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GENERAL OBJECTIVES:
Neurosurgery residents at the University of Toronto are required to spend at least 3 months on a neuroradiology rotation as part of their training. As so much of successful neurosurgery relies on and depends on the best neuro-imaging studies possible, this is considered an important rotation for all residents. Neurosurgery residents usually undertake their neuroradiology training as intermediate level residents (PGY3- and -4) and will rotate to one of three different teaching hospitals within the University: Sunnybrook Health Sciences Centre, Toronto Western Hospital, and St Michael's Hospital.. The following is a description of the rotation-specific objectives for neurosurgery residents undertaking their neuroradiology rotations as intermediate level residents:
GOAL
This rotation is designed to give neurosurgery residents the skills to review routine X-rays, CT scans, MRI scans and other diagnostic imaging techniques by one-on-one teaching with the Radiologists/Neuroradiologists, attendance at teaching rounds and self-directed study.
DESCRIPTION
The residents will be expected to participate in all daily activities involving review and reporting of neuroimaging cases along with staff and rotating radiology trainees. Residents will also participate in all rounds and teaching sessions planned by the neuroradiologists during the rotation.
SPECIFIC OBJECTIVES:
MEDICAL EXPERT/CLINICAL DECISION MAKER
SKILLS
- plain x-ray
- angiograms
- CT scan
- MRI scan
- SPECT scan
- MR spectroscopy
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KNOWLEDGE
The resident will be able to demonstrate knowledge concerning the appropriate diagnostic imaging techniques and imaging findings for most of the following clinical conditions/problems
Skull
- Congenital
- Inflammatory (osteomyelitis)
- Trauma (fractures)
- Tumors (metastases, dermoid)
Spine
Congenital
- absence or hypoplasia of the odontoid
- os odontoideum
- segmentation anomalies
- Klippel-Feil anomaly
- butterfly vertebrae
- spinal dysraphism
- diastematomyelia
Inflammatory
- discitis
- tuberculosis spondylitis
Neoplasms
- aneurysmal bone cyst
- osteoblastoma
- osteoid osteoma
- Langerhans cell histiocytosis of bone
- metastases
Trauma
- fractures/dislocations
- atlanto-dens and atlanto-occipital injuries
- spondylolysis/spondylolisthesis
Brain
Congenital
- malformations of cortical development
- lissencephaly
- pachygyria
- schizencephaly
- heterotopic gray matter
- polymicrogyria
- focal cortical dysplasia
- holoprosencephaly
- anomalies of the corpus callosum
- Dandy-Walker malformations
- Chiari malformations
- neurocutaneous syndromes
- aqueductal stenosis
Inflammatory
- bacterial infections ( including meningitis, cerebritis, and abscess)
- tuberculosis infections
- viral infections (encephalitis)
- AIDS
- Rasmussen's encephalitis
- Acute disseminated encephalomyelitis
Neoplasms
- medulloblastoma
- ependymoma
- brainstem glioma
- astrocytoma
- pineal region tumors
- craniopharyngioma
- astrocytoma
- oligodendroglioma
- PNET
- choroid plexus tumors
Cerebral infarction/ischemia
- cerebral injury (including shearing injuries and concussion)
- subdural hematoma
- epidural hematoma
- subarachnoid hemorrhage
Metabolic brain disorders
Leukodystrophies
Mesial temporal sclerosis
Spinal Cord
Congenital
- myelomeningocele/meningocele
- lipomyelomeningocele
- diastematomyelia
- tethered cord
- dermal sinus
- intradural lipoma
- hydrosyringomyelia
Tumours
- neurofibroma
- astrocytoma
- ependymoma
- metastases
Inflammatory
- ADEM
- Leigh's disease
- Transverse myelitis
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COMMUNICATOR:
General Requirements
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Be able to explain findings to patients, families, and other consultants.
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Discuss appropriate information with patients/families and the health care team.
Specific Requirements
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Obtain and synthesize relevant history from the examination request and be willing to acquire more information as required from the referring physician.
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Communicate examination results effectively and in a timely fashion.
COLLABORATOR:
General Requirements
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Be able to consult effectively with radiologists and technical staff regarding indications for diagnostic imaging, including appropriate history, physical and diagnostic considerations.
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Contribute effectively to other interdisciplinary team activities especially neurosurgery.
Specific Requirements
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Provide instruction to medical students and more junior physicians at a level appropriate to their clinical education and professional competence.
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Willingly share knowledge with others with whom they are associated, thus ensuring the most effective delivery of health care to patients .
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MANAGER:
General Requirements
Specific Requirements
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Recognize that effective use of time depends upon punctuality.
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Recognize that effective use of time requires planning.
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Develop speed as well as accuracy in diagnostic imaging skills.
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Reserve time for reading and keeping current with the neurosurgical and neuroradiological literature.
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Establish routines for carrying out regular activities and adhere to them.
HEALTH ADVOCATE:
General Requirements
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Identify the important determinants of health affecting patients.
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Contribute effectively to improved health of patients and communities.
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Recognize and respond to those issues where advocacy is appropriate.
Specific Requirements
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Learn about community resources (e.g. diagnostic imaging facilities)
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Understand the role of national and international bodies in the promotion of neurosurgical health, and the prevention, detection, and treatment of neurosurgical disorders.
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SCHOLAR:
General Requirements
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Develop, implement and monitor a personal continuing education strategy.
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Critically appraise sources of medical information.
PROFESSIONAL:
General Requirements
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Deliver highest quality care with integrity, honesty and compassion.
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Exhibit appropriate personal and interpersonal professional behaviors.
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Practice medicine ethically consistent with obligations of a physician.
Specific Requirements
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Be willing to participate in case discussions concerning appropriate diagnostic and management procedures.
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Be willing and able to appraise accurately his/her own professional performances and show that he/she recognizes his/her own limitations with regard to skill and knowledge by appropriately consulting other physicians and paramedical personnel when caring for the patient.
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Be willing and able to keep his/her practice current through reading and other modes of continuing medical education and develop a habit of maintaining current his/her clinical skill and knowledge base through continuing medical education.
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Introduction
