Neurological Surgery Residency Program

Physicians participating in the Neurological Surgery Residency Program at Cedars-Sinai Medical Center will receive the following training over a six-year period:

  • 8 months of general surgery in the PGY1 year
  • 42 months of clinical neurosurgery
  • 3 to 6 months of neurology
  • 5 to 7 months of electives
  • 12 months of basic science and laboratory research
  • 12 months as chief resident

Each year of the training is described below.

Year 1 (PGY 1)

The first year of postgraduate training is spent acquiring fundamental clinical skills. This includes eight months of general surgery rotations and one month of neurosurgery in the Department of Surgery. An additional three months are spent on the neurology rotation at the University of Southern California Division of Neurology.

Applicants accepted by the department are automatically assigned to the surgical internship, but are required to enter their name through the San Francisco Matching Program. At the conclusion of the PGY 1 year, the resident is promoted to the NS-1 position, if his or her performance has been satisfactory.

PGY-1 level residents should demonstrate an appropriate level of basic science and clinical knowledge. This knowledge should be incorporated in an analytic approach to the patient's problem. The PGY-1 resident should be able to use information technology to support his or her education. The physician should analyze practice experience and modify clinical practice base on that experience.

Year 2 (PGY 2 - NS-1)

The NS-1 rotation focuses on the skills and knowledge required for preoperative and postoperative care of patients with neurosurgical disease in the hospital ward and intensive care unit. This rotation involves supervised evaluation and management of neurosurgical disorders including a spectrum or cranial and spinal disorders in adult and pediatric patients.

Their responsibilities include daily duties on the clinical neurosurgery inpatient service as well as evaluating and managing emergency neurosurgical patients. They will be assisted in their daily responsibilities by physician's assistants and nurse practitioners whose primary responsibility is nonsurgical care of neurosurgical patients.

The resident initially works under the supervision of the neurosurgical faculty in obtaining a patient's history, doing physical examination, ordering diagnostic studies and formulating a treatment plan. Later, the junior resident will also work under the supervision of the senior and chief residents. During this year, the resident will be first or second assistant on cases that include laminectomies, scheduled and emergency craniotomies and cerebrospinal fluid shunting procedures.

During this year, the resident is expected to attain a set of objective, essential skills. For a description of these skills, click here.

Year 3 (PGY 3 - NS 2)

Most residents will do a second neurology rotation in subspecialties at the primary clinical site (Cedars-Sinai). These include the epilepsy, neurooncololgy, stroke or outpatient neurology service. The residents will then participate in elective experiences in neuropathology, neuroanatomy, peripheral nerve service, stereotactic radiosurgery and endovascular surgery. Time on the elective service will be limited to three to four months at discretion of the Director of the Residency Program. During this time the residents will meet with the Program Director to begin to formulate their plans for their research year.

A minimum of six months of this year will be spent on the adult and pediatric spine surgery service. During this time, the resident will be advancing his or her neurosurgical skills in treating spinal disorders including the use of complex spinal instrumentation. Residents will have preoperative and postoperative rounds and clinical duties on patients for whom they have been the first or primary surgeon. They also attend an outpatient spine clinic under direct supervision of faculty.

(Although residents may not be able to attend all outpatient clinics, it is expected that they will be freed from other inpatient clinical responsibilities to shadow the faculty in the outpatient setting at least twice a month. Failure to do so will result in revoking the privilege of operating for a set period).

Residents are also exposed to operative care by other surgical specialties involved in the care of adult and pediatric patients with spine pathology. By the end of this rotation, residents will be proficient in diagnosing and treating radioculopathies, degenerative disc disease, traumatic spinal injuries and fractures and complex spinal deformity.
In-hospital call will be every fourth night.

During this year, the resident is expected to attain a set of objective, essential skills. For a description of these skills, click here.

PGY 4 (NS 3) - Senior Inpatient Neurosurgical Service Resident

The resident coordinates inpatient and emergency room consultation services under the supervision of the chief resident, while continuing to advance his or her neurosurgical skills. The primary responsibility for inpatient consultations will be split into adult and pediatric service, as will the operative exposure, allowing a close teaching relationship between the senior resident and the faculty.

On most days, there are five to seven neurosurgery or spinal surgeries running simultaneously. This allows for a choice of neurosurgical procedures for the senior and chief residents to participate in. The senior residents operating experience will be primarily on vascular, pediatric or neurosurgery services (when such cases are not attended by the chief resident) or brain tumors and complex spine cases when there are no vascular or pediatric cases scheduled.

Opportunity for increased exposure to neurosurgical patients in the outpatient setting is also incorporated into the fourth year.

During this year, the resident is expected to attain a set of objective, essential skills. For a description of these skills, click here.

PGY 5 (NS 4)

During this year of training, the residents will pursue an area of neurosurgical research in basic, clinical and applied sciences pertaining to neurological surgery. Exposure to the clinical service will be limited to call coverage for other residents on vacation or sick leave. There will be no daily clinical duties.

Training in grantsmanship and formal clinical study design will be provided to allow to the trainee to excel as academic neurosurgeons. A didactic curriculum is planned to assist residents in attaining the skills required for writing research and clinical trial design. This includes course work in biostatistics; grant writing and clinical trial design, as well as other pertinent seminars.

The Neurosurgical faculty anticipates that the residents will simultaneously work in their choice of neurosurgery, spine or related neuroscience laboratories. They are expected to devise a novel basic science or clinical research project under the direction of the faculty member providing guidance in their laboratory. They will be expected to conduct independent research, acquire and collect data for tabulation, analysis, and interpretation that ultimately result in preparation of manuscripts submitted for publication and presented at national meetings.

During this year, the resident is expected to attain a set of objective, essential skills. For a description of these skills, click here.

PGY 6 (NS 5) - Chief Resident Rotation

Each resident will have a full 12-month rotation as Chief Resident to acquire the necessary skills and experience in administration, patient management and surgery. More than 2,000 major neurosurgical operations are performed at Cedars-Sinai Medical Center, providing ample opportunity for a full 12-month chief resident surgical experience. The chief resident will have opportunities to be the primary neurosurgical care provider for patients in the chief resident clinic under supervision of neurosurgery faculty.

As part of the mission of training academic neurosurgeon, the faculty of the Division of Neurological surgery strongly encourages publication of original work throughout the years of training. As such, there will be a requirement of publishing one paper per year as a requirement for progress to Chief Resident.

The responsibilities of the Chief Resident include coordinating the hospital clinical service for all neurosurgical disorders. This includes administrative supervision of residents and medical students on the clinical service under the supervision of the residency and program directors. Additionally, the Chief Resident coordinates specific weekly teaching and clinical conferences, including Morbidity and Mortality. The Chief Residents will be expected to be the primary surgeons in the cases they participate in, but will be supervised by attending physicians. The chief resident will have a chief resident clinic where he or she will evaluate patients, order appropriate studies and follow patients on whom he or she has operated.

During this year, the resident is expected to attain a set of objective, essential skills. For a description of these skills, click here.

Evaluations

The program director meets with residents on clinical rotations individually to review their progress, evaluation and publications.