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    • Division of NeurosurgeryResidency training program overview
    • Neurosurg 2 INTRODUCTION: Welcome to the Neurosurgical training program at McMaster University. This document is an effort to provide the reader an overview of the residency program in Neurosurgery at McMaster University. DESCRIPTION OF PROGRAM: ADULT NEUROSURGERY: There are currently four adult Neurosurgeons at the McMaster affiliated teaching hospitals. Dr.Rocco Devilliers is a general neurosurgeon with an interest in Neuro- Oncology. His Neurosurgical training was in South Africa and Toronto and he has been in practice for over 2 decades, most of it in Hamilton. Dr.Naresh Murty is general neurosurgeon with an interest in vascular neurosurgery and skull base surgery. He is the latest addition to our group. His Neurosurgical training was in Ottawa. Dr.Kesh Reddy is a general neurosurgeon with interest in Skull base surgery and Neuro-endoscopy. His Neurosurgical training was in India, UK and Winnipeg. He has been in clinical practice for 11 years, all in Hamilton. Dr.John Wells is a general neurosurgeon with an interest in vascular neurosurgery. His Neurosurgical training was at McGill. He has been in clinical practice for over 2 decades, most of it in Hamilton. PEDIATRIC NEUROSURGERY: Dr. Hollenberg is a full-time pediatric neurosurgeon. After his Neurosurgical residency at the Montreal Neurological Hospital and Institute (McGill), he practiced at the Montreal Children’s Hospital for a few years prior to joining the McMaster faculty in 1981. GENERAL DESCRIPTION:
    • Neurosurg 3 The bulk of the adult Neurosurgery is performed at the Hamilton Health Sciences (HHS) at the General site. Some adult work, mostly spine is done at the St.Joseph’s Hospital. All of the pediatric Neurosurgery takes place at the HHS at the McMaster site. The pediatric Neurosurgical patients are admitted under the pediatricians/ the pediatric intensivists, who deal with the non-Neurosurgical aspects of the pediatric patient care. The Division of Neurosurgery at McMaster University is a regional service catering to approximately 1.8 million people living in the central west region, though the geographical borders are not rigid. In an effort to provide a regional service, we have outreach clinics at St.Catherines (Attended by Dr.Wells) Burlington (Attended by Dr.Murty) We currently have 4 residents in the program. Dr.Louis Crevier is a PGY3 resident. Drs.Almunder Algird and Dr.Celeste Thirwell are PGY2 residents. Dr.Aleksa Cenic is at the PGY1 level. Hamilton is geographically well placed. While the city itself is best known as a producer of steel, there are some beautiful and affordable residential areas in and around the city. Green space is abundant in the form of conservation areas, provincial parks and the Royal Botanical Gardens. The proximity of Toronto offers the cultural advantages without the disadvantages of large cities. The lush greenery of the Niagara peninsula and the vineyards are an added attraction.TYPICAL ROTATIONS IN THE PROGRAM:Program Content and Sequence of RotationsYear Number of Months (or 4-week blocks)_____________________________________________________________________________________ 1 2 3 4 5 6 7 8 9 10 11 12 13_____________________________________________________________________________________Core Surgery N. Medicine General . Head&Neck Orthopedics Neurology Surg surgery_____________________________________________________________________________________________________________________Core Surgery Ped. Neurosurg ICU Core Plastics Elective/Neurosurg._____________________________________________________________________________________________________________________Third Neurosurgery -------------------------------Neurosurg Research --------------------------------------------_____________________________________________________________________________________________________________________Fourth Neurosurg. Neuro Neurosurgery Neuropathology Neurosurg. Radiology_____________________________________________________________________________________________________________________Fifth ---------------------------------------------Neurosurgery -------------------------------------------------------------------_____________________________________________________________________________________________________________________Sixth --------------Neurosurgery -------------- Ped. Neurosurg. ---------Neurosurgery ------------------
    • Neurosurg 4 The rotations have been designed to be compliant with the Royal college guidelines.Resident rotations will start initially as outlined above. The structure of the residencyprogram will be under constant review by the Residency Program Committee (RPC), whichmeets quarterly. The rotations can be modified in special situations by the RPC within theguidelines of the Royal College. Elective rotations could include Head & Neck surgery,Plastic surgery, infectious disease, endocrinology, radiotherapy, Neuro-Anesthesia, andemergency medicine. Other elective rotations in other specialties, such as in the service ofthrombosis, can be facilitated because of the strength of such programs at our center. . The Neurosurgical component of the program will gradually increase as the residentprogresses in the program. During the core surgical years, there will be short rotations inNeurosurgery, which are designed to serve as an introduction to the specialty. The residentsare expected to work with all staff members while in the neurosurgical part of the program.The expectation is that the residents’ clinical and surgical responsibilities will graduallyincrease with timeRESIDENT RESPONSIBILITIES: The residents are responsible for the day-to-day clinical care of the patients. Theyare expected to round and write legible notes at least once a day prior to attending theoperating room. The notes must be dated and timed .The residents should contact thefamily physician at the time of discharge from the hospital. They are encouraged to contactthe patient a few days after discharge to check on clinical course. In some of these duties,the the residents will collaborate with the four advanced practice nurses that work in theNeurosciences program The residents are also expected to become clinical skills preceptors for medicalstudents after the PGY2 year for 3 months out of the year (Sept-Dec). More detailed training objectives are delineated in Objectives of Trainingdocuments. The senior residency is the last 12 months of the training and this follows theguidelines set up by the Royal College. The senior resident is expected to play a major rolein guiding the junior residents. The content and organization of the teaching rounds and thecall schedules will also become the responsibility of the senior resident. As our program isrelatively new the senior most resident in the program is currently making the callschedules. The senior resident will have several administrative responsibilities includingmaking call schedules, arranging the weekly seminars (in conjunction with the programdirector). If there are two residents at the senior level of training at the same time, the chiefresident responsibilities will be shared (six months each). The resident rotations aretypically person based. Usually one resident spends 3 months with one of the staffmembers. The person based approach has evolved in an effort to maximize the learningand minimize the routine chores for the resident.
    • Neurosurg 5RESEARCH: We feel that the research component of the program should be flexible. Given thestrong department of clinical epidemiology at our center, all the residents in the programwill be strongly encouraged to apply to the Msc or PhD programs in the department ofClinical epidemiology and Biostatistics (CE&B).Two of our residents are currently enrolled inthe MSc program in clinical epidemiology. At the very least, the residents are expected toenroll in 2 introductory courses in CE&B. should a resident choose to pursue basic scienceresearch this will be encouraged and facilitated. The residents are allowed up to 6 monthsof elective research time. A longer research period is possible but can not be funded fromthe program. The sources of start-up funding for the research include the research committee ofthe department of surgery, Regional Medical Associates (RMA) and the foundations of thetwo hospital corporations in the city(Hamilton Health Sciences and St.Joseph’s Hospitalfoundations). The residents, with the help of their supervisors are encouraged to apply forpeer reviewed grants form other sources such as the PSI foundation. Surgical OutcomesResearch Center (SOURC) is an organization within the department of surgery that focuseson surgical outcome based research. Dr. Wells and Dr.Reddy are members of SOURC. Thisorganization and it’s members are also available to guide the residents in clinical researchmethodology, statistical assistance etc. The opportunities for research are ample, with an active basic neuroscienceresearch group at McMaster University and availability of potential collaborators in severaldepartments and the free availability of individuals with expertise in clinical researchmethodology. The proposed opening of the Mind and Body imaging center at St.Joseph’sHospital with the planned installation of a PET scanner and a 3Tesla research magnet(projected 2003) is also expected to increase the residents’ abilities to participate inresearch projects.RESIDENT ON-CALL DUTY: The residents will be on call no more than 1 in 3(home) as per the latest agreementbetween PAIRO and the Ontario Teaching hospital association. If the call is very busy andthe resident happens to be in the hospital longer than 4 hours, he/she has the option ofdoing one less call for the month, provided they notify the program director and thesupervising staff. Pregnant residents are not required to take call after the 5th month ofpregnancy. Once the resident has completed the core training, the first phone call from areferring center would go to the resident. If he/she feels comfortable in handling thereferral, he/she will discuss the patient with the referring physician and handle itaccordingly with the advice of the on-call staff neurosurgeon. Until the residents have beenon the Neurosurgical service at least 6 months, they are expected to call the staff surgeonon call prior to accepting a patient transfer or making clinical decisions. As much aspossible, the resident is expected to follow through on the surgical and the follow-up care ofthe patients that he/she has admitted. The resident’s role in decision making with regards
    • Neurosurg 6to patient care will be expected to increase gradually concurrently with the improvement intechnical skills.RESIDENT EDUCATION: The core surgery aspect of resident education takes place from 9am to 11am onWednesdays for the first 2 years of their training. The relatively didactic part of theNeurosurgical teaching is currently taking place in the form of seminars on Fridays. Theseminars start at 7am, followed by interactive neuroradiologic rounds. This in turn isfollowed by an hour of basic neuroscience/communication skills/medico-legal issues andother topics relevant to the practice of Neurosurgery. Once a month Mortality & Morbidityrounds occur during this hour. Brain cutting/histopathology take place from 10am to 11amafter the seminars. We hope to cover the entire spectrum of neurosurgery over a 2-yearperiod There are facilities available currently for fresh and fixed specimen dissections toassist residents with various surgical approaches. Discussions are underway to expand andimprove these facilities and to formally have a department of surgery-administeredanatomy laboratory. In conjunction with our neuro-otologist Dr.Robertson, we are planningto start a temporal bone laboratory to help the residents with the complex temporal boneanatomy. CMAS (Center for Minimal Access Surgery) facilities located at St.Joseph’shospital are also available for any resident wishing to enhance his/her endoscopic skills. Alist of clinics associated with the Neurosurgery service is listed below. It is mandatory forthe residents to attend these clinics during their time with the particular staff person withan interest in the topic Currently the only Neurosurgical procedures that are not performed at our center areFunctional and Epilepsy surgery procedures. We have an informal arrangement with theUniversity of Western Ontario for those residents who wish to be exposed to theseprocedures during their training. To accentuate the pediatric neurosurgical training at ourcenter, the residents will spend 3 months at the Hospital for Sick children in Toronto.ACADEMIC AND SCHOLARLY ASPECTS OF THE PROGRAM: WEEKLY ACADEMIC ACTIVITIES: Tuesday 0700-0800: Spine rounds attended by the spinal orthopedic surgeons andthe spinal rehabilitation consultant (Dr.Bugaresti) as well as the orthopedic residents. Theserounds are conducted in the radiology conference room at the general site and are wellattended. Wednesday 0900- 1100: MUMC- Core surgical program for the PGY1 and PGY2residents. This is coordinated by Dr.Dath and is held at MUMC. Thursday 0800- 0900 hrs: (HGH 3 North Teaching Room) Neurology andNeurosurgery combined rounds-Neuropathology and neuroradiology also participateperiodically. Thursday 0130 hrs (MUMC) - Clinical Epidemiology Rounds at MUMC
    • Neurosurg 7 Thursday 1200-1300 hrs: Oncology Rounds at the Ontario Cancer Foundation. Theseare sometimes related to neuron-oncology and are presented by various content experts,and are often presented in a multimodality fashion Friday 0700 to 1000 hrs: Resident Seminars 0700-0800: A didactic Neurosurgical topic is presented by the Neurosurgicalresidents. As mentioned above, We plan to cover the entire spectrum of neurosurgery overa two year period. 0800- 0900: This hour is dedicated to presentation and discussion of Radiologicstudies. The staff and residents bring interesting cases and present them. At least one ofthe Neuroradiologists, some neurologists and some of the radiology residents are presentduring this part of the rounds. 0900-1000: . This hour is spent on basic neurosciences, Bioethics as they relate toneurosurgery, Medico-legal issues, Communication skills or Mortality & Morbidityrounds(once a month) 1000-1100: Brain cutting and Histopathologic presentations are undertaken duringthis period. These are run by one of our Neuropathologists, Dr.Provias or Dr.Sur. MONTHLY ACADEMIC ACTIVITIES: Journal Club: Occurs once a month and the topic/s and the main papers arecirculated at least a week prior to the session. The residents are expected to take a veryactive role in the arranging and running of the journal club. Neurosurgical staff host theseon a rotating basis. We occasionally incorporate Neurosurgical “product fairs” by variousNeurosurgical product vendors with our journal clubs. These typically take place for 30minutes prior to the starting of the journal club. We combine our journal club periodicallywith that of the basic neuroscientists (arranged in conjunction with Dr.Sandra Witelson).This is being tried in an effort to promote collaborative work with the basic neuroscientists. QUARTERLY ACADEMIC ACTIVITIES: Neuroscience Academic half-days: These are conducted in conjunction with theneurology group and are hosted by a neurologist and a neurosurgeon together on a rotatingbasis. These are usually held outside the hospital, and are sponsored by corporate vendors.Invited speakers (usually one from Neurology and one from Neurosurgery) give talks onneuroscience topics. Quarterly - Surgical Grand Rounds: Content to be determined by the chairman of thedepartment of surgery, and held at MUMC: ANNUAL ACADEMIC ACTIVITIES: Annual Resident research day The division has thus far held three annual researchdays with the help of corporate sponsors. The invited guest lecturers have been and will beNeurosurgeons from other centers. The lectureship has been named after Dr.S.W.Schatz,Emeritus Professor of Surgery, who retired from the Division of Neurosurgery a few yearsago. The presenters have been the residents in the program as well as residents in other
    • Neurosurg 8residency programs at McMaster University that have been working on topics of interest toclinical neurosciences. At the end of the day the invited lecturer and two other individualspick the winners for the first, second and third prizes. Every resident in the program is expected to present a new project at the annualacademic research day. The best two presenters will go on to present at the department ofSurgery’s annual research day. It is the expectation of the residency program that everyresident produces a publishable paper yearly. They are expected to present every year at anational or international meeting. They are strongly encouraged to start thinking about nextyear’s project as soon as the current year’s project is presented at the annual research day.COURSES: Lougheed Course: Residents at PGY-3 Level will attend this cadaver Course in techniques in neurosurgery in Toronto (coordinated by Dr. C. Wallace). Attending this course once is mandatory. It is optional to repeat this course later in the resident’s training depending on his/her progress in the program Microsurgical techniques course: All residents are encouraged to attend this course, which is run by the Plastic Surgery service. This is optional Review Course (Cook County): All residents at the chief resident year will attend the neurosurgery review course in Chicago or equivalent towards the end of their training. This is mandatory. Spinal instrumentation course: Residents will be encouraged to attend. These courses are typically hosted and arranged by one of the spinal instrumentation companies. This is optional The residency program funds all the mandatory courses (excluding travel and accommodation)NEUROSURGICAL FELLOWSHIPS: The Neurosurgical program at McMaster University does not officially provide afellowship level training. However, clinical fellows have been accepted in the past if theyhave a funding source. This practice will continue, although not on a regular basis. Thechief resident with the help of the program director will determine the specific role of theNeurosurgical fellows to ensure that the fellowship training does not negatively impact theresidents’ training..ROTATING RESIDENTS: Typically residents from services such as Orthopedics, Plastic surgery, psychiatry,Physical medicine and rehabilitation, Emergency medicine and general surgery rotatethrough the Neurosurgical service. Their numbers vary. It is expected that their surgicallearning will not interfere with the Neurosurgical resident training, as their objectives arequite different. The participation of the rotating residents in the semi-didactic Neurosurgicalrounds has proven to be beneficial to both the Neurosurgical and the rotating residents.
    • Neurosurg 9CLINICAL VOLUME: The number of adult Neurosurgical cases total approximately 1200 per year at theGeneral sit of HHS. We have 36 beds for the Neuroscience program. The Neurosurgicalpatients use most of the beds(Neurology occasionally has some in patients) A separateward has been created. Some of the Neurosurgical patients will also have access to thesebeds. While there is no CTU as such, at least 20 of these beds are usually active. Onaverage there are 2 rotating residents on the service, supplemented at times by clinicalclerks who often do elective rotations There is no specific Neurosurgical Intensive care butwe are allowed 10 beds for Neurosurgery and Neurotrauma in the ICUs at the General site. The case volume at St.Joseph’s hospital is approximately 100 per year. These aremainly degenerative spine cases. . At MUMC approximately 100 pediatric cases areperformed yearlyNEURO-ONCOLOGY: The residents will be encouraged to participate in the multi-modality brain tumorclinic, which is attended by two of the Neurosurgeons (Drs.Devilliers and Reddy alternating)along with a Neurologist, 2 radiotherapists, and a chemotherapist and support staff such associal worker and study nurses. The resident involvement in these clinics is expected togradually increase over time. The residents will handle all the referrals made during theemergency call days with advice from staff.TRAUMA: Approximately 30% of all Neurosurgical admissions are traumatic as HamiltonGeneral Hospital (HGH) is a Level 1 trauma center. There is a well-organized trauma teamin which Neurosurgical residents will be integrated (whenever there is Neurotraumainvolved). It will also be the residents responsibility (with staff guidance) to follow allNeurotrauma patients in the ICU and interact with other personnel included with their care. The Childrens Hospital is the pediatric Regional Trauma Center; the resident rotatingin pediatric neurosurgery will be a part of the Pediatric Trauma Team.NEUROLOGY: McMaster University has an active and large neurology service at all the teachinghospitals. Some of the neurologists are actively involved with research as well. Allresidents will be required to spend a minimum of 3 months on the neurology service.However, for residents with special interest in functional neurosurgery/epilepsy, a longerstint in neurology may be arranged. The residents will learn the indications and the interpretation of investigations suchas EEG, EMG, and nerve conduction studies during their neurology rotation. A neurologyresidency training program application is being submitted and it is expected that this will be
    • Neurosurg 10underway in 2003.This will likely enhance the training of the Neurosurgical residents aswell.NEUROPATHOLOGY: All the neuropathology training will take place at the Hamilton General Hospital.Currently there are two neuropathologists (Drs.Provias and Sur. The autopsy rate is low (thisseems to be a global phenomenon) but several brains are sent to this center fromelsewhere and the weekly brain cutting sessions are quite valuable learning experiences.Biopsy material is abundant and varied.NEURO-RADIOLOGY: The neuroradiology service has three radiologists (Dr. Franchetto, Ellins andDr.Chan). Interpretation of neuroimaging studies is expected to occur on an ongoing basisthroughout residency. This is ensured by daily x-ray review after ward rounds, and thediscussion with the radiologists on a regular basis. Also, Neurosurgical staff is expected todo much of the day-to-day Radiologic study interpretation and help the residents. The Fridaymorning Neuroradiology component of the rounds and the Thursday morning combinedNeurology- Neurosurgery rounds also add to the Radiologic learning of the residents. Thethree-month Neuroradiology rotation is expected to further enhance the Neuroradiologiclearning on a full-time basis. In terms of facilities, MR imaging access has improved considerably in the recentpast with the acquisition of a fourth diagnostic MR in the city. In addition two of ourreferring centers(St.Catherines and Burlington) have MR facilities of their own. St.Joseph’sHospital is expecting to add a 3Tesla magnet and another PET scan (There is one at MUMC)in 2003.These are meant mainly for research use.NEURO-OPTHALMOLOGY AND NEURO-OTOLOGY: Dr.J. Harvey is an ophthalmologist with an interest in orbital pathology. Some of thesurgeons actively collaborate with him in the surgical management of relevant disorders.Currently there are attempts underway to recruit a full time Neuro-opthalmologist. If aresident is interested, an elective rotation will be arranged with the ophthalmologydepartment at the University of Ottawa with whom we have an informal arrangement. Dr.D.Robertson is a fully trained Neuro-otologist that collaborates on all the skullbase tumors that require a Neuro-otologist’s assistance. He will also likely be involved withthe establishment of a temporal bone laboratory.
    • Neurosurg 11INTENSIVE CARE: The intensive care ward at the general site (HHS) has dedicated beds forneurosurgery and Neurotrauma. The day-to-day management of Neurosurgical patients isperformed by the intensive care residents/Critical Care assistants (CCAs) under thedirection of the coordinator. There are residents/CCAs) in-house around the clock. There isone neurointensivist(Dr.Jijichi) who is a practicing neurologist with experience in neurocritical care. He also acts as a liaison between the Neurosurgical service and the criticalcare group in an effort to further cooperative clinical management of the criticallyneurologically impaired.EMERGENCY CARE: Referrals to the neurosurgery service are made quite often directly to theneurosurgery service (resident first). These patients are initially seen in the EmergencyDepartment/wards and dealt with following discussions with the attending staff. In traumacases, the trauma team leader handles the overall management of the trauma patient, butrefers to the neurosurgeons (resident first) when head injury is suspected. Where spinalinjuries are suspected, the on call spinal surgeon (neuro/ortho) is consulted and his/herresident sees the patient first.AMBULATORY CARE: The residents are expected to attend all the clinics that his/her attending staffperson attends. These include the neurovascular clinic, brain tumor clinic and the skullbase clinic. During their pediatric neurosurgery rotations, attending the pediatricneurosurgery clinics is mandatory. The residents are expected to attend the Neurosurgicalsatellite clinics in St.Catherines and Burlington. These experiences are likely to enhancetheir abilities to deal with referring physicians and community Neurosurgical practice. Theresidents are also expected to spend time in staff offices whenever possible Brain tumor clinic: Neuro-oncology clinic held weekly. These are multi-modalityrounds with neurology, radiotherapy and chemotherapy content experts participating inaddition to three neurosurgeons(Drs.Devilliers, Murty and Reddy) on a rotating basis. Pediatric Neurosurgery Clinics: In addition to the regular clinics, there arespecialized clinics for the care of the spina bifida patients, a pediatric multimodality neuro-oncology clinic, and a pediatric head injury clinic. All consultations from referring sources (predominantly internal medicine,emergency medicine and trauma, though others also refer) are first seen by the residentsand discussed with the staff person. Ward clerks, who page the residents, arrange theconsultation.QUALITY CONTROL OF PATIENT CARE AND DIAGNOSTIC PROCEDURES:
    • Neurosurg 12 Monthly mortality and morbidity rounds will be conducted where staff/residents willpresent cases from the previous month. This will provide a forum for quality control on theservice. Autopsies are conducted whenever possible and brain cutting sessions performed bythe Neuropathologists as a teaching and quality control method. Participation in mortality &morbidity rounds and other activities of the service is mandatory for residents.BIOMEDICAL ETHICS:The residents are mandated to attend the many CME activities the university undertakes inthis topic (multidisciplinary academic days or MAD). The specific Neurosurgical relatedethical issues are being addressed 3-4 times a year in the bioethics rounds held under thesupervision of an ethicist. These issues will also be addressed during the weeklyneurosurgery rounds and on a day- to- day basis. When difficult ethical issues come upduring the day-to-day Neurosurgical practice, the participation of the ethics committee ofthe hospital will be sought, along with the help of the hospital ethicist. The residents arealso expected to participate in the discussions regarding the major ethical issues that comeup during their ICU rotation.OPPORTUNITIES TO ATTEND CONFERENCES: All residents will be encouraged to become resident members of the CanadianNeurosurgical Society and at least one of the two large American Neurosurgicalorganizations (Association of American Neurosurgeons-AANS or the Congress ofNeurological Surgeons-CNS). They will be expected to attend one conference every year. Ifthey are presenting, part of the cost of the resident’s attendance at the conference (up to amaximum of $1000) will be absorbed by the program.ACQUISITION OF TEACHING SKILLS: There are ample opportunities for teaching of undergraduates, other residents(rotators), clerks, and paramedical personnel during day-to-day encounters. Whenever thestaff are asked to participate in such activities, the residents are informed of this and giventhe opportunity to do the teaching instead.READING AND REFERENCE MATERIAL: A reasonably stocked learners room is on the 7th floor at the general site adjacentto the neurosurgical ward. This room has three computers with Internet capability, severaleducational videotapes, CD-ROMs and textbooks. The HGH library and the universitylibraries are available for use by the residents, though the Neurosurgical material availableis sparse. The residents are also encouraged to use the personal libraries of the staff. Theresidents are also provided with on line access to several of the relevant journals.
    • Neurosurg 13RESEARCH OPPORTUNITIES: While the existing research support is meager, start up funds for resident researchare available from the Department of Surgery, Regional Medical Associates and privateindustry. The residents will also be encouraged to apply for other sources such as the PSIFoundation. Residents will be strongly encouraged to participate in research, be it in basicscience or clinical epidemiology. Drywells is in charge of research in the division ofneurosurgery. CAREER PLANNING AND COUNCELLING: The program director will meet with each resident at least 4 times a year to discuss progress, career goals & objectives. This is usually combined with the evaluation meetings that take place every quarter. If special/additional training elsewhere in the country or abroad is felt to be beneficial, attempts will be made to arrange this. Ongoing counseling and assistance will be provided to all the residents by the program director and other faculty members. All residents are encouraged to join the resident sections of the Canadian Neurosurgical Society, and either the AANS or the CNS. All of these organizations advertise staff and fellowship positions. The residents are encouraged to approach the residency program committee, the program director, or any of the faculty members he/she feels comfortable with, to discuss stress related and/or any other issues. A sexual harassment officer is available at the university for counseling should this become necessary. The university also funds an employee assistance program, which is available for short term counseling on financial, legal, and stress related issues. The McMaster University appeal mechanism is as described in the “House staff manual” EVALUATION: Evaluation of the Program: The program itself will undergo the mandatory internal reviews by the University and the 6 yearly Royal College accreditation survey. Evaluation of residents: While the residency committee meetings are quarterly, the residents are evaluated on an ongoing basis. The factors being evaluated are not just the
    • Neurosurg 14 academic capabilities, but also professional behavior, attitude, and the residents interaction with other professionals. On an ongoing basis, the residents are encouraged to contact the program director or any of the residency program committee members with any useful suggestions regarding program structure and function. Resident performance in various rotations is assessed based on the resident evaluation forms that should be returned promptly after the rotation. It is the resident’s responsibility to make sure that the forms are filled out and returned to the program director. Informal discussions with staff and allied health care personnel are also conducted to help with the assessment of the resident’s progress through the program. EVALUATION OF RESIDENT PERFORMANCE Twice every year resident examinations will be held. These will be in the currentRoyal College format (written and oral) and the residents will be quizzed in all aspects ofthe examinations, i.e., the organization, presentation and the actual knowledge. During thefinal year, they are examined more frequently. For the ITER, which needs to be filled out every 4 months, the staff person withwhom the resident has had the most contact is expected to fill out the ITER and theevaluation form for technical skills (appended) and conducts an interview with the resident.Consideration is being given to have the resident interview, examine and dictate aconsultation note on the patient. The resident will then be expected to formulate amanagement plan and discuss the surgical approach and the literature regarding thedisease. A written report is given to the resident after each examination and feedbackprovided. The residents maintain a log of all cases and the residents are expected to pass thison to the department of surgery’s post-graduate education committee (Dr.Baille’ssecretary) who will enter this data into the BRDS database. This database will hopefullydemonstrate that the residents are gradually being given increasing responsibilities. Thisdatabase continues to evolve and the accuracy and usefulness of this depends on theresident’s diligence in submitting the data while there are some potential biases it isconfidential and the program director alone has access to this. It is hoped that this willallow the program director to pick up any unhealthy trends in the residency training andcorrect them as needed.
    • Neurosurg 15COMMUNICATIONS SKILLS EVALUATION: The residents are taught to respect the people they work with from the beginning,i.e., nurses, patients, peer and staff surgeons. Nurses are required to immediately reportany problems to the program director. The "team" concept is stressed. While many"styles" of functioning may exist, a basic level of manners, social decorum, and compassionare expected of all the residents. While the resident’s attitude is not formally assessed allthrough the program informal assessment of attitudes and behaviors are assessed, and anydeviation dealt with quickly, clearly, and without ambiguity. Apart from the 4 monthly meetings for ITER, the residents are encouraged to befrank with the staff, and are strongly encouraged to discuss with the program director anyperceived difficulties, lack of progress, or any other issues. When weakness/other problem are identified, a frank discussion will take placebetween the resident and the program director, and the resident is given a chance toimprove by the next RPC meeting. If there are major problems in spite of remedialmeasures, an urgent RPC meeting is held to determine whether the resident shouldcontinue in the program. The Rap’s decision is then conveyed to the resident. All of thesemeasures will be undertaken with full consultation from the post graduate dean and thechairman of the department of surgery’s post graduate education committee. Special meeting of the program committee will review all items on the "FITER (FinalIn-Training Evaluation Report) prior to this being filled out by the program director. Themajority views and the previous Tiers will be reflected in the FITER.EVALUATION OF FACULTY: The residents are also expected to evaluate the supervisors and rotations (sampleforms appended) promptly at the end of each rotation. The rotation evaluations have to bereturned to the program director of the program that the resident is rotating through, aswell as the program director of the neurosurgery residency program. In conclusion, we feel confident that we have a comprehensive Neurosurgicaltraining program that will enable the residents to develop the necessary skills andknowledge to enable them to be confident, ethical and able fully independentneurosurgeons with critical appraisal skills.