The majority of PGY-1 is dedicated to neurosurgery, neurology and neurocritical care. Junior residents will spend three to four months on the neurosurgery service at Grady Memorial Hospital (Grady), two months in the neurosurgery ICU at Emory University Hospital (EUH) and one month at GMH, one month in the surgical ICU at EUH, one month on pediatric surgery at Egleston, one month on ENT (otolaryngology) at EUH Midtown, one month of emergency medicine at GMH and one month on anesthesia/neurosurgery clinic at EUH.
The remainder of PGY-1 time is dedicated to electives, which include: one month of neuro-ophthalmology, stereotactic radiosurgery, neuro-pathology, neuro-radiology and endovascuar neurosurgery. Research projects and solidification of a preferred academic track are to be developed during this time.
Interns are responsible for learning basic pre and postoperative care of surgical patients, management of critically ill neurology and neurosurgical patients, and performing and becoming proficient in the five critical bedside procedures (external ventricular drain placement, lumbar drain placement, lumbar puncture, central line placement and arterial line placement). In addition, time will be spent learning to place headframes for stereotactic radiosurgery, deep brain stimulation, and cervical traction.
Current ACGME guidelines do not permit PGY-1 residents to work more than 16 hours straight, and as such, residents are typically not required to take overnight call.
PGY-2 is spent full-time at EUH, where residents become members of the neurosurgical team.
On service PGY-2 residents are responsible for seeing all floor patients prior to rounds with the chief residents. Following rounds, all residents proceed to the operating rooms for cases. Junior residents are responsible for seeing all patients and consults during the day. Two chief residents are available to mentor and teach the junior residents at all times.
Residents are responsible for all consults and admissions from the emergency room or transfer service.
Typical cases include: open craniotomy for treatment of aneurysm, AVM, cavernous malformation, tumor, lesional epilepsy, implantation of intracranial monitoring for epilepsy and trigeminal neuralgia, deep brain stimulation for movement and non-movement disorders, transsphenoidal pituitary adenomectomy, minimally invasive laser ablation for tumors, epilepsy, and cavernous malformations, peripheral nerve dissections, percutaneous treatment of trigeminal neuralgia, open spine treatment of AVMs, dural AVFs, spinal cord tumors and chiari malformations, vagus nerve stimulator placement and deep brain stimulator battery placement and exchange
Residents are split so there are two PGY-2 residents on service at EUH during the day and one who covers call at night (night float from Sunday night to Thursday night). The “day” residents will cover call on Friday and Saturday nights and Sunday during the day, usually with the help of a PGY-3 resident.
The night float resident is responsible for being on call at both EUH and CHOA Egleston from 7:00 pm to 7:00 am, Sunday through Thursday. The resident is responsible for all consults and admissions from the emergency room or transfers in the neurosurgery service. The resident will typically have two nurse practitioners who help run the Neuro ICU at night.
There is a scholastic requirement of one published paper during this year, as well as responsibility for preparing and presenting two didactic presentations to the resident cohort.
PGY-3 is split between full-time service at Grady with chief backup and elective time.
The Grady Memorial Hospital rotation is typically four months long. The junior resident is paired with a chief resident and intern, while beginning to operate on an independent level. Residents are responsible for all consults, floor and ICU patients, as well as operating.
Typical cases include: craniotomy for trauma, tumor, stroke and aneurysm, as well as spine decompression and fusion for trauma and degenerative disease.
The on-service junior resident is responsible for covering the pager Monday through Friday, 7:00 am to 7:00 pm. The off-service junior residents alternate monthly between electives and night float Sunday through Friday evenings. Saturday and Sunday day shifts are covered by the on-service and elective junior residents.
PGY-3 residents are expected to produce at least one publication-ready paper during this year, as well as three didactic presentations.
PGY-4 year is split between six months of pediatrics at both Scottish Rite and Egleston hospitals, as well as six months at Emory University Hospital Midtown split between spine and neuro-oncology services.
As a mid-level resident, the PGY-4 works solely in conjunction with the primary attending in a mentor-mentee relationship.
During the pediatrics rotation, residents will be exposed to all facets of pediatric neurosurgery including: tumor, spine, congenital malformations, hydrocephalus and shunts, trauma and vascular malformations.
The spine rotation includes: degenerative spine, complex deformity, tumor, and minimally invasive approaches.
Call as a PGY-4 resident is taken in the EUH-Midtown/CHOA call pool and is home-call. Residents typically take one night of home-call during the week for Midtown, and on the weekends for Friday night call at CHOA Scottish Rite, weekend call for EUH-Midtown or rounding in the morning only at EUH-Midtown or CHOA Egleston. Typically one in every three weekends is off.
The neuro-oncology rotation is augmented by training in neuro-endoscopy.
PGY-4 residents are expected to publish one paper or book chapter during this year.
PGY-6 will be spent refining judgment, technical and time management skills with eight months available for further research and elective time, as well as four months as the senior resident at Grady Memorial Hospital.
As the senior resident at GMH, the resident will be more involved in the management of service, evaluation and surgical decision making of the patients under their responsibility, and performance of surgical procedures under the guidance of an attending physician.
Assume primary responsibility as supervisor of a junior resident and other rotators.
Make daily rounds on all patients on the neurosurgical service, in addition to attendance at clinics on the Grady campus.
For two-thirds of the year, PGY-6 residents fill in intermittently at EUH-Midtown and CHOA Scottish Rite. Average call is one weeknight per one-to-two weeks at EUH-Midtown and one Friday night at CHOA Scottish Rite per month. The remaining one-third of the year will be in the chief call pool.
Chief residents oversee the team management of all patients on the adult neurosurgery service in conjunction with preferences of the attending surgeons.
It is the chief resident's responsibility to round on all patients in the morning, review pertinent events, lab or radiographic data, and nursing reports.
Responsible for providing ample instruction or insight as to how decisions are made for the more junior-level residents.
Evening rounds are to be conducted by a chief resident. All radiographic studies performed that day should be reviewed during evening rounds.
The chief resident should round each day on the weekends. The chief resident will assign residents to cases in advance to allow each resident the opportunity to have pre-operative consultation with the specific attending to clarify operative goals, positioning, approach, equipment needed, etc.
The chief resident should participate in the advancement of each junior resident's technical skills in the operating room. All invasive CNS procedures performed in the intensive care unit or on the ward should be supervised by the chief resident until a junior-level resident is deemed capable of functioning independently.
The chief resident must review all consultation cases referred to the neurosurgery service with the resident who performed the initial consultation, and confer directly with or oversee the efficient communication between other residents and the attending on call or the attending requested.
Any complaints lodged by patients, their families, nursing staff, hospital personnel, or other physicians against the resident team should be discussed with that particular resident. If a suitable course of action is not taken, the chief resident should communicate directly with the chairman.
It is the responsibility of the administrative chief resident to compose the schedule of the grand rounds talks and notify speakers.
By completion of the chief resident year, the resident should be proficient in all commonly performed intracranial procedures and microsurgery, treatment of traumatic brain lesions, CSF-diversion techniques and surgical treatment of intracranial infections. The resident should be proficient in a variety of spinal operations for degenerative, traumatic, infectious and neoplastic disease. This includes basic knowledge and skill in spinal instrumentation, as well as basic skills in the management of common pediatric disorders.
Chief residents are on call every third to fourth night for the entire year. Call is to back up all juniors and mid-levels throughout the system. Each chief resident will take one call weekend per month, have one weekend as “back-up” call, which includes morning rounds at Emory University Hospital or Grady Memorial and one-to-two weekends free of duty depending on scheduling.