Neurosurgery Residency Rotations
The residency program curriculum at NYU Langone’s Department of Neurosurgery consists of 60 months of clinical neurosurgery experience, including 24 months as a senior resident and 24 months as chief resident. It is our belief that these training experiences enable our graduates to become highly motivated, confident, and clinically expert neurological surgeons who are not only skilled in the technical aspects of the specialty, but also appreciate the humanistic and academic sides of the practice of medicine. We equip residents with the tools necessary to make significant contributions to the specialty of neurological surgery.
Residency Training Sites
Our residency program takes place at four medical institutions, all located in close proximity to each other on the East Side of Manhattan between 23rd and 34th Streets: NYU Langone’s Tisch Hospital and Kimmel Pavilion, NYC Health + Hospitals/Bellevue, and the Manhattan campus of the VA NY Harbor Healthcare System.
As you progress through the residency and rotate through the various services, you take on increasing levels of responsibility in patient evaluation, management, and surgery. At NYU Langone, junior- and intermediate-level residents work under the supervision of experienced neurosurgeons. As you progress, you learn surgical techniques and adopt our standards of care.
The Bellevue service allows intermediate-level and chief residents more autonomy. These residents run both the outpatient and the inpatient neurosurgical service and perform all surgical procedures under close faculty supervision. This rotation exposes residents to emergency patient management and trauma at a large inner-city Level 1 Trauma Center, in addition to a busy outpatient clinic and elective case experience.
A chief resident, under the direct supervision of full-time faculty, also runs the neurosurgical service at the VA NY Harbor Healthcare System and functions with increasing autonomy in this primarily elective inpatient and outpatient practice. Residents at Bellevue and the VA NY Harbor Healthcare System employ the methods and standards of neurosurgery practice learned at NYU Langone. Over the course of our seven-year training program, you progress from being a supervised patient care provider and surgical assistant to a competent practitioner of neurosurgery, who can function and operate independently at a very high level.
We strictly follow resident work hour requirements set by the Accreditation Council for Graduate Medical Education (ACGME) and New York State. Each resident is solely responsible for adhering to these requirements and reporting violations, for which we have a zero-tolerance policy. Moonlighting is not permitted at any time by any house staff member of the Department of Neurosurgery. In addition, all residents and faculty must follow NYU Langone and HIPAA guidelines regarding patient privacy.
All residents must pass the written examination of the American Board of Neurological Surgery before becoming chief resident and graduating from the training program.
Every three months throughout your residency, you receive an evaluation. As a resident, you are evaluated on core competencies, operating room skills appropriate to your level of training, and how well you are achieving program goals and objectives. You are also expected to provide an evaluation of the program and the faculty.
The department is dedicated to the concept of wellness and work–life balance. We recognize that peak performance requires team building, self-care, and adequate time to recharge between work shifts. The department and institutional GME sponsor a variety of formal and informal gatherings to foster camaraderie and team ethos. Recent examples include happy hours, yoga, and spinning class. The department enjoys its reputation as a perennial underdog at the annual Neurosurgery Research and Education Foundation charity softball tournament in New York City.
Because the practice of neurosurgery is broad and complex, neurosurgeons often choose a subspecialty area in which to become an expert. The Department of Neurosurgery is organized into the following subspecialty areas:
- brain and spine tumors (Brain and Spine Tumor Center)
- radiosurgery (Center for Advanced Radiosurgery)
- stroke (Center for Stroke and Neurovascular Diseases)
- neuromodulation (Center for Neuromodulation)
- epilepsy (Comprehensive Epilepsy Center)
- neurocritical care
- pediatric neurosurgery
- peripheral nerve surgery
- spinal surgery (Spine Center)
Most of our faculty members confine their practice to one of these specific areas, enabling a depth of clinical experience and expertise that results in superior patient care. During residency, you are exposed to faculty in each of these subspecialty areas, resulting in a comprehensive neurosurgical training experience, and an understanding of which subspecialty area you would like to pursue.
The first postgraduate year (PGY-1) is a transitional year, during which residents must participate in a neurosurgical internship at NYU Langone. This consists of three months of neurology and one month of neuropathology at NYU Langone, and three months of neurosurgery at Bellevue, in addition to one month of vacation. The internship also includes experiences in adult general surgery, the intensive care unit (ICU)/critical care, cardiothoracic surgery, and trauma surgery. Most of these rotations involve major critical care experience.
The three-month neurosurgery rotation allows new residents to become familiar with the day-to-day operation of NYU Langone’s neurosurgical service. You learn what will be required as you progress through the training program. The three-month neurology rotation has been incorporated into PGY-1 to give you the skills in neurological examination and diagnosis you’ll need during clinical neurosurgery rotations.
PGY-2: Clinical Neurosurgery, Neuropathology, and Neuroradiology
PGY-2, PGY-3, and PGY-4 comprise your junior residency. You spend these years at our three affiliated institutions: Tisch Hospital/Kimmel Pavilion, Bellevue, and the Manhattan campus of the VA NY Harbor Healthcare System. Each center employs nurse practitioners and physician assistants to enable compliance with work hour regulations and to maximize surgical exposure and education.
In PGY-2, you complete three-month rotations in four distinct neurosurgical services: Tisch Hospital/Kimmel Pavilion Team 1-Kelly (tumor/vascular/skull base/neuromodulation/epilepsy services); Tisch Hospital/Kimmel Pavilion Team 2-Ransohoff (spine/peripheral nerve services); Bellevue; and the VA NY Harbor Healthcare System. These rotations provide neurosurgical ward, critical care, and operative experiences in varied neurosurgical practice environments. With appropriate supervision, residents are introduced to basic ward and operative procedures including cerebrospinal fluid diversion (ventriculostomies and shunts), lumbar punctures, traction placement, simple spine procedures, peripheral nerve procedures, angiography, and intracranial pressure monitoring.
PGY-3: Clinical Neurosurgery, Neuropathology, and Neuroradiology with Graduated Responsibilities
In PGY-3, residents’ rotations continue with graduated levels of ward, ICU, and operative responsibilities in the same four three-month rotations as the previous year: Tisch Hospital/Kimmel Pavilion Team 1-Kelly, Tisch Hospital/Kimmel Pavilion Team 2-Ransohoff, Bellevue, and the VA NY Harbor Healthcare System. The rotations continue to provide neurosurgical ward and critical care experiences in varied neurosurgical practice environments. With close supervision from the chief residents and faculty, residents are introduced to increasingly complex cases, operative procedures, interventional neuroradiology procedures, and outpatient clinics (one day per week). In addition, you learn the management of neurosurgical emergencies in the emergency department and the neonatal ICU (NICU).
PGY-4 is divided between six months as the senior resident on the pediatric neurosurgery service, and six months as the senior resident on the trauma service at Bellevue. These rotations provide graduated clinical and operative responsibility with a defined patient population. The six-month rotation period as chief resident on the pediatric neurosurgery service allows for in-depth exposure to the subdiscipline of pediatric neurosurgery. During these six months, the chief is exposed to a full range of operative pediatric neurosurgical disorders, including pediatric brain tumors, epilepsy, and procedures such as cranial endoscopy. The division collaborates with the Hansjörg Wyss Department of Plastic Surgery in the treatment of craniofacial disorders. The trauma experience at Bellevue represents a unique neurosurgical experience at one of the busiest trauma centers in New York City.
PGY-5 is designed to be a hypothesis-driven, basic science research year. Early in PGY-1, you meet with faculty and the residency program director to begin identifying areas of interest for the research rotation. You identify appropriate mentors and laboratories at that time. In many instances, residents have begun research projects, secured funding, and designed experiments before beginning the formal research year. Previous graduates have won national research awards and the Van Wagenen Fellowship based on their work during this rotation. In lieu of the research rotation residents may choose a dedicated intraresidency clinical fellowship in complex spine, pediatric, endovascular, skull base, or other cases. Each PGY-5 resident also participates in night call as the primary emergency consult resident and first assistant for the chief resident at Bellevue for emergency and trauma cases, with graduated levels of operative responsibility. Residents continue to attend neurosurgical didactic conferences and other major departmental events during this year.
PGY-6: Clinical Neurosurgery (Chief Resident Year 1)
The final two years, PGY-6 and PGY-7, are your chief resident years. PGY-6 is divided between two six-month senior resident rotations on Tisch Hospital/Kimmel Pavilion Team 1-Kelly (brain tumor/vascular/skull base/functional/epilepsy service) and Tisch Hospital/Kimmel Pavilion Team 2-Ransohoff (spine/peripheral nerve services), with responsibilities including operative cases, inpatient management, and conference preparation. These rotations provide the opportunity to manage a clinical service with direct supervision of and educational responsibility for the junior residents and rotating medical students. Under the supervision of the neurosurgical faculty, you assume increasing operative and nonoperative patient care responsibilities. This is the start of preparation for your second chief resident year. You also spend time discussing career plans with faculty mentors and the program director.
PGY-7: Clinical Neurosurgery (Chief Resident Year 2)
PGY-7 year is devoted to six months each as chief resident at Bellevue and the VA NY Harbor Healthcare System. The Bellevue experience is a comprehensive exposure to cranial and spine surgery. The full-time staff and other attending physicians from the department with subspecialty qualification assist with cases at your request. You also serve as administrative chief resident for the entire NYU Grossman School of Medicine Neurosurgery Residency program. The other half of the year is spent at the VA NY Harbor Healthcare System, with an emphasis on complex degenerative spinal cases.
These rotations provide residents with an opportunity to direct a clinical service that involves longitudinal continuity of all patients, from initial consultation in clinics or the emergency department through to postoperative follow-up.
The Department of Neurosurgery holds intra- and interdepartmental teaching conferences throughout the week, with Fridays devoted to conferences from 7:30AM to 3:00PM. Elective surgery is not performed on Fridays. Conferences emphasize resident education—trainees present clinical problems and are questioned to sharpen their decision-making skills. The format is modeled after the oral neurosurgical board examination, helping ensure that our residents are well prepared for this test by the completion of their training.