University of Utah Department of Neurosurgery Skull Base Fellowship Description (Revised )

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1 University f Utah Department f Neursurgery Skull Base Fellwship Descriptin (Revised ) INTRODUCTION The Skull Base Fellwship Prgram at the University f Utah accepts ne fellw annually. Applicants must have cmpleted neursurgical residency training and fellws are selected after review f applicatins and an interview prcess. The neursurgery fellw will spend 12 mnths n the neursurgery service at the University f Utah Hspital. In additin they are encuraged t engage in schlarly activity and have the pprtunity t participate in research prjects with all the vascular neursurgens. The residency training prgram in the Dept. f Neursurgery is the pririty f ur faculty. Fellwship applicants are advised that ur educatinal missin is resident centric. The chief residents have their chice f cases n which t scrub. Hwever, with the vlume f material n the neursurgery service, there are ften three r fur perating rms running simultaneusly. While the chief residents can chse the cases that interest r challenge them the mst, the vlume f cases is such that there is ample material fr fellwship trainees as well. With this balance, there has been a gd acceptance f the case-sharing cncept necessary t preserve resident experience. Unrestricted educatinal grants are prvided by industry and this is used t prvide salary supprt fr the fellwship. The department prvides structured teaching and case cnferences and access t ur medical library. The department als prvides ffice space with a cmputer and clerical staff. The interactins between the department and the fellw are mutually beneficial. The fellw is able t augment the teaching prvided t the residents, assist them in cvering OR cases and prvide supervisry cverage in clinics, thereby freeing up the chief residents and allw them increased perative experience. STRUCTURE Duratin: The Fellwship is expected t be fr ne year. Training Site: University f Utah Hspital Clinical Duties: The fellw is expected t rtate and participate in the clinical diagnsis, preperative assessment, intraperative participatin and pstperative management f patients with skull base lesins. The skull base prcedures include management f cmplex tumrs at the base f the skull extending frm the anterir t the psterir cranial fssa. Als included in the skull base prcedures is the vast experience with management f cmplex aneurysms lcated at the cranial base. The clinical material als cnsists f management f head and neck cancer patients alng with the ENT Divisin within the Department f Surgery. Nne f the invlvement f the fellw will interfere with neursurgical resident training. The material in the Department f Neursurgery exceeds the ability f senir resident invlvement in all cases. The fellw will als be invlved with teaching f residents at all levels. University f Utah Skull Base Fellwship Page 1

2 Clinical Oriented Research: The fellw is expected t be invlved in the study f the varius disease prcesses that invlve the cranial base. In additin, the anatmical skull base labratry prvided by the Department f Neursurgery is available fr crrelative anatmical studies and the develpments and refinements in skull base appraches. The bjective f training is t give fellws an rganized, cmprehensive, supervised, full-time educatinal experience in pen skull base surgery. This experience includes the management f patients with all types f vascular cnditins, the perfrmance f simple and cmplex pen surgical prcedures, and the integratin f these techniques int the surgical therapy f patients with cmplex vascular and skull base neplastic diseases. al Cmmitment: There is a mnthly multi-disciplined cnference in cnjunctin with ENT. The cases are presented fr discussin and management. The Neurradilgy Department participates in the evaluatin f the films fr the skull base surgery. SUPERVISION Supervisin: Prgram Faculty will have respnsibility fr teaching, supervisin, and frmal evaluatin f the fellw s perfrmance in accrdance with the prgram Standards f Perfrmance. All plicies and prcedures fr the skull base fellwship are cnsistent with the institutinal and ACGME prgram requirements and duty hurs. Prcedures: Fr prcedures in the perating rm, the faculty will always be present within the building where the perating rm is lcated and within the perating rm fr the critical prtin f all cases. Fr the majrity f cases the faculty neursurgen is scrubbed as either primary surgen r the first assistant. The Prgram Faculty includes: William T. Culdwell, M.D., Ph.D., Prfessr and Chairman, Fellwship Prgram Directr Richard H. Schmidt, M.D., Ph.D., Assciate Prfessr f Neursurgery Jel D. MacDnald, M.D., Assciate Prfessr f Neursurgery Min S. Park, M.D., Assistant Prfessr f Neursurgery Philipp Taussky, M.D., Assistant Prfessr f Neursurgery EVALUATION Evaluatins: The fellw is frmally evaluated by the faculty every three mnths. This is dne n line at using evaluatin frms based n the six cmpetencies as utlined by the ACGME/Neursurgery RRC. An assessment f their strengths and weaknesses and recmmendatins fr imprvement is develped. These evaluatin frms are reviewed by the Fellwship Directr. The Fellwship Directr then meets with the fellw individually t review the evaluatin. The fellw receives a cpy f the evaluatin and may discuss it further at any time. FELLOWSHIP IMPACT The skull base fellw wrks primarily with Dr. Culdwell n cmplex vascular and skull base cases. On mst perative days Dr. Culdwell runs tw perative rms, with the chief resident wrking in ne rm and the fellw in the ther. Occasinally, n cases with exceptinal teaching value, the skull base fellw and the chief, senir r junir resident may wrk tgether in University f Utah Skull Base Fellwship Page 2

3 the same rm. The skull base fellw als scrubs in and assists in cases where a resident is nt available. There are enugh cmplex skull base and vascular prcedures that the fellw des nt interfere with senir r chief resident educatin. The skull base fellw rutinely assists in the instructin f the resident staff by teaching in the OR. Overall, the impact f the skull base fellw is very psitive n the resident training prgram. The skull base fellw participates in the Wednesday resident educatinal sessins. The skull base fellw als helps in the didactic instructin in the OR with junir and mid-level residents (pening and clsing). FELLOWSHIP FACULTY William Culdwell M.D., Ph.D. (Fellwship Prgram Directr) Medical Specialty: Neursurgery Institutin: University f Utah Health Care Faculty Rank: Prfessr Hspital Psitin: Chairman, Department f Neursurgery Participatin in Subspecialty: Full - time Medical Schl / Graduatin Year: McGill University/1984 Internship / Graduatin Year: University f Suthern Califrnia /1985 Residency / Graduatin Year: University f Suthern Califrnia / 1989 State and License #: Utah Certificatin Bdy / Year: ABNS/1994 Date Current Appintment Began: Jel MacDnald M.D. Medical Specialty: Neursurgery Institutin: University f Utah Health Care/Intermuntain Medical Center Faculty Rank: Assciate Prfessr Hspital Psitin: Assciate Prfessr Participatin in Subspecialty: Full - time Medical Schl / Graduatin Year: University f Nrth Carlina/1989 Internship / Graduatin Year: Carlinas Medical Center /1990 Residency / Graduatin Year: University f Utah/1995 State and License #: Utah Certificatin Bdy / Year: ABNS / 2001 Date Current Appintment Began: Min S. Park, M.D. Medical Specialty: Neursurgery Institutin: University f Utah Health Care Faculty Rank: Assistant Prfessr Hspital Psitin: Assistant Prfessr Participatin in Subspecialty: Full - time Medical Schl / Graduatin Year: Indiana University / 2002 Internship / Graduatin Year: University f Califrnia, San Dieg / 2003 Residency / Graduatin Year: University f Califrnia, San Dieg / 2007 State and License #: Utah Certificatin Bdy / Year: ABNS/2013 Date Current Appintment Began: University f Utah Skull Base Fellwship Page 3

4 Richard Schmidt M.D., Ph.D. Medical Specialty: Neursurgery Institutin: University f Utah Health Care Faculty Rank: Assciate Prfessr Hspital Psitin: Assciate Prfessr Participatin in Subspecialty: Full - time Medical Schl / Graduatin Year: University f Iwa/1985 Internship / Graduatin Year: University f Washingtn/1986 Residency / Graduatin Year: University f Washingtn/1993 State and License #: Utah Certificatin Bdy / Year: ABNS/1998 Date Current Appintment Began: Philipp Taussky M.D. Medical Specialty: Neursurgery Institutin: University f Utah Health Care Faculty Rank: Assistant Prfessr Hspital Psitin: Assistant Prfessr Participatin in Subspecialty: Full - time Medical Schl / Graduatin Year: University f Basel, Basel, Switzerland / 2003 Internship / Graduatin Year: University Hspital Bern, Bern Switzerland / 2004 Residency / Graduatin Year: Kantnsspital Aarau, Aarau, Switzerland / 2009 State and License #: Utah Certificatin Bdy / Year: N/A Date Current Appintment Began: PREVIOUS FELLOWS NAME RESIDENCY FELLOWSHIP COMPLETION DATE Aarn Cutler, M.D. UCLA Martin Cte, M.D. Laval University, Quebec Canada Rukz Chamun, M.D. Baylr Tamer Altay, M.D. Hacettepe University, Ancara, Turkey Philip Taussky, M.D. Inselspital Bern, Kantnsspital Aarau, Switzerland Michael Walsh, M.D. University f Vermnt Jeren Cppens, M.D. St. Luis University University f Utah Skull Base Fellwship Page 4

5 Gals and Objectives FELLOWSHIP GOALS In this subspecialty, the bjective f training is t give fellws an rganized, cmprehensive, supervised, and full time educatinal experience in cerebrvascular and skull base neursurgery. This expertise includes the evaluatin and medical and surgical treatment f diseases f the vasculature f the brain and spinal crd, cmplex tumrs at the base f the skull extending frm the anterir t the psterir cranial fssa. Als included in the skull base prcedures is the vast experience with management f cmplex aneurysms lcated at the cranial base. The clinical material als cnsists f management f head and neck cancer patients alng with the ENT Divisin within the Department f Surgery. By the end f the training, fellws: will have received brad expsure t clinical evaluatin and apprpriate patient selectin fr perative and nn-perative management in bth the inpatient and utpatient settings will have an expanded and cultivated their knwledge and skills develped during residency in the diagnsis, treatment, and management f skull base diseases will have actively participated in the perative management f a wide range f cerebrvascular cnditins including bth extracranial and intracranial vascular diseases and abnrmalities will have taken part in clinical, anatmic, and neurscience research as an integral cmpnent f the educatinal experience will gain training and experience in the: signs and symptms f disrders amenable t diagnsis and treatment by skull base techniques; pathphysilgy and natural histry f neurlgical disrders; indicatins fr and cntraindicatins t skull base surgical prcedures; clinical and technical aspects f skull base surgical prcedures; medical and surgical alternatives; preperative and pstperative management f skull base surgical patients; neurintensive care management; fundamentals f imaging physics and radiatin bilgy; and, interpretatin f neurangigraphic studies pertinent t the practice. University f Utah Skull Base Fellwship Page 5

6 COMPETENCY-BASED OBJECTIVES Patient Care Fellws must be able t prvide patient care that is cmpassinate, apprpriate, and effective fr the treatment f health prblems and the prmtin f health. Fellws: will participate in the daily peratin f the clinical skull base service must make daily runds with the attending faculty during which patient management decisins are discussed and made; will participate in the assessment f patients including clinical examinatin and diagnstic prcedures will perfrm clinical pre-prcedure evaluatins f patients; will participate in diagnstic prcedures including radilgic and physilgic studies will interpret preliminary diagnstic studies; will participate in the interpretatin f the abve data leading t the decisin making prcess, ultimately develping a treatment plan will participate as an active member f the surgical team, enabling him/her t gain the essential surgical experience t cnduct these prcedures efficiently and effectively will cnsult with clinicians n ther services; will perfrm diagnstic and therapeutic skull base surgical prcedures; will generate prcedural reprts; will play an active rle in the periperative management f these patients, particularly management f the patient in the Neursurgical Critical Care Unit. will participate in shrt-term and lng-term pst-prcedure fllw-up care, including neurintensive care; will maintain cntinuity f care f sufficient duratin t ensure that the fellws are familiar with the utcme f all skull base surgical prcedures; will serve as cnsultants under the supervisin f staff neursurgical practitiners. Direct interactins f fellws with patients must be clsely bserved t ensure that apprpriate standards f care and cncern fr patient welfare are strictly maintained. Cmmunicatin, cnsultatin, and crdinatin f care with the referring clinical staff and clinical services must be maintained and dcumented with apprpriate ntes in the medical recrd must attend cnferences rganized by the faculty and held t allw discussin f tpics selected t braden knwledge in the field f skull base neursurgery. University f Utah Skull Base Fellwship Page 6

7 Medical Knwledge Fellws must demnstrate knwledge f established and evlving bimedical, clinical, epidemilgical and scial-behaviral sciences, as well as the applicatin f this knwledge t patient care. Fellws: will gain expertise in the clinical management f patients sustaining ischemic and/r hemrrhagic injury t the brain and/r spinal crd including: Initial resuscitatin and emergency treatment/diagnstic evaluatin. Critical care management and treatment f ischemic/hemrrhagic brain and spinal crd injuries. Transitining patients t the neurlgical rehabilitatin phase f their treatment. will gain knwledge and understanding f the cllabrative interactin between neurradilgists, neurlgists, and neursurgens will gain a wrking knwledge f the physilgy and pathphysilgy f ischemic/hemrrhagic brain and spinal crd injury. will gain expertise in the surgical treatment and management f patients with cerebrvascular disease including aneurysms, arterivenus malfrmatins, intracerebral hemrrhages, and cartid artery disease. will participate in available pprtunities fr clinical and/r labratry research in nging and/r newly develped studies. will have the pprtunity t carry ut all f the fllwing under clse supervisin: Anatmical and physilgic basic knwledge: Basic knwledge in arterial and venus angigraphic anatmy f the brain, spine, spinal crd, and head and neck. Venus angigraphic anatmy f the brain, spine, spinal crd, and head and neck. Cllateral circulatin Dangerus anastmses Cerebral bld flw Autregulatin Pharmaclgy f CNS vasculature Technical aspects f endvascular neurlgical surgery including: Catheter and delivery systems Emblic agents in cerebral, spinal, and head and neck emblizatin Flw-cntrlled emblizatin Cmplicatins f cerebral emblizatin Flw cntrl between the extracranial and intracranial circulatin Electrphysilgy Prvcative testing (pre-therapeutic evaluatin) Cmplicatins f brain, spine, spinal crd, and head and neck emblizatin. Imaging f the vascular system Pharmaclgy Cntrast materials Prvcative testing with anesthetics and sedatives Anticagulants Thrmblytics Cagulatin cascade University f Utah Skull Base Fellwship Page 7

8 Brain/spine arterivenus malfrmatins, arterivenus fistulas f the brain, spine, spinal crd, head and neck vascular malfrmatins, ischemic strke, and cerebral aneurysms (all types f ischemic and hemrrhagic diseases f central and peripheral neuraxes) Classificatin Clinical presentatins Natural histry Epidemilgy Hemdynamic basis Indicatins fr treatment Cntraindicatins fr treatment Therapeutic mdalities Cmbined therapies Tumrs f the head, neck, spine, and central nervus system Revascularizatin fr cclusive vascular diseases Arteripathies Athersclertic lesins Techniques f revascularizatin: balln angiplasty, thrmblytics, and stenting. All frms f pharmaclgic and mechanical revasculariztin. Emblizatin fr epistaxis r ther causes f hemrrhage Invasive functinal testing Balln test cclusins Practice-Based Learning and Imprvement Fellws must demnstrate the ability t investigate and evaluate their care f patients, t appraise and assimilate scientific evidence, and t cntinuusly imprve patient care based n cnstant self-evaluatin and life-lng learning. Fellws are expected t develp skills and habits t be able t meet the fllwing gals: identify strengths, deficiencies, and limits in ne s knwledge and expertise; set learning and imprvement gals; identify and perfrm apprpriate learning activities; systematically analyze practice using quality imprvement methds, and implement changes with the gal f practice imprvement; incrprate frmative evaluatin feedback int daily practice; lcate, appraise, and assimilate evidence frm scientific studies related t their patients health prblems; use infrmatin technlgy t ptimize learning; and, participate in the educatin f patients, families, students, fellws and ther health prfessinals. University f Utah Skull Base Fellwship Page 8

9 Interpersnal and Cmmunicatin Skills Fellws must demnstrate interpersnal and cmmunicatin skills that result in the effective exchange f infrmatin and cllabratin with patients, their families, and health prfessinals. Fellws are expected t: cmmunicate effectively with patients, families, and the public, as apprpriate, acrss a brad range f sciecnmic and cultural backgrunds; cmmunicate effectively with physicians, ther health prfessinals, and health related agencies; wrk effectively as a member r leader f a health care team r ther prfessinal grup; act in a cnsultative rle t ther physicians and health prfessinals; and, maintain cmprehensive, timely, and legible medical recrds, if applicable. Prfessinalism Fellws must demnstrate a cmmitment t carrying ut prfessinal respnsibilities and an adherence t ethical principles. Fellws are expected t demnstrate: cmpassin, integrity, and respect fr thers; respnsiveness t patient needs that supersedes self-interest; respect fr patient privacy and autnmy; accuntability t patients, sciety and the prfessin; and, sensitivity and respnsiveness t a diverse patient ppulatin, including but nt limited t diversity in gender, age, culture, race, religin, disabilities, and sexual rientatin. Systems-Based Practice Fellws must demnstrate an awareness f and respnsiveness t the larger cntext and system f health care, as well as the ability t call effectively n ther resurces in the system t prvide ptimal health care. Fellws are expected t: wrk effectively in varius health care delivery settings and systems relevant t their clinical specialty; crdinate patient care within the health care system relevant t their clinical specialty; incrprate cnsideratins f cst awareness and risk-benefit analysis in patient and/r ppulatin- based care as apprpriate; advcate fr quality patient care and ptimal patient care systems; wrk in inter-prfessinal teams t enhance patient safety and imprve patient care quality; and, participate in identifying system errrs and implementing ptential systems slutins. University f Utah Skull Base Fellwship Page 9