Liaison Committee on Medical Education (LCME) or the American Osteopathic Association (AOA).
- Graduate of an international medical school, meeting one of the following qualifications:
- Have a currently valid ECFMG certificate or
- Have a full and unrestricted license to practice medicine in a U.S. licensing jurisdiction.
- Graduate of international medical school who has completed a Fifth Pathway program provided by an LCME-accredited medical school.
All first year residency positions (PGY-1) should be offered through the National Residency Matching Program. When programs do not fill through the match, residents may subsequently be appointed to unfilled positions from the pool of unmatched students, or other sources, as long as they meet institutional standards.
All resident applicants must be subjected to a Security Background Check (please see specific policy) before beginning residency training. Any individuals listed by a federal agency as excluded, suspended, or otherwise ineligible for participation in federal programs (Institutional Compliance Agreement p.6 of 18) are ineligible for residency or fellowship at UTSCSA.
The non-citizen resident must have permanent resident status, J-1 visa, or approved H-1B visa for medical residency position at the UTHSCSA (please refer to the visas policy).
Resident Selection and Appointment
It is the policy of the UTHSCSA and its affiliated hospitals to sustain resident selection processes that are free from impermissible discrimination. In compliance with all federal and state laws and regulations, the University of Texas System Policy , and Institutional Policy, no person shall be subject to discrimination in the process of resident selection on the basis of gender, race, age, religion, color, national origin, disability, sexual orientation, or veteran status.
Residency programs’ resident selection committees rank candidates on the basis of the group’s assessment of the individual’s potential contributions in that particular specialty of medicine. These judgments are based on the applicant’s academic performance, the assessment of their faculty as reflected in letters of recommendation, and personal qualities evaluated during the interview process conducted by faculty and resident representatives, including motivation, integrity, and communication skills.
In addition to the guidelines above, the TSBME mandates a postgraduate resident permit for all residents entering Texas programs. These rules essentially make it necessary for the resident to demonstrate that he/she will be eligible for permanent licensure in Texas . Residents are expected to be familiar with the regulations at http://www.tsbme.state.tx.us.