The BWHCH Neurosurgery Department Curriculum

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The BWH/CH Neurosurgery Department Curriculum

• Dong H. Kim, Mark Proctor, Arthur Day

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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

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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
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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
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ACGME Core Competencies

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

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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
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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
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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
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Our Educational Activities Must be monitored
and supervised by an attending!!

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

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Educational Activities
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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)

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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)

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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

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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

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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

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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

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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

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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

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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)

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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

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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

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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)

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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

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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

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Curriculum Conference (contd)

• one intern and one pathology session per month
• One hour basics review by the intern
• One hour slide-review (with neuropathologist)
• 3 two-hour sessions per month
• Tumor, Spine/PN, Cerebrovascular, Pediatrics
• 15 sessions each
• Trauma and Functional/Pain
• 6 sessions each
• Use of SANS to assess progress

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ICU/critical care conferences

• ICU core lecture/training
• During 6 month PGY1 ICU rotation
• Under Bill Gormleys Direction