THE RESIDENCY REVIEW COMMITTEE FOR NEUROLOGICAL SURGERY

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THE RESIDENCY REVIEW COMMITTEE FOR NEUROLOGICAL SURGERY

  1. 1. THE RESIDENCY REVIEW COMMITTEE FOR NEUROLOGICAL SURGERY 515 N State, Ste 2000, Chicago, IL 60610 • (312) 755-5000 • www.acgme.org FOR CONTINUED ACCREDITATION GENERAL INSTRUCTIONS REVIEW OF AN ACCREDITED PROGRAM OR RE-ACCREDIATION OF A PROGRAM: If the Program Information Form (PIF) is being completed for a currently accredited program, follow the provided instructions to create the correct form. Go to the Accreditation Data System found on the ACGME home page (www.acgme.org) under Data Collection Systems. Using your previously assigned User ID and password, proceed to the PIF Preparation section on the left hand menu and update the Common PIF data. Most data are updated through annual updates, but some information is required at the time of site visit only. Once the data entry is complete, select Generate PIF to review and print the Common PIF (PDF). Once the Common PIF is complete, proceed to the appropriate Residency Review Committee webpage to retrieve the Specialty Specific PIF for CONTINUED ACCREDITATION. Once the forms are complete, enter page numbers for the Continued PIF in the bottom right for each page that consecutively follows the Common PIF numbering, combine the Common PIF and the Continued Accreditation PIF and complete the Table of Contents (found with the Specialty Specific PIF instructions). After completing the PIF/documents, make four copies. They must be identical and final. Draft copies are not acceptable. The forms should be submitted bound by either sturdy rubber bands or binder clips. Do not place the forms in covers such as two or three ring binders, spiral bound notebooks, or any other form of binding. Mail one set of the completed forms to the site visitor at least 14 working days before the site visit. The remaining three sets should be provided to the site visitor on the day of the visit. Review the Program Requirements for Residency Education in Neurological Surgery. The Program Requirements or the Institutional Requirements may be downloaded from the ACGME website (www.acgme.org): For word processing questions/problems regarding: -the completion of the form (content), contact the Accreditation Administrator. -the Accreditation Data System, email WebADS@acgme.org. For a glossary of terms, use the following link – http://www.acgme.org/acWebsite/GME_info/gme_glossary.asp The program director is responsible for the accuracy of the information supplied in this form and must sign it. It must also be signed by the designated institutional official of the sponsoring institution. SPECIALTY SPECIFIC INSTRUCTIONS Instructions have been provided at the top of each form. Please read them carefully before providing information. Please note that only these forms are to be used for supplying information and surgical statistics and only requested information is to be attached. The information being submitted should be as concise as possible. Do not attach any unnecessary materials such as curriculum vitae, reprints, brochures, annual reports, minutes of meetings, etc. The RRC will not review unsolicited preprinted materials. This form is designed so that all information regarding intramural or multi-site programs can be included on one set of forms. A complete set of these forms should be sent to each participating hospital so it can provide its own statistics. The same reporting period must be used by all participating sites. Information is Neurological Surgery PIF- Continued Accreditation 1
  2. 2. to be collected by the Program Director for consolidation and transfer to a single set of forms. The Program Director is responsible for overseeing the accurate compilation of requested data for all participating sites. Surgical List for Sites: Statistics are to be provided for the most recent full academic year (July 1st to June 30th) for which this information is available. The same reporting period must be used by all participating sites. The information is to be provided in separate totals for the site’s staff and the resident(s) training at the site. Grand totals are to be provided in the fifth column for all sites. Forms must be typed. All copies must be legible. NOTE: Computer print-outs or any other method employed in reporting SITE statistics to the Residency Review Committee will not be accepted. Only the surgical list provided is to be used. Use the "Other" category only for procedures that cannot be classified any other way. Resident’s Surgical Log: The Resident's Surgical Log is included with these forms. Statistics are to be provided on this form only. Graduating Chief/Senior resident(s) must submit his/her ENTIRE neurological surgery operative experience gained within the approved sites of the program. Foreign and/or external elective experiences should not be included. Combined surgical statistics from ALL sites in which the resident served during this time are to be compiled on this one form and not broken down into separate sites. Please read carefully the instructions provided with the Resident's Surgical Log. Make sure that dates and signatures are provided. Logs will not be accepted without the proper signatures. Forms must be typed. Examples: For some sections of the Program Information Forms, an example page has been provided as guidance for completing the form. (The example is not intended to indicate the right way to do any particular program component but merely to provide a sample of a correctly completed form). Do not insert your program information on the example pages and do not include the example pages with your final submitted copies of the Program Information Forms. Neurological Surgery PIF- Continued Accreditation 2
  3. 3. Please have the following documents available for the site visitor: 1. Overall educational goals for the program 2. Written competency-based goals and objectives for each experience at each educational level (if your Review Committees wishes to see a sample, it will request one to be appended to the PIF) 3. Current Program Letters of Agreement (PLAs) 4. Files for current residents/fellows and most recent program graduates 5. Files of residents/fellows who have transferred into the program (if applicable), including documentation of previous experience and competency-based performance evaluation 6. Program Policy Manual, including: a) policies for resident appointment, eligibility, selection, and promotion b) policies for supervision of residents c) policies and procedures for resident duty hours and the working environment d) moonlighting policy 7. Institutional policy for remediation and dismissal of residents, including due process. 8. Documentation of resident evaluation including: a) Resident evaluation at the end of each rotation or similar educational experience b) Written or electronic semiannual evaluation of the resident with feedback c) A final (summative) evaluation for each resident that documents the resident’s performance during the final period of education and verifies that the resident has demonstrated sufficient competence to enter practice without direct supervision (files for the most recent year’s graduates for review by the site visitor) 9. Completed evaluations of the faculty by the residents 10. Completed evaluations of the program by the residents 11. The written improvement action plan the program prepared after a review of the aggregated results of residents’ performance and/or other program evaluation results 12. Documentation of resident duty hours 13. Documentation of internal review (date, participants’ names and titles, type of data collected, when reviewed by the GMEC) 14. The resident supervision policy that addresses the following: a) Residents’ responsibilities for patient care b) Progressive responsibility for patient management c) Supervision of patient care 15. Documentation of conference attendance, if applicable 16. For single-program institution (e.g., an institution that sponsors just one accredited program) or an institution with multiple residencies accredited by the same Review Committee: A copy of the resident contract/agreement with the items required by the ACGME numbered according to Institutional Requirement II.D.) Neurological Surgery PIF- Continued Accreditation 3
  4. 4. THE RESIDENCY REVIEW COMMITTEE FOR NEUROLOGICAL SURGERY 515 N State, Ste 2000, Chicago, IL 60610 • (312) 755-5000 • www.acgme.org 10 Digit ACGME Program I.D. #: Program Name: TABLE OF CONTENTS When you have the completed forms, number each page sequentially in the bottom right hand corner. Report this pagination in the Table of Contents and submit this cover page with the completed PIF. Common PIF1 Page(s) Accreditation Information Participating Sites Sponsoring Institution/Single or Limited Residency Institution (If applicable) Faculty/Teaching Staff Program Director Information Physician Faculty Roster Faculty Curriculum Vitae Non Physician Faculty Roster Non Physician Faculty Curriculum Vitae Resident Appointments Number of Positions Actively Enrolled Residents (if applicable) Aggregated Data on Residents Completing or Leaving the Program for the last 3 years (if applicable) Residents Completing Program in the Last 3 years (if applicable) Transferred, Withdrawn, and Dismissed Residents (if applicable) Evaluation Resident Duty Hours Specialty Specific PIF Page(s) Patient Care Program Organizational Structure 1 Statistical Information For Neurological Surgery and Neurology 1Residents Appointment 1Block Rotational Diagram Narrative Description of the Program Medical Knowledge Other Training Programs Training in Neurosciences Experience in Stereotactic Radiosurgery Experience in Endovascular Neurosurgery Conferences Resident Research Practice-Based Learning & Improvement Interpersonal & Communication Skills Professionalism Systems-Based Practice Appointment of Residents Neurological Surgery PIF- Continued Accreditation 4
  5. 5. Fellowship Programs Outpatient Department Information and Facilities 1Educational Program Narrative Description Program Director's Clinical Responsibility Supervision Duty Hours Support Services Operative Experience Residents Institutional Operative Experience Appendix A - Call Schedule Neurological Surgery PIF- Continued Accreditation 5
  6. 6. RESIDENCY REVIEW COMMITTEE FOR NEUROLOGICAL SURGERY 515 N State, Ste 2000, Chicago, IL 60610 • (312) 755-5000 • www.acgme.org SPECIALTY SPECIFIC PROGRAM INFORMATION FORM I. PATIENT CARE A. Program Organizational Structure 1. Is neurological surgery a separate unit (department/division/section) of surgery?( ) YES ( ) NO 2. If this is a medical school affiliated program, is neurological surgery a separate division or department within the medical school? 3. Does the program director have responsibility for appointing a local site director at each site ............................................................................................................................( ) YES ( ) NO B. 1Statistical Information for Neurological Surgery and Neurology Provide the information for each site listed in the Common PIF. Duplicate the tables to add more sites if needed. NEUROSURGICAL DATA Site #1 Site #2 Site #3 Site #4 Total Current Hospital Bed Capacity Number of Hospital Admissions/Year Neurosurgical Bed Capacity Number of Neurosurgery Admissions/ Year Neurosurgical Discharges/Year Average Neurosurgery Census/Daily Number of Neurosurgical Deaths/Year Average Inpatient Consultations/Day Average Neurosurgery ED Consultations/Day NEUROLOGY DATA Site #1 Site #2 Site #3 Site #4 Total Number of Neurology Admissions/Year Average Neurology Census/Daily Neurological Surgery PIF- Continued Accreditation 6
  7. 7. C. 1Block Rotational Diagram This block rotational diagram should show the progression of a typical resident (or residents) through his/her educational experience. The PR for Neurological Surgery require that this educational experience be 60 months in length; the diagram should show how the sixty months of required training are spent. Using the six-month blocks, indicate where each resident will be for that period of time. Where rotations are less than six months the table sections may be subdivided with the length of time indicated. Block Rotational Diagram Sample Year July to December January to June PGY-2 X: Hospital I Hospital I (NS1) Y: Hospital I Hospital I PGY-3 X: ELECTIVE Neurological/ ELECTIVE (NS2) Y: Neurological/ ELECTIVE ELECTIVE PGY-4 X: Hospital II Hospital I (NS3) Y: Hospital I Hospital II PGY-5 X: Lab/ ELECTIVE Lab/ ELECTIVE (NS4) Y: Lab/ ELECTIVE Lab/ ELECTIVE PGY-6 X: Hospital I (C) Hospital II (C) (NS5) Y: Hospital II (C) Hospital I (C) PGY-7 For 6 year Either 6th year of training and/or fellowship programs Block Rotational Diagram Year July to December January to June PGY-2 (NS1) PGY-3 (NS2) PGY-4 (NS3) PGY-5 (NS4) PGY-6 (NS5) PGY-7 For 6 year programs Neurological Surgery PIF- Continued Accreditation 7
  8. 8. D. Narrative Description of the Program Provide a narrative in the following format, addressing each item. Brevity is appreciated, but explain the program in significant detail. DO NOT append brochures, program descriptions, curricula vitae, or other printed materials. 1. Describe the training program covering each year specifically. This information must include: a) A brief discussion of each assignment as it appears in the block diagram b) Progressive responsibility of resident in each year c) Scheduled teaching rounds. d) Outpatient and inpatient facilities. e) Research facilities. f) Operating rooms and scheduled surgery days. Indicate whether the residents work simultaneously, or if not, how many work at one time and at what level in each site listed. g) If the program trains more than one resident per year, describe how the program ensures that each resident has a full 12-month chief resident experience. h) Describe how the program provides progressively responsible patient management opportunities at each level of training. Include a description of the chief resident's clinical and administrative responsibilities. i) Describe the outpatient experience and responsibilities of the residents, including the role of the resident in preoperative evaluation and management of patients as well as post-discharge follow up. j) Describe the critical care experiences of the residents. Indicate the specialty and position of the clinical director of the ICU. Describe the position of the individual responsible for the management of critical care neurosurgical patients. Describe the responsibility for management of critical care neurosurgical patients. Neurological Surgery PIF- Continued Accreditation 8
  9. 9. k) List by name where each resident in the program took his/her neurology experience and in which years of training. Resident Name Program Name Which Years of Training Neurological Surgery PIF- Continued Accreditation 9
  10. 10. II. MEDICAL KNOWLEDGE A. 1Other Training Programs Answer "YES/NO" for the information requested below for each hospital participating in the program. Other Training Site #1 Site #2 Site #3 Site #4 Programs In: Anesthesiology ( ) YES ( ) NO ( ) YES ( ) NO ( ) YES ( ) NO ( ) YES ( ) NO Endocrinology ( ) YES ( ) NO ( ) YES ( ) NO ( ) YES ( ) NO ( ) YES ( ) NO General Surgery ( ) YES ( ) NO ( ) YES ( ) NO ( ) YES ( ) NO ( ) YES ( ) NO Internal Medicine ( ) YES ( ) NO ( ) YES ( ) NO ( ) YES ( ) NO ( ) YES ( ) NO Neurology ( ) YES ( ) NO ( ) YES ( ) NO ( ) YES ( ) NO ( ) YES ( ) NO Ophthalmology ( ) YES ( ) NO ( ) YES ( ) NO ( ) YES ( ) NO ( ) YES ( ) NO Orthopaedics ( ) YES ( ) NO ( ) YES ( ) NO ( ) YES ( ) NO ( ) YES ( ) NO Otolaryngology ( ) YES ( ) NO ( ) YES ( ) NO ( ) YES ( ) NO ( ) YES ( ) NO Pediatrics ( ) YES ( ) NO ( ) YES ( ) NO ( ) YES ( ) NO ( ) YES ( ) NO Pathology ( ) YES ( ) NO ( ) YES ( ) NO ( ) YES ( ) NO ( ) YES ( ) NO Psychiatry ( ) YES ( ) NO ( ) YES ( ) NO ( ) YES ( ) NO ( ) YES ( ) NO Radiology ( ) YES ( ) NO ( ) YES ( ) NO ( ) YES ( ) NO ( ) YES ( ) NO 1. If residencies do not exist for anesthesiology, endocrinology, ophthalmology, orthopaedics, otolaryngology, pathology, and psychiatry, describe the resources for education of neurological surgery residents below. 2. Describe whether the department is used for undergraduate teaching and if yes, by what medical school. Describe the role of the neurosurgery residents in teaching medical students and other residents. Indicate how many medical students are on the same team with the neurosurgery residents. Neurological Surgery PIF- Continued Accreditation 10
  11. 11. B. Training in Neurosciences Describe the amount and type of training the residents receive in the following areas. Include a description of how this training is integrated into the clinical neurological surgery experience. 1. Neurology 2. Neuropathology 3. Neuroanatomy 3. Neurophysiology 4. Neuroradiology C. Experience in Stereotactic Radiosurgery (Mark one or more as appropriate) 1. What type of Radiosurgery is offered? ( ) None ( ) Leksell Gamma Unit ( ) Linear Accelerator ( ) Protein Beam or Particle Beam 2. Do residents have a defined experience in Stereotactic Radiosurgery? ( ) YES - required ( ) YES - elective ( ) NO D. Experience in Endovascular Neurosurgery Do residents have a defined experience in Endovascular Neurosurgery?..................( ) YES ( ) NO Neurological Surgery PIF- Continued Accreditation 11
  12. 12. E. Conferences Provide a schedule of required departmental conferences for the most recent academic year held with resident staff and list other formal teaching exercises including Journal Club. The schedule should include the frequency and year the topic, and the name of the individual responsible for oversight of the conference, and the name of the individual presenting the conference. Name of Individual Name of Individual Required to Attend Responsible for Presenting the Type Frequency Year Oversight Converence Faculty Residents Neurosurgical Neuropathology Tumor Clinics M and M Neurological Neuroradiological Other G. Resident Research List the papers published since the last survey of the program in which a resident of the program was author or joint author. Underline the resident participant's name. Neurological Surgery PIF- Continued Accreditation 12
  13. 13. III. PRACTICE-BASED LEARNING AND IMPROVEMENT Examples of Learning Activities: didactic lecture, assigned reading, seminar, self-directed learning module, conference, small group discussion, workshop, online module, journal club, project, case discussion, one-on-one mentoring, or other examples of learning activities. 1. Describe one learning activity in which residents engage to identify strengths, deficiencies, and limits in their knowledge and expertise (self-reflection and self-assessment); set learning and improvement goals; identify and perform appropriate learning activities to achieve self-identified goals (life-long learning). Limit your response to 400 words. 2. Describe one example of a learning activity in which residents engage to develop the skills needed to use information technology to locate, appraise, and assimilate evidence from scientific studies and apply it to their patients’ health problems. The description should include: a) locating information b) using information technology c) appraising information d) assimilating evidence information (from scientific studies) e) applying information to patient care Limit your response to 400 words. 3. Give one example and the outcome of a planned quality improvement activity or project in which at least one resident participated in the past year that required the resident to demonstrate an ability to analyze, improve and change practice or patient care. Describe planning, implementation, evaluation and provisions of faculty support and supervision that guided this process. Limit your response to 400 words. 4. Describe how residents: a) develop teaching skills necessary to educate patients, families, students, and other residents; b) teach patients, families, and others; and c) receive and incorporate formative evaluation feedback into daily practice. (If a specific tool is used to evaluate these skills have it available for review by the site visitor.) Limit your response to 400 words. Neurological Surgery PIF- Continued Accreditation 13
  14. 14. IV. INTERPERSONAL AND COMMUNICATION SKILLS 1. Describe one learning activity in which residents develop competence in communicating effectively with patients and families across a broad range of socioeconomic and cultural backgrounds, and with physicians, other health professionals, and health related agencies. Limit your response to 400 words. 2. Describe one learning activity in which residents develop their skills and habits to work effectively as a member or leader of a health care team or other professional group. In the example, identify the members of the team, responsibilities of the team members, and how team members communicate to accomplish responsibilities. Limit your response to 400 words. 3. Explain (a) how the completion of comprehensive, timely and legible medical records is monitored and evaluated, and (b) the mechanism for providing residents feedback on their ability to competently maintain medical records. Limit your response to 400 words. Neurological Surgery PIF- Continued Accreditation 14
  15. 15. V. PROFESSIONALISM 1. Describe at least one learning activity, other than lecture, by which residents develop a commitment to carrying out professional responsibilities and an adherence to ethical principles. Limit your response to 400 words. 2. How does the program promote professional behavior by the residents and faculty? Limit your response to 400 words. 3. How are lapses in these behaviors addressed? Limit your response to 400 words. Neurological Surgery PIF- Continued Accreditation 15
  16. 16. VI. SYSTEMS-BASED PRACTICE 1. Describe the learning activity(ies) through which residents achieve competence in the elements of systems-based practice: work effectively in various health care delivery settings and systems, coordinate patient care within the health care system; incorporate considerations of cost- containment and risk-benefit analysis in patient care; advocate for quality patient care and optimal patient care systems; and work in interprofessional teams to enhance patient safety and care quality. Limit your response to 400 words. 2. Describe an activity that fulfills the requirement for experiential learning in identifying system errors. Limit your response to 400 words. Neurological Surgery PIF- Continued Accreditation 16
  17. 17. VII. 1APPOINTMENT OF RESIDENTS 1. Does the program routinely participate in the Neurosurgery Match?....................( ) YES ( ) NO 2. How many years are appointments made for? 3. Are residents appointed annually, July 1st?.........................................................( ) YES ( ) NO If no, explain Neurological Surgery PIF- Continued Accreditation 17
  18. 18. VIII. 1FELLOWSHIP PROGRAMS List all fellows currently appointed to this program (active clinical residents are listed in the Resident Appointments section) and provide the information requested. For "Type of Fellowship Program" give the name of the program and type of service. Example: Duke/NS. Type of Fellowship Program Number of Trainees Neurological Surgery PIF- Continued Accreditation 18
  19. 19. IX. 1OUTPATIENT DEPARTMENT INFORMATION AND FACILITIES Provide the information for each site (add another table for more sites if needed). Provide the information requested for each hospital participating in the program. If position does not exist, enter "None." If position is vacant, enter "vacant." Site #1 Site #2 Site #3 Site #4 Total Outpatient Visits Percent Participation by % % % % Residents Emergency Department Total Number of NS Consultations/Year Neurology Total Number of NS Consultations/Year Facilities [PR IV.A] Interventional Neuroradiology ( ) YES ( ) NO ( ) YES ( ) NO ( ) YES ( ) NO ( ) YES ( ) NO Stereotactic Radiosurgery ( ) YES ( ) NO ( ) YES ( ) NO ( ) YES ( ) NO ( ) YES ( ) NO Neurological Surgery PIF- Continued Accreditation 19
  20. 20. X. EDUCATIONAL PROGRAM NARRATIVE DESCRIPTION A. Program Director's Clinical Responsibility Describe the program director's major clinical responsibilities at the primary clinical site as well as any responsibilities he/she may have at other participating sites. B. Supervision Describe how the program ensures direct and appropriate supervision of residents at each level of training. C. Duty Hours Attach the call schedule as Appendix A. D. Support Services Describe the support services the program/site provides to ensure that residents do not routinely engage in activities that do not require the skills of a physician. Describe the type and availability of sleeping, lounge, and food facilities provided to residents on-call in the hospital. Neurological Surgery PIF- Continued Accreditation 20
  21. 21. XI. 1OPERATIVE EXPERIENCE A. 1Residents 1Supply the number of cases for the most recently graduating resident representing his/her entire neurosurgery experience. This information is to be reported separately: by senior clinical year, and by all other clinical years. Combined surgical statistics from ALL institutions in which the resident served are to be included on this one form and not broken down into separate institutions. Count only those cases in which the resident had a significant decision making role (including pre- and post-operative care). "Surgeon" refers to primary responsibility; "Assistant" refers to surgeon acting as an assistant. Patients up to 16 years of age inclusive are considered pediatric cases. Procedures listed as "Other", should be explained in the "Other" section of this log. Attach additional pages as necessary. Resident's Name Log Covering Period (dates) Resident Signature Senior Clinical Other Clinical Total Experience Year Years All Years Cranial Procedures - Vascular Aneurysm - craniotomy Aneurysm - endovascular AVM/other malformation - craniotomy AVM/other malformation - endovascular AVM/other malformation - stereotactic radiosurgery Hematoma non-traumatic Other (vascular) Total Cranial Procedures - Vascular Cranial Procedures - Tumor Intra-axial - craniotomy Intra-axial - stereotactic biopsy Intra-axial - stereotactic radiosurgery Extra-axial - craniotomy Extra-axial - stereotactic radiosurgery Parasellar/sellar tumor - craniotomy Parasellar/sellar tumor - transsphenoidal Parasellar/sellar tumor - radiosurgery Skull base/endovascular/neuroendoscopy/ other Total Cranial Procedures - Tumor Cranial Procedures - Functional Epilepsy, diagnostic - craniotomy Epilepsy, diagnostic - stereotactic implantation Epilepsy, therapeutic - craniotomy Epilepsy, therapeutic - vagal nerve Neurological Surgery PIF- Continued Accreditation 21
  22. 22. Senior Clinical Other Clinical Total Experience Year Years All Years stimulation Epilepsy, therapeutic - other Movement disorder surgery - stereotactic lesion Movement disorder surgery - stimulation Neuralgia - stimulation Neuralgia - percutaneous lesion creation Neuralgia - craniotomy/craniectomy Neuralgia - stereotactic radiosurgery Other (functional) Total Cranial Procedures – Functional Cranial Procedures - Trauma Depressed skull fracture/penetrating wound Hematoma Other (trauma) Total Cranial Procedures - Trauma Cranial Procedures - Cranial Recon/Cranioplasty Craniosynostosis Craniofacial reconstruction Cranioplasty Total Cranial Procedures - Cranial Recon/Cranioplasty Cranial Procedures - Other Infection/cyst/orbit/skull lesion/dural- CSF/Chiari Total Cranial Procedures - Other Extracranial/Intracranial Occlusive Vascular Dis Carotid endarterectomy Endovascular EC/IC bypass Vascular repair/patch/bypass/ligation/other Total Extracranial/Intracranial Occlusive Vascular Dis CSF Shunting Initial Revision Third ventriculostomy Other (CSF shunting procedures) Total CSF Shunting Neurological Surgery PIF- Continued Accreditation 22
  23. 23. Senior Clinical Other Clinical Total Experience Year Years All Years Spinal Procedures - Disc and/or Spondylosis Cervical - discectomy/decompression Cervical - with instrumentation/fusion Thoracic - discectomy/decompression Thoracic - with instrumentation/fusion Lumbar/sacral - discectomy/decompression Lumbar/sacral - with instrumentation/fusion Total Spinal Procedures - Disc and/or Spondylosis Spinal Procedures - Tumor/Vascular Lesion Primary tumor resection Primary tumor - resection w/instrumentation/fusion Metastatic tumor resection Metastatic tumor resection w/instrumentation/fusion Vascular lesion Total Spinal Procedures - Tumor/Vascular Lesion Spinal Procedures - Trauma Cervical - operative decompression/reduction Cervical - with instrumentation/fusion Thoracic - operative decompression/reduction Thoracic - with instrumentation/fusion Lumbar/sacral - operative decompression/reduction Lumbar/sacral - with instrumentation/fusion Total Spinal Procedures - Trauma Spinal Procedures - Dysraphism Spinal dysraphism Total Spinal Procedures - Dysraphism Spinal Procedures - Spasticity/Pain Pump implantation Rhizotomy Stimulation Total Spinal Procedures - Spasticity/Pain Spinal Procedures - Vertebral Reconstruction Vertebroplasty/kyphoplasty Neurological Surgery PIF- Continued Accreditation 23
  24. 24. Senior Clinical Other Clinical Total Experience Year Years All Years Total Spinal Procedures - Vertebral Reconstruction Spinal Procedures - Other Non-neoplastic lesions/deformity/infection/other Total Spinal Procedures - Other Peripheral Nerve Procedures Neurolysis/transposition Nerve repair Sympathectomy Nerve stimulation Peripheral nerve section/rhizotomy Excision tumor/neuroma/neurolytic agent/other Total Peripheral Nerve Procedures Minor/Diagnostic Procedures Muscle/nerve biopsy ICP monitoring Tongs/halo application Ventriculostomy Arteriography Injection/Aspiration/Biopsy/Punctures/Other Total Minor/Diagnostic Procedures No Operative Procedure No procedure this hospitalization Total No Operative Procedure Secondary Codes Cranial - other Spinal Peripheral Total Secondary Codes GRAND TOTAL INDEXED CASES: Neurological Surgery PIF- Continued Accreditation 24
  25. 25. B. 1Institutional Operative Experience Supply the number of cases for each institution participating in the program. Attach a description of how the data were tabulated and the method used to confirm the accuracy of the information reported. Operative experience for the previous academic year should be reported. Log Covering July 1, ---- to June 30, ---- Period (dates) Program Director Signature / Date Total Site 1 Site 2 Site 3 Site 4 Experience Cranial Procedures - Vascular Aneurysm - craniotomy Aneurysm - endovascular AVM/other malformation - craniotomy AVM/other malformation - endovascular AVM/other malformation - stereotactic radiosurgery Hematoma non-traumatic Other (vascular) Total Cranial Procedures - Vascular Cranial Procedures - Tumor Intra-axial - craniotomy Intra-axial - stereotactic biopsy Intra-axial - stereotactic radiosurgery Extra-axial - craniotomy Extra-axial - stereotactic radiosurgery Parasellar/sellar tumor - craniotomy Parasellar/sellar tumor - transsphenoidal Parasellar/sellar tumor - radiosurgery Skull base/endovascular/neuroendoscopy/ other Total Cranial Procedures - Tumor Cranial Procedures - Functional Epilepsy, diagnostic - craniotomy Epilepsy, diagnostic - stereotactic implantation Epilepsy, therapeutic - craniotomy Epilepsy, therapeutic - vagal nerve stimulation Epilepsy, therapeutic - other Movement disorder surgery - stereotactic lesion Movement disorder surgery - stimulation Neuralgia - stimulation Neurological Surgery PIF- Continued Accreditation 25
  26. 26. Total Site 1 Site 2 Site 3 Site 4 Experience Neuralgia - percutaneous lesion creation Neuralgia - craniotomy/craniectomy Neuralgia - stereotactic radiosurgery Other (functional) Total Cranial Procedures – Functional Cranial Procedures - Trauma Depressed skull fracture/penetrating wound Hematoma Other (trauma) Total Cranial Procedures - Trauma Cranial Procedures - Cranial Recon/Cranioplasty Craniosynostosis Craniofacial reconstruction Cranioplasty Total Cranial Procedures - Cranial Recon/Cranioplasty Cranial Procedures - Other Infection/cyst/orbit/skull lesion/dural- CSF/Chiari Total Cranial Procedures - Other Extracranial/Intracranial Occlusive Vascular Dis Carotid endarterectomy Endovascular EC/IC bypass Vascular repair/patch/bypass/ligation/other Total Extracranial/Intracranial Occlusive Vascular Dis CSF Shunting Initial Revision Third ventriculostomy Other (CSF shunting procedures) Total CSF Shunting Spinal Procedures - Disc and/or Spondylosis Cervical - discectomy/decompression Cervical - with instrumentation/fusion Thoracic - discectomy/decompression Thoracic - with instrumentation/fusion Neurological Surgery PIF- Continued Accreditation 26
  27. 27. Total Site 1 Site 2 Site 3 Site 4 Experience Lumbar/sacral - discectomy/decompression Lumbar/sacral - with instrumentation/fusion Total Spinal Procedures - Disc and/or Spondylosis Spinal Procedures - Tumor/Vascular Lesion Primary tumor resection Primary tumor - resection w/instrumentation/fusion Metastatic tumor resection Metastatic tumor resection w/instrumentation/fusion Vascular lesion Total Spinal Procedures - Tumor/Vascular Lesion Spinal Procedures - Trauma Cervical - operative decompression/reduction Cervical - with instrumentation/fusion Thoracic - operative decompression/reduction Thoracic - with instrumentation/fusion Lumbar/sacral - operative decompression/reduction Lumbar/sacral - with instrumentation/fusion Total Spinal Procedures - Trauma Spinal Procedures - Dysraphism Spinal dysraphism Total Spinal Procedures - Dysraphism Spinal Procedures - Spasticity/Pain Pump implantation Rhizotomy Stimulation Total Spinal Procedures - Spasticity/Pain Spinal Procedures - Vertebral Reconstruction Vertebroplasty/kyphoplasty Total Spinal Procedures - Vertebral Reconstruction Spinal Procedures - Other Non-neoplastic lesions/deformity/infection/other Neurological Surgery PIF- Continued Accreditation 27
  28. 28. Total Site 1 Site 2 Site 3 Site 4 Experience Total Spinal Procedures - Other Peripheral Nerve Procedures Neurolysis/transposition Nerve repair Sympathectomy Nerve stimulation Peripheral nerve section/rhizotomy Excision tumor/neuroma/neurolytic agent/other Total Peripheral Nerve Procedures Minor/Diagnostic Procedures Muscle/nerve biopsy ICP monitoring Tongs/halo application Ventriculostomy Arteriography Injection/Aspiration/Biopsy/Punctures/Other Total Minor/Diagnostic Procedures No Operative Procedure No procedure this hospitalization Total No Operative Procedure Secondary Codes Cranial - other Spinal Peripheral Total Secondary Codes GRAND TOTAL INDEXED CASES: Provide a description of how the data were tabulated and the method used to confirm the accuracy of the information reported Neurological Surgery PIF- Continued Accreditation 28
  29. 29. APPENDIX A - CALL SCHEDULE Attach the call schedule as Appendix A Neurological Surgery PIF- Continued Accreditation 29

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