THE RESIDENCY REVIEW COMMITTEE FOR NEUROLOGICAL SURGERY

THE RESIDENCY REVIEW COMMITTEE FOR NEUROLOGICAL SURGERY515 N State, Ste 2000, Chicago, IL 60610 (312) 755-5000 www.acgme.org

FOR CONTINUED ACCREDITATION

GENERAL INSTRUCTIONS

REVIEW OF AN ACCREDITED PROGRAM OR RE-ACCREDIATION OF A PROGRAM: If the Program Information Form (PIF) is being completed for a currently accredited program, follow the provided instructions to create the correct form. Go to the Accreditation Data System found on the ACGME home page (www.acgme.org) under Data Collection Systems. Using your previously assigned User ID and password, proceed to the PIF Preparation section on the left hand menu and update the Common PIF data. Most data are updated through annual updates, but some information is required at the time of site visit only. Once the data entry is complete, select Generate PIF to review and print the Common PIF (PDF).

Once the Common PIF is complete, proceed to the appropriate Residency Review Committee webpage to retrieve the Specialty Specific PIF for CONTINUED ACCREDITATION. Once the forms are complete, enter page numbers for the Continued PIF in the bottom right for each page that consecutively follows the Common PIF numbering, combine the Common PIF and the Continued Accreditation PIF and complete the Table of Contents (found with the Specialty Specific PIF instructions). After completing the PIF/documents, make four copies. They must be identical and final. Draft copies are not acceptable. The forms should be submitted bound by either sturdy rubber bands or binder clips. Do not place the forms in covers such as two or three ring binders, spiral bound notebooks, or any other form of binding. Mail one set of the completed forms to the site visitor at least 14 working days before the site visit. The remaining three sets should be provided to the site visitor on the day of the visit.

Review the Program Requirements for Residency Education in Neurological Surgery. The Program Requirements or the Institutional Requirements may be downloaded from the ACGME website (www.acgme.org):

For word processing questions/problems regarding:

-the completion of the form (content), contact the Accreditation Administrator.

-the Accreditation Data System, email [email protected].

For a glossary of terms, use the following link – http://www.acgme.org/acWebsite/GME_info/gme_glossary.asp

The program director is responsible for the accuracy of the information supplied in this form and must sign it. It must also be signed by the designated institutional official of the sponsoring institution.

SPECIALTY SPECIFIC INSTRUCTIONS

Instructions have been provided at the top of each form. Please read them carefully before providing information. Please note that only these forms are to be used for supplying information and surgical statistics and only requested information is to be attached. The information being submitted should be as concise as possible. Do not attach any unnecessary materials such as curriculum vitae, reprints, brochures, annual reports, minutes of meetings, etc. The RRC will not review unsolicited preprinted materials.

This form is designed so that all information regarding intramural or multi-site programs can be included on one set of forms. A complete set of these forms should be sent to each participating hospital so it can provide its own statistics. The same reporting period must be used by all participating sites. Information is

Neurological Surgery PIF- Continued Accreditation 1

http://www.acgme.org/acWebsite/GME_info/gme_glossary.asp

http://www.acgme.org/

to be collected by the Program Director for consolidation and transfer to a single set of forms. The Program Director is responsible for overseeing the accurate compilation of requested data for all participating sites.

Surgical List for Sites: Statistics are to be provided for the most recent full academic year (July 1st to June 30th) for which this information is available. The same reporting period must be used by all participating sites. The information is to be provided in separate totals for the site’s staff and the resident(s) training at the site. Grand totals are to be provided in the fifth column for all sites. Forms must be typed. All copies must be legible. NOTE: Computer print-outs or any other method employed in reporting SITE statistics to the Residency Review Committee will not be accepted. Only the surgical list provided is to be used. Use the "Other" category only for procedures that cannot be classified any other way.

Resident’s Surgical Log: The Resident's Surgical Log is included with these forms. Statistics are to be provided on this form only. Graduating Chief/Senior resident(s) must submit his/her ENTIRE neurological surgery operative experience gained within the approved sites of the program. Foreign and/or external elective experiences should not be included. Combined surgical statistics from ALL sites in which the resident served during this time are to be compiled on this one form and not broken down into separate sites. Please read carefully the instructions provided with the Resident's Surgical Log. Make sure that dates and signatures are provided. Logs will not be accepted without the proper signatures. Forms must be typed.

Examples: For some sections of the Program Information Forms, an example page has been provided as guidance for completing the form. (The example is not intended to indicate the right way to do any particular program component but merely to provide a sample of a correctly completed form). Do not insert your program information on the example pages and do not include the example pages with your final submitted copies of the Program Information Forms.


Please have the following documents available for the site visitor:

1. Overall educational goals for the program

2. Written competency-based goals and objectives for each experience at each educational level (if your Review Committees wishes to see a sample, it will request one to be appended to the PIF)

3. Current Program Letters of Agreement (PLAs)

4. Files for current residents/fellows and most recent program graduates

5. Files of residents/fellows who have transferred into the program (if applicable), including documentation of previous experience and competency-based performance evaluation

6. Program Policy Manual, including:a) policies for resident appointment, eligibility, selection, and promotionb) policies for supervision of residentsc) policies and procedures for resident duty hours and the working environmentd) moonlighting policy

7. Institutional policy for remediation and dismissal of residents, including due process.

8. Documentation of resident evaluation including:a) Resident evaluation at the end of each rotation or similar educational experienceb) Written or electronic semiannual evaluation of the resident with feedbackc) A final (summative) evaluation for each resident that documents the resident’s performance during

the final period of education and verifies that the resident has demonstrated sufficient competence to enter practice without direct supervision (files for the most recent year’s graduates for review by the site visitor)

9. Completed evaluations of the faculty by the residents

10. Completed evaluations of the program by the residents

11. The written improvement action plan the program prepared after a review of the aggregated results of residents’ performance and/or other program evaluation results

12. Documentation of resident duty hours

13. Documentation of internal review (date, participants’ names and titles, type of data collected, when reviewed by the GMEC)

14. The resident supervision policy that addresses the following:a) Residents’ responsibilities for patient careb) Progressive responsibility for patient managementc) Supervision of patient care

15. Documentation of conference attendance, if applicable

16. For single-program institution (e.g., an institution that sponsors just one accredited program) or an institution with multiple residencies accredited by the same Review Committee:A copy of the resident contract/agreement with the items required by the ACGME numbered according to Institutional Requirement II.D.)


THE RESIDENCY REVIEW COMMITTEE FOR NEUROLOGICAL SURGERY515 N State, Ste 2000, Chicago, IL 60610 (312) 755-5000 www.acgme.org

10 Digit ACGME Program I.D. #:Program Name:

TABLE OF CONTENTS

When you have the completed forms, number each page sequentially in the bottom right hand corner. Report this pagination in the Table of Contents and submit this cover page with the completed PIF.

Common PIF Page(s)Accreditation InformationParticipating Sites

Sponsoring Institution/Single or Limited Residency Institution (If applicable)Faculty/Teaching Staff

Program Director InformationPhysician Faculty RosterFaculty Curriculum VitaeNon Physician Faculty RosterNon Physician Faculty Curriculum Vitae

Resident AppointmentsNumber of PositionsActively Enrolled Residents (if applicable)Aggregated Data on Residents Completing or Leaving the Program for the last 3 years (if applicable)Residents Completing Program in the Last 3 years (if applicable)Transferred, Withdrawn, and Dismissed Residents (if applicable)

EvaluationResident Duty Hours

Specialty Specific PIF Page(s)Patient Care

Program Organizational Structure Statistical Information For Neurological Surgery and NeurologyResidents AppointmentBlock Rotational DiagramNarrative Description of the Program

Medical KnowledgeOther Training ProgramsTraining in Neurosciences Experience in Stereotactic RadiosurgeryExperience in Endovascular NeurosurgeryConferences Resident Research

Practice-Based Learning & ImprovementInterpersonal & Communication SkillsProfessionalismSystems-Based PracticeAppointment of Residents


Fellowship ProgramsOutpatient Department Information and FacilitiesEducational Program Narrative Description

Program Director's Clinical ResponsibilitySupervisionDuty HoursSupport Services

Operative ExperienceResidentsInstitutional Operative Experience

Appendix A - Call Schedule


RESIDENCY REVIEW COMMITTEE FOR NEUROLOGICAL SURGERY515 N State, Ste 2000, Chicago, IL 60610 (312) 755-5000 www.acgme.org

SPECIALTY SPECIFIC PROGRAM INFORMATION FORM

I. PATIENT CARE

A. Program Organizational Structure

1. Is neurological surgery a separate unit (department/division/section) of surgery?( ) YES ( ) NO

2. If this is a medical school affiliated program, is neurological surgery a separate division or department within the medical school?

3. Does the program director have responsibility for appointing a local site director at each site..............................................................................................................................( ) YES ( ) NO

B. Statistical Information for Neurological Surgery and Neurology

Provide the information for each site listed in the Common PIF. Duplicate the tables to add more sites if needed.

NEUROSURGICAL DATA Site #1 Site #2 Site #3 Site #4 TotalCurrent Hospital Bed CapacityNumber of Hospital Admissions/YearNeurosurgical Bed CapacityNumber of Neurosurgery Admissions/YearNeurosurgical Discharges/YearAverage Neurosurgery Census/DailyNumber of Neurosurgical Deaths/YearAverage Inpatient Consultations/DayAverage Neurosurgery ED Consultations/Day

NEUROLOGY DATA Site #1 Site #2 Site #3 Site #4 TotalNumber of Neurology Admissions/YearAverage Neurology Census/Daily


C. Block Rotational Diagram

This block rotational diagram should show the progression of a typical resident (or residents) through his/her educational experience. The PR for Neurological Surgery require that this educational experience be 60 months in length; the diagram should show how the sixty months of required training are spent. Using the six-month blocks, indicate where each resident will be for that period of time. Where rotations are less than six months the table sections may be subdivided with the length of time indicated.

Block Rotational Diagram Sample

Year July to December January to JunePGY-2(NS1)

X: Hospital IY: Hospital I

Hospital IHospital I

PGY-3(NS2)

X: ELECTIVEY: Neurological/ ELECTIVE

Neurological/ ELECTIVEELECTIVE

PGY-4(NS3)

X: Hospital IIY: Hospital I

Hospital IHospital II

PGY-5(NS4)

X: Lab/ ELECTIVEY: Lab/ ELECTIVE

Lab/ ELECTIVELab/ ELECTIVE

PGY-6(NS5)

X: Hospital I (C)Y: Hospital II (C)

Hospital II (C)Hospital I (C)

PGY-7For 6 year programs

Either 6th year of training and/or fellowship

Block Rotational Diagram

Year July to December January to JunePGY-2(NS1)PGY-3(NS2)PGY-4(NS3)PGY-5(NS4)PGY-6(NS5)PGY-7For 6 year programs


D. Narrative Description of the Program

Provide a narrative in the following format, addressing each item. Brevity is appreciated, but explain the program in significant detail. DO NOT append brochures, program descriptions, curricula vitae, or other printed materials.

1. Describe the training program covering each year specifically. This information must include:

a) A brief discussion of each assignment as it appears in the block diagram

b) Progressive responsibility of resident in each year

c) Scheduled teaching rounds.

d) Outpatient and inpatient facilities.

e) Research facilities.

f) Operating rooms and scheduled surgery days. Indicate whether the residents work simultaneously, or if not, how many work at one time and at what level in each site listed.

g) If the program trains more than one resident per year, describe how the program ensures that each resident has a full 12-month chief resident experience.

h) Describe how the program provides progressively responsible patient management opportunities at each level of training. Include a description of the chief resident's clinical and administrative responsibilities.

i) Describe the outpatient experience and responsibilities of the residents, including the role of the resident in preoperative evaluation and management of patients as well as post-discharge follow up.

j) Describe the critical care experiences of the residents. Indicate the specialty and position of the clinical director of the ICU. Describe the position of the individual responsible for the management of critical care neurosurgical patients. Describe the responsibility for management of critical care neurosurgical patients.


k) List by name where each resident in the program took his/her neurology experience and in which years of training.

Resident Name Program Name Which Years of Training


II. MEDICAL KNOWLEDGE

A. Other Training Programs

Answer "YES/NO" for the information requested below for each hospital participating in the program.

Other Training Programs In:

Site #1 Site #2 Site #3 Site #4

Anesthesiology ( ) YES ( ) NO ( ) YES ( ) NO ( ) YES ( ) NO ( ) YES ( ) NOEndocrinology ( ) YES ( ) NO ( ) YES ( ) NO ( ) YES ( ) NO ( ) YES ( ) NOGeneral Surgery ( ) YES ( ) NO ( ) YES ( ) NO ( ) YES ( ) NO ( ) YES ( ) NOInternal Medicine ( ) YES ( ) NO ( ) YES ( ) NO ( ) YES ( ) NO ( ) YES ( ) NONeurology ( ) YES ( ) NO ( ) YES ( ) NO ( ) YES ( ) NO ( ) YES ( ) NOOphthalmology ( ) YES ( ) NO ( ) YES ( ) NO ( ) YES ( ) NO ( ) YES ( ) NOOrthopaedics ( ) YES ( ) NO ( ) YES ( ) NO ( ) YES ( ) NO ( ) YES ( ) NOOtolaryngology ( ) YES ( ) NO ( ) YES ( ) NO ( ) YES ( ) NO ( ) YES ( ) NOPediatrics ( ) YES ( ) NO ( ) YES ( ) NO ( ) YES ( ) NO ( ) YES ( ) NOPathology ( ) YES ( ) NO ( ) YES ( ) NO ( ) YES ( ) NO ( ) YES ( ) NOPsychiatry ( ) YES ( ) NO ( ) YES ( ) NO ( ) YES ( ) NO ( ) YES ( ) NORadiology ( ) YES ( ) NO ( ) YES ( ) NO ( ) YES ( ) NO ( ) YES ( ) NO

1. If residencies do not exist for anesthesiology, endocrinology, ophthalmology, orthopaedics, otolaryngology, pathology, and psychiatry, describe the resources for education of neurological surgery residents below.

2. Describe whether the department is used for undergraduate teaching and if yes, by what medical school. Describe the role of the neurosurgery residents in teaching medical students and other residents. Indicate how many medical students are on the same team with the neurosurgery residents.


B. Training in Neurosciences

Describe the amount and type of training the residents receive in the following areas. Include a description of how this training is integrated into the clinical neurological surgery experience.

1. Neurology

2. Neuropathology

3. Neuroanatomy

3. Neurophysiology

4. Neuroradiology

C. Experience in Stereotactic Radiosurgery (Mark one or more as appropriate)

1. What type of Radiosurgery is offered?

( ) None ( ) Leksell Gamma Unit ( ) Linear Accelerator ( ) Protein Beam or Particle Beam

2. Do residents have a defined experience in Stereotactic Radiosurgery?

( ) YES - required ( ) YES - elective ( ) NO

D. Experience in Endovascular Neurosurgery

Do residents have a defined experience in Endovascular Neurosurgery?..................( ) YES ( ) NO


E. Conferences

Provide a schedule of required departmental conferences for the most recent academic year held with resident staff and list other formal teaching exercises including Journal Club. The schedule should include the frequency and year the topic, and the name of the individual responsible for oversight of the conference, and the name of the individual presenting the conference.

TypeFrequenc

y Year

Name of Individual

Responsible for Oversight

Name of Individual

Presenting the Converence

Required to Attend

FacultyResident

sNeurosurgicalNeuropathologyTumor ClinicsM and MNeurologicalNeuroradiologicalOther

G. Resident Research

List the papers published since the last survey of the program in which a resident of the program was author or joint author. Underline the resident participant's name.


III. PRACTICE-BASED LEARNING AND IMPROVEMENT

Examples of Learning Activities: didactic lecture, assigned reading, seminar, self-directed learning module, conference, small group discussion, workshop, online module, journal club, project, case discussion, one-on-one mentoring, or other examples of learning activities.

1. Describe one learning activity in which residents engage to identify strengths, deficiencies, and limits in their knowledge and expertise (self-reflection and self-assessment); set learning and improvement goals; identify and perform appropriate learning activities to achieve self-identified goals (life-long learning).

Limit your response to 400 words.

2. Describe one example of a learning activity in which residents engage to develop the skills needed to use information technology to locate, appraise, and assimilate evidence from scientific studies and apply it to their patients’ health problems. The description should include:

a) locating informationb) using information technologyc) appraising informationd) assimilating evidence information (from scientific studies)e) applying information to patient care


3. Give one example and the outcome of a planned quality improvement activity or project in which at least one resident participated in the past year that required the resident to demonstrate an ability to analyze, improve and change practice or patient care. Describe planning, implementation, evaluation and provisions of faculty support and supervision that guided this process.


4. Describe how residents:

a) develop teaching skills necessary to educate patients, families, students, and other residents;b) teach patients, families, and others; and c) receive and incorporate formative evaluation feedback into daily practice. (If a specific tool is

used to evaluate these skills have it available for review by the site visitor.)



IV. INTERPERSONAL AND COMMUNICATION SKILLS

1. Describe one learning activity in which residents develop competence in communicating effectively with patients and families across a broad range of socioeconomic and cultural backgrounds, and with physicians, other health professionals, and health related agencies.


2. Describe one learning activity in which residents develop their skills and habits to work effectively as a member or leader of a health care team or other professional group. In the example, identify the members of the team, responsibilities of the team members, and how team members communicate to accomplish responsibilities.


3. Explain (a) how the completion of comprehensive, timely and legible medical records is monitored and evaluated, and (b) the mechanism for providing residents feedback on their ability to competently maintain medical records.



V. PROFESSIONALISM

1. Describe at least one learning activity, other than lecture, by which residents develop a commitment to carrying out professional responsibilities and an adherence to ethical principles.


2. How does the program promote professional behavior by the residents and faculty?


3. How are lapses in these behaviors addressed?



VI. SYSTEMS-BASED PRACTICE

1. Describe the learning activity(ies) through which residents achieve competence in the elements of systems-based practice: work effectively in various health care delivery settings and systems, coordinate patient care within the health care system; incorporate considerations of cost-containment and risk-benefit analysis in patient care; advocate for quality patient care and optimal patient care systems; and work in interprofessional teams to enhance patient safety and care quality.


2. Describe an activity that fulfills the requirement for experiential learning in identifying system errors.



VII. APPOINTMENT OF RESIDENTS

1. Does the program routinely participate in the Neurosurgery Match?....................( ) YES ( ) NO

2. How many years are appointments made for?

3. Are residents appointed annually, July 1st?..........................................................( ) YES ( ) NO

If no, explain


VIII. FELLOWSHIP PROGRAMS

List all fellows currently appointed to this program (active clinical residents are listed in the Resident Appointments section) and provide the information requested. For "Type of Fellowship Program" give the name of the program and type of service. Example: Duke/NS.

Type of Fellowship Program Number of Trainees


IX. OUTPATIENT DEPARTMENT INFORMATION AND FACILITIES

Provide the information for each site (add another table for more sites if needed). Provide the information requested for each hospital participating in the program. If position does not exist, enter "None." If position is vacant, enter "vacant."

Site #1 Site #2 Site #3 Site #4

Total Outpatient Visits

Percent Participation by Residents

% % % %

Emergency Department

Total Number of NS Consultations/Year

Neurology

Total Number of NS Consultations/Year

Facilities [PR IV.A]

Interventional Neuroradiology ( ) YES ( ) NO ( ) YES ( ) NO ( ) YES ( ) NO ( ) YES ( ) NO

Stereotactic Radiosurgery ( ) YES ( ) NO ( ) YES ( ) NO ( ) YES ( ) NO ( ) YES ( ) NO


X. EDUCATIONAL PROGRAM NARRATIVE DESCRIPTION

A. Program Director's Clinical Responsibility

Describe the program director's major clinical responsibilities at the primary clinical site as well as any responsibilities he/she may have at other participating sites.

B. Supervision

Describe how the program ensures direct and appropriate supervision of residents at each level of training.

C. Duty Hours

Attach the call schedule as Appendix A.

D. Support Services

Describe the support services the program/site provides to ensure that residents do not routinely engage in activities that do not require the skills of a physician. Describe the type and availability of sleeping, lounge, and food facilities provided to residents on-call in the hospital.


XI. OPERATIVE EXPERIENCE

A. Residents

Supply the number of cases for the most recently graduating resident representing his/her entire neurosurgery experience. This information is to be reported separately: by senior clinical year, and by all other clinical years. Combined surgical statistics from ALL institutions in which the resident served are to be included on this one form and not broken down into separate institutions. Count only those cases in which the resident had a significant decision making role (including pre- and post-operative care). "Surgeon" refers to primary responsibility; "Assistant" refers to surgeon acting as an assistant. Patients up to 16 years of age inclusive are considered pediatric cases. Procedures listed as "Other", should be explained in the "Other" section of this log. Attach additional pages as necessary.

Resident's Name

Log Covering Period (dates)

Resident Signature

Senior Clinical Year

Other Clinical Years

Total Experience All Years

Cranial Procedures - VascularAneurysm - craniotomyAneurysm - endovascularAVM/other malformation - craniotomyAVM/other malformation - endovascularAVM/other malformation - stereotactic radiosurgeryHematoma non-traumaticOther (vascular)

Total Cranial Procedures - Vascular

Cranial Procedures - TumorIntra-axial - craniotomyIntra-axial - stereotactic biopsyIntra-axial - stereotactic radiosurgeryExtra-axial - craniotomyExtra-axial - stereotactic radiosurgeryParasellar/sellar tumor - craniotomyParasellar/sellar tumor - transsphenoidalParasellar/sellar tumor - radiosurgerySkull base/endovascular/neuroendoscopy/other

Total Cranial Procedures - Tumor

Cranial Procedures - FunctionalEpilepsy, diagnostic - craniotomyEpilepsy, diagnostic - stereotactic implantationEpilepsy, therapeutic - craniotomyEpilepsy, therapeutic - vagal nerve





stimulationEpilepsy, therapeutic - otherMovement disorder surgery - stereotactic lesionMovement disorder surgery - stimulationNeuralgia - stimulationNeuralgia - percutaneous lesion creationNeuralgia - craniotomy/craniectomyNeuralgia - stereotactic radiosurgeryOther (functional)

Total Cranial Procedures – Functional

Cranial Procedures - TraumaDepressed skull fracture/penetrating woundHematomaOther (trauma)

Total Cranial Procedures - Trauma

Cranial Procedures - Cranial Recon/Cranioplasty

CraniosynostosisCraniofacial reconstructionCranioplasty

Total Cranial Procedures - Cranial Recon/Cranioplasty

Cranial Procedures - OtherInfection/cyst/orbit/skull lesion/dural-CSF/Chiari

Total Cranial Procedures - Other

Extracranial/Intracranial Occlusive Vascular Dis

Carotid endarterectomyEndovascularEC/IC bypassVascular repair/patch/bypass/ligation/otherTotal Extracranial/Intracranial Occlusive

Vascular Dis

CSF ShuntingInitialRevisionThird ventriculostomyOther (CSF shunting procedures)

Total CSF Shunting





Spinal Procedures - Disc and/or Spondylosis

Cervical - discectomy/decompressionCervical - with instrumentation/fusionThoracic - discectomy/decompressionThoracic - with instrumentation/fusionLumbar/sacral - discectomy/decompressionLumbar/sacral - with instrumentation/fusion

Total Spinal Procedures - Disc and/or Spondylosis

Spinal Procedures - Tumor/Vascular LesionPrimary tumor resectionPrimary tumor - resection w/instrumentation/fusionMetastatic tumor resectionMetastatic tumor resection w/instrumentation/fusionVascular lesion

Total Spinal Procedures - Tumor/Vascular Lesion

Spinal Procedures - TraumaCervical - operative decompression/reductionCervical - with instrumentation/fusionThoracic - operative decompression/reductionThoracic - with instrumentation/fusionLumbar/sacral - operative decompression/reductionLumbar/sacral - with instrumentation/fusion

Total Spinal Procedures - Trauma

Spinal Procedures - DysraphismSpinal dysraphism

Total Spinal Procedures - Dysraphism

Spinal Procedures - Spasticity/PainPump implantationRhizotomyStimulationTotal Spinal Procedures - Spasticity/Pain

Spinal Procedures - Vertebral Reconstruction

Vertebroplasty/kyphoplasty





Total Spinal Procedures - Vertebral Reconstruction

Spinal Procedures - OtherNon-neoplastic lesions/deformity/infection/other

Total Spinal Procedures - Other

Peripheral Nerve ProceduresNeurolysis/transpositionNerve repairSympathectomyNerve stimulationPeripheral nerve section/rhizotomyExcision tumor/neuroma/neurolytic agent/other

Total Peripheral Nerve Procedures

Minor/Diagnostic ProceduresMuscle/nerve biopsyICP monitoringTongs/halo applicationVentriculostomyArteriographyInjection/Aspiration/Biopsy/Punctures/Other

Total Minor/Diagnostic Procedures

No Operative ProcedureNo procedure this hospitalization

Total No Operative Procedure

Secondary CodesCranial - otherSpinalPeripheral

Total Secondary CodesGRAND TOTAL INDEXED CASES:


B. Institutional Operative Experience

Supply the number of cases for each institution participating in the program. Attach a description of how the data were tabulated and the method used to confirm the accuracy of the information reported. Operative experience for the previous academic year should be reported.

Log Covering Period (dates)

July 1, ---- to June 30, ----

Program Director Signature / Date

Site 1 Site 2 Site 3 Site 4Total

ExperienceCranial Procedures - Vascular

Aneurysm - craniotomyAneurysm - endovascularAVM/other malformation - craniotomyAVM/other malformation - endovascularAVM/other malformation - stereotactic radiosurgeryHematoma non-traumaticOther (vascular)

Total Cranial Procedures - Vascular

Cranial Procedures - TumorIntra-axial - craniotomyIntra-axial - stereotactic biopsyIntra-axial - stereotactic radiosurgeryExtra-axial - craniotomyExtra-axial - stereotactic radiosurgeryParasellar/sellar tumor - craniotomyParasellar/sellar tumor - transsphenoidalParasellar/sellar tumor - radiosurgerySkull base/endovascular/neuroendoscopy/other

Total Cranial Procedures - Tumor

Cranial Procedures - FunctionalEpilepsy, diagnostic - craniotomyEpilepsy, diagnostic - stereotactic implantationEpilepsy, therapeutic - craniotomyEpilepsy, therapeutic - vagal nerve stimulationEpilepsy, therapeutic - otherMovement disorder surgery - stereotactic lesionMovement disorder surgery - stimulationNeuralgia - stimulation



ExperienceNeuralgia - percutaneous lesion creationNeuralgia - craniotomy/craniectomyNeuralgia - stereotactic radiosurgeryOther (functional)

Total Cranial Procedures – Functional

Cranial Procedures - TraumaDepressed skull fracture/penetrating woundHematomaOther (trauma)

Total Cranial Procedures - Trauma

Cranial Procedures - Cranial Recon/Cranioplasty

CraniosynostosisCraniofacial reconstructionCranioplasty

Total Cranial Procedures - Cranial Recon/Cranioplasty

Cranial Procedures - OtherInfection/cyst/orbit/skull lesion/dural-CSF/Chiari

Total Cranial Procedures - Other

Extracranial/Intracranial Occlusive Vascular Dis

Carotid endarterectomyEndovascularEC/IC bypassVascular repair/patch/bypass/ligation/other

Total Extracranial/Intracranial Occlusive Vascular Dis

CSF ShuntingInitialRevisionThird ventriculostomyOther (CSF shunting procedures)

Total CSF Shunting

Spinal Procedures - Disc and/or Spondylosis

Cervical - discectomy/decompressionCervical - with instrumentation/fusionThoracic - discectomy/decompressionThoracic - with instrumentation/fusion



ExperienceLumbar/sacral - discectomy/decompressionLumbar/sacral - with instrumentation/fusion

Total Spinal Procedures - Disc and/or Spondylosis

Spinal Procedures - Tumor/Vascular LesionPrimary tumor resectionPrimary tumor - resection w/instrumentation/fusionMetastatic tumor resectionMetastatic tumor resection w/instrumentation/fusionVascular lesion

Total Spinal Procedures - Tumor/Vascular Lesion

Spinal Procedures - TraumaCervical - operative decompression/reductionCervical - with instrumentation/fusionThoracic - operative decompression/reductionThoracic - with instrumentation/fusionLumbar/sacral - operative decompression/reductionLumbar/sacral - with instrumentation/fusion

Total Spinal Procedures - Trauma

Spinal Procedures - DysraphismSpinal dysraphism

Total Spinal Procedures - Dysraphism

Spinal Procedures - Spasticity/PainPump implantationRhizotomyStimulation

Total Spinal Procedures - Spasticity/Pain

Spinal Procedures - Vertebral Reconstruction

Vertebroplasty/kyphoplastyTotal Spinal Procedures - Vertebral Reconstruction

Spinal Procedures - OtherNon-neoplastic lesions/deformity/infection/other



ExperienceTotal Spinal Procedures - Other

Peripheral Nerve ProceduresNeurolysis/transpositionNerve repairSympathectomyNerve stimulationPeripheral nerve section/rhizotomyExcision tumor/neuroma/neurolytic agent/other

Total Peripheral Nerve Procedures

Minor/Diagnostic ProceduresMuscle/nerve biopsyICP monitoringTongs/halo applicationVentriculostomyArteriographyInjection/Aspiration/Biopsy/Punctures/Other

Total Minor/Diagnostic Procedures

No Operative ProcedureNo procedure this hospitalization

Total No Operative Procedure

Secondary CodesCranial - otherSpinalPeripheral

Total Secondary CodesGRAND TOTAL INDEXED CASES:

Provide a description of how the data were tabulated and the method used to confirm the accuracy of the information reported


APPENDIX A - CALL SCHEDULE

Attach the call schedule as Appendix A


THE RESIDENCY REVIEW COMMITTEE FOR NEUROLOGICAL SURGERY

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