Adult Neurosurgery (NSUR 4001)

General

The clerkship will be on month in duration and is designed for students interested in pursuing a career in neurosurgery. On the first day of service, the medical students will be expected to meet the clerkship director and resident liaison at 1pm in the Neurosurgery ICU, after their UT orientation has been completed. The students will be placed on four, one week services. All clerkship questions/problems/concerns should be directed to the course directors.

Lectures

All students will be expected to attend all lectures. Failure to attend any lecture will be reflected on the student’s evaluation. A list of the weekly lectures is included in this handbook.

Clinical Duties

Students will be expected to function as integral members of their respective neurosurgical teams and function at the sub-intern level. In general, they will be expected to go to the OR and follow the post-op course of their patients. They should go to the respective clinics of their services each week. Students will have an average of four days off during this rotation and are encouraged to take overnight call (although not required). The morning after call, students are expected to return home free of clinical duties after morning check out. Students will NOT be allowed to scrub on cases until they have completed a sterile technique orientation with our Neurosurgery pod RN (Jenna Miller). In addition, two learning videos on “How to Behave in the OR” and “Inserting an EVD” are required to view prior to starting the rotation.

Specific Rotations

Spine
Chief Service
Night float
Pediatric/epilepsy/functional service

Supplemental readings/Webinars

A list of required readings and webinars is included in this handbook.

Presentations

The student will be expected to give a 20 minute presentation at the conclusion of the rotation. The student should get approval for their topic one week prior to their talk and review the presentation with the directors 1-2 days before the talk.

Lecture Schedule

General Conferences: Attendance is Mandatory

Resident Teaching Conference – Every Monday 7:00 – 8:00 AM (MNA Conference Room 27^th floor of 6400 Fannin)

The residents have a teaching conference intended for basic knowledge and board preparation.

Curriculum Conference – Every Tuesday 7:00 – 8:00 AM (MNA Conference Room 27^th floor of 6400 Fannin)

The curriculum is a two-year-long comprehensive coverage of topics relevant to neurosurgery, and each conference session is guided by an expert generally from the faculty or from visiting professors in the conference topic.

Spine Conference – 1^st and 3^rd Wednesday 7:00-8:00 AM (MNA Conference Room 27^th floor of 6400 Fannin)

Basic topics related to spine are discussed, and cases are presented

Cerebrovascular Conferences – Every Wednesday 7:00 – 8:30 AM (Radiology Conference Room: Jones 2.246)

Each week, cases demonstrating various vascular conditions are chosen for presentation, some of which deal with surgical or endovascular technique, others with diagnosis, others of interest to the Neurology service. The specific details of vascular anatomy, physiology, and pathophysiology are emphasized, along with education in the reading of radiographic studies, including MRI, CT, and arteriography.

Morbidity & Mortality – Every Thursday 7:00 – 8:00 AM (MSB G.100)

Monthly reviews of either conventional or selective complications of preceding periods. One of the residents on service is responsible for presenting the complications and current literature pertinent to the topic. This activity is monitored by an assigned attending. On a rotation basis, topics are assigned to Trauma, Cv/Tumor, Spine, Functional/Pediatrics and Critical Care cases. All faculty, residents and medical students on rotation are required to attend.

Grand Rounds – 1st, 3rd, 4th Thursdays 8:00 – 9:00 AM (MSB G.100)

Program Director selects the speakers for grand rounds, ensuring that each speaker covers one or more of the 6 core competencies. Attendance is required of the faculty, residents, and medical students on rotation.

Neurosurgery/Neurology Conference – 2nd Thursdays 8:00 – 9:00 AM (MSB G.100)

This is a combined neurosurgery and neurology conference. Issues of mutual interest to Neurology, Neurosurgery, and Neuro-ICU are discussed among the services. The conference also serves as an opportunity to discuss QA issues related to the topic under discussion. Attendance is required of the faculty, residents, and medical students on rotation.

Neuroradiology Conference – 1st Thursday 8:00 – 9:00 AM (MSB G.100)

A neuroradiology conference is held monthly, overseen by the chief of neuroradiology. The Chief resident designates a resident to select the cases to be discussed at the conference and the program director oversees the conference.

Medical Student Conference – Every Friday 7:00-7:30 (or 8:00) AM (MNA Clinic Conference Room 28^th floor of 6400 Fannin)

The medical student conference occurs every Friday. It is the essentials of neurosurgery taught by the neurosurgery faculty.

Week	Time	Faculty	Topic
1st Friday	7-7:30	Mark Dannenbaum	Intracranial Hemorrhages
1st Friday	7:30-8:00	Nitin Tandon	Cranial Neurosurgery
2nd Friday	7-7:30	Dong Kim	Intracranial Pressure
3rd Friday	7-8:00	Pediatric Faculty	Pediatric Neurosurgery
4th Friday	7-7:30	Michele Johnson	Spinal Neurosurgery
5th Friday	7-7:30	Tiffany Chang	Neurocritical Care

Subspecialty Conferences: Attendance at these conferences may be assigned depending on your rotation.

Pediatric Neurosurgery Conference – Every Monday 3:45 – 4:45 PM (Radiology Conference Room: Jones 2.246) Pediatric cases will be reviewed and discussed.
Neurotrauma Conference – 3^rd Wednesday 7:00 – 8:00 AM in January/April/July/October (MSB Basement Classroom) Interdisciplinary conference between the Neurotrauma service and General surgery trauma service. Topics are chosen and presented alternatively between the two services.
Epilepsy Conference – Every Friday 1:30 – 3:00 PM (Neurophysiology Lab: Jones B300) Complex epilepsy cases are presented to different members of our faculty and staff to discuss patient treatment plans. This involves services from Neurosurgery, Neurology, Neuroradiology, Neuropsychology and Neuropathology.
Tumor Board – Every Tuesday 12:00 – 1:00 PM (MNA Conference Room 27^th floor of 6400 Fannin) Complex brain tumor and neuro-oncology cases are presented in a multi-disciplinary forum to discuss treatment and management. This involves services from Neurosurgery, Neuropathology, Radiation Oncology, Neuro-Oncology, and Neuro-Ophthalmology.
Service Schedules: Spine Service

Service Outline

The spine service provides the medical students with the opportunity to be involved in a variety of degenerative and traumatic conditions of the spine. This rotation should include inpatient care, clinic, and operating room experiences.

Attendings:

Michelle Johnson
Daniel Kim
Ryan Kitagawa
Karl Schmitt

Clinical Responsibilities:

The students will be required to follow a minimum of two patients each day, and if the student is involved in the surgery of a patient, they are required to follow them while in the hospital. They should see and evaluate their patients each morning and assist the residents prior to rounds. They will be expected to present to the attendings during their rounds as well.

Call:

The students will have no call responsibilities during this rotation week.

Clinic:

All students on the spine rotation will be expected in Dr. Johnson’s clinic Wednesday and Friday mornings starting at 9am. The clinic is on the 28^th floor of 6400 Fannin.

Operating Room:

The students will be expected to spend at least two days in the operating room during this rotation. The residents will assist the students of the particular OR schedules.

Didactic Lectures:

Students will be expected to attend all mandatory lectures. There are no additional spine conferences.

Spine Service Week

Monday

6am-7am: Round on individual patients

7am-8am: Residents Conference (MNA Conference Room 27^th floor of 6400 Fannin)

8am: OR/Attending rounds

9am: Dr. Kim’s clinic (28^th floor of 6400 Fannin)

Tuesday

6am-7am: Round on individual patients

7am-8am: Curriculum Conference (MNA Conference Room 27^th floor of 6400 Fannin)

8am: OR/Attending rounds

Wednesday

6am-7am: Round on individual patients

7am-8am: Spine Conference – 1^st and 3^rd Wednesday 7:00-8:00 AM (MNA Conference Room 27^th floor of 6400 Fannin)

Cerebrovascular Conferences – Every Wednesday 7:00 – 8:30 AM (Radiology Conference Room: Jones 2.246)

9am: Dr. Johnson’s Clinic or Dr. Kim’s clinic (28^th floor of 6400 Fannin)

Thursday

6am-7am: Round on individual patients

7am-9am: Morbidity & Mortality/Grand Rounds (MSB G.100)

9am: OR/Attending rounds

Friday

6am-7am: Round on individual patients

7am-8am: Medical Student Lecture (TBD)

8am: OR/Attending rounds

9am: Dr. Johnson’s Clinic (28^th floor of 6400 Fannin)

Weekends

TBD by the individual service attends and residents, but the student should have a minimum of one day off per week.

Service Schedules: Chief Service

Service Outline:

The chief service allows the students to spend time with the senior faculty members and to gain experience with vascular neurosurgery patients. This rotation should include inpatient care, clinic, interventional radiology, and operating room experiences.

Attendings:

Dong Kim
Arthur Day
Mark Dannenbaum (Interventional Radiology)
Roc Chen (Interventional Radiology)

Clinical Responsibilities:

Call:

The students will have no call responsibilities during this rotation week.

Clinic:

All students on the chief rotation will be required to attend the clinics of Dr. Dong Kim and Dr. Arthur Day. Dr. Kim’s clinic is Tuesday at 9am. Dr. Day’s clinic is Wednesday at 9am. The clinic is on the 28^th floor of 6400 Fannin.

Operating Room:

The students will be expected to spend at least one day in the operating room and one day in the interventional radiology suite. The residents will assist the students with the particular OR and IR schedules.

Didactic Lectures:

Students will be expected to attend all mandatory lectures. There are no additional conferences for this rotation.

Chief Service Week

Monday

6am-7am: Round on individual patients

7am-8am: Residents Conference (MNA Conference Room 27^th floor of 6400 Fannin)

8am: OR/IR/Attending rounds

Tuesday

6am-7am: Round on individual patients

7am-8am: Curriculum Conference (MNA Conference Room 27^th floor of 6400 Fannin)

9am: Dr. Kim’s Clinic (28^th floor of 6400 Fannin)

Wednesday

6am-7am: Round on individual patients

7am-8am: Spine Conference – 1^st and 3^rd Wednesday 7:00-8:00 AM (MNA Conference Room 27^th floor of 6400 Fannin)

Cerebrovascular Conferences – Every Wednesday 7:00 – 8:30 AM (Radiology Conference Room: Jones 2.246)

9am: Dr. Day’s Clinic (28^th floor of 6400 Fannin)

Thursday

6am-7am: Round on individual patients

7am-9am: Morbidity & Mortality/Grand Rounds (MSB G.100)

9am: OR/IR/Attending rounds

Friday

6am-7am: Round on individual patients

7am-8am: Medical Student Lecture (TBD)

8am: OR/IR/Attending rounds

Weekends

TBD by the individual service attends and residents, but the student should have a minimum of one day off per week.

Service Schedules: Night Float

Service Outline:

The night float service provides the medical students with the opportunity to be involved in a variety of neurosurgical emergencies. This service also allows the student to become familiar with emergency procedures and surgeries. The limited staff during the night makes the student an essential team member with opportunities for independence.

Clinical Responsibilities:

The students will be required to assist will all of the evening consults and admissions, emergency procedures, and work. They will assist the night float resident and evening PA. Their shift will be from 6pm until 6am on Monday, Wednesday and Friday and from 6pm until midnight on Tuesday and Thursday. No clinical responsibilities will be present after check out. This will take place Monday evening through Saturday morning.

Clinic:

The students will have no clinic responsibilities on this rotation.

Operating Room:

The students are welcome to scrub into any cases that occur during their shift.

Didactic Lectures:

Students will be expected to attend all mandatory morning lectures on Tuesday and Thursday. They may leave as soon as the lectures are complete.

Night Float Service Week

Monday

6pm-6am: Assist night float and PA with all consults/procedures/surgeries

Tuesday

7am-8am: Curriculum Conference (MNA Conference Room 27^th floor of 6400 Fannin)

6pm-6am: Assist night float and PA with all consults/procedures/surgeries

Wednesday

6pm-6am: Assist night float and PA with all consults/procedures/surgeries (If the student is scheduled for their Grand Rounds presentation on Thursday, then they will have this day off)

Thursday

7am-9am: Morbidity & Mortality/Grand Rounds (MSB G.100)

7pm-6am: Assist night float and PA with all consults/procedures/surgeries

Friday

7am-8am: Medical Student Lecture (TBD)

6pm-6am: Assist night float and PA with all consults/procedures/surgeries

The students will be off from Saturday at 6am until Monday at 6am.

Service Schedules: Pediatric/Epilepsy/Functional Service

Service Outline:

This service gives the students the opportunity to explore a wide variety of services including pediatric, epilepsy, and functional neurosurgery. This service will include inpatient care, clinics, and operating room experiences. The students will be a part of the functional and epilepsy service on Tuesday and Wednesday and will be a part of the Pediatric service on Monday, Thursday, and Friday.

Attendings:

Albert Fenoy
Nitin Tandon
David Sandberg
Stephen Fletcher

Clinical Responsibilities:

The students will be required to follow a minimum of two patients each day, and if the student is involved in the surgery of the patient, they are required to follow them while in the hospital. They should see and evaluate their patients each morning and assist the residents prior to rounds. They will be expected to present to the attendings during their rounds as well.

Call:

The students will have no call responsibilities during this rotation week.

Clinic:

All students on this rotation will be required to attend Dr. Tandon’s clinic (28^th floor of 6400 Fannin ) or Dr. Sandberg’s/Dr. Fletcher’s clinic (UT professional building room 950).

Operating Room:

The student is expected in the OR two days per week. This may be for pediatrics, epilepsy, and functional cases.

Didactic Lectures:

Students will be expected to attend all mandatory lectures. Additionally, all students on this service will be required to attend: Epilepsy Conference on Friday at 1:30PM and Tumor Board on Tuesday at 12:00PM

Pediatric/Epilepsy/Functional Service Week

Monday (Pediatrics)

6am-7am: Round on individual patients on the pediatric service

7am-8am: Residents Conference (MNA Conference Room 27^th floor of 6400 Fannin)

8am: OR/Attending rounds for pediatric service

3:45pm-4:45pm Pediatric Neurosurgery Conference (Radiology Conference Room: Jones 2.246)

Tuesday (Epilepsy/Functional)

6am-7am: Round on individual patients on the pediatric service

7am-8am: Curriculum Conference (MNA Conference Room 27^th floor of 6400 Fannin)

9am: Dr. Sandberg’s Clinic (UT professional building room 950)

12pm-1pm: Tumor Board (MNA Conference Room 27^th floor of 6400 Fannin)

1pm: OR for the epilepsy and functional service

Wednesday (Epilepsy/Functional)

6am-7am: Round on individual patients on the epilepsy/functional service

7am-8am: Spine Conference – 1^st and 3^rd Wednesday 7:00-8:00 AM (MNA Conference Room 27^th floor of 6400 Fannin)

Cerebrovascular Conferences – Every Wednesday 7:00 – 8:30 AM (Radiology Conference Room: Jones 2.246)

9am: OR/Attending rounds for the epilepsy and functional service

Thursday (Pediatrics)

6am-7am: Round on individual patients on the epilepsy/functional service

7am-9am: Morbidity & Mortality/Grand Rounds (MSB G.100)

9am: Dr. Fletcher’s clinic (UT professional building room 950)

1pm: OR for the epilepsy and functional service

Friday (Pediatrics)

6am-7am: Round on individual patients on the pediatric service

7am-8am: Medical Student Lecture (TBD)

8am-1:30pm: OR/Attending rounds for pediatric service

1:30pm: Epilepsy Conference (Neurophysiology Lab: Jones B300)

Weekends

TBD by the individual service attends and residents, but the student should have a minimum of one day off per week.

Time Off and Absences

Any student requiring time off for interviews or other necessities will obtain approval from the course directors prior to the start of the rotation. Exceptions will be made for medical or family emergencies, but it is the responsibility of the student to notify the course directors and the residents on the appropriate service as soon possible. Any unexcused absences will directly affect the student’s performance evaluation.

Grading/Check List

Grading will be based on attendance and clinical performance. All of the following elements MUST be completed to pass the course.

Required Elements (75%):

Attend required conferences
Attend clinics (see individual rotations)
Attend all service responsibilities (rounding, OR, etc)
Grand rounds presentation

Evaluations (25%):

Evaluation by Dr. Day

Please make note of the required readings and webinars as the faculty will ask questions regarding these materials while on rounds.

Reading Assignments

NSUR 3030/SURG 3001 Required Reading

From Handbook of Neurosurgery, Mark S. Greenberg, Seventh Edition

Chapter 5, PP. 86-87, 89, 94, 96 – 97, 112-114 (Neuroanatomy and Physiology)

Chapter 12, PP. 279-292 (Coma and Brain Death)

Chapter 15, PP. 307-315, 321-331 (Hydrocephalus)

Chapter 18, PP. 442-447, 515 (Spine)

Chapter 21, PP. 585-587, 590-664 (Brain Tumors)

Chapter 27, PP. 850-915 (Head Trauma)

Chapter 30, PP. 1034-1040, 1043-1060 (Subarachnoid Hemorrhage)

Chapter 32, PP. 1118-1128 (Intracerebral Hemorrhage)

Resources

Essential Neurosurgery – http://www.netlibrary.com.ezproxyhost.library.tmc.edu/Details.aspx **Please use your University Login and Password to access.

Books for Purchase (optional):

*Neurosurgery Explained: A Basic and Essential Introduction – $72

http://www.amazon.com/gp/product/0954881303?ie=UTF8&tag=uncleharvecom- 20&linkCode=as2&camp=1789&creative=9325&creativeASIN=0954881303

*Essential Neurosurgery -$64

*Greenberg’s Handbook of Neurosurgery -$88

http://www.amazon.com/M-Greenbergs-Handbook-Seventh-Neurosurgery- Paperback/dp/B0041AV3VK/ref=sr_1_3?s=books&ie=UTF8&qid=1301187721&sr=1-3

*The Neurosurgeon’s Handbook -$106

Other Online Sources of Information:

*SANS Medical Student Curriculum – http://w3.cns.org/education/medStudCur/index2.asp http://w3.cns.org/education/sans.asp (Click “Neurosurgery Gray Matter,” upper left corner)

*CNS Neuro Wiki – http://wiki.cns.org/wiki/index.php/Main_Page Brain & Tumor Pathology – http://library.med.utah.edu/WebPath/CNSHTML/CNSIDX.html

Webinars:

Dr. Dong Kim

Chiari Malformations

Trigeminal Neuralgia

Dr. Arthur Day

Pituitary Brain Tumors

Dr. Nitin Tandon

Epilepsy

Dr P. Roc Chen

Brain Aneurysm

Dr. Michele Johnson