NAME: Neurosurgery
COORDINATOR: Prof. Gianluigi Zona
LOCATION: IRCCS Ospedale Policlinico San Martino
DURATION: 5 years
TRAINING PROGRAM:
Each year of the program includes 60 university educational credits (CFU), for a total of 300 CFU. These credits include both classroom-based learning and professional/practical training activities.
1st YEAR:
Basic Training Activities: General disciplines for specialist training, classroom-based activities.
Core Activities, Areas: Common clinical specialist curriculum; Common clinical curriculum, emergency and urgent care; Specific disciplines of the specialty.
In particular:
Understand the principles of patient positioning for cranial, spinal, and peripheral approaches.
Know the principles of antisepsis and be able to independently prepare a sterile surgical field.
Assist in the operating room, developing skills in tissue management.
Become familiar with surgical sutures for various types of tissues, both in macroscopic surgery and under the microscope, and know the surgical instruments.
Learn to use and adjust the operating microscope, anticipating surgical maneuvers and offering timely useful suggestions, working as an integral part of the surgical team.
Understand the basics of stereotaxy, fluoroscopy, neuronavigation, and intraoperative ultrasound.
Perform the placement of ventricular and lumbar drains and monitor intracranial pressure (ICP).
Perform drainage of chronic subdural hematomas.
Mandatory professional training activities to achieve educational objectives:
• Participate as second operator in 10 major surgery procedures.
• Participate as second operator in 25 intermediate surgery procedures.
• Perform as first operator some minor surgery interventions, including outpatient and Day Hospital (D.H.) procedures, and participate as second operator in 30 minor surgery interventions.
• Actively contribute to the diagnostic process for at least 100 patients with neurosurgical conditions.
2nd YEAR:
Core Activities, Areas: Common clinical specialist curriculum; Specific disciplines of the specialty.
In particular:
Be able to write a basic scientific article, such as a case report.
Know how to correctly interpret complex laboratory tests and imaging.
Be able to plan and implement management plans for patients with complex clinical conditions.
Correctly interpret diagnostic images such as MRI, angiography, and computed tomography (CT).
Collaborate with the tutor during on-call duties for consultations and hospital emergencies.
Procedural skills:
Correctly plan the incision for craniotomy.
Plan the incision for spinal surgery procedures.
Plan the incision for peripheral nerve surgeries.
Plan craniotomies or craniectomies.
Perform burr holes.
Expose the spinal lamina.
Properly manage hemostasis.
Know how to adequately close the dura mater.
Interpersonal and communication skills:
Communicate clearly and professionally with patients and their families in the ward, emergency room, and outpatient clinic, explaining the disease course and therapeutic options, including benefits, risks, and complications.
Use appropriate and understandable language.
Know the ethical and legal aspects related to neurosurgical practice.
Understand the principles of cost-effective practice and the management costs of patients and related procedures.
Mandatory professional training activities to achieve educational objectives:
• Participate as second operator in 12 major surgery procedures.
• Participate as second operator in 30 intermediate surgery procedures.
• Perform as first operator 30 minor surgery interventions, including outpatient and Day Hospital (D.H.) procedures, and participate as second operator in 60 minor surgery interventions.
• Participate in conducting clinical or basic research.
3rd YEAR:
Core Activities, Areas: Common clinical specialist curriculum; Specific disciplines of the specialty;
Demonstrate the ability to critically evaluate scientific literature.
Understand the basics of neuropathology and the classification of brain tumors.
Assist the tutor in consultations and management of hospital emergencies.
Demonstrate the ability to prepare an abstract and give an oral presentation at a scientific conference.
Assist the tutor in the outpatient clinic.
Procedural skills:
Perform myocutaneous flap for craniotomy.
Perform craniotomies or craniectomies.
Perform emergency evacuation of extradural hematomas.
Perform approaches for lumbar stenosis, cervical stenosis, lumbar disc herniation, lumbar stabilizations.
Hemostasis.
Microscopically close the dura mater.
Release of the median nerve at the wrist (carpal tunnel).
Insertion and revision of ventriculoperitoneal shunts.
Decompressive craniectomy.
Cranioplasty.
Mandatory professional training activities to achieve educational objectives:
• Participate as second operator in 12 major surgery procedures.
• Participate as second operator in 10 intermediate surgery procedures, 5 as first operator.
• Perform as first operator 30 minor surgery interventions, including outpatient and Day Hospital (D.H.) procedures, and participate as second operator in 60 minor surgery interventions.
• Participate in conducting clinical or basic research.
4th YEAR:
Core Activities, Areas: Common clinical specialist curriculum; Specific disciplines of the specialty;
In particular:
Knowledge and deepening of Pediatric Neurosurgery and Gamma Knife techniques.
Mastery in managing complications and procedures aimed at their prevention.
Autonomy in writing scientific papers.
Procedural skills:
Autonomy in cranial surgical approaches.
Ability to effectively assist in all types of surgery: cranial, spinal, and peripheral, both elective and emergency.
Perform approaches for cervical hernias.
Independently place cervico-thoracolumbar stabilization systems and other complex spinal instrumentation.
Demonstrate the ability to remove simple extra-axial tumors.
Mandatory professional training activities to achieve educational objectives:
• Participate as first operator in 3 major surgery procedures.
• Participate as second operator in 10 intermediate surgery procedures, 7 as first operator.
• Perform as first operator 30 minor surgery interventions, including outpatient and Day Hospital (D.H.) procedures, and participate as second operator in 60 minor surgery interventions.
• Participate in conducting clinical or basic research.
5th YEAR:
Core Activities, Areas: Common clinical specialist curriculum; Specific disciplines of the specialty;
In particular:
Assist tutors in the academic and clinical development and growth of junior residents.
Full autonomy in consultations and management of an active neurosurgical on-call service.
Full autonomy in managing a neurosurgical outpatient clinic.
Procedural skills:
Surgical planning.
Patient positioning.
Knowledge of the specific procedure.
Instruct junior residents in neurosurgical operative techniques.
Independently perform all neurosurgical emergency procedures.
Independently perform surgeries for lumbar stenosis, cervical stenosis, lumbar hernia, and cervical hernia.
Independently perform cervico-thoracolumbar vertebral stabilization surgeries.
Independently perform intracranial mass removal surgeries.
Ability to interact and collaborate with specialists from other disciplines in a multidisciplinary team.
Mandatory professional training activities to achieve educational objectives:
• Participate as first operator in 5 major surgery procedures.
• Participate as second operator in 12 intermediate surgery procedures, 10 as first operator.
• Perform as first operator 30 minor surgery interventions, including outpatient and Day Hospital (D.H.) procedures, and participate as second operator in 60 minor surgery interventions.
• Participate in conducting clinical or basic research.
• Final exam.
EDUCATIONAL OBJECTIVES:
Integrated Educational Objectives (i.e., Common Core)
The candidate resident must have acquired a solid theoretical knowledge and professional competence in recognizing and treating the most common pathologies in internal medicine and developmental age, including emergency situations. For all specialties in the same class, considering their cultural interconnection, the university educational credits (ECTS) in the common core of related specialties must include the following:
Theoretical knowledge of the anatomy and physiology of the central and peripheral nervous system.
General theoretical knowledge of the etiopathogenetic mechanisms of neurological and neurosurgical diseases across different life stages.
Basic theoretical knowledge and practical experience of diagnostic methodologies, including differential diagnosis (clinical examination, imaging diagnostics, electrophysiological techniques, chemical-biological analyses, and psychometric evaluations) of neurological and neurosurgical diseases throughout life.
Theoretical knowledge and clinical-practical experience (including emergency situations) of major neurological and neurosurgical diseases at different life stages, including neurological and neurosurgical complications of internal medicine diseases.
Basic theoretical knowledge and clinical-practical experience of the main techniques for prevention, treatment, and rehabilitation of neurological and neurosurgical diseases throughout life.
Knowledge of the ontogenesis and structural organization of the nervous system; the functioning of the central and peripheral nervous systems under normal and pathological conditions; fundamentals of statistical analysis and epidemiological methods; computer skills for data acquisition and processing.
Learning the biological basis of drug actions, as well as medico-legal and bioethical implications of drug use and, more generally, issues related to neurological diseases; learning fundamental etiopathogenetic mechanisms, including molecular medicine applied to neurology and clinical neurochemistry.
Educational Objectives Specific to the School’s Specialty
Medical and Scientific Knowledge
Acquire a practical understanding of the normal anatomy and physiology of the nervous system.
Understand the pathophysiology, clinical history, and management of patients with conditions such as increased intracranial pressure, cranial and spinal trauma, infections, cerebral edema, ischemia, epileptic seizures, hydrocephalus, myeloradicular compression, hemorrhagic pathologies, and peripheral nervous system disorders.
Have a comprehensive view of problems and care in intensive therapy.
Apply evidence-based clinical practices.
Be capable of reading and interpreting scientific articles.
Know how to conduct bibliographic research using major databases.
Patient Care and Clinical Skills
Be able to collect a complete patient history and conduct a targeted physical examination to detect nervous system lesions and formulate differential diagnoses.
Actively participate in the care of patients with neurosurgical diseases.
Record examinations, differential diagnoses, and therapeutic plans in the clinical record.
Correctly use and interpret laboratory and imaging exams.
Know the therapeutic options, both surgical and non-surgical.
Acquire skills to promptly recognize postoperative complications.
Be able to promptly identify medical and surgical emergencies and urgencies.
Gain experience in managing critically ill or fragile patients.
Participate in pre-operative, intra-operative, and post-operative care.
Develop basic surgical skills and understand various types of anesthesia, including related risks.
STRUCTURES AFFILIATED TO THE SCHOOL'S TRAINING NETWORK:
IRCCS Policlinic San Martino Hospital of Genoa, U57 Neurosurgery and Neurotraumatology Clinic
SS. Antonio and Biagio and Cesare Arrigo University Hospital - Alessandria, Neurosurgery
Giannina Gaslini Pediatric Institute, Neurosurgery
Santa Corona Hospital Pietra Ligure, Neurosurgery
Marche University Hospital of Ancona, Neurosurgery