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The Chairman’s View: Neurosurgery Training at The University of Rochester Medical Center (URMC) How We View Your Resident Education How We View Your Resident Education Your residency experience in Neurosurgery will present you with daunting obstacles and inspiring opportunities over your years of training. Neurosurgery will challenge your intellectual and technical skills, your dedication to high achievement, your physical stamina and your character and humanity like no other field in Medicine. As you cross the threshold into Neurosurgery residency you will encounter the jewel of medical specialties, which is dynamically changing and on the threshold of major advances in the treatment of Neurological diseases. It is the responsibility and privilege of our clinical and scientific faculty, to provide you with the opportunity to become an outstanding technical neurosurgeon; to enrich your clinical judgement and ethical sensibilities as you care for patients with life threatening nervous system illnesses; and to challenge your intellect at the scientific frontiers of Neuroscience Medicine. Our vision of residency training in Neurosurgery incorporates five components: (1) Tutorial clinical partnerships with each of our clinical faculty beginning on day one; incorporating rich operative, inpatient and outpatient experiences across the entire spectrum of Neurosurgical practice. (2) Acquisition of core technical operative skills in the early years of residency under the broad direction of Dr. Paul Maurer, Chief of the new Division of Operative and Technical Neurosurgery; Dr. Maurer is one of the nation’s gifted operative neurosurgeons and a supremely talented teacher of technical Neurosurgery (3) A vastly expanded core educational and didactic curriculum which addresses all of the competencies of Neurosurgical practice over the 6 years of residency (4) Research at the frontiers of translational Neurosurgery with our world class scientific faculty who are leaders in the search for new therapies for Neuroscience Diseases (5) Preparation for practice and leadership in the evolving arena of Neuroscience Medicine which will embrace multidisciplinary disease management approaches, will emphasize measures of quality and cost effectiveness of Neurosurgical care and which will irrevocably transform current practice models in our specialty Explosive Growth in Our Department: Implications for Your Training With the explosive growth of our Department in every sector we offer you a unique educational experience in Rochester which is challenging, enriching and collegial. We are determined to create an unequalled training environment in Rochester and this perspective has guided each of our Departmental initiatives: (1) to dramatically expand resident operative case volume and diversity (2) to emphasize the acquisition of core operative and technical skills by junior residents, setting the stage for operative independence in the senior years of residency (3) to eliminate non-productive clinical service activities by our residents, through the recruitment of mid-level providers (4) to recruit outstanding clinical and academic neurosurgeons to our faculty who will transmit the excitement of academic Neurosurgery to our residents (5) to recruit a world class scientific faculty who themselves are leaders in translational Neurosurgery and who will challenge our residents to contribute to the evolution of surgical therapies to Neuroscience Diseases (6) to recruit the most competitive resident applicants with the talent and motivation to tackle the challenges and opportunities we provide URMC Neurosurgery: A Burgeoning Department A review of our Department’s growth over the three years since my appointment as Chair, reveals a burgeoning enterprise which is approaching national stature in many areas. The Rochester Community Neurosurgery Initiative. With the formation in 2003 of Rochester Neurosurgery, “a regional initiative to promote improvements in the care of Neuroscience diseases” the URMC Department of Neurosurgery assumed leadership of Neurosurgical care across all health systems serving the Rochester region.
As a result, the case volume at our teaching facility, Strong Memorial Hospital, increased from 800 cases per year (1999) to 1900 cases per year (2005), with 2600 cases performed city wide by our faculty. This community initiative has spurred the growth of subspecialty programs including complex and minimally invasive spine, cerebrovascular, epilepsy, movement disorders and pain, pediatric, pituitary, skull base and neuro-oncologic surgery. Clinical Faculty Recruitment. Over the past three years, 7 outstanding clinical faculty have been recruited to our Department. These faculty have fostered subspecialty clinical programs and active collaborations with our scientific faculty. Our faculty now includes 11 clinical Neurosurgeons, with additional recruitments anticipated this coming year. Paul Maurer, M.D. one of the nation’s finest general operative neurosurgeons and most talented teachers was recruited in 2003 and has recently assumed leadership of the Division of Operative and Technical Neurosurgery. Subsequent recruitments have included Rafael Allende, M.D. and James T. Maxwell, M.D. (General Neurosurgery), Jason H. Huang, M.D. (Minimally Invasive and Complex Spine; Spinal Trauma, Peripheral Nerve Surgery), G. Edward Vates, M.D., Ph.D. (Open Cerebrovascular, Pituitary, Skull Base), and Jason Schwalb, M.D. (Functional and Stereotactic, Pain). Pending recruitments over the next 2 years will define our clinical and research programs in Neuro-oncology and endovascular neurosurgery. As our faculty grows and the dramatic expansion of clinical programs continues, our residents will enjoy an increasing diversity of training experiences. Research Faculty Recruitment. Our vision that partnerships between Neurosurgeons and translational neuroscientists are essential to the advancement of our specialty has stimulated the recruitment of extraordinary neuroscientists to our Department. These internationally recognized translational neuroscientists provide leadership for our Department in the development of new therapies for Neuroscience diseases. With the establishment of the Frank P. Smith Neurosurgical Research Laboratories and the recruitment of Berislav Zlokovic, M.D., Ph.D. as Vice Chair for Research in Neurosurgery, our research infrastructure expanded dramatically, eclipsing historical precedents and capapaulting our Department into the top 10 nationally in NIH funding. Dr. Zlokovic joined Shirley A. Joseph, Ph.D., a longstanding member of our scientific faculty. With the subsequent recruitment of Maiken Nedergaard, M.D., Ph.D. as Professor of Neurosurgery and Steven Goldman, M.D., Ph.D. as Professor of Neurology and Neurosurgery our Department assumed a position of national leadership in translational Neurosurgical research. Scientific leadership in the search for pathogenetic insights and new therapies for epilepsy, brain tumors, spinal cord and closed head injury, Alzheimer’s Disease, Stroke, Parkinson’s Disease, as well as stem cell transplantation, and gene therapies, is documented by numerous papers in high impact journals (impact factor > 10) over the past 5 years, including Nature Medicine (10), Science (1), Nature Reviews Neuroscience (1), Nature Biotechnology (3), Neuron (5), Trends in Neurosciences (4), Journal of Clinical Oncology (1), PNAS (3), and Blood (1). The combined faculty and staff of Departmental Laboratories over the past five years has grown extensively and provides an outstanding environment within which our residents can pursue challenging research projects in Neurosurgical Diseases. University of Rochester Medical Center (URMC): A Thriving Enterprise The University of Rochester Medical Center (URMC) amalgamates Strong Memorial Hospital, Highland Hospital, the Golisano Children’s Hospital, the University of Rochester Medical School, and the Aab Biomedical Research Institute. The URMC is contiguous with the University of Rochester River Campus which itself encompasses several outstanding neuroscience research departments. Strong Memorial Hospital, our teaching hospital, is an internationally recognized university hospital delivering the most comprehensive and specialized care in the region. It is the largest hospital (750 beds) in the Finger Lakes Region and serves a broad regional population of 2.3 million patients. Strong Memorial Hospital is a vibrant and profitable enterprise, averaging > 90% bed occupancy and reporting a 52M profit margin in 2004 – 2005, #1 among academic hospitals in New York State. Strong Memorial is the only level 1 trauma center in the Rochester region and recently opened a new, state of the art Burn – Trauma ICU. An impressive array of infrastructure improvements at URMC over the past decade includes new ambulatory care buildings, emergency/trauma facility, Neurosurgery operating rooms, adult and pediatric ICUs, a dramatically expanded Golisano Children's Hospital, and the URMC Eye Institute. Construction of a new five-story Wilmot Cancer Center is targeted for completion in 2007 A vibrant biomedical research environment is reflected in the annual ranking of URMC in the top 30 nationally in NIH funding. Neuroscience research represents the largest single contributor to URMC NIH funding, accounting for > 27% of the total. The Department of Neurology ranks 5th nationally in NIH funding, has 70 faculty members, and Robert Griggs, M.D. the Chair of Neurology is the editor of the prestigious journal Neurology. The Department of Neurosurgery ranks 10th nationally in NIH funding and in aggregate Neurology/Neurosurgery funding only two Universities in the nation rank higher. Other outstanding neuroscience research departments include the Department of Neurobiology and Anatomy at URMC and the Center for Visual Sciences and the Center for Brain and Cognitive Science on the River campus, whose Chair, Elissa Newport was recently elected to the National Academy of Sciences. The recently completed Aab Biomedical Research Institute at URMC provides an outstanding environment for our burgeoning translational research programs in Neurosurgery. The integration of URMC provides an ideal platform for advances in institutional Neuroscience Medicine initiatives with important implications for Neurosurgery program development and for resident education. Residency Training at URMC: Past, Present and Future A Collegial Training Environment. Historically, our residency has boasted a uniquely collegial relationships between faculty and residents. Rochester residents enjoy residency and form strong professional and personal relationships with clinical and scientific faculty. Another program strength has been the intense exposure to independent operative responsibility from early in residency and as a result, graduates of our program are traditionally quite advanced technically upon completion of residency. Residents are encouraged to approach clinical problems thoughtfully, and to formulate operative and clinical management decisions independently in preparation for academic or private practice. In summary, Rochester residents are happy in residency, rewarded by their relationships with faculty and are confident surgeons upon graduation. These important characteristics of Neurosurgery training in Rochester form the bedrock upon which our program expansion is constructed and upon which we are building a uniquely resourced training experience for talented residents. Residency in the Era of the 80 Hour Work Week.The Rochester response to the 80 hour work week requirement has been to reinvent our residency training program in a deliberate and comprehensive manner. We have used this mandate as a vehicle to enhance the vitality and effectiveness of our residency training experience and to improve the quality of life for our residents. 80 hours is a long time if used effectively. We therefore focused our attention on improving the time - efficiency of the clinical training experience for our residents. Broadly speaking, we sought to eliminate non-educational clinical service activities and to optimize didactic, research, clinical management and operative experiences which construe educational value. To advance our time - efficiency initiative, our Department recruited a team of floor-based and practice-based Nurse Practitioners who work closely with the resident staff to address patient care needs in the outpatient, inpatient, operative and perioperative settings. At Chief Resident’s sign-in rounds at 7 AM all residents meet with attendings and Nurse Practitioners to establish care plans for all in-patients. With the substantial resource provided by 9 talented mid-level providers, admissions, discharges, inpatient evaluations, stereotactic frame placements, family counseling, imaging studies, etc. are performed seamlessly and efficiently, under the broad direction of the Chief Resident and the on-call resident. In this model, quality of care, patient satisfaction, length of stay and clinical volumes have improved dramatically. Our residents learn to effectively manage a health care delivery team and are able to focus upon the critical aspects of their training program while not sacrificing patient care objectives. With this care initiative, despite the 80 hour mandate, academic conferences and research opportunities have been expanded and resident operative experience has skyrocketed. To dovetail with these programmatic improvements, in 2004 a work hours compliance model was developed by Dr. Jeffrey Tomlin (Chief Resident 2005 – 06) which has been applied to our residency program and which ensures compliance with the 80 hour mandate. Jeff presented this model in a plenary session presentation at the 2004 AANS meeting, and won an award for its development. In summary, residency training in Rochester in the era of the 80 hour work week is better in all regards, and provides superior training for neurosurgery practice of the 21st century. Preparing for Change in Health Care.The “80 hour work week” mandate is only one of many sweeping changes which will impact Neurosurgeons during first quarter of this century. This is a signal that historical practice models in Neurosurgery must be dramatically transformed to meet the challenges of contemporary Neuroscience Medicine. Traditional models of solo practice or loose associations of academic or private practice Neurosurgeons will be discarded. Evolving practice models will emphasize regional disease management approaches which will often be multidisciplinary. Increasingly, our practice of Neurosurgery will be guided by measures of outcome of surgery and the quality and cost effectiveness of care. Neurosurgeons will be called upon to lead multidisciplinary teams to address these goals; and to interface effectively with all the stakeholders in health care. Our goal is to immerse our residents in this evolving 21st century practice model to prepare them for the challenges with which they will be confronted upon graduation, and for leadership in the evolving arena of Neuroscience Medicine. The expansion of our clinical and research programs attests to the vitality of the Department of Neurosurgery at our institution. Our Department is in an exciting growth phase, adding outstanding individuals to our clinical and scientific faculty. In partnership with other Departments we are defining institutional initiatives designed to place our medical center in the elite ranks in Neuroscience Medicine nationally. In 2005, we are the only program and hospital in upstate New York to receive a U.S.News and World Report “top hospitals” ranking for Neurosurgery/Neurology, attesting to the advances we have made over the past three years. No listing of Departmental accomplishments, however, eclipses the importance we place upon resident training. Our most important contribution to our profession and to society lies in the talented young people we educate to be neurosurgeons. Resident training represents our highest calling, and residents are the lifeblood of Neurosurgery and the future leaders of the burgeoning field of Neuroscience Medicine. The intimate tutorial experience of training young residents inspires and invigorates our entire clinical and scientific faculty and is a joy to share with the trainees fortunate enough to be selected to join us here in Rochester, New York. I know this is a very exciting time for you as you carefully consider where you will spend the next and most exciting phase of your professional training. We will be delighted to help you explore your interest in Neurosurgery Resident education at University of Rochester Medical Center. Please feel free to contact our Residency Administrator, Melanie Zandvoort with any questions you might have. I certainly look forward to reviewing your application and to meeting you during your interview. Sincerely, Webster H. Pilcher, MD, PhD Frank P. Smith Professor and Chair
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