Junior residency training at the University of Iowa is comprised of the PGY-1 to PGY-3 years. The junior resident is involved in direct patient care on the neurosurgical floor as well as the surgical ICU under the supervision of the chief residents. 

The neurosurgical floor team has dedicated APPs who provide significant assistance in day-to-day patient care. 

The surgical ICU is an open unit with dedicated teams of staff physicians, residents, and APPs working closely together to direct daily care while the neurosurgical team serves as a consulting service. 

In addition to providing direct patient care on the floor and in the ICU, junior residents are involved in operative cases and primary call. The operative experience for junior residents typically involves one-on-one scrubbing with faculty or chief resident.

PGY-1

The PGY-1 year is comprised of 6 months of off-service rotations and 6 months on the neurosurgery service. The off-service rotations include:

• Trauma Surgery
• Stroke Neurology
• Neurotology
• Neuro-Ophthalmology
• ICU
• Neurointerventional Radiology 

The schedule is structured such that only one intern is on the neurosurgery service at any given time. The interns rotate in 2-month periods, spending 2 months on the neurosurgery service followed by 2 months off-service. A sample schedule is provided below:

While on the neurosurgery service, interns provide care for patients admitted to the neurosurgical floor (20-40 total, half covered by the intern). Rounds (led by the chief residents) start at 0500 and end by 0700. OR first start is 0730 every day except for Tuesday (0830).  Between the end of rounds and OR start time, the intern is expected to provide updates to the APP team as well as check in patients for surgery. The APP team serves as first contact for questions regarding floor patients during the day, allowing interns to focus directly on the surgical cases they are assigned to. The intern scrubs one-on-one with faculty on a range of cases including, but not limited to, deep brain stimulation (DBS), spinal cord stimulators (SCS), DBS/SCS battery changes, degenerative spine surgery, and burr holes/EVDs. Occasionally, the intern will scrub with a PGY6 or PGY7, if not needed elsewhere, and assist with complex cranial cases, learning the basics of cranial surgery (positioning, pinning, opening, turning the craniotomy, closing). Throughout the year, the intern will take buddy call with the PGY-2s and PGY-3s to gradually learn how to take call prior to independently taking call in the month of June. The expectation by the end of the PGY-1 year is for the resident to be able to expose and close a spine incision as well as perform basic neurosurgical procedures, such as EVDs, burr holes, generator replacements, independently. Interns will typically log 275-300 cases. 

The entire PGY-2 and half of PGY-3 year are spent on the general service. During these 18 months, the PGY-2s and PGY-3 on service cover primary call, which is done in 24-hour shifts followed by a post-call off day. This is generally Q3-Q5 call, depending on how many pre-clinical fellows are trained to take call. These 18 months are the only period of primary call during training. Primary call responsibilities include fielding outside triage calls, all consults (10-20/24 hours), and any questions regarding established inpatients for the entire service. Being the only tertiary care hospital in the state of Iowa, the residents get to experience a wide variety of neurosurgical pathologies. The on-call resident runs new consults and questions through the on-call chief resident, with an expectation towards graduated autonomy in managing these patients while being on call. At the end of this period, residents are proficient in workup and management of almost any neurosurgical pathology. Additionally, the PGY-2s and on service PGY-3 cover the pediatric, ICU, and off service (inpatients we are consulted on) patients. A breakdown of PGY-2 and PGY-3 assignments is below. 

Non-call days are spent operating. The pediatric resident (6-month period) is preferentially assigned to cover pediatric cases, which cover the entire breadth of pediatric neurosurgery as University of Iowa is the only hospital in the state with pediatric neurosurgery. The other 12 months of this period are spent primarily covering general service cases, mostly covering spine and general cranial cases. Residents generally log 300-375 cases during this 18 months.

The 6 months of continuity of care or CoC rotation involve the most autonomy in operative experience apart from chief residency. The CoC rotation is a mentorship model whereby he or she works with Drs. Jangbo Lee and Satoshi Yamaguchi exclusively. Tuesdays and Thursdays are clinic days, where elective spine cases are booked for Mondays, Wednesdays, and Fridays. In clinic, the CoC resident learns clear indications for elective spine surgery, having a significant influence over the care of these patients. In the operating room, the resident is treated as the primary surgeon, becoming proficient performing most elective spine surgeries (decompressions, ACDF, corpectomy, posterior instrumentation, TLIF, and occasional tumors). The CoC resident on average performs 100-130 cases. Given the graduated autonomy in decision making and witnessing the wide variety of pathologies on 1^st call, the CoC resident starts taking ‘chief call’ over the weekends in this rotation.

All of fourth and fifth years offer protected time for career advancement with exemplary support from program leadership, particularly chairman Dr Matthew Howard. Every week, residents from PGY-1 to PGY-5 present a “research update” to Dr Howard on a rotating basis. This update mainly consists of the residents’ interests and their goals during research years so that a plan is already in place before you start your research years. The research years are tailored to each individual’s interests. In the past, residents have been involved with wet labs doing basic science or translational research, the biomechanics spine lab, helping with clinical trials, performing human brain physiology research, and a host of clinical research. Previous residents have had a lot of success in achieving independent funding including institutional grants as well as NIH grants (T32, R25/UE5 and F32). Clinical duties during this time are limited to 6 months as the epilepsy resident, covering SEEG implantations, ATLs, seizure focus resections, RNS, and DBS in addition to covering weekend chief call (Saturday morning to Monday morning) every 4^th to 5^th week.

The chief residency year is the pinnacle of operative training at University of Iowa. The neurosurgery service is split into “Chief 1” and “Chief 2”. Chief 1 is also the administrative chief and both chiefs rotate after 6 months. The neurosurgery service is a chief run service, with chief residents responsible for making decisions regarding basic neurosurgical management of inpatients as well as on-call consults. Chiefs are on Q2 home-call Monday-Friday. The chief year is the busiest operative year, typically logging 400-500 cases.

Completing the chief resident year as a PGY-6 enables the PGY-7 to tailor this year to their interest. The PGY-7 year is also split into two 6 months rotation. One of the PGY-7 is treated as junior faculty, dubbed Super Chief, during their 6 months of in-house rotation. The super-chief runs their own clinic on Monday, scheduling cases for Tuesday-Friday which are done with a faculty supervisor. During this time, they also take buddy call with faculty intermittently. The other 6 months are dedicated for an informal fellowship at an institute and subspecialty of the resident’s choice. Recent residents have spent time at UVA, Banner, Loyola, England (NHS), Japan, New Zealand, and Australia. This fellowship is aided by a generous housing stipend to assist with external rotation and salary provided by UIHC while away.