Neurosurgery Residency

The Neurosurgery Residency Program’s mission is to train neurosurgery residents in the profession of neurosurgery, providing for them an educational, clinical, operative, and research environment of the highest standard.

To this end the Penn State Neurosurgery Residency will:

• Prepare trainees for the neurosurgical career of their choice.
• Enable trainees to successfully compete for the professional opportunities of their choosing, including those of academia.
• Foster an appreciation among residents and staff for the scholarly values and societal ideals that are the underpinnings of the profession.
• Promote a responsible, productive, and healthy work ethic recognizing the needs of both society and the individual.
• Further the knowledge of basic and clinical neuroscience through neurosurgical research.
• Encourage active participation in the regional, national, and international neurosurgical community.
• Facilitate access to the broader academic programs of Penn State College of Medicine, Penn State Health Milton S. Hershey Medical Center and Penn State for the benefit of undergraduate, medical, and graduate students as well as colleagues and self.
• Ensure that both Penn State Neurosurgery’s goals and its individuals’ needs can be met in a working environment that is collegial, collaborative, facilitative, fair, and personally rewarding.

Application Overview

The Neurosurgery Residency participates in the National Residency Matching Program (NRMP) and matches three residents per year as a categorical training program.

Concurrent with participating in the NRMP, neurological surgery programs use the Electronic Residency Application Service (ERAS). Applications are taken through ERAS only. All applications are considered without regard to race, religion, gender or national origin.

Steps for a Successful Match

• Register with the National Resident Matching Program (NRMP). All first-year residency positions are filled through the NRMP.
• Register with the Electronic Residency Application Service (ERAS). All applicants to the residency program must come through ERAS.
• Application deadline: Due to the volume of applications received and the time constraints of individual interviews, applications received after Oct. 1 may not be considered.
• A completed application is required for review.

Application Requirements

The following items must be included in the ERAS application:

• Personal statement
• Curriculum vitae
• Letters of recommendation: At least three letters of recommendation from faculty members with whom the applicant has worked, and at least one from a neurosurgeon. The program will not review more than four letters of recommendation and does not require a letter from the applicant’s department chair.
• Dean’s letter
• Medical school transcripts
• For international medical graduate students, ECFMG certification is required as a part of the application. Penn State Health only accepts/sponsors J-1 visas.
• USMLE Step 1 and Step 2 CK is required to be selected for an interview.

Program Signals

Per the American Medical Association (AMA),program signaling is a system that allows applicants to indicate interest in a limited number of residency programs. Because the applicants are given a limited number of signals, they should be given to programs in which they believe they are most interested. Residency Programs receiving the signals in turn utilize it as one of many data points when considering who they will invite to interview.

Non-U.S. Citizens

Applicants who are not U.S. citizens are responsible for obtaining a visa that permits direct patient care. Employment is contingent upon evidence of the appropriate visa and permission to work in the United States presented to a medical center official. The program accepts only J-1 training visas for non-U.S. citizens who are entering an ACGME training program.

Foreign Medical Graduates

All graduates of international medical schools must hold a valid certificate issued by the Educational Commission for Foreign Medical Graduates (ECFMG) to be appointed as a resident or fellow. For details, contact ECFMG at info@ecfmg.org or ECFMG, 3624 Market St., Philadelphia PA 19104-2685, USA.

For international medical graduates, U.S. clinical experience is strongly recommended including neurosurgery electives and/or other clinical experiences.

Interviews

Interviews are by invitation only. Once the program reviews completed ERAS files, qualified applicants will be invited for an interview with faculty, residents, and other key members of the neurosurgery team. It is advisable to respond to the invitation for an interview as quickly as possible since interview dates fill up quickly.

Travel and Lodging

The program does not pay for candidate travel or lodging but will share travel tips and any discounts available to candidates.

Welcome to Hershey

More About Hershey

Interested in learning more about living and working in Hershey, Pa.? See details here:

• Benefit and stipend information
• Virtual tour
• GME policies
• Wellness resources
• More about Penn State Health and its locations
• Application and visa requirements

Wellness, including emotional, spiritual, social and physical health, is a crucial component to training and to becoming a professional, compassionate and resilient physician. Self-care is a skill which must be continually practiced and reinforced. Penn State College of Medicine and Penn State Health are committed to addressing wellness among residents and fellows, with multiple resources readily available.

Institutional resources

• Visit BeWell – a health program designed to support Penn State Health employees
• See Penn State College of Medicine wellness resources here
• Employee Health Care Concierge and Case Management Service
• Partners in Medicine
  Moving to a new city with your family does not have to be stressful. Residency programs have assisted many significant others with finding employment. There is also a GME-Wide Partners in Medicine (PIM) group that offers networking opportunities as well as various social and community oriented activities.
• The Doctors Kienle Center for Humanistic Medicine
• Active and easily accessed Office of Professional Mental Health

Graduate medical education resources

• See resident and fellow wellness resources here

Institutional Resources

Penn State Health and Penn State College of Medicine celebrate, embrace and support the diversity of all patients, faculty, staff, students and trainees.

Office for Diversity, Equity and Inclusion

In keeping with this, Penn State Health has an active Office for Diversity, Equity and Inclusion with various programs, networks and resource groups, including:

• Talks and lectures on diversity, equity and inclusion through the Inclusion Academy
• Regular events on topics such as eradicating racism and creating a culture of inclusiveness
• Many Business Employee Resource Groups (BERGs), including:
  • Disability Business Employee Resource Group
  • Interfaith Business Employee Resource Group
  • LGBTQ+ Business Employee Resource Group
  • Military and Veterans Business Employee Resource Group
  • Multicultural Business Employee Resource Group
  • NextGen Business Employee Resource Group
• Black Physician Professional Staff Association – Resource Group
• Hispanic Professional Association
• Asian Physician and Professional Staff Association
• International Workforce Inclusion
• Inclusion Academy

Learn more about the Penn State Health Office for Diversity, Equity and Inclusion

Learn more about the College of Medicine’s Office for Diversity, Equity and Belonging

Office for Culturally Responsive Health Care Education

The vision at Penn State College of Medicine and Penn State Health is to equip learners with the knowledge, skills and attitudes they will need to provide culturally excellent health care and research for an increasingly diverse U.S. population. The Office for Culturally Responsive Health Care Education was formed to help meet that goal.

Learn more about the Office for Culturally Responsive Health Care Education

Office for a Respectful Learning Environment

In addition, the institution does not tolerate discrimination, biases, microaggression, harassment or learner mistreatment of any kind, and any concerns are immediately addressed by the Office for a Respectful Learning Environment.

Learn more about the Office for a Respectful Learning Environment

Network of Under-represented Residents and Fellows
The Network of Under-represented Residents and Fellows (NURF) is a group of diverse residents and fellows representing all specialties. NURF’s goal is to promote cultural diversity in the residency programs through community involvement, mentorship with diverse faculty, professional networking and support for the recruitment of diverse medical students into the residency programs.

NURF is sponsored by the Penn State College of Medicine Graduate Medical Education Office and the Penn State Health Office for Diversity, Equity and Inclusion.

Learn more information about NURF

The Accreditation Council for Graduate Medical Education and the Neurosurgery Residency Review Committee have provided core curriculum and core competency standards that must be met at each stage of the neurosurgical residency.

Each resident is expected to meet these standards on the appropriate schedule; faculty evaluations will include an assessment of each resident’s progress toward these goals.

In response to this ACGME requirement for competency in these areas, all residents are expected to participate in core competency training as defined by the program.

All required clinical rotations occur on Penn State Health’s campus in Hershey, Pa. Penn State Health Milton S. Hershey Medical Center, Penn State Health Children’s Hospital, the East Campus Neuroscience Clinic and Hershey Outpatient Surgery Center are all on campus. Elective rotations can be done elsewhere in central Pennsylvania, with a typical four-month elective at Penn State Health Holy Spirit Medical Center, a nearby 300-bed community hospital, occurring in the PGY-3 year.

One resident per year has the opportunity to serve as a registrar at the Sir Charles Gairdner Hospital in Perth, Australia, if they desire. Other, shorter rotations abroad at a variety of locations can also be arranged.

The clinical component of the Neurosurgery Residency is organized around three distinct services within Penn State Health: two adult neurological services and a pediatric neurological service.

The Harbaugh Service aka Red Service has an emphasis on neurocritical care, neurosurgical trauma, cerebrovascular surgery, and endovascular neurosurgery.

The Page Service aka Blue Service has an emphasis on skull base surgery, neuro-oncology, complex spine surgery, peripheral nerve surgery, and stereotactic and functional neurosurgery.

The Johnson Service aka Pink Service has an emphasis on pediatric neurosurgery and electives.

Structured rotations on each of these services provide training in all areas of neurosurgical care.

The Neurosurgery Residency is flexible enough to accommodate each trainee’s individual educational needs and interests. Residents are advanced to higher levels of responsibility based on performance evaluations. Elective rotations are scheduled throughout the program, and the use of elective time is determined based on the resident’s interests and experience. Elective time may be spent studying a subspecialty of neurosurgery or performing research.

History Behind the Service Line Names

Red Service: Harbaugh Service was named in honor of Dr. Robert E. Harbaugh, the first Chair of the Department of Neurosurgery at Penn State College of Medicine.

Dr. Harbaugh graduated from Penn State College of Medicine in 1978. He then went on to complete his neurosurgery residency at Dartmouth-Hitchcock Medical Center. After spending much of his career leading the cerebrovascular disease program at Dartmouth, he was appointed the inaugural chair of the Penn State Department of Neurosurgery in 2003. Dr. Harbaugh is internationally known for his work on cerebrovascular disease, in particular awake carotid endarterectomy. He was one of the early pioneers of neurosurgical involvement in neuro-critical care and was a founding member of the Neurocritical Care Society. Dr. Harbaugh has held numerous leadership roles in organized neurosurgery, including serving as Chair of the Joint Cerebrovascular Section of the American Association of Neurological Surgeons (AANS) and Congress of Neurological Surgeons (CNS), President of the AANS, President of the Society of Neurological Surgeons, and Chair of the Neurosurgery Residency Review Committee (RRC) of the Accreditation Council for Graduate Medical Education (ACGME). In 2018 Dr. Harbaugh was appointed Senior Vice President for Academic Practices at Penn State Health. In 2021, he stepped aside as neurosurgery department chair to concentrate on his growing health system role, a role he continues to focus on today.

Blue Service: Page Service was named for Dr. Robert B. Page, one of the original faculty members of the Division of Neurosurgery and the last chief of the division before neurosurgery became its own department.

Dr. Page received his MD from Columbia University’s College of Physicians and Surgeons in 1963. He began his surgical internship in 1963 with the First (Columbia) Surgical Division at Bellevue Hospital in New York City and completed his first year of surgical residency there in 1965. After two years of service in the United States Navy, Dr. Page trained in neurosurgery at Yale New Haven Hospital from 1967 to 1972. In 1972, he joined the surgical faculty in the Division of Neurosurgery at the then new medical school of the Pennsylvania State University at the Milton S. Hershey Medical Center as an Assistant Professor. Dr. Page’s NIH funded research focused on the anatomy of the pituitary gland’s microvasculature and the regulation of blood flow within the gland. Dr. Page was elected a Faculty Scholar at the Pennsylvania State University in 1985. He was a delegate to the Council of State Neurosurgical Societies and a member of the Board of Directors of the American Association of Neurological Surgeons and the Pennsylvania Trauma Systems Foundation. He was President of the Pennsylvania Neurosurgical Society from 1990-1991. Dr. Page retired in 2004 and after spending a few years in rural Maine, he now lives in Camp Hill, Pennsylvania.

Pink Service: Johnson Service was named after Dr. Dennis L. Johnson, the first pediatric neurosurgeon at Penn State Health Milton S. Hershey Medical Center.

Dr. Johnson went to medical school at the University of California – Irvine and did his neurosurgical residency at the University of Virginia and Brigham & Women’s Hospital in Boston. He completed a fellowship in Pediatric Neurosurgery at Boston Children’s Hospital. Dr. Johnson joined the faculty at Penn State College of Medicine at Hershey Medical Center in 1992 as the institution’s first pediatric neurosurgeon. Known for his often colorful descriptions of the children he took care of Dr. Johnson was a highly regarded expert on pediatric traumatic and non-traumatic brain injury. Soon after receiving a heart transplant for viral cardiomyopathy in 1997, Dr. Johnson gradually transitioned away from the practice of pediatric neurosurgery. In 2000, he transferred to the Department of Medicine where he founded the Palliative Care Program. He dedicated the remainder of his career to advancing the, at the time, relatively new field of palliative care medicine. Dr. Johnson left Penn State for his former alma mater, the University of Virginia in 2011. He passed away in 2015.

You may expect the following at each training level, as described by residents.

PGY-1

PGY-1 year is divided into two-month blocks of work on either the neurocritical care unit or neurosurgery service. While in the neurocritical care unit, you learn the fundamentals of critical care and develop your procedural skills. Work on the neurosurgical service is split between the clinic or the operating room and managing the neurosurgery service as the first point of contact for neurosurgical patient needs. Throughout the year you rotate through each of the three neurosurgical subspecialty teams at Penn State.

• Three months neurocritical care
• Three months neurocritical care basic science
• Six months general patient care in neurosurgery

PGY-2

In PGY-2 you will spend four months on each of the three services: red (trauma, vascular), blue (spine, functional, tumor, peripheral nerve), and pink (pediatrics). You will do cases for your service most days, either single-scrubbed or double-scrubbed with a chief. You spend about one day a week in the clinic with your service. On Blue, you will also get lots of experience with framing and planning for stereotactic procedures, including stereotactic radiosurgery and deep brain stimulation. On the red service, you will be the ICU senior, rounding with the Neuro ICU in the morning and teaching the ICU intern, then going to the OR after rounds. You start to take house call for neurosurgery, which is shared between PGY2-4. You round on the patients on your service and help take care of the patients throughout the day. The PGY 2’s also have a significant role in training the interns.

• Four months red service
• Four months blue service
• Two months pink service
• Two months off-service time (neuroradiology, neuropathology, clinical or research elective)

PGY-3

As a third-year resident, you take on a more senior role in managing your service and teaching interns and second-year residents. You are on in-house call for approximately six days per month, including one weekend. During this year, you spend four months on the vascular and neuro-trauma service. You complete an endovascular rotation with our four vascular/endovascular neurosurgeons. As the endovascular resident you will learn how to diagnose and treat a broad variety of neurovascular diseases, as well as complete between 100-150 diagnostic and therapeutic neuroendovascular cases. Another four months can be split between two months of pediatrics and two months on the spine, functional, and neuro-oncology service. Additionally, you have an opportunity to spend four months at Penn State Health Holy Spirit Hospital in Harrisburg, PA, a community hospital where you are the sole (neurosurgery) resident, supported by three advanced practice providers. This rotation offers excellent operative experience and teaches you how to manage a neurosurgical service outside of an academic center. During this rotation you would take two days of home call per week and one weekend of home call every 4-6 weeks.

• Four months red service
• Four months blue service
• Two months pink service
• Two months off-service time (neuroradiology, neuropathology, clinical or research elective)

PGY-4

As a PGY-4, you have block times on the red, blue, and pediatric services. There is an additional 2-month period of elective time, which can be used to pursue other professional interests, such as using the time towards a Neurocritical Care fellowship. Two months are yours to spend how you would like – most residents do research of some kind, but the time can also be used for clinical electives or the ICU fellowship. Two months are spent on peds, then four each on the red and blue services. In-house call is 1-2 times per month, and backup call (for acute ischemic stroke intervention) is about one week per month. PGY-4 residents still round in the morning, although typically just on stable floor patients and then operate during the day.

• Four months red service
• Four months blue service
• Two months pink service
• Two months off-service time (neuroradiology, neuropathology, clinical or research elective)

PGY-5

PGY-5 residents spend 6 months on the trauma vascular, and neurocritical care neurosurgery services and the other 6 months on the spine, functional, tumor, and peripheral nerve neurosurgery services. As a PGY-5 resident, you will have elective time to further your career interests. Fifth-year residents are senior residents and share senior resident call with the chief residents, which is typically taken from home a week at a time.

One PGY-5 resident will have the opportunity to travel to Perth, Australia for a one-year rotation as a Registrar of the Neurosurgery Service at the Sir Charles Gardiner Hospital. This is a great opportunity to gain maturity in clinical judgment and operative skills, as well as manage many unique cases.

• Six months senior resident on red service elective
• Six months senior resident on blue/pediatric service electives

PGY-6

The sixth year of residency at Penn State is typically the chief resident year and is one of our most challenging but also most rewarding years. Being a chief here means spending 4 months on each of our services. During that time, the chief resident will take full responsibility for the clinical service, run work rounds, dictate operative plans and decisions, and discuss plans with attendings. They perform the most complex and advanced cases in each of our services on a daily basis. At this point, they are near graduation and thus have increased their independence with clinical decision-making and operative autonomy. They also spend time training junior residents and managing multi-disciplinary teams. On top of neurosurgical responsibilities, they also have administrative responsibilities. Since there are 3 chief residents, they chose to split the administrative role by each of them taking on the responsibilities of the administrative chief every 3rd week. The duties of the “admin chief” include making the daily schedule, including coverage plans, and running conferences.

• All 12 months as chief resident
• Four months senior resident on red service
• Four months senior resident on blue service
• Four months senior resident on pediatric service

PGY-7

PGY7 is a post-chief year that may be used to advance an individual’s professional interests, whether that may be clinical training with enfolded fellowship time or research. Many residents will take this time to participate in one of our many CAST-accredited fellowships. A fellowship is a great time to be exposed to different ways of doing things. Residents can focus on a particular skill set without the responsibilities that the senior residents or clinical faculty have.

• Independent study: This year can be used for a focused clinical training/enfolded fellowship or for basic, translational, or clinical research.

Rotation service lines

Harbaugh (Red Service) Rotations cover the neurocritical care unit, trauma and vascular service lines.

Page (Blue Service) Rotations covers the spine, functional and stereotactic, epilepsy, peripheral nerve, and neurosurgical oncology, and skull base service lines.

Johnson (Pink Service) Rotations cover the pediatrics service as well as neuroradiology, neuropathology and “other specialty” electives.

Penn State Health Milton S. Hershey Medical Center Elective provides a mix of neurosurgery outpatient services, as well as complex spine and skull base surgeries at our affiliate hospital.

Learn more about neurosurgery training requirements.

The Neurosurgery Residency offers fellowships in the following subspecialties. These fellowships are currently offered as enfolded experiences to trainees in the Neurosurgery Residency.

• Endovascular Neurosurgery Fellowship (CAST Accredited): Scott Simon, MD, FAANS, Fellowship Director
• Neurocritical Care Fellowship (CAST Accredited): J. Christopher Zacko, MD, Fellowship Director
• Neurosurgical-Oncology and Skull Base Surgery Fellowship: Brad Zacharia, MD, MS, Fellowship Director
• Peripheral Nerve Neurosurgery Fellowship (CAST Accredited): J Christopher Zacko, MD, Fellowship Director
• Spinal Neurosurgery Fellowship (CAST Accredited): G. Timothy Reiter, MD, Fellowship Director
• Stereotactic and Functional Neurosurgery Fellowship (CAST Accredited): James McInerney, MD, FAANS, FACS, Fellowship Director

The department also offers unaccredited focused specialty training in the following areas:

• Cerebrovascular Microsurgery
• Peripheral Nerve Surgery

In addition to exceptional clinical training, neurosurgery residents have access to a robust neuroscience research program in neurosurgery. Eight full-time research faculty members have ongoing programs in a wide range of areas, including neural engineering, a joint program between Penn State Neurosurgery and the Department of Engineering Science and Mechanics, at Penn State University’s main campus. Penn State Neurosurgery has more than $8,000,000 in active grants and ranks among the highest neurosurgery departments in NIH funding nationwide.

The department also supports a vigorous clinical research program with a well-developed clinical trials group. More than 40 investigator-initiated or industry-sponsored clinical studies are underway.

Residents are required to participate in a research activity during their residency, and time has been set aside during the rotations for this pursuit. An independent study year can be used for research in an area of the resident’s choice, and additional research time is available throughout the training.

The department has a wealth of opportunities in basic, translational and clinical research in all areas of neurosurgery. In addition, there are strong collaborations with researchers in other Penn State departments both in the College of Medicine and the broader University.

Residents are expected to use their research time wisely to work with a faculty mentor within the department, within the institution, or outside of the institution with prior approval. Residents should plan their research time during the year preceding their actual research year to make optimum use of their time.

Residents should discuss their plans with the program director and the appropriate faculty members in advance and obtain approval for their research projects. The resident is responsible for contacting an appropriate faculty mentor and setting up a research program consistent with their area of interest and experience. Each resident is expected to create a manuscript for publication on basic, translational, or clinical research each year from PGY-2 to PGY-7.

Those residents who choose to do an enfolded fellowship during their independent study year are expected to make research a meaningful part of the fellowship experience.

The Department of Neurosurgery works closely with the following labs:

• Arnone Laboratory
• Connor Laboratory
• Jin Laboratory
• Li Laboratory
• Mansouri Laboratory
• Proctor Laboratory
• Yang Laboratory

Penn State Neurosurgery takes the resident education mission very seriously. Each Friday is devoted to resident teaching conferences from 7 a.m. to 4 p.m.

Additional conferences occur on Thursday mornings before operations begin.

The conference schedule is meant to expose residents to all disciplines of basic and clinical neuroscience. Participation in multidisciplinary conferences with other specialties within the institution contributes to a sound educational experience for the residents.

Extensive training in biostatistics and clinical trial design is included as a routine part of every resident’s education.

Penn State College of Medicine and Penn State Health Milton S. Hershey Medical Center accept ongoing nominations for the Exceptional Moments in Teaching award.

The award, given monthly by the Office for a Respectful Learning Environment, accepts nominations from College of Medicine students who are invited to submit narratives about faculty members, residents, fellows, nurses or any other educators who challenge them and provide an exceptional learning experience. See more about the award here.

Previous nominees from the Neurosurgery Residency are listed here. Click the + next to a nominee name to read their nominator’s comments.

The annual Resident/Fellow Research Day is held each year (with exception of during the COVID-19 pandemic) on and around the Penn State Health Milton S. Hershey Medical Center campus.

The intent of the event is to provide an opportunity for residents and fellows to showcase their research accomplishments to their peers in other clinical departments, as well as their colleagues in the basic sciences.

Learn more about Resident/Fellow Research Day here.

Previous presentations from the Neurosurgery Residency are listed here.