SURGICAL NEURO-ONCOLOGY FELLOWSHIP

UNIVERSITY OF CINCINNATI-MAYFIELD CLINIC
DEPARTMENT OF NEUROSURGERY

University of Cincinnati
Department of Neurosurgery
P.O. Box 670515
Cincinnati, OH  45267-0515
Contact:  Penny Schwab
513-558-5387 (phone)
513-558-4878 (fax)
pschwab@mayfieldclinic.com (e-mail)
Clinical Director:  Christopher M. McPherson, M.D.
Alternate Program Contact:  Jeffrey T. Keller, Ph.D.

General Overview

The Surgical Neuro-Oncology Fellowship is a clinical fellowship focused on the training of neurosurgeons in the surgical and clinical care of patients with tumors of the nervous system, primarily brain tumors. Fellows will also gain experience in the treatment of tumors of the skull, skull base, spine, spinal cord, and peripheral nerves. The fellowship is available to neurosurgeons who have completed residency training and would like to pursue specialized training in this area. The fellowship duration is 12 months. Candidates from outside the US with appropriate training and credentials are eligible. Although neurosurgeons with a goal of pursuing an academic career are preferred, this is not mandatory.

Surgical and Clinical Component

One of the primary roles of the fellow will be to oversee the Surgical Neuro-oncology Service at the University Hospital, working in collaboration with the residents, nurse practitioners, and other support staff. The fellow will be responsible for surgical patients who have tumors of the brain, cranium, skull base, spine, and spinal cord, specifically in terms of pre- and intraoperative evaluation and management and postoperative care. The fellow will be exposed to both standard and complex cranial and spinal surgical procedures used for neuro-oncologic cases. Additionally, the fellow will practice techniques in frameless navigation for stereotactic biopsy and for surgical adjuncts (e.g., functional MRI and diffusion tensor imaging). Other skills gained will include the use of intraoperative MRI for brain tumor surgery; intraoperative mapping for motor and speech cortex including awake surgical techniques; implants for brain tumor adjunctive therapy (i.e., I-125 seeds, chemotherapy wafers); and microsurgical and endoscopic surgical techniques. The fellow will also play an active role in stereotactic radiosurgery cases, both in evaluation of patients and treatment planning, and will gain expertise in both frame-based and frameless radiosurgery techniques. The fellow will have the chance to work with both Novalis and Lexar radiation technology.

Evaluation of patients in the clinic will be an important part of the fellowship. The fellow will see patients in the multi-disciplinary neuro-oncology clinics supervised by Dr. McPherson and Dr. Warnick. The fellow will be responsible for organizing, supervising, and contributing to the weekly Brain Tumor Board.

Finally, one month will be spent with the medical neuro-oncology service to gain a comprehensive overview of the treatment of neuro-oncology patients.

Research Component

Clinical research is a key portion of the fellowship as at least 1 day per week will be devoted to clinical research projects. The fellow is expected to complete two clinical research projects for submission; at least one submission should be an original clinical research project for a peer-reviewed journal. The second project can be a review for journal submission or chapter. The fellow is responsible for at least one grand rounds presentation.

Neuro-Oncology Service at The University Hospital and Mayfield Clinic
Unique characteristics of our program include:

• Well-known and respected regional referral source for the diagnosis and treatment of brain tumors.
• Active neuro-oncology team, including a multidisciplinary neuro-oncology clinic and weekly Brain Tumor Board.
• Active radiosurgery unit for treatment of tumors with special focus on frameless radiosurgery. Novalis and Lexar technologies are used.
• Access to multiple clinical trials that cover the range of brain tumors.
• More than 10 years experience using intraoperative MRI for brain tumor surgery.
• Special emphasis on surgical implants for brain tumor therapy including I-125   seeds, chemotherapy wafers, and use of combination therapy.
• Well-funded Brain Tumor Center supported by the University of Cincinnati, the University Hospital, and the Mayfield Clinic.
• 20-bed Neurosurgery ICU with dedicated critical care team.
• Well-respected residency program that accepts 3 residents per year with an active teaching staff.
• Medical communications department that provides medical illustration, photography, and editorial assistance for all publications and projects.

GOALS AND OBJECTIVES

Patient Care

Clinical Care

• Demonstrate the highest level of patient care skills, problem solving skills, and technical skills.
• Become proficient in the complete management of surgical neuro-oncology patients.
• Demonstrate a high level of multi-tasking for administrative, academic, and clinical endeavors.
• Manage and administrate the surgical neuro-oncology team in conjunction with residents, nurse practitioners, and other ancillary staff.

Skills

• Demonstrate proficiency with all surgical approaches to brain tumors.
• Place surgical implants including I-125 seeds and chemotherapy wafers.
• Manage and plan radiosurgical cases, both frame-based and frameless.
• Plan and perform frameless stereotactic biopsy procedures.
• Become familiar with surgical adjuncts to brain tumor surgery including frameless navigation, use of functional MRI and diffusion tensor imaging for surgical guidance, intraoperative mapping techniques for motor cortex and speech cortex localization including awake surgical techniques, intraoperative MRI techniques, and microsurgical and endoscopic techniques.

Medical Knowledge

• Demonstrate ability to teach effectively.
• Manage and lead the weekly Brain Tumor Board conference.
  Assist program director in overseeing personal, academic, and clinical growth and development of residents.
• Participate actively and lead conferences in a manner that demonstrates a high level of global awareness regarding clinical neurosurgery, applied research, an understanding of the literature, neurosurgical education, and program building.

Practice-Based Learning and Improvement

• Manage and administrate the quality improvement program for the neurosurgical service.
• Demonstrate application of evidence-based medical practice.
• Demonstrate knowledge of current neurosurgical literature.
• Apply knowledge to clinical practice.

Interpersonal and Communication Skills

• Demonstrate a high level of interpersonal communication skills within the neurosurgical team as well as with patients and their families.
• Manage the efficient and effective flow of information between the neurosurgical team and attendings.

Professionalism

• Demonstrate a high level of professionalism at all times.
• Develop, nurture, and demonstrate high level leadership skills.

Systems-Based Practice

• Demonstrate understanding of legal issues in neurosurgery.
• Demonstrate a high level of understanding regarding practice types, medical economics, and medical politics.
• Incorporate evidenced-based methodologies on an ongoing basis to the clinical practice of neurosurgery.
• Practice cost-effective neurosurgery.

Evaluation Process

The Fellow will be evaluated semiannually by the Director of the Surgical Neuro-Oncology Fellowship program and members of the neurosurgical faculty team who participate in the care of patients of the Surgical Neuro-Oncology service.

Teaching Staff

Christopher M. McPherson, M.D., Director, Surgical Neuro-Oncology Fellowship
Ronald E. Warnick, M.D., Director, Division of Surgical Neuro-Oncology
John M. Tew, M.D., Medical Director, The Neuroscience Institute
Philip Theodosopoulos, M.D., Director, Division of Skull Base Surgery
John Breneman, M.D., Radiation Oncology
Margie Lewis, M.D., Neuro-Oncology
Jeffrey T. Keller, Ph.D., Research Director, Division of Skull Base Surgery