Residency Program Description
Postgraduate Year 1 (PGY1) Residents
PGY1 – Introduction to progressive responsibility, patient management, and basic operative skills
The PGY1s rotate on the Neurosurgery Service at University Hospital and the Audie L. Murphy VA, and in the Neuro ICU. They are supervised by UT Health neurosurgery attendings, intermediate neurosurgery residents (PGY3–PGY4), and senior/chief neurosurgery residents (PGY6–PGY7), as well as Neuro ICU attendings.
A PGY1 resident will take a complete history and physical examination (H&P) on all new admissions to the neurosurgical service and will document them on the approved hospital forms in the patient’s chart or in a computerized clinical record. After discussion with the attending physician and supervising resident, the PGY1 will write an assessment and initial management plan and institute a therapeutic intervention.
The PGY1 resident, under the supervision of the senior resident and attending physician, will participate in daily rounds and write daily progress notes that include an interim history and physical exam, laboratory and radiographic data, and assessment and plan. If a significant new clinical development arises, there will be timely communication by a member of the resident team with the attending. The house staff and attending must communicate with each other as often as is necessary to ensure the best possible patient care.
The PGY1 resident may be responsible for completion of discharge summaries. Transfer notes and acceptance notes between critical care units and floor units, when required, can be written by the PGY1 resident. Such transfer notes shall summarize the hospital course and list current medications, pertinent laboratory data, active clinical problems, and physical examination findings. The supervising resident and the attending must be involved to ensure that such transfer is appropriate.
PGY1 residents are expected to assist the chief resident and attending in setting up neurosurgical cases in the OR and to assist during surgery under direct supervision. They will be responsible for preoperative preparation of the patient, first assisting during all cases, writing postoperative orders and notes, rounding on postoperative patients, and directly reporting their findings to the attending.
All PGY1 residents, when leaving an inpatient team, must write an “off-service” note summarizing pertinent clinical data about the patient. The new resident team must notify the attending physician of the change in resident teams and review the management plan with the attending.
Postgraduate Year 2 (PGY2) Residents
PGY2 – Progressive responsibility, patient management and leadership, advanced operative skills
The PGY2 residents rotate in the Baptist system and receive supervision from UT Health neurosurgery attendings and senior neurosurgery residents (PGY6).
PGY2 residents must maintain close contact with the attending physician for each patient and notify the attending as quickly as possible of any significant changes in the patient’s condition or therapy. All decisions related to invasive procedures, contrast radiology, imaging modalities, and significant therapies must be approved by the attending.
Postgraduate Year 3 (PGY3) Residents
PGY3 – Progressive responsibility, patient management and leadership, advanced operative skills
PGY3 residents rotate on the Neurosurgery Service at University Hospital and the Audie L. Murphy VA, as well as on the Pediatrics, Endovascular, and Functional Neurosurgery services at University Hospital. While on the Neurosurgery Service, they are supervised by UT Health neurosurgery faculty and senior/chief residents (PGY6–PGY7). PGY3 residents also provide direct supervision to PGY1 residents rotating at University Hospital under the oversight of the attending neurosurgeon.
PGY3 residents may perform any of the PGY1 or PGY2 tasks outlined above at the discretion of the attending or patient care area policies. They will also be available to provide assistance with difficult cases and provide instruction in patient management problems when called upon to do so by other residents. They will assume direct patient care responsibilities when needed to assist more junior residents during times of significant patient volume or severity of illness.
Postgraduate Year 4 (PGY4) Residents
PGY4 – Progressive responsibility, patient management and leadership, advanced operative skills
PGY4 residents rotate on the Neurosurgery Service at University Hospital and the Multispecialty and Research Hospital (MSRH). They may also complete a Pediatrics elective at Children’s Hospital of San Antonio (CHOSA); however, this elective is not being offered to PGY4 residents during the current academic year. They are supervised by UT Health neurosurgery attendings and senior/chief neurosurgery residents (PGY6–PGY7). PGY4s provide supervision of PGY1s rotating at University Hospital.
The residents are assigned to rotate at Brooke Army Medical Center (BAMC). As such, these intermediate residents will work directly with the attending surgeons and will either first assist or be allowed to be the primary surgeon of the case when their level of development permits them to do so. These rotations are designed for home call and ongoing clinical service under duty hour restrictions. The residents perform and write H&Ps, do daily rounds, write daily notes, coordinate discharge planning, and dictate discharge summaries. The resident is expected to attend the surgeon’s clinics and participate in all of the clinic activities.
Postgraduate Year 5 (PGY5) Residents
PGY5 – Dedicated research training, senior call coverage, and progressive assumption of service leadership
The PGY5s spend the majority of the year on elective research time but do provide chief call coverage at University Hospital and receive supervision from the UT Health neurosurgery attendings. When on call, PGY5s provide supervision of the junior residents at University Hospital.
During this year, the resident is expected to fully participate in a basic science project (or projects) under the direct supervision of the department’s Director of Research. This year is designed so that the resident has protected time from daily clinical activities, except for his/her duties to back up the chief resident on selected weekends and vacations. This setup allows the PGY5 to begin to assume the leadership role of the service in a gradual fashion. By first covering the weekends, the resident begins to assume the role of leader and chief resident during off-clinical hours. The resident leads rounds, assigns tasks, supervises junior residents’ minor procedures, supervises consults, and consults directly with the attending on all emergency consults for the weekend. He/she acts as the primary surgeon during all emergency and urgent surgeries.
When assuming leadership of the service during long vacations or educational meetings for the chief resident, the resident begins to experience a more intense and concentrated role by managing the service, including emergency and elective surgeries. As such, the resident begins to build self-confidence in managing a busy neurosurgical service and in improving communication skills with attendings, junior residents, OR staff, nursing staff, and other hospital personnel. Additionally, the resident is expected to be fully engaged in research and to produce at least one first-author, peer-reviewed publication and several presentations at local, regional, and national venues.
In addition, PGY5 residents have the opportunity to participate in an ABNS/CAST-accredited fellowship in Neurocritical Care or Neuroendovascular Surgery. Residents electing to pursue such a fellowship will complete the enfolded training under the supervision of the appropriate subspecialty faculty, with the level of supervision and progressive responsibility determined by the Program Director and the supervising faculty in accordance with this policy.
Postgraduate Year 6 (PGY6) Residents
PGY6 – Progressive responsibility, patient management and leadership, advanced operative skills, coordination of patient management, advancement of independent management and operative skills, leadership
PGY6 residents rotate on the Neurosurgery Service at University Hospital, St. Luke’s Baptist Hospital (SLB), Brooke Army Medical Center (BAMC), and/or the Audie L. Murphy VA. Residents rotating at University Hospital, St. Luke’s Baptist Hospital, and the VA are supervised by UT Health neurosurgery faculty. Residents rotating at BAMC are supervised by BAMC neurosurgery faculty. The PGY6 provides supervision for the PGY2s rotating in the Baptist system.
As a senior resident, the PGY6 continues to develop surgical skills by serving as the primary surgeon in all cases in which he/she participates. In the “chief” role at St. Luke’s Baptist Hospital, the PGY6 takes intermittent primary call along with the PGY2s and provides important supervision for the PGY2s. This strong relationship is integral to the development and education of the PGY2s.
Postgraduate Year 7 (PGY7) Residents
PGY7 – Progressive responsibility, coordination of patient management, advancement of independent management and operative skills, leadership, role model
PGY7 chief residents rotate at University Hospital, the Audie L. Murphy VA, and/or Brooke Army Medical Center (BAMC). While rotating at University Hospital, they are supervised by UT Health neurosurgery attending physicians. While rotating at BAMC, they are supervised by BAMC neurosurgery attending physicians. PGY7 residents provide supervision of all junior and intermediate residents rotating at University Hospital.
The resident fully assumes the role of leader of the service. He/she has full control of the administrative matters of the service. The resident makes the call and vacation schedule, assigns junior residents to surgeries, makes daily rounds, and directs all clinical decisions in direct consultation with the attending staff. The resident selects the cases of his/her choice and is the primary surgeon in most of those cases. The PGY7 is in charge of many of the educational conferences, including Quality Assessment, CPC, Journal Club, and the preoperative and postoperative conferences. The chief resident assists the attending staff during the cranial and spinal surgical and anatomic cadaveric dissections that take place monthly.
In addition, PGY7 chief residents have the opportunity to participate in an ABNS/CAST-accredited Spine Fellowship. Residents electing to pursue such a fellowship will complete the enfolded training under the supervision of the appropriate subspecialty faculty, with the level of supervision and progressive responsibility determined by the Program Director and the supervising faculty in accordance with this policy.
Policy on Resident Selection and Appointment
Resident Eligibility
As per ACGME Institutional Requirements, applicants for residency training at the University of Texas at San Antonio, UT San Antonio must meet one of the following qualifications:
- Graduate of a medical school in the U.S. or Canada accredited by the Liaison Committee on Medical Education (LCME) or the American Osteopathic Association (AOA).
- Graduate of an international medical school, meeting one of the following qualifications:
- Have a currently valid ECFMG certificate or
- Have a full and unrestricted license to practice medicine in a U.S. licensing jurisdiction.
- Graduate of an international medical school who has completed a Fifth Pathway program provided by an LCME-accredited medical school.
All first-year residency positions (PGY-1) should be offered through the National Residency Matching Program. When programs do not fill through the match, residents may subsequently be appointed to unfilled positions from the pool of unmatched students or other sources, as long as they meet institutional standards.
All resident applicants must be subjected to a Security Background Check (please see specific policy) before beginning residency training. Any individuals listed by a federal agency as excluded, suspended, or otherwise ineligible for participation in federal programs (Institutional Compliance Agreement, p.6 of 18) are ineligible for residency or fellowship at the University of Texas at San Antonio, UT San Antonio.
The non-citizen resident must have permanent resident status, a J-1 visa, or an approved H-1B visa for a medical residency position at the University of Texas at San Antonio UT San Antonio (please refer to the visa policy).
Resident Selection and Appointment
It is the policy of the University of Texas at San Antonio, UT San Antonio and its affiliated hospitals to sustain resident selection processes that are free from impermissible discrimination. In compliance with all federal and state laws and regulations, the University of Texas System Policy, and Institutional Policy, no person shall be subject to discrimination in the process of resident selection on the basis of gender, race, age, religion, color, national origin, disability, sexual orientation, or veteran status.
Residency programs’ resident selection committees rank candidates on the basis of the group’s assessment of the individual’s potential contributions in that particular specialty of medicine. These judgments are based on the applicant’s academic performance, the assessment of their faculty as reflected in letters of recommendation, and personal qualities evaluated during the interview process conducted by faculty and resident representatives, including motivation, integrity, and communication skills.
In addition to the guidelines above, the TSBME mandates a postgraduate resident permit for all residents entering Texas programs. These rules essentially make it necessary for the resident to demonstrate that he/she will be eligible for permanent licensure in Texas . Residents are expected to be familiar with the regulations at http://www.tsbme.state.tx.us.