Neurosurgery Residency

Overview

Neurosurgery Residency training at Western University provides a rigorous, immersive, and comprehensive education in neurosurgery. From an early stage, residents gain hands-on experience assisting in the operating room. Because we are a mid-sized program, our consultants know every resident personally, allowing them to tailor teaching to individual learning needs and foster a clear sense of graduated progression. Beyond clinical training, we offer the flexibility and support needed to achieve diverse academic goals, whether in pedagogy, research, or leadership. Our graduates practice across Canada in both academic and community settings, spanning every subspecialty of neurosurgery.

General Organization

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.

Application

Application Process

Currently, the neurosurgery program only accepts applicants through the Canadian Resident matching Service (CaRMS).

Selection Criteria

From the candidates applying, future residents are selected based on:

Academic Merit – as evidenced by the student’s MSPR, Curriculum Vitae, and performance on elective rotations.
Reference letters – Applicants are encouraged to obtain letters from physicians, ideally neurosurgeons with whom the candidate has worked closely with.
Understanding and Interest – As evidenced by the candidate’s personal statement, rotations during medical school, and interview performance.
Interpersonal skills – Assessed by performance on electives and at interviews.

Learning

Rounds

Residents have the opportunity to participate in Clinical Neurological Sciences Grand Rounds, presenting two to three times per academic year. Additionally, residents attend multidisciplinary neurovascular rounds on Wednesday mornings. During pediatric rotations, residents are expected to both attend and actively participate in pediatric neuro-oncology rounds on Friday mornings.

Teaching

The academic half-day consists of a seminar series following a two-year, cyclical curriculum that covers all major facets of neurosurgery and CanMEDS roles. The curriculum is structured into distinct blocks by neurosurgical subspecialty.

Seminars are followed by weekly teaching rounds, which alternate between:

Small Case Rounds: Led by the chief resident, these sessions allow residents to work through clinical scenarios to prepare for oral examinations.
Morbidity and Mortality (M&M) Rounds: Presented by the chief resident.
Dedicated Spine Rounds: Focused subspecialty teaching.

Evaluation

At the end of each teaching block, residents take a written, in-service practice exam. This exam is graded and subsequently reviewed with the resident to serve as a personal benchmark, helping track knowledge progression and ensure steady preparation for the Royal College written examination. Additionally, all residents participate in the National Practice Exam annually.

Research

Residents have direct access to our research director, Dr. Lau, to discuss and map out their academic interests. The program provides dedicated mentorship to help residents identify research passions and secure longitudinal projects to work on throughout their training.

Starting at the PGY-2 level, residents are expected to participate in the annual CNS Research and Innovation in Education Day, an event where the neurosurgery department consistently maintains a strong record of award-winning presentations and posters. Furthermore, residents in good clinical standing who demonstrate a strong interest in academic medicine have the opportunity to apply to the Clinician Investigator Program (CIP) to secure funding for specialized, intensive research training at the PGY-4 level.

Facilities

University Hospital (LHSC)
Victoria and Children’s Hospital (LHSC)
Ouellette Campus (Windsor Regional Hospital)
Joseph’s Healthcare London

The University Hospital site represents the primary training facility of the neurosurgery residency program and home of the clinical neurological sciences department.

Why CNS?

Residency training at Western University provides a rigorous, immersive, and comprehensive education in neurosurgery. From an early stage, residents gain hands-on experience assisting in the operating room. Because we are a mid-sized program, our consultants know every resident personally, allowing them to tailor teaching to individual learning needs and foster a clear sense of graduated progression. Beyond clinical training, we offer the flexibility and support needed to achieve diverse academic goals, whether in pedagogy, research, or leadership. Our graduates practice across Canada in both academic and community settings, spanning every subspecialty of neurosurgery.

Residency Life

Salary & Benefits

Residents are compensated according to the pay scale negotiated between the Ministry of Health and the Professional Association of Residents of Ontario (PARO), which can be found at myparo.ca/during-residency/. Residents also receive a call stipend, claimed in accordance with the guidelines outlined at the same link. Comprehensive health benefits and insurance are similarly provided through PARO.

Additionally, a reimbursement program is available to support travel expenses for residents presenting their research at academic conferences.

Leave

Leave allocation is also managed through PARO guidelines. All residents receive four weeks of vacation per year (calculated as 5 weekdays plus 2 weekend days), which can be taken as full weeks or in smaller segments. Residents are also allotted 7 professional days for educational purposes, five consecutive days off during the winter holiday break, and one floating day.

Living in London

London, affectionately nicknamed the "Forest City," serves as the central hub of Southwestern Ontario. The city boasts close proximity to three Great Lakes, as well as easy access to the major metropolitan centers of Toronto and Detroit. It is large enough to offer every amenity you could want, while maintaining a sense of calm and quiet that provides a welcome balance during the busy years of residency. For those moving with families, London offers an exceptional school system.

Ultimately, what truly makes the city remarkable is its community. You will regularly engage with various hospital departments, co-residents, and staff, and you will be warmly welcomed into the London neurosurgery family.