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[Curriculum]
[Childrens]
[Laboratory]
[Neurocritical Care]
[Parkland Chief]
[Parkland Junior]
[Neurology]
[Spine]
[Tumor]
[VA]
[Vascular Chief]
[Vascular Junior]
Zale Vascular Chief
 
 
A.   NEURORADIOLOGY
UNIT OBJECTIVES
Demonstrate an understanding of neuroradiological imaging and interventions as they specifically relate to neurosurgical patients.
 
COMPETENCY-BASED KNOWLEDGE OBJECTIVES:
    Review the indications for interventional endovascular therapies for:
      aneurysms
      vasospasm
      cranial vascular malformations
      spinal vascular malformations
      tumor embolization
      carotid and vertebral stenosis
      carotid and vertebral dissection
    Describe the indications and techniques of endovascular trial occlusions.
    Review the role of quantitative cerebral blood flow studies in the management of neurosurgical patients.
    Describe the concepts of positron emission tomography. Review the indications for obtaining such scans.
    Describe the concepts of functional MR imaging. Review the indications for obtaining such scans.
    Describe the concepts of MR spectroscopy. Review the indications for obtaining such evaluations in neurosurgical patients.
    Discuss the indications and technique of discography. Describe the procedure.
    Discuss the indications for percutaneous vertebroplasty. Describe the procedure
COMPETENCY-BASED SKILL OBJECTIVES:
Demonstrate the ability to accurately interpret radiological examinations of neurosurgical patients.
    Demonstrate the ability to use intraoperative ultrasonography
 
 
B.  GENERAL CRITICAL CARE
UNIT OBJECTIVES
Demonstrate an ability to triage neurosurgical patients to and from a critical care setting. Demonstrate knowledge of and the ability to manage neurosurgical patients in the critical care setting.
 
COMPETENCY-BASED KNOWLEDGE OBJECTIVE:
 
Oversee and direct the junior and middle level resident management of critically ill neurosurgical patients
 
 
 
C. PRACTICE MANAGEMENT, LEGAL AND SOCIOECONOMIC ISSUES
UNIT OBJECTIVES
Demonstrate an understanding of the principles of practice management and the business aspects associated with the delivery of health care.
 
COMPETENCY-BASED KNOWLEDGE OBJECTIVES:
    Review the requirements to obtain certification from The American Board of Neurological Surgery.
    Discuss the available opportunities to obtain continuing medical education credits.
    Describe the political, economic, and social factors which impact on the practice of medicine generally and neurosurgery specifically.
    Demonstrate a working knowledge of the International Classification of Diseases (ICD) and the Current Procedural Terminology (CPT) coding and analysis.
    Discuss the concept of relative values units (RVUs).
    Summarize the process of impairment determination as it relates to the neurosurgical patient population.
    Review the availability, requirements, and application procedures for post-residency fellowship if appropriate.
    Discuss the following issues as they relate to planned neurosurgical practice:
      healthcare delivery systems, including managed care
      health care economics
      political and legislative processes in healthcare
    Obtain a demographic profile of potential practice locations to include population and medical demographics.
    Outline the essential business characteristics of neurosurgical practice including:
      content and interpretation of financial reports
      management of human resources
      facility design and maintenance
      billing and collection processes
    Discuss the key elements of a provider professional services agreement, such as a PPO or HMO contract, and identify provisions that require particular attention.
    Describe the typical provisions and considerations in a physician employment contract including what to look for and what to avoid.
    Describe, compare, and contrast partnership versus corporate practice structures, including the tax and liability advantages and disadvantages of each.
    Describe the advantages and disadvantages of solo, single specialty group, and multispecialty group practice.
    Review the financial issues associated with the neurosurgical career options under consideration.
    Describe the administrative structures and processes required for managing an office practice including:
      billing and collection for medical services
      financial accounting and reporting
      scheduling
      transcription
      medical record management
      appointment scheduling
      information system
      facility selection and maintenance
      secretarial services
    Describe the content, interpretation, and utilization of the following financial documents:
      balance sheet
      income and expense statement
      accounts payable and receivable
      collection analysis
    Discuss the insurance requirements associated with neurosurgical practice including:
      personal and professional liability
      personal health and disability
      casualty, fire, and theft
      personal life
    Discuss the issues of quality assurance as related to neurosurgical practice including:
maintenance of the clinical record
review and documentation of morbidity and mortality
risk management
Discuss the theory and organization of CPT coding, along with examples of complex procedural coding.
Describe the considerations in Evaluation and Management (E & M) coding, including documentation requirements.
Describe the work, practice expense, and malpractice expense components of Medicare's Resource-based Relative Value Scale (RBRVS) and how they are derived.
Explain how Medicare and commercial payer conversion factors are derived and used to create a fee schedule from the RBRVS.
Describe commonly used methods of physician risk contracting, such as capitation payment, and explain the considerations in negotiating such a contract.
Describe the practice information necessary to safely and profitably manage a neurosurgical risk contract.
Review the features, similarities, and differences in various third party payment systems including:
      Medicare
      Medicaid
      commercial insurance
      worker's compensation
    Contrast HMO and PPO health plans.
    Describe the meaning of "managed care" and its typical components including:
      contractual discounts
      provider risk arrangements
      utilization management
      provider report cards
      practice guidelines
      restricted access models
        primary gatekeeper
        point of service
        open access
    List and discuss the ethical issues and conflicts of interest involved in managed care treatment decisions such as:
      capitation reimbursement
      risk pools
      cost saving incentive bonuses
    Discuss antitrust considerations faced by physicians in payer contract negotiations including the concepts of collective bargaining, price fixing, and group boycott.
    Describe types of retirement plans and funding considerations and limitations.
    Explain the differences between occurrence and claims-made professional liability insurance and considerations made in selecting insurer and coverage levels.
COMPETENCY-BASED SKILL OBJECTIVES:
    Demonstrate the ability to properly code neurosurgical activities.
    Accurately assign and justify medical impairment ratings for neurosurgical patients.
    Outline a post-residency career track.
    Apply for post-residency fellowship if appropriate.
    Obtain information about specific practice, research, or administrative career opportunities as appropriate.
    Compose a list of questions to ask and things to see when interviewing for a neurosurgical position.
    Read and interpret a financial report.
    Design a structure for an office practice including a listing of the generic office processes and how to arrange staffing.
    Prepare lists of neurosurgical instruments/equipment needed for specific operative procedures.
    Select a proper practice, research, or administrative opportunity if appropriate.
    Complete license and registration requirements for your chosen location.
    Complete applications for hospital staff membership and clinical privileges.
    Complete resident case data sheet for the American Board of Neurological Surgery and have same signed by Program Chair.
 
 
NEUROSURGICAL CLINIC TOPICS SECTION
 
D.  CEREBROVASCULAR SURGERY
UNIT OBJECTIVES
Demonstrate an understanding of the anatomy, physiology, pathophysiology and presentation of cerebrovascular diseases, including ischemic and hemorrhagic stroke, and other diseases and malformations of intracranial, extracranial, and spinal vasculature. Demonstrate the ability to formulate and implement a diagnostic and treatment plan for cerebrovascular diseases, including medical and surgical management.
 
COMPETENCY-BASED KNOWLEDGE OBJECTIVES:
    Demonstrate a sophisticated understanding of current literature related to basic neuroscience knowledge objectives acquired as a junior and middle resident. Define scientific hypotheses in relationship to controversies and evolving knowledge regarding these same objectives and demonstrate the ability to interpret and adapt new knowledge to evolving patient-care paradigms.
    Demonstrate a mature fundamental knowledge in clinical and teaching conferences, specialty conferences, and in publications and scientific presentations.
    Understand the guidelines, protocols, and literature controversies regarding the diagnostic imaging modalities available in cerebrovascular disease.
COMPETENCY-BASED SKILL OBJECTIVES:
    Review fundamental concepts of cerebrovascular disease during conferences and clinical rounds with the house staff and medical student.
    Demonstrate a mature clinical judgment related to the spectrum of problems encountered in hemorrhagic and ischemic stroke states.
    Formulate independent plans for patient assessment and management, including prioritization in cerebrovascular disease while maintaining a clear reporting relationship with faculty.
    Supervise house staff and medical student team in daily patient assessment and care.
    Identify the indications and controversies of endovascular catheter procedures, perioperative management, and follow-up. Implement and supervise patient care protocols related to these procedures.
    Display a mature and detailed understanding of indications, principles, and interpretation of the full spectrum of neurodiagnostic armamentarium. Formulate independent management plans based on sophisticated interpretation of diagnostic studies for concise presentation to faculty.
    Apply evolving technology and new methods to patient protocols and the education of house staff and medical students.
    Demonstrate a mature understanding of surgical strategies and approaches to common and unusual vascular disease.  
    Apply the principles of intraoperative anesthetic management, proximal and distal control, temporary arterial occlusion, brain protective strategies, and intraoperative localization as applied to vascular disease.
    Complete the planning, positioning, and execution of pterional craniotomy for common vascular disease.
    Perform microsurgical dissection of the Sylvian fissure and exposure of the basal cisterns for vascular disease.
    Perform microsurgical exposure and clipping of intracranial aneurysm.
    Complete the planning, positioning, and execution of non-pterional craniotomy for intracranial vascular disease.
    Assist in the microsurgical management of highly complex cerebrovascular disease.
    Plan and execute the craniotomy for the evacuation of intracranial hematomas.
    Supervise other house staff in meeting their surgical objectives.
    Describe the exposure and treatment of intraspinal vascular lesions. Assist in such operations.
    Oversee all aspects of patient care, identification of appropriate cases for database analysis, morbidity, mortality, conferences, and discussions. Supervise medical students and house staff in every aspect of patient care.  
    Report appropriate patient care issues to responsible faculty members in a timely fashion.
    Organize and administer teaching conferences.
    Display mature participation in specialty conferences.
    Assign responsibilities to junior residents and residents, with the aim of fulfilling their respective educational objectives

Last Updated Feb 2013