91社区

Neurosurgery Residency Program

The residency training program in neurosurgery is under the direction of the Division of Neurosurgery of 91社区. It is an integrated program. Adult elective neurosurgery is done exclusively at the Montreal Neurological Hospital. Paediatric neurosurgery including paediatric neurotrauma is done at the Montreal Children's Hospital. Neuro-Trauma is done at the Montreal General Hospital. All sites belong to the 91社区 Health Centre (MUHC).

Although the integrated program is of six years' duration, the length of the program varies depending on the resident's career goals, the qualifying specialty body for which he or she is making preparation and the individual background of experience at 91社区 in medical and surgical disciplines. Residents will need one year of Surgical Foundations (available at 91社区) followed by a minimum of five years of Neurosurgical Training. The first year of neurosurgical training is considered part of the Surgical Foundations Program. Residents should pass the Surgical Foundation examination during their second year of Surgical Foundations. They are expected to attend mandatory SF preparatory sessions to that effect.

For the Neurosurgical Training, forty-two blocks are expected of individual residents. Individual rotations are of three to four blocks' duration. Residents will be expected to rotate through the four adult neurosurgery services at the Montreal Neurological Hospital, the trauma rotation at the MGH site and the paediatric rotation at the MCH site in junior resident capacity. When they return to these rotations they automatically assume a senior resident role on individual services. The second set of rotations are usually of four blocks' duration.

Additionally residents are expected to do a year of rotations in neurology, neuroradiology, neuropathology and critical care neurosurgery.

Participation in research programs for qualified and interested residents is encouraged during the course of training. Selected candidates may register for graduate degrees with the approval of the head of the laboratory, the research director and the program director. They can also register to the clinical investigator program of the Royal College of Physicians and Surgeons of Canada. Their first year of research is part of the residency training and can be extended to two further years to obtain a degree.

The academic program includes weekly Academic Half Day Activities (Grand Rounds, Pathology Rounds, Radiology Rounds, Journal Club, Case presentations and lecture series) scheduled. There is a weekly seizure conference, tumour board and vascular rounds to discuss difficult cases. 听At the MCH there are tumour board, radiology rounds, surgical grand rounds and trauma rounds.听 Twice yearly, senior residents are given mock oral and written examinations of the Royal College Format and a national in-training practice exam yearly.

Canadian PGY-1 applicants are accepted via CaRMS.

Inquiries and applications should be directed to:

Dr. Carlo Santaguida, Program Director
Ms Sherisse Seale, Program Coordinator
Tel.: (514) 398-1935听听听 Fax: (514) 398-2811 听

Email: residency.neurosurgery [at] mcgill.ca

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Curriculum

The residency program is under the direction of the Division of Neurosurgery of 91社区. It is an integrated program with the main location being the Montreal Neurological Hospital (MNH). Residents rotate through the neurosurgical services at the Montreal General Hospital (MGH), Jewish General Hospital (JGH) and Montreal Children鈥檚 Hospital (MCH) for sessions of usually three to six months.

Participation in research programs for qualified and interested residents is encouraged during their training. This usually commences at the beginning of the R4 year. Interested candidates may register for graduate degrees with the approval of the head of the laboratory and the program director.

The academic program includes protected academic half-days, which include weekly Grand Rounds and a didactic lecture series, a neuropathology and a neuroradiology session monthly, and journal club, as well as chapter reviews. Internal In-training written examinations occur three times a year and formal Royal College mock oral exams twice a year. It is important that all residents pass these Internal In-training exams. (See below for more details about in-training exams and passing grades).听 Residents are mandate to participate in the microsurgical laboratory for practice of microsurgical technique, dissection and anastomosis.

Examinations

In-Training written examinations and听 听formal Royal College format mock oral exams both occur twice yearly. 听It is mandatory that all senior residents pass these exams. 听National in-training practice written examination developed by Dr Findlay is also offered to all our residents yearly.听 All of these exams provide individual guidance to ensure progressive learning in all aspects of neurosurgery for best patient care and eventually passing the Royal College exam.听

PGY-1

This year is the first year of the core training in surgery and includes General Surgery (2 blocks), Vascular Surgery (2 blocks), Emergency (1 block), Surgical Intensive Care Unit (3 blocks), Neurosurgery (5 blocks). See Approach to First Year and the SF (below).

PGY-2

This year concludes the second year of surgical foundation training and includes thirteen blocks of neurosurgery, which usually includes three to four blocks of neurotrauma, and three blocks of neurology 听and 2 blocks of radiology and rotations in other services. At the end of this year (usually early April) the Principles of Surgery (SF) exam is taken. It is extremely important that you pass this exam to show that you have a good grasp of surgical concepts in general, and therefore can proceed with your 鈥渟pecialized鈥� neurosurgical training.

PGY-3 to PGY 6

These years include 27 months of core neurosurgery, including five to six months each of Vascular & Skull Base (White Service), Spine & Peripheral Nerve (Spine Service), Epilepsy & Functional (Red Service), Oncology (Yellow Service), and six months of Pediatric Neurosurgery, as well as, three months each of Neuropathology, Neuroradiology and Neurology (if the latter was not completed in PGY2). There is also a two to three-block period of neurosurgery at the JGH for minimally invasive spine surgery and skull base and spine trauma at the MGH. Twelve months is allotted as Senior Neurosurgery training in the above disciplines, as well as twelve months for clinical and/or basic research. The candidate may wish to enrol in the graduate program and ask for a one-year leave of absence in order to obtain an MSc or PhD.

Approach to Core Surgery & SF

This is an opportunity to gain extensive surgical and medical knowledge, much of which you will carry with you听for the rest of your career. You will learn the basics of surgery, from hands on things like knot-tying and听vascular anastomosis, to wound healing, hemostasis, and fluid balance. Your time in the ICU during Core surgery听will refresh and solidify your 鈥渕edical鈥� knowledge for one of the last times in your career, unless you work in critical听care in the future.

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Site Specifics

MNH (Montreal Neurological Hospital): The majority of your training will take place at the MNH.. There are three to four operating rooms running each day (if vacant hospital beds permit). It is important to manage your patients efficiently, but safely, to discharge patients when they are ready to go home and not have them waiting around for tests and appointments that could have been done earlier. On some days when all operating rooms are running it can be difficult to find residents to cover all rooms! As such, you will have a lot of opportunity and exposure in the OR.

The Montreal General Hospital (MGH): is one of the major trauma centres of Montreal. Neurosurgery coverage at the MGH is for specifically for Trauma. The regular Trauma Neurosurgeons who work at the MGH are Dr. Marcoux, Dr. Maleki and Dr Saluja.

We do not do elective neurosurgery of any kind at the MGH, even post-craniectomy, cranioplasties are done at the MNH. However, when you are on call at the MGH you may be consulted either from the emergency department or from the various wards for patients with neurosurgical problems because it is still a 鈥済eneral鈥� hospital (i.e., newly discovered brain tumours, non-traumatic SAH, or VP shunts problems). These patients should be seen in consultation, and discussed with the staff covering the MGH and/or the staff covering the MNH. Urgent and traumatic spine consults are also handled at the MGH by a combined group of orthopedic and neurosurgical spine specialists.听 Residents will be given an opportunity to participate in out-patient clinic, in-patient consults, academic spine teaching and operative management during their training.

MCH (Montreal Children鈥檚 Hospital):

You are expected to do up to 6 periods at the MCH, usually 3 periods as a junior and 3 periods as a senior. This is always an excellent learning experience where you see a wide variety of cases and get excellent clinic and OR experience. The three neurosurgeons at the MCH, Dr. Atkinson, Dr. Farmer, and Dr. Dudley often organize additional teaching sessions and journal clubs.

There are a few other unique and beneficial things about the MCH. First, at the MCH there is a clinic called the SDC (Surgical Day Centre ) where we can see patients and families with concerns during daytime hours so that the patients can avoid the long waiting times and other problems associated with the emergency room. They often call ahead to make an appointment, so that you are aware they are coming. Second, there is a very helpful Neurosurgery Clinical Nurse Specialist, who works very closely with you and the staff on a regular basis. Thirdly, a very unique feature of the MCH experience is the exposure to the intraoperative MRI, which was a project lead by the MCH Neurosurgery department.

The Jewish General Hospital (JGH):

At the JGH you will work with two neurosurgeons: Dr Golan specializes in minimally invasive spine surgery and Dr Di Maio specializes in skull base including endoscopic and transphenoidal approaches.听 At the JGH you will participate in out-patient clinics, emergency room consults and operative procedures, post-operative ward care is managed in conjunction with hospitalists.听听听听听听