Clinical Rotations/Milestones


The University at Buffalo Neurosurgery residency program is a seven-year training program that continues to maintain and adapt its curriculum and training expectations for our residents based on current requirements as per the Accreditation Council for Graduate Medical Education (ACGME) and the ever-changing field of neurosurgery. The program embraces a progressive learning experience and responsibility for residents as they advance.  The program utilizes a monthly night float call coverage, which enables residents to meet the requirements of the ACGME and the New York State Bell 405 duty hour regulations.  During clinical rotations, the residents are assigned to participate in various specialty clinics that further augment their specific rotational educational experience.

 

PGY 1

  • Neurology rotation—1 month
  • Trauma surgery rotation—2 months
  • Neurosurgical critical care rotation—3 months
  • General neurosurgical rotation—6 months

PGY 2

  • General neurosurgical rotation—12 months

PGY 3

  • Neuro-endovascular rotation—3 months
  • Functional neurosurgery rotation—3 months
  • Spine rotation—3 months
  • General neurosurgery rotation—3 months

PGY 4

  • Neuro-oncology rotation
  • Pediatric neurosurgery

PGY 5/PGY 6

  • Dedicated research time
  • Enfolded clinical fellowship
  • Clinical electives

PGY 7

  • Chief Year
  • General neurosurgery rotation—12 months


Preliminary Resident—PGY 1

University at Buffalo Neurosurgery offers a structured year designed to prepare residents with the clinical and surgical skills needed to begin their neurosurgical training. This year includes four months on the general (trauma) surgical service as well as three months of neurology. The remainder of the year is spent on the general neurosurgical service with three months of focused neurosurgical critical care exposure. During this year, the residents become acclimated to the neurosurgical service and obtain exposure to all the clinical sites. PGY 1 residents also attend The Society of Neurological Surgeons (SNS) PGY 1 “Bootcamp,” which is held every July in Boston, Massachusetts.

Intern level Resident—PGY 2

In the second year of training, residents serve as the true “intern” of the neurosurgical service. They evaluate patients preoperatively and assist in postoperative care. They admit patients from the emergency room and directly from the neurosurgical clinics and handle all inpatient neurosurgical consultations. In addition, they perform neurosurgical operative procedures commensurate with ability. During this year, residents are encouraged to attend as many operative procedures as possible and to learn the basics of neurosurgical preoperative, operative, and postoperative care. In order to facilitate their ability to attend operative cases, several dedicated neurosurgical nurse practitioners help with basic floor and intensive care duties.

Mid-Level Resident—PGY 3, PGY 4

During the mid-level years, residents are encouraged to focus on improving their operative skills by performing basic cranial and spinal operative procedures in addition to developing an appreciation for more complex procedures and approaches. They are expected to keep abreast of current literature and accrue general knowledge in the field of neurosurgery, all the while providing excellent patient care. In addition to spending time on the main neurosurgical service at the Buffalo General Medical Center, mid-level residents perform dedicated neuro-endovascular, functional, spine, neuro-oncology and pediatric rotations. Opportunities to cover cranial and spinal trauma at the Erie County Medical Center are also available during this time.

Neuroendovascular Rotation—PGY 3

As required by the ACGME, a three-month neuroendovascular rotation is mandatory and is performed on the neuroendovascular service. The residents work closely with the cerebrovascular neurosurgeons as well as the neuroendovascular fellows. During this time, the residents become facile in performing and interpreting cerebral angiograms and are exposed to more complex endovascular interventions such as aneurysm coiling, stroke intervention, and carotid stenting. Residents routinely perform 150 angiograms during this 3-month time period. In addition to caring for the hospitalized neuroendovascular patients, the residents participate in the neuro-endovascular clinics and learn to manage cerebrovascular conditions in the outpatient arena.

Functional Neurosurgery Rotation—PGY 3

An opportunity to perform a focused functional rotation is provided during this year as well. The resident works closely with our functional neurosurgeon and his specialized team to learn basic functional management principles and to perform procedures including trials and implantations of intrathecal medical pumps and spinal cord stimulators. In addition, the residents are involved in complex frame-based stereotactic procedures, such as deep brain stimulation to treat conditions such as Parkinson’s disease and essential tremors. During this rotation, the residents attend the functional specialty clinics and learn to manage these patients in the perioperative period as well.

Spine Rotation—PGY 3

During their third year of residency, the resident also rotates through a dedicated spine rotation where the resident is exposed to a suburban and academic spine practice managing patients clinically and operatively. The residents attend the spine clinics and become comfortable with clinical evaluation and perioperative management of patients with spinal disorders. In addition, residents learn complex spinal procedures including deformity correction and reconstruction as well as minimally invasive techniques incorporating anatomical preservation approaches. These operations are often performed in conjunction with the University at Buffalo Orthopedic Department through a strong, joint affiliation with UBNS.

Pediatric Rotation—PGY 4

During their pediatric rotation at the John R. Oishei Children’s Hospital, the residents work directly under the supervision of the pediatric neurosurgeons. They are intimately involved in all areas of pediatric neurological care including performing operative procedures, participating in perioperative care, and attending general and specialized pediatric clinics such as the multidisciplinary spasticity, spina bifida, and oncologic clinics. In addition, the residents participate in many specialized conferences, such as oncologic and epilepsy conferences. Dedicated educational sessions are held weekly between the residents and neurosurgical attendings to further augment their knowledge base.

Neuro-oncologic Rotation—PGY 4

In addition to the pediatric rotation, the fourth-year resident performs a neurological oncology rotation at Roswell Park Comprehensive Cancer Center. This rotation provides exposure to the clinical and surgical management of brain and spine oncology. Residents participate in operative procedures as well as gamma knife radiation procedures. They attend comprehensive oncology clinics and multidisciplinary conferences during their rotation.

Senior Level Resident—PGY 5, PGY 6

In accordance with the seven-year resident curriculum as mandated by the ACGME, the fifth and sixth years of residency training are focused on providing the residents with opportunities to engage in research or complete enfolded fellowships whether at home or away institutions. During this time, the resident may also elect to continue on the main neurosurgical service at the Buffalo General Medical Center to further augment their operative skills and to sharpen their clinical acumen.

If the resident choses to pursue basic neuroscience and/or clinical research, they may conduct original research projects and prepare manuscripts summarizing research findings. The resident is expected to produce at least two manuscripts of publication quality during the research rotation. Residents may elect to work under the auspices of a University at Buffalo Neurosurgery faculty member or, alternatively, they can work with a member of the University at Buffalo faculty conducting neuroscience research. University at Buffalo Neurosurgery sponsors laboratories at Buffalo General Medical Center, Roswell Park Comprehensive Cancer Center, University at Buffalo (South Campus) and with the Canon Stroke & Vascular Research Center located at the University’s Clinical and Translational Research Center (CTRC).

Completion of CAST (Committee on Advance Subspecialty Training) accredited fellowships during this time at an internal or external institution may also be an option depending upon the resident’s clinical and operative performance.

Before the completion of the sixth year of training, each resident must pass for credit the primary examination of the American Board of Neurological Surgery. Any resident who does not pass the examination for credit will not be able to assume the duties of chief resident.

Chief Resident—PGY 7

Residents spend their seventh year of training at Buffalo General Medical Center. During this year, they are expected to fine-tune their clinical and operative skills and gain administrative experience prior to completing the training program. Seventh year residents also serve as chief residents and are responsible for the day-to-day operation of the neurosurgical service, including managing the resident complement and select administrative duties. Opportunities exist for chief residents to gain experience in subspecialty areas such as intracranial and skull base endoscopy, complex spine procedures, and open cerebrovascular procedures as well as more general neurosurgical techniques. Chief residents attend the chief resident clinic during this year and may attend any neurosurgical conference they feel will be beneficial to their future.

Specialized Neurosurgical Clinic Opportunities

  • Pediatric Spasticity
  • Pediatric Neuro-oncology
  • Pediatric Spina Bifida
  • Neuro-endovascular Clinic
  • Functional Neurosurgical Clinic
  • Adult Oncology Clinic
  • Chief Resident Clinic 


Interview Schedule

Resident interviews take place every year between October and December. For more information, contact UBNS residency program coordinator Jennifer Schram (716.218.1000 x5115, jschram@ubns.com) or consult the University at Buffalo Office of Graduate Medical Education Department.


Resident Evaluation Process

In order for any training program to assess its ability to meet its goals and objectives, it is essential that the program have a comprehensive evaluation process, including formative and summative evaluations of the residents, and an evaluation process of the program and the faculty.

Residents are evaluated in writing at midterm as well as at the conclusion of each academic year.  Faculty with whom they rotated during that period will provide ACGME milestone evaluation as gathered through the E*Value system.  Faculty will also provide comments regarding strengths, weaknesses and any areas identified as needing improvement and/or continued focus going forward.  Residents’ “professionalism” is evaluated by nursing staff and members of the health care team utilizing 360 evaluations and included as part of the complete evaluation process.  Mock Oral Board sessions are also utilized each term.

Once every six months, each resident receives a formal “summative evaluation” conducted by his/her program director (or designee). Each resident meets individually with the program director or associate program director to review the evaluations. During this meeting, a copy of the evaluations and a written summary sheet detailing the materials reviewed is provided to the resident. The resident’s strengths as well as areas for improvement are noted; any corrective measures are also discussed.