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The BWHCH Neurosurgery Department Curriculum

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Title: The BWHCH Neurosurgery Department Curriculum

1
The BWH/CH Neurosurgery Department Curriculum

Dong H. Kim, Mark Proctor, Arthur Day

2
Overview

Models of accreditation
ACGME Core Competencies
New teaching methods/curriculum is required
New evaluation methods are required
BWH/CH curriculum
BWH/CH evaluation plan

3
Models of Accreditation

Previous Model
Emphasized the POTENTIAL of a program to educate
residents by focusing on structure and process
components.
Does the program comply with existing
requirements?
Are there established objectives and an organized
curriculum?
Does the program evaluate its residents and
itself?

http//www.acgme.org/outcome/project/proHome.asp
4
Models of Accreditation

New Model
Emphasizes a programs ACTUAL ACCOMPLISHMENTS
through assessment of educational outcomes
Do the residents achieve the learning objectives
set by the program?
What evidence can the program provide to support
this achievement?
How does the program demonstrate continuous
improvement in its own educational processes?

http//www.acgme.org/outcome/project/proHome.asp
5
ACGME Core Competencies

Patient Care
Medical Knowledge
Practice-Based Learning and Improvement
Interpersonal and Communication Skills
Professionalism
Systems-Based Practice

6
ACGME Competencies

Patient Care that is compassionate, appropriate,
and effective for the treatment of health
problems and the promotion of health
Medical Knowledge about established and evolving
biomedical, clinical, and cognate (e.g.,
epidemiological and social-behavioral) sciences
and the application of this knowledge to patient
care

http//www.acgme.org/outcome/comp/compMin.asp
7
ACGME Competencies

Practice-Based Learning and Improvement that
involves investigation and evaluation of their
own patient care, appraisal and assimilation of
scientific evidence, and improvements in patient
care
Interpersonal and Communication Skills that
result in effective information exchange and
teaming with patients, their families, and other
health professionals

http//www.acgme.org/outcome/comp/compMin.asp
8
ACGME Competencies

Professionalism, as manifested through a
commitment to carrying out professional
responsibilities, adherence to ethical
principles, and sensitivity to a diverse patient
population
Systems-Based Practice, as manifested by actions
that demonstrate an awareness of and
responsiveness to the larger context and system
of health care and the ability to effectively
call on system resources to provide care that is
of optimal value

http//www.acgme.org/outcome/comp/compMin.asp
9
Our Educational Activities Must be monitored
and supervised by an attending!!

Operating Room
ICU Rounds (family meetings)
Clinic
Grand Rounds
Conferences
M and M

10
Educational Activities
11
Operating Room

Teach surgical competence (PC)
Discuss the indication and scientific basis for
surgery (MK)
Attendings serve as role models for Interpersonal
Skills and Professionalism (ISP)
Observe and mentor the resident on ISP
Discuss the rationale for use of OR resources
(cost-benefit analysis), discuss OR systems and
how it relates to service/hospital efficiency
(SBP)

12
ICU/Clinic

Complete review of medical/ICU management
Teach procedural competence - lines, EVD
Residents conduct occasional family meetings,
with attending present mentor the resident on
ISP
Teach the resident to work with nurses, other
services and consultants (ISP, SBP)
Discuss the rationale for use of hospital
resources (length of stay), discuss interactions
with care coordinators, therapists, other
hospitals, including transfer and insurance
issues (SBP)

13
MM, Grand Rounds

M/M practice-based learning and improvement
Grand Rounds 4 week cycle
Week 1 Research
Week 2 Neurosurgery CPC
Week 3 Professionalism and Systems Based
Practice
Week 4 Controversies in Neurosurgery

14
Grand Rounds summer

8 sessions in July and August
Keep current format acute neurosurgery
introduction
Trauma/ICP management
SAH/vasospasm management
Seizures/Epilepsy
Acute stroke/cerebrovascular
Acute tumor presentation/management
Spinal cord compression/fracture
Hydrocephalus
Pediatric emergencies

15
Grand Rounds-Research

10 sessions (September to June)
Joe Madsen to lead
Content
Faculty presentation (particularly research
faculty)
Invited talks
Resident research updates
Before starting in lab
After year one
After year two

16
Grand Rounds CPC (10 sessions)

Run by PGY 6
each PGY 6 does one session every other month
Resident picks case for discussion
interesting medical issue or surgical case,
unusual lesion, etc. - does not have to be a
complication
Invites a multidisciplinary group of experts that
were involved
ICU team, pathologists, radiologists,
consultants, neurologists, etc
After discussion, literature review by the
resident
15 minutes (PC, MK, and PBL)
Will promote multi-disciplinary understanding and
teamwork

17
Grand Rounds Professionalism and Systems-Based
Practice (10 sessions)

Joe Madsen to lead
Recurring, invited talks (CH and BWH staff)
State of the residency (matching program,
ACGME/RRC reports, etc)
Risk management
Professionalism in workplace
Ethics in neurosurgery
Our responsibility to our patients, informed
consent, end of life issues, relationship to
equipment manufacturers/pharma
National regulatory bodies and laws
JCAHO, RRC, ACGME, federal funding of graduate
ed.
EMTALA, ADA, OSHA, HIPAA

18
Professionalism and Systems-Based Practice
-continued

NS leadership
National organizations (what it does, how to get
involved)
What can we do locally, regionally, and
nationally?
Requirement for certification by the board
Payment/insurance (2 sessions)
CPT system, E/M, ICD 9, billing requirements
HCVA, contracts, HMO, PPO
State and national laws on billing
Career options
Academic, private, Kaiser, VA/military, research
Role of fellowships in career development
Future of medicine/neurosurgery
Coming trends, future of medicare, partners
policies

19
Controversies in Neurosurgery (10 sessions)

Run by PGY 7 (each PGY 7 does one session every
other month)
Resident picks case for discussion
case with several treatment options
Discussion led by specific faculty member (with
remaining faculty interaction)
risks and benefits of each option
what option was used
what others would do
Literature review of the controversy and possible
treatments 30 minutes (PC, MK, and PBL)

20
Conferences on-service residents

Wednesday
645am Mock Oral Boards
730am MM
Thursday
700am Grand Rounds
800am Radiology conferences
900am Chiefs Conf (once/month)
1230pm Program Directors Conf
100pm Surgical Anatomy Conf
2-4pm Curriculum Conf

21
Conferences (research residents)

Surgical Anatomy and Skull Base Lab
9am-12pm two Thursdays/month
In anatomy lab at HMS (David Cardozo)
Taught by Bill Gormley and Dong Kim
Review of all Rhoton anatomy papers
Direct dissection on cadaver heads
All aspects of anatomy and surgical approaches
covered over two years
Research residents continue to think surgically
Bill Gormley can impart his surgical experience
Our dissections and faculty help teach the
medical students

22
BWH/CH Radiology Conference

Maintain case-based format
In addition, presentation every session from a
neuroradiology fellow
10-20 minutes at the beginning
Review of specific aspect of neuroimaging
Review of various MRI imaging sequences (what
each is designed to detect)
Review of best test to detect specific lesions
(abscess? Glioma? Etc)
Discuss complications of imaging (contrast, dose,
etc)
Show teaching cases of images we dont see
often (neurodegeneration, encephalopathy, etc)

23
Curriculum Conference

48 sessions per year
leaves 5 for meetings and holidays
Over 2 year cycle, comprehensive review of all
relevant topics in NS
as defined by the CNS education committee
Resident preparation with attending proctoring of
each topic
All faculty are encouraged to participate in
their areas of expertise
Mark Proctor and/or Dong Kim will attend most
sessions

24
Curriculum Conference

Each resident will prepare a one-hour
presentation per month (for PGY 6 and 7s grand
rounds presentation counts as one hour)
The topics will be pre-defined to complete review
over 2 year cycle
(series of questions set by CNS committee)
Each talk will be saved on our website
review in the next cycle will mean updating to
topic only
Each resident will have 2 cycles of review by
graduation

25
Curriculum Conference (contd)