OBJECTIVES

The OBJECTIVE of NSTP-ECSA and its institutions is to provide the resources, facilities, and opportunity for the trainee to become a fully trained neurosurgeon who:

Is clinically competent, thus able to demonstrate:

• I) A comprehensive and thorough knowledge of neuroscience,  neuroanatomy, neurophysiology and neurosurgical disorders.
• II) Expertise in neurologic and systemic history-taking and physical examination.
• III) Expertise in the diagnosis, investigation and management of neurosurgical disorders.
• IV) A broad knowledge base of related disciplines, including neurology, neuropathology, neuroradiology, neurooncology and neuropsychology.
• V) Technical excellence in all common aspects of operative neurosurgery.
• VI) Comprehensive knowledge of operative preparation, operative strategy, complication avoidance and management, postoperative care and followup.

Develops skills as an efficient communicator, collaborator, medical manager, health advocate, scholar and professional.

Will complete all requirements to pass a COSECSA  Specialty Examination in Neurosurgery FCS-ECSA (Neuro).


MISSION [top]

To provide an organized program of rotations and other educational experiences, both mandatory and elective, designed to provide neurosurgical trainees with the necessary opportunities to fulfill the educational requirements and achieve competence in neurosurgery.

To provide each trainee with increasing professional responsibility for the management of neurosurgical patients, with increasing surgical responsibility ultimately including the major procedures under appropriate supervision.

To offer community based neurosurgical experiences as part of an elective rotation.

To provide sufficient resources including teaching faculty, number and variety of patients, physical and technical resources, as well as supporting facilities and services necessary to provide the opportunity for all trainees in the program to achieve the educational objectives and receive full training in neurosurgery.

Teaching Faculty

• To ensure a sufficient number of qualified teaching staff in the program and at each participating institution, to supervise trainees at all levels.

Number and Variety of Patients

• The number and variety of patients and of surgical procedures in each category to be satisfactory to ensure that all trainees are able to attain the competencies outlined in the training requirements.
  
  • Intracranial Neoplasms. An adequate number and variety of patients to ensure experience in a broad spectrum of representative pathology.
  • Vascular Neurosurgery. This component of the program to include the surgical or medical management of lesions of the intra- and extra-cranial carotid and vertebral arteries and their branches including aneurysms and vascular malformations. Facilities and opportunities to learn the principles and techniques of microvascular surgery are essential.
  • Spinal Surgery. This category to include adequate resources for training in the investigation and management of neoplasms, degenerative disease, and trauma of the spinal cord and nerve roots.
  • Pediatric Neurosurgery. An organized teaching service for the neurosurgery of infants and children, with all appropriate supporting staff and facilities. A close association with a pediatric service, to include a pediatric neurologist. An adequate number and variety of patients to ensure experience in the management of neoplastic disease, trauma, congenital disorders, vascular anomalies and hydrocephalus.
  • Trauma of the Nervous System. Adequate numbers of patients within the units of the program to provide each resident with training in the diagnosis and management of head, spinal and peripheral nerve injuries. Experience in major trauma is essential, including participation in the initial management of multiple injuries as a member of an inter-disciplinary team.
  • Other.  Facilities and opportunities to be available within the  program, or by arrangement with other programs or institutions, for experience in the following areas: functional neurosurgery (management of pain, movement disorders, epilepsy); trans-sphenoidal pituitary surgery; and surgery of the peripheral nervous system.

• In-Patient
  • The program to be organized into one or more adequately supervised training sites each with an adequate number of patients available for teaching and each site administered by a site director to whom the trainee is directly responsible.
  • The clinical teaching sites making up the program to provide full training in diagnosis and management of neurosurgical conditions in each of the areas listed under "Number and Variety of Patients".
• Ambulatory
  • In-patient and out-patient clinical teaching services to be integrated as far as possible, in order to provide continuity of observation of patients both in and out of hospital.
  • Organized clinics or other facilities to provide opportunities for consultation, investigation and post-discharge follow-up of patients in all categories mentioned above. It is essential that clinics provide a teaching milieu and that schedules of trainees be so arranged as to facilitate their attendance.
• Consultation
• Hospitals participating in the program to have a designated neurosurgical operating room with sufficient operating time, and facilities for micro-neurosurgery to permit graded responsibility in the performance of operative procedures. Within the training program, there to be a sufficient number and variety of major neurosurgical cases to represent a well-balanced spectrum of cranial and extra-cranial neurosurgery.
• Trainees to participate in primary consultations, both elective and emergency, to other services such as neurology, psychiatry, internal medicine, and other branches of surgery, including trauma, on a continuing basis throughout training.

Surgical Services

• Intensive Care Units
  • The program to provide experience in the broad field of intensive care of critically ill and injured patients. The organization of the intensive care units admitting neurosurgical patients to ensure that trainees assume major responsibility under appropriate supervision.
• Emergency Facilities
  • There to be adequate supervision of trainees to ensure expertise in the initial management of all types of emergencies related to neurosurgery, including those presenting in the emergency department. Experience in responding to emergencies and providing a consultative service under such conditions is essential.
• Community Learning Experiences
  • Community experiences to be available which provide a learning environment with appropriate supervision, patient encounters, and opportunities for evaluation based on rotation specific objectives. This assumes administrative support and linkages with the program.

Supporting Services — Clinical, Diagnostic, Technical

There to be appropriate liaison with teaching services in areas relevant to the practice of neurosurgery including all of the following related areas: internal medicine, pediatrics, neurology, anesthesia, neuropathology, and in diagnostic radiology.

The following facilities and services to be available:

• An active teaching neurology service, preferably with an accredited training program in neurology, with adequate arrangements to ensure an understanding of the methods and concepts of medical neurology;
• An active teaching service in neuropathology with provision for the study of neuropathological material under the direction of a neuropathologist, and organized for teaching of neurosurgical trainees;
• An active teaching service in diagnostic radiology and neuroradiology, with facilities for computerized axial tomography, magnetic resonance imaging, myelography, and angiography;
• Adequate arrangements in neuro-oncology to ensure an understanding of the methods and concepts of neuro-oncology including surgery, radiation therapy, and chemotherapy;
• Other diagnostic services, including specialized staff and facilities, in the following areas: electroencephalography, electromyography and nerve conduction studies; radioisotopic diagnosis and ultrasonography. Access to neuro-ophthalmology and otology units is desirable;
• Other surgical training programs that provide experience relevant to neurosurgery include general surgery, orthopedic surgery, otolaryngology, plastic and vascular surgery. The Training Program Committee to ensure that clinical training in surgery other than neurosurgery meets the needs of neurosurgery trainees;
• Rehabilitation services, staffed by qualified medical personnel and allied non-medical professional staff in physical medicine, psychology, social work, and occupational therapy.