Goals and Objectives of the Stanford Neurosurgery Resident Training Program The Department is committed to training neurosurgeons who are thoughtful, skillful, and innovative. Almost all senior residents score highly on the ABNS written exam and every resident graduating since 1985 who has taken the oral exam is ABNS board certified. Currently, our senior and chief residents are each involved in about 350 index cases a year, but numerous complex index cases of greatest educational value to a senior or chief resident still go uncovered. These have increased significantly in recent years (AY 2007-2008 and 2009-2009) with our expansion to 23 clinical faculty members with Stanford admitting and operating privileges. We anticipate that by the time we have filled out the increased complement of residents and added Santa Clara Valley Medical Center, a minimum of 500 index cases of greater complexity will be available to each of the six senior and chief residents. Since 2004, the department has been among the top four neurosurgery departments in the country in grant support from the NIH. The Program Director holds one of two R25 NIH grants for Neurosurgery Resident Training in Research (2020-2014). This environment provides our residents opportunities to obtain grant support (3 NRSA/NIH awards, 3 NREF awards, 2 Giannini Foundation awards, one Christopher Reeve Paralysis Foundation grant, and one Elekta Resident Research Grant in the last 6 years), to publish extensively (22 peer reviewed publications and 26 presentations at national meetings in 2008), and to earn recognition (the 2007 CNS Resident Research Award, a citation for a top 10 score (by a PGY4 resident) on the ABNS written exam, second place pair in the 2008 CNS SANS Challenge, and the 2004-2005 and 2008-2009 van Wagenen Fellowships). Of our last 16 graduates, eight hold full time academic appointments (at Stanford (3), Johns Hopkins, Mount Sinai, North Carolina, Brown, Boston University, and Cedars-Sinai), and another two maintain research interests at Stanford. Our current 2 chief residents have accepted academic faculty positionsstarting July 2011, one at Duke and one at Stanford. We are succeeding in our goal of training academic neurosurgeons. 1) The PGY 1 experience will consist of 13 four week rotations: 4 in General Surgery Skills (Adult General Surgery, Pediatric General Surgery, ER-Trauma, SICU), 3 in Neurology (6 weeks each of Neurology Consults and Neuro-ICU), 4 in Allied Clinical Neurosciences (Neuropathology, Neuroradiology, Endovascular Neurosurgery, Stereotactic Radiosurgery), and 2 in Neurosurgery. 2) PGY-2 emphasizes the fundamentals of neurosurgical care and surgery as the resident cares for neurosurgical patients as Junior Resident at Stanford University Hospital; 3) PGY-3 encourages greater primary responsibility in basic subspecialty neurosurgical care and surgery as Senior Resident at Lucille Packard Children’s Hospital, Palo Alto VA Hospital, and Santa Clara Valley Medical Center ; 4) PGY-4 initiates dedicated laboratory research, an enfolded clinical fellowship emphasizing outcomes research, or their combination; 5) PGY-5 completes dedicated laboratory research, an enfolded clinical fellowship emphasizing outcomes research, or their combination; 6) PGY-6 provides greater experience with primary responsibility for medical and surgical management of neurosurgical cases as Senior Resident at SUH; and 7) PGY-7 permits additional experience with advanced techniques for the most demanding cases and requires the development of administrative abilities as Chief Resident at SUH. Educational Goals and Objectives of Training Year NS-1 Patient care: The resident will develop the ability to Perform and document a comprehensive general, neurologic and neurosurgical history and physical examination Practice critical care skills as required for inpatient general surgery, neurology, and neurosurgery Understand the indications for and interpret the meaning of presurgical laboratory studies and imaging Develop patient care plans appropriate to a patient's presenting problems or postoperative course in consultation with the chief resident or attending surgeon Establish and implement effective patient care plans Counsel patients on the risks, goals, limits, and alternatives to simple surgical and neurosurgical procedures and more complex procedures under supervision of the chief resident or attending surgeon Perform selected surgical procedures under direct supervision (e.g., ventriculostomies, VP shunt placement, simple spine surgery and craniotomies, angiography) Assist in major surgical procedures and perform those portions of such procedures, under supervision, that are appropriate for his or her level of training Work with health care professionals composing the general surgical, neurology or neurosurgery team and other members of the health care team from other disciplines Medical Knowledge: The resident will develop the ability to Initiate a program of independent study in preparation for the ABNS primary examination Demonstrate a solid foundation of knowledge of anatomy, physiology, and pharmacology related to inpatient general surgical, neurology, and neurosurgery patients Correctly interpret basic laboratory and radiological studies Demonstrate a growing familiarity with classic and current aspects of the neurosurgical literature Demonstrate a foundation for clinical general surgical, neurological and neurosurgery problem solving and decision making Practice-Based Learning and Improvement: The resident will develop the ability to Demonstrate an ongoing and improving ability to learn from errors Locate, appraise, and assimilate evidence from scientific studies related to common general surgical, neurological, and neurosurgical problems Identify areas of neurosurgical practice where current knowledge is inaccurate or inadequate, and participate in clinical studies to improve the general fund of knowledge in neurosurgery Construct and implement educational goals for instruction in different elective fields (e.g., general surgery, neurology, neuropathology, neuroradiology, radiosurgery, endovascular neurosurgery) Interpersonal and Communication Skills: The resident will develop the ability to Provide compassionate ward and outpatient care as determined by patients, families, colleagues, and auxiliary health professionals Work effectively as a member of a health care team Communicate effectively with other health care professionals on consulting services Professionalism: The resident will develop the ability to Demonstrate sensitivity and responsiveness to patients' culture, age, gender, and disabilities Demonstrate integrity and a commitment to patients that supercedes self interest Participate meaningfully in ongoing professional development by submitting research for peer review to journals and national meetings System Based Practice: The resident will develop the ability to Understand the university-based practice of general surgery, neurology, and neurosurgery, including its interactions with other health care organizations and how these elements of health care affect the university practice Advocate for quality patient care and assist patients in dealing with system complexities Practice cost-effective health care and resource allocation through evidence-based medical practice that does not compromise quality of care Educational Goals and Objectives for Training NS-2 Patient Care: The resident will develop the ability to Perform and document a neurosurgery history and physical examination, with emphasis on spinal and complex neurosurgical disorders Understand the indications for and interpret the meaning of laboratory studies and imaging as relates to neurosurgery in general Develop complex diagnostic and patient-management skills, including participation in busy outpatient neurosurgical clinics Establish and implement effective patient care plans Counsel patients on the risks, goals, limits, and alternatives to neurosurgical procedures, with an emphasis on spinal neurosurgery Perform selected surgical procedures under direct supervision, focusing on spinal neurosurgery (e.g., lumbar and cervical laminectomies, lumbar discectomy, anterior cervical discectomy with and without fusion) Assist in major surgical procedures and perform those portions of the operation that are appropriate to the resident's level of training under guidance Competently perform inpatient procedures Medical Knowledge: The resident will develop the ability to Score above 200 on the ABNS primary examination Demonstrate a solid foundation of knowledge of anatomy, physiology, and pharmacology related to inpatient neurosurgery patients, pain management, and critical care neurology Demonstrate an expanded familiarity with the neurosurgical literature, with special emphasis on spine, tumor, trauma, vascular and functional neurosurgery and critical care issues Demonstrate accuracy in clinical evaluation skills, including the correct interpretation of basic and advanced laboratory and radiological studies Practice-Based Learning and Improvement: The resident will develop the ability to Demonstrate an ongoing and improving ability to learn from errors Construct and implement educational goals for instruction in different elective fields (e.g., radiosurgery, neuro-oncology, vascular neurosurgery, functional neurosurgery, spine disease) Develop fundamental research skills that can be used to develop a fundable basic science research proposal Locate, appraise, and assimilate evidence from scientific studies related to common neurosurgical problems, with emphasis on spinal and pediatric neurosurgery Identify areas of neurosurgical practice where current knowledge is inaccurate or inadequate and participate in clinical studies to improve the general fund of knowledge in neurosurgery Interpersonal and Communication Skills: The resident will develop the ability to Provide compassionate ward and outpatient care as determined by patients, families, colleagues, and auxiliary health professionals, including joint neurosurgical spine, and multidisciplinary clinics Work effectively as a member of a health care team, especially in an outpatient specialty clinic setting Participate meaningfully in multidisciplinary conferences focused on specific neurosurgical fields (e.g., vascular, tumor and spine neurosurgery) Professionalism: The resident will develop the ability to Demonstrate sensitivity and responsiveness to patients' culture, age, gender, and disabilities Demonstrate integrity and a commitment to patients that supercedes self interest Participate meaningfully in ongoing professional development by submitting research for peer review to journals and national professional meetings Systems Based Practice: The resident will develop the ability to Understand the university-based practice of neurosurgery, including its interactions with other health care organizations and how these elements of health care affect the university practice Advocate for quality patient care and assist patients in dealing with system complexities, especially in an outpatient setting Practice cost-effective health care and resource allocation through evidence-based medical practice that does not compromise quality of care Understand practice management issues, such as patient processing, evaluation, and management coding, procedural terminology, documentation of services rendered, and other reimbursement process related issues in outpatient clinic setting Demonstrate an understanding of practice opportunities, practice types, health care delivery systems, and medical economics Educational Goals and Objectives for Training Year NS-3 Patient Care: The resident will develop the ability to Perform and document a senior level neurosurgery history and physical, with special emphasis on quick patient assessment and a concise communication for patients with immediately life-threatening traumatic and vascular neurosurgical disorders Understand indications for and interpret the meaning of routine and more complicated laboratory studies and imaging, with an emphasis on pediatrics and traumatic nervous system injury Devise patient care plans at a senior level, with the speed and accuracy needed for patients with immediately life-threatening neurosurgical disorders, under appropriate supervision from attending surgeons, while also managing busy outpatient clinics (PAVA and SCVMC) Establish and implement effective patient care plans, assuming the role of leader on a health care team, under appropriate supervision of an attending surgeon Counsel patients on the risks, goals, limits, and alternatives to most neurosurgical procedures Perform complex neurosurgery procedures (cranial and spinal) and begin to assist at the chief resident level with a higher degree of independence Instruct residents and medical students regarding their performance of selected noncomplex surgical procedures appropriate to their level of training, acting as assistant to the chief resident in the management of a busy neurosurgical service or as chief resident at PAVA and SCVMC Medical Knowledge: The resident will develop the ability to Score above 300 on the ABNS primary examination (for credit) Demonstrate an advanced knowledge of anatomy, physiology, and pharmacology related to inpatient and outpatient neurosurgery care, with special emphasis on traumatic nervous system injury and vascular neurosurgical disorders Demonstrate an advanced familiarity with the neurosurgical literature, with special emphasis on traumatic nervous system injury and pediatric neurosurgery Teach and mentor PGY-1 and PGY-2 residents Practice-Based Learning and Improvement: The resident will develop the ability to Demonstrate an advanced ability to learn from errors Finalize the design of a research project to be carried out during the 4th year and submit a grant proposal for its funding Establish a solid evidence-based approach to patient care at a more senior level Demonstrate senior level critical appraisal of evidence from scientific studies in the neurosurgical literature, with emphasis on traumatic nervous system injury and pediatric neurosurgery Identify areas of neurosurgical practice where current knowledge is inaccurate or inadequate and participate in clinical studies to improve the general fund of knowledge in neurosurgery Interpersonal and Communication Skills: The resident will develop the ability to Provide compassionate ward and outpatient care at a senior level as determined by patients, families, colleagues, and auxiliary health professionals, serving as the primary provider of care at PAVA and SCVMC Work effectively as the leader of a health care team in both inpatient and outpatient settings Participate meaningfully in multidisciplinary conferences, serving as the primary representative of neurosurgical practice at PAVA and SCVMC Professionalism: The resident will develop the ability to Demonstrate sensitivity and responsiveness to patients' culture, age, gender, and disabilities, especially in the setting of providing care to the indigent and underserved Demonstrate integrity and a commitment to patients that supercedes self interest, serving as primary neurosurgeon at PAVA and SCVMC Participate meaningfully in ongoing professional development by submitting research for peer review to journals and national professional meetings System Based Practice: The resident will develop the ability to Demonstrate an understanding of practice opportunities, practice types, health care delivery systems, and medical economics though participation at a chief level in a variety of health care delivery settings (LPCH, PAVA, SCVMC) Advocate for high-quality patient care and assist patients in dealing with system complexities, especially in the setting of providing care for the indigent or underserved Practice cost-effective health care and resource allocation through evidence-based medical practice that does not compromise quality of care Understand practice management issues such as patient processing, evaluation, and management coding, procedural terminology, documentation of services rendered, and other reimbursement process related issues in both inpatient and outpatient settings, serving as the primary provider of care (PAVA and SCVMC) Educational Goals and Objectives for Training Year PGY-4 This is a dedicated research year; residents during this year of training participate in clinical duties or activities only when required for coverage for their peers’ vacation or academic meetings Patient Care: The resident will develop the ability to Understand indications for and interpret the meaning of routine and complex laboratory studies and imaging Counsel patients on the risks, goals, limits, and alternatives to most neurosurgical procedures Medical Knowledge: The resident will develop the ability to Score above 400 on the ABNS primary examination (for credit) Demonstrate an advanced knowledge of anatomy, physiology, and pharmacology related to inpatient and outpatient neurosurgical care Demonstrate an advanced familiarity with the neurosurgical literature Demonstrate the ability to evaluate and synthesize hypotheses regarding basic scientific investigations Practice-Based Learning and Improvement: The resident will develop the ability to Demonstrate an ongoing and improving ability to learn from errors Demonstrate a high capacity for work and intensity in a basic science research environment Develop problem solving skills that can be used to design, implement, analyze, and report basic science research that is relevant to the clinical arena Establish sound research and research-related problem-solving habits, including the establishment of familiarity with relevant research literature Become an integral component of a research team Continue a research project, refine a research plan and submit additional grant proposals Learn significant features of outcomes research and clinical epidemiology Interpersonal and Communication Skills: The resident will develop the ability to Communicate effectively with all members of the research team Utilize communication and interpersonal skills to effectively participate in and lead research projects Communicate research results effectively and persuasively through written and oral presentations Professionalism: The resident will develop the ability to Demonstrate a commitment to academic and scientific integrity through participation in Departmentsponsored educational forums on basic and clinical research Participate meaningfully in ongoing professional development by submitting research for peer review to journals and national meetings Educational Goals and Objectives for Training Year PGY-5 This is a second dedicated research year; residents during this year of training participate in clinical duties or activities only when required for coverage for their peers’ vacation or academic meetings Patient Care: The resident will develop the ability to Understand indications for and interpret the meaning of routine and complex laboratory studies and imaging Counsel patients on the risks, goals, limits, and alternatives to most neurosurgical procedures Medical Knowledge: The resident will develop the ability to Perform above the 50th % ile level of the ABNS primary examination (for credit) Demonstrate an advanced knowledge of anatomy, physiology, and pharmacology related to inpatient and outpatient neurosurgical care Demonstrate an advanced familiarity with the neurosurgical literature Demonstrate the ability to evaluate and synthesize hypotheses regarding basic scientific investigations Practice-Based Learning and Improvement: The resident will develop the ability to Demonstrate an ongoing and improving ability to learn from errors Demonstrate a high capacity for work and intensity in a basic science research environment Develop problem solving skills that can be used to design, implement, analyze, and report basic science research that is relevant to the clinical arena Establish sound research and research-related problem-solving habits, including the establishment of familiarity with relevant research literature Become an integral component of a research team Learn significant features of outcomes research and clinical epidemiology Interpersonal and Communication Skills: The resident will develop the ability to Communicate effectively with all members of the research team Utilize communication and interpersonal skills to effectively participate in and lead research projects Communicate research results effectively and persuasively through written and oral presentations Professionalism: The resident will develop the ability to Demonstrate a commitment to academic and scientific integrity through participation in Departmentsponsored educational forums on basic and clinical research Participate meaningfully in ongoing professional development by submitting research for peer review to journals and national meetings System Based Practice: The resident will develop the ability to Demonstrate an understanding of practice opportunities, practice types, health care delivery systems, and medical economics Educational Goals and Objectives of Training Year PGY-6 Patient Care: The senior resident will develop the ability to Gather essential and accurate information about all presurgical patients, either directly or through the management of more junior residents Understand indications for and interpret the meaning of all laboratory studies and imaging used in neurosurgery Devise patient care plans at a level approaching that of an independent neurosurgeon, under appropriate supervision from the chief resident and attending surgeons; and also guide more junior residents in the evaluation and management of patients Establish and implement effective patient-care plans, assuming, at times, the role of primary leader on the neurosurgery service, under appropriate supervision of a chief resident or an attending surgeon Counsel patients on the risks, goals, limits, and alternatives to all neurosurgical procedures Demonstrate the ability to perform many major neurosurgical procedures at an independent level, under appropriate supervision of a chief resident or attending surgeon Manage and administrate the complexities of a large clinical and academic service Medical Knowledge: The senior resident will develop the ability to Demonstrate an advanced knowledge of anatomy, physiology, and pharmacology related to all aspects of neurosurgery Demonstrate a familiarity with the neurosurgical literature approaching that of an independent surgeon capable of life-long learning Manage and lead academic conferences Participate actively and lead conferences in a manner that demonstrates a high level of global awareness regarding clinical neurosurgery, basic and applied research, and understanding of the literature, neurosurgical education, and program building Practice-Based Learning and Improvement: The senior resident will develop the ability to Manage and administrate the complexities of a large clinical and academic service Develop skills as a program builder and an administrator of the neurosurgical service Demonstrate a solid evidence-based approach to patient care at the level of a practicing surgeon Demonstrate sound habits of personal scholarship and inquiry Interpersonal and Communication Skills: The senior resident will develop the ability to Assist the Chief Resident, PD and faculty in overseeing the personal, academic, and clinical growth and development of junior residents Instruct and nurture junior residents in all aspects of neurosurgical patient care (outpatient, inpatient, and ICU settings) Demonstrate the ability to interact with many different health care personnel with efficiency and efficacy in the pursuit of patient care and service management Demonstrate leadership skills in the management of more junior residents Professionalism: The senior resident will develop the ability to Demonstrate sensitivity and responsiveness to patients' culture, age, gender, and disabilities Demonstrate integrity and a commitment to patients that supercedes self interest, serving as primary neurosurgeon Participate meaningfully in ongoing professional development by submitting research for peer review to journals and national professional meetings Systems Based Practice: The senior resident will develop the ability to Demonstrate an understanding of practice opportunities, practice types, health care delivery systems, and medical economics at a level that approaches that of an independent neurosurgeon Advocate high-quality patient care and assist patients and the responsible junior residents in dealing with system complexities Guide junior residents in the practice of cost-effective health care and resource allocation through evidence-based medical practice that does not compromise quality of care Understand practice management issues such as patient processing, evaluation and management coding, procedural terminology, documentation of services rendered, and other reimbursement process related issues in both inpatient and outpatient settings, serving as the primary provider of care Educational Goals and Objectives of Training Year PGY-7 Patient Care: The chief resident will develop the ability to Gather essential and accurate information about all presurgical patients, either directly or through the management of more junior residents Understand indications for and interpret the meaning of all laboratory studies and imaging used in neurosurgery Devise patient care plans at the level of an independent neurosurgeon, under appropriate supervision from attending surgeons; and also guide more junior residents in the evaluation and management of patients Establish and implement effective patient-care plans, assuming the role of primary leader on the neurosurgery service, under appropriate supervision of an attending surgeon Counsel patients on the risks, goals, limits, and alternatives to all neurosurgical procedures Demonstrate the ability to perform all major neurosurgical procedures at an independent level, under appropriate supervision of an attending surgeon Manage and administrate the complexities of a large clinical and academic service Medical Knowledge: The chief resident will develop the ability to Demonstrate an advanced knowledge of anatomy, physiology, and pharmacology related to all aspects of neurosurgery Demonstrate a familiarity with the neurosurgical literature appropriate for an independent surgeon capable of life-long learning Manage and lead academic conferences Participate actively and lead conferences in a manner that demonstrates a high level of global awareness regarding clinical neurosurgery, basic and applied research, and understanding of the literature, neurosurgical education, and program building Practice-Based Learning and Improvement: The chief resident will develop the ability to Manage and administrate the complexities of a large clinical and academic service Develop skills as a program builder and an administrator of the neurosurgical service Demonstrate a solid evidence-based approach to patient care at the level of a practicing surgeon Demonstrate sound habits of personal scholarship and inquiry Interpersonal and Communication Skills: The chief resident will develop the ability to Assist the PD and Resident Education Committee in overseeing the personal, academic, and clinical growth and development of junior residents Instruct and nurture junior residents in all aspects of neurosurgical patient care (outpatient, inpatient, and ICU settings) Demonstrate the ability to interact with many different health care personnel with efficiency and efficacy in the pursuit of patient care and service management Demonstrate leadership skills in the management of more junior residents Professionalism: The chief resident will develop the ability to Demonstrate sensitivity and responsiveness to patients' culture, age, gender, and disabilities Demonstrate integrity and a commitment to patients that supercedes self interest, serving as primary neurosurgeon Participate meaningfully in ongoing professional development by submitting research for peer review to journals and national professional meetings Systems Based Practice: The chief resident will develop the ability to Demonstrate an understanding of practice opportunities, practice types, health care delivery systems, and medical economics at a level that is expected of an independent neurosurgeon Advocate high-quality patient care and assist patients and the responsible junior residents in dealing with system complexities Guide junior residents in the practice of cost-effective health care and resource allocation through evidence-based medical practice that does not compromise quality of care Understand practice management issues such as patient processing, evaluation and management coding, procedural terminology, documentation of services rendered, and other reimbursement process related issues in both inpatient and outpatient settings, serving as the primary provider of care The educational rationale for this program is multifaceted: curricular, pedagogic and research-directed: 1) Recent technological developments such as Endovascular Neurosurgery (EVNS), Stereotactic Radiosurgery (SRS), Minimally Invasive Complex Spine Surgery (MICSS), and Endoscopic Pituitary and Skull Base Surgery (EPSBS) have prompted the ABNS to mandate training in EVNS and SRS and encourage training in MICSS and EPSBS; in turn, Stanford has expanded its training and facilities in these areas. 2) Recent studies have shown superior learning in training programs organized around small teams which allow both greater subspecialty focus and better mentoring through faculty-resident relationships with greater resemblance to apprenticeship (c.f., Schneider JR, et al, Implementation and evaluation of a new surgical residency model. J Am Coll Surg 2007; 205:393-404); the flexibility of scheduling afforded by the proposed incremental half resident FTE and 4 month long rotations permits exposure of small teams to novel areas; 3) A 24 month research block free of on-call responsibility (except to cover absences for educational courses, national meetings, and vacations) enhances appreciation of the scientific bases of neurosurgery and fully utilizes the resources provided by our recent receipt of an NIH R25 Resident Research Training Award (one of only two received by a neurosurgical training program) As depicted in the Block Diagram below, focused training in new areas will occur as follows: 1) EVNS in PGY-1 (1m, partial), PGY-6 (4m dedicated), and PGY-7 (4m, combined); 2) SRS in PGY-1 (1m, partial), PGY-3 (4m, combined), and PGY-7 (4m, combined); 3) MICSS in PGY-7 (4m dedicated); and 4) EPSBS in PGY-7 (4m, combined). The greater number of residents and the more numerous rotations (4 months vs the current 6 months in length) allows division into smaller teams, with two or three residents assigned to a pair of faculty members. This permits adding rotations in novel techniques without deleting current rotations of value and encourages closer faculty-resident mentoring. The 24 month block of PGY-4,5 is dedicated to research, either in the laboratory or in an enfolded clinical fellowship (such as EVNS or SRS) emphasizing outcomes analysis. Call responsibility is limited to covering special situations (educational courses, national meetings, and other residents’ vacations). Block Diagram PGY I (3) II (3) III (3) IV (3) V (3) VI (3) VII (3) July - Oct Nov-Feb Mar - June Surgery (16 weeks): Adult GS, Ped GS, ERTrauma, SICU Junior NS-A: SUH (Tumor-SRS) Neurology (12 weeks): (Neuro consult, ICU); Neurosurgery (8 weeks) Junior NS-B: SUH (Functional-Spine) Allied Clinical Neuroscience (16 weeks): NRad, NPath, EVNS, SRS Junior NS-C; SUH (Vascular-EVNS) Senior NS-A: PAVAH (Spine, PN, Tumor) Senior NS-B: LPCH (Pediatric NS) Senior NS-C: SCVMC (Trauma) Clinical Elect / Research Clinical Elect / Research Research / Clinical Elect Research / Clinical Elect Senior NS A: Vascular-Endovascular Chief NS A: Min Invasive Complex Spine Senior NS B: Pediatric NS Chief NS B: SRS-Endo-Micro for Skull Base and Pituitary Tumors Clinical Elect / Research Research / Clinical Elect Senior NS C: Functional-Spine Chief NS C: Micro-Endo Vascular Faculty to Resident Ratio Key Faculty: 23 Active Residents On Duty: 14 Non-active Residents: 3 (In Program but Doing Research/Other Training) The teaching program at Stanford which includes the following: Topic Frequency Friday 1) Neurosurgery Grand Rounds Weekly 7 am 2) Neurology Grand Rounds Weekly 8 am 3) Visiting Professor Case Presentation Weekly 9--12am 4) Tumor Board Weekly 12:15-1:15 pm 5) Didactic Session Weekly 1:15-4 pm Teaching sessions at SCVMC include the following: Topic Frequency Day Time 1. Cranial Trauma Conference weekly Monday 7 am 2. Spinal Trauma Conference weekly Tuesday 7 am 3. Elective Cranial Case Review weekly Wednesday 7 am 4. Elective Spinal Case Review weekly Thursday 7am To ensure full participation of these residents in the education program at Stanford, they will have no clinical responsibilities at SCVMC on Friday from 7 am to 5 pm and, instead, will attend all Friday teaching sessions at Stanford. On Friday, the Stanford Neurosurgery Program academic day, the SCVMC residents will participate fully in the teaching program at Stanford.