Year 4 (PGY4)

The PGY-4 resident spends four months as senior resident on the UCSF Neurosurgery Service (Moffitt/Long Hospital on the Parnassus campus), four months as Chief Resident at San Francisco General Hospital (SFGH), and four months as Chief Resident at the San Francisco Veterans’ Affairs Medical Center (SFVAMC).

UCSF Senior Resident (4 months): The senior resident on the UCSF Neurosurgery Service works closely with the Chief Resident in conducting the operating room schedule at Moffitt/Long Hospital and shepherding junior residents. This rotation emphasizes clinical and operative care of patients with vascular diseases. Together with the second-year residents, the PGY-4 resident records histories and conducts physical examinations on patients who are admitted to the vascular neurosurgery service. The senior resident will evaluate and formulate diagnoses based on neuroimaging and neurophysiological tests, and assist in and/or make surgical approaches in graded but more advanced cases under the direct supervision of the Chief Resident and attending neurosurgeons. Neurocritical care, neuroanesthesia, and more advanced neurosurgical techniques, including microsurgical skills, are emphasized. Residents are also responsible for managing inpatient care of all vascular neurosurgery inpatients, including critical care patients under direct supervision of the Chief Resident and attending neurosurgeon. They participate in multidisciplinary care conferences with the endovascular, neurology, nursing, physical/occupational therapy, and psychosocial services, developing care and discharge plans. By this point it is expected that the residents will have started to make the transition from assistant to primary surgeon, with the understanding that psychomotor skills and aptitude vary and that residents will require more or less supervision from the Chief Resident and attending neurosurgeon. No in-house call; senior residents share weekend at-home call at SFGH with the SFGH Chief.

SFGH Chief Resident (4 months):The SFGH Chief has full responsibility for the neurosurgical service under the supervision of the attending surgeons, with the assistance of 3 general surgery interns. The SFGH Chief evaluates patients, supervises the junior staff, and leads daily inpatient rounds under the supervision of the attending surgeons, who also participate in daily rounds. He or she performs major and difficult neurosurgical procedures, assists interns in performing less complicated procedures, and teaches junior house staff and medical students. The SFGH Chief also has full responsibility for running 2 days of outpatient neurosurgery clinic under the supervision of the attending surgeons. As Chief, the resident is exposed to a broad spectrum of neurosurgical cases with an emphasis on neurotrauma, which is concentrated during this rotation at the designated Level 1 Trauma Center for the City & County of San Francisco. SFGH is a “resident managed” hospital, in which the neurosurgery resident is provided a high level of autonomy in decision-making and surgical execution, while still provided an attending surgeon’s consistent, personal supervision in every phase of patient care. The resident also participates in neuroradiology, spine trauma, and neurocritical care conferences with allied services. No in-house call; on home-call shared with the UCSF senior resident.

SFVAMC (4 months): : The SFVAMC Chief has full responsibility for the neurosurgical service at the SFVAMC under the direct supervision of attending staff and leads 2 days of outpatient clinic. Patient care and management includes making evaluations, treating medically or surgically, and making surgical recommendations to patients. The resident uses and integrates the findings of diagnostic techniques including CT, MRI, EEG, EMG, and angiography. He or she plans and carries out all surgical procedures in cranial, spinal, and peripheral nerve neurosurgery, including micro-dissection techniques and the use of modern navigation instruments, electrocorticography, cortical motor and speech mapping, and sensory- and motor-evoked potentials. The SFVAMC Chief evaluates and discusses surgical findings and the associated prognosis with patients and their families. At this site, all patients, who understand that the resident is the patient’s surgeon, although an attending acts as a teaching neurosurgeon and assumes professional responsibility for these patients by reviewing all phases of patient management and by supervising surgical procedures. The SFVAMC Chief also has primary responsibility for teaching medical students on the service. A unique aspect of this rotation is the PADREC center of excellence in Parkinson’s Disease where residents participate in multi-disciplinary care of patients with advanced Parkinson’s Disease, including clinical assessment and surgical management. No in-house call. Home call for week days and shared weekend coverage with SFGH Chief.