Welcome to the NEUR S 675 Clerkship with the Billings Clinic Department of Neurological Surgery! We are thrilled to have you on our service and hope that you will find your clerkship to be intellectually challenging and rewarding.
Your mission during the four weeks it to learn the basics of clinical neuroscience (such as the neurological exam, neurological localization, and basic neuroimaging) as you learn about surgical and non-surgical management of common and/or emergent neurological diseases.
The clerkship will take place at the Billings Clinic Hospital and Clinics in Billings, Montana. Billings Clinic is the largest healthcare organization in the state. It is the only Level 1 Trauma Center and Comprehensive Stroke Center within a 500-mile radius and cares for patients with the most complex medical problems. Patients come from throughout the state of Montana, Northern Wyoming, and western North & South Dakota. The department does outreach clinics in Cody, Wyoming, and Miles City, Montana, and students interested in these rural outreach clinics could participate.
You will have a rich assortment of clinical experiences to learn from and we encourage you to immerse yourself this month seeing as many patients as you can in the Emergency Room, the ICU, on the wards, in the operating rooms, and in the clinic. Due to the busy nature of the service and the high acuity of the patients, you may not have as much autonomy as in other clerkships. Nevertheless, you should seek as many opportunities as you can to examine patients, review their imaging, consider a differential diagnosis and workup, and propose management. As with medicine in general, the more actively you apply yourself, the better you will learn.
DEPARTMENTAL STRUCTURE
The department of neurosurgery at the Billings Clinic consists of six board-certified or eligible neurosurgeons and one board-certified orthopedic spine surgeon. While each surgeon has their own area of interest, all neurosurgeons cover general neurosurgery and trauma. As we have no neurosurgery residents at Billings Clinic, each surgeon consists of teams with Advanced Practice Providers (APPs). The APPs work both in the Operating Room as a first assistant as well as provide support in the clinic and hospital. They are an invaluable resource for the surgeons and students. Take advantage and learn from their knowledge.
DEPARTMENT EDUCATORS
Mark Piedra, MD
Site Clerkship Director
mpiedra@billingsclinic.org
Areas of interest: Brain tumors & neuro-oncology, deep brain stimulation, Gamma Knife radiosurgery, pain, neuro-modulation
Michael “Manny” Morone, MD, PhD
mmorone@billingsclinic.org
Areas of interest: Spine surgery, Neuro-trauma
PAs/MAs/RNs: Valerie Rowen, RN; Linda Himmespach, RN; Payton Richey, PA
Marlin “Dusty” Richardson, MD
Department Chair
mrichardson1@billingsclinic.org
Areas of interest: Adult spinal deformity, Peripheral nerve, Neuro-trauma, Gamma Knife radiosurgery
PAs/MAs/RNs: Georgee Gee, LPN; Jamaica Moore, PA; Taylor Richey, PA
Christopher Stewart, DO
cstewart5@billingsclinic.org
Areas of interest: General neurosurgery, spine, neuro-trauma
PAs/MAs/RNs: Margarita Adame, MA; Reid Gage, PA
Vance Fredrickson, MD
vfredrickson@billingsclinic.org
Areas of interest: Cerebrovascular and neuro-interventional, skull base, neuro-oncology
PAs/MAs/RNs: Ruth Corey, RN; Kellie Alfaro, PA
Shervin Dashti, MD
sdashti1@billingsclinic.org
Areas of interest: Cerebrovascular and neuro-interventional
PAs/MAs/RNs: Ruth Corey, RN; Kellie Alfaro, PA
Anthony “Tony” Roccisano, DO
aroccisano1@billingsclnic.org
Areas of interest: Orthopedic spine surgery
PAs/MAs/RNs: Tara Kostalecky, MA; Monica Schwomeyer, PA; Jen Kuhr, PA
Additional APPs:
Rachel Poston, PA (hospital); Aaron Furchner, PA (hospital); Ryan Callahan, PA (clinic); Kayla Nagle, PA (Cody clinic)
GENERAL SCHEDULE
Monday
7:00am – Rounds
7:30am – Operating room
4th Monday
7:00am – Trauma Case Conference
8:30am – Operating Room
Tuesday
7:00am – Rounds
7:30am – Operating room
Wednesday
6:30am – Rounds
8:00am – Didactic teaching (location varies)
10:00am to Noon – Clinic
Noon – Neuroradiology Conference (location varies)
1:00pm to 4:30pm – Clinic
3rd Wednesday
6:30am – Spine Conference (location varies)
Thursday
7:00am Rounds
8:30am to 4:30pm clinic
3rd Thursday
6:30am – Trauma M&M Conference (location varies)
Friday
6:30am – Gamma knife radiosurgery (hospital MRI)
7:00am – Tumor Board (via Teams, only when neuro cases being presented)
7:30am – Rounds
11:00am – 3:00pm clinic
Clinics and Conferences
When not in the OR, students are expected to participate in clinics, teaching sessions and conferences, or assist in seeing consults and procedures in the hospital. Didactic teaching sessions and conferences take precedence and STUDENT ATTENDANCE IS MANDATORY.
Dates and times of teaching sessions and conferences vary by rotation and will be given to the student at the start of the clerkship.
Site-Based Didactic Teaching Sessions and Conferences
Students are required to attend regular didactic teaching sessions and conferences. Didactic teaching sessions include the following topics:
Brain Tumors and neuro-oncology
Cerebrovascular disease and stroke
Spine
Trauma
Neuro-Radiology
Rounds
It is expected that all students are on time to rounds every day. Attire is expected to be professional, and you should only wear scrubs on days when you will be in the OR. It is expected, and when possible, appreciated for students to help facilitate rounds by helping to collect and communicate information and assisting with patient care in an effort to make rounds run smoothly; this also helps to familiarize students with patients on the service.
Operating Room
Surgeons will assign surgical cases to clerkship students the evening before cases. Students must be on time in the Operating Room (7:30am for first start cases every day; 8:30am for second Wednesday and last Monday of the month).
When arriving to the OR, students are expected to introduce themselves to the attending surgeon, anesthesiologist, surgical assistant, scrub technician, and circulating nurse.
Taking Call
To expose students to the breadth and depth of neurosurgical emergencies, we expect students to participate in overnight call with the attending surgeon ONE night per week of the rotation. These nights will be assigned at the beginning of the rotation. Students are not expected to stay in-house, but will be called in to participate in evaluation and treatment of neurosurgical emergent cases at the discretion of the attending neurosurgeon on call.
Materials
We recommend having at least a penlight and a reflex hammer for neurologic exams. Required and suggested readings will be given by your attending surgeon.
Closing Remarks:
While a part of the neurosurgery team at the Billings Clinic we will see and care for some of the sickest patients in the hospital. Patients who are sick often have difficulty coping with their illness; those with neurological impairments often have trouble even understanding their situations which can make it even more challenging. The same can be true for the patient’s loved ones and even for the people providing their care. Please understand that people can handle difficult situations differently, but every neurosurgery team-member respects our patients and knows his or her responsibility towards them. We expect the same from our students. No one is immune to the demands of the neurosurgery service and please know that we are here to support medical students as much as we are here to support each other through difficult times. Please contact the Clerkship Director, Clerkship Coordinator or Administrator of Education if you experience any issues with coping or need support or feel someone else might benefit.
We sincerely look forward to working with you and to your successful career in medicine.
Best regards,
Billings Clinic Department of Neurological Surgery