The Methodist Neurological Institute
Neurosurgery is an integral part of The Methodist Hospital Neurological Institute. The Institute has a staff of 16 neurosurgeons, 2 neuro-oncologists, 3 neuro-intensivists, 14 neurologists, 9 neuroradiologists, 2 neuropathologists, 6 physiatrists, 1 neuro-ophthalmologist, 2 psychiatrists, and 5 neuroscientists. There were over 4,000 operative cases, including radiosurgery and interventional neuroradiology.
PROGRAM DESCRIPTION
The Neurosurgery residency develops neurosurgeons for academic and for practice careers. The residency is seven years in length, including the PGY-1 year.
PGY-1
Due to the change in ACGME program requirements for neurosurgery, the PGY1 year of fundamental skills is now integrated into the neurosurgery program under the leadership and direction of the neurosurgery program director. The year is spent in rotations in Anesthesiology, ENT, General Surgery, Orthopedic Surgery, Plastic Surgery, Surgical Critical Care, Neuro-Ophthalmology, Neuro Intensive Care, Trauma, and three months of Neurosurgery.
PGY-2
The first full year of Neurosurgery is one of rapid learning of the basics of neurosurgical disease, of operative anatomy and technique, and of patient care.
During the year the resident will perform ventriculostomies, place lumbar drains, open and close craniotomies, perform peripheral nerve explorations, and perform decompressive cervical and lumbar laminectomies and discectomies.
The resident is responsible for the care of patients in the neurosurgical intensive care unit under the direction of neuro-intensivists, Anakara V. Sukumaran, MD, Michael E. Zwillman, MD, and Eric A. Bedell, MD.
By the end of this year, the resident will have experience with the full range of neurosurgical procedures and will be competent to manage critically ill patients.
PGY-3
The year is divided into 4 blocks of three months each, in which competence is gained in the neurosciences on which Neurosurgery depends for making diagnostic and therapeutic decisions.
The rotation in neurology refines the resident’s history-taking and physical examination skills. Experience is gained with electrodiagnostic methods including electroencephalography.
On neuropathology the resident performs the initial reading of frozen and permanent sections and participates in brain cutting. The resident works closely with Dr. Suzanne Powell, Director of Neuropathology, and learns contemporary preparation and interpretation of neuropathological material.
On neuroradiology the resident works closely with Dr. Hani Haykal, Director of the Service, Dr. Richard Klucznik, Director of Interventional Neuroradiology, and the 7 other neuroradiologists. The resident participates in the daily reading of imaging studies.
The resident also participates in diagnostic and therapeutic studies including myelograms, kyphoplasties, vertebroplasties, angiography, and interventional endovascular procedures.
On neuro-ophthalmology, the resident learns the intricacies of the neurological eye examination, and the variety of ways in which CNS disease involves the ophthalmic system. The resident works closely with Andrew Lee, M.D., a neuro-ophthalmologist with extensive training and experience.
During this year the resident takes the Microsurgery Course at TMH, which provides excellent experience in microsurgery of vessels and nerves.
PGY-4
The PGY4 resident performs more advanced procedures and assumes more administrative responsibility. By the end of this year the resident is able to be the primary surgeon on most neurosurgical procedures.
PGY-5 - Research Year
The research year is dedicated to laboratory or to clinical research. The resident can work in one of the department’s laboratories or elsewhere.
Residents working with our faculty have been able to complete research projects in the areas of intracranial pressure and blood flow monitoring, ischemia protection, brain tumor biology and treatment, and gene therapy for brain tumors. Support is available for study design, biostatistics, and manuscript presentation.
PGY-6
The year is dedicated to gaining greater experience with Neurosurgical subspecialties.
The resident spends 4 months on the Pediatric Neurosurgical service at Texas Children’s Hospital in Houston, or, because of our affiliation with the Weill Cornell College of Medicine, on the Pediatric Neurosurgical service at Weill College of Medicine of Cornell University Hospital at New York-Presbyterian Hospital. The rotation at New York Presbyterian Hospital is an option that can be selected by the resident.
Enfolded subspecialty experiences at TMH are taken in two 4-month blocks. Experience is available in the following subspecialties:
- vascular
- brain tumors
- radiosurgery
- complex spine
- stereotactic and functional
- epilepsy
- interventional neuroradiology
PGY-7 Chief Resident
The chief resident performs all major surgery with the supervision of the attending staff.
The Chief Resident also has responsibility for :
- supervising senior and junior residents and medical students
- scheduling all activities of the Neurosurgical Service
- organizing clinical and basic material presented at conferences, including tracking and presentation of morbidity and mortality data, and selection of articles for presentation at Journal Club.
EDUCATION
Scheduled Conferences and Teaching Rounds
TMH Neurological Institute (Neurosurgery-Neurology-Neuroradiology) Grand Rounds present the latest information about the nervous system and neurological disorders. It is also a venue for presentations by visiting professors. Grand Rounds are held on Fridays at noon in the Blue Bird Auditorium. Lunch is served.
TMH Radiosurgery Conference for Neurosurgery and Radiation Oncology faculty and residents. All patients undergoing radiosurgery are discussed at this conference. The conference is held on Mondays at 7 a.m. in the Blackwell Library of the Methodist Radiology Department.
TMH Neurosurgery Didactic Teaching Conference systematically reviews the anatomy, physiology and surgical techniques that are used in neurosurgical practice. The initial sessions focus on demonstrations and teaching in the operating room, proper use of instruments and the operating microscope, and positioning of patients. Later sessions cover specific surgical techniques and neurosurgical disorders. This conference is held in the Neurosurgery Library adjacent to the TMH NICU every Wednesday at 7 a.m.
TMH Neurosurgery Grand Rounds are held in the Comal Room of the TMH Conference Center on the first floor of the hospital, convenient to the NICU, patient floor, operating rooms, and Neuroradiology. The Grand Round cycle monthly through the following topics:
1st Friday: Case Presentations and Literature Review
At least three recent cases are presented. A resident presents the patient’s history, radiological findings, and pathological findings, if the patient had surgery. Literature on the condition being presented is then critically reviewed. The residents and faculty question the presenting resident and provide additional information and insight. The style and format of these Grand Rounds is similar to that used in the oral examinations of the American Board of Neurological Surgery (ABNS). This method of education teaches the residents to think critically and concisely about operative approaches and medical management of their patients.
2nd Friday: Morbidity and Mortality Conference
This conference critically reviews all significant morbidity and deaths that occurred in the previous month. The history, protocols, therapeutic approach, x-rays, and pathological material are used to understand the prevention of complications and deaths.
3rd Friday: Tumor Board
Presented by Dr. Pamela New and Dr. Yvonne Kew, Neuro-Oncologists, the Tumor Board is attended by Neurosurgery, Radiation Oncology, and Neuropathology. At least three cases are presented, which are often of a particular type of tumor, and the differences in the behavior and response to treatment of the tumor are highlighted for each patient. The literature on treatment is reviewed.
4th Friday: Journal Club
The chief resident, in cooperation with the faculty, chooses recent articles from the literature for a resident and faculty member to review and to discuss critically. Four papers are usually discussed in an hour.
Intensive Care Teaching Rounds
Neuro-Intensive Care Daily Rounds are conducted by Dr. Anakara Sukumaran, Dr. Michael Zwillman, and Dr. Eric Bedell in the 16-bed neurosurgical intensive care unit.
FACILITIES
Inpatient
The Neurosurgery Service has six operating rooms that are in daily use. All craniotomy and major spine surgery patients are admitted to the 16-bed neurosurgical intensive care unit (NICU).
Private sleeping accommodations for the on-call resident are located adjacent to the NICU. The residents’ in-hospital workroom and library is located next to the NICU. PACS system radiographic images are available on-line throughout the hospital, including the NICU, ER, and operating rooms. PACS images can also be viewed from outside the hospital via the Internet.
Outpatient
The outpatient facilities are located on the 9th floor of the Scurlock Tower, which is connected via crosswalk to The Methodist Hospital. The academic offices and outpatient facilities of the Departments of Neurosurgery and Neurology are adjacent to each other. The neurosurgery clinic is approximately 6,000 square feet. The academic offices are approximately 8,000 square feet and include offices for the faculty and their staff, administrative offices, and a large conference room/library.
Equipment
Computerized monitoring and charting is available in the intensive care units and on the floors. In addition three-dimensional reconstruction of angiography, image-guided stereotactic surgery, endovascular surgery, stereotactic radiosurgery, and neurophysiologic monitoring are used in the care of neurosurgical patients.
Computers and workspace are available to each resident within the academic offices on Scurlock Tower 9. In addition, a library is available with the most useful text and reference books.
Research
The Department currently has 3,000 square feet of laboratory space for molecular biology and experimental surgery. The laboratory contains: wet lab space, a fully-equipped experimental animal surgery operating room that can accommodate small and large animals, cell culture facilities including BLT 2 hoods, and facilities for florescent microscopy.
On Call Requirements
The Methodist Hospital provides excellent patient care support including Physician Assistants and Neuro-intensivists who are available 24 hours a day, seven days a week. Time on call is therefore appropriately limited to evaluation and treatment of patients. Call is no more than once every fourth night.
APPLICATION INFORMATION
The program accepts one resident per year. Our program utilizes the National Resident Matching Program (NRMP) and the Electronic Residency Application Service (ERAS) for the matching process. Applicants must register with both NRMP and ERAS to participate in the services of both. Please see these websites for instructions: www.nrmp.org and (www.aamc.org/students/eras)
Application Requirements:
Residency applications and the items below must be submitted through ERAS:
- Medical school academic transcript
- Dean’s letter
- Curriculum vitae
- USMLE Scores
- Four letters of recommendation
- Personal statement
Time Table: Applicants are encouraged to have their application, prepared through ERAS, completed to begin applying on September 1, 2009. This will allow our residency selection committee to review their application in October.
- Application receipt deadline is October 16, 2009.
- Interviews are by invitation only. If you have been selected for interview, you will be contacted by email through the ERAS system.
- 2009-2010 Interview Dates (Interview day begins at 7 a.m. on Friday and concludes with dinner with the residents Friday evening):
- October 30, 2009
- November 20, 2009
- December 11, 2009
- January 22, 2010
The Program Director, David S. Baskin, M.D. (dbaskin@tmhs.org) and the Chair of the Department and of the Institute, Robert G. Grossman, M.D. (rgrossman@tmhs.org), welcome your inquiries.
Elective Rotations:
Applicants wishing to do an elective prior to the interview season are required to complete the Rotating Learner Application Packet available from the Graduate Medical Education office. They should contact the residency coordinator, Angela Patrick, at ampatrick@tmhs.org or by phone at 713 441-3696 to check date availability.
Official Health Care Provider of:
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