Resident Training Program Policies and Procedures 2012-2013 (PDF)

Benefits | Recommendations | Board Exam | Research | Cases | Evaluations | Conferences

Benefits

PARTICIPATION IN THE EDUCATIONAL PROGRAM Updated August 10, 2011

PURPOSE: To establish and communicate expectations for both faculty and trainees regarding participation in the educational program.

POLICY: Ongoing participation in the educational program is the mutual responsibility of the faculty and the trainees. The following expectations are outlined to enhance the educational process.

•I. Attendance of Teaching Conferences: Wednesday conferences are an integral component of the educational program. These conferences are compulsory for all residents. Attendance will be documented by personnel signature recorded on the sign-in sheet. The absence of a signature will be regarded as an unexcused absence. Failure to comply with the minimal attendance standards set forth below or the failure to demonstrate an effort to attend conferences may result in probationary action for trainees.

Excused absences will be allowed in the following circumstances:

•1) Notification of the Neurological Surgery Education Office (310 794 7362) prior to or within 48 hours of the conference date

•2) Scheduled vacation time

•3) Approved absence from the program such as meeting travel, interviews, and leaves

•4) Post-call residents

Ambulatory Patient Care:

Exposure to the continuity established in the preoperative evaluation and postoperative visit(s) is essential to the training of surgical housestaff. For this reason, all trainees to Harbor UCLA Medical Center and West Los Angeles VA Medical Center will attend the outpatient clinic for their service a minimum of one day per week (with the exception of the third Wednesday for the UCLA Neurosurgery education day), unless the trainees' immediate attention is required for other patient care.

Operating Room Experience

All trainees, irregardless of institutional assignment, are expected to attend the operating room.

Trainees are expected to accomplish the following in participating in operative cases:

Prior to the operation, make themselves familiar with the patient's history including diagnostic studies, and have an understanding of the indications for surgery.

Personally examine the patient prior to operation

Document their involvement with a preoperative note.

Consult with the attending physician regarding the operative care to be delivered.

Personally participate in the operation.

Document a summary of the operation in the form of a brief, handwritten operative note.

Personally participate in the immediate in-hospital postoperative care of the patient and document that participation in the form of a postoperative note in the medical record within the first 48 hours after operation.

Participation in the outpatient postoperative care of the patient by personally seeing the patient in the outpatient setting and determining follow-up care.

Invasive Procedures

All trainees must perform, under appropriate supervision, the requisite number of invasive procedures to demonstrate competency. All first-year trainees will be observed during a probationary period until competency has been established by successful performance of the requisite number of procedures. During this probationary period, the following criteria must be met:

All procedures must be performed in the presence of a supervising resident physician or an attending physician.

Each trainee is expected to learn the indications, technical maneuvers, and possible complications of each procedure.

Trainees will provide the patient with informed consent regarding the procedure, and document, either by signed consent form, or by handwritten note that consent was given.

Trainees will document performance of the procedure with a handwritten note in the medical record noting the procedure, indication(s), and their supervising resident or attending physician, anesthetic used, and any complications.

Trainees will maintain a log of procedures completed to document his/her activity.

EDUCATION-RELATED BENEFITS FOR TRAINEES

To support and foster the education of trainees, the Department of Neurosurgery will provide the following items:

Meal Cards
Balances are cleared annually. Meal cards are for UCLA Clinical rotations only. Some funds are assigned to each resident for vacation/emergency coverage. Funds may not be replenished. There are separate meal programs at Harbor-UCLA and West Los Angeles Veterans Administration.

1) One pair of surgical loupes
2) $500 annual educational gift beginning in January of the NS1 year. The funds are intended for books but may be used for other neurosurgical essentials with prior approval from the program director.
3) Registration and examination fees for Fluoroscopy certification

The Department does not cover/reimburse the following expenses:
1) California Medical Board Licensing (application and renewal)
2) Personal computers, stethoscopes, or other medical equipment

Back to top

Recommendations

BOOK RECOMMENDATIONS

General Surgery:
Advanced Trauma Life Support (ATLS) manual, American College of Surgeons
Marino, The ICU Book, 2006

Neurosurgery:
Youmans Neurological Surgery, Sixth Edition, 2011
Greenberg, Handbook of Neurosurgery, Seventh Edition, 2010
Schmidek and Sweet, Operative Neurosurgical Techniques, Fifth Edition, 2006

Neuroradiology:
Castillo: The Core Curriculum: Neuroradiology, 2002

Board Review:
Citow, Comprehensive Neurosurgery Board Review, 2000
Moore, Definitive Neurological Surgery Board Review, 2004

Back to top

Board Exam

AMERICAN BOARD OF NEUROLOGICAL SURGERY EXAMINATION

POLICY: All residents in the Neurological Surgery Training Program are required to complete the ABNS Primary Examination the last Saturday of March each year until the exam has been passed for credit. Exam must be passed prior to program completion. Residents must take exam as 'Self-Assessment' and receive a passing score prior to taking exam for credit.
Residents take exam for Self-Assessment beginning in the NS1 year.
Board Review Courses require Program Director approval.

Minimum performance expectations are:
NS1 - 10th percentile
NS2 - 15th percentile
NS3 - 15th percentile
NS4 - 20th percentile
NS5 - 20th percentile

Residents will receive one additional academic week (in addition to contracted vacation time) during Chief Year if they have scored 85% or higher on the ABNS exam. This week will be scheduled to take place during the UCLA Chief Resident rotation with internal cross-coverage by the UCLA resident team.

The Program Director must approve exceptions to the Board Exam requirement.

Back to top

Research

RESEARCH

The American Board of Neurological Surgeons mandates the production of scholarly work. Creative and productive scholarly work is expected of all residents. Each senior resident should work towards the production of one peer-reviewed manuscript per year.

Linda M. Liau, M.D., Ph.D. is the chair of the Resident Research Committee. Residents are required to present plans for research to Dr. Liau and the research committee. Research may be done within the Department of Neurosurgery. It is also possible to work with affiliated specialties to prepare critical literature reviews, laboratory experiments, and manuscripts.

Residents are strongly encouraged to apply for educational grants in support of their research activity. The faculty mentor is expected to support academic travel.

One resident may apply/be accepted to the UCLA STAR Ph.D. Program for a period not to exceed three (3) years.

Back to top

Cases

MINIMUM OPERATIVE CASE VOLUME

PURPOSE: To ensure adequate operative experience and documentation of cases.

POLICY: All residents in the Neurological Surgery Training Program are required to enter cases in the ACGME Case Log system in a timely fashion. Residents must complete a minimum number of cases to advance to the next year or have a favorable review. A deviation of 20% fewer cases than the minimum may lead to disciplinary action or dismissal.

Minimum number of cases per year:
NS1 200
NS2 50
NS3 150
NS4 200
NS5 200

Residents must record surgical case participation on a constant basis. Daily input is preferred. Cases must be logged at a minimum of each week. Chief Residents present a summary case tally monthly during the Quality Assurance/Morbidity and Mortality Conference. Residents are encouraged to attend one or two peripheral nerve cases per week with Dr. Meals. His average case is 1-2 hours long. Carpal Tunnel 3-6 Cases, Elbow 3-6 Cases

Back to top

Evaluations

EVALUATIONS

Evaluations of Residents

The faculty is responsible for ensuring that residents proceed through the training program in a satisfactory manner. The residents are evaluated clinically based on the six competencies: patient care, medical knowledge, professionalism, interpersonal and communication skills, practice-based learning, and systems based practices.

Faculty and senior residents, as indicated in the lines of supervision, provide formative comments daily throughout clinical rotations. The faculty complete summative evaluations at the end of each rotation via the Verinform electronic system. As part of the residents' 360? evaluation process, clinical staff and patients also submit evaluations.

Any resident receiving two or more unsatisfactory evaluations will receive an unsatisfactory evaluation for that category. The Program Director reviews unsatisfactory results and determines if disciplinary action, including remediation to achieve a satisfactory result, is necessary. The program director will also address responses from two or more rotational attendings of "cannot evaluate due to insufficient contact"

The Program Director reviews a composite of each resident's evaluations with each resident during his individual, semi-annual meeting. The residents are expected to have a continual maturation of clinical skills and to have completed academic requirements in a timely fashion. The Program Director also reviews the resident's performance on the American Board of Neurological Surgery (ABNS) In-Service exam, the residents' surgical and duty hour logs, and the residents' portfolio with him during each semi-annual meeting. Ongoing research activity and future rotations are also discussed during this evaluative and mentoring meeting.

Evaluation of Faculty
Residents evaluate attendings teaching skills at the end of each rotation via the Verinform electronic system. The evaluation is based on a resident's clinical interaction in the operating room, ward, and clinic; and the faculty member's lecture performance, scholastic achievement, and overall performance.

The Chair and Program Director reviews the results of these evaluations with each faculty member during an annual review meeting. Meetings are scheduled on a more frequent basis as needed.

Evaluation of Program

The residents evaluate the program during their monthly Residents' Meeting. This meeting is led by the UCLA Chief Resident and occurs as the first meeting on each education day to insure maximal resident attendance.

The Program Director also has a monthly meeting with the residents on Education Day. During these meetings, residents review aspects of training and patient care at each of our four training locations.

The residents have a confidential, semi-annual retreat with the resident program ombudsman. Anonymous meeting notes are distributed to both faculty and residents highlighting attributes of the training program, documenting concerns, and listing requests for programmatic updates.

Residents complete the annual, electronic, UCLA Graduate Medical Education evaluation. Residents also complete the American Council on Graduate Medical Education (ACGME) biennial electronic evaluation

Faculty evaluate the training program during the monthly faculty meetings and also submit a confidential, written evaluation of the training program annually via an electronic survey.

Beginning in 2008, resident alumni will also complete formal evaluations of the training program.

The program reviews the percentage of alumni continuing into academia and passing the ABNS Oral Exam as part of the evaluative process.

Back to top

Conferences

DIDACTIC EDUCATION

UCLA NEUROSURGERY RESIDENT CONFERENCE ATTENDANCE POLICY

The Department of Neurosurgery requires residents to attend all Education Day conferences (third Wednesday of the month) and a minimum of seventy-five percent (75%) of all scheduled didactic core conferences. Core conferences are required teaching in addition to morning reporting and rounds.

The Education Office must have advance notice for excused absences (i.e. vacation, post-call). All other absences without proper permission will be listed as non-excused and count against the required minimum attendance.

The Division has a policy communicated to all Attendings that residents are protected from clinical obligations to attend these conferences.

Official attendance is tracked using sign-in sheets and is periodically reviewed by the Program Director. Non-satisfactory attendance will be addressed by the Program Director during the resident's semi-annual progress meeting.

The conference calendar is created and maintained by the Education Office. A monthly schedule is both forwarded to residents and faculty via email and posted in the Residents' Library. Weekly updates are forwarded via email.

All Neurosurgery Residents are required to attend the monthly Quality Assurance/Morbidity and Mortality Conference. Attendance is also required for rotating interns, sub-interns, and visiting medical students.

Interns, Sub-Interns, and rotating medical students are required to attend Neurocritical Care Rounds on Wednesday afternoons (2pm). In-houseUCLA NS1 residents are required to attend this conference if not attending to an emergency clinical situation or not needed in the operating room.

To support conference attendance at other required rotations (i.e. Neurology, Pathology, Functional, Radiology, and Interventional Radiology), credit will be given for attendance if documentation is forwarded to the Resident Program Administrator. Credit will also be given for non-UCLA lectures if appropriate documentation (i.e. sign-in sheets) is forwarded to the Education Office. It is the responsibility of the resident to forward this information to the Program Administrator.

The Harbor Chief Resident and Harbor Senior Resident are required to attend the Friday morning teaching rounds, radiology lecture, neuropathology lecture, and noontime journal club.

Santa Monica Spine Conference occurs Monday evenings 5:00PM. The Santa Monica Spine Senior is required to attend. All residents on elective and research rotations are encouraged to attend.

UCLA Neurology Conferences occur on Wednesday mornings. Attendance is required for residents on the Neurology Rotation. Neurosurgery Residents on the Neurology rotation are still required to attend Education Day conferences that do not conflict with the Neurology Teaching Rounds.

There are also several additional meetings/seminars required throughout the academic year. These include R2 Orientation, Skull-Base Lab lectures, and other courses as directed by the Resident Program Director.

Exceptions:
The UCLA Chief Resident may be excused from morning conferences to begin first start cases.

Residents who have successfully completed the American Board of Neurological Surgery Exam for credit are not required to attend the Board Preparation lectures.

Post-call residents (UCLA service) are required to attend the 7-9am lectures but are excused from the remainder of the Education or academic day lectures. Sign-out must occur before morning conference. Residents who are post-call from moonlighting activities are required to attend conferences. Therefore, UCLA residents should not be scheduled for pre-Harbor call or moonlighting on Tuesday nights.

Residents may be excused with permission from the Program Director, Vice-Chairs of Clinical Affairs, or the Chief Resident (UCLA or Harbor) to attend to emergent/urgent clinical service needs.

The Harbor Chief Resident is excused from conferences between 9am-12n on Education Days (Surgical Science, Neuroscience, and Basic Science) to run the Harbor Neurosurgery Clinic.

/cb

CONFERENCE

BASIC SCIENCE
BOARD PREPARATION
CASE PRESENTATIONS
ICU MONITORING
JOURNAL CLUB
NEUROANATOMY
NEURO ICU ROUNDS
NEUROLOGY
NEUROPATHOLOGY
NEURORADIOLOGY
NEUROSCIENCE
NEUROSURGERY GRAND ROUNDS/SYMPOSIA
NEUROSURGERY 100
PEDIATRIC
PROFESSIONALISM
1. COMPLIANCE
2. ETHICS
QUALITY ASSURANCE/MORBIDITY AND MORTALITY
SPINE CONFERENCE
SURGICAL SCIENCE
SYMPOSIA/NEUROSURGERY GRAND ROUNDS

Monday, 5pm
Santa Monica Spine Conference
Joint Neurosurgery/Orthopedic teaching conference reviewing spinal surgical.
Required for Santa Monica Spine Resident. All residents are encouraged to attend.
Coordinator: Audrey Rouge, Administrative Assistant

Wednesday, 7am (Second and Fifth Wednesdays)
Case Presentations
This conference is an in-depth presentation of one or more cases by the neurosurgery residents. The neuroradiologic and neuropathologic findings of the case are discussed, and the historical background of the field and the relevant literature are presented. Residents and faculty are required to attend. 

Wednesday, 7am (Third)
Residents' Meeting
Moderator: UCLA Chief Resident

Wednesday, 7am (Fourth)
Quality Assurance/Morbidity and Mortality
Required attendance: Neurosurgery Faculty and Residents
Faculty Host: Nader Pouratian, M.D. 

Wednesday, 8am
Neurosurgery 100 Conference Series
Resident attendance required. Faculty attendance encouraged. 

Wednesday, 8am (First, Second, and Fifth)
Neuroradiology/Neuroscience Conference Series
Resident attendance required. Faculty attendance encouraged.
Faculty Coordinators: Ulrich Batzdorf, M.D. and Noriko Salamon, M.D.

Wednesday, 8am (Third Wednesday)
Case Presentations
Four to five brief case presentations of ongoing patient treatment.

Wednesday, 9am (Second and Fourth Wednesdays)
Board Preparation Sessions
Faculty Moderator: Dennis Malkasian, M.D., Ph.D.

Wednesday, 9am (Third Wednesday)
Surgical Science Lecture
Faculty lecture highlighting the decision-making process of determining surgical or alternative treatment plans for patient care.
Faculty Coordinator:

Wednesday, 10am (Third Wednesday)
Neuropathology Lecture
Didactic teaching featuring Division of Neuropathology Faculty
Harry Vinters, M.D., Neuropathology Division Chief

Wednesday, 11am (Third Wednesday)
Basic Science Lecture Series
Faculty Coordinator: David Hovda, Ph.D.
Pituitary and Skull base Tumor Lecture Series
Faculty Coordinator: Marvin Bergsneider, M.D.
Neuroanatomy Lecture
Dennis Malkasian, M.D., Ph.D.

Wednesday, 11am
Brain Tumor Board
Multi-disciplinary conference reviewing clinical presentation, imaging, operative findings, and pathology for pediatric brain and spine nerve tumor cases. Clinical options are discussed and decisions are made regarding clinical care. Residents are encouraged to attend.
Faculty Coordinator: Linda Liau, M.D., Ph.D.

Wednesday, Noon (Third Wednesday)
Resident Program Director's Meeting 
Linda Liau, M.D., Ph.D. Interim Chair

Wednesday, 1pm (Third Wednesday)
Multidisciplinary Pituitary Tumor Conference
Residents are encouraged to attend
Faculty Coordinators: Marvin Bergsneider, M.D. and Anthony Heaney, M.D.

Wednesday, 2pm
Neurocritical Care Rounds
Mandatory attendance for R2 residents, Neurosurgery interns, and rotating medical students
Faculty Coordinator: Paul Vespa, M.D.

Wednesday, 2pm
Cognitive Neurophysiology Meetings
Discussion of epilepsy patients and their treatment plans by the multidisciplinary team.
Multidisciplinary forum for discussing surgical management of refractory epilepsy patients.
Attendance is optional.
Faculty Coordinator: Itzhak Fried, M.D.
Wednesday, 3pm
Journal Club
Residents are required to attend

Wednesday, 5pm
Neurosurgery Grand Rounds/Symposia Lecture Series
Continuing Medical Education credits
Faculty Coordinator: Paul Vespa, M.D.

Friday, 7am
Harbor-UCLA Conferences
Harbor Chief and Senior are required to attend
Faculty Coordinator: Duncan McBride, M.D.

.
DATE: June 24, 1998 UPDATED: October 16, 2011

SUBJECT: MORBIDITY AND MORTALITY CONFERENCE

PURPOSE: To provide an educational forum for the open discussion of the perioperative and intraoperative aspects of patient care. Such discussion will provide resident physicians the opportunity to critically review various aspects of patient care, to be exposed to contemporary principles guiding surgical decision-making, and insight into the processes of improving the quality of care. This conference is an essential component of the educational process necessary for the training of residents and a requirement for accreditation by the Residency Review Committee for Surgery of the Accreditation Council for Graduate Medical Education (ACGME)

POLICY: Attendance to this conference is considered a compulsory component of participation in the educational program for both faculty and residents alike. Confidentiality regarding the discussion conducted during this conference is expected.

The following criteria for case reporting to the conference will be used:
1) It is the administrative responsibility of the service chief or senior resident to report the required data on a monthly basis to the Neurosurgery Education Office. The data required is the average daily census of the service, the number of hospital admissions and discharges to and from the service, the total number of inpatient and outpatient operative cases performed the number of reportable events occurring, and the number of deaths occurring.

2) The data accrual period is the seven (7) calendar days preceding the date of the conference. In the event that a conference is postponed, or cancelled, the data must still be reported. Any cases previously reported since the last conference was conducted, but not presented, may still be selected for presentation at the discretion of the conference moderator.

3) All events will be reported for the month in which they occurred, regardless of severity, responsible attending availability, or current status of the patient. The selection for presentation of the case will be at the discretion of the conference moderator. The primary reportable events are defined as the following:
a) Unplanned need for secondary operation, whatever the nature.
b) Unanticipated admissions to any acute care facility within 30 days of discharge.
c) Unanticipated significant escalation of care required.
d) Death
e) Event Codes: see attachment regarding classification of cases presented at conference.

4) The chief or senior resident involved in the critical aspects of the perioperative care, primarily the decision for operation and the operation itself will make the presentation of the case. This includes clinical training years IV to VI only. In the event, that the involved resident is no longer on service, that individual will still be responsible for the presentation of the case. The appropriate clinical data and imaging studies will be available for presentation, and that the presenting resident is expected to have reviewed the case, and considered the possible causes of the complication and potential approaches in which the complication could be avoided in the future.

Back to top