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Intervention Model: Clinical rotations



Outpatient clinic and surgical cue triage


Assessment and plan of potential cases

WEEK 3 & 4:



Emergency neurosurgical procedures


Post-operative care & rehabilitation


Begin triage for next month's rotation



Surgeries are supervised by a US faculty neurosurgeon


Cases are obtained from clinical assessments

The Format


  • Responsibilities of the visiting US team will include:

    • completion of the spectrum of inpatient and outpatient responsibilities inside and outside of the operating room required to successfully manage a neurosurgical service.

    • participation with on-site OR personnel to facilitate procurement of replacements for damaged or consumable instrumentation and material. The proposed intervention centers around a rotation at PIH HUM by senior level U.S. neurosurgical residents.

Protections: Promoting High-Quality Care


Multiple tiers of protection will be added to ensure that care is provided commensurate to that in US residency training programs.


  • Participating residents will be in the senior portion of their training.

  • For the duration of the rotation, a US-based attending will be present or available to assist in clinical plan formulation. All consultations will be discussed with the US- based neurosurgical attending.

  • For emergent scenarios, in the absence of a US neurosurgical attending, cases will be staffed by an attending HUM general surgeon. In all scenarios, management considerations will have been discussed with the attending on-call if that individual is not on-site.

  • Elective cases will be completed in the presence of the US-based attending that will be on-site for approximately one week per month.

  • Monthly service statistics and all episodes of morbidity and mortality will be discussed at the monthly quality assurance morbidity and mortality conference. M&M conference will take place at regardless of the program of origin of participating resident and attending.

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