First Year: PGY-1
This year, which is usually completed at The Mount Sinai Hospital, includes three months of neurology, three months of neurosurgery, and six months of general surgery. The three-month neurology rotation is largely focused within the Neurosurgery-Neurology ICU and adult neurology. We have incorporated neurology into the first postgraduate year in order to prepare residents with the appropriate fundamental skills in neurological examination and diagnosis and critical care management prior to beginning their clinical neurosurgery rotations.
PGY-1s attend the Society of Neurological Surgeons PGY1 Neurosurgery Resident Course (known as the Neurosurgery 'Bootcamp'). The camp focuses on fundamental skills, patient safety, professionalism, and communications. Neurosurgical faculty lead intensive hands on exercises oriented to fundamental bedside procedural and operative skills. These exercises have been designed to allow residents to familiarize themselves with the basics in an educational and risk free environment. Skills relevant to all PGY1 residents, such as line placement and suturing, as well as specific neurosurgical skills, such as drilling and craniotomy, are covered.
Second Year: PGY-2
The second year of the program is a full time assignment in clinical studies, with nine months in the neurosurgery service at The Mount Sinai Hospital and three months at Elmhurst Hospital. During the first year, you’ll begin to gain knowledge into the evaluation of neurosurgical patients, pre-operative evaluation, and post-operative management. There is introductory operative management in simple spine, CSF diversion, functional neurosurgery, neurotrauma, bedside procedures, and the set-up and opening of cranial surgical procedures.
Elmhurst Hospital is a city hospital where the neurosurgical service is resident run with attending supervision. There is an extensive neuro-trauma experience and outpatient experience during the time spent there.
You’ll spend nine months on the neurosurgery service as a junior resident at The Mount Sinai Hospital and three months at Elmhurst Hospital. You’ll have the opportunity to admit, examine and care for neurosurgical patients, assist in the operating room, attend outpatient clinic, consult on emergency room and other hospital cases, attend all conferences and participate in the teaching of medical students. The endovascular experience will be incorporated into the daily operating room (OR) schedule during all the years of residency. You will participate in the endovascular operating suite, taking on progressive responsibility. The intention is to incorporate a full fellowship experience in neuroendovascular procedures.
Third Year: PGY-3
In the third year, you’ll also spend nine months at The Mount Sinai Hospital and three months at Elmhurst Hospital.
During the nine months at Mount Sinai, one month will focus on neuroradiology and one month on neuro-pathology. The other seven months will be on the neurosurgery service. You’ll examine and participate in the care of each patient and scrub on all cases going to surgery. In addition to management of patients on the ward in the intensive care unit (ICU) and the emergency room (ER), you’ll gain greater experience in the OR. The duties are as outlined for the first year but with additional responsibilities and expectations. During the second year, you’ll be expected to participate in clinical research projects and to attend a national meeting. You’ll also be encouraged to present at meetings on your clinical or laboratory studies.
The three months at Elmhurst hospital emphasize the skills and techniques necessary for trauma neurosurgery.
Allied Specialties: Neuroradiology and Neuropathology
During the neuroradiology rotation, you’ll participate in the performance of myelograms, arteriograms and all interventional procedures. You’ll also participate in all neuroradiology conferences and often lead the radiology review sessions for the Department of Neurosurgery. During the neuropathology rotation, you’ll spend time reviewing current cases with the attending neuro-pathologist, in the frozen section room, and in brain cutting sessions.
Fourth Year: PGY-4
The fourth year is devoted to a hypothesis-driven basic science research project in order to establish the foundation for an academic or other innovative neurosurgical career.
You may pursue your work in an appropriately mentored environment in any Mount Sinai science laboratory. Because neurosciences at Mount Sinai are exceedingly strong and diverse, you can study in a laboratory that fits your interests.
The year may be spent, for example, in a neurosurgery laboratory or a laboratory of an associated department such as neurobiology or molecular biology:
- In a neurosurgery laboratory, you may join investigations focused on ischemic models and cerebral protection, cerebrovascular physiology, neuro-oncology/gene therapy for malignant brain neoplasms, and neurophysiology with epilepsy models.
- Associated laboratories, for example, are studying molecular aspects of brain tumors and ischemic disease. A portion of the time may also be used for an enfolded clinical neurosurgical fellowship; however, the expectation is that the resident will continue to participate in clinical research during that time.
Certain residents may take advantage of graduate programs in public health, outcome research, and other programs offered at the Icahn School of Medicine at Mount Sinai.
Regardless of what you choose, the experience is expected to result in several publications and presentations at national meetings based on a more focused understanding of the area investigated and further ability in the subspecialty area. If you choose to focus the year in a subspecialized area such as spine or pediatric neurosurgery, the rotation may be moved to a later phase of training when you have more surgical experience necessary for the clinical rotation. During this time, you will provide on-call neurosurgical coverage at Mount Sinai Hospital and Elmhurst Hospital so that you’ll maintain contact with clinical neurosurgery and continue to enhance your operative skills. These calls will be performed while maintaining compliance with the duty hour regulations.
Fifth Year: PGY-5
The fifth year is the second required basic science laboratory experience and/or clinical elective. This is a continuation of the previous year to complete a hypothesis-driven basic science research project or neurosurgical sub-specialization in order to establish the foundation for an academic or other innovative neurosurgical career.
During this time, you’ll be expected to complete the research plans formulated and begun the previous year. A portion of this time may also be used for an enfolded clinical neurosurgical fellowship; however, the expectation is that you will continue to participate in clinical research during that time.
Finally, certain residents may take advantage of graduate programs in public health, outcome research, and other programs offered at Icahn School of Medicine. You’ll provide call coverage at Mount Sinai Hospital and Elmhurst Hospital, while maintaining compliance with duty hour regulations.
Sixth Year: PGY-6
The sixth year is divided between six months as Chief Resident at Elmhurst Hospital, three months as Senior Resident at Mount Sinai Hospital, and three months of Pediatric Neurosurgery at Montefiore Hospital.
These rotations provide the opportunity to direct a clinical service with a defined patient population and longitudinal follow-up of all service patients from their initial consultation to postoperative follow-up. As Elmhurst Chief Resident, you will be the primary neurosurgeon overseeing the outpatient/emergency room setting, the OR, inpatient management, and post-operative outpatient follow-up – all with faculty supervision. As Chief Resident, you’ll manage the neurosurgical service and be the primary operative surgeon on all neuro-surgical procedures. This rotation also provides an extensive experience in neuro-trauma.
The time as Senior Resident at Mount Sinai Hospital is spent focusing on enhancing the operative experience, especially with more difficulty procedures.
The final three months of pediatric neurosurgery at Montefiore Hospital is spent focusing on pediatric neurosurgery and obtaining a broad exposure to this sub-specialty.
Seventh Year: PGY-7
The seventh year is devoted to 12 months of Chief Residency. Two chief residents work together to direct the neurosurgery service and are independently responsible for the patients cared for by the neurosurgery attendings on their respective services.
The two chief residents alternate months as the “Super Chief,” whose responsibilities include:
- Managing patients in the neurosurgical service
- Managing one OR daily
- Planning and executing all types of neurosurgical operations
- Providing guidance on all important management decisions and serving as the primary surgeon on all operative cases they choose and are capable of performing (under the supervision of faculty)
- Acting as the primary surgeon or first assistant in operations on a daily basis and guiding junior residents when appropriate
- Overseeing the management of post-operative care
- Coordinating operating schedules and resident assignments
- Teaching junior residents, interns, and medical students
- Conducting house staff rounds each morning and evening
- Participating in the planning and organization of teaching conferences
- Implementing and supervising the call and vacation schedules (in accordance to departmental policies and in conjunction with Program Coordinator and Director)
- Serving as the first line of communication for issues concerning duty hour regulations and violations
- Suggesting policy and administrative proposals from the residents to the Program Director and faculty
With increasing responsibilities in the operating room and following the surgery, you and your counterpart will expand both manual dexterity and judgment to achieve the goal of a mature experienced neurosurgeon with appropriate judgment and skill to care for all neurosurgical diseases.