12 months, Neurosurgery Internship
24 months, Junior Residency
12 months, Senior Residency*
18 months, Protected Research time*
6 months, International Elective in Ireland
12 months, Chief Residency
*Residents have the option of participating in a 24-month Expanded Investigator Track from January of PGY-4 year to December of PGY-6 year. Residents in this track will maintain the Ireland Elective.
- This is accomplished by incorporating “standard” PGY-2 to PGY-4 research rotations into 24 months of continuous research time and reducing several clinical rotations.
- Residents submit formal research proposal to participate in this track during PGY-2 year.
- Residents do not match into this program as an applicant.
Residency Educational Program
Residents at the PGY-1 level spend three months completing their neurology requirements for the ABNS. The remaining nine months are split between rotations on neurosurgery, cardiothoracic intensive care unit, surgical intensive care unit, emergency department, otolaryngology, and neuropathology/radiology.
PGY-1 residents are expected to be able to perform a history and physical exam, order medication and diagnostic tests, collect and analyze test results and communicate these results to the members of the team and faculty. The PGY-1 resident is also expected to learn to obtain informed consent, assist in the operating room and perform invasive procedures such as central line placement, Swan Ganz catheter placement, chest tube placement, ICP monitor and ventriculostomy placement under the supervision of the faculty or senior residents at the discretion of the responsible faculty member. At the completion of the PGY-1 year, the resident should understand enough of the basics of neurosurgery to be able to begin seeing consults and managing patients as a junior resident at the beginning of the PGY-2 residency year.
Residents at the PGY-2 level are considered “junior residents” on the neurosurgical service. They cover the five adult services (Dacey/Dowling/Zipfel/Hawasli, Chicoine/Rich, Ray/Kim/Osbun, Wright/Santiago, and Dorward/Dunn/Leuthardt), and they cover three months of “night float.” Residents focus on vascular neurosurgery, neuro-oncology, complex spine surgery, functional neurosurgery, epilepsy, and endovascular neurosurgery. Residents will also learn the fundamentals of frame-based and frameless stereotaxis, gamma Knife neurosurgery during this first year of neurosurgical training. Extensive experience is gained taking care of critically ill neurosurgical patients. When covering the “night float” rotation, junior residents work from 6 p.m. to 6 a.m., six nights per week, seeing consultations in the Emergency Department and the hospital, and managing the entire inpatient service. Residents operate as first assist to faculty as well as under the supervision of the neurosurgical chief residents and senior residents during this year.
During the PGY-3 neurosurgical year, residents are considered “junior residents.” Residents spend six months rotating on each the three chief-led services at Barnes-Jewish Hospital, four months at St. Louis Children’s Hospital under the supervision of a senior resident, and two months rotating on the neuropathology and neuroradiology services. The resident works under the direct supervision of the chief resident, but he or she is given increasing autonomy in patient care as well as in the operating room.
Read more: A Year in Perspective from a PGY-3
Residents at the PGY-4 level are considered “senior residents.” As seniors, the residents spend four months at St. Louis Children’s Hospital where they are responsible for their own service and eight months at Barnes-Jewish Hospital on a chief-led service. The senior residents are expected to function as first assistants in the operating room with their attending surgeons.
At St. Louis Children’s Hospital, the senior resident is responsible for managing the pediatric neurosurgical service. The resident works in concert with a pediatric neurosurgery fellow and a team of nurse practitioners and physician assistants to see patients on the ward and in the clinics and maintain a busy operative schedule.
A PGY-4 resident is expected to begin to develop clinical and research interests, with projects initiated with various members of the departmental staff. He or she is expected to prepare research for presentation at national meetings and to begin to plan for his or her time in the laboratory beginning in the PGY-5 year.
Read more: A Year in Perspective from a PGY-4
Joint Neurosurgery and Otolaryngology Skull Base Course.
PGY-5 and PGY-6:
The PGY-5 and -6 years are spent in the research laboratory. The experiences available to residents are many and varied. While spending time in the laboratory, the resident is expected to continue his or her didactic education. The resident is a frequent participator in neurosurgical conferences, further augmenting his or her academic development.
During the research years, six months of time are spent as a senior registrar on the neurosurgical service at Beaumont Hospital in Dublin, Ireland. This experience is an excellent precursor to the resident’s chief residency experience.
*Residents have the opportunity to participate in a 24-month Expanded Investigator Track from January of their PGY-4 year through December of their PGY-6 year. This is accomplished by incorporating “standard” PGY2-4 research rotations into 24-months of continuous research time and reducing several clinical rotations. Residents submit formal research proposal to participate in this Track during PGY-2 year. Residents do not match into this program as an applicant. Residents in this track are still able to spend 6 months in Ireland.
Chief Residency Year (PGY-7):
During the chief residency year, the PGY-7 resident functions as the primary physician responsible for the management of the adult neurosurgical services. The chief resident should be able to perform most complex and high-risk procedures expected of a neurosurgeon independently or with the assistance of the attending surgeon. These procedures include complex spinal instrumentation, aneurysm clipping, removal of intra- and extra-axial neoplasms, temporal lobectomy and carotid endarterectomy. The chief resident should be able to manage the neurosurgical patient from the clinic or the emergency department, with an understanding of the differential diagnosis and treatment plan for even the most complex neurosurgical and neurological problems. He or she functions under the direct supervision of the neurosurgery faculty, but by the completion of the chief residency year, the PGY-7 resident should begin to feel comfortable practicing and operating independently, transitioning to either a subspecialty fellowship training environment or to independent practice.
Read more: A Year in Perspective from a PGY-7