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THE ROYAL COLLEGE OF PHYSICIANS AND SURGEONS IN CANADA
THE ROYAL COLLEGE OF PHYSICIANS AND SURGEONS IN CANADA
THE ROYAL COLLEGE OF PHYSICIANS AND SURGEONS IN CANADA
THE ROYAL COLLEGE OF PHYSICIANS AND SURGEONS IN CANADA
THE ROYAL COLLEGE OF PHYSICIANS AND SURGEONS IN CANADA
THE ROYAL COLLEGE OF PHYSICIANS AND SURGEONS IN CANADA
THE ROYAL COLLEGE OF PHYSICIANS AND SURGEONS IN CANADA
THE ROYAL COLLEGE OF PHYSICIANS AND SURGEONS IN CANADA
THE ROYAL COLLEGE OF PHYSICIANS AND SURGEONS IN CANADA
THE ROYAL COLLEGE OF PHYSICIANS AND SURGEONS IN CANADA
THE ROYAL COLLEGE OF PHYSICIANS AND SURGEONS IN CANADA
THE ROYAL COLLEGE OF PHYSICIANS AND SURGEONS IN CANADA
THE ROYAL COLLEGE OF PHYSICIANS AND SURGEONS IN CANADA
THE ROYAL COLLEGE OF PHYSICIANS AND SURGEONS IN CANADA
THE ROYAL COLLEGE OF PHYSICIANS AND SURGEONS IN CANADA
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THE ROYAL COLLEGE OF PHYSICIANS AND SURGEONS IN CANADA

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  1. Division of Neurosurgery Residency training program overview
  2. 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:
  3. 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 Rotations Year 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 ------------------
  4. 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 residency program will be under constant review by the Residency Program Committee (RPC), which meets quarterly. The rotations can be modified in special situations by the RPC within the guidelines of the Royal College. Elective rotations could include Head & Neck surgery, Plastic surgery, infectious disease, endocrinology, radiotherapy, Neuro-Anesthesia, and emergency medicine. Other elective rotations in other specialties, such as in the service of thrombosis, can be facilitated because of the strength of such programs at our center. . The Neurosurgical component of the program will gradually increase as the resident progresses in the program. During the core surgical years, there will be short rotations in Neurosurgery, which are designed to serve as an introduction to the specialty. The residents are 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 gradually increase with time RESIDENT RESPONSIBILITIES: The residents are responsible for the day-to-day clinical care of the patients. They are expected to round and write legible notes at least once a day prior to attending the operating room. The notes must be dated and timed .The residents should contact the family physician at the time of discharge from the hospital. They are encouraged to contact the 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 the Neurosciences program The residents are also expected to become clinical skills preceptors for medical students after the PGY2 year for 3 months out of the year (Sept-Dec). More detailed training objectives are delineated in Objectives of Training documents. The senior residency is the last 12 months of the training and this follows the guidelines set up by the Royal College. The senior resident is expected to play a major role in guiding the junior residents. The content and organization of the teaching rounds and the call schedules will also become the responsibility of the senior resident. As our program is relatively new the senior most resident in the program is currently making the call schedules. The senior resident will have several administrative responsibilities including making call schedules, arranging the weekly seminars (in conjunction with the program director). If there are two residents at the senior level of training at the same time, the chief resident responsibilities will be shared (six months each). The resident rotations are typically person based. Usually one resident spends 3 months with one of the staff members. The person based approach has evolved in an effort to maximize the learning and minimize the routine chores for the resident.
  5. Neurosurg 5 RESEARCH: We feel that the research component of the program should be flexible. Given the strong department of clinical epidemiology at our center, all the residents in the program will be strongly encouraged to apply to the Msc or PhD programs in the department of Clinical epidemiology and Biostatistics (CE&B).Two of our residents are currently enrolled in the MSc program in clinical epidemiology. At the very least, the residents are expected to enroll in 2 introductory courses in CE&B. should a resident choose to pursue basic science research this will be encouraged and facilitated. The residents are allowed up to 6 months of elective research time. A longer research period is possible but can not be funded from the program. The sources of start-up funding for the research include the research committee of the department of surgery, Regional Medical Associates (RMA) and the foundations of the two hospital corporations in the city(Hamilton Health Sciences and St.Joseph’s Hospital foundations). The residents, with the help of their supervisors are encouraged to apply for peer reviewed grants form other sources such as the PSI foundation. Surgical Outcomes Research Center (SOURC) is an organization within the department of surgery that focuses on surgical outcome based research. Dr. Wells and Dr.Reddy are members of SOURC. This organization and it’s members are also available to guide the residents in clinical research methodology, statistical assistance etc. The opportunities for research are ample, with an active basic neuroscience research group at McMaster University and availability of potential collaborators in several departments and the free availability of individuals with expertise in clinical research methodology. The proposed opening of the Mind and Body imaging center at St.Joseph’s Hospital 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 in research projects. RESIDENT ON-CALL DUTY: The residents will be on call no more than 1 in 3(home) as per the latest agreement between PAIRO and the Ontario Teaching hospital association. If the call is very busy and the resident happens to be in the hospital longer than 4 hours, he/she has the option of doing one less call for the month, provided they notify the program director and the supervising staff. Pregnant residents are not required to take call after the 5th month of pregnancy. Once the resident has completed the core training, the first phone call from a referring center would go to the resident. If he/she feels comfortable in handling the referral, he/she will discuss the patient with the referring physician and handle it accordingly with the advice of the on-call staff neurosurgeon. Until the residents have been on the Neurosurgical service at least 6 months, they are expected to call the staff surgeon on call prior to accepting a patient transfer or making clinical decisions. As much as possible, the resident is expected to follow through on the surgical and the follow-up care of the patients that he/she has admitted. The resident’s role in decision making with regards
  6. Neurosurg 6 to patient care will be expected to increase gradually concurrently with the improvement in technical skills. RESIDENT EDUCATION: The core surgery aspect of resident education takes place from 9am to 11am on Wednesdays for the first 2 years of their training. The relatively didactic part of the Neurosurgical teaching is currently taking place in the form of seminars on Fridays. The seminars start at 7am, followed by interactive neuroradiologic rounds. This in turn is followed by an hour of basic neuroscience/communication skills/medico-legal issues and other topics relevant to the practice of Neurosurgery. Once a month Mortality & Morbidity rounds occur during this hour. Brain cutting/histopathology take place from 10am to 11am after the seminars. We hope to cover the entire spectrum of neurosurgery over a 2-year period There are facilities available currently for fresh and fixed specimen dissections to assist residents with various surgical approaches. Discussions are underway to expand and improve these facilities and to formally have a department of surgery-administered anatomy laboratory. In conjunction with our neuro-otologist Dr.Robertson, we are planning to start a temporal bone laboratory to help the residents with the complex temporal bone anatomy. CMAS (Center for Minimal Access Surgery) facilities located at St.Joseph’s hospital are also available for any resident wishing to enhance his/her endoscopic skills. A list of clinics associated with the Neurosurgery service is listed below. It is mandatory for the residents to attend these clinics during their time with the particular staff person with an interest in the topic Currently the only Neurosurgical procedures that are not performed at our center are Functional and Epilepsy surgery procedures. We have an informal arrangement with the University of Western Ontario for those residents who wish to be exposed to these procedures during their training. To accentuate the pediatric neurosurgical training at our center, 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 and the spinal rehabilitation consultant (Dr.Bugaresti) as well as the orthopedic residents. These rounds are conducted in the radiology conference room at the general site and are well attended. Wednesday 0900- 1100: MUMC- Core surgical program for the PGY1 and PGY2 residents. This is coordinated by Dr.Dath and is held at MUMC. Thursday 0800- 0900 hrs: (HGH 3 North Teaching Room) Neurology and Neurosurgery combined rounds-Neuropathology and neuroradiology also participate periodically. Thursday 0130 hrs (MUMC) - Clinical Epidemiology Rounds at MUMC
  7. Neurosurg 7 Thursday 1200-1300 hrs: Oncology Rounds at the Ontario Cancer Foundation. These are 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 Neurosurgical residents. As mentioned above, We plan to cover the entire spectrum of neurosurgery over a two year period. 0800- 0900: This hour is dedicated to presentation and discussion of Radiologic studies. The staff and residents bring interesting cases and present them. At least one of the Neuroradiologists, some neurologists and some of the radiology residents are present during this part of the rounds. 0900-1000: . This hour is spent on basic neurosciences, Bioethics as they relate to neurosurgery, Medico-legal issues, Communication skills or Mortality & Morbidity rounds(once a month) 1000-1100: Brain cutting and Histopathologic presentations are undertaken during this 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 are circulated at least a week prior to the session. The residents are expected to take a very active role in the arranging and running of the journal club. Neurosurgical staff host these on a rotating basis. We occasionally incorporate Neurosurgical “product fairs” by various Neurosurgical product vendors with our journal clubs. These typically take place for 30 minutes prior to the starting of the journal club. We combine our journal club periodically with 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 the neurology group and are hosted by a neurologist and a neurosurgeon together on a rotating basis. 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 on neuroscience topics. Quarterly - Surgical Grand Rounds: Content to be determined by the chairman of the department of surgery, and held at MUMC : ANNUAL ACADEMIC ACTIVITIES: Annual Resident research day The division has thus far held three annual research days with the help of corporate sponsors. The invited guest lecturers have been and will be Neurosurgeons 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 years ago. The presenters have been the residents in the program as well as residents in other
  8. Neurosurg 8 residency programs at McMaster University that have been working on topics of interest to clinical neurosciences. At the end of the day the invited lecturer and two other individuals pick the winners for the first, second and third prizes. Every resident in the program is expected to present a new project at the annual academic research day. The best two presenters will go on to present at the department of Surgery’s annual research day. It is the expectation of the residency program that every resident produces a publishable paper yearly. They are expected to present every year at a national or international meeting. They are strongly encouraged to start thinking about next year’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 a fellowship level training. However, clinical fellows have been accepted in the past if they have a funding source. This practice will continue, although not on a regular basis. The chief resident with the help of the program director will determine the specific role of the Neurosurgical fellows to ensure that the fellowship training does not negatively impact the residents’ training.. ROTATING RESIDENTS: Typically residents from services such as Orthopedics, Plastic surgery, psychiatry, Physical medicine and rehabilitation, Emergency medicine and general surgery rotate through the Neurosurgical service. Their numbers vary. It is expected that their surgical learning will not interfere with the Neurosurgical resident training, as their objectives are quite different. The participation of the rotating residents in the semi-didactic Neurosurgical rounds has proven to be beneficial to both the Neurosurgical and the rotating residents.
  9. Neurosurg 9 CLINICAL VOLUME: The number of adult Neurosurgical cases total approximately 1200 per year at the General sit of HHS. We have 36 beds for the Neuroscience program. The Neurosurgical patients use most of the beds(Neurology occasionally has some in patients) A separate ward has been created. Some of the Neurosurgical patients will also have access to these beds. While there is no CTU as such, at least 20 of these beds are usually active. On average there are 2 rotating residents on the service, supplemented at times by clinical clerks who often do elective rotations There is no specific Neurosurgical Intensive care but we 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 are mainly degenerative spine cases. . At MUMC approximately 100 pediatric cases are performed yearly NEURO-ONCOLOGY: The residents will be encouraged to participate in the multi-modality brain tumor clinic, 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 as social worker and study nurses. The resident involvement in these clinics is expected to gradually increase over time. The residents will handle all the referrals made during the emergency call days with advice from staff. TRAUMA: Approximately 30% of all Neurosurgical admissions are traumatic as Hamilton General Hospital (HGH) is a Level 1 trauma center. There is a well-organized trauma team in which Neurosurgical residents will be integrated (whenever there is Neurotrauma involved). It will also be the residents' responsibility (with staff guidance) to follow all Neurotrauma patients in the ICU and interact with other personnel included with their care. The Children's Hospital is the pediatric Regional Trauma Center; the resident rotating in pediatric neurosurgery will be a part of the Pediatric Trauma Team. NEUROLOGY: McMaster University has an active and large neurology service at all the teaching hospitals. Some of the neurologists are actively involved with research as well. All residents 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 longer stint in neurology may be arranged. The residents will learn the indications and the interpretation of investigations such as EEG, EMG, and nerve conduction studies during their neurology rotation. A neurology residency training program application is being submitted and it is expected that this will be
  10. Neurosurg 10 underway in 2003.This will likely enhance the training of the Neurosurgical residents as well. 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 (this seems to be a global phenomenon) but several brains are sent to this center from elsewhere 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 and Dr.Chan). Interpretation of neuroimaging studies is expected to occur on an ongoing basis throughout residency. This is ensured by daily x-ray review after ward rounds, and the discussion with the radiologists on a regular basis. Also, Neurosurgical staff is expected to do much of the day-to-day Radiologic study interpretation and help the residents. The Friday morning Neuroradiology component of the rounds and the Thursday morning combined Neurology- Neurosurgery rounds also add to the Radiologic learning of the residents. The three-month Neuroradiology rotation is expected to further enhance the Neuroradiologic learning on a full-time basis. In terms of facilities, MR imaging access has improved considerably in the recent past with the acquisition of a fourth diagnostic MR in the city. In addition two of our referring centers(St.Catherines and Burlington) have MR facilities of their own. St.Joseph’s Hospital 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 the surgeons actively collaborate with him in the surgical management of relevant disorders. Currently there are attempts underway to recruit a full time Neuro-opthalmologist. If a resident is interested, an elective rotation will be arranged with the ophthalmology department 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 skull base tumors that require a Neuro-otologist’s assistance. He will also likely be involved with the establishment of a temporal bone laboratory.
  11. Neurosurg 11 INTENSIVE CARE: The intensive care ward at the general site (HHS) has dedicated beds for neurosurgery and Neurotrauma. The day-to-day management of Neurosurgical patients is performed by the intensive care residents/Critical Care assistants (CCAs) under the direction of the coordinator. There are residents/CCAs) in-house around the clock. There is one neurointensivist(Dr.Jijichi) who is a practicing neurologist with experience in neuro critical care. He also acts as a liaison between the Neurosurgical service and the critical care group in an effort to further cooperative clinical management of the critically neurologically impaired. EMERGENCY CARE: Referrals to the neurosurgery service are made quite often directly to the neurosurgery service (resident first). These patients are initially seen in the Emergency Department/wards and dealt with following discussions with the attending staff. In trauma cases, the trauma team leader handles the overall management of the trauma patient, but refers to the neurosurgeons (resident first) when head injury is suspected. Where spinal injuries are suspected, the on call spinal surgeon (neuro/ortho) is consulted and his/her resident sees the patient first. AMBULATORY CARE: The residents are expected to attend all the clinics that his/her attending staff person attends. These include the neurovascular clinic, brain tumor clinic and the skull base clinic. During their pediatric neurosurgery rotations, attending the pediatric neurosurgery clinics is mandatory. The residents are expected to attend the Neurosurgical satellite clinics in St.Catherines and Burlington. These experiences are likely to enhance their abilities to deal with referring physicians and community Neurosurgical practice. The residents are also expected to spend time in staff offices whenever possible Brain tumor clinic: Neuro-oncology clinic held weekly. These are multi-modality rounds with neurology, radiotherapy and chemotherapy content experts participating in addition to three neurosurgeons(Drs.Devilliers, Murty and Reddy) on a rotating basis. Pediatric Neurosurgery Clinics: In addition to the regular clinics, there are specialized 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 residents and discussed with the staff person. Ward clerks, who page the residents, arrange the consultation. QUALITY CONTROL OF PATIENT CARE AND DIAGNOSTIC PROCEDURES:
  12. Neurosurg 12 Monthly mortality and morbidity rounds will be conducted where staff/residents will present cases from the previous month. This will provide a forum for quality control on the service. Autopsies are conducted whenever possible and brain cutting sessions performed by the 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 in this topic (multidisciplinary academic days or MAD). The specific Neurosurgical related ethical issues are being addressed 3-4 times a year in the bioethics rounds held under the supervision of an ethicist. These issues will also be addressed during the weekly neurosurgery rounds and on a day- to- day basis. When difficult ethical issues come up during the day-to-day Neurosurgical practice, the participation of the ethics committee of the hospital will be sought, along with the help of the hospital ethicist. The residents are also expected to participate in the discussions regarding the major ethical issues that come up during their ICU rotation. OPPORTUNITIES TO ATTEND CONFERENCES: All residents will be encouraged to become resident members of the Canadian Neurosurgical Society and at least one of the two large American Neurosurgical organizations (Association of American Neurosurgeons-AANS or the Congress of Neurological Surgeons-CNS). They will be expected to attend one conference every year. If they are presenting, part of the cost of the resident’s attendance at the conference (up to a maximum 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 the staff are asked to participate in such activities, the residents are informed of this and given the opportunity to do the teaching instead. READING AND REFERENCE MATERIAL: A reasonably stocked learners' room is on the 7th floor at the general site adjacent to the neurosurgical ward. This room has three computers with Internet capability, several educational videotapes, CD-ROMs and textbooks. The HGH library and the university libraries are available for use by the residents, though the Neurosurgical material available is sparse. The residents are also encouraged to use the personal libraries of the staff. The residents are also provided with on line access to several of the relevant journals.
  13. Neurosurg 13 RESEARCH OPPORTUNITIES: While the existing research support is meager, start up funds for resident research are available from the Department of Surgery, Regional Medical Associates and private industry. The residents will also be encouraged to apply for other sources such as the PSI Foundation. Residents will be strongly encouraged to participate in research, be it in basic science or clinical epidemiology. Drywells is in charge of research in the division of neurosurgery. 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
  14. Neurosurg 14 academic capabilities, but also professional behavior, attitude, and the resident's 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 current Royal College format (written and oral) and the residents will be quizzed in all aspects of the examinations, i.e., the organization, presentation and the actual knowledge. During the final year, they are examined more frequently. For the ITER, which needs to be filled out every 4 months, the staff person with whom the resident has had the most contact is expected to fill out the ITER and the evaluation form for technical skills (appended) and conducts an interview with the resident. Consideration is being given to have the resident interview, examine and dictate a consultation note on the patient. The resident will then be expected to formulate a management plan and discuss the surgical approach and the literature regarding the disease. A written report is given to the resident after each examination and feedback provided. The residents maintain a log of all cases and the residents are expected to pass this on to the department of surgery’s post-graduate education committee (Dr.Baille’s secretary) who will enter this data into the BRDS database. This database will hopefully demonstrate that the residents are gradually being given increasing responsibilities. This database continues to evolve and the accuracy and usefulness of this depends on the resident’s diligence in submitting the data while there are some potential biases it is confidential and the program director alone has access to this. It is hoped that this will allow the program director to pick up any unhealthy trends in the residency training and correct them as needed.
  15. Neurosurg 15 COMMUNICATIONS 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 report any 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 compassion are expected of all the residents. While the resident’s attitude is not formally assessed all through the program informal assessment of attitudes and behaviors are assessed, and any deviation dealt with quickly, clearly, and without ambiguity. Apart from the 4 monthly meetings for ITER, the residents are encouraged to be frank with the staff, and are strongly encouraged to discuss with the program director any perceived difficulties, lack of progress, or any other issues. When weakness/other problem are identified, a frank discussion will take place between the resident and the program director, and the resident is given a chance to improve by the next RPC meeting. If there are major problems in spite of remedial measures, an urgent RPC meeting is held to determine whether the resident should continue in the program. The Rap’s decision is then conveyed to the resident. All of these measures will be undertaken with full consultation from the post graduate dean and the chairman of the department of surgery’s post graduate education committee. Special meeting of the program committee will review all items on the "FITER (Final In-Training Evaluation Report) prior to this being filled out by the program director. The majority 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 (sample forms appended) promptly at the end of each rotation. The rotation evaluations have to be returned to the program director of the program that the resident is rotating through, as well as the program director of the neurosurgery residency program. In conclusion, we feel confident that we have a comprehensive Neurosurgical training program that will enable the residents to develop the necessary skills and knowledge to enable them to be confident, ethical and able fully independent neurosurgeons with critical appraisal skills.

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