At Parkland Memorial Hospital, our main teaching facility, Clinical care is provided by a neurosurgery chief resident, two neurosurgery junior residents, and two general surgery PGY-1 residents. At the junior level, the neurosurgery junior residents share coverage with the two general surgery residents rotating on the service at any one time, resulting in the neurosurgical resident rotating on every fourth night in house. This is the only in house call of the residency. The chief resident is off every other weekend. Each PGY-1 and PGY-2 resident is off two weekends/month.

At William P. Clements Jr. University Hospital, the chief resident, two senior residents, and a junior resident provide the coverage. No in-house coverage is required. The residents alternate and cover evenings one night a week. The Chief resident is off every other weekend with the PGY-2 neurosurgery resident off two weekends/month. Senior residents are also off every other weekend.

The Dallas VA Medical Center resident takes home calls during the week and has every other weekend off. The resident at Children’s Health provides coverage every third week alternating with the two pediatric fellows. The resident is off call two out of three weekends.

The Zale Lipshy-Pavillion of the Clements University Hospital houses the spine center. Call is alternated a week at a time between chief and senior resident alternating home call during the week and every other weekend.

Texas Heath Resources Community hospital is an opportunity for junior residents to operate independently, directly with the faculty. In addition to the elective operative schedule, residents on this rotation take 14 nights a month of home call and are first responders and primary resident on call cases. Additional night call opportunities exist for residents to take, on a volunteer basis, as paid moonlighters as long as they are not exceeding the ACGME rules for work hours.

Conferences

There are numerous conferences during the week. Conferences are “mandatory” to ensure the residents are able to attend. Residents are free from clinic and elective patient care during this time. Emergencies may still be attended to as needed. Some of the conferences are attended by all the residents, giving people a chance to all get together, while others are attended only when rotating on specific subspecialty rotations.

Chairman’s Conference

Chairman’s conference is a recent addition to the weekly conference schedule, aptly named since it was created by the chairman in response to residents’ request for more direct lectures from the faculty. Each week a different faculty member presents a 15-minute lecture on a timely topic. This is followed by a chief resident presentation of the “case of the week” from their service. Junior residents are cross-questioned in an oral board preparation style. Our 5 year oral board pass rate is 100% so it seems to be working. Junior residents can “phone a friend” if they get stuck.

Journal club

Journal club is held once a month. Each month a sponsoring faculty picks two or three articles, either classic commentaries from the past or topical current articles. The sponsoring faculty also picks the location, often at an off-campus but nearby restaurant. Residents review the articles and take turns summarizing, critiquing, and presenting them.

Visiting Professor Conference (a.k.a. Grand Rounds)

On the fourth Friday of the month, elective clinical activity is suspended and a half day educational conference takes place. One of the faculty sponsors the event by inviting an established or rising star in national neurosurgery. The visiting professor rounds with the residents on Thursday afternoon. Thursday night, there is a dinner at the Chairman’s house or a nearby restaurant, at which, faculty and residents can interact with the visitor and each other.

On the protected Friday morning, the visiting professor usually gives two talks from their area of expertise. These talks are augmented by local speakers, including on occasion, a select resident. Breakfast and lunch are served.

Approach Courses

On some fourth Fridays, a dissection course is held in the Samson-Clark bioskills lab. This lab, recently renovated courtesy of department philanthropists, has numerous stations for cadaver dissections and other technical exercises. It includes operative microscopes, endoscopes, and video displays. The dissection course is sponsored by a faculty member and a standard or novel operative approach is featured. A resident is selected to give an overview of the approach and then faculty and chief residents spend time with the more junior residents teaching operative anatomy, technical skills and nuances. Both spine and cranial approaches are featured at the discretion of the faculty in charge.

Rotation Specific Conferences

Tumor conference is a working conference held weekly. Residents rotating on the tumor service are expected to come but all residents are welcome to this lunch providing event. The conference is multidisciplinary with representative from pathology, oncology, radiology, radiation oncology, and neurosurgery. Cases are presented and pre- and post-operative imaging are reviewed. Relevant pathology slides are presented and decisions are made about additional management including more surgery, adjuvant chemotherapy, and radiation treatment.

Vascular conference is another multidisciplinary conference attended by the residents rotating on the vascular service and Parkland. Stroke neurology, radiology, and vascular neurosurgery faculty are present. Cases seen in clinic from the prior week are presented and decisions are made about patient management. Residents receive instruction on clinical decision making, surgical and endovascular approaches, and outcomes management.

Spine conference is held weekly and explores the cases coming up in the following weeks. Surgical planning, pre- and post-operative management are explored, and treatment plans are created. Relevant surgical anatomy and instrumentation options are heavily featured.

Epilepsy conference is a practical working conference in which epilepsy neurology, neurosurgery faculty, and the entire team discuss patient management. Diagnostic, medical, and surgical treatments are discussed.

UTSW O’Donnell Brain Institute conferences are head almost daily throughout the week. Residents attend conferences that match their interests, particularly residents on their research rotations. A biannual trainee research day is part of the institute conference schedule and neurosurgery residents with relevant research projects take part in the presentations.

Trauma conference is the backbone of the Parkland trauma rotation. Run by the general surgery trauma team, this conference reviews key trauma cases managed at Parkland, looking for opportunities for improvement and congratulating great saves.

Regional and national Conferences

Conferences regularly attended by residents:

• Texas Association of Neurological Surgeons
• Congress of Neurological Surgeons
• American Association of Neurological Surgeons
• Rocky Mountain Neurosurgical Society