(PGY-1)   |  (PGY-2)   |   (PGY-3)   |   (PGY-4 and 5)   |   (PGY-6 and 7)

Our program has a robust educational curriculum with a focus on passing the American Board of Neurological Surgery (ABNS) primary and oral board exams. We review our curriculum annually and partner with our residents so that it continually improves.

Curriculum Highlights

  • Our block schedule is built to provide our residents with the core neurosurgical skills they need to be excellent surgeons while also allowing the flexibility to tailor the training to their individual needs.
  • Our seven-year program meets and exceeds each of the ACGME Program Requirements for Neurological Surgery while also allowing for up to 18 months of elective rotations. During their elective months the residents are supported by clinical and research faculty working in multiple NIH funded labs each within the Department of Neurosurgery.
  • Our academic day occurs every Wednesday from 8 a.m. to 1 p.m. As a resident, you are protected from call and pager duties during this time so you can focus on the didactic presentations.

PGY-I residents are expected to accomplish and maintain the following objectives:

PGY-I Neurosurgical Residents are expected to spend the majority of their time in the hospital providing patient care and under the supervision of more senior residents and attending surgeons. PGY-I Residents are given graduated responsibility for patient care that is based on training received prior to residency and during the course of their residency. It is recognized that specific experience and knowledge of each physician may be different.

PGY-I Neurosurgical Residents in the clinic or on the wards will:

  1. Obtain and record detailed historical information from patients and families.
  2. Perform and record detailed physical examinations on their patients.
  3. Discuss with their supervising resident and/or attending surgeon the history and physical examinations, and use this to define a diagnostic and therapeutic plan.
  4. Write orders for patient care, including diagnostic studies and therapies which will be written based on the above plan.
  5. Daily progress notes will be recorded in the patient record. Modifications of the management plan based on further examination of the patient, new diagnostic information and discussion with supervising resident and/or attending surgeon will be recorded in these progress notes and reflected in the patient care orders.
  6. The PGY-I Neurosurgical Residents will discuss, as appropriate, the diagnoses and therapeutic plan with other professionals involved in the patient’s care (i.e. nursing, physical therapy, social work, physician consultants, etc.) and the patient and/or family.
  7. Supervision of procedures performed by the PGY-I Neurosurgical Residents will be done by a senior Neurosurgical Resident, or by the attending surgeon. The supervising resident is expected to have demonstrated knowledge and experience in performing the indicated procedure, as well as the indications and risks. Direct supervision by the senior resident or attending physician is required until the PGY-1 resident has demonstrated the knowledge and experience to perform the procedure safely. After which, appropriate supervision that is on site and immediately available to the PGY-1 resident is required.
  8. Emergency life-saving procedures may be initiated and performed, as necessary, by PGY-I Neurosurgical Residents in circumstances where direct supervision by the supervising resident is not immediately available.
  9. Discharge planning, writing of prescriptions, and discharge from inpatient or outpatient care is done by PGY-I Neurosurgical Residents under the supervision of the senior Neurosurgical Resident and/or the attending physician.
  10. The PGY-I Neurosurgical Resident(s) will be actively involved with teaching, directing and supervising medical and APP students.
  11. Hospital and department policies define hours of duty, on-call responsibility and availability, procedures for illness or absences, dress codes and professional behavior, patient confidentiality, and safety procedures.
  12. The PGY-I Neurosurgical Resident is expected to fully participate in the teaching program including teaching conference, attending surgeon rounds, interdisciplinary care conferences and other defined educational experiences. It is expected that PGY-I Neurosurgical Residents will be self-directed learners, including studying outside of the structured education program.
  13. PGY-I Neurosurgical Residents will be evaluated based on Neurosurgery milestones and at the end of each rotation by the supervising attending(s) for that particular rotation. Evaluations will be constructive and directed at assisting the process of graduated learning. More frequent evaluations should be expected whenever problems in performance are identified. A summary evaluation is conducted by the Program Director with input from all the teaching institutions and from Clinical Competency Committee assessments on a semi-annual basis.
  14. PGY-1 Neurosurgical Residents will take the ABNS Primary exam for self-assessment.
  15. The selection of PGY-I Neurosurgical Residents includes analysis of medical school education and performance, and evaluation of both written and oral communication. Competence during the year is assured by direct observation by supervising residents and attending surgeons, including review of verbal presentation, physical examination, and written notes in patient records. These observations are used for the formal evaluations noted above.

Examples of Procedures for PGY-I Neurosurgical Residents with Supervision by More Senior Residents or Attending Surgeons

  • Insert peripheral intravenous catheters
  • Insert urinary bladder catheters
  • Insert nasogastric tubes Suture uncomplicated wounds
  • Insert central venous lines Insert peripheral arterial lines
  • Insert chest tubes Halo ring placement
  • Insert pulmonary artery catheters
  • Thoracentesis
  • Change central venous catheters over a wire
  • Twist drill drainage of subdural fluid collection Incision, debridement, and drainage of soft tissue infections
  • During PGY-I year, neurosurgical residents should seek experience with the procedures PGY-2 residents are expected to perform without direct supervision. These procedures will be done under the supervision of more senior residents or an attending surgeon.Burr hole placement

Emergency Procedures for PGY-I Neurosurgical Residents with appropriate ACLS, ATLS or BLS training can be performed without Supervision

Chest compressions
Defibrillate the heart during cardiac arrest
Endotracheal intubation in a life-threatening situation

The PGY-I Neurosurgical Resident is considered competent to perform procedures without direct Supervision by an Attending or Higher Level Neurosurgical Resident after successfully Meeting Supervision Proctoring Criteria

  • ICP bolt monitor placement (5)
  • Ventriculostomy placement (10)
  • Lumbar puncture (5)
  • Lumbar drain placement (5)
  • Ventricular shunt/Ommaya reservoir tap (5)

All procedures require a formal “time out” prior to starting These procedure minimums may not always be completed during the first year of residency and appropriate supervision would then continue into the second year.

PGY-II residents are expected to accomplish and maintain the following objectives:

PGY-II Neurosurgical Residents will evaluate and provide care for patients in the surgical ward, surgical clinics, operating room, Intensive Care Units and in the Emergency Department under the supervision of more senior residents and attending surgeons. PGY-2 Neurosurgical Residents begin to supervise PGY-1 Neurosurgery Residents in addition to medical students and other trainees in these settings, with the assistance of senior residents, and attending surgeons. PGY-2 Neurosurgical Residents are given increasing responsibility for patient care that is based on training and demonstrated ability. It is recognized that specific experience and knowledge of each surgical resident may be different.

PGY-II Neurosurgical Residents Will:

  1. Obtain and record detailed historical information from patients and families, and verify the information gathered by PGY-1 residents under their supervision.
  2. Perform and record detailed physical examinations on their patients, and verify the physical examinations done by the PGY-1 residents under their supervision.
  3. Discuss with their supervising resident, and/or attending surgeon the history and physical examinations, and use this to define a diagnostic and therapeutic plan.
  4. Write orders for patient care including diagnostic studies and therapies based on the above plan. They will verify the orders for patient care written by PGY-1 residents under their supervision.
  5. Record daily progress notes in the patient record. Modifications of the diagnostic and therapeutic plan based on further examination of the patient and discussion with supervising residents and/or attending surgeons, will be recorded in these progress notes and patient care orders.
  6. The PGY-II neurosurgical residents will discuss as appropriate the diagnoses and diagnostic and therapeutic plan with other professionals involved in the patient care (i.e. nursing, physical therapy, social work, consulting physicians, etc.) and the patient and/or family.
  7. The PGY-II neurosurgical resident is expected to demonstrate increasing levels of competence in performing the procedures essential for the practice of neurosurgery. They will supervise simple procedures and bed side procedures of PGY-I residents.
  8. Life-sustaining procedures may be initiated and performed, as necessary, by PGY-II neurosurgical resident in circumstances where direct supervision by the supervising resident is not immediately available.
  9. Discharge planning, writing of prescriptions, and discharge from inpatient or outpatient care is done by PGY-II neurosurgical residents under the supervision of the PGY-IV, V, or VI resident and/or attending surgeon.
  10. Completion of medical records will be done by the PGY-II neurosurgical residents in accordance with hospital guidelines.
  11. The PGY-II neurosurgical resident will be actively involved with teaching, directing, and supervising PGY-I neurosurgical residents, medical students, and physician assistant students.
  12. Hospital and department policies define hours of duty, on-call responsibility and availability, procedures for illness or absences, dress codes, and professional behavior, patient confidentiality, and safety procedures.
  13. The PGY-II neurosurgical resident is expected to fully participate in the teaching program including teaching conferences, attending rounds, interdisciplinary care conferences, and other defined teaching conferences. It is expected that PGY-II neurosurgical residents will be self-directed learners, including studying outside of the structured education program.
  14. PGY-II resident will be evaluated at the end of each rotation using neurosurgery milestones and formative feedback by the faculty.  Evaluations will be constructive and directed at assisting the process of graduated learning.  More frequent evaluations should be expected whenever problems in performance are identified.  A summary evaluation is conducted by the program director on a semi-performance basis that also includes the faculty assessment generated during clinical competency committee meetings. 
  15. Competence during the year is assured by direct observation by supervising residents and attending physicians, including review of verbal presentation, physical examination, and written notes in patient records. These observations are used for the formal evaluations noted above.
  16. The PGY-II residents will participate as the primary surgeon or first assistant as his/her operative skills improve. At the end of the second academic year, the PGY-2 resident is expected to demonstrate the ability to perform posterior exposures for cervical and lumbar disc surgery, placement of ventriculoperitoneal shunts, placement of burr holes for drainage or biopsy and completion of craniotomy bone flaps. The Program Director with input from the Clinical Competency Committee evaluates the PGY-2 resident at the end of the second year of training and advances the resident into the third year of training if appropriate.
  17. PGY-II residents are expected to prepare for and pass the ABNS Neuroanatomy exam before the conclusion of their second year of residency training. They will also take the ABNS primary exam for self-assessment. While it is not expected of most PGY-2 residents, if she/he passes the ABNS primary exam for self-assessment in the first year they will be given the opportunity to take the exam for credit.

PGY-III residents are expected to accomplish and maintain the following objectives:

PGY-III Neurosurgical Residents will evaluate and provide care for patients in the surgical ward, surgical clinics, operating room, Intensive Care Units and in the Emergency Department under the supervision of more senior residents and attending surgeons. PGY-III Neurosurgical Residents supervise PGY-I and II Neurosurgical Residents in addition to medical students and other trainees in these settings, with the assistance of PGY-IV, V, VI, and VII residents, and attending surgeons. PGY-III Neurosurgical Residents are given increasing responsibility for patient care that is based on training and demonstrated ability. It is recognized that specific experience and knowledge of each surgical resident may be different.

PGY-III Neurosurgical Residents Will:

  1. Obtain and record detailed historical information from patients and families, and verify the information gathered by PGY-1 residents under their supervision.
  2. Perform and record detailed physical examinations on their patients, and verify the physical examinations done by the PGY-1 residents under their supervision.
  3. Discuss with their supervising resident, and/or attending surgeon the history and physical examinations, and use this to define a diagnostic and therapeutic plan.
  4. Write orders for patient care including diagnostic studies and therapies based on the above plan. They will verify the orders for patient care written by PGY-1 residents under their supervision.
  5. Record daily progress notes in the patient record. Modifications of the diagnostic and therapeutic plan, based on further examination of the patient and discussion with supervising residents and/or attending surgeons, will be recorded in these progress notes and patient care orders.
  6. The PGY-III Neurosurgical Residents will discuss as appropriate the diagnoses and diagnostic and therapeutic plan with other professionals involved in the patient care (i.e. nursing, physical therapy, social work, consulting physicians, etc.) and the patient and/or family.
  7. The PGY-III Neurosurgical Resident is expected to demonstrate increasing levels of competence in performing the procedures essential for the practice of Neurosurgery. They will supervise simple procedures of PGY-1 residents as defined previously.
  8. Life-sustaining procedures may be initiated and performed, as necessary, by PGY-III Neurosurgical Resident in circumstances where direct supervision by the supervising resident is not immediately available.
  9. Discharge planning, writing of prescriptions, and discharge from inpatient or outpatient care is done by PGY-III Neurosurgical Residents under the supervision of the PGY-IV, V, VI, or VII resident and/or attending surgeon.
  10. Documentation of medical records will be done by the PGY-3 Neurosurgical Residents in accordance with hospital guidelines.
  11. The PGY-III Neurosurgical Resident will be actively involved with teaching, directing and supervising PGY-I Neurosurgery Residents, medical students and physician assistant students.
  12. Hospital and department policies define hours of duty, on-call responsibility and availability, procedures for illness or absences, dress codes and professional behavior, patient confidentiality and safety procedures.
  13. The PGY-III Neurosurgery Resident is expected to fully participate in the teaching program including teaching conferences, attending rounds, interdisciplinary care conferences and other defined teaching conferences. It is expected that PGY-3 Neurosurgical Residents will be self-directed learners, including studying outside of the structured education program.
  14. PGY-III Residents will be evaluated using Neurosurgery milestones and formative feedback at the end of each rotation by the faculty. Evaluations will be constructive and directed at assisting the process of graduated learning. More frequent evaluations should be expected whenever problems in performance are identified. A summary evaluation is conducted by the Program Director on a semi-annual basis that also includes the faculty assessment generated during Clinical Competency Committee meetings.
  15. Competence during the year is assured by direct observation by supervising residents and attending physicians, including review of verbal presentation, physical examination, and written notes in patient records. These observations are used for the formal evaluations noted above.
  16. The PGY-III resident will be given increasing responsibility in and out of the OR as her/his technical skills improve. At the end of the third year of neurosurgical training, the PGY-III resident is expected to be able to complete cervical and lumbar discectomies with attending surgeon assistance, perform simple instrumentation – cervical plating, perform uncomplicated craniotomies for supratentorial tumors or trauma, and perform posterior fossa exposures.
  17. PGY-III residents are expected to prepare for and pass the ABNS primary exam for self-assessment. PGY-III residents can expect two months of dedicated time off clinical service to prepare for the exam. Timing and duration of this ‘board prep’ time is at the discretion of Program Leadership. PGY-3 residents who previously passed the ABNS primary exam for self-assessment will be given the opportunity to take the exam for credit.

PGY-IV and PGY–V are expected to accomplish and maintain the following objectives:

PGY-IV and -V Neurosurgical Residents may spend a portion their time in the laboratory if assigned to research but also will provide direct patient care throughout the hospital and will supervise other residents, medical students and physician assistants under the direct guidance of the chief resident and attending surgeons. PGY-4 and 5 Neurosurgical Residents will also have administrative responsibilities including arrangement of and leading out in teaching conferences.

PGY-VI and -V Neurosurgical Residents will:

  1. Obtain and record detailed historical information from patients and families, and verify the information gathered by physicians under their supervision.
  2. Perform and record detailed physical examinations on their patients, and verify the physical examinations done by the physicians under their supervision.
  3. Discuss with the chief resident and/or attending the history and physical examinations and will use this to define a diagnostic and therapeutic plan. They will assist the physicians under their supervision in defining a diagnostic and therapeutic plan.
  4. Write orders for patient care including diagnostic studies and therapies based on the above plan. They will verify the orders for patient care written by physicians under their supervision.
  5. Record daily progress notes in the patient record. Modifications of the diagnostic and therapeutic plan, based on further examination of the patient and discussion with attending surgeons, will be recorded in these progress notes and patient care orders.
  6. PGY-IV and -V Neurosurgical Residents will discuss as appropriate the diagnoses and diagnostic and therapeutic plan with other professionals involved in the patient care (i.e. nursing, social work, etc.) and the patient and/or family.
  7. PGY-IV and -V Neurosurgical Residents are expected to demonstrate increasing levels of competence in performing the procedures essential for the practice of surgery. They will supervise bedside procedures performed by residents under their supervision.
  8. Discharge planning, writing of prescriptions, and discharge from inpatient or outpatient care is done by PGY-VI and -V Neurosurgical Resident under the supervision of the attending surgeon.
  9. Dictation of medical records will be done by the PGY-VI Neurosurgical Resident in accordance with hospital guidelines. Attending neurosurgeons are responsible for operative dictations.
  10. The PGY-IV and -V Neurosurgical Resident will be actively involved with teaching, directing and supervising PGY-I, II and III Residents, medical students and physician assistant students. They will participate in the evaluation of these individuals. PGY-V residents will occasionally be asked to assume the responsibilities of the PGY-VI and -VII (Chief) residents when these residents are unavailable.
  11. The PGY-IV and -V Neurosurgical Resident is expected to fully participate in the teaching program including teaching conferences, attending rounds, interdisciplinary care conferences and other defined teaching conferences. It is expected that PGY-4 Neurosurgical Residents will be self-directed learners, including studying outside the structured education program.
  12. PGY-IV and -V Residents will be evaluated at the end of each rotation by the supervising attending(s). Evaluations will be constructive and directed at assisting the process of graduated learning. More frequent evaluations should be expected whenever problems in performance are identified. A summary evaluation is conducted by the Program Director on a semi-annual basis that also includes the faculty assessment generated during Clinical Competency Committee meetings.
  13. Competence during the year is assured by direct observation by fellows and attending physicians, including review of verbal presentation, physical examination, and written notes in patient records. These observations are used from the formal evaluations noted above.
  14. PGY-IV and PGY-V Neurosurgical Residents are strongly encouraged to utilize reserved elective months to conduct clinical and/or basic science research, either on-or off-campus. It should be noted that the resident is encouraged to do research within the Department of Neurosurgery at Loma Linda but the experience is tailored to the educational wishes and needs of the individual resident, as developed by the Program Director and the resident. During these years, the resident is expected to participate in all academic conferences.
  15. PGY-VI residents are expected to prepare for and pass the ABNS primary exam for credit. Consideration of the timing of research and elective non-clinical rotations during the fourth year of training will be given in order to allow for ‘board prep’ time. PGY-4 residents who have not passed the primary exam for self-assessment will continue to take the exam for self-assessment until achieving a passing score. A passing score for credit is a requirement to successfully move on to the PGY-VII chief year.

Elective Procedures for PGY-IV and V Neurosurgical Residents without Supervision

All PGY I, II and III elective procedures without supervision

Emergency Procedures without Supervision

  • Defibrillate the heart
  • Emergency tracheostomy
  • Emergency cricothyroidotomy
  • Evacuation of soft tissue infection, abscess or hematoma

PGY-VI and VII residents are expected to accomplish and maintain the following objectives:

Either the PGY VI or PGY VII years will be the formal “Chief Resident” year depending upon the educational needs of the resident and the decision by the faculty that the resident has met the requirements and possess the skill set to progress to the chief resident year. The PGY VI or VII resident will spend the majority of their time providing direct patient care and supervising other residents, medical students and APPs under the direct guidance of attending surgeons. Chief Neurosurgical Residents will also have additional administrative responsibilities including making the resident call schedule, daily resident OR case assignments and daily assignments of service duties for both residents and APPs. The Chief Resident will also monitor and track operative cases that meet criteria for presentation at the monthly Neurosurgical M&M/QI conference. The Chief Resident will prepare a report of these cases monthly and provide this report to the attending surgeon assigned as the Neurosurgery QI Director. The Chief Resident will present these cases at the M&M/QI conference at the discretion of the QI Director. The Chief Resident year provides the final preparation and acquisition of skills required for independent practice.

PGY-VI or VII Neurosurgical Residents will:

  1. Obtain and record detailed historical information from patients and families, and verify the information gathered by physicians under their supervision.
  2. Perform and record detailed physical examinations on their patients, and verify the physical examinations done by the physicians under their supervision.
  3. Discuss with their fellow and/or attending the history and physical examinations, and will use this to define a diagnostic and therapeutic plan. They will assist the physicians under their supervision in defining a diagnostic and therapeutic plan.
  4. Write orders for patient care including diagnostic studies and therapies based on the above plan. They will verify the orders for patient care written by physicians under their supervision.
  5. Record daily progress notes in the patient record. Modifications of the diagnostic and therapeutic plan, based on further examination of the patient and discussion with attending surgeons, will be recorded in these progress notes and patient care orders.
  6. PGY-VI or VII Neurosurgical Residents will discuss as appropriate the diagnoses and diagnostic and therapeutic plan with other professionals involved in the patient care (i.e. nursing, social work, etc.) and the patient and/or family.
  7. The PGY-VI or VII Neurosurgical Residents is expected to demonstrate increasing levels of or 7 competence in performing the procedures essential for the practice of surgery. They will supervise bedside procedures.
  8. Discharge planning, writing of prescriptions, and discharge from inpatient or outpatient care is done by PGY-VI or VII Neurosurgical Residents under the supervision of the attending surgeon.
  9. The PGY-VI or VII Neurosurgical Residents will be actively involved with teaching, directing and supervision of junior Neurosurgical Residents, medical students and physician assistant students. They will participate in the evaluation of these individuals.
  10. The PGY-VI or VII Neurosurgical Resident is expected to fully participate in the teaching program including teaching conferences, attending rounds, interdisciplinary care conferences and other defined teaching conferences. It is expected that Neurosurgical Residents at this level of training will be self-directed learners, including studying outside of the structured education program.
  11. PGY-VI or VII7 Neurosurgical Resident will be evaluated at the end of each rotation by the supervising attending(s). Evaluations will be constructive and directed at assisting the process of graduated learning. More frequent evaluations should be expected whenever problems in performance are identified. A summary evaluation is conducted by the Program Director on a semi-annual basis that also includes the faculty assessment generated during Clinical Competency Committee meetings.
  12. Competence during the year is assured by direct observation by fellows and attending physicians, including review of verbal presentation, physical examination, and written notes in patient records. These observations are used for the formal evaluations noted above.

Elective Procedures for PGY-VI and VII (Chief) Neurosurgical Residents without Supervision

All PGY I, II, and III elective procedures without supervision

Emergency Procedures without Supervision

  • Defibrillate the heart
  • Emergency tracheostomy
  • Emergency cricothyroidotomy
  • Evacuation of soft tissue infection, abscess, or hematoma