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Overview

The Westchester Medical Center Neurosurgery Service is comprised of five full-time and multiple part-time faculty members, a chief resident, a senior resident, and a junior resident. [The NS4 resident is at Saint Vincent’s Hospital Manhattan each year, and the NS5 resident spends the entire year doing research (see below).] The Residency Training Program is in full compliance with the New York State 405 and ACGME workforce regulations. Residents on clinical service begin each day with rounds at 6:00 a.m. At the end of rounds, the chief resident assigns the day’s work. At Westchester Medical Center the Neurosurgery Clinic is held once a month, and residents are excused from surgery to attend. Similar procedures are followed at Saint Vincent’s Hospital Manhattan, where there are two full-time and one part-time faculty to supervise the residents. On Fridays, all residents participate in teaching conferences from 8 a.m. to 2 p.m. Residents are sent to a number of courses during their years in the program at the Department’s expense.

NEUROSURGERY 1

The NS1 (intern) spends one year doing a General Surgery/Basic Skills rotation. This year includes eight months of a surgical experience (two on neurosurgery and the other six divided among orthopedics, vascular surgery, general surgery, and critical care), three months of neurology, and one month of vacation. The neurology rotation includes outpatient experience and neuro-ophthalmology.

NEUROSURGERY 2

The NS2 is assigned full-time to the Neurosurgery Service at Westchester Medical Center. The resident is exposed to a busy Neurosurgery Service and begins his or her neurosurgical training. Supervision and one-on-one training is abundant and is facilitated by the Chief Resident and all faculty members. After morning rounds and didactic programs, the NS2 is involved with inpatient care activities on the patient care unit and in the Neurosurgical ICU and participates in surgery as an assistant. With the NS1, the NS2 gathers the data and participates in sign-out rounds at the end of the day. His/her clinical duties predominantly involve patient care, particularly critical care, under the supervision of both neurosurgery faculty members and a critical care medicine specialist.

NEUROSURGERY 3

The NS3 year is largely a continuation of the first year at Westchester Medical Center, where the resident has gradually increasing responsibility for the management of patients in the Neurosurgical ICU. The NS3 works with the critical care team and with the individual neurosurgery faculty members who are each responsible for his/her own patients. The NS3 spends an increasing amount of time in the OR, in addition to being responsible with the NS2 for emergency room and inpatient consultations. The NS3 also participates actively in the endovascular procedures. During the rotation the NS3 is given two months of dedicated neuroradiology and neuropathology experience. This resident is responsible for cadaver dissections, including skull base microdissection, in the Anatomy Department. The residents take the Part I Neurosurgery Boards for practice in the first two years and for credit in the NS4 year.

NEUROSURGERY 4

The NS4 resident spends the full year in the Department of Neurosurgery at Saint Vincent’s Hospital Manhattan, a busy general hospital with both primary and tertiary care. The single resident functions as clinical and administrative Chief Resident directing the entire service, under the supervision of the full-time and part-time faculty. The house staff includes a general surgery rotating resident and two house surgeons assigned to the Department of Neurosurgery. The resident operates four days a week, participating in elective surgical procedures, and gains special experience in stereotactic surgery, skull base surgery, management of open nervous system trauma, surgical treatment of trigeminal neuralgia, and endovascular neurosurgery. A very active endovascular neurosurgery program exists, and procedures such as G.D.C. embolization of aneurysms are routinely performed. The hospital is also attached to a Comprehensive Cancer Center for managing patients with malignant tumors of the nervous system. A neuro-oncology Tumor Board meeting is held monthly for comprehensive care of patients with brain and spinal cord tumors. Stereotactic radiosurgery is performed at the Comprehensive Cancer Center. The NS4 resident participates in conferences, is on-call for all emergencies, and has responsibility for scheduling cases, admissions, transfers, and discharges.

The NS4 resident is in charge of the Neurosurgical ICU and co-manages this unit with help of the critical care team.

The resident is relieved of all clinical duties on Fridays so that most of the day can be spent at the Departmental Offices in Westchester, participating in the combined conferences and other teaching sessions. During this year, the resident begins to formulate a plan for the research project to be undertaken the following year.

NEUROSURGERY 5

The goal of the NS5 resident is to design and undertake a research project, with a minimum of interruption from the rigors of the clinical service. The project will result in the preparation and submission of at least one manuscript based on original work to be published in a peer-reviewed forum. The resident may choose to implement a clinical research or basic science program with neurosurgical or basic science faculty at New York Medical College, or established research facilities in the New York metropolitan region. The resident is supervised by the research coordinator, who is approved by the Program Director.

In addition to this primary research project, the NS5 resident is involved in ongoing clinical projects with the full-time faculty at Westchester Medical Center or Saint Vincent’s Hospital Manhattan. As the clinical responsibilities during this year are minimal, participation in more than one project is encouraged. The resident also utilizes this opportunity to complete academic work on projects initiated while on the clinical service. The resident is on-call at Westchester Medical Center on a more limited basis but continues to participate in scheduled conferences. The NS5 is encouraged to attend basic science courses and meetings in his or her area of research.

NEUROSURGERY 6

The goal of the Chief Resident is to master neurosurgical operative and patient management skills by performing a majority of the complex cases done at Westchester Medical Center each year. The NS6 manages the Neurosurgical Service and is responsible for making independent patient evaluations and treatment plans. At the end of this year, the NS6 is able to diagnose and treat neurosurgical patients with authority.

The Chief Resident supervises and teaches the junior residents through morning rounds, inpatient management, and in the operating room. Administrative duties include coordinating on-call, OR, vacation, and rotation schedules. Also, the Chief Resident helps to coordinate Journal Club, the Quality Improvement program, and some of the Friday teaching conferences.