Clinical neurosurgery and research experience - 72 Months (PGY 2-7)
- PGY 2 - Junior Resident, one and a half months Neuropathology, one and a half months Neuroradiology, nine months Neurosurgery
- PGY 3 - Neurosurgery, nine months Mount Sinai, three months Elmhurst
- PGY 4 and 5 - Six months Pediatrics, electives, clinical, and research time
- PGY 6 - Chief Resident, six months Elmhurst, Senior Resident six months Mount Sinai
- PGY 7 - Chief Resident 12 months Mount Sinai Hospital
Chronological Rotations
Internship: 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.
First-Year: PGY-2
The first year of the program is a full time assignment in clinical studies, with nine months on neurosurgery and one and a half months
each on neuroradiology and neuropathology. This year is designed to provide each resident with a thorough
knowledge of the detailed neurological examination and the manifestations of neurosurgical disorders. The year serves
as an intensive introduction into the evaluation, diagnosis and management of the neurosurgical patient in the inpatient,
outpatient and the emergency room setting. In addition, the first year is designed to provide fundamental skills in the
allied disciplines of neuroradiology and neuropathology. First-year residents are encouraged to attend the RUNN
Neurobiology course given in Woods Hole to prepare them for their future research years.
Allied Specialties: Neuroradiology and Neuropathology
During the neuroradiology rotation, the resident participates in the performance of myelograms, arteriograms and all
interventional procedures, participates in all neuroradiology conferences and often leads the radiology review sessions
for the Neurosurgery Department. Neuropathology introduces the resident to the study of tissue samples from surgical cases
and different histopathological techniques and immunostains necessary to understand the neurosurgical disease processes
and future cases.
Neurosurgery
The remaining nine months are spent on the neurosurgery service as a junior resident, six months at The Mount Sinai Hospital
and three months at Elmhurst Hospital. The resident admits, examines and cares for neurosurgical patients, assists in
the operating room, attends outpatient clinic, consults on emergency room and other hospital cases, attends all conferences
and participates in the teaching of medical students. The endovascular experience will be incorporated into the daily OR schedule
during all the years of residency. The resident will participate in the endovascular operating suite, taking on progressive
responsibility. The intention is to incorporate a full fellowship experience in neuroendovascular procedures.
Second-Year: PGY-3
The second year is spent in clinical neurosurgery. The resident examines and participates in the care of each patient and
scrubs on all cases going to surgery. The year is devoted to clinical adult neurosurgery with nine
months at The Mount Sinai Hospital and three months at Elmhurst Hospital. In addition to management of patients on the
ward, in the ICU and the ER, the resident gains greater experience in the operating room. The duties are as outlined
for the first year but with additional responsibilities and expectations. During the second year the resident is expected
to participate in clinical research projects and to attend a national meeting. He/she is encouraged to present at
meetings on his/her clinical or laboratory studies.
Third-and Fourth-Years: PGY-4 and 5
During the PGY-4 year, the resident completes a six month pediatric rotation which exposes him/her to a wide range of
pediatric neurosurgical disorders. These years are also elective years to be spent either in basic or clinical research or
focused in a subspecialized area such as spine, endovascular, stereotactic (functional or radiosurgery). In either case, 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. Because neurosciences at Mount Sinai are exceedingly strong and diverse, the
resident can study in a laboratory to fit his/her interests. (Figures released by the federal government in May 2003
show that Mount Sinai School of Medicine has the fastest growing research program in New York.) 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, the resident may join investigations focused on ischemic models and cerebral
protection, cerebrovascular physiology, neuro-oncology/gene therapy for malignant brain neoplasms, neurophysiology with
epilepsy models and basic dissection of skull base anatomy. Associated laboratories, for example, are studying molecular
aspects of brain tumors and ischemic disease. If the resident chooses 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 the resident has more
surgical experience necessary for the clinical rotation.
Fifth-Year: PGY-6
PGY-6 is a clinical year during which the resident assumes greater responsibilities in making independent
decisions regarding patient evaluation and care and significantly increases operating experience and skills. For six
months, as Chief Resident at Elmhurst Hospital, the resident directs the clinical service where he/she admits, evaluates
and treats all patients directed to neurosurgery and operates on approximately 150 cases. At Elmhurst, there is a large
outpatient clinic which functions as an outpatient practice; the resident has primary responsibility but an attending is
always there to supervise and educate. The other six months are spent as senior resident at The Mount Sinai Hospital
where he/she participates in all clinical care, directs the consult and pediatric neurosurgical services, coordinates
the quality assurance conferences and neuropathology conferences and generally is responsible for the third neurosurgical
operating room daily.
Sixth-Year: PGY-7
Surgery
PGY-7 is as Chief Resident at The Mount Sinai Hospital; two chief residents work together to direct the service.
Each of the chief residents is in charge of one of the four operating rooms daily and performs surgery with an attending
neurosurgeon. The residents are expected to learn the planning and execution of all types of neurosurgical operations.
Depending on the complexity of the case and experience of the resident, the resident assumes major responsibility and
participation, acting as primary surgeon or as first assistant in operations on a daily basis and guiding the junior
resident when appropriate. He/she also oversees the management of post-operative care. With increasing responsibilities in
the operating room and following the surgery, the resident expands 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.
The residents have the advantage of working in operating rooms with the most sophisticated neurosurgical instruments
including the latest Leica or Zeiss operating microscopes, frameless stereotaxy and intra-operative monitoring.
The microsurgery is televised to various monitoring consoles for observation and instruction.
Administration
In addition to patient care, the two chief residents share administrative responsibilities. They direct the management and
care of all patients, those on the service as well as consult and outpatients. They also coordinate operating schedules and
resident assignments. They teach junior residents and medical students, conduct house staff rounds each morning and evening, and
participate in the planning and organization of teaching conferences.
