Neurosurgery Residency Program

Duke University Medical Center offers excellent training in neurosurgery with two to three positions per year. The residency at Duke is a six year program (one year of surgery internship plus five years of neurosurgery) which includes one year of basic science research. Two years of research in a seven year program can usually be arranged for those interested. Duke participates in the Neurosurgery Residency Matching Program (NSMP) and accepts applications through the Electronic Resident Application Service (ERAS). Our Neurosurgery Residency Coordinator is Maggie Denny (DUMC Box 3807, Room 4546; phone: 919-684-3053; email: maggie.denny@duke.edu).

The structure of the neurosurgery residency is outlined below. For more detailed information, please see the Resident's Manual and Curriculum.

PGY 1:

Applicants accepted to the neurosurgery residency at Duke are strongly encouraged to complete their general surgery internship at Duke. The surgery internship at Duke includes rotations in neurosurgery, the neurosciences intensive care unit (NICU), and the emergency room, as well as a mix of surgery specialties. The call schedule is every third night or less frequent and the Department of Surgery maintains overall hours of work at 80 hours/week on average or less. Surgery interns are given two weeks of vacation plus 5-6 days off over the Christmas or new year holidays. Dinner is provided without charge in the Duke Hospital cafeteria for all interns and residents on-call.

Neurosciences Intensive Care Unit (NICU)

The 3 month rotation in the NICU is an excellent educational rotation. The neurosurgery resident on the NICU rotation rounds daily with the NICU team which includes an attending, a NICU fellow, 1-2 nurse practioners, a pharmacist, and the charge nurse. Patient management is discussed in-depth, and a care plan is formulated for each patient for the day. The resident then carries out necessary care for each patient with the help of the nurse practioner and the NICU fellow. The resident takes in-house call in the NICU every fourth night, rotating with nurse practioners, and reports to the NICU attending on call. The rotation work hours are less than 80 hours/week.

PGY 2-3:

Over the first two years in the neurosurgery residency, each resident completes 21 months on the neurosurgical service at Duke Hospital and 3 months in neurology. The order in which the rotations are completed varies, but generally each resident will complete his 3 month neurology rotation during his PGY 2 year. Each rotation is described below.

Neurosurgery Service

Each junior resident on the neurosurgery service is assigned to specific attendings in 1-2 month blocks. The resident is responsible for oversight of their attending's inpatients, works with their attendings in the OR, and attends clinic with one of their attendings one day/week. They are assisted with their duties by a physician's assistant who works full-time with the residents. The junior residents take call every fourth or fifth night during which they cover inpatient and emergency room consults, the neurosurgery patients in the NICU, and back-up the intern on-call covering the neurosurgery inpatients. The junior neurosurgery resident on-call is assisted by a nurse practioner or resident on-call in the NICU, and reports to the chief resident and/or attending on-call.

The post-call resident rounds with the team in the morning and leaves after signing out with the on-call resident (typically by 10AM), with the option to stay for a morning surgical case if the work hours permit. Each resident participates in over 600 operations during the 21 months on the neurosurgery service at Duke Hospital . Each resident receives 4 weeks of vacation/year plus 5-6 days off over the Christmas or new year holidays.

Neurology Service
The 3 month rotation in neurology is required by the American Board of Neurological Surgery (ABNS). The neurosurgery resident rotating on the neurology service performs the same duties as a PGY 2 neurology resident and reports to the neurology chief resident at Duke. The schedule is determined by the neurology department and generally includes one month covering the outpatient neurology clinic at the Durham Veterans Affairs Medical Center, one month covering one of the inpatient neurology services at Duke Hospital, and one month covering Duke neurology consults . The schedule includes every fourth night in-house call at Duke, and one week of vacation. Overall work hours are less than 80 hours/week.

NOTE: There has been a recent new national change in policy regarding passing USMLE steps. All residents must pass step 3 before starting their PGY3 year. See http://www.gme.duke.edu/hsmanual/usmlepolicy.htm for more details about this policy.

PGY 4:

After completion of the junior residency, each resident participates in at least one year of basic science research. The resident is permitted to choose the laboratory in which the research rotation is performed, and is not discouraged from working outside of the division of neurosurgery laboratories. Residents interested in performing two years of research in a seven year residency program are usually able to be accommodated. Infolded fellowships or other educational opportunities are also possible during this year.

PGY 5:

The PGY 5 year is divided into 2 6-month rotations, one as chief resident at the Durham Veterans Affairs Medical Center (DVAMC), then at the Durham Regional Hospital (DRH), which is a 369-bed community hospital and a short drive from the main Duke campus. Each rotation is described below:

Durham VA Hospital

The DVAMC offers the only VA neurosurgery service in the state of North Carolina. It has the only dedicated VA Brain and Spine Tumor center in the state and the only VA epilepsy center on the east coast. The chief resident runs the neurosurgery clinic two days a week, operates three days a week, and is responsible for the care of all neurosurgery patients during the rotation. The chief resident is assisted by two full-time physician assistants and staffs each operative case with one of the neurosurgery attendings at Duke. The service varies according to the desires of the residents, but generally includes 300+ operations/year with a wide variety of adult neurosurgical procedures. The rotation offers an excellent opportunity for the residents to function independently in all aspects of patient management from pre-operative planning through post-operative follow-up. The residents take call from home and receive two weeks of vacation during the 6 month rotation plus 5-6 days off over the Christmas or new year holidays. Vacation coverage is provided by the lab residents.

Durham Regional Hospital

The resident rotating at Durham Regional works with a private practice group of three neurosurgeons who perform approximately 500 operations/year. The group performs a wide variety of adult neurosurgical procedures. The resident obtains excellent operative experience every day of the week, as well as exposure to an active private practice. The resident takes call from home with every other weekend off (covered by the DRH attendings). The resident also receives two weeks of vacation during the 6 month rotation plus 5-6 days off over the Christmas or new year holidays.

PGY 6:

The final year of neurosurgical training is spent as Chief Resident (CR) at Duke Hospital . Both CRs spend the final year on service at Duke, with each alternating as the primary chief. The CR is responsible for oversight of all care of the neurosurgical inpatients and the daily operative and call assignments. The two CRs divide the call schedule so that one is on call each day to back-up the junior neurosurgery resident in-house (the CR may take call from home). Each CR has one meeting paid for without presenting (plus additional meetings if presenting), gives a grand rounds lecture near the end of the year, and receives four weeks of vacation plus 5-6 days off over the Christmas or new year holidays.

DHTS Web Services

Division of Neurosurgery