Neurosurgery Residency Program Overview & Curriculum

PGY-I: 12 months Combined Surgery / Clinical Neurosciences Internship

In complete fulfillment of ABNS requirements for training in general care, Neurology and Allied Clinical Neurosciences, this year combines a variety of clinical rotations including Neurosurgery, Endovascular Neurosurgery, Neurology, MICU, NeuroICU, Stereotactic Radiosurgery, Neuroradiology, and Neuropathology,  

During this year the resident acquires expertise in the diagnosis and treatment of general medical, neurosurgical, and neurological diseases and conditions. The resident learns to manage a busy clinical service of neurosurgery floor patients efficiently. This includes obtaining a medical history, performing a physical exam, ordering appropriate tests, interpreting test results, performing daily care, writing accurate and concise daily notes, discharge planning and dictating discharge summaries. The resident builds a fund of knowledge in general medicine and neurosurgery.

During this year, the resident also acquires knowledge and experience in neuroradiologic and neuropathologic diagnosis and radiosurgical and endovascular treatment of neurosurgical disease. The Neurology experience includes rotations in the Neuro Intensive Care Unit and neurology consult service. Neuropathology is taught through a combination of readout sessions, post-mortem brain cutting sessions, and special tutorials provided by the Neuropathology Division. Similarly, the Neuroradiology rotation consists of participation in readout sessions, tutorials and conferences. The resident studies Neuroangiography and observes endovascular procedures with the Endovascular Neurosurgery Service. The resident participates in case selection and post-treatment followup in the Radiosurgery Clinic, studies MRI and CT anatomy and radiobiological principles in helping with treatment planning and observes patient treatment with the Cyberknife.

PGY-II: Junior Resident I: 12 months at SUMC and LPCH

The PGYII year is spent in clinical Neurosurgery as Junior Resident I at SUMC and LPCH. The trainee works with the Chief Resident, the Senior Resident, and interns and medical student clerks rotating through the service. The resident joins fulltime and clinical neurosurgical faculty in the initial assessment, operative treatment and postoperative care of patients.The PGY-II resident is responsible for inpatient consultations. Subspecialty clinics in which the resident conducts preoperative assessment and postoperative followup include cerebrovascular, tumor, spine/peripheral nerve, pediatric, functional (epilepsy, pain, movement disorders) and general neurosurgery. Stanford has a fully integrated night float system, and the 3 PGY-II's rotate as the night float, day consult and operative resident.

The resident becomes familiar with the diagnosis, surgery, and both preoperative/postoperative care of patients with neurosurgical problems. This includes ICU care of critically ill patients, emergency management of neurosurgical conditions and neurosurgical consultations. The resident also learns to manage an outpatient clinic, including the diagnosis of neurosurgical problems, communication with patients, the decision process for surgery and postoperative care. Emphasis is placed on improvement of communication skills for relating to patients and families and on issues of medical ethics. The resident learns to supervise interns and teach medical students.

During this year, the resident acquires familiarity with the basic principles of operative neurosurgical technique, including patient positioning, surgical exposure and surgical closure. The resident also acquires proficiency in performing minor procedures (lumbar puncture, lumbar drain, ventriculostomy, muscle/nerve biopsy,and  halo placement); craniotomy for trauma, tumor, hematoma, and abscess; basic cervical and lumbar spinal surgery; peripheral nerve surgery; and stereotactic biopsy. The resident also begins to explore clinical research interests, submit abstracts regarding this research to regional and national meetings and present clinical data at local, regional and national conferences. The resident is expected to broaden a fund of basic and clinical neuroscience knowledge and take Part I (written) of the Neurosurgical Boards for self-assessment.

PGY-III: Junior Resident II: 4 months each at PAVAH, LPCH and SCVMC

The PGYIII year is divided between PAVAH, LPCH and SCVMC. For 4 months at PAVAH, the resident is the primary resident for all neurosurgical care. The resident acquires increased independence in managing neurosurgical problems by acting as patients’ primary neurosurgeon during inpatient, outpatient, and consultative care. Proficiency in general neurosurgery, particularly that required by the degenerative diseases commonly encountered in the veteran population, is emphasized at PAVAH. The resident develops skills in neoplastic and degenerative spine surgery, craniotomy for straightforward aneurysms, tumors, and vascular malformations, carotid endarterectomy and transsphenoidal surgery. The resident supervises a team of NPs and PAs on the VA neurosurgery service. The resident works under the supervision of 2 fulltime VA faculty/Stanford faculty who both cover challenging subspecialty cases. The resident evaluates all inpatient and outpatient consults, works up all new cases for admissions, participates in all operations as primary surgeon or first assistant, and directs postoperative care. The resident usually operates 2 full days at PAVAH and attends the outpatient PAVAH clinic 1 day per week. PGY-III residents share Saturday call coverage at SUMC throughout the year.

For the 4 months at SCVMC, the resident serves as the primary resident for all neurosurgical care. The resident operates daily under the direct supervision of 4 experienced attendings. As the area's main county hospital, SCVMC offers full exposure to the breath of neurosurgery as well as in-depth experience in neurosurgical trauma.

The last 4 months are spent as the primary resident on the LPCH Pediatric Neurosurgery Service. Under the supervision of 3 experienced pediatric neurosurgeons and a pediatric neurosurgery fellow, the resident acquires more advanced diagnostic and patient management skills relevant to diseases of infants and children. Understanding of the unique conditions and the special considerations required in treating neurosurgical diseases in children is obtained. The resident is involved in initial assessment and case selection in clinic, preoperative evaluation, surgery, postoperative care and outpatient followup.

During this year, the resident should actively pursue clinical research interests, submit abstracts regarding this research to regional and national meetings, and present clinical data at local, regional and national conferences. The resident is also expected to expand basic knowledge of neuroscience, neurology and neurosurgery, and to take the Written Neurosurgical Boards for self-assessment.

NS-4 Enfolded Fellowship II: Enfolded Clinical Fellowship and/or Basic/Clinical Research

During these 2 years, the resident completes a fellowship consisting of either an enfolded clinical fellowship or clinical/basic science research. Clinical or basic science research may be performed in the Neurosurgical Research Laboratories, another laboratory at Stanford or, in special cases, a laboratory at another institution or in industry. Research may be complemented by advanced subspecialty surgical training in Functional Neurosurgery, Stereotactic Radiosurgery, Endovascular Neurosurgery and Spine Neurosurgery.

In clinical or basic science research, the resident develops academic skills, including critical review of existing literature, hypothesis driven research, creative and rigorous experimental design, precise performance of procedures, interpretation of data, synthesis of experimental results with existing literature, and preparation of reports for publication and presentation at regional and national meetings. Some may choose to pursue an advanced degree such as a PhD or MPH during this time. The resident continues to accumulate a fund of basic and clinical neuroscience knowledge and takes the written Part I Neurosurgical Board exam for credit. Each resident is required to pass the written boards at the 50th percentile before beginning the PGY-VI year.

Policy regarding ABNS Pass Rate (AY 2018 and beyond)

This policy is based on the belief of the Stanford Faculty that a deep and broad fund of knowledge in the basic and clinical neurosciences is essential to neurosurgeons’ ability to practice safe, effective patient care and that the ABNS written exam is a reasonable standard for assessing this knowledge.

Because we expect Stanford-trained residents to become leaders in neurosurgery in pursuing excellence and innovation, we believe they will desire to pursue and should be required to achieve a higher standard than their peers.

All residents are expected to pass the ABNS written exam with a score of at least the 50^th % ile (the “Stanford Pass”) before graduating from the program.

Each resident will take the ABNS written exam annually until meeting two requirements:

1)      achieving a “Stanford Pass”, whether the exam is taken for practice or credit, and

2)      achieving a “National Pass” when taking the exam for credit.

A resident may take the exam for credit only after achieving a score of at least the 20^th%ile when taking the exam for practice.

A resident failing to achieve a “Stanford Pass” score of at least the 50^th %ile by May of the PGY-5 Year will not be allowed to begin the PGY-6 clinical year until such a score has been achieved.

NS-5 Enfolded Fellowship II: Enfolded Clinical Fellowship and/or Basic/Clinical Research

During these 2 years, the resident completes a fellowship consisting of either an enfolded clinical fellowship or clinical/basic science research. Clinical or basic science research may be performed in the Neurosurgical Research Laboratories, another laboratory at Stanford or, in special cases, a laboratory at another institution or in industry. Research may be complemented by advanced subspecialty surgical training in Functional Neurosurgery, Stereotactic Radiosurgery, Endovascular Neurosurgery and Spine Neurosurgery.

In clinical or basic science research, the resident develops academic skills, including critical review of existing literature, hypothesis driven research, creative and rigorous experimental design, precise performance of procedures, interpretation of data, synthesis of experimental results with existing literature, and preparation of reports for publication and presentation at regional and national meetings. Some may choose to pursue an advanced degree such as a PhD or MPH during this time. The resident continues to accumulate a fund of basic and clinical neuroscience knowledge and takes the written Part I Neurosurgical Board exam for credit. Each resident is required to pass the written boards at the 50th percentile before beginning the PGY-VI year.

Policy regarding ABNS Pass Rate (AY 2018 and beyond)

This policy is based on the belief of the Stanford Faculty that a deep and broad fund of knowledge in the basic and clinical neurosciences is essential to neurosurgeons’ ability to practice safe, effective patient care and that the ABNS written exam is a reasonable standard for assessing this knowledge.

Because we expect Stanford-trained residents to become leaders in neurosurgery in pursuing excellence and innovation, we believe they will desire to pursue and should be required to achieve a higher standard than their peers.

All residents are expected to pass the ABNS written exam with a score of at least the 50^th % ile (the “Stanford Pass”) before graduating from the program.

Each resident will take the ABNS written exam annually until meeting two requirements:

1)      achieving a “Stanford Pass”, whether the exam is taken for practice or credit, and

2)      achieving a “National Pass” when taking the exam for credit.

A resident may take the exam for credit only after achieving a score of at least the 20^th%ile when taking the exam for practice.

A resident failing to achieve a “Stanford Pass” score of at least the 50^th %ile by May of the PGY-5 Year will not be allowed to begin the PGY-6 clinical year until such a score has been achieved.

PGY-VI: NS-6 Senior Resident at SUMC and KPRCMC

During this year the resident is expected to become proficient in the outpatient and inpatient diagnosis and management of neurosurgical diseases, including those in the subspecialty areas of vascular, tumor, spine/peripheral nerve, pediatric, functional and general neurosurgery. 8 months are spent as a senior resident at SUMC.  4 months are spent at Kaiser Permanente Redwood City Medical Center. The resident should demonstrate proficiency in supervision of junior residents, interns and medical students and in communication with patients, families, colleagues, and staff. The resident should learn to balance the analytical and scientific aspects of medicine and surgery with humanitarian concern. The resident is expected to develop microsurgical operative skills, including those for aneurysms, vascular malformations, epilepsy, microvascular decompression, brain tumors, transsphenoidal procedures, spinal tumors, spinal dysraphism, carotid endarterectomy, sympathectomy, functional neurosurgery, craniofacial reconstruction, craniosynostosis repair, and complex spine surgery.

Policy regarding ABNS Pass Rate (AY 2018 and beyond)

This policy is based on the belief of the Stanford Faculty that a deep and broad fund of knowledge in the basic and clinical neurosciences is essential to neurosurgeons’ ability to practice safe, effective patient care and that the ABNS written exam is a reasonable standard for assessing this knowledge.

Because we expect Stanford-trained residents to become leaders in neurosurgery in pursuing excellence and innovation, we believe they will desire to pursue and should be required to achieve a higher standard than their peers.

All residents are expected to pass the ABNS written exam with a score of at least the 50^th % ile (the “Stanford Pass”) before graduating from the program.

Each resident will take the ABNS written exam annually until meeting the two requirements:
1)      achieving a “Stanford Pass”, whether the exam is taken for practice or credit, and
2)      achieving a “National Pass” when taking the exam for credit.
A resident may take the exam for credit only after achieving a score of at least the 20th %ile when taking the exam for practice.
A resident failing to achieve a “Stanford Pass” score of at least the 50th %ile by May of the PGY-5 Year will not be allowed to begin the PGY-6 clinical year until such a score has been achieved.

PGY-VII: NS-7 Chief Resident at SUMC and LPCH

This final year as Chief resident in Neurosurgery is spent primarily at SUMC. Three Chief Residents cooperatively lead the entire resident team and manage the neurosurgical service at SUMC and LPCH. Although the three Chief Residents alternate Chief call throughout the year, primary responsibility for the clinical service and for administrative duties is alternated throughout the year. The chief residents lead daily patient rounds in the ICU and on the ward. The Chief Residents are responsible for ensuring that all in-patient and emergency room consultations are evaluated initially and presented to a staff physician. Under direct faculty supervision, the Chief Residents perform the vast majority of the difficult operative procedures carried out at SUMC. Challenging cases are sufficiently numerous to provide intensive surgical and peri-operative management experience to both Chief Residents. At the Chief Residents' discretion, less challenging cases are assigned to the senior and junior residents. The Chief Residents also assist in organizing weekly Neurosurgery Grand Rounds and monthly Morbidity and Mortality Conference.

During this year, the resident becomes proficient in independently managing an inpatient and outpatient neurosurgical service, including supervision of the neurosurgical housestaff, rotating interns and medical students. The resident further hones comprehensive neurosurgical operative skills, including microscopic surgery for difficult aneurysms, vascular malformation, tumors, epilepsy and pituitary lesions; carotid endarterectomies and vascular reconstructive procedures, including EC-IC bypass; complex spinal reconstruction; and pediatric neurosurgical procedures. The resident should be able to supervise and teach junior residents and interns, both in the operating room and on the wards. The resident continues to pursue basic or clinical research and to refine academic skills. At the conclusion of the PGY-VII year the neurosurgical resident should be fully qualified to join the neurosurgical faculty at an academic institution or an active private practice group.