ACGME Core Competencies
SIU Neurosurgery residents are expected to gather data; order diagnostic tests; interpret data; make decisions, perform procedures; manage patient therapies; and to work with others to provide the patient-focused care.
- These skills are developed in didactic lectures sessions, and through participation on the Neurosurgical patient care services at the SIU School of Medicine. The curriculum for this training is outlined in the Society of Neurological Surgeons Matrix curriculum. This curriculum is incorporated into the SIU Neurosurgery Residency Training Program.
- SIU Neurosurgery Residents will be expected to demonstrate a progression in obtaining these clinical skills by achieving the milestones as outlined in the Society of Neurological Surgeons Milestones Project. Achievement of these milestones is evaluated by the Neurosurgery Faculty and also by self-evaluation and evaluations from peers, nurses, mid-level providers and patients.
SIU Neurosurgery Residents are expected to develop a fund of knowledge and to make use of knowledge to solve medical problems.
- This knowledge is to be developed through didactic lecture series, reading of key textbooks and articles, and active participation in clinical situations and laboratory dissections and simulation including computer generated virtual reality.
- This knowledge is assessed and documented by the Neurosurgery Faculty through various assessment tools. The residents participate in the Self-Assessment in Neurological Surgery (SANS) program. SANS: Lifelong Learning is a sophisticated online learning tool published by the Congress of Neurological Surgeons (CNS) for residents and practicing neurosurgeons, and also endorsed by the ABNS for the lifelong learning component of MOC (thus it truly represents a lifelong training and practice continuous improvement tool). The CNS renews 25% of the content each year. Our residents have a free account provided by our program and must complete a full 240 question cycle every 2 years starting with the PGY-2 year. In addition to giving overall first pass answer scores and subset scores in each area, to self-identify knowledge gaps, each question/answer also has a peer-reviewed critique for instruction and additional live web-based learning links for further self-directed study. SANS includes BOTH clinical and non-clinical competency related material. SANS participation/completion is tracked in the residents portfolio – competencies tracking form. Faculty members are also encouraged to participate in the SANS program. As an incentive for good performance for both the faculty and the residents, any resident who scores higher than the average score of the faculty is entitled to a cash award from the faculty.
- Residents knowledge is also assessed through the American Board of Neurological Surgery Part I Written Exam. Each resident is expected to take this exam for practice or credit each year until the exam is passed. Every resident is expected to pass this exam before they can enter the final year as Chief Resident.
Practice Based Learning and Improvement
SIU Neurosurgery Residents are expected to analyze practice performance and carry out needed improvements; locate and apply scientific evidence to the care of patients; critically appraise the scientific literature; use the computer to support learning and patient care; and facilitate the learning of other health care professionals.
- Each resident in the PGY3 year will be expected to participate in a SIU Human Investigations Program. The course is a faculty driven and an onl-line program with full interactive projects and activities, grading, face to face attendance at lectures and small group activities. The course covers informatics, including the location of existing medical evidence, use of information technology to compile, extend and evaluate evidence including meta-analysis, as well as evidence based medicine, including appraising the quality and level of clinical data, assimilating evidence from scientific studies, and applying information to patient care. As part of the course, each resident is expected to design a clinical trial or study that can be carried out in a reasonable amount of time.
- Residents are expected to help track outcomes by contributing to the SIU Neurosurgery Outcome Registry/Database. This prospective registry can be used for either retrospective analysis of outcomes or prospective analysis of outcomes for various clinical questions. This database combines the operative experience in Neurosurgery for both St. John’s Hospital and the Memorial Medical Center. It currently has 3062 patients with 3624 admissions and 3703 surgical procedures, covering the period from January 1, 2009 to the present. This registry is separate and parallel to the resident operative logs.
- The SIU competencies curriculum requires each resident to complete a quality improvement project prior to graduation from the Program. Projects are expected to be directly related to clinical improvement (for example the creation of new care pathways and templates in electronic medical records for order sets for standard neurosurgical procedures/admissions) to indirect patient care improvement through improvements to the educational environment.
- As part of this training, the residents are expected to participate in the GME and Quality Improvement Training Series.
- Residents are expected to achieve the general milestones for Practice-based learning and improvement outlined in the paper by Nasca TJ, Philibert I, Brigham T, Flynn TC. The Next GME Accreditation System – rationale and benefits. NEJM 2012 Feb 22 (Epub ahead of print). They are also expected to achieve the Neurosurgery Milestones recently developed by the Society of Neurological Surgeons.
- PGY1 residents will have explicit communications skills exercises, which give direct, mentored experience with feedback, based on initial didactic instruction as part of the residency conference curriculum. All residents in all years are evaluated using the Clinical Assessment and Management Exam – Outpatient (CAMEO) evaluation tool developed at SIU. This experience is tracked in the clinical and non-clinical competencies portion of the resident portfolio.
- Residents are expected to teach patients and families in the hospital during clinical interactions, present various conferences to faculty and peers (M&M, Neuro-Oncology, Spine conferences, various curriculum conference topics such as board review), teach medical students, and teach and supervise extern rotators visiting our neurosurgical service.
- Communications with families, nurses and peers are evaluated every 3 months with secure, online 360 degree evaluations (New Innovations) and communications/teaching (including presentations) abilities are evaluated by the faculty every 3 months in rotation evaluations (New Innovations). The Program Director reviews all teaching and communication feedback (formal and ad hoc) at each 3-monthly performance evaluation.
- The residents will be expected to be a tutor for bi-weekly two-hour small group problem-based learning (PBL) sessions for 2nd year medical students for a quarter in their PGY-3 year. Each session is composed of 8-10 students where students are presented with a patient scenario and the students are expected to investigate and discuss all aspects of the patient’s problem. The effectiveness of the tutors is a key element in the operation of problem-based learning. A tutor works with a group of six students over the course of a unit, guiding students through the process of learning. Tutors also evaluate and provide feedback to students.
- Education skills are enhanced by periodic "Resident as Teacher" sessions that are presented by Faculty and Guest Speakers and are presented by the SIU School of Medicine. Attendance will be mandatory for all residents in Neurosurgery at the SIU School of Medicine.
- In addition, and most importantly, the senior and Chief residents are expected to be the immediate supervisors and mentors for visiting (and internal) 3rd and 4th year medical students rotating on our service. Our residents are also expected to be intimately involved in the resident recruitment process and faculty-resident selection meetings for the rank list each year. The Chief residents expected to draft all medical student rotation evaluations, which are edited and finalized in conjunction with the Program Director, also giving them some direct feedback in constructive, compliant and respectful evaluations.
Interpersonal and Communication Skills
SIU Neurosurgery Residents are expected to develop a therapeutic relationship with patients and their families; use verbal and non-verbal skills to communicate effectively with patients and their families; and work effectively as a team member or leaders.
- SIU has two educational centers which provide training for residents both across the specialties and in specialty-specific conferences. First, there is the Southern and Central Illinois Advisory Group for Ethics (SAGE) which, in association with the Clinical Ethics Center (CEC) at Memorial Medical Center provides a series of training sessions on effective communication with patients and families across a broad range of socioeconomic and cultural backgrounds. Second, there is the SIU School of Medicine Office of Diversity, Multicultural and Minority Affairs which provides training at all levels in these areas as well. These training activities are incorporated into the Neurosurgery Resident Didactic Conference series and the Department of Surgery Lecture Series.
- Most activities in SIU Neurosurgery are accomplished in the setting of some sort of team. For example, all surgeries for movement disorders require the participation of a team of health care providers including faculty, residents, nurses, mid-level providers, neuropsychologists and social work professionals from Neurosurgery, Neurology, and Psychiatry. Residents are expected to actively participate in this team at all levels of interaction, including conferences where specific care plans for patients are discussed. Communication is within patient care conferences, by electronic medical records and personal communication. These communications occur in the clinic, in the hospital, in the operating room and in the conference room. The ultimate responsibility for decisions is always between the patient (and the patient’s family) and the appropriate attending physician.
- Other, similar team activities occur with the Epilepsy Team, Neurovascular team, Neuro-Oncology Team, etc.
- Residents are trained in electronic medical record (EMR) use at both hospitals and in the clinics before the start of the PGY-1 year. Both hospitals have separate distinct EMR systems and both will be paperless by 2013. The SIU Clinics and the Springfield Clinic also have comprehensive EMR systems and are both paperless at the present time.
- Both hospitals and both clinics have all diagnostic images on a PACS system. Both hospitals have extensive communication networks with all hospitals within a 200 mile radius of Springfield where images can be transported electronically between patient care centers for immediate review by the neurosurgery faculty and residents.
- Both hospitals and both clinics will track the completion of all major clinical reports, such as operative notes, order signatures, and other EMR components, with direct report in real time of deficiencies to the Program Director. Excessive delinquency or other deficiencies will result in warnings and then (rarely) residents will be removed from clinical duties until the deficiencies can be corrected. All records are timed and legible by definition as part of each EMR system. Failure to correct dictation errors/uninterpretability as requested automatically within the system is also tracked and remediated.
SIU Neurosurgery Residents are expected to demonstrate integrity and honesty; accept responsibility; act in the best interest of the patient; and demonstrate sensitivity to patients’ ethnicity, age and disabilities.
- Every month, one of the weekly Neurosurgery conferences will focus on an “interesting case” where management decisions are complicated by ethical or moral dilemma(s). These cases are chosen and presented by the residents and will include an extensive discussion of the ethical and moral issues involved. The faculty member(s) associated with each case will also discuss these issues. Input and interaction to and from the resident with the Clinical Ethics team from the involved hospital is greatly encouraged and will also be discussed in these presentations.
- The Neurosurgery conference curriculum addresses various topics relevant to professionalism (risk management, appropriate billing and coding, mock oral boards, etc). Professionalism and mentored supervision are explicit topics at the inception of training as part of the Society of Neurological Surgeons PGY-1 Boot Camp Courses, which all SIU PGY1 Neurosurgery Residents are required to attend. It is also covered by SIU core curriculum for PGY-1 residents in the Department of Surgery.
- Additionally, throughout residency, the residents are required to perform and are evaluated on numerous activities relevant to professionalism, including conference and M&M presentations, the monthly ethics case presentations, leadership service during Chief residency, etc. Professionalism is explicitly evaluated by the faculty for each resident every 6 months as part of the competency-based online secure summative evaluations, and reviewed by the Program Director with the resident privately at 6 monthly performance evaluations. Other components of the residency training also address issues of professionalism, for example proper handling of data and attribution in research and medical publishing, covered in the Human Investigations Program and in individual publishing projects of the clinical and basic science faculty with residents.
- Professional development is additionally supported by attendance by all SIU Neurosurgery residents at the Society of Neurological Surgeons Research and Update in Neurosurgery and Neuroscience (RUNN) course in Woods Hole, during the PGY3 year.
- The faculty of SIU is expected to attend an AANS Coding and Reimbursement course in the first year as a new faculty member and at least every four years after that. Professionalism and participation in local and antional organizations is encouraged.
- Violations of SIU Neurosurgery and Department of Surgery policies relevant to professionalism, including comportment, presentation, accurate and compliant duty hours, timely medical record and residency record keeping, attendance, competencies curriculum completion, etc, are monitored by the Program Director and Coordinator. Professional behavior in the clinical setting is monitored by faculty, mid-levels, nurses and peers using New Innovations online evaluations. Positive and negative feedback by patients and others, patient/family surveys, patient/family letters, clinical risk system reports, etc, is monitored by the Program Director. Poor performance in professionalism is discussed with the resident by the Program Director at 6 monthly performance evaluations or ad hoc as needed between evaluations. Repeat or serious transgressions/deficiencies are discussed by the residency advisory committee and a written remediation plan required, generally in consultation with and with the support of specialists available to SIU GME (for professionalism and communications skills, counseling, test taking skills, etc.). The Program Director monitors all formal remediation or probation plans with reports to the RAC, and as needed the DIO. The Program complies with all SIU GME and SIU School of Medicine institutional policies with regards to remediation, probation, and disciplinary action or termination.
- Violations of policies relevant to professionalism by faculty are reported to the relevant division.
- Some issues may be immediately reviewed with an individual faculty member by the relevant Division Head and/or the Department Chair, or overall performance regarding professionalism reviewed at annual performance evaluations. Professionalism in resident teaching is tracked in resident confidential (New Innovations) teaching evaluations for each faculty member, and this data reviewed by the Program Director at the Residency Advisory Committee meeting each six months and also included as relevant in summative evaluations of faculty teaching that are formulated by the Program Director and used by the Chair in annual faculty performance evaluations.
SIU Neurosurgery Residents are expected to demonstrate awareness of interdependencies in the health care system that affect quality of care; provide cost-effective care; advocate for quality patient care; and work with hospital management and interdisciplinary teams to improve patient care.
- The SIU competencies curriculum requires each resident to complete a quality improvement project prior to graduation from the Program. These projects can include an analysis of health care systems that can adversely affect patient outcomes, including problematic devices, architecture, design and processes. Training in analysis of adverse events through root-cause analysis is stressed in didactic teaching and whenever possible in morbidity and mortality discussions.
- Residents will also be required to participate in hospital or medical school committees that review issues of health care value, weighing cost-containment verses patient health outcome measures. Residents are expected to help track outcomes by contributing to the SIU Neurosurgery Outcome Registry/Database.
- As part of this training, the residents are expected to participate in the GME and Quality Improvement Training Series.
- Residents are expected to achieve the general milestones for Systems-based practice outlined in the paper by Nasca TJ, Philibert I, Brigham T, Flynn TC. The Next GME Accreditation System – rationale and benefits. NEJM 2012 Feb 22 (Epub ahead of print) and also the specific milestones for systems-based practice outlined by the Society of Neurological Surgeons Milestones Project.
- Residents will be required to participate in hospital or medical school committees that review issues of health care value, weighing cost-containment verses patient health outcome measures. Residents are expected to help track outcomes by contributing to the SIU Neurosurgery Outcome Registry/Database and use these outcomes as well as outcome measures tracked by the hospitals and other organizations that track health care quality measures.