Procedural Competence -Neurosurgery Program

Procedural Competence -Neurosurgery Pediatric Program

Progression to the next level assumes that resident can perform all tasks from preceding level.

Invasive procedures and operations, even though they may be performed independently, presume discussion with the attending physician beforehand, or, in the case of emergency, life-saving procedures, immediately afterwards as soon as the patient has been stabilized and communication is feasible.

PGY-2

All residents at this level may perform independently:

� H&Ps and consultations
� Write orders, including admission, pre-op, post-op, discharge
� Obtain consent for surgery
� Discharge day management
� Interpretation of Laboratory Studies
� Interpretation of Basic Radiographic Studies
� Venipuncture
� Arterial Puncture
� Venous Cut-Down
� Intubation (Nasotracheal or Orotracheal)
� Basic Cardiopulmonary Resuscitation
� Emergency Drug Treatments

� Position patients for some surgical procedures (competence with more complicated positioning expected to be graduated with experience in subsequent years)
� Application of Mayfield Headrest
� Close wound/incision on uncomplicated cranial, spinal, and peripheral nerve operations
� Lumbar puncture
� Myelographic dye injection (via LP)

Some residents at this level may perform independently:

� Place central venous line/Swann-Ganz catheter
� Place intraparenchymal intracranial pressure monitor
� Place ventriculostomy
� Place lumbar drain
� Begin opening for uncomplicated cases
� Supervise Code Blue Cases/Perform ACLS

PGY-3

All residents at this level may perform independently:

o Lumbar discectomy
o Burr holes for evacuation of chronic SDH

� Some simple operative cases, e.g.,

o Excision of Lipoma or Skin Lesion
o Tagging Nerves in Acute Penetrating Trauma

� Spine Clearance
� Placement of Halo Vest

Some residents at this level may perform independently:

� Supervise Code Blue Cases/Perform ACLS
� Simple operative cases, e.g.,

o Carpal tunnel release
o Open depressed skull fracture (without underlying hematoma)
o Burr holes for evacuation of chronic SDH

PGY-4

All residents at this level may perform independently:

� Some simple operative cases, e.g.,

o Carpal Tunnel Release
o Open Depressed Skull Fracture (without underlying hematoma)
o Burr Holes for Evacuation of Chronic SDH

Some residents at this level may perform independently:

� Application of Gardner-Wells tongs/Closed Cervical Spinal Column Reduction
� Some operations, e.g.,

o Lumbar Discectomy (without fusion)
o Cervical Discectomy (without fusion)
o Resection simple convexity meningioma
o Shunt Revision
o Stimulator or Pump Removal
o Placement of Stereotactic Biopsy Frame
o Uncomplicated cranioplasty

PGY-5

All residents at this level may perform independently:

� Application of Gardner-Wells tongs/Closed Cervical Spinal Column Reduction
� Some operations, e.g.,

Some residents at this level may perform independently:

� Some more complicated operative procedures, e.g.,

o Craniotomy for evacuation of subdural hematoma
o Craniotomy for evacuation of epidural hematoma
o Craniotomy for evacuation of intraparenchymal hematoma
o Craniotomy/Exenteration of Frontal Sinus
o Ventriculoperitoneal Shunt Placement
o Uncomplicated spinal fusion/instrumentation

PGY-6

All residents at this level may perform independently:

� Some more complicated operative procedures, e.g.,

Some residents at this level may perform independently:

� More complicated operative procedures, e.g.,

o Complex spinal instrumentation
o Craniotomy for Brain Tumor Resection