Neurology PGYII

Description of Rotation or Educational Experience

The two-week rotation of Neurology during the second year of training will prepare the resident for recognition, assimilation and mastering those aspects of neurological diseases that are necessary for daily patient care.  At the conclusion of this training, the resident should have the knowledge and skills to manage neurological problems that are commonly seen in Family Medicine and also recognize the need for proper referral and consultation by a specialist for those problems that are beyond the scope of practice of a family physician.  The needed skills will be obtained through several resources, including the attending neurologist’s outpatient private patients, the resident’s panel of patients at the FMC, Internal Medicine and Family Medicine Service rotations, didactic lectures and conferences.

Goal I: To provide outpatient learning opportunities in the area of neurology through a two-week block rotation in the second year of training and continuous longitudinal experience throughout the Residency.

Goal II: To provide learning opportunities in neurology that demonstrate the importance of the Behavioral Sciences and disease prevention in the comprehensive and continuing care of the patients and their families.

Goal III: To recognize the need for proper referral and consultation to a specialist for those neurological diseases that are beyond his/her capabilities.

Patient Care

Goal

Residents must be able to provide patient care that is compassionate, appropriate, and effective for the treatment of health problems and the promotion of health.  Residents are expected to:

Competencies

Be able to diagnose

• Dementia/Delirium
• Seizure Disorders
• Herniated Disc
• Zoster
• Headache
• CVA/TIA
• Pseudo Seizure
• Convulsive Disorder
• Myopathy
• Peripheral Neuropathy

Objectives

The resident will:

• Perform a neurological exam of the adult patient.
• Retrieve imaging studies and review with radiologist and neurologist.
• Perform lumbar puncture with assistance from neurology, family medicine faculty, and radiology.
• Appropriately utilize diagnostic testing including: CT scan, MRI, EEG, and EMG.

Medical Knowledge

Goal

Residents must demonstrate knowledge of established and evolving biomedical, clinical, epidemiological, and social-behavioral sciences, as well as the application of this knowledge to patient care.  Residents are expected to:

Competencies

CATEGORY A                                                               CATEGORY B                                                      

1.         Acute Trauma to CNS                                        1.         Herpes Zoster

2.         Meningitis                                                         2.         Bell's Palsy

3.         Alterations in Consciousness                              3.         Migraine

4.         Dementia/Pseudodementia/                                4.         Vertigo

  Confusion                                                        5.         Pain Syndrome

5.         Epilepsy/Seizure Disorders                                                (Low back/Chronic)

6.         Dementia                                                          6.         Headaches

7.         Guillain-Barre Syndrome                                     7.         Cerebral Vascular Accident

8.         Parkinson's Disease                                           8.         Transient Ischemic Attack

9.         Multiple Sclerosis                                              9.         Drug Intoxication

10.        Myasthenia gravis/polymyositis                          

11.        Neurosyphilis

12.        Tourette's Syndrome

13.        Meniere's Syndrome

14.        Narcolepsy

15.        Herniated Intervertebral Disc

16.        Subdural/Epidural Hematoma                                         

17.        Neurogenic Hysteria                                          

18.        Brain Death/Vegetative States                            

19.        Testing Procedures/Evaluation                           

- Electroencephalogram                                                   

- Electromyography                                                       

- CT/MRI                                                          

- Audiometry                                                     

- Angiography

- Vestibular Function Tests

- Tensilon/Prostigmin Test

Objectives

• The resident will have a basic knowledge of the above by the end of this rotation. 

Practice- Based Learning and Improvement

Goal

Residents must demonstrate the ability to investigate and evaluate their care of patients, to appraise and assimilate scientific evidence, and to continuously improve patient care based on constant self-evaluation and life long learning.  Residents are expected to develop skills and habits to be able to :

Competencies

• Identify strengths, deficiencies and limits in one’s knowledge and expertise;
• Use information technology to optimize learning such as: UpToDate and DynaMed that provides concise family medicine knowledge and care to be utilized.
• Complex neurological problems and trauma require an understanding of the limitations of family physicians.
• To recognize the need for proper referral and consultation to a specialist for those neurological diseases that are beyond his/her capabilities.

Systems Based Practice

Goal

Residents must demonstrate an awareness of and responsiveness to the larger context and system of health care, as well as the ability to call effectively on other resources in the system to provide optimal health care.  Residents are expected to:

Competencies

• Work in interdisciplinary teams to enhance patient care, working with neurologists, social workers, physical therapists, occupational therapists, nurses, respiratory therapists and family medicine attendings.

Objectives

• The resident will become knowledgeable with the process and develop abilities to coordinate this type of teamwork.

Professionalism

Goal

Residents must demonstrate a commitment to carrying out professional responsibilities and an adherence to ethical principles.  Residents are expected to demonstrate:

Competencies

• Compassion, integrity, and respect for others. 
• Chronic neurological problems (CVA, dementia, spinal chord trauma) require compassion and respect.

Objectives

• The resident will be evaluated on his/her compassion by faculty and preceptors.

Interpersonal and Communication Skills

Goal

Residents must demonstrate interpersonal and communication skills that result in the effective exchange of information and teaming with patients, their families, and professional associates.  Residents are expected to:

Competencies

• Communicate effectively with patients and families across a broad range of socioeconomic and cultural backgrounds
• Communicate effectively with physicians, other health professionals, and health related agencies
• The above mentioned team will be an excellent training for the resident as he/she must communicate with other physicians (neurologists) and health related agencies (rehab hospitals, social security disability, etc.).

Objectives

• Inpatient care, timely transfers, and appropriate consultation will be monitored at report and on rounds by residency faculty.

Teaching Methods

Direct preceptor/resident interaction in the outpatient setting.

Assessment Method

At the conclusion of each resident rotation, the residency coordinator sends a formative-type, rotation-specific performance evaluation form to the rotations’ supervising physician.  When the completed evaluation is returned, the resident physician and the resident’s faculty advisor review the evaluation and attest to reviewing it by signing/initialing the form.  Next, the program director reviews and attests to the document.  Once all three have reviewed and attested the evaluation, it is included in the resident’s permanent file. 

Each resident is asked to evaluate the rotation and supervising physician(s) at the end of the rotation.  The resident’s faculty advisor and program director review the evaluation and attest to reviewing it by signing/initialing the form. These evaluations are filed together by resident year.

Educational Resources

Resources distributed to resident at start of the rotation:

“Neurology” (Hose Officer Series), 7^th Edition, Weiner, Levitt, Rae-Grant.

“The Little Black Book of Neurology”, 5^th Edition, Zaidat and Lerner.

Minimally accepted reading and knowledge for which the resident will be accountable during interaction with neurology attendings.

References available at the AHEC Library:

Adams and Victor, Textbook of Neurology.

Online Resources:

UpToDate and DynaMed