PGY-1
- The majority of PGY-1 is dedicated to neurosurgery, neurology and neurocritical care. Junior residents will spend months on the neurosurgery service at Grady Memorial Hospital (Grady) and Emory University Hospital (EUH), two months in the neurosurgery ICU at EUH and one month at GMH.
- The remainder of PGY-1 time is dedicated to electives, which include: one month of neuro-ophthalmology, neuro-otology, neuro-pathology/neuro-radiology. Research projects and solidification of a preferred academic track are to be developed during this time.
- Interns are responsible for learning basic pre and postoperative care of surgical patients, management of critically ill neurology and neurosurgical patients and performing and becoming proficient in the five critical bedside procedures (external ventricular drain placement, lumbar drain placement, lumbar puncture, central line placement and arterial line placement).
- Current ACGME guidelines do not permit PGY-1 residents to work more than 16 hours straight, and as such, residents are typically not required to take overnight call.
PGY-2
- PGY-2 residents spend 10 months at EUH, where residents become members of the neurosurgical team.
- The remaining two months are spent in the Skull Base Lab at Grady Memorial Hospital, where residents can improve dissection skills and develop research projects.
- On service PGY-2 residents are responsible for seeing all floor patients prior to rounds with the chief residents. Following rounds, all residents proceed to the operating rooms for cases. Junior residents are responsible for seeing all patients and consults during the day. Two chief residents are available to mentor and teach the junior residents at all times.
- Residents are responsible for all consults and admissions from the emergency room or transfer service.
- Typical cases include: open craniotomy for treatment of aneurysm, AVM, cavernous malformation, tumor, lesional epilepsy, implantation of intracranial monitoring for epilepsy and trigeminal neuralgia, deep brain stimulation for movement and non-movement disorders, minimally invasive laser ablation for tumors, epilepsy and cavernous malformations, peripheral nerve dissections, percutaneous treatment of trigeminal neuralgia, open spine treatment of AVMs, dural AVFs, spinal cord tumors and chiari malformations, vagus nerve stimulator placement and deep brain stimulator battery placement and exchange
- Residents are split so there are two PGY-2 residents on service at EUH during the day and one who covers call at night (night float).
PGY-3
- PGY-3 is split between full-time service at Grady with chief backup, EUHM and Endovasular rotation at EUH. A one month rotation at Grady Memorial Hospital in the Skull Base Lab is allotted for dissection and research.
- The Grady Memorial Hospital rotation is typically six months long. The junior resident is paired with a chief resident and intern, while beginning to operate on an independent level. Residents are responsible for all consults, floor and ICU patients, as well as operating. Typical cases include: craniotomy for trauma, tumor, stroke and aneurysm, as well as spine decompression and fusion for trauma and degenerative disease.
- GMH employs a night float system for coverage
- The EUHM rotation is typically three months long and focuses on skull base neurosurgery.
- The EUH rotation focuses on endovascular neurosurgery and is typically two months long.
PGY-4
- PGY-4 year is split between six months of pediatrics at both Scottish Rite and Arthur M. Blank hospitals, as well as six months at Emory University Hospital Midtown on the spine services.
- As a mid-level resident, the PGY-4 works solely in conjunction with the primary attending in a mentor-mentee relationship.
- During the pediatrics rotation, residents will be exposed to all facets of pediatric neurosurgery including: tumor, spine, congenital malformations, hydrocephalus and shunts, trauma and vascular malformations.
- The spine rotation includes: degenerative spine, complex deformity, tumor and minimally invasive approaches.
- Call as a PGY-4 resident is taken in the EUH-Midtown/CHOA call pool and is home-call.
PGY-5
- PGY-5 is dedicated to either a year of research or electives. Numerous research opportunities are available depending on interest. This year will be personalized to the resident’s interests and career goals.
- Resident will spend an elective month at ESJH learning Gamma Knife Radiosurgery
- PGY-5 residents fill in intermittently at EUH-Midtown and CHOA.
- They participate in the chief call pool.
- PGY-5 residents also plan and coordinate weekly Grand Round lectures.
- Residents will be expected to pass the written boards by this year.
PGY-6
- PGY-6 is spent as chief year.
- Chief residents oversee the team management of all patients on the adult neurosurgery service in conjunction with preferences of the attending surgeons.
- It is the chief resident's responsibility to round on all patients in the morning, review pertinent events, lab or radiographic data and nursing reports.
- Responsible for providing ample instruction or insight as to how decisions are made for the more junior-level residents.
- Evening rounds are to be conducted by a chief resident. All radiographic studies performed that day should be reviewed during evening rounds.
- The chief resident should round each day on the weekends. The chief resident will assign residents to cases in advance to allow each resident the opportunity to have pre-operative consultation with the specific attending to clarify operative goals, positioning, approach, equipment needed, etc.
- The chief resident should participate in the advancement of each junior resident's technical skills in the operating room. All invasive CNS procedures performed in the intensive care unit or on the ward should be supervised by the chief resident until a junior-level resident is deemed capable of functioning independently.
- The chief resident must review all consultation cases referred to the neurosurgery service with the resident who performed the initial consultation, and confer directly with or oversee the efficient communication between other residents and the attending on call or the attending requested.
- Any complaints lodged by patients, their families, nursing staff, hospital personnel or other physicians against the resident team should be discussed with that particular resident. If a suitable course of action is not taken, the chief resident should communicate directly with the chairman.
- It is the responsibility of the administrative chief resident to compose the schedule of the grand rounds talks and notify speakers.
- By completion of the chief resident year, the resident should be proficient in all commonly performed intracranial procedures and microsurgery, treatment of traumatic brain lesions, CSF-diversion techniques and surgical treatment of intracranial infections. The resident should be proficient in a variety of spinal operations for degenerative, traumatic, infectious and neoplastic disease. This includes basic knowledge and skill in spinal instrumentation, as well as basic skills in the management of common pediatric disorders.
- Chief residents are on call every fourth night for the entire year. Call is to back up all juniors and mid-levels throughout the system. Each chief resident will take one call weekend per month, have one weekend as “back-up” call, which includes morning rounds at Emory University Hospital or Grady Memorial.
PGY-7
- PGY-7 will be personalized to the resident’s career goals and spent as a dedicated research year, elective or the opportunity to do an enfolded CAST fellowship. We offer several CAST fellowship opportunities, including Neurosurgical Oncology, Stereotactic and functional neurosurgery, Neurosurgical spine surgery, interventional neuroradiology, cerebrovascular neurosurgery and skull base neurosurgery.
- Three months can be spent at ESJH focusing on privademic spine, tumor and stereotactic radiosurgery.