Intern (PGY-1)

The Intern (PGY-1) year consists of the following rotations:

  • Neurosurgery (6 months)
  • 1 Month Rotations in Related Specialties (3 months)
  • Critical Care (3 months)

The PGY-1 year is structured so that the Intern is exposed to various services (noted above) to develop skills in general inpatient management, gain an understanding of the function and daily operations of those services in addition to the operations and functions of ULH.  Under the guidance of related departments, interns will spend 1 month in neuro-oncology, one month in neuroradiology, and 1 month in neuro-otology.In addition, a three-month rotation in Critical Care is required, where the resident develops skills in general inpatient management, gains an understanding of the function and daily operations of the service, and acquires skills in specific areas that are pertinent to neurosurgical practice. The remaining six months are spent on the neurosurgical service. During this time, the intern will also learn bedside procedures including external ventricular drain and lumbar drain placement.

Junior Resident (PGY-2)

The PGY-2 year is spent at the main University of Louisville Hospital as the junior resident on services including trauma, neuro-oncology, and vascular/endovascular. The PGY-2 year offers intense exposure to inpatient management, especially of acutely ill patients, including emergency inpatient consults. Junior residents are supervised by the Chief Resident and receive direct operative mentorship from faculty throughout the PGY-2 year. During this time, residents should be able to perform all bedside procedures and will participate in surgery for patients they have worked up.

Senior Resident (PGY-3)

The PGY-3 year is structured as a clinical neuroscience year, which includes three months of pediatric neurosurgery at Norton Children's Hospital where they will typically be the sole neurosurgery resident on service. There are three month rotations in neuro-oncology and three months of endovascular at University Hospital, serving as the mid-level resident. The final three month rotation is with the UofL Hospital trauma service where they are the upper-level resident. These rotations aid the resident’s transition to acting as an independently functioning chief level resident. At intervals throughout this year, the resident will work with a faculty mentor to choose and plan a research project, developing a formal research proposal to be pursued in the upcoming PGY-4 year devoted to research.


Senior Resident (PGY-4)

The year will be spent devoted to intense research. There are no formal daytime clinical responsibilities and greatly reduced night call expectations. The resident will work with a faculty research mentor throughout the year.  The PGY-4 resident is expected to pass the American Board of Neurological Surgery Preliminary Exam for self-assessment prior to their PGY-4 year, and he or she will be expected to pass for credit during the PGY-4 year.  


Senior Resident (PGY-5)

Beginning in PGY-5, residents serve as the senior most resident team member on service. They will spend the year on complex and minimally-invasive spine, neuro-oncology, vascular/endovascular neurosurgery, and functional services. There is a focus on surgical technical skill development as well as management decision making during this year.  

Administrative Chief Resident (PGY-6)

During PGY-6, residents become “Chief Residents” of the program. The year is intensely focused on operative and management skills, including leading the team and supervising the resident interaction with other services.  Academic and administrative responsibilities are divided and managed in turn between the PGY-6 residents. The two PGY-6 residents will typically each serve as Academic and Administrative Chief in rotations of 6 months. They will interact as needed to optimize the overall functioning of the service. 

The Administrative Chief duties include the primary responsibility of the day-to-day operation of the University of Louisville Hospital and Jewish Hospital service, dividing up the resident work load as equitably as possible. They will assume the highest clinical and operative duties as well as a significant amount of administrative duties including day-to-day operations of the neurosurgical clinical services, supervision of the Junior and Senior residents as well as rotating residents and medical students, and assignments of residents to the operating rooms and other procedures. With oversight by the program director, the Chief Resident also assigns resident coverage for the clinics, in-house call, and vacation schedules.

The PGY-6 year will also provide an opportunity to finely tune operative skills and provide oversight for the entire management of the patient population on the service, utilizing the consultative opportunities provided by the attending staff, and allied clinical services.   

Chief residents will be able to assume total care of any patient with any neurosurgical problem and to establish the foundation of a career in either academic or community-based practice. In addition, the PGY-6 will be able to do the following: counsel and educate patients and their families; use technology to support their own education; facilitate the learning of students and other health care professionals; work effectively with others as the leader of a health care team; demonstrate sensitivity and responsiveness to patients’ culture, age, gender, and disabilities; and assist patients in dealing with health care system complexities.

The Academic Chief responsibilities include:

  • Coordination of Didactics:
    • Topic selection and scheduling in conjunction with faculty oversight
    • Assignment of presentations to residents
  • Teaching/coordination assistance with cadaver labs
  • New Intern/Resident integration
    • Bedside teaching/mentoring to help new residents become familiar with routines and standards of the neurosurgery service in the various locations we staff
    • Didactic presentations to familiarize residents with knowledge and concepts critical to effective participation in the service
  • Encouragement of academic engagement
    • Maintaining a list of available courses and conferences and encouraging resident attendance/participation throughout their training
    • Coordinating with the Administrative Chief to facilitate resident participation in conferences and courses, and presentation of research/results of academic productivity
  • Logistical support and availability for Senior residents
    • Participation in the senior call pool as needed to prevent excessive strain on senior resident
    • Maintain availability to staff emergent/major cases when Chief/Senior residents are unavailable

Upon the completion of the PGY-6 year, the resident should be able to manage the full spectrum of neurological disease and to understand the mechanisms of supervision at every level of resident education.

Transition to Practice (PGY-7)

During this year, each resident is given the opportunity to round out their education, developing skills valuable to their upcoming practice.  Residents planning to stay in academic practice may choose to include time to develop teaching skills and grant writing skills related to an area of thematic research. Some may choose to devote this year to an enfolded fellowship in a subspecialty area. Thus, each PGY-7 year will vary based on the interests and future plans of the resident. By February of PGY-6, each resident should create a proposal that details where their professional interests lie and a 12 month schedule that meets those interests. The Program Director and faculty members will meet with each resident to create a plan that supports these interests and prepares the resident for upcoming success as an independent practitioner.