In keeping with the expectation that all residency programs require their residents to obtain competencies in the six defined areas of:  Patient Care, Medical Knowledge, Practice-Based Learning and Improvement, Interpersonal and Communication skills, Professionalism, and Systems-Based Practice, this webpage will serve to outline the goals for each of the six core competencies. 

The approach and evaluation method used for each of the six competencies is outlined below:

Patient Care
Medical Knowledge
Practice-Based Learning and Improvement
Interpersonal and Communication Skills
Professionalism
Systems-Based Practice

Patient Care

It is the expressed goal of the Iowa Neurosurgery program that each resident will be able to:

• Communicate effectively and demonstrate caring and respectful behavior when interacting with patients and their families
• Gather essential and accurate information about their patients
• Make informed decisions about diagnostic and therapeutic interventions, based on patient information and preferences, up-to-date scientific evidence, and clinical judgment
• Develop and carry out patient management plans
• Counsel and educate patients and their families effectively
• Use information technology to support patient care decisions and patient education
• Competently perform all medical and invasive procedures considered essential for neurosurgery
• Provide health care services aimed at preventing health problems or maintaining health
• Work with health care professionals, including those from other disciplines, to provide patient-focused care

Training primarily is directly taught in the delivery of patient care by talented and dedicated faculty and colleagues.  Role modeling is felt by the department to be an essential component of the educational process.  Residents work side by side with attending physicians in the delivery of care.  Evaluation of the resident's performance takes place on many levels, but it is felt that the most important mechanism is through directly observed interactions with the patient, followed immediately by constructive feedback.  End of rotation evaluations are performed and given to the resident by the faculty.  Specific emphasis is placed upon professionalism and humanism with specific evaluations of each.

Medical Knowledge

Residents must demonstrate knowledge about all aspects of the neurosciences and the application of this knowledge to neurosurgical patient care.  Residents are expected to:

• Demonstrate an investigative and analytic thinking approach to clinical situations
• Gather, understand and analyze essential patient information in a timely manner
• Analyze practice experience and participate in practice-based improvement activities using systematic methodologies
• Work with health care professional, including those from other disciplines, to provide patient-focused care
• Use information technology to manage information, access on-line medical information, and support their own education
• Know and apply the basic and clinically supportive sciences which are appropriate to neurosurgery

Our scheduled didactic curriculum includes interactive and case-based conferences in neuro-oncology, neuropathology, neuroradiology, neuroanatomy, and neurosurgical research each week.  Residents are occasionally responsible for researching topics and presenting these to their colleagues and members of the faculty in this setting as well.  In addition to these didactic conferences, a significant portion of each resident’s education is obtained through direct one-on-one faculty interaction, graduated responsibility, and hands-on instruction in the operating room.

Evaluation of the resident's knowledge base is performed on several fronts, including faculty and colleague evaluation, participation in conferences, and the annually administered written examination for Primary Certification from the American Board of Neurological Surgery (ABNS).  Residents felt to have an inadequate knowledge base are individually counseled with specific programs designed to improve deficiencies.

Practice-based Learning and Improvement

Residents must be able to investigate and evaluate their patient care practices, appraise and assimilate scientific evidence, and improve their patient care practices. Residents are expected to:

• Analyze practice experience and perform practice-based improvement activities using a systematic methodology
• Locate, appraise, and assimilate evidence from scientific studies related to their patients' health problems
• Obtain and use information about their own population of patients and the larger population from which their patients are drawn
• Apply knowledge of study designs and statistical methods to the appraisal of clinical studies and other information on diagnostic and therapeutic effectiveness
• Use information technology to manage information, access on-line medical information and support their own education
• Facilitate the learning of colleagues, students and other health care professionals

Each month, journal club is held to develop skills in keeping up-to-date with and critically reviewing the medical literature.  Specific skills to practice evidence-based neurosurgery are emphasized as faculty lead these formal discussions. The focus of these sessions is the application of these skills to patient care.  Every resident in the program is provided with instruction on the use of information technology to manage information, and a neurosurgery-focused “electronic library” utilizing the University medical library’s online electronic resources (including available electronic journals, textbooks, evidence-based medicine review sites, PubMed, etc.), which has been created as a centralized resource. 

Access is available from any computer with internet access such as those in the hospital, research buildings, and the resident’s home.

Each resident will be required to participate in at least two quality improvement programs during their residency.  These will be on topics of each resident’s choosing under the guidance of the departmental Performance Improvement (PI) chair.  Evaluation of Practice-Based Learning and Improvement is primarily performed based upon the QI projects required of the residents as well as evaluation of the performance of the residents in presentation of article reviews and application of information in the care of their respective patients.

Interpersonal and Communication Skills

Residents must be able to demonstrate interpersonal and communication skills that result in effective information exchange and teaming with patients, families, and professional associates.  Residents are expected to:

• Create and sustain a therapeutic and ethically sound relationship with patients
• Communicate effectively with patients, families and the public across a broad range of socio-economic and cultural backgrounds
• Use effective listening skills and elicit and provide information using effective nonverbal, explanatory, questioning, and writing skills
• Work effectively with others as a member or leader of a health care team or other professional group
• Involve patients in decision-making

The instruction of the residents in interpersonal and communication skills occurs primarily in the same manner as that covered under the patient care section. Evaluation is in a similar manner as well. It is strongly felt that role modeling by effective senior clinicians, and feedback by the same physicians, is essential in the development and maintenance of these skills in young physicians.

Professionalism

Residents must demonstrate a commitment to carrying out professional responsibilities, adherence to ethical principles, and sensitivity to a diverse patient population. Residents are expected to demonstrate:

• Accountability to patients, society and the profession
• Responsiveness to patient needs that supersedes self-interest
• Demonstrate respect, compassion, integrity at all times, and a commitment to excellence and on-going professional development
• Demonstrate a commitment to ethical principles pertaining to provision or withholding of clinical care, confidentiality of patient information, informed consent, and business practices
• Demonstrate a commitment to ethical principles pertaining to provision or withholding of clinical care, confidentiality of patient information, informed consent, and business practices
• Demonstrate sensitivity and responsiveness to a patient's culture, age, gender, and disabilities

In addition to role modeling, specific monthly conferences are held to teach professionalism and leadership skills.  These sessions are highly interactive and multiple instructional techniques are used. Evaluation of performance in professionalism is performed by faculty, patients and ancillary staff utilizing a 360-degree evaluation program.

Systems-based Practice

Residents must demonstrate an awareness of and responsiveness to the larger context and system of health care and the ability to effectively utilize system resources to provide care that is of optimal value. Residents are expected to:

• Understand how their patient care and professional practices affect other health care professionals, the health care organization, and the larger society and how these elements of the system affect their own practice
• Know how types of medical practice and delivery systems differ from one another, including methods of controlling health care costs and allocating resources
• Practice cost-effective health care and resource allocation that does not compromise quality of care
• Advocate for quality patient care and assist patients in dealing with system complexities
• Know how to partner with health care managers and health care providers to assess, coordinate, and improve health care, and know how these activities can affect system performance

Specific instruction in consultation is provided to the residents in all rotations.  Residents work side-by-side with ancillary personnel in the delivery of care.  They are instructed in the roles of social workers, case managers, and other health care managers.  In the current environment of careful attention to the delivery of cost-effective health care, residents are occasionally asked to provide justification for test ordering.  The 360-degree evaluations also provide insight into the resident's performance in this area.

Residency Program

Residency Policies

Fellowships