Neurological Surgery Residency Curriculum

General surgery residents rotate through the following sites: 

Primary 

• SSM Health Saint Louis University Hospital 
• SSM Health Cardinal Glennon Children’s Hospital  
• SSM Health St. Mary’s Hospital - St. Louis  

Together, these sites provide over 1,000 admissions and 800 operations annually on the neurosurgery service.  

Affiliated Site 

• Mercy Hospital St. Louis 

This site provides a more private setting for neurological care.  

First-year training focuses on neurosciences, critical care and neurosurgery.  

Experiences 

• Three months of critical care training 
  • Anesthesia surgical critical care service rotation 
  • Neuroscience critical care service rotation 
• One-month training blocks 
  • Neuropathology 
  • Neuro-radiology 
  • Neurology subspeciality 
• Six months on the neurosurgery service 
• Contribute to the call pool once a minimum number of procedures is achieved 

The second-year resident is the junior neurosurgery resident at SSM Health Saint Louis University Hospital.  

Experiences 

• Assistance with daily patient care for inpatient neurosurgery service, including pre- and post-operative care 
• Neurosurgical consultation services to the ER and inpatient services 
• Assistance in the operating room 
• Call coverage at SSM Health Saint Louis University Hospital and SSM Health Cardinal Glennon Children’s Hospital 

Third-year training focuses on subspecialty and community hospital electives. Rotations are designed to help residents develop specific interests.  

Experiences 

• Available rotations:
  • Complex spine
  • Endovascular
  • Radiation oncology
  • Movement disorder
  • Peripheral nerve
  • Neuro-oncology
  • Neuro-ophthalmology
  • Potential self-designed electives
• Available elective away rotations 
  • Three-month spine and networked health rotation at SSM Health St. Mary’s Hospital and SSM Health DePaul Hospital - St. Louis 
  • Three-month cranial and spine rotation at Mercy Hospital St. Louis 

Fourth-year training focuses on pediatric and adult neurosurgery. Residents spend the majority of the year at SSM Health Cardinal Glennon Children’s Hospital.  

Experiences 

• Pediatric cases and clinics 
• Continued adult neurosurgery exposure based on call and case coverage needs 
• Advanced surgical skill development 
• Increased autonomy 

Year five is a designated research year. The resident participates in a chair- and program director-approved basic science or clinical research project.  

Experiences 

• Development of an investigation plan based on specific interests 
• Clinical conferences 
• Call duty 

The sixth-year resident is the senior neurosurgical resident at SSM Health Saint Louis University Hospital.  

Experiences 

• Increased operations 
• Back-up to junior hospital staff 
• Subspecialty focus 
• Honing of future career goals 

The seventh-year resident is the chief resident of the neurosurgery service spanning both SSM Health Saint Louis University Hospital and SSM Health Cardinal Glennon Children’s Hospital.   

Experiences 

• Care for all neurosurgical patients on the inpatient service 
• Primary surgeon in both routine and complex neurosurgical operations 
• Leadership, teaching, administrative duties, clinical roles 

When clinical coverage is provided by nurse practitioners, residents are encouraged to attend clinics to broaden their education in pre- and post-operative patient management. 

Adult Neurosurgery Clinics 

• Faculty have a half- or full-day clinic once per week 
• Staffed with clinical nurse 
• Resident roles: 
  • History and exam 
  • Imaging review 
  • Management plan 

Pediatric Neurosurgery Clinics 

• Children’s hospital clinic  
  • Pediatric resident covers one half-day per week 
  • Staffed with clinical nurse and pediatric nurse practitioner 
• Monthly pediatric multidisciplinary clinics 
  • Includes myelomeningocele and brain tumor clinics 
  • Staffed by residents when they are not in the operating room 

Resident call schedules are designed to maintain compliance with the ACGME for the 80-hour work week restriction. Call schedules are provided monthly and include information on resident call, attending call, and resident days off/vacation.  

Responsibilities by PGY Level

• PGY-1 to PGY-4: Residents cover in-house calls for both SSM Health Saint Louis University Hospital and SSM Health Cardinal Glennon Children’s Hospital. The PGY-1 resident must complete a required number of supervised procedures before joining the call pool.  
• PGY-5 to PGY-7: Residents provide home backup call coverage at all times. 

Coverage and Clinical Duties

• In-House Call: In-house call is covered by junior residents nightly with the chief residents 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 calls.
• Spine Call: Spine call is shared with the orthopedic service. On average, neurosurgery takes one in three weeks of spine call throughout the year.  
• Coverage: Residents on call field for all ER calls, floor consultations and ICU and floor nurse calls.
• Operative Cases: Cases are staffed by the backup senior resident, the on-call resident (when able) and the attending on call.
• Bedside Procedures: Neurosurgical bedside procedures are performed by the on-call resident or the senior backup resident as necessary. 
• Didactic Support: Physician extenders cover one night of call per week to maximize resident attendance at didactic sessions.  

• Journal Club: review and critical evaluation of impactful scientific papers 
• Patient Care Conference: review and discussion of difficult or perplexing cases 
• Resident Teaching Conference: resident-led presentations on anatomic, radiographic and operative techniques 
• Fetal Care Conference: review of active patients followed by the Fetal Care Institute and discussion of prenatal and postnatal care for patients with congenital and neonatal complex medical problems 
• Pediatric Tumor Board: Pediatric Oncology-led discussion; neurosurgical patients discussed with other disciplines/subspecialties as needed 
• Spine Conference: discussion of upcoming spinal surgeries or interesting/challenging spine cases for both neurosurgery and orthopedic spine 

• Grand Rounds: at least once per month; multidisciplinary presentations on a topic of choice 
• Morbidity and Mortality Conference: chief resident-led presentation of previous month’s complications and/or deaths 
• Epilepsy Conference: multidisciplinary discussion of adult/pediatric epilepsy patients likely to require surgical care 
• Movement Disorders Conference: presentation of potential surgical candidates by movement disorders specialists 
• Neuropathology Conference: comprehensive review of pathologies of the nervous system 
• Neurosurgery Tumor Board: multidisciplinary presentations; cases introduced by neurosurgery residents 
• Psychosurgery Conference: discussion of overlapping neurosurgical and psychiatric cases/topics 
• Radiation Oncology Conference: presentation on radiation oncology and basic physics as it relates to tumors of radiation effects on the central nervous system 
• Resident Meeting: discussion with program leaders about resident concerns and updates 
• Resident Research Conference: presentation and discussion of ongoing resident research projects 
• Spine Trauma Conference: presentation and discussion of spine trauma cases; attended by an interdisciplinary group of internal and external specialists 

The Division of Neurological Surgery hosts a quarterly cadaveric workshop, allowing residents to learn and practice faculty-guided surgical approaches and under the direction of Dr. Joanna Kemp.  

Workshops are held at Practical Anatomy and Surgical Education (PASE), a specialized hands-on educational facility with laboratory workstations and 3D auditorium.  

Residents can also access the many other national workshops hosted at the lab.  

Explore PASE Workshops