PGY 7

The chief resident is primarily responsible for the academic teaching service, operative case scheduling and assignment of duties to residents and medical students, along with playing a major role in the development of didactic lectures on Academic Day. The chief resident is in direct communication with the attending neurosurgeons, but is responsible for most patient management and may designate authority and liability as necessary and appropriate to lower-level residents. The chief resident is aware of the progress of the residents and, along with the attending neurosurgeons, is responsible for the supervision of each operative case, encouraging and allowing their participation as assistants in increasingly more difficult cases, and as surgeons in simple cases.

The chief resident is given preference for selection of operative cases.

The chief resident’s clinical experience involves performing most of the complex surgeries on the neurosurgical service, including:

• Craniotomies for tumors and vascular disorders
• Spinal procedures for degenerative, vascular and neoplastic spinal diseases
• Complex neurointerventional procedures

The chief resident performs these surgical procedures supervised by an attending surgeon in a progressive fashion. This individual also serves as a resource for the on-call resident for emergent and non-emergent patient care issues, along with the attending surgeon on-call.

The chief resident’s administrative responsibilities include supervision and organization of the weekly teaching conferences and coordination of quality-assurance and other clinically related conferences. Other responsibilities include: supervision of the junior residents; overseeing the daily activities of the residents’ schedules and assignments under the direction of the program director; and overseeing the chief resident outpatient clinic, where the resident will evaluate patients, order appropriate studies and provide follow-up care. Residents, including the chief resident, are at all times supervised by faculty members of the academic teaching service.

During this year, the resident is expected to attain a set of objectives and essential skills:

The chief resident will develop the ability to:

• Gather accurately essential information about all presurgical patients, either directly or by managing more junior residents
• Understand indications for and interpret the meaning of all laboratory and imaging studies used in neurosurgery
• Devise patient-care plans at the level of an independent neurosurgeon, under appropriate supervision from attending surgeons; and also guide more junior residents in evaluating and managing patients
• Establish and implement effective patient-care plans, assuming the role of primary leader on the neurosurgery service, under appropriate supervision of an attending surgeon
• Counsel patients on the risks, goals, limits and alternatives to all neurosurgical procedures
• Demonstrate the ability to perform all major neurosurgical procedures at an independent level, under appropriate supervision of an attending surgeon

The chief resident will develop the ability to:

• Demonstrate an advanced knowledge of anatomy, physiology and pharmacology related to all aspects of neurosurgery
• Demonstrate a familiarity with the neurosurgical literature appropriate for an independent surgeon capable of lifelong learning
• Manage and lead academic conferences

The chief resident will develop the ability to:

• Develop skills as a program builder and administrator of a neurosurgical service
• Demonstrate a solid, evidence-based approach to patient care at the level of a practicing surgeon
• Demonstrate sound habits of personal scholarship and inquiry

The chief resident will develop the ability to:

• Assist the program director in overseeing the, academic and clinical growth and development of junior residents
• Instruct and nurture junior residents in all aspects of neurosurgical patient care (outpatient, inpatient and ICU settings)
• Demonstrate the ability to interact efficiently and effectively with many different healthcare personnel in the pursuit of patient care and service management
• Demonstrate leadership skills in the management of more junior residents

The chief resident will develop the ability to:

• Demonstrate sensitivity and responsiveness to patients' culture, age, gender and disabilities
• Demonstrate integrity and a commitment to patients that supersedes self-interest, serving as primary neurosurgeon
• Participate meaningfully in ongoing professional development by submitting research for peer review to journals and national professional meetings

The chief resident will develop the ability to:

• Demonstrate an understanding of practice opportunities, practice types, healthcare delivery systems and medical economics at a level that is expected of an independent neurosurgeon
• Advocate high-quality patient care and assist patients and the responsible junior residents in dealing with system complexities
• Guide junior residents in the practice of cost-effective healthcare and resource allocation through evidence-based medical practice that does not compromise quality of care
• Understand practice management issues, such as patient processing, evaluation and management coding, procedural terminology, documentation of services rendered and other reimbursement process related issues in both inpatient and outpatient settings, serving as the primary provider of care

The program director meets individually with the resident on clinical rotations twice a year to review the resident's progress, evaluations and publications.