Pediatric neurosurgery and research are the emphasis of the PGY-4 year. The PGY-4 year is completed at Children's Hospital of Philadelphia (CHOP). At CHOP, our residents will be involved in the full breadth of neurosurgical care for the pediatric population. This year focuses on developing skills for evaluating pediatric neurosurgical patients, generating appropriate differential diagnoses, participating in pediatric neuro-critical care, and developing technical skills to efficiently perform bedside procedures and interventions in the operative theatre for pediatric neurosurgical patients.
The PGY-4 year includes 6 months of dedicated pediatric neurosurgery research time. During the clinical rotation at CHOP, residents will engage their attending faculty to develop a clinical question for research. The resident will then participate in completing this project during their 6 months of dedicated research. While participating in research, residents will maintain their clinical skills by participating in one twelve-hour neurosurgical shift per week.
Pediatric Neurosurgery (Months 1-6)
Patient Care:
- Formulate a work-up and treatment plan for pediatric patients (e.g., trauma, tumor, hydrocephalus, synostosis, tethered cord, birth injury).
- Independently perform routine procedures (Shunt tap, Advanced cerebral monitoring).
- Evaluate and develop a treatment plan for newborn myelomeningocele patients.
- Describe the physical findings and mechanisms of head shape abnormalities.
- Perform complex procedures with assistance (e.g., brain tumor, synostosis repair, tethered cord, ventricular endoscopy, indirect vascular bypass, craniotomy for epilepsy).
- Manage complications with assistance.
- Proficiently conduct brain death examination in infants/children.
- Communicate diagnoses and treatment plans effectively with patients and families.
Medical Knowledge:
- Describe the natural history of congenital CNS anomalies.
- Describe the implications of spinal column development for patterns of injury and treatment choice in children.
- Describe the impact of refractory epilepsy and spastic cerebral palsy on development and function.
- Describe treatment strategies for CNS tumors in children.
- Identify methods to limit radiation exposure in children during imaging.
Practice Based Learning and Improvement:
Residents must have the ability to use scientific evidence and methods to investigate, evaluate, and improve patient care practices. Each provided through role modeling by attending, participation in workshops, and direct patient care experience. Assessed through evaluation form by attending, and self-assessment.
- Identify areas for personal and practice improvement and implement strategies to enhance knowledge, attitudes, skills, and processes of care.
- Examine and analyze personal and practice improvement and implement strategies to continually improve the quality of patient care provided utilizing a systematic methodology.
- Demonstrate and recognize the importance of life-long learning in surgical practice.
- Demonstrate the ability to apply knowledge of study designs and statistical methods of clinical studies applicable to neurosurgery.
- Demonstrate a willingness to receive constructive feedback from fellow residents, attending physicians, and other healthcare professionals.
- Demonstrate the ability to utilize information technology in order to access online medical information in support of ongoing learning.
- Understand and be able to apply knowledge of scientific data to the care of surgical patients.
- Facilitate the learning process for students and other healthcare professionals (e.g., pre-operative and post-operative care, completing progression notes, and writing orders).
Interpersonal and Communication Skills:
Residents must be able to demonstrate interpersonal and communication skills that assist in effective information exchange and be able to team with patients, patients’ families, and professional associates. Each provided through role modeling of Attending, participation in workshops or didactic conferences, and direct patient care experience. Assessed through evaluation form by attending, evaluation form by team members or peers and self-assessment and evaluation form.
- Demonstrate the ability to sustain therapeutic and ethically sound relationships with patients, patients’ families, and other resident colleagues.
- Demonstrate the ability to correctly obtain and provide patient information utilizing both verbal and nonverbal forms of communication.
- Demonstrate the ability to maintain comprehensive, legible, and timely medical records documentation.
- Demonstrate the ability to work and communicate effectively with other professionals as a member or leader of a health care team.
- Demonstrate the ability to assist patients in understanding and applying information they acquire on their own.
- Demonstrate the ability to communicate all adverse events in a timely fashion to other residents and/or attending physicians.
- Demonstrate the ability to provide prompt and effective professional consultations to other residents and other health care professionals.
Professionalism:
Residents must demonstrate a commitment to carrying out professional responsibilities, adherence to ethical principles, and sensitivity to a diverse population. Each provided through role modeling by attending, participation in workshops, and direct patient care experience. Assessed through evaluation form by attending, and self-assessment.
- Demonstrate the ability to appropriately communicate with patients, families, and other healthcare professionals in a respectful and compassionate manner.
- Demonstrate the ability to respond to patients care concerns in a timely manner.
- Demonstrate a commitment to basic ethical principles (i.e., autonomy, benevolence, non-malfeasance, and justice).
- Demonstrate accountability to patients, society, and the profession. a. Develop and maintain habits of punctuality and efficiency; b. Demonstrate uncompromised honesty; c. Maintain a good work ethic (i.e., positive attitude, high level of initiative).
- Demonstrate a commitment to excellence and continuous professional development.
- Demonstrate responsiveness and sensitivity to the age, sexual preferences, cultural beliefs, socioeconomic status, behaviors, and disabilities of patients and professional colleagues.
System-based Practice:
Residents must demonstrated an awareness of and responsiveness to the larger context and system of health care and the ability to effectively call on system resources to provide care that is of optimal value. Each provided through role modeling by attending, participation in workshops, and direct patient care experience. Assessed through evaluation form by attending, and self-assessment.
- Identify how patient care and other professional duties impact health care professionals and the entire health care organization.
- Demonstrate the ability to effectively utilize resources and avoid any inefficiencies or unnecessary services in providing quality care.
- Demonstrate the ability to facilitate dialogue between patients/families and other healthcare professionals in other hospital departments (e.g., emergency department, intensive care unit, etc.).
- Express the importance of quality patient care and assist patients in dealing with complexities of the health care system.
- Demonstrate an understanding of patient safety and why it is always a primary concern for a physician.
- Identify errors in management with peers and patients in order to improve patient safety;
- Develop a continuous willingness to learn from errors and use them as a way to improve the system or the process of caregiving;
- Partake in hospital Quality Improvement activities and Patient Safety initiatives.
- Demonstrate an understanding of risk management and professional liability
- Describe the institutional processes and participate in disclosure and discussion of adverse events with patients.
- Understand and appreciate patients’ interest and convenience when coordinating care management plans
- Demonstrate the ability to work with health care managers and providers to evaluate, coordinate, and improve health care and understand how these activities affect system performance.
Pediatric Neurosurgery Research (months 7-12)
The PGY-4 year is completed at Children's Hospital of Philadelphia (CHOP). This year is divided into a 6-month clinical rotation and 6-month research rotation. Residents will dedicate 6 months of this year to learning clinical pediatric neurosurgery while participating on the neurosurgical service and attending weekly conferences and didactics. During this time, residents will identify a neurosurgical mentor at CHOP. Residents will work directly with their mentor to develop a project. The resident will take leadership in the project by performing a literature review and writing an IRB proposal which will be submitted at least 2 months prior to completing their clinical rotation.
The research rotation will be completed during the second 6 months of the PGY-4 year. Ideally, our residents will begin this rotation with an approved IRB proposal. If not, they will utilize the first 4 weeks of this rotation to edit their IRB proposal for approval. During the remainder of this rotation, residents will participate in data acquisition, analysis, and interpretation. Residents will meet weekly with their research mentor to discuss progress and troubleshooting. Additionally, residents will present research updates monthly at our Neurosurgical grand rounds. Residents will have figures drafted for their manuscript at the completion of this rotation and aim to have their manuscript completed and submitted to a peer-reviewed journal within the first 6 months of their PGY-5 year. During the research rotation, residents will maintain clinical neurosurgery skills and knowledge by participating in one twelve-hour clinical shift per week at Cooper University Hospital, and attend weekly neurosurgery conferences and didactics.
Goals:
- Learn the process for developing a clinical question.
- Learn basic scientific technique and how to collaborate with clinical and academic researchers.
- Become efficient at conducting relevant literature reviews.
- Develop a hypothesis-driven research plan.
- Develop an understanding of experiment design, statistical analysis and data interpretation.
- Successfully develop an IRB proposal for approval of a research plan.
- Learn basics of data analysis and implement this knowledge for completing research plan.
- Learn how to draft a manuscript for a peer-reviewed pediatric journal.
- Present research at a national conference.
Practice Based Learning and Improvement:
Residents must have the ability to use scientific evidence and methods to investigate, evaluate, and improve patient care practices. Each provided through role modeling by attending, participation in workshops, and direct patient care experience. Assessed through evaluation form by attending, and self-assessment.
- Demonstrate appraisal and assimilation of scientific evidence.
- Identify ways to improve scientific practice.
- The resident will be responsible for working with supervisory staff and co-participants in troubleshooting the methods of the proposed research.
Interpersonal and Communication Skills:
Residents must be able to demonstrate interpersonal and communication skills that assist in effective information exchange and be able to team with patients, patients’ families, and professional associates. Each provided through role modeling of Attending, participation in workshops or didactic conferences, and direct patient care experience. Assessed through evaluation form by attending, evaluation form by team members or peers and self-assessment and evaluation form.
- Present scientific data and peer-review, ideally via submission of one abstract or manuscript during the course of training.
- Communicate effectively and professionally with others in healthcare.
- Good communication with other researchers is necessary for collaboration in research. The resident will learn how to obtain informed consent, enroll the patients, and communicate with regulatory personnel.
Professionalism:
Residents must demonstrate a commitment to carrying out professional responsibilities, adherence to
ethical principles, and sensitivity to a diverse population. Each provided through role modeling by attending, participation in workshops, and direct patient care experience. Assessed through evaluation form
by attending, and self-assessment.
- Demonstrate sensitivity to patients, and respect for patient privacy.
- The resident will demonstrate ongoing self-education and habits of life-long learning.
- Residents will maintain the highest standards of professionalism, especially in interactions with patients or with other research colleagues.
- The resident will be responsible for tracking duty hours and reporting them to the supervisory attending.
System-based Practice:
Residents must demonstrated an awareness of and responsiveness to the larger context and system of health care and the ability to effectively call on system resources to provide care that is of optimal value. Each provided through role modeling by attending, participation in workshops, and direct patient care experience. Assessed through evaluation form by attending, and self-assessment.
- The resident recognizes that he/she is part of a research team.
- The resident develops knowledge for regulatory guidelines in basic, translational and clinical research.
- Demonstrate an awareness of health care systems.
- Research requires absolute compliance with regulatory guidelines such as HIPAA for patient based research and animal safety regulations for basic science research.
- The resident will learn how to complete projects within this regulatory environment.