Junior residents then embark on a clinical experience consisting of rotations on the pediatric service as well as the adult microvascular, trauma, spine, vascular, and stereotactic services. This first year strongly emphasizes basic operative technique and clinical decision making. Routinely, junior residents are assigned to an operating room three to four days a week, and most residents participate in more than 250 cases during their first year. The bulk of the cases are trauma craniotomies, routine spinal procedures, stereotactic intervention, and shunts.
Clinical judgment is enhanced by spending one day a week in the outpatient office.
The second year of neurosurgical training comprises rotations on the neuroradiology, neuropathology, and image-guided surgery services. During this time, residents maximize their non-clinical hours with supplemental reading and clinical reviews in preparation for a practice run of the written board exam in the spring. In their third year, PGY-4 residents return to the clinical service as senior residents and continue their operative experience. Increasingly difficult procedures are assigned to senior residents and consist mainly of complex spinal procedures with instrumentation, craniotomies for intra-axial tumors and meningiomas, and posterior fossa surgery. Residents spend 12 to 24 months of PGY-5 and 6 conducting clinical or basic science research on focused projects.