Program Structure

Educational Responsibilities

The TRAINEE

• The major responsibility for the learning aspects of the training program rests with the trainee. His objective is to become an independent, competent neurosurgeon. His responsibilities are to develop and practice the skills of self-learning which will lead him to independence from his teachers.
• The accumulation of knowledge in both basic and clinical sciences is the responsibility of the trainee. The trainee to plan his study in a disciplined fashion, outlining for himself topics and appropriate material to review, spread comprehensively over the period of his training. This should include a study of basic textbooks, a review of the classical liturature, review of articles on major topics, and current journal reviews.
• The cognitive skills of analysis and problem-solving, clinical judgement and decision-making are learned through the development of careful system of analysis. It is suggested that each trainee develop of himself a system which takes into consideration:
  • the anatomical diagnosis;
  • a clinical diagnosis;
  • the indications and alternatives for confirmatory investigation, the expected results, and interpretation of same;
  • a carefuls analysis of the differential diagnosis;
  • a provisional diagnosis;
  • a statement of the natural history of the condition;
  • a critical analysis of the treatment alternatives;
  • a plan for action.
• Technical skills are learned under supervision and practiced repetitively to perfection. The aspects of operating skills include:
  • Cognitive Aspects: The traniee comes to the operating room prepared with an operative plan. He knows his surgical anatomy and on the basis of his reading or previous experience condenses the operation into definable steps. He anticipates areas of difficulty and has defined the acceptable end results. Problems are recognized and possible solutions analyzed and he becomes proficient at dealing with technical difficulties and mechanical problems.
  • Psychomotor Aspects: A superior trainee is dexterous and uses sharp dissection precisely. He follows each step in sequences and procees confidently. He selects and uses the intruments correctly. He develops a good three dimensional perception in and out of the wound and under magnification has learned to use visual feedback. His actions are time and motion efficient.
  • Affective Aspects: He is confident and secure and maintains his performance in the face of frustration, technical difficulties, and disagreement. He incorporates suggestions into his actions. He involves assistants in the case and is polite and professional with the operating room staff.
• Patient -related skils are learned from day to day interaction. It is suggested that in discussing patients' illnesses with them, that the trainee develop a specific pattern which would include:
  • a clear statement of the diagnosis;
  • a natural history of the disease and prognosis;
  • the recommended treatment and influence on natural history;
  • the expected results;
  • the risks involved in the treament;
  • consideration of the patient as a person in crisis seeking help; the physician must respect his anxiety, questions, dignity, and hopes.
• The trainee's knowledge-base, cognitive, technical, and patient-relational skills are continuously monitored, evaluated, critiqued and upgraded in both formal and informal means throughout the residency. This is accomplished by the structure of the training program (rounds, didactic sessions, journal club, etc.) and the guidance of the attending staff.

The Staff Neurosurgeon

• The responsibilities of the attending neurosurgical staff in the program are to assist the trainee to achieve a competent state of independence in the practice of neurosurgery. This can be done by giving guidance in reading and studying, by supervising and demanding excellence in data gathering skills, by supervising the trainee's development of a system of analysis and decision making, and in supervising and teaching technical skills. The staff to provide regular positive and constructive feedback of the trainee by coordinating and participating in seminars, by giving guidance in topics of priority, and from time-to-time providing references and pertinent articles for review so as to stimulate resident reading. The training system can best be described as a mentor/apprentice relationship between student and teacher. It has been clearly shown that the relationship and interaction between student and teacher is the most important single element in the training process.
• There are several aspects in the developement of this relationship.
  • Repeated and frequent exposure and interaction between staff and trainees.
  • A relationship which is characterized by trust and respect.
  • Expectations and demand for excellence on both parties.
  • An attitude and activity of contructive input into each others' performance.
  • An understanding that both staff and trainees are integral to the program and share the same objectives and aims.

Training Program Description

Course Structure and Duration

• Training program shall be on a full-time basis.
• The course shall consist of Part A and Part B.
• The program shall be completed in a minimum of 48 months and a maximum of 96 months.
• The program shall be a 4 year core course in clinical neurosurgery, with rotations in neuroscience disciplines.
• Each candidate shall be required to undertake research leading to writing a dissertation.
• The research theme shall be within the area of Neurosurgery and Neurosciences, and will be agreed upon between the candidate and the Affiliate Site Director. The project research and report preparation shall be during the clinical neurosurgical training period.
• Training shall be through lectures, tutorials, clinical work, clinical teaching and seminars.
• Graduates are expected to obtain FCS ECSA (Neuro) certification to be able to practice independently as specialists. A candidate who fails to satisfy the examiners in the Fellowship examiniation may be allowed to re-sit once at a period to be determined by the NSTP-ECSA Training Committee of COSECSA. Failure to pass in a re-sit examination will require re-entry of the full year.

Curriculum Outline

• Year 1
  • To include neuroradiology - 3 months
  • To include neuropathology - 3 months
  • To include neurology - 3 months
  • Part A Examination
• Years 2, 3, 4 Clinical Neurosurgery
  • To include pediatric neurosurgery, spinal surgery, cerebrovascular surgery, skull base surgery, neurosurgical oncology, neurotrauma, surgery of peripheral nervous system, stereotactic and functional neurosurgery, pain management
  • Part B Examination. FCS ECSA (Neuro)
  • Dissertation - submission 3 months prior to sitting the final fellowship examination
• Rotations will be planned and assisgned at the discretion of the NSTP-ECSA Training Committe of COSECSA Council.
• Examination Regulations
  • Examination at the end of each part.
  • Must score more than 50% in each subject.
  • Permitted to sit the failed examination within a period determined by the NSTP-ECSA Training Committee of COSECSA.
  • A candidate cannot repeat a course or re-sit an examination more than twice.

Training Expectations

• Organized teaching sessions and learning times will be developed by each training site. Trainees to rotate at the discretion of the NSTP- ECSA Training Committee of COSECSA Council to any or all of the training sites with emphasis and designation dependent upon the trainees' educational requirements, not upon the service requirements of the institution. Advanced teaching schedules and plans at each teaching site will be developed in cooperation with the NSTP-ECSA Training Committee. Detailed summaries of teaching activities will be submitted by the site director to the NSTP-ECSA Training Committee on a quarterly basis.
• Visiting professors in neurosurgery will be invited on a regular basis as the opportunity presents. The visiting professor will be provided with the opportunity to present educational material at lectures, rounds, or seminars as he wishes. The trainees are expected to participate in these academic events.
• The trainees are expected to contribute to the scientific basis of neurosurgery. To this end it is expected that each trainee participate in a research project and write a dissertation.
• It is expected that a trainee will prepare a minimum of one paper or article suitable for presentation at a scientific meeting in each year of his training. This work should be presented at a local or regional scientific meeting. It is expected that the candidate will publish one paper during the course of training. The trainees will be supported to attend an educational meeting under the following guidelines:
  • That they prepare and present a paper.
  • That the paper has a co-author, one of the neurosurgical attending staff.
  • That there is an intent to publish the paper.
  • That the presentation of the paper will be supported only once.
  • That they are expected to attend as many academic sessions as they can while at meeting.
  • They are expected to attend social activities in order to meet and interact with peers and snior and accomplished participants.
• It is expected that they program director and participating staff will ensure that the service to education ratio is kept in balance and that there will be time protected for the trainee to engage in adequate study, clinical research, and publication and personal interest.
• It is expected that there will be time available for clinical teaching with emphasis on case presentation and finding, differential diagnosis, natural history, investigative options, and treatment alternatives.