Curriculum

Neurosurgery Residency Program Curriculum

PGY1

The PGY-1 year involves a wide range of rotations, including 6 months of neurosurgery at the University Hospital site.  Residents additionally complete blocks in trauma surgery, inpatient general neurology, otolaryngology – head and neck Surgery/otology, plastic surgery with a focus on peripheral nerve management, neuroradiology, neuropathology, and general internal medicine on the consult medicine service. 

Over the course of the year, our residents obtain a broad knowledge base, allowing them to take on a wide variety of challenges, and think about neurosurgical presentations from the perspective of various specialties.  In each of these rotations, residents will have the ability to hone their skill and focus on applying each of these specialties to their neurosurgical training.  In addition, residents work with colleagues in other specialties that they will work with as part of interprofessional teams over the coming years.

Throughout the year, residents participate in the Principles of Surgery Royal College curriculum, as well as the general neurosurgical academic curriculum.  Residents acquire rudimentary skills, and are able to participate in standard neurosurgical cases.  Overall, the first year allows residents to develop a breadth of transferrable skills that they will carry through them throughout residency.

PGY2

PGY-2 residents complete a significant amount of time on the neurosurgical service.  Residents rotate both at the University Hospital site, as well as at Victoria and Children’s Hospital, where they will continue to gain their independence.  At the University Hospital site, residents are directly supervised by our chief residents, as well as the consultants.  Residents participate in a significant volume of patient assessment/care, as well as emergency procedures.  During this year, residents continue to develop their operative skills. 

At the Victoria and Children’s Hospital rotation, residents work directly under the supervision of the faculty.  This rotation includes independently managing the adult cranial head trauma service at a ward and critical care level, general neurosurgery consultation service, and the pediatric neurosurgery unit.  Residents participate in the multidisciplinary care of pediatric and trauma patients.

In this year, residents also participate in a three-month block of critical care medicine split between the Critical Care Trauma Centre (CCTC) at Victoria Hospital, and the Medical/Surgical Intensive Care Unit (MSICU) at University Hospital.  In this rotation, residents gain independence at placing lines, and managing the resuscitative and intensive care of both neurological and general patients.

PGY3

The PGY-3 year covers a diverse range of rotations.  Residents perform a second rotation at the Victoria and Children’s Hospital, as well as begin to work as a mid-level resident at the University Hospital.  At university hospital, there is a greater focus on operative independence, and performing larger parts of neurosurgical procedures with supervision from the chief residents and staff.  Residents in the PGY-3 year are also given the opportunity to assist in cases of higher difficulty.

In this year, residents also complete a rotation at the Ouellette Campus of Windsor Regional Hospital.  This beloved community rotation allows for residents to understand and get exposure to neurosurgery outside of an academic centre, and to build further exposure with spine surgery in particular. 

Residents also complete rotations in Gamma Knife Radiosurgery at Toronto Western Hospital, exposing residents to stereotactic radiosurgery, for a wide range of indications from trigeminal neuralgia to brain metastases.  Residents additionally complete another rotation in neuropathology to further solidify their understanding of brain tumours, as well as to begin taking on more challenging histopathological cases.

PGY4

The PGY-4 year is the elective year for neurosurgery residents that have successfully completed the previous junior years of the program in good standing.  Residents are given the latitude to participate in academic activities, or further clinical work.  Throughout the second and third year of the program, residents work with their mentors to identify their interests to pursue, and are supported in developing either research or clinical plans. 

Residents interested in pursuing research are welcome to pursue a year of scholarly work culminating in a project, or pursue advanced degrees.  Residents in our program have been very successful at accessing the Clinician Investigator Program to obtain further years of funding, in addition to the PGY-4 year if they wish to pursue an advanced degree.  Furthermore, residents have similarly been very successful in earning CIHR and NSERC funding to support themselves through research years.  Our department boasts several clinician scientists covering nearly every subspecialty of neurosurgery, and residents are welcome to work with consultants locally or identify projects at other institutions to collaborate with.

Residents interested in pursuing further clinical work are welcome to join the University Hospital service, or additionally seek electives at other institutions.

PGY5

During this year, residents begin by rotating through a selection of neuropathology, neuro-oncology, EMG, or the Epilepsy Monitoring Unit to gain advanced skills in many of the specialties peripheral to neurosurgery.  During this time, residents also write the written segment of the royal college examination in the third block of the year.  After this, residents spend the remainder of the year as senior neurosurgery residents at the University Hospital site.  They are exposed to all facets of neurosurgery, build independence and begin performing more complex cases.  At this time, residents have identified their specialty of interest and are applying for fellowships if applicable.  In the final quarter of the year, residents begin to specifically prepare for becoming the chief residents.

PGY6

The PGY-6 year is spent entirely as a chief resident at the University Hospital site.  Chief residents are responsible for independently managing the neurosurgery service, directly supervised by the attending physicians.  Chief residents directly review and prepare the final plans for all patients on the ward, and are present for after-hours operations to supervise junior residents, and participate.  As part of the transition to independent practice, chief residents run teaching rounds every Tuesday, along with monthly Morbidity and Mortality rounds.  In short, chief residents are present for the most complex cases offered at University Hospital each and every day, providing an immersing, intense, yet incredibly rewarding end to residency and transition to practice. 

 

*Please note: The above provides a general overview of the structure of our neurosurgery residency program. Our curriculum is designed in accordance with the Royal College of Physicians and Surgeons of Canada's Competency-Based Medical Education (CBME) framework and its required training experiences. As such, individual residents' rotation schedules, timelines, and progression may be adapted to reflect their achievement of required competencies and Entrustable Professional Activities (EPAs), rather than following a strictly fixed calendar. This ensures each resident receives training tailored to their individual development while meeting all Royal College certification requirements.