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Chief Resident at Emory University Hospital
The chief residents oversee the team management of all patients on the adult neurosurgery service in conjunction with the preferences of each individual attending surgeon. It is the Chief resident's responsibility to round on all patients in the morning, review all pertinent events, lab or radiographic data, and nursing reports.

The chief resident should personally examine or directly supervise the examination of all patients on the service during morning work rounds. The chief resident is responsible for the final decision on all management issues in the morning, and should provide ample instruction or insight for the more junior-level residents as to how those decisions were made.

Rounds are to be conducted with all residents (assigned full-time to the EUH service) on all patients. Each resident should have a working knowledge of each patient's diagnosis, neurological examination and plans for the day. The start time of morning rounds is set by the chief resident each evening and is based on the current census.

Evening rounds are to be conducted by a chief resident. All radiographic studies performed that day should be reviewed during evening rounds. There should be constant communication and updates between the residents on the ward/ICU and those who are in the operating room during the day. Any resident completing an operation who is entering the ward/ICU should be aware of any significant recent developments.

The chief resident should round each day on the weekends. The chief resident will assign residents or physician-assistants (PA) to cases in advance to allow each resident or PA the opportunity to have pre-operative consultation with the specific attending to clarify operative goals, positioning, approach, equipment needed, etc. It should be customary for each resident to review an upcoming case with the attending regardless of the degree of complexity.

On days where a heavy operative schedule is anticipated, the chief resident must inform faculty members if they will not have a resident assistant in surgery. The chief resident has first choice in assigning cases, and he/she is encouraged to garner a broad experience rather than consistently selecting cases of one subspecialty. The chief resident should establish a standard of dictating cases directly following completion of a procedure with each new group of junior residents dependent upon the attendings' desires.

It is the chief resident's responsibility to set an example of arriving in the operating room promptly for anesthetic induction, positioning, writing of postoperative orders, and planning of the sequence of instruments with the nurses. Waiting to be paged after the anesthesiologist is "ready" is not acceptable. The chief resident must balance the need to keep cases moving in a fluent manner with the necessity to involve more junior level residents in the surgical procedure.

The chief resident should personally participate in the advancement of each junior resident's technical skills in the operating room. All invasive CNS procedures performed in the intensive care unit or on the ward should be supervised by the chief resident until a junior-level resident is deemed capable of functioning independently.

The director of the neurosurgical ICU must be informed in a timely manner prior to the performance of invasive procedures in the ICU. ICU rounds with the ICU-Attending physician will be conducted twice per week.

The chief resident must review all consultation cases referred to the neurosurgery service with the resident who performed the initial consultation and confer directly with or oversee the efficient communication between other residents and the attending on call or the attending requested. In order to ensure that all neurosurgical consultation activity is known to the chief resident, no case should be presented to the attending on-call without review by the chief resident unless he/she is physically unable to be present.

Any complaints lodged by patients, their families, the nursing staff, hospital personnel, or other physicians against the resident team should be discussed with that particular resident. If a suitable course of action is not taken, the chief resident should communicate directly with the chairman.

The chief resident should promote resident attendance at all pertinent radiology and pathology conferences, neurosurgery grand rounds, etc. It is the responsibility of the administrative chief resident to compose the schedule of the grand rounds talks and notify the speakers.

The chief resident is not obligated to take in-house call on the Emory service but must always be available by beeper and/or telephone to consult with the in-house resident at night and on weekends. PGY7 and PGY6 residents will rotate Chief call covering all hospitals as back up to the junior level residents. They may need to return to the hospital to discharge this responsibility. Senior-level coverage must be arranged for all time away. The chief resident will make a monthly call schedule and submit the schedule to the Office Manager in neurosurgery by the 15th of the preceding month.

By the completion of the chief resident year, it is the goal of the training program that the resident be proficient in all commonly performed intracranial procedures and microsurgery , treatment of traumatic brain lesions, CSF-diversion techniques, and surgical treatment of intracranial infections. The resident should be proficient in a variety of spinal operations for degenerative, traumatic, infectious and neoplastic disease. This includes basic knowledge and skill in spinal instrumentation. Basic skills in the management of common pediatric disorders are also goals.

The chief resident must have current BCLS and ACLS certification.