The residency in neurological surgery at Saint Louis University is a seven-year graduated training experience.
The program has a staff of six full-time faculty members, one interventional neurology faculty member and one clinical cerebrovascular fellow.
Major areas of interest include the following:
- Vascular neurosurgery
- Neurosurgical oncology
- Neurosurgical trauma and critical care
- Spinal neurosurgery
- Functional neurosurgery
- Stereotactic/image-guided neurosurgery (including CyberKnife)
- Skull base neurosurgery
- Pediatric neurosurgery
- Endovascular neurosurgery
- Endoscopic neurosurgery
Fifty-four months of the residency program are spent in clinical neurosurgery, including one year as a chief resident and one year as a subspecialty chief resident. One year is spent rotating on elective services such as neurology, neuropathology, neuroradiology and neuro-ophthalmology services. Another year is spent performing either basic science research or clinical and outcomes based research based on individual preferences and career goals.
Our two training sites, SSM Health Saint Louis University Hospital and SSM Health Cardinal Glennon Children's Hospital, together provide over 1,100 admissions and 800 operations per year on the neurosurgery service.
Residents are required to attend clinics on a weekly basis while on service. Patients seen in the clinic fall into one of the following broad categories: specialty-specific preoperative consultations or operative evaluations, postoperative follow-ups, or follow-ups from on-call inpatient consultations (e.g., trauma patients).
Residents are expected to provide coverage for adult neurosurgery clinics. Each of the adult faculty has either a half or full day clinic once a week. The clinic is located in the Cancer Center on the second floor, immediately adjacent to the hospital.
Each attending has a clinical nurse who is responsible for scheduling outpatient tests, follow-up appointments, and other preoperative or postoperative studies. The role of the resident is to perform a thorough history and physical examination on new patients, a focused history and exam on follow-up patients, review any and all imaging studies with the attending physician, and generate a management plan.
The pediatric neurosurgery clinic is held at SSM Health Cardinal Glennon Children's Hospital on the ground floor in the outpatient area. The pediatric resident will cover half a day in the clinic each week. Each clinic is also staffed with a clinical nurse as well as a pediatric nurse practitioner. There are also monthly separate pediatric multidisciplinary clinics that involve neurosurgery, including myelomeningocele and brain tumor clinics that are staffed by residents when they are not in the operating room.
Resident call schedules are designed to maintain compliance with the Accreditation Council for Graduate Medical Education (ACGME) 80-hour work week restriction. Currently, the PGY2-PGY5 cover in-house call for both SSM Health Saint Louis University Hospital and SSM Health Cardinal Glennon Children’s Hospital.
A senior (PGY6/7) provides at home backup call coverage at all times. Attending call schedules are separated into cranial neurosurgical call and neurovascular call at SSM Health Saint Louis University Hospital (SLUH) and SSM Health Cardinal Glennon Children's Hospital (CGCH), and adult spine call at SLUH. Call schedules are provided on a monthly basis and include information including resident call, attending call, and resident days off/vacations.
In-house call is covered by junior residents nightly with the chief resident or subspecialty chief resident as senior level backup. During vacation time for on service residents, the off service resident is available to cover in-house call as well as the daily service responsibilities. Interns work from 6 a.m. to approximately 6 p.m. daily Sunday through Friday.
The neurosurgical service at Saint Louis University is heavily dependent upon computer technology. Both of the main hospitals use EPIC for electronic health records throughout the system in both the inpatient and outpatient environment. Additionally, the neurosurgical service retains a separate database of our patient files.
Patients' admission notes, day-to-day progress, and management plans are maintained on a central server and can be accessed by a mobile device. A database dating back to 2000 of nearly 10,000 patients is maintained on an internal server. Very detailed information is tracked and is available for quick reference and updated "on-the-fly" while rounding.
The neurosurgery attendings rotate on the general neurosurgery call schedule. Vascular call is shared by Jeroen Coppens, M.D. When a resident is on call, he or she will field all ER calls, floor consultations, and ICU and floor nurse calls both at SSM Health Cardinal Glennon Children's Hospital and SSM Health Saint Louis University Hospital.
When the service is consulted, the on-call attending and backup resident are notified. For any inpatient management question, the back-up resident is available either over the phone or for direct supervision as needed. Any operative cases are staffed by the backup senior resident, the on-call resident when able and, of course, the attending on call. Neurosurgical bedside procedures are performed by the resident on-call or the senior backup resident as necessary.
Spine call is shared with the orthopaedic service. On average, neurosurgery takes one in three weeks of spine call throughout the year.
The residency program has a robust schedule of didactic conferences. These are held in the KR Smith Conference room, which is equipped with a large wall mounted monitor and a desktop computer, wireless accessories and capability to project from laptop computers.
The hospital provides high-speed 802.11b/WiFi capability. All residents are required to attend scheduled conferences. These take place on Wednesday mornings at 7:30 a.m., Thursday mornings at 7:30 a.m. and Thursday afternoons from 1-5 p.m.
Dandy Journal Club: At least one week in advance, articles are selected from relevant neurosurgical journals and assigned to both on- and off-service residents. These articles are then presented by respective residents and discussed with faculty.
Patient Care Conference: During this conference, interesting cases are discussed and teaching points are made. This educational experience often includes reviewing imaging in the form of conventional radiographs and/or intraoperative video or photography. It also provides a forum for faculty and residents to collaborate and discuss difficult or perplexing cases.
Resident Teaching Conference: This conference consists of didactic sessions given by neurosurgical faculty on various anatomic, radiographic and operative topics.
The Greenberg Review: The off-service senior resident generates a presentation regarding a predetermined chapter in “Greenberg Handbook of Neurosurgery.”
Psychosurgery Conference: Overlapping neurosurgical and psychiatric cases and topics are discussed. Residents and faculty from neurosurgery and psychiatry are present.
Morbidity and Mortality Conference (M and M): This conference consists of case presentations by the chief resident from the previous month’s complications and/or deaths.
Movement Disorders Conference: This is hosted by Drs. Richard Bucholz and Pratap Chand, the movement disorders specialist. Potential surgical candidates are presented, often with videographic data.
Neuro-Critical Care Conference: This conference is shared with surgical critical care (neuro-anesthesia), stroke neurology and neurosurgery. Interesting cases, patient morbidity and mortality, and relevant literature are presented by each of the respective services in a rotating fashion.
Neuropathology Conference: This conference is hosted by neuropathologist Miguel Guzman, M.D. The curriculum consists of a comprehensive review of pathologies of the central nervous system.
Neurosurgery Tumor Board: This is a multidisciplinary conference and often includes presentations from neurology, oncology, radiology, radiation oncology, pathology and neurosurgery. The cases are introduced by neurosurgery residents. SSM Health Cardinal Glennon Children's Hospital also hosts its own Tumor Board but is not restricted to CNS pathology.
Radiation Oncology Conference: This conference is hosted by John Dombrowski, M.D., chair of Radiation Medicine. The curriculum includes radiation oncology and basic physics as it relates to tumors of the central nervous system and the late effects of radiation on the central nervous system
Resident Meeting: The resident meeting is hosted by Richard Bucholz, M.D. the program director. During this meeting, a predetermined agenda is discussed.
Resident Research Conference: Resident ongoing research projects are presented and discussed with Dr. Bucholz.
Saint Louis University is home to Practical Anatomy and Surgical Education (PASE), which is recognized among the finest hands-on educational facilities for health care professionals in the world. The extensive laboratory workstations, 3D auditorium and convenient location make this an ideal facility for our residents to explore new surgical techniques.
All of our residents attend a minimum of two cadaveric workshops at PASE each year at no cost to the resident.