Program Structure

 

The NYU School of Medicine’s Neurosurgery Residency Training Program is a seven-year program that provides graduated levels of responsibility in patient evaluation, management and surgery as residents rotate through the various services at NYU Langone Health (Tisch Hospital), Bellevue Hospital Center (BHC), and the New York Harbor Health Care System (VA).

At NYU Langone Health, junior- and intermediate-level residents work under the supervision of experienced neurosurgeons who allow them to assume more and more direct responsibility and surgical opportunities in the care of patients as they progress through the program. In the process, surgical techniques are learned and standards of care adopted.

The Bellevue Hospital Center (BHC) service allows the intermediate-level and chief residents more autonomy, as they run both the out-patient and the in-patient neurosurgical service and perform all surgical procedures under close faculty supervision. The Bellevue Hospital Center 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 New York Harbor Health Care System (VA) and functions with increasing autonomy in this primarily elective in-patient and out-patient practice. At Bellevue and the VA, residents employ the methods and standards of neurosurgery practice learned at NYU Langone Health. Over the course of the seven years of the training program, residents progress from supervised patient care providers and surgical assistants to competent practitioners of neurosurgery, who can function and operate independently at a very high level.

Our neurosurgery program requires strict adherence to the ACGME and NYS duty-hour requirements. There is a zero tolerance policy for work hour violations. Each resident is solely responsible for adhering to the duty hour requirements and reporting violations. All residents are required to pass the written examination of the American Board of Neurological Surgery prior to becoming Chief Resident and graduating from the training program. In addition to evaluating the training program, residents are evaluated by the faculty and provide evaluations of the faculty every three months. Residents are evaluated on the basis of core competencies, operating-room skills appropriate to level of training, and how well they are achieving the goals and objectives of the training program. At each level, they are given direct feedback on their overall performance at each training level. Moonlighting is not permitted at any time by any house staff members of the department of neurological surgery. In addition, all residents and faculty must follow the Institutional and HIPAA guidelines regarding patient privacy.

Chronological Rotation of Resident Assignments

The NYU Neurological Surgery Residency Program curriculum consists of 60 months of clinical neurosurgery experience, including 24 months as a senior resident and 12 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-equipping them with the tools that will allow them to make significant contributions to the specialty of Neurological Surgery.

Postgraduate Year 1: Internship

The PGY1 year is in essence a transitional year, with rotations in neurosurgery, neurology, neuroradiology, neuropathology and critical care. In this year, residents who have matched into the NYU Langone Neurological Surgery Residency are required to participate in a neurosurgical internship at NYU Langone Health. This intern year consists of three months of neurology and one month each of neuropathology, neuroradiology, and neurosurgery (at Bellevue Hospital Center), in addition to one month of vacation.

The one-month Neurosurgery rotation allows the new residents to become familiar with the day-to-day operation of the NYU neurosurgical service, enabling them to learn what will be required of them as they progress through the training program. The three-month neurology rotation has been incorporated into the first postgraduate year in order to prepare residents with the requisite skills in neurological examination and diagnosis prior to beginning their clinical neurosurgery rotations. The internship also includes experiences in adult general surgery, emergency medicine, ICU/Critical care, cardiothoracic surgery, and trauma surgery. Most of these rotations have major critical care experiences as part of the overall internship experience.

Postgraduate Year 2: Clinical Neurosurgery, Neuropathology, Neuroradiology

The years of junior residency, PGY2, 3 and 4, are spent among our three affiliated institutions, NYU Langone Health (Tisch Hospital), Bellevue Hospital and the Manhattan Veteran’s Administration Hospital. Each center employs a number of Nurse Practitioners and Physician’s Assistants to allow for compliance with work hours regulations, and maximize surgical exposure and education.

In the second year of neurosurgery residency (PGY2), the residents have four three-month rotations in four distinct neurosurgical services: Tisch Hospital Team1 (Tumor/Vascular/Skull Base/Neuromodulation/Epilepsy Service), Tisch Team 2 (Spine/Peripheral Nerve Services), Bellevue Hospital Center, and New York Harbor Health Care System (VA). These rotations provide neurosurgical ward, critical care and operative experiences in varied neurosurgical practice environments. With appropriate supervision, the residents are introduced to basic ward and operative procedures including cerebrospinal fluid (CSF) diversion (ventriculostomies and shunts), lumbar punctures, traction placement, simple spine procedures, peripheral nerve procedures, angiography and intracranial pressure monitoring.

Postgraduate Year 3: Clinical Neurosurgery, Neuropathology, and Neuroradiology with Graduated Responsibilities

In the third year of neurosurgery residency (PGY3), the residents’ rotations continue, with graduated levels of both ward, ICU, and operative responsibilities, through the same four three month rotations as the previous year: Tisch Hospital Team 1 (Brain Tumor/Vascular/Skull Base/Functional/Epilepsy Service), Tisch Hospital Team 2 (Spine/Peripheral Nerve Services), Bellevue Hospital, and the New York Harbor Health Care 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, the residents are introduced to increasingly complex ward, operative procedures, interventional neuroradiology procedures, and outpatient clinics at BHC and the VA (one day per week). In addition, they learn the management of neurosurgical emergencies in the ER and the NICU.

Postgraduate Year 4: Pediatrics/Epilepsy

The fourth neurosurgery year (PGY4) is divided between six months as the senior resident on the pediatric neurosurgery service at NYU Langone Health’s Tisch Hospital and six months as the senior resident on the Trauma service at Bellevue Hospital. 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 with Drs. Wisoff, Weiner, and Harter allows for particularly indepth exposure to the sub-discipline of pediatric neurosurgery through the continuity of care in the neurosurgical and medical management of these patients. During these six months, the chief is exposed to the full range of operative pediatric neurosurgical disorders, including an extensive experience with pediatric brain tumors, epilepsy and cranial endoscopy. The division has collaborative efforts with the Department of Plastic surgery in the treatment of craniofacial disorders. The trauma experience at the Bellevue Hospital represents a unique neurosurgical experience at one of the busiest trauma centers in New York City.

Postgraduate Year 5: Research/Elective

The fifth neurosurgery year (PGY-5) is designed to be a hypothesis-driven, basic science research year. Early on in the internship year, residents meet with faculty and the residency program director to begin identifying areas of interest for the research rotation. Appropriate mentors and their laboratories are then identified. In many instances residents will have begun research projects, participated in securing funding and designed experiments prior to beginning the formal research year. Previous graduates have won national research awards and the Von Wagenen Fellowship based on their work during this rotation. For residents who so desire, a dedicated intra-residency clinical fellowship (complex spine, pediatric, endovascular, skull base or others) may be substitute for the research rotation. Each PGY5 resident also participates in night call as the primary emergency consult resident and first assistant for the Bellevue Hospital Chief Resident in emergency/trauma cases with graduated levels of operative responsibility. Residents continue to attend neurosurgical didactic conferences and other major departmental events during this year.

Postgraduate Year 6: Clinical Neurosurgery (Chief Resident Year #1)

The final two years, PGY 6 and 7 are chief resident years. PGY6 is divided between two six-month senior resident rotations on the Tisch Hospital Neurosurgery services: Team 1 (Brain Tumor/Vascular/Skull Base/Functional/Epilepsy Service), and Team 2 (Spinal and 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, the resident assumes increasing operative and non-operative patient care responsibilities. This begins the process of preparing the resident for the chief resident year. By this point, career planning is well underway through discussions with faculty mentors and the program director.

Postgraduate Year 7: Clinical Neurosurgery (Chief Resident Year #2)

The PGY7 year is devoted to six months each as chief resident at the Bellevue Hospital Center and at the VA New York Harbor Health Care System Hospital, respectively. The Bellevue experience is a comprehensive exposure to operative cranial and spine surgery. The full-time Bellevue staff, Dr. Huang and Dr. Russell, and other attending from the department with subspecialty qualification are available to assist with cases at the request of the Chief. The Bellevue chief resident also serves as administrative chief resident for the entire NYU Neurosurgery Residency Program. The other half of the year is spent at the VA hospital, with an emphasis on complex degenerative spinal cases. The attending faculty at the VA includes Drs. Pacione, Smith and Placantonakis.

With appropriate supervision, these rotations provide the residents with an opportunity to direct a clinical service with longitudinal continuity of all patients from initial consultation (in the clinics or ER) through to postoperative follow-up. The New York Harbor Health Care System is the regional VA neurosurgical referral center for the tri-state region, while Bellevue Hospital is a busy Level 1 trauma center and a tertiary care center of the public hospital system (HHC system) in New York City.