UF Stereotactic and Functional/Movement Disorders Neurosurgery Fellowship Details

A. Program Demographics

1. Host Institution: University of Florida Department of Neurosurgery,

UF Center for Movement Disorders and Neurorestoration

2. Program Subspecialty: Functional Neurosurgery/Deep Brain Stimulation

3. Program Mailing Address: PO Box 100265

Gainesville, FL 32610

4. Program Physical Address: 1149 S Newell Drive, Bldg 59, L2-100

Gainesville, FL 32611

5. Phone Number: (352) 273-9000

6. Fax Number: (352) 392-8413

7. Program Email: foote@neurosurgery.ufl.edu

8. Program Director: Kelly D. Foote, MD

9. Alternate Program Contact: Ashley Kolosky (Ashley.kolosky@neurosurgery.ufl.edu ).

 

B. Introduction

1. History: The UF Deep Brain Stimulation (DBS) program and the University of Florida Movement Disorders Center were founded in July 2002 by Drs. Kelly Foote (neurosurgeon) and Michael Okun (neurologist). Now, over a decade later, the UF Center for Movement Disorders and Neurorestoration (CMDNR) comprises over 25 clinical and research faculty from 14 different departments, all of whom share a specialty interest in Parkinson’s disease, and other movement disorders and are housed in a new custom designed clinical facility occupying the top floor of the UF Orthopedics and Sports Medicine Institute. This interdisciplinary team has assembled with the following common goals:

a) to provide the best possible comprehensive medical and surgical care possible to patients afflicted with Parkinson’s disease and other Movement Disorders using a novel, patient-centered interdisciplinary team approach;

b) to maximize our positive impact on the lives of patients with these disorders globally through high quality, cutting edge research;

c) to provide effective education at all levels—medical students, residents, fellows, staff, patients, and the community;

d) to develop outreach programs that start at home but extend beyond the United States.

Our DBS program has become one of the world’s busiest, and Dr. Foote, with the support of Dr. Okun and the multidisciplinary DBS team, has implanted over 950 deep brain stimulation systems over the past 11 years. While a few of the University of Florida neurosurgery residents have spent their dedicated research year as functional neurosurgery “fellows” developing subspecialty expertise in deep brain stimulation, and we have hosted a few foreign functional neurosurgical research fellows, a formal fellowship in Stereotactic and Functional Neurosurgery was not instituted at UF until 2012.

2. Duration: The length of the fellowship training program is 12 months for a PGY6+ level fellow.

3. Prerequisite Training/Selection Criteria: Candidates for training must have satisfactorily completed a residency which satisfies the educational requirements for board certification in neurological surgery.

4. Goals and Objectives for Training:

To provide the functional neurosurgery fellow with organized, comprehensive, supervised training so that on completion, the trainee will be well prepared to function independently in an academic position as the surgeon/leader of a functional neurosurgery program with special expertise in Deep Brain Stimulation and interdisciplinary care of patients with movement disorders.

Objectives by Competency

  • Medical KnowledgeExpert level understanding of movement disorders, image guidance, indications for functional procedures
  • Patient CareDBS, stereotaxy, radiosurgery, SCS, ITB/ITM
  • Practice Based Learning and ImprovementCompetence and productivity in clinical research
  • Interpersonal and Communication SkillsEffective teamwork in interdisciplinary care setting, Effective patient/family education, Effective resident/student teaching
  • ProfessionalismEffective leadership
  • Systems Based Practice
  • Sophisticated understanding of the dynamics of a successful movement disorders program

5. Accreditation:  The University of Florida Stereotactic and Functional Neurosurgery Fellowship is accredited by the Society of Neurological Surgeons Committee on Accreditation Subspecialty Training (SNS/CAST). Ours is one of only seven functional neurosurgery programs in North America with CAST accreditation.

C. Resources

1. Teaching Staff:

Kelly Foote, MD (Fellowship Director)

Specialties: Stereotactic and Functional Neurosurgery, deep brain stimulation, brain tumors, radiosurgery, spinal cord stimulation, intrathecal pumps.  

Michael Okun, MD (Fellowship Co-Director) 

Specialties: deep brain stimulation, research involving non-motor basal ganglia brain features, teaching/mentorship of movement disorders fellows

William Friedman, MD – Professor and Chairman of the Department of Neurosurgery.

Specialties: Stereotactic and Functional Neurosurgery, radiosurgery, brain tumors, trigeminal neuralgia.

Steven Roper, MD – Professor of Neurosurgery

Specialties: Stereotactic and Functional Neurosurgery, Epilepsy surgery.

Frank Bova, PhD – Professor of Biomedical Engineering.

Specialties: Medical physics, image guided neurosurgery and radiosurgery.

Dawn Bowers, PhD – Professor of Neuropsychology.

Specialties: Movement disorders, deep brain stimulation, neuropsychology.

Herbert Ward, MD – Professor of Psychiatry.

Specialties: Movement disorders, deep brain stimulation, psychiatry.

Meredith DeFranco, DPT – Professor of Physical Therapy.

Specialties: Movement disorders, deep brain stimulation, physical therapy.

Lisa Wharen, MHS, OTR/L – Professor of Occupational Therapy.

Specialties: Movement disorders, deep brain stimulation, occupational therapy.

Michelle Troche, PhD – Professor of Speech Pathology and Communication Disorders.

Specialties: Movement disorders, deep brain stimulation, speech pathology and communication disorders.

2. Facilities: training will be conducted at the UF Center for Movement Disorders and Neurorestoration, Shands Hospital at the University of Florida, Shands Florida Surgical Center, and the McKnight Brain Institute.

D. Educational Program – Basic Curriculum

1. Clinical Activities

A period of 12 continuous months will be spent in clinical functional neurosurgery training with a primary focus on the development of true expertise in the delivery of deep brain stimulation (DBS) therapy. The fellow will also be trained in other aspects of functional neurosurgery (spinal cord stimulation, intrathecal drug delivery pumps, stereotactic radiosurgery, framed and frameless intraoperative stereotactic techniques and epilepsy) to varying degrees according to the expressed interests and goals of the individual fellow. In order to develop a deeper understanding of the disorders typically treated with DBS (Parkinson’s disease, tremors, dystonia), the fellow will participate in movement disorders neurology clinic in addition to neurosurgical clinical activities. The fellow will appropriately document all clinical activities in the EPIC computerized medical record system. The fellow’s clinical responsibilities at each training site are outlined as follows:

Functional Neurosurgery Outpatient Clinic:

Each Monday, the fellow will attend Dr. Foote’s clinic at the UF Center for Movement Disorders and Neurorestoration (UF CMDNR) where he or she will carry out the following under close supervision:

  1. evaluation of patients referred for consideration of possible DBS surgery, including appropriate history and physical examination,
  2. acquisition and evaluation of preliminary diagnostic studies (MRI, functional imaging),
  3. development of a risk vs. benefit analysis for DBS surgery and proposal of a potential plan for surgical intervention tailored to the specific needs of each patient,
  4. patient education regarding DBS surgery including appropriate indications for DBS, methodology of DBS implantation, risks and potential benefits, and expected outcomes,
  5. evaluation and management of post-operative DBS patients, especially those with complications or suboptimal outcomes of DBS surgery,
  6. evaluation and management of pre- and post-operative patients referred for possible spinal cord stimulator implantation (intractable neuropathic extremity pain, failed spine surgery syndromes),
  7. evaluation and management of pre- and post-operative patients referred for possible intrathecal pump implantation (intractable spasticity, intractable pain),
  8. evaluation and management of pre- and post-operative patients referred for possible stereotactic radiosurgery (metastatic brain tumors, cerebral AVMs, vestibular schwannomas, meningiomas, trigeminal neuralgia not amenable to other therapy, other),
  9. consultation and collaboration with the other clinicians in the UF CMDNR (neurology, psychiatry, neuropsychology, PT, OT, speech and swallowing disorders, nursing, clinical trials)

Movement Disorders Neurology Outpatient Clinic:

For the first 3 months of the fellowship year, the fellow will attend Dr. Okun’s Movement Disorders Neurology Clinic at the UF CMDNR every other Thursday. (one Thursday per month after the first three months), where he or she will carry out the following under close supervision:

  1. evaluation and medical management of new and established patients with Parkinson’s disease, Parkinson plus syndromes, tremor, dystonia, chorea, tic disorders, spasticity, psychogenic and other movement disorders,
  2. identification of potentially appropriate DBS surgical candidates,
  3. electronic analysis and programming of DBS pulse generators,
  4. initial evaluation of patients referred due to sub-optimal outcomes of DBS surgery at other institutions,
  5. administration of standardized rating scales used to evaluate patients with movement disorders (UPDRS, TRS, BFMDRS, TWSTRS, etc.)

Shands Hospital at the University of Florida Operating Rooms:

Each Wednesday, the fellow will participate in all DBS lead implantation procedures with Dr. Foote (typically three cases each Wednesday) and occasional deep brain target ablation procedures (pallidotomy, thalamotomy, subthalamotomy), where he or she will carry out the following under close supervision:

  1. Stereotactic head ring application,
  2. Acquisition of stereotactic high resolution CT images for DBS targeting,
  3. Fusion of stereotactic CT images to pre-operatively acquired, high resolution, non-stereotactic MR images for DBS targeting,
  4. Virtual reality based computer targeting for DBS, including manipulation of a scalable three-dimensional brain atlas to facilitate direct targeting of deep brain structures,
  5. All technical aspects of DBS lead implantation,
  6. All technical aspects of deep brain lesion generation,
  7. Intra-operative microelectrode recording

On the 2nd and 4th Fridays of each month, the fellow will participate in other functional neurosurgical operative procedures at Shands at UF with Dr. Foote including spinal cord stimulator implantation, intrathecal drug delivery pump implantation, stereotactic brain biopsies, and frameless stereotactic brain tumor resections.

Shands Florida Surgical Center (FSC):

On the 1st, 3rd, and any 5th Fridays of each month, the fellow will participate in outpatient functional neurosurgical procedures with Dr. Foote including DBS pulse generator implantations, DBS pulse generator replacements due to end of battery life, spinal cord stimulator pulse generator replacements, and intrathecal pump replacements (typically 5 to 10 cases per day).

Shands Hospital at the University of Florida Inpatient Management:

The fellow will make regular hospital rounds to manage functional neurosurgery inpatients on the neurosurgical wards and in the NeuroIntensive Care Unit as necessary. He or she will be expected to carefully follow all post-operative patients, and will also be called upon for subspecialty consultation when DBS or other functional neurosurgery patients are seen in the Emergency Department or as consults on non-neurosurgical wards.

Shands Hospital Department of Radiation Oncology and Trilogy Radiosurgery Suite:

One Tuesday each month, the fellow will participate stereotactic radiosurgery treatments with Dr. Foote where he or she will carry out the following under close supervision:

  1. Stereotactic head ring applications,
  2. Acquisition of stereotactic high resolution CT or CTA images for radiosurgical targeting,
  3. Fusion of stereotactic CT images to pre-operatively acquired, high resolution, non-stereotactic MR images for radiosurgical targeting,
  4. Image guided computerized dose planning for radiosurgery in collaboration with a radiation oncologist and a medical physicist
  5. Observation of the delivery of radiosurgical treatments with the Trilogy radiosurgery system

2. Conferences and didactic teaching

To strengthen his or her fundamental subspecialty knowledge base, each fellow will begin his or her didactic fellowship experience by attending the Movement Disorders Society sponsored annual three-day July course:  “A Comprehensive Review of Movement Disorders for the Clinical Practitioner in Aspen, Colorado.

The fellow will be expected to attend and participate in several regular didactic conferences as follows:

Each Tuesday at 8 am, a general conference is held in the McKnight Brain Institute DeWeese Auditorium for all members of the UF Center for Movement Disorders and Neurorestoration. Attendees include center faculty, trainees and guests from neurology, neurosurgery, psychiatry, neuropsychology, physical therapy, occupational therapy, communication and swallowing disorders, nursing, social work, neuroscience, applied physiology and kinesiology. The conference format alternates weekly with clinical case presentations and discussion on the 1st and 3rd Tuesday of each month and research presentations by center members on the 2nd and 4th Tuesday of each month. The functional neurosurgery fellow will be expected to collaborate with the four movement disorders neurology fellows who are primarily responsible for the organization and presentation of these important conferences.

One Tuesday per month at 7 am, the functional neurosurgery fellow will be responsible for the preparation and presentation of a didactic functional case review conference for the neurosurgery department as part of the neurosurgery daily conference schedule.

One Tuesday per month at 9 am, the functional neurosurgery fellow will participate in the preparation of our monthly Interdisciplinary DBS Surgical Planning and Complications Conference. Each Monday and Tuesday, as part of the DBS “Fast Track” program, three or four patients are evaluated in the UF CMDNR clinic as potential candidates for DBS surgery by key representatives from neurosurgery, neurology, psychiatry, neuropsychology, physical therapy, occupational therapy, communication and swallowing disorders, nursing, and social work. At this meeting, key representatives from each of these departments meet to discuss each DBS candidate on a case-by-case basis. A global risk vs. benefit analysis is developed with consideration of input from all specialists and a consensus recommendation is made regarding DBS surgery that is tailored to the situation of each patient (yes or no to DBS, optimal surgical target, unilateral vs. bilateral, staged vs. simultaneous bilateral, exceptional risks or indications, replacement vs. rescue leads for DBS failure patients, etc.). Patients are contacted after the meeting, given these recommendations, and surgery is scheduled accordingly. This meeting is also the venue where all DBS-related adverse events from the preceding month are summarized and discussed. The functional neurosurgery fellow will be responsible for meticulously maintaining the record of all DBS-related adverse events in our computerized clinical/research database.

The fellow will also be encouraged to attend most of the daily 7 am didactic conferences in the department of neurosurgery as follows:

Conference Frequency Individual Responsible for Oversight Individual Presenting the Conference Required to Attend
Function Case Conference 1 per month Dr. Foote Functional Fellow Fellows, Residents and Faculty
Neurosurgical Conferences 3 per week Drs. Friedman and Lister TTP, Residents Fellows, Residents and Faculty
Neuropathology Conference 1 per month Dr. Yachnis Dr. Yachnis Fellows, Residents and Faculty
Morbidity and Mortality Conference Monthly Dr. Hoh Chief Resident Fellows, Residents and Faculty
Neuroanatomy Conference Monthly Dr. Lister Dr. Rhoton and Dr. Lister Fellows and Residents
Journal Club Monthly Dr. Murad Residents and Fellows Fellows and Residents

 

3. Opportunities/responsibilities for research

In the realm of research, our team at the CMDNR has published over 250 Movement Disorders-related research studies in peer-reviewed journals in the past ten years. We have produced and contributed to several textbooks, and our team members have presented hundreds of lectures and posters at national and international meetings. Over 100 of these publications have been directly related to deep brain stimulation, with 20 DBS-related papers published during the recently completed calendar year (2011). The UF CMDNR team is recognized as a world leader in deep brain stimulation. The functional neurosurgery fellow will be expected to have a productive research year in addition to his clinical and didactic activities.

Our goal is to insure that each fellow in this program acquires the skills necessary for a successful career in academic neurosurgery. To this end, each fellow will be assigned multiple research projects, with both primary and collaborative roles. Each fellow will be expected to participate in the conception and design of at least one research study of his or her choosing. Mentorship will be provided to assist the fellow in the following research associated activities: 

  • Refinement of an answerable and meaningful research question including review of pertinent literature
  • Identification of appropriate collaborators
  • Study design and biostatistical planning
  • Applying for and obtaining IRB approval for human subject research
  • Database mining, if appropriate for the study
  • Subject recruitment
  • Collection and organization of pertinent data
  • Data analysis and biostatistics
  • Abstract presentation at a scientific meeting
  • Manuscript preparation, submission, and ultimate publication.

It is our expectation that the research efforts of each fellow will result in at least three or four first author publications and multiple collaborative authorships, and that this research experience will serve as a solid foundation upon which to build a career in academic neurosurgery.

To facilitate this research mission, the functional fellow will have dedicated time allotted for research activities every Tuesday afternoon, every other Thursday for the first three months, and all but one Thursday per month (spent in neurology clinic) thereafter. He or she will have a dedication workstation with a computer and personal storage space in the Fellows Suite at the UF CMDNR. He or she will be provided with biostatistical and editing support as needed. He will have access to the UF CMDNR’s 6000 patient clinical research database (“INFORM”) and will receive input from the center’s database committee on all proposed research projects. The fellow will meet with Dr. Foote for weekly mentoring sessions and collaborate with faculty and fellows from other departments. As is our custom at the UF CMDNR, the fellow will be expected to involve residents and students in his or her research, assuming the role of mentor, especially in the latter part of the fellowship year. Finally, each fellow will be expected to attend and present his or her research at the Department of Neurosurgery’s Annual Research Day, and at one or more national or international scientific meetings in stereotactic and functional neurosurgery.

4. Multidisciplinary Roles / Interaction with other specialties

Through his or her involvement and participation (as described above) in the interdisciplinary care model of the UF CMDNR, the functional neurosurgery fellow will be exposed to one of the nation’s most successful multidisciplinary clinical and research collaborations. We are hopeful that this model of patient-centered, interdisciplinary care and collaborative clinical research will be propagated as a more intelligent and effective model for health care delivery. With regard to DBS, it is our contention that optimal outcomes can only be achieved through effective interdisciplinary collaboration on behalf of the patient. We believe that fellows trained under this paradigm will insist on this high level of collaboration and patient-centered care when they are building clinical and research programs of their own. We respectfully submit that very few DBS programs could offer similar volume and diversity of clinical cases, research infrastructure and opportunities, or interdisciplinary collaboration to those available at the UF Center for Movement Disorders and Neurorestoration.

Role of the Fellow in education/training neurosurgery residents

As described above, the functional neurosurgery fellow will be responsible for preparing regular subspecialty specific didactic conferences for the neurosurgery residents and the multidisciplinary membership of the UF CMDNR. He or she will assist the neurosurgery residents with evaluation and management of functional neurosurgical patients who present to the emergency department or require neurosurgical consultation while admitted to other services.

On Wednesdays and Fridays in the operating room, a (usually junior) neurosurgery resident is assigned to Dr. Foote’s DBS and other functional procedures in addition to the functional fellow, which provides the fellow an opportunity to develop his or her skills as an intra-operative teacher. DBS lead implantation is performed as a dual operation, with one operation performed in “virtual-space” on the stereotactic computer workstation, and a parallel operation performed in “real-space” on the patient’s head in a sterile environment. At present, the neurosurgery residents are essentially limited to participation in the real-space operation, and have very limited exposure to the tremendous learning opportunity associated with the virtual, computer-based operation. It is actually during the virtual operation that the DBS surgeon is more cognitively challenged, and the most important principles of DBS surgery are learned. While there are important technical lessons that must be learned hands-on in the sterile field, the real space operation is generally the straightforward execution of the surgical plan derived from the more complex decision-making during pre-operative evaluation and virtual-space targeting. Having a fellow, in addition to the neurosurgery resident that is assigned to participate in each DBS case, will allow both the fellow and the resident to alternate between virtual-space operator and real-space operator on a case-by-case basis. On a typical Wednesday, for example, when three or four consecutive DBS lead implantations are performed; both the resident and the fellow will have an enriched learning experience where they participate in both virtual and real operations multiple times in the course of one day. This is an experience that very few neurosurgery residency programs could offer.

As previously mentioned, the functional neurosurgery fellow will be expected to involve residents and students in his research. It is our vision that the functional fellow will serve as a subspecialty mentor to the neurosurgery residents and to non-neurosurgical trainees in the UF CMDNR.

Several tools and techniques will be used to provide the Fellow with the necessary skills to instruct their peers, students, patients and patient’s families.

In dealing with patient and family education, the technique most commonly used is modeling of experienced faculty. To this end, the functional fellow will accompany Dr. Foote on Thursday morning rounds in addition to the extensive exposure provided by neurosurgery and neurology outpatient clinics. Also serving as excellent communicator role models and mentors are our several Advanced Registered Nurse Practitioners (ARNP) and Physician’s Assistants (PA), all of whom excel at patient and family education.

In the fall of 2009, the Resident as Teacher program at UF was redesigned to include a longitudinal curriculum for more senior residents and fellows that can lead to the fellows earning a certificate. The curriculum includes topics such as: giving feedback, teaching at the bedside, preparing effective lectures, how to teach procedures and leadership skills. The functional neurosurgery fellow will be expected to participate in this program.

Fellow involvement in non-fellowship related patient care

It is not anticipated that the functional neurosurgery fellow will participate in the general neurosurgery call schedule, and the fellow should very rarely be called upon to provide neurosurgical clinical backup when resident manpower is lacking. This fellowship will be dedicated virtually exclusively to the development of subspecialty expertise in DBS and functional neurosurgery.

Figure 1. Typical weekly schedule of the functional neurosurgery fellow

Monday Tuesday Wednesday Thursday Friday
6 am prn: morning inpatient rounds prn: morning inpatient rounds prn: morning inpatient rounds Morning inpatient rounds prn: morning inpatient rounds
7 am Neurosurgery Conference Neurosurgery Conference Neurosurgery Conference Neurosurgery Conference Neurosurgery Conference
am Neurosurgery Clinic Weekly CMDNR ConferenceMonthly DBS planning/ complications meetingWeekly mentorship meeting with Dr. Foote OR: DBS lead implantation surgery Neurology Clinic every other week (first 3 months, then monthly)Protected research time every other week (first 3 months, then all but one Thursday per month) OR: DBS pulse generator implantations and replacements, other functional neurosurgical procedures
pm Protected research time

 

5. Fellowship Organization – Supervision

Policy for supervision of the functional neurosurgery fellow

Every patient seen by the Department of Neurosurgery at Shands/UF is assigned to a faculty level physician, who supervises every aspect of care, whether it is in the clinic, operating room, emergency room, or hospital. Fellows are paired with faculty on the Functional Neurosurgery service and will round together and discuss all patient issues at least once daily with their attending faculty member. Faculty members will be available at all times by pager, cell phone or onsite for further consultation. Level of fellow responsibility is dependent on several factors as determined by the attending physician: the individual’s level of knowledge, skill, expertise and the complexity of the patient’s illness and risk of operation. Every operative or interventional procedure is supervised, directly and onsite by the attending physician.

The Quality Assurance Committee of the Department of Neurosurgery exhaustively reviews on a monthly basis complications experienced by Shands UF neurosurgery patients. Any aspects of patient care problems that relate to lack of appropriate supervision are addressed and corrected in that forum.

The fellow will see all hospitalized functional neurosurgery patients in the morning before the 7 am conference and meet with faculty each morning, either before or after the conference, to discuss each patient. This type of consultation goes on throughout the day as problems arise. The faculty and fellows commonly make rounds to see each patient together in the late afternoon and on weekends. A faculty member is in attendance at all operative procedures even when the fellow has the primary operative responsibility. Each patient seen in the emergency room is discussed with the faculty prior to making a decision to admit or discharge the patient. New admissions or transfer patients will be discussed with the attending faculty member. All inpatient consultations are reviewed and seen with a member of the faculty. In the outpatient clinics, all patients evaluated by the functional neurosurgery fellow will be seen in conjunction with a faculty member.

E. Evaluation Process

Evaluation of the functional neurosurgery fellow:

The functional fellow will meet weekly with the fellowship director for informal mentorship sessions. These meetings are intended to assess and encourage progress on research projects and to provide an opportunity for discussion of any concerns the fellow or the director may have regarding patient care, progress in the development of subspecialty knowledge or operative skills, collaborations, time management, or other issues.

A formal evaluation of the fellow will occur at the end of each quarter of the fellowship year. The fellowship director will meet with the fellow at the end of each quarter to discuss the results of his or her formal evaluation and the fellow will be provided with a written summary of the evaluation for reference. The evaluation will be administered through the neurosurgery education office using the New Innovations online evaluation system that is currently used for all resident and fellow evaluations in the University of Florida Neurosurgery Department. The formal evaluation of the fellow will include the following elements:

Competency Assessment Method(s) Evaluator(s)*
Patient Care Direct observation Faculty, nursing, patients, peers, self
Global assessment Faculty, nursing,  patients, peers, self
Surgical log review Director, self
Medical Knowledge Direct observation Faculty, nursing, patients, peers, self
Global assessment Faculty, nursing, patients, peers, self
Research project assessment Faculty
Written examination at 6 month evaluation Director
Oral examination at 9 month evaluation Faculty
Practice-based Learning & Improvement Global Assessment Faculty, nursing,  patients, peers, self
Project Assessment Faculty, Project committee, self
Interpersonal & Communication Skills 360 evaluation Faculty, Fellows, Residents, nursing staff
Global Assessment Faculty
Direct Observation Faculty, nursing, patients, peers, self
Professionalism 360 Evaluation Faculty, Fellows, Residents, nursing staff
Global Assessment Faculty, nursing, patients, peers, self
Direct Observation Faculty, nursing, patients, peers, self
Systems-based Practice 360 evaluation Faculty, Fellows, Residents, nursing staff
Global Assessment Faculty, nursing, patients, peers, self
Direct Observation Faculty, nursing, patients, peers, self

*Director = Dr. Foote, Faculty = Dr. Foote and Dr. Okun (+Dr. Roper if the epilepsy track is chosen, and/or Dr. Friedman if the intensive radiosurgery track is chosen)

The functional neurosurgery fellow’s evaluation of the fellowship and faculty:

1) Each spring, the Fellow will be afforded the opportunity to anonymously evaluate the teaching faculty via an on-line service, New Innovations. New Innovations allows the Fellow access to a strictly confidential and password protected site where they are asked a series of questions about each faculty’s teaching ability. A numerical score is tabulated for the answers to each question. In addition, multiple written comments by the Fellows are recorded. To ensure confidentially, the evaluations completed by the Fellow will be combined with the residents’ evaluations of each faculty member. Dr. Foote’s evaluations will be combined with the neurosurgery residents’ data. Likewise, Dr. Okun’s evaluation data will be combined with the neurology residents’ data. The results of this evaluation are accessible only to the appropriate Core Residency Program Director and the Chairman of the Department. Results of this evaluation will be relayed to the faculty member during their annual evaluation by the Department Chairman.

2) Graduating Fellows will be asked to complete an end-of-Fellowship written evaluation.  Graduating residents will complete the same form. The forms will be distributed using the online system, New Innovations. Responses are anonymous in the New Innovations system.  The Fellow and residents results will be then reported in aggregate to the Department Chairman and Program Director.

3) At the July semi-annual faculty retreat, the Chairman and Fellowship Director will lead a critical review of the current state of the Functional Neurosurgery Fellowship including the aforementioned data. Curricular deficiencies will be reviewed in a candid fashion and a written program remediation plan will be developed for implementation. At this meeting, the quality improvement initiatives underway will also be reviewed. New program goals and initiatives will be presented for review and faculty approval.