Goals and Objectives

PGY-1

Applicants accepted to the neurosurgery residency at Duke are strongly encouraged to complete their general surgery internship at Duke.

The surgery internship at Duke includes rotations in neurosurgery, the neurosciences intensive care unit (NICU), neurology, as well as a mix of surgery specialties.

The call schedule is every third night, or less frequently, and the department maintains overall hours of work at 80 hours per week on average or less. Surgery interns are given two weeks of vacation, plus five to six days off over the winter holidays.

Dinner is provided without charge in the Duke University Hospital cafeteria for all interns and residents on call.

Neurosciences Intensive Care Unit (NICU)
The three-month rotation in the NICU is an excellent educational rotation. The neurosurgery resident on the NICU rotation rounds daily with the NICU team, which includes an attending, a NICU fellow, one or two nurse practitioners, a pharmacist, and the charge nurse.

Patient management is discussed in depth, and a care plan is formulated for each patient for the day. The resident then carries out necessary care for each patient with the help of the nurse practitioner and the NICU fellow.

The resident takes in-house call in the NICU every fourth night, rotating with nurse practitioners, and reports to the NICU attending on call. The rotation work hours are less than 80 hours per week.

PGY-2, PGY-3

Over the first two years in the neurosurgery residency, each resident completes 21 months on the neurosurgical service at Duke University Hospital and three months in neurology.

The order in which the rotations are completed varies, but generally each resident will complete their three-month neurology rotation during the PGY-2 year. Each rotation is described below.

Neurosurgery Service
Each junior resident on the neurosurgery service is assigned to one of the four neurosurgery services.

The resident is responsible for oversight of their attending's inpatients, works with their attendings in the OR, and attends clinic with one of their attendings one day each week. They are assisted with their duties by a physician assistant or nurse practitioner who works full time with the residents.

The junior residents take call every fourth or fifth night, during which they cover inpatient and emergency room consults, the neurosurgery patients in the NICU, and back up the intern on call covering the neurosurgery inpatients. The junior neurosurgery resident on call is assisted by a nurse practitioner or resident on call in the NICU, and reports to the chief resident or attending on call.

The post-call resident rounds with the team in the morning and leaves after signing out with the on-call resident (typically by 10:00 a.m.), with the option to stay for a morning surgical case if the work hours permit.

Each resident participates in over 600 operations during the 21 months on the neurosurgery service at Duke University Hospital.

Each resident receives four weeks of vacation per year plus five or six days off over the winter holidays.

Neurology Service
The three-month rotation in neurology is required by the American Board of Neurological Surgery (ABNS).

The neurosurgery resident rotating on the neurology service performs the same duties as a PGY-2 neurology resident and reports to the neurology chief resident at Duke.

The schedule is determined by the Department of Neurology and generally includes one month covering the outpatient neurology clinic at the Durham Veterans Affairs Medical Center (DVAMC), one month covering Duke Neurology consults, and one month doing EEG and EMG.

The schedule includes every fourth night in-house call at Duke, and one week of vacation. Overall work hours are less than 80 hours per week.

PGY-4

After completion of the junior residency, each resident participates in at least one year of basic science research, master's degrees in clinical sciences, health sciences or global health.

The resident is permitted to choose the laboratory in which the research rotation is performed, and is not discouraged from working outside of the Department of Neurosurgery laboratories.

Residents interested in performing two years of research in a seven-year residency program can usually be accommodated. 

PGY-5

The PGY-5 year is divided into an eight-month rotation at the Durham Veterans Affairs Medical Center (DVAMC), and four months as the chief resident of the Pediatric Neurosurgery Service.

Durham VA Medical Center
The DVAMC offers the only VA neurosurgery service in North Carolina. It has the only dedicated VA brain and spine tumor center in the state and the only VA epilepsy center on the East Coast.

The chief resident runs the neurosurgery clinic two days a week, operates three days a week, and is responsible for the care of all neurosurgery patients during the rotation. The chief resident is assisted by their co-chief PGY-5 and two full-time physician assistants, and staffs each operative case with one of the neurosurgery attendings at Duke.

The service varies according to the desires of the residents, but generally includes over 600 operations per year with a wide variety of adult neurosurgical procedures, mainly focused on spine surgeries.

The rotation offers an excellent opportunity for the residents to function independently in all aspects of patient management, from preoperative planning through postoperative follow up.

The residents take call from home and receive four weeks of vacation during the six month rotation, plus five or six days off over the winter holidays, and two weeks of vacation during the four months as pediatric neurosurgery chief. The lab residents provide vacation coverage.

PGY-6

The chief residency year of neurosurgical training is spent as chief resident (CR) at Duke University Hospital. The chief residents each spend four months on the tumor, spine/functional, and vascular services, respectively.

The CR is responsible for oversight of all care of the neurosurgical inpatients and the daily operative and call assignments. The chief residents are treated as junior faculty and viewed as colleagues of the faculty. The CRs divide the call schedule so that one is on call an average of one day each week and one weekend per month (the CR may take call from home).

Each CR has one meeting paid for without presenting (plus additional meetings if presenting), and receives four weeks of vacation plus five or six days off over the winter holidays.

PGY-7

The enfolded fellowship year. Residents will choose from the following: Neuro-oncology, functional, pediatrics, spine, endovascular, neuro ICU.