Neurology Residency Handbook 2013-2014

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Content: Neurology Residency Handbook 2017-2018 Richard M. Dubinsky, MD, MPH Program Director Mamatha Pasnoor, MD, Associate Program Directors Tara Logan, Senior Coordinator Richard J. Barohn, MD, Chair version date 6/30/2016 1
FOREWORD........................................................................................................................................................................................ 5 PART 1 MISSION STATEMENT, DEPARTMENT GOALS AND OBJECTIVES ...................................................................... 6 PART 1 EXPECTATIONS OF LEARNERS ..................................................................................................................................... 7 STRONGLY SUGGESTED TEXTBOOKS:.....................................................................................................................................10 PART 2 ACGME MILESTONES AND NEUROLOGY CORE COMPETENCIES......................................................................11 PART 3 WORK ENVIRONMENT .................................................................................................................................................. 14 PART 4 ­ DIDACTICS ..................................................................................................................................................................... 15 NEUROLOGY CONFERENCE SCHEDULE ............................................................................................................................................... 15 PODCASTS ..................................................................................................................................................................................................................... 15 REMOTE VIEWING OF LECTURES: ...................................................................................................................................................... 16 CORE COMPETENCY LECTURES .......................................................................................................................................................... 16 CONFERENCES: .................................................................................................................................................................................... 16 PART 5 TRAINING OVERVIEW ................................................................................................................................................... 18 PGY 1 .................................................................................................................................................................................................. 18 PGY1 learning objectives................................................................................................................................................................................... 18 PGY 2 .................................................................................................................................................................................................. 18 PGY2 LEARNING OBJECTIVES:.......................................................................................................................................................................... 19 DESCRIPTION PGY3: ....................................................................................................................................................................... 19 PGY3 LEARNING OBJECTIVES:.......................................................................................................................................................................... 19 DESCRIPTION PGY4: ....................................................................................................................................................................... 20 PGY4 LEARNING OBJECTIVES:.......................................................................................................................................................................... 20 PEDIATRIC NEUROLOGY FELLOW ...................................................................................................................................................... 20 SCOPE OF PRACTICE:...........................................................................................................................................................................21 PART 6 HOW WE DO THINGS ..................................................................................................................................................... 22 CASE PRESENTATION .......................................................................................................................................................................... 22 INPATIENT ROTATIONS ...................................................................................................................................................................... 22 COMBINED CLINIC AND CONSULT SERVICES ...................................................................................................................................... 23 NIGHT FLOAT / CLINIC ROTATION .................................................................................................................................................... 23 TMC NEUROLOGY ............................................................................................................................................................................... 23 LONGITUDINAL CLINICS ...................................................................................................................................................................... 23 OTHER MANDATORY ROTATIONS ..................................................................................................................................................... 23 NEUROPATHOLOGY / NEURORADIOLOGY ............................................................................................................................................................... 23 NICU.............................................................................................................................................................................................................................. 23 PEDIATRIC NEUROLOGY ............................................................................................................................................................................................. 24 SUPERVISING RESIDENT KUH WARDS..................................................................................................................................................................... 24 PSYCHIATRY.................................................................................................................................................................................................................. 24 ELECTIVE GUIDELINES ........................................................................................................................................................................ 24 CLINICAL ELECTIVES: ................................................................................................................................................................................................. 24 EEG ................................................................................................................................................................................................................................ 24 EMG............................................................................................................................................................................................................................... 24 RESEARCH ELECTIVE .................................................................................................................................................................................................. 25 DESIGN YOUR OWN ELECTIVE.................................................................................................................................................................................... 25 AWAY ELECTIVES ................................................................................................................................................................................ 25 HAND-OFFS ......................................................................................................................................................................................... 25 NIGHT FLOAT AND THE SPECIAL ....................................................................................................................................................... 26 2
TRANSITIONS IN CARE ........................................................................................................................................................................ 26 NOTES .................................................................................................................................................................................................. 26 PART 7 EVALUATIONS ................................................................................................................................................................. 27 THE NEXT ACCREDITATION SYSTEM (NAS) AND GRADES .............................................................................................................. 27 PROGRAM EVALUATION ..................................................................................................................................................................... 27 PROGRAM EDUCATION COMMITTEE:....................................................................................................................................................................... 27 RESIDENT EVALUATION TOOLS ......................................................................................................................................................... 28 RESIDENCY IN-SERVICE TRAINING EXAMINATION ............................................................................................................................ 28 ABPN CLINICAL SKILLS EVALUATION OF RESIDENTS ...................................................................................................................... 28 ASSESSMENT BY MEDICAL STUDENTS ............................................................................................................................................... 29 CHART REVIEW ................................................................................................................................................................................... 29 RESIDENT CASE LOG ........................................................................................................................................................................... 29 360° EVALUATION ............................................................................................................................................................................. 29 RESIDENT PORTFOLIO ........................................................................................................................................................................ 29 CLINICAL COMPETENCY COMMITTEE.................................................................................................................................................29 RESIDENCY STEERING COMMITTEE ................................................................................................................................................... 29 BIANNUAL EVALUATION ..................................................................................................................................................................... 30 CRITERIA FOR ADVANCEMENT: .......................................................................................................................................................... 30 USMLE 3 OR COMLEX 3 ......................................................................................................................................................................................... 30 ABPN CERTIFICATION ....................................................................................................................................................................... 30 PART 8 ­ RESEARCH INITIATIVES ............................................................................................................................................ 31 RESIDENT RESEARCH EXPERIENCE .................................................................................................................................................... 31 RESIDENT AND FELLOW RESEARCH SYMPOSIUM..............................................................................................................................31 PART 9 ­ POLICIES.........................................................................................................................................................................32 POLICY ON SELECTION OF RESIDENTS ............................................................................................................................................... 32 LEVEL OF APPOINTMENT GUIDELINE ...................................................................................................................................................................... 32 COMMUNICATION COMPETENCY REQUIREMENT ................................................................................................................................................... 32 INTERNATIONAL MEDICAL GRADUATES ................................................................................................................................................................. 32 POLICY ON RESIDENT SUPERVISION .................................................................................................................................................. 33 POLICY ON PROGRESSIVE RESPONSIBILITY FOR PATIENT MANAGEMENT ...................................................................................... 35 POLICY ON RESIDENT WORK HOURS.................................................................................................................................................35 POLICY ON FATIGUE............................................................................................................................................................................35 VACATION POLICY...............................................................................................................................................................................35 ACADEMIC LEAVE ................................................................................................................................................................................ 35 FMLA .................................................................................................................................................................................................. 36 DISABILITY .......................................................................................................................................................................................... 36 POLICY ON EVALUATION AND PROMOTION OF RESIDENTS .............................................................................................................. 36 POLICY ON EVALUATION OF FACULTY AND OF THE RESIDENCY PROGRAM.....................................................................................36 POLICY ON SUPPORT FOR RESIDENT TRAVEL TO SCIENTIFIC MEETINGS........................................................................................36 MOONLIGHTING POLICIES .................................................................................................................................................................. 37 Computer Security ......................................................................................................................................................................... 37 social media POLICY........................................................................................................................................................................37 OMBUDSMAN ....................................................................................................................................................................................... 37 PART 10 BIBLIOGRAPHY FOR ADULT NEUROLOGY RESIDENTS ................................................................................... 38 REVISION HISTORY ....................................................................................................................................................................... 42 DEPARTMENT OF NEUROLOGY CLINICAL FACULTY .......................................................................................................... 43 3
DEPARTMENT OF NEUROLOGY RESIDENT ROTATION SCHEDULES..................................................................................................45 IMPORTANT DATES FOR 2016-2017 .............................................................................................................................................. 47 APPENDICES: ................................................................................................................................................................................... 48 NEUROLOGY MILESTONES ......................................................................................................................................................................................... 48 NEX FORMS .................................................................................................................................................................................................................. 48 CHART DOCUMENTATION .......................................................................................................................................................................................... 48 ELEMENTS AND STYLE OF NOTES, CONSULTS, DISCHARGE SUMMARIES AND CORRESPONDENCE ................................................. 74 ELEMENTS AND STYLE OF A GOOD HISTORY AND PHYSICAL............................................................................................................................... 74 PROGRESS NOTES: .............................................................................................................................................................................. 75 ELEMENTS AND STYLE OF A GOOD DISCHARGE SUMMARY ................................................................................................................................. 76 ELEMENTS AND STYLE OF A GOOD DAILY PROGRESS NOTE ................................................................................................................................ 78 ELEMENTS AND STYLE OF A GOOD CLINIC NOTE .................................................................................................................................................. 79 ELEMENTS AND STYLE OF GOOD CORRESPONDENCE ............................................................................................................................................ 81 4
Foreword This handbook encompasses the basic information for our neurology residency program and is updated annually. The handbook is in two parts, the first is Policies and Procedures (How We Do Things) and the second is rotation specific information and other items. The Goals & Objectives are presented as a separate appendix document while basic information on the rotations is in this handbook in a friendlier format. This handbook is in harmony with the GME Policy and Procedure Manual (gme.kumc.edu/school-ofmedicine/gme/policies-and-procedures.html). Where there is a discrepancy, this stricter policy takes precedence. For example, while moonlighting is possible within certain GME imposed restrictions it is not allowed for neurology residents. Richard M. Dubinsky, MD, MPH Professor and Program Director Department of Neurology 5
Part 1 Mission Statement, Department Goals And Objectives Mission Statement The mission of the Department of Neurology is to provide the best possible clinical care for patients and the best possible education for medical students, residents, and fellows while engaged in world-class research in the neurosciences. These goals are accomplished through the high caliber faculty, house officers, and support staff employed by the department and with the support of the University of Kansas Medical Center, the Kansas City Veterans Affairs Medical Center, the Leavenworth Veterans Affairs Medical Center, and Children's Mercy Hospital. Departmental Goals and Objectives · To provide general and subspecialty neurology clinical services to patients from the greater Kansas City metropolitan area and the surrounding region. · To provide the training needed for our house officers to excel in clinical care and in research. · To provide instruction in the basic and clinical neurosciences to medical students, allied health students, and to house officers in other disciplines. · To promote and support basic science and clinical research in the neurosciences. · To achieve national recognition of our clinical and research endeavors. Educational Mission Statement The educational mission of the Department of Neurology is to provide an optimal educational environment to prepare the neurology resident for the independent practice of clinical neurology. An experienced faculty with board certification by the American Board of Psychiatry and Neurology, with subspecialty expertise in all major disciplines of neurology, assures, through close supervision, that neurology residents receive extensive exposure to the basic neurosciences and clinical skills. The program director and neurology faculty ensure that patient care responsibilities are balanced with teaching to enhance the educational experience of the neurology resident. Our residents are trained to communicate effectively with their patients and families in a caring and respectful manner. Residents are trained to apply knowledge of study designs and statistical methods to the appraisal of clinical studies, assessing diagnostic and therapeutic effectiveness. They learn how to practice cost-effective health care and allocate resources without compromising care quality. Educational Goals The educational goals of the Neurology residency program are to: · Train clinicians for independent practice of Neurology, · Provide the educational background for life long learning in Neurology, · Encourage participation in clinical research during training, and through out the careers of our graduates, and · Train our residents to provide compassionate care for their patients, and the families of their patients. Educational Objectives: The Neurology resident will: · Through supervised clinical work, become proficient in the care of the neurological patient · Assume increasing responsibility for the evaluation and management of neurology patients in the hospital and in the clinic · Through lectures, and independent study, develop a foundation of knowledge in the basic neurosciences 6
Part 1 Expectations of Learners These are both the explicit and implicit (hidden curriculum) for Neurology residency. The competencies for each expectation are in the parentheses: 1. Show up on time. (Prof.) a. To not is unprofessional and expresses your disdain and disregard for others. This is for all lectures, conferences, team huddle and rounds. 2. Be prepared (Patient Care, Prof.) a. Do the background reading b. Review patient charts before clinic c. See patients before rounds, pre-rounding electronically is not enough. d. Know what is going on by the morning Huddle 3. Arrive ready and willing to learn (Medical Knowledge) a. Learning is an active process b. Your study time away from the hospital is when you learn the facts c. Rounds and lectures are places to learn concepts and how to put things together d. You are expected to spend at least one hour a day on your own on didactics. e. Minimum score on RITE is 40th percentile for rank. 4. Be engaged (Prof.) a. Your activities are directed to the task at hand b. Accessing information before a presentation or even during is good c. Using a digital device to do something else is not d. Make eye contact with the teacher, ask and answer questions, participate 5. Don't pretend to know what you don't (Prof. Interpersonal Communication Skills) a. For factual data (e.g. a laboratory result) admit it if you don't know the answer. i. Make sure you know the answer the next time, and every time after that b. Guessing is encouraged, just be honest. If you don't know the mechanism of a disease or a treatment, speculate. "Luck favors the prepared" Edna Mode (The Incredibles 2004) "Fortune favors the prepared mind." Louis Pasteur 6. Completion of notes (Pt. Care, Prof, ICS, Systems Based Practice) a. Inpatient notes are to be completed by end of that business day. b. Clinic notes are completed within three days (KUPI rule) c. Consult notes are started before the patient is seen by the attending physician and completed by the end of the business day that the patients is seen by staff. d. ED consultations are completed before you leave the ED. A brief note within 30 minutes of staffing the patient, a complete note within five hours. e. Notes from stroke activation calls are completed by the end of the activation. f. Do not copy and paste your notes or plagiarize the notes of others. You may copy appropriate history forward. Any examination that you document must be the examination that you did that day. 7. Administrative tasks (Prof.) a. Duty hours are always up to date b. Evaluations are completed within two days of assignment. c. Vacation and elective requests are completed at least 60 days in advance d. Administrative tasks are completed promptly i. Pages are answered 7
What is an honors level resident? 1. All of the above plus: 2. Be prepared (Patient Care, Med, Know., Prof.) a. Seeks out additional background reading. For example, in Journal club they read not only the article, but seek out the background articles on the outcome assessment tool (e.g. UPDRS) 3. Proof of learning (Medical Knowledge) a. RITE score above 80th percentile for rank. 4. Be engaged (Prof. ICS, SBP) a. Actively involved in participation in rounds b. Teaches other learners (residents and students) in an exemplary fashion. c. Knows when to be quiet. 5. Notes (Pt. Care, Prof, ICS, Systems Based Practice) a. Notes are complete are not only concise, accurate and prepared ahead of time, b. Notes contain concise, pertinent, differential diagnosis showing their thought processes and a discussion of therapeutic options c. Discharge summaries are concise and have clear instructions for what needs to done (test results, scheduled therapies, follow-up appointments) 6. Administrative tasks (Prof.) a. Never needs reminders to perform administrative tasks. b. Keeps tracks of, and renews licenses and DEA permit. 8
The Next Accreditation System (NAS) and Grades The 29 milestones in Neurology, are mapped onto the six competencies. The levels of the milestones are based on Dreyfus model of learning. (Dreyfus 1980) These stages are analogous to Levels 1-5 in the milestones, but are not equivalent to post graduate year (or level) of training (PGY). Each level requires mastery of the one below. A novice learner knows the rules, applies them without explicit responsibility and has to do everything by rote. They require constant supervision A proficient learner knows, the rules, accepts limited responsibility yet needs close supervision or oversight. They can filter out unnecessary elements in their presentations, but still need to do most everything in their evaluations A competent learner is able to filter out the unnecessary elements quickly in their clinical encounters and presentations. They not only grasp the nuances of common presentations of common disease, but also the common presentation of uncommon disease. They prioritize their evaluation based on the likelihood of the disorders in their differential and re-evaluate frequently An expert learner quickly grasps the nuances of the situation. They develop a hypothesis, test it on the fly with questions, examination and tests and constantly re-evaluate and adjust accordingly. A master learner likes surprises. They seek out the exceptions to the rules and thus expand our overall knowledge of a subject. They challenge assumptions and in doing so advance the field. They are actively engaged in research in their discipline. For example, if a resident can correctly identify a patient as having progressive supranuclear palsy (level 3 or 4), yet state that deep brain stimulation is the preferred treatment for a patient with the recent onset of Parkinson's disease (failed level 3), they are performing at level 2, as long as they can tell the difference between hyper and hypokinetic disorders (level 2). 9
Strongly Suggested Textbooks: PGY2 · Neuroanatomy Through Clinical Cases, 2nd Edition,2011 (Hal Blumenfeld) $65.10 · Adams and Victor's Principles of Neurology 10th Edition Hardcover ­ 2014 Allan Ropper, Martin Samuels, Joshua Klein $160.40 · Manter and Gatz's Essentials of Clinical Neuroanatomy and Neurophysiology, 10th Edition (Gilman and Newmann), 2002 $40.40 · Introduction to Neuropsychopharmacology. Iversen, Iverson Bloom and Roth, 2008 $42.09 Total: $307.99 ­plus tax, shipping and handling. Prices from Amazon.com subject to change. PGY3 and PGY4 · Escourolle & Poirier's Manual of Basic Neuropathology, 5th Edition, 2013 (Francoise Gray, Charles Duyckaerts, and Umberto De Girolami editors) $93.58 · Principles of Neural Science, Eric Kandel, 5th Edition, $98.87 · Osborn's Brain: Imaging, Pathology, and Anatomy, Anne Osborn, 2012, $331.55 Worth buying if you can find it: · Core Text of Neuroanatomy, Malcom Carpenter, 1991 $57.04 Your annual book budget is adequate to purchase all of these in PGY2 10
Part 2 ACGME Milestones and Neurology Core Competencies Over 10 years ago the American Council on Graduate Medical Education (ACGME) announced the six core competencies as part of an overhaul of post-graduate training for residents. In 2012 the next step, aptly termed the Next Accreditation System (NAS) went into effect for many disciplines. The competencies were the lofty goals to be achieved through training; the NAS incorporates milestones that must be achieved during the residency program. The milestones, while specialty specific are based on the Dreyfus Model of Skill Acquisition (Dreyfus SA, Dreyfus HI. A Five Stage Model of the Mental Activities involved in Direct Skill Acquisition. UC, Berkeley). The Novice is taught a set of rules before they acquire experience. This is the medical student and intern. Competent: the learner applies the rules to the situation. This is the beginning neurology resident. Proficient: this learner can handle more than one situation at a time, and is able to appropriately and independently exclude irrelevant details. This is the advanced resident. Expert: learner is able to intuitively grasp the situation and to do the appropriate steps or actions. This is the resident who is about to complete their training. Master: in this stage the performer (or physician, or athlete...) no longer has to self monitor their activities and they can transcend their performance at the expert level by using freed resources from self-monitoring into the task at hand. The master seeks out unusual and difficult situations and welcomes surprises. This is the experienced clinician who has developed style. The labels have been changed over time and in the current ACGME learner model, master is level four and expert is level five. The take home messages are that the levels are not equivalent to PGY and that a learner can perform at different levels for different milestones in their training. The first proposed milestone is:
History­ Patient Care
Level 1
Level 2
Obtains a
Obtains a complete
neurological history and relevant
neurological history
Level 3 Obtains a complete, relevant and organized neurological history
Level 4 Efficiently obtains a complete, relevant., and organized neurological history
Level 5 Efficiently obtains a complete, relevant, and organized neurological history incorporating verbal and non-verbal clues
As of July 1, 2014 the milestones are used as the basis for evaluations. When you review the milestones you will note that they are divided into the six competencies.
ACGME Core Competencies: Patient Care: Residents must be able to provide patient care that is both appropriate and compassionate and that is effective for the promotion of health and the treatment of health problems and disease. Residents must: · Use all sources to gather essential and accurate information about their patients, including medical interviews, medical examinations, and medical records. · Make informed recommendations to patients and their families regarding treatment plans and recommended diagnostic and therapeutic interventions that are based upon patient preference, scientific evidence, and clinical judgment. · Develop and carry out patient management plans, counsel and educate patients and their families, and collaborate with other health care professionals (including those from different disciplines) to provide patient-focused care. · Competently perform all essential medical and invasive procedures.
Medical Knowledge: Residents must demonstrate knowledge about current and established clinical, biomedical, epidemiological, and social-behavioral sciences and will apply this knowledge to patient care. Residents must: · Learn the clinical aspects of adult and pediatric neurological disorders and the basis for working up these conditions. 11
· Utilize readings to learn the causes of neurological conditions and apply this knowledge in a clinical setting. · Learn the appropriate use of diagnostic procedures used to detect common and uncommon neurological disorders. Practice-Based Learning and Improvement: Residents must be able to use information technology, scientific methods, and scientific evidence to evaluate, investigate, and improve patient care. Residents must: · Use information technology, scientific methods, and scientific evidence to evaluate, investigate, and improve patient care. · Identify areas for self-improvement and facilitate learning among students and other health care professionals. · Implement strategies to enhance patient care. · Analyze practice experience and perform practice-based improvement activities using a systematic methodology. · Find and evaluate evidence from scientific studies related to patient health problems and incorporate findings into patient care. · Obtain and utilize information about their population of patients as well as the larger population from which their patients are drawn. Interpersonal and Communication Skills: Residents must demonstrate interpersonal and communication skills resulting in effective communication with patients, families and other medical professionals. Residents must: · Create and sustain a therapeutic and ethically sound relationship with patients · Use listening, nonverbal, explanatory, questioning and writing skills to effectively provide information to and elicit information from patients, families and other medical professionals. · Work effectively with health care teams and other colleagues as a member or as a leader. Professionalism: Residents have an obligation to professionalism and sensitivity and must adhere to ethical principles within a diverse patient population. Residents must: · Demonstrate accountability, respect, integrity, and empathy toward patients and their families and to society. · Demonstrate openness and sensitivity to the culture, age, gender, disabilities, Socioeconomic Status, beliefs and behaviors of patients, patients' families, and professional colleagues. · Adhere to ethical principles concerning the withholding of clinical care, confidentiality of patient information, informed consent, and business practices · Be able to communicate with patients, families, members of the health care team, and colleagues in clear, English, using and understanding North American and Midwestern idiomatic English. · At all times residents must interact with patients, their families, and the staff with a pleasant demeanor, in a calm fashion, and with respect. Inappropriate behavior is not tolerated. · Residents must work with each other to provide cross coverage for hospital and clinic patients and for education activities. Systems-Based Practice: Residents must be responsive and aware of the larger health care system and framework and will effectively utilize system resources to provide superior patient care. Residents are expected to: · Practice cost-effective health care and resource allocation that does not compromise the patient's quality of care or the health care system. · Assist patients and their families who are navigating complex health care systems. · Know the different types of health care systems and be able to work with other medical professionals to improve system performance. 12
· Understand how their patient care affects the patient and the patients' families, society, the health care system and other medical professionals. Realize how the system components affect their practice. The master spreadsheet of competencies along with the goals and objectives for each rotation are in the Appendix. The residents and supervising faculty are sent the goals and objectives along with the evaluation tool just before the beginning of reach rotation. It is their joint responsibility to review these at the beginning of the month and to go over the evaluation of the resident by the faculty member at the end of each rotation. 13
Part 3 Work Environment From the GME Housestaff manual section 5.8.3 The University of Kansas Medical Center will: § Use its best efforts, within the limits of available resources, to provide an educational training program that meets the ACGME's accreditation standards § Use its best efforts, within the limits of available resources, to provide the resident with adequate and appropriate support staff and facilities in accordance with federal, state, local, and ACGME requirements orient the resident to the facilities, philosophies, rules, regulations, procedures and policies of the Medical Center, School, Department and Program and to the ACGME, and RRC, Institutional and Program Requirements § Provide the resident with appropriate and adequate faculty and Medical Staff supervision and guidance for all educational and clinical activities commensurate with an individual resident's level of advancement and responsibility § Allow the resident to participate fully in the educational and scholarly activities of the Program and Medical Center and in any appropriate institutional medical staff activities, councils and committees, particularly those that affect Graduate Medical Education and the role of the resident staff in patient care subject to these policies and procedures § Through the officers of the program and the attending medical staff, clearly communicate to the resident any expectations, instructions and directions regarding patient management and the resident participation therein. § Maintain an environment conducive to the health and well being of the resident § Within limits of available resources, provide: o Adequate and appropriate food service and sleeping quarters to the resident while on call or otherwise engaged in clinical activities requiring the resident to remain in the Medical Center overnight, o Personal protective equipment including gloves, face/mouth/eye protection in the form of masks and eye shields, and gowns. The Occupational Safety and Health Administration (OSHA) and the Centers for Disease Control (CDC) assume that all direct contacts with a patient's blood or other body substances are infectious. Therefore, the use of protective equipment to prevent parenteral, mucous membrane and non-intact skin exposures to a healthcare provider is recommended, o Patient and information support services, o Security, and o Uniform items, limited to scrub suits and white clinical jacket. § Through the Program Director and Program faculty, evaluate the educational and professional progress and achievement of the resident on a regular and periodic basis. The Program Director shall present to and discuss with the resident a written summary of the evaluations at least semiannually. § Provide a fair and consistent method for review of the resident's concerns and/or grievances, without the fear of reprisal. § Provide residents with an educational and work environment in which residents may raise and resolve issues without fear of intimidation or retaliation including the following mechanisms: o The GME office ensures that all programs provide their residents with regular, protected opportunities to communicate and exchange information on their educational and work environment, their programs, and other resident issues, with/without the involvement of faculty or attending. Such opportunities include, but are not limited to, confidential discussion with the chief residents, program director, program chair, core program director, and/or core program chair. Other intradepartmental avenues to confidentially discuss any resident concern or issue occur during the Annual program evaluations completed by each resident and/or through 14
discussion with the resident representative during the required Annual Program Review (Annual Program Outcomes Assessment and Action Plan Report). o The internal review process, during which residents in each program are afforded the opportunity to discuss their concerns about their programs with a resident from another program and have them presented confidentially to the GMEC, o An ombudsman, the Assistant Dean for GME Administration, or any other member of the GME staff, including the Executive Vice Chancellor, Senior Associate Dean and the Associate Dean, who are available for the residents to bring any issues raised in these protected resident meetings, or any other issues a resident may need to address, o Peer leadership and membership of the University of Kansas School of Medicine Resident Council, who are available to confidentially receive any resident concern and present their concerns to the Graduate Medical Education Committee and GME Staff o MedHub ,'On The Fly,' praise and concern comments can be sent through MedHub directly and confidentially to the program director. In addition, `On The Fly,' comments can be /confidentially sent to the DIO. This can be accessed through any resident's MedHub user menu. o ACGME Resident Survey, administered directly to all residents in ACGME accredited Programs with four (4) or more residents. This survey provides summary and anonymous feedback to Program and GME Leadership. For programs with less than four residents the GME Resident Survey, which is a confidential, anonymous survey organized by the GME office, is administered annually. o A grievance process, as outlined in section 13 of this Manual, which provides the resident with a formal mechanism for addressing serious concerns within their programs. o ACGME Department of Resident Services at [email protected] or by phone (312) 7557498 is available
Part 4 ­ Didactics Neurology Conference Schedule Residents are expected to attend at least 70% of the lectures during their residency. The 70% benchmark takes into account vacation and sick leave, NICU where the resident is excused from their regular lectures to attend lectures in the NICU and Pediatric Neurology where residents are excused from Dr. Dubinsky's reading conference March through December. Residents are expected to arrive on time for all lectures and conferences. Residents are free to leave lectures at 8:30 am Monday through Thursday and Friday at 9:00 to attend their assigned rotations, even if the lecture or conference is running over allotted time.
Podcasts Certain didactic sessions are recorded for later podcast for residents who were not able to attend or to review the subject matter
Lecture and Conference Schedule:
Monday 7:30­8:00 am Morning report with Dr. Barohn
8:00­8:30 am Handoff or Lecture
5:30 pm
Neuro-Oncology tumor board
Tuesday 7:30­8:00 am Lecture
8:00­8:30 am Lecture
Or
6:30­7:30 am Second Tuesday, monthly core competency lecture at
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Wednesday Thursday Friday
7:30­8:30 am 7:30­8:00 am 8:00­8:30 am 7:30­8:30 am 7:00­8:00 am 8:00­9:00 am 9:00-10:00am 10:00­11:00 am 12:00­1:00 pm
KUH Dr. Dubinsky's reading conference, followed by didatics or Monthly Neuro-Ophthalmology lecture Morning report with Dr. Dubinsky Lecture or monthly Journal Club Or First Thursday Pediatric Neurology conference for adult Neurology residents Neurology and Neurosurgery Case Conference Neurology and Neurosurgery Grand Rounds Neurodegenerative case review with Dr. Newell, held every other month on the second Friday in the Surgical Pathology Sleep Disorders lecture with Dr. S. Stevens, Fairway Building (elective residents) Neuropathology Review with Dr. Newell, second Friday of each month, Kepes conference room, 5th floor Delp
Exceptions: · Resident assigned to NICU attend the NICU lectures and conferences for that month · Residents assigned to Pediatric Neurology attend their Grand Rounds every Wednesday from 8-9 am and the monthly Tuesday case conference.
Remote Viewing of Lectures: The Emergency Neurology lectures in July and June have been replaced with podcasts that are accessible on Blackboard
Core Competency Lectures Monthly core competency lectures are provided monthly through the Graduate Medical Education Committee. Attendance is required, either at the time of the lecture or viewing the podcast remotely through CHALK. Residents are required to attend or to view ALL OF THESE LECTURES during their training. Conferences: Academic productivity is one of the metrics that are used to measure both residents and faculty. Towards that end, we have developed a weekly series of conferences and lectures. Residents take more responsibility for formal teaching as they progress through their training. Morning Report On Monday and Thursday mornings morning report is held at 7:30 am in room 200, Landon Center on Aging. The residents on call over the weekend, or on Wednesday night are to be present to present their cases. The faculty lead the discussion about the cases. On holidays the Monday morning report is delayed until the next regular business day.
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Curriculum Lectures These lectures are on a two-year cycle covering most of adult neurology. Each topic incorporates the basic science, anatomy, neurophysiology, genetics, neuropharmacology and clinical aspects of a subdiscipline of neurology. Lectures are 30 minutes long and are given the faculty and by the residents. Topics include: neuro-degenerative disorders, multiple sclerosis and similar disorders, epilepsy, neuromuscular disorders, movement disorders, neuropsychological assessment, Evidence Based Medicine (utilizing the American Academy of Neurology EBM Toolkit©) and other topics. Emergency Neurology Lectures These lectures are designed to get the PGY2 resident up to speed and are held in July and August of each Academic Year. Unlike the more in-depth two-year curriculum lectures, these are geared towards the urgent evaluation and management of common neurological disorders and emergencies. Both faculty and senior residents give thirty-minute long lectures. These are now viewed as podcasts. Reading Conference Each Wednesday morning Dr. Dubinsky holds his reading conference. A textbook is assigned and chapters are read in advance of the lectures. There is a quiz to start the session and then discussion about the quiz and the subject matter. The materials are provided for the residents. From late December through February, Dr. Dubinsky replaces these lectures with preparation for the Resident In Training Examination. Monthly Lectures On the second Tuesday of each month there is a mandatory core competency lecture provided by the University's Graduate Medical Education Committee. These are from 6:30 am until 7:30 and breakfast is provided. Each month the Wednesday morning lecture is devoted to neuro-ophthalmology presentations by Dr. Whittaker at the KUMC Eye Clinic, 73rd and State Line.. Journal Club Each month Dr. Gronseth presents one or more articles for Journal Club. The most important aspect of Journal club is for residents to develop the skills needed to quickly assess the medical literature to answer focused clinical, patient based questions. The question is oftentimes stated in the PICO format: Patient, Intervention, Comparison, and Outcome. One example would be in patients with suspected carpal tunnel syndrome are nerve conduction studies superior to peripheral nerve ultrasound for diagnostic accuracy. Journal clubs utilize the precepts of evidence-based medicine, which are continually taught to the residents throughout their training. Case Conferences: Each Friday from 7:00 am until 8:00 am there is a combined Neurosurgery and Neurology case conference. Usually the first case is presented by Neurosurgery, followed by a Neurology Case conference. These are assigned in advance and the resident is expected to prepare a 20-25 minute presentation. The format is usually a brief history of the case, a discussion led by a faculty member on the localization and differential diagnosis, followed by the rest of the talk. Residents are encouraged to seek out a faculty member to assist them in the presentation and discussion and to review Dr. Dubinsky's brief lecture on how to give a talk. The slides sets are posted on our Department's web site after any identifying information is removed. Grand Rounds Each Friday from 8:00 until 9:00 am there is combined Neurosurgery and Neurology Grand Rounds. Lectures are given by faculty members in both departments, other faculty on this campus and visiting professors and faculty candidates; highlighting their research and clinical focus. Towards the end of their senior year, residents present a Grand Rounds lecture. 17
Part 5 Training Overview PGY 1 The first year of training is spent with Internal Medicine learning the basics of caring for patients. In AY 2015-16 five months are spent at the University of Kansas Hospital (KUH and seven months at the Kansas City Veteran's Affairs Medical Center (VAMC). PGY1 Learning Objectives · Gather accurate, essential information from all sources, including medical interviews, physical examinations, medical records, and diagnostic/therapeutic procedures. · Make informed recommendations about preventive, diagnostic, and therapeutic options and interventions that are based on clinical judgment, scientific evidence, and patient preference. · Develop, negotiate, and implement effective patient management plans and integration of patient care. · Perform competently the diagnostic and therapeutic procedures considered essential to the practice of internal medicine. · Access and critically evaluate current medical information and scientific evidence. · Develop clinically applicable knowledge of the basic and clinical sciences that underlie the practice of internal medicine and apply this knowledge to clinical problem solving, clinical decisionmaking, and critical thinking. · Identify areas for improvement and implement strategies to enhance knowledge, skills, attitudes, and processes of care. · Apply evidence-based, cost-conscious strategies to prevention, diagnosis, and disease management. · Collaborate with other members of the health care team to assist patients in dealing effectively with complex systems and to improve systematic processes of care. PGY 2 During the first formal year of neurology training the resident divides their time between the ward and consult services at KUH, the clinic and consult services at the Leavenworth and KC VAMC, Neurology Clinics at the Landon Center on Aging and Truman Medical Center. Call is taken at their assigned institutions for all except Leavenworth VAMC. The first year of Neurology is weighted toward teaching the resident patient care responsibilities. The resident learns how to perfect their neurological exam. Three to four inpatient months are spent on the ward service, and one to two months spent on the consult service at KUH. Three to five months are spent at the Kansas City Veterans Administration Medical Center (KC-VAMC) with primary clinic responsibilities and some consult responsibilities. One or two months are spent doing clinics at the Landon Center on Aging. Here the residents receive a broad exposure to the full time faculty at both institutions and start to become proficient at the evaluation and management of the clinic patient. One month is spent at the Leavenworth VAMC. This unique experience involves the resident in the evaluation and management of inpatients, domiciliary patients, outpatients, consultations, and the performance of electrodiagnostic tests. Here they learn how the neurologist functions within the complex system of health care provided by the Leavenworth VAMC. Two months are spent on Night Floats/Clinics. Here the resident covers the inpatient services from 7 pm to 7 am, six days a week for two weeks, then rotates through the clinics at the Landon Center on Aging and our Fairway location for the other two weeks. New in AY 2015-16 is a one month rotation with the Neurology Service at Truman Medical Center, in Kansas City, Missouri. 18
PGY2 Learning Objectives: · To develop proficiency in the neurological interview and examination. · To use these findings to generate a broad differential diagnosis starting with the most likely diagnosis. · To understand the appropriate use of clinical and laboratory testing; and their indications, cost, specificity, and sensitivity. They also learn how to prioritize the tests based upon the ordering of their differential diagnosis, the prevalence of disease states and the likelihood ratio of the tests. · To triage, stabilize and manage patients presenting to the ER with acute neurological disease. · To learn how to evaluate and manage ICU patients. · To learn how to coordinate and supervise a clinical team as well as partner with allied health team members to optimize patient care. · To conduct appropriate literature searches and understand electronic patient information systems. · To explain to the patient and family in a clear and respectful manner, information about the patient's disease and prognosis. · To present a case presentation with review of the literature at the Annual Resident Research Day. · Demonstrate a commitment to ethical principles pertaining to provision or withholding of clinical care, patient confidentiality, and informed consent. · To take the USMLE 3 or COMLEX 3 examination. Description PGY3: The second year of neurology training continues to refine the resident's abilities in patient care and also educates the resident about the specialized skills required of a neurologist. Residents spend time on the consultation services at KU and KC-VAMC. One month at Leavenworth-VAMC, a month at Truman Medical Center, one month is spent in the Neuro-Sciences Intensive Care Unit (NSICU), one month supervising the KUH ward service, and three months of elective. We are transitioning Pediatric Neurology to PGY-3, when that happens some of the one-month rotations will transition to PGY-4. One month is spent on Night Float/Consults PGY3 Learning Objectives: · To further refine the neurological interview and examination and to demonstrate a problem focused approach. · To demonstrate a broadening fund of knowledge in neurological disease. · To acquire proficiency in reading CT, MRI, and plain film studies. · To understand gross and microscopic pathology and correlate it with clinical and neuroimaging information. · To teach and manage a clinical team with medical students and residents from other programs rotating on service. · To demonstrate knowledge of the principles of evidence-based medicine. · To learn the basic principles of research under the guidance of a faculty mentor. 19
· To make informed decisions about diagnostic and therapeutic interventions based on patient preferences, current scientific evidence and clinical judgment. · To competently perform lumbar punctures and basic electrodiagnostic studies. · To work effectively as a neurologic consultant and be responsive to the patient's referring physician(s). · To develop and to sustain a therapeutic and ethically sound relationship with patients. · To have taken and passed USMLE 3 or COMLEX 3 Description PGY4: The final year of training is weighted towards rounding out the resident's education with a three month rotation on pediatric neurology (if not done in PGY 3), psychiatry, one to two months of additional consult duty at KUH and KC-VAMC, one month in NSICU, one month supervising the ward service at KUH, one month of Night Float/Clinics and four months of elective time. Elective time is individualized based on the resident's career plans. PGY4 Learning Objectives: · To demonstrate an increasing ability to function independently as a neurologist. · To demonstrate an extensive fund of knowledge of common neurological disorders, some familiarity with rare disorders, and the ability to research the differential of a rare disorder based upon his or her own clinical evaluation. · To provide advanced teaching of neurological disorders and exam techniques and to mentor junior neurology residents. · To demonstrate sensitivity to pediatric patients and their families, and understand the different needs of the pediatric patient and their parents. · To understand the utility of EEGs, Evoked Potentials and EMG/NCS. · To recognize unusual patterns of disease and to learn when to request neurology subspecialty consultations · To complete a research project with faculty guidance and present it in a scholarly fashion. · To apply the methods of evidence-based medicine to the analysis of medical literature. · To learn and make best use of different services provided by ancillary members of the pediatric health care team, including developmental specialists, geneticists, and behavioral psychologists. · To develop his or her career path through seeking and evaluating job opportunities in fellowships and in practice. Pediatric Neurology Fellow The pediatric neurology fellow, or fellows, rotate at KUH functioning as a PGY2 resident in Neurology. The differences are that they do not rotate at the VAMCs, they will spend six month on inpatient services, three months in out patient clinics and three months of adult neurology electives. 20
Scope of Practice: The role of a resident is rigidly defined, as are the roles of nurses, therapists, attending physicians and all members of the health care team. Neurology residents are not to go beyond their scope of practice. For example, neurology residents are not to adjust ventilators or IV pumps. 21
Part 6 How we Do Things Case Presentation The neurology game consists of what is wrong, where is the lesion, and what to do about it. Otherwise know as the `Hunh,' `Where,' and `What.' Thus the presentation of a case, whether on the wards, clinic, over the phone when on call, or at morning report, is vital to exchange the proper information in a formal fashion. The order of presentation is: · History of current neurological problem · Relevant past medical history · Current medications · Neurological examination: o Vital signs o mental status examination o Cranial Nerve examination (in order please) o Motor examination: includes muscle bulk, tone, strength and subtle signs of weakness (e.g. pronator drift) o Sensory examination including the peripheral modalities (light touch, pin prick, pressure, temperature, vibration, proprioception) and when appropriate central modalities (finger identification, stereognosis, graphesthesia, etc.) o Coordination: this includes hand movements, trunk and leg movements, stance, gait and postural stability o Muscle stretch reflexes: biceps, triceps, knees, ankles, and pathological reflexes (present or absent) o Abnormal movements: tremor, etc. Then you should have a three-sentence summary of the case: This is a seventy-four year old, right-handed male, who is a retired minister with a history of essential tremor and Parkinson's disease. His current problems are end of dose dyskinesias, daytime hallucinations that are very bothersome to him and to his family. He is currently taking carbidopa/levodopa, ropinirole and quetiapine. Inpatient Rotations At the University of Kansas Hospital our department has a primary ward service, a stroke service (beginning in October 2013), a consult service, an Epilepsy Monitoring Unit (EMU) and the Neurological, Neurosurgical Intensive Care Unit (NICU). On the ward team two PGY2 residents, a pediatric neurology fellow, and rotating residents from Neurosurgery and Psychiatry care for the neurology inpatients. They are supervised by a senior (PGY3 or PGY4) neurology resident and one of several neuro-hospitalists, who cover the service for a week at a time. Morning rounds are held daily. On the weekends and holidays, residents are assigned to short and to long call to provide for continuity of care. The stroke service is staffed by a PGY2 resident, a nurse practitioner, at times the vascular neurology fellow and is led by a vascular neurologist. The stroke service cares for patients admitted for cerebrovascular disease and they response to all stroke calls. The consult service, consisting of one or more neurology residents, and rotating residents from Internal Medicine respond to all consults from the hospital and the Emergency Department (ED). Daily sit-down rounds are held by the neurology attending physician prior seeing the consult patients. Residents assigned to the KU ward, stroke, and consult services take in house weekend and holiday call at the University of Kansas Hospital in rotation along with the resident assigned at the Leavenworth VAMC. This is separate from the Night Float/Clinic rotation. 22
Combined Clinic and Consult Services At the Kansas City VAMC the three residents staff the clinic and perform consults, and learn about and how to perform clinical neurophysiological tests. The clinic patients include consults from other services and physicians and patients with neurological disorders whose care is provided by the Neurology clinic. At the Leavenworth VAMC residents see both clinic and consult patients are involved in performing and interpreting EEGs and EMGs. At both sites residents are responsible for the evaluation and treatment of patients in the Emergency Department. The residents at the KC-VAMC divide the call, which is taken from home. The resident at Leavenworth VAMC takes call in rotation at KUH. Night Float / Clinic Rotation Beginning in AY 2014-15 the PGY2 and PGY3 residents took part in combined Night Float / Clinic months. Two weeks are spent on night float and two weeks in the clinic. From August through January the resident is assigned to he different general and subspecialty clinics by the program director. From January through June the resident may select specific clinics and that rotation must be approved by the program director. TMC Neurology KU Neurology residents who rotate through the neurology service at Truman Medical Center will participate in the care of adult neurology patients, splitting time roughly equally between the inpatient and outpatient settings. Under the supervision of attending neurologists, the neurology resident will assist in the evaluation and management of adults with neurological disorders in the clinic and on an inpatient consult service. The resident will cover neurology call from home on select weekends. The resident will also play a role in the education of rotating medical students, and will present cases as indicated at the weekly neuroradiology conference and clinical case conference. Longitudinal Clinics All residents in PGY2­4 have a weekly Ѕ day clinic at the Landon Center on Aging. These occur on Thursday and Friday morning and afternoons. The clinics are composed of residents from all three levels and are staffed by neurology faculty. The typical workload for a PGY2 resident is one new and two return patients and two to three new patients and two to three follow-up patients for more senior residents. Patients are seen in follow-up from the Emergency Department, Neurology ward and consult services. Patients are also referred to our clinics by other departments and by community physicians. The resident is responsible for caring for their patients throughout the course of their illness. Other Mandatory Rotations Neuropathology / Neuroradiology During PGY3 or PGY4 our residents spends one month working with both neuro-radiology and neuro- pathology. This is typically spent as a half day with each discipline. NICU Residents in PGY3 and 4 spend one month in the Neurological and Neurosurgical Intensive Care Unit (NICU). On the rotation residents provide care for patients with severe and life threatening neurological problems. Intensive care physicians from the Departments of Anesthesia and Neurology staff the NICU. These attending physicians rotate every week and should be contacted for any questions regarding patient care. 23
Residents are on call every fourth night in rotation with anesthesia and neurosurgery residents. Advanced Registered Nurse Practitioners are also used to provide continuity of care during the evenings. Residents are encouraged to take their Emergency / Critical Care Neurology NEX during this rotation. According to the ABPN rules, and our policies, this must be signed off by an ABPN board certified neurologist and not a by an anesthesiologist. Pediatric Neurology During PGY3 or PGY4 the adult neurology residents spends three consecutive months in pediatric neurology at Children's Mercy Hospital. This is about 10 minutes away on the Hospital Hill campus of the University of Missouri-Kansas City. Under the supervision of faculty pediatric neurologists, and working with the pediatric neurology fellows, the adult neurology resident takes care of the evaluation and management of children with neurological disorders in the clinic and on a consult service. Our residents are not responsible for the over all care of pediatric patients. Residents on this rotation are on rotating call from home under the supervision of the faculty pediatric neurologists. Supervising resident KUH wards During PGY3 and PGY4 neurology residents spend one month each year supervising the KUH ward service. They are responsible for the day-to-day management of the service, care of the neurology patients, and teaching of the residents and medical students on the service. They take over the patient management for residents who have gone home after call or who are in their longitudinal clinic. They pitch in to help cover when a resident is post call or in their longitudinal clinic. Residents on this rotation take part in the call rotation at KUH. Psychiatry Our residents take a mandatory, one-month rotation in Psychiatry during PGY 4. This month is spent on the psychiatry in-patient consult service at KUH under the supervision of KU faculty psychiatrists. In addition to the Neurology didactic lectures, the neurology resident also attend the Psychiatry didactic lectures Tuesday from 9:00­noon and Psychiatry Grand Rounds on Friday from 11:00­noon. Elective Guidelines Clinical Electives: Residents are encouraged to develop month long clinical rotations covering many subspecialty neurology clinics, or focusing on a major area. Dr. Dubinsky must approve each elective. It is the responsibility of the resident to have the faculty that they will work with sign off on the clinical responsibilities for each half day during the week. Some possibilities are: EEG During PGY3 or 4 each resident may choose to complete a one-month rotation that concentrates on the technical aspects of EEG and the management of patients with epilepsy or suspected epilepsy. They read EEGs daily, admit, evaluate, manage and discharge the Epilepsy Monitoring Unit (EMU) patients, with the faculty epileptologist for that week. EMG During PGY3 or 4 each resident may choose to complete a one-month rotation that concentrates on the technical aspects of nerve conduction studies and electromyography (NCS and EMG) and in the evaluation and management of clinic and hospital consult patients with neuromuscular, or suspected neuromuscular disorders. 24
Neurobehavior Residents work with the faculty clinicians, ARNPs, and researchers in the clinical evaluation and management of patients with cognitive impairment and behavioral problems Headache Elective Residents can structure an elective to spend time in adult headache clinics and in the pediatric Headache Clinic with Jennifer Bickel, MD. During this month they can arrange for training with Dr. Dubinsky the injection of Botox® (onabotulinum toxin) for the treatment of chronic daily headache (also known as chronic migraine headache). Neuro-ophthalmology Elective The resident works directly with Thomas Whittaker, MD, JD in the evaluation and management of patients with neuro-ophthalmological disorders. Sleep Medicine Elective The resident works with M. Suzanne Stevens, MD, and our sleep disorders fellow in the evaluation and treatment of patients with sleep disorders. This includes both clinic and the interpretation and scoring of polysomnographic sleep studies. Movement Disorders Elective The resident works with Drs. Pahwa, Dubinsky and Sharma seeing patients with a wide variety of hypokinetic and hyperkinetic movements disorders. They also participate in chemodenervation clinic. Research Elective Residents may develop an elective for one month, or longer, in either clinical or basic science research. Dr. Dubinsky must sign off on the elective before it starts. The resident is required to have a research mentor, a project, and a product at the end of the rotation. Design your own elective In conjunction with a faculty member and the program director a resident may design their own one- month elective in an area not covered above. One such custom elective is an Evidence Based Medicine resource elective, where the resident on elective searches the literature to determine research answers to clinical questions from the Hospital Services. Away Electives At the moment, on a case-by-case basis, electives are possible at institutions outside of our core hospitals. Making arrangements for an away rotation is an arduous task that must begin many, many months prior to the planned rotation. It is uncertain that funding for away rotations will be available in the future. The resident must be involved in hands-on patient care during an Away Elective. Not being involved in active patient care or research is an observership and is vacation, not an elective. Hand-Offs Transitions in care are difficult. Every effort must be made by our residents for smooth transitions in care. The key elements in care transitions are: · The patient knows who is providing care for them at the resident and at the faculty levels. o The resident introduces themself to the patients when they first meet, and when another resident takes over. o The faculty introduce themselves to the patient when they first meet. 25
· Service hand-off is handled in person at the start of each call day and at the end of the day the residents check out to the on-call resident. Hand-off is supervised by the attending for that service. After it has been determined that the residents are capable, unsupervised hand-off can occur in the mornings. Starting in 2015 we use POC surveys to be completed by faculty witnessing hand-off to document resident proficiency. · Faculty are present for the morning and the afternoon huddle, and service handoff to the night resident occurs during the afternoon huddle, which takes place in person. · A service census is available through the KUH electronic health record (O2, for Optimal Outcomes). Using the O2 hand-off tool a resident generates the checkout sheet. This has the pertinent demographic information, urgent test results to be followed up and current treatment. It is preferred that this be kept electronically and then wiped from memory. If a paper copy is used it must be placed in a shred box when done. Night Float and The Special Beginning in August 2014 we have instituted a Night Float System. Two residents each month are assigned to Night Float/Clinic Rotation. For the first half of the month one resident is on night float and the other is assigned to the clinic, and then they switch. Night float coverage is 7 pm to 7 am Monday evening through Sunday morning. A senior resident is on 24-hour call Sunday 7 am until Monday 7 am and on holidays The inpatient and consult teams must be physically present and get check out from the night resident before 7:00 am. The Special gets hand-off from the three teams at 4:30 pm, takes care of consults (ED and inpatient) until 7:00 pm when they hand off to the night float resident. Transitions in Care Important transition in care occurs at transfer between services and at discharge form the hospital. Transfers to and from the NICU are handled by hand-off between attending physicians and hand-off between the residents. Planning for discharge transition starts at the time of admission. Planning is reviewed and acted upon daily during the morning and afternoon huddles. The morning huddle is intra-disciplinary. Transitions in care also occur at the end of residency training. Patients are assigned to the supervising attending or residency program director, until that patient is seen in the resident clinic. The attending will be assigned any pending laboratory or clinical studies. Notes Adequate chart documentation is important for patient care and patient safety. It allows others to look at the medical record, determine what has happened, what is currently happening and what the plans are for the immediate future. Do not cut and paste notes. This is unprofessional behavior and hinders rather than helps communication. Copying someone else's note, be it a resident or an attending is plagiarism, which will lead to disciplinary proceedings and possible dismissal from the program. Templates are perfectly acceptable and some examples are in the Appendices. Residents may not enter anything into someone else's note. If the plan changes during rounds, a member of the resident team should document this in a separate note rather than changing the note of a resident who is not available. Do not fight in the medical record. This is also unprofessional behavior. If a member of a health care teams has documented multiple attempts to contact you, start your note as `I received a page at 7:10 pm to perform a neurology consult for a question of.....' 26
Part 7 Evaluations The Next Accreditation System (NAS) and Grades The 29 milestones in Neurology, are mapped onto the six competencies. The levels of the milestones are based on Dreyfus model of learning. (Dreyfus 1980) These stages are analogous to Levels 1-5 in the milestones, but are not equivalent to post graduate year (or level) of training (PGY). Each level requires mastery of the one below. A novice learner knows the rules, applies them without explicit responsibility and has to do everything by rote. They require constant supervision A proficient learner knows, the rules, accepts limited responsibility yet needs close supervision or oversight. They can filter out unnecessary elements in their presentations, but still need to do most everything in their evaluations A competent learner is able to filter out the unnecessary elements quickly in their clinical encounters and presentations. They not only grasp the nuances of common presentations of common disease, but also the common presentation of uncommon disease. They prioritize their evaluation based on the likelihood of the disorders in their differential and re-evaluate frequently An expert learner quickly grasps the nuances of the situation. They develop a hypothesis, test it on the fly with questions, examination and tests and constantly re-evaluate and adjust accordingly. A master learner likes surprises. They seek out the exceptions to the rules and thus expand our overall knowledge of a subject. They challenge assumptions and in doing so advance the field. They are actively engaged in research in their discipline. For example, if a resident can correctly identify a patient as having progressive supranuclear palsy (level 3 or 4), yet state that deep brain stimulation is the preferred treatment for a patient with the recent onset of Parkinson's disease (failed level 3), they are performing at level 2, as long as they can tell the difference between hyper and hypokinetic disorders (level 2). The complete Neurology Milestone Matrix is in the Appendix. Program Evaluation Our program is continually evaluated through the monthly meetings of the Program Education Committee (PEC), monthly faculty meetings, formal evaluations through MedHub and informal evaluations and discussions. A formal report is filed through WebAds (ACGME) and for the institution and NAS through REDCAP. Program Education Committee: Background: The PEC is required by the Common Program Requirements in 2013. Charge: The PEC is charged with annually reviewing the entirety of the Neurology residency program at the University of Kansas Medical Center. This includes the curriculum, rotations, goals and objectives, handbooks (program and GME house staff), evaluations of the program by residents and faculty, academic productivity of the program, residents and faculty, RITE scores and ABPN pass rate. Membership: One member from each level is appointed by their peers to the PEC, Chief Resident, Program Director and Associate Program Directors. 27
Meetings: The PEC meets quarterly and conducts the annual review in August following the close of each academic year. Report: At the completion of each Annual Review the PEC issues a report and action plan that become part of the self-study for the NAS. Resident Evaluation Tools The forms used for resident evaluations are based in the NAS milestone and are in Appendix 1.Please see Appendix 2 for rotation Goals & Objectives. Residency In-service Training Examination The American Academy of Neurology Resident In-Service Training Exam (RITE) is administered in late February or early March each year. The performance of each resident is reviewed by the program director to target educational areas that need to be strengthened in the curricula. Residents who perform in an unsatisfactory fashion on their clinical rotations or on this test are assigned a faculty mentor for remedial one on one tutoring. A score of 65% correct is strongly predictive of passing the American Board of Psychiatry and Neurology (ABPN) written neurology examination on the first try. ABPN Clinical Skills Evaluation of Residents To graduate and to take the ABPN examination each resident must pass the five Neurological Evaluation Examinations (NEX). These are patient encounters that are witnessed by a board certified neurologist, or neurologists and last 45 minutes. During this time the resident is to take the history, perform an appropriate examination and then to discuss their assessment and plan with the patient, even though they are not assuming care of the patient. The neurologists grade the resident's performance using the NEX forms (see Appendix 2). Five examinations must be passed at the level of a graduate neurology to graduate from the program and to take the ABPN examination. They are: neuromuscular, neurodegenerative, ambulatory, pediatric neurology, and critical care / emergency neurology. It is the duty of the resident to arrange for these examinations during the appropriate rotations. The examinations must be given and signed by a board certified adult neurologist or pediatric neurologist. Three of these witnessed examinations are given during Mock Orals, which are usually held the first Saturday in May. In front of a faculty and community neurologist, each resident examines a patient over 45 minutes. Afterwards their performance is discussed with the senior neurologists. The residents are evaluated over several domains and assigned a numeric score. The most important is the overall score, which involves these questions: Did the resident pass at their current level of training? And, did they pass at a graduate level? Most often for PGY2 and PGY3 residents pass at their level of training, but not at the level of a graduate. It is possible, though rare, for a resident to pass at a graduate level while a PGY2. The NEX may be taken as often as needed for the resident to pass, but they must pass by the end of their residency, otherwise they can't sit for the ABPN examination. While according to the ABPN rules the NEX may be taken after graduation, our program is under no obligation to provide these for you after graduation. Thus far we have charged former graduates $750 per exam to complete these post residency. You have seven years from the date of your last NEX to pass the ABPN written examination, if not you start over again. These are set pieces, like a recital, to prove that you can do the necessary parts of an examination. Thus they are a minimal standards test and the majority of the documentation provided by the examiners is on what the resident failed to do, rather than what they did well. 28
Assessment by Medical Students Starting in AY 2013-14 medical students evaluate resident through the E-Value system. They students self select residents to evaluate based upon their contact with the residents. Chart Review In addition to the NAS Milestones from the Neurology Residency Review Committee (RRC) are Entrustable Professional Activities (EPAs). These are elements of the practice of medicine and neurology that once mastered a resident should be able to always execute properly. One of these is chart documentation. Periodically throughout residency the trainee will be asked to select several charts for review by the program director or associate program director to determine their ability to document clinical encounters. Resident Case Log The Neurology RRC does not require case logs. However almost all hospital credentialing committees do require case logs and procedure logs. It is your responsibility to keep track of these or to try to obtain them through the Electronic Health Record (EHR). 360° Evaluation Each year the residents evaluate each other; and patients, nursing personnel and administrative personnel, evaluate them. Resident Portfolio We will help you to develop your portfolio. This contains all of you presentations (case conference, grand rounds, research day presentation, etc.), papers, practice based learning, quality improvement and quality measurement project. Also included are you evaluations, RITE scores, NEX results, letters of recommendation and biannual evaluations. Clinical Competency Committee As part of the Next Accreditation System (NAS) we have formed a Clinical Competency Committee for residents in PGY2­4. The Clinical Competency Committee of the Department of Medicine, at KUMC, evaluates PGY1 residents. The Neurology CCC is chaired by D., Mamatha Pasnoor, the associate program director and includes: · At least two hospitalists, Dr. Sachen who is in charge of the Resident Longitudinal Clinic · JoAnne Locke, RN, the clinic nurse in support of the residents · Nursing staff from the Neurology and NICU floors, and · Tara Logan, education coordinator, as staff support. This committee meets each Academic Year (AY) in December and in June. Resident evaluation scores are shared along with the aggregate scores on all 29 milestones. A consensus is reached on the level for each of the 29 milestones. The results are shared with the resident at their biannual evaluation with the program director. This committee advises the program director as to the competency of each resident. The program director has the ultimate decision and reports progress of the milestones to the ACGME through WebAds. Residency Steering Committee This committee meets quarterly, or more often as necessary to cover the day-to-day management of the residency program. It is composed of: Dr. Dubinsky, program director, as chair, associate program director Dr. 29
Pasnoor, the chief resident, and a resident elected by their peers from each level of training, and the education coordinator. Biannual Evaluation In early January and late June of each academic year all residents meet with the program director to review their progress. At that time these items are reviewed: · Evaluations from each rotation · Clinical Competency Committee review · Case presentations · RITE scores (June of each year) · NEX performance and mock orals (June of each year) · 360є evaluations · Chart review · Conference attendance · Medical student evaluations · Resident portfolio · Research day presentation · Career plans Criteria for Advancement: The Clinical Competency Committee and the program director look at all aspects of the resident to determine if they will advance to the next level of training. Overall, we are looking for maturation of the resident, increase in their medical knowledge, increasing responsibility in patient care, and increasing ability to deal with uncertainty. USMLE 3 or COMLEX 3 All residents must take USMLE 3 or COMLEX 3 to matriculate into PGY3. They must pass USMLE 3 of COMLEX 3 to matriculate into PHY4. Their certificate of training is held if they do not pass by their completion date and we can't verify training until these examinations are passed. ABPN Certification All residents are expected to pass the ABPN certification examination in adult neurology on their first try. The best time to take this examination is just after graduation. The resident must apply in the winter of their senior year. We will complete the Pre-Certification to verify training for the resident with the ABPN. A permanent state license is required by early September of the year that the resident sits for the examination. Otherwise, their examination fee may be forfeit. 30
Part 8 ­ Research Initiatives Resident Research Experience Each year we present a series of basic lectures on the principles of clinical research. Residents are encouraged to participate in clinical or basic science research with a faculty mentor. Elective months may be spent in research. To do so, a resident must make arrangements ahead of time for a faculty mentor, research project, and a research product (e.g. paper, poster, abstract, planned publication). Resident and Fellow Research Symposium On the second or third Friday of June all residents (PGY2­4) and fellows participate in Resident Research Day. Everyone presents a 10-12 minute platform with 3-5 minutes available for questions and discussion. PGY2 residents generally present a case report or case series and the more advanced residents present research testing a hypothesis. This can be a large case series, systematic literature review, basic science or clinical research, etc. Residents are encouraged to work with a faculty mentor. Dr. Pasnoor is in charge of Research day and will post deadlines for title, abstract, and slides. Residents are encouraged to submit their Research Day abstract the next spring for the Resident and Post-Doctoral Fellowship Research Day, usually in May. 31
Part 9 ­ Policies Policy on Selection of Residents Residency candidates are invited to interview with our residency program based on these criteria: · Performance in medical school, as shown on their official transcript and Dean's letter · Performance in the basic and clinical science years, as evidenced by the Medical Student Performance Evaluation (MSPE) · Performance on the USMLE Step 1 and Step 2 or COMPLEX 1 and 2 examinations · A letter of reference from the Chairman of Neurology at their medical school · Two additional letters of reference, preferably from Neurologists · Their personal statement Level of Appointment Guideline On occasion, a resident may change core programs. Pleas see section 29.7 PGY Level Appointment Guidelines in the GME manual: · _Residents that change Core Programs will start the new program at the core program PGY 1 level or if applicable in an advanced program at the PGY 2 level. Communication competency requirement From the GME manual, section 4.1.3 Applicants are required to demonstrate spoken, auditory, reading, and writing proficiency in the English language. This is determined during the application review and in the interview process. International Medical Graduates International Medical Graduates applying for a Neurology residency at the University of Kansas Medical Center are selected on the basis of the same criteria as above. In addition, they must have the following: · ECFMG certification at the time of application to the residency program, · Employment Authorization Documentation (EAD) or Green Card, or · The applicant must have a J1 visa at the time of application. For holders of H1 visas, these must be converted to J1 by the start of training. We do not sponsor H1 visas. In addition, a foreign graduates medical school must be included in the list of "approved" medical schools on the KSBHA's website (http://ksbha.org/medicalschoolsapprovedunapproved.html) and the school must not appear on the list of "disapproved" schools Candidates who are more than five years after graduation or who have failed USMLE of COMLEX multiple times are not considered as candidates for our residency program. The Neurology Residency Selection Committee, consisting of the chair, residency program director, the associate director, faculty members and residents meet jointly to review all candidates and to determine our rank order list. In addition to the criteria above, we consider personal and professional traits, based on interviews with the Program Director and several other faculty and residents in the Department of Neurology at the University of Kansas Medical Center We fully support the All In policy of the National Residency Match Program (NRMP) and will not make or consider any offers outside of the Match and the post match SOAP program. 32
Policy on Resident Supervision Each resident is assigned a faculty supervisor for each rotation or clinical experience (inpatient or outpatient). The level and method of this supervision is consistent with the ACGME Special Requirements for Neurology. Explicit and written descriptions of lines of responsibility for the care of patients are provided in the core curriculum descriptions for each required rotation. Residents and faculty are provided with personal pagers for rapid, reliable systems of communication. This helps to insure appropriate involvement of supervisory physicians in a manner appropriate for quality patient care and educational programs. Phone and pager numbers of the staff and residents are provided in the appendix via electronic mail and laminated cards distributed at the beginning of each academic year. Each faculty member with direct supervision of the resident provides a written summary of their assessment of the resident's performance during the period that the resident was under their direct supervision. The Program Director counsels and provides written evaluations of each resident at least twice during each year of training. The purpose of this counseling is to provide feedback to the resident on clinical performance and suggest ways for the resident to improve his or her knowledge and skills. The Neurology Residency Committee meets monthly to address the performance and concerns of the educational activities of the residents. This information is also presented at the monthly Faculty meetings. The Program Director advances residents to positions of higher responsibility on the basis of evaluation of their readiness for advancement. This advancement is dependent on the resident's performance and maturation throughout their training. The Program Director and Tara Logan , education coordinator maintain individual resident folders with monthly and semiannual evaluations. These folders also include results of the Neurology Residency In-Training Examination (RITE) and Mock Oral Boards. This file is available for residents to review upon request and most evaluations are available for review through MeHub.. 33
Level of Supervision and Supervisor*
Direct, Physician
Indirect, direct
Direct supervision available
present with resident supervision immediately
and patient
available
Clinical activity PGY1 KUH Rounds New patient admissions Daily work Call KC VAMC Rounds New patient admissions Daily work Call PGY 2-4 KUH Wards Rounds New patient admissions Daily work Call Consults Rounds New consults Follow-up consults Neuropathology / neuroradiology** Neuromuscular Epilepsy NICU Clinic Elective KC VAMC Clinics Consults Leavenworth VAMC Clinics and consults Children's Mercy Hospital
F F F F F F F F F F F F
Pediatric Neurology Clinic Consults Call
F F * F = faculty R = senior resident Primary supervision Secondary supervision
F R F R F F F
F R F
F R R, F F
F F R
F
F

F, F, NM Fellow VV F F F
F
F
F
F
F F F
F F ** Patient contact rare
34
Policy on Progressive Responsibility for Patient Management As shown in the above policy of supervision, the resident is given more responsibility for patient management as they progress through their training. As the resident enters into PGY3 and PGY4 they are expected to be able to assume responsibility for all care for their patients, yet remain under the supervision as detailed above. This progressive responsibility also encompasses awareness of fatigue and fatigue mitigation. Policy on Resident Work Hours Each month the program director reviews the duty hour logs for potential violations and may request clarification from residents regarding their logged hours. To be compliant with the ACGME duty hour rules it is imperative that residents log their hours in a timely fashion. Policy on Fatigue Fatigue is insidious. People with impairment due to fatigue have a loss of insight into their level impairment. In numerous studies, including at least one with residents, impairment due to fatigue was directly compared to alcohol-induced impairment. After starting work at 7 am, residents were impaired from a motoric and a cognitive standpoint to an equivalent BAC of 0.08, or legally intoxicated. By daylight the next morning their impairment had improved to the equivalent of a BAC of 0.05, which is still impaired. More importantly all of the residents underestimated the degree of their impairment. Therefore, it is imperative that residents learn to recognize impairment and situations that can lead to impairment. To mitigate fatigue we have a call room in the southwest corner of the 8th floor of the hospital, the neurology floor. Residents have access to this room 24 hours a day. Thus after call a resident can nap in the call room and then return home. We also have cab vouchers available to transport a resident home after call and to return them back to work the next morning. These vouchers are kept in the resident's workroom on the 8th floor. Please notify the Tara Logan, Education Coordinator and Dr. Dubinsky when they are used so we can complete the necessary paperwork and to replace the used voucher. Vacation Policy From the ABPN requirements: Training programs may schedule individual leave or vacation time for residents in accordance with the overall institutional policy. Leave or vacation time may not be utilized to reduce the total amount of required residency training or to make up deficiencies in training Residents are allowed three weeks of vacation per year and two weeks of sick time. Refer to GME policy 5.5.10, 5.5.11 and 5.5.12 Vacations are scheduled in advance by the Chief Resident and are distributed throughout the academic year to provide adequate coverage for all services. Unused vacation time, like sick leave, can't be carried over into the next academic year. Residents are considered yearly employees and can't carry over vacation or sick leave from one year to the next. Vacations are not taken during NICU rotation months, nor are they allowed on the Saturday of The Examination Formerly Known as Mock Orals, Research Day, the first two weeks of July or the last two weeks of June. In general residents are not allowed to take more than one week off during any given month long rotation. The exception is that senior residents may take vacation during the last two weeks of their final month of training to move their household before starting their next job. Vacation leave is used for interviews. Academic Leave On a case-by-case basis residents are granted up to five days of academic leave each year to present at national meetings. Academic leave is not used for interviews. 35
FMLA GME Policy 5.5.12 addresses leave without pay for reasons that meet FMLA. Meet with HR to see if you qualify for FMLA and discuss payments for benefits, if paid time is exhausted. Oftentimes residents use FMLA for Maternity or Paternity leave. A reading elective is not available to extend time away from training. Disability Disability insurance is provided by the University for all residents and was covered at orientation. Short- term disability is available at cost, and was covered at orientation. If you are interested in this please consult the GME handbook and Human Resources. Policy on Evaluation and Promotion of Residents Each resident is on a year-to-year contract. Failure to adequately advance across all the professional domains, unprofessional behavior, endangerment of patients, combined with failure to take corrective action as mandated by the program director, associate program director, or department chair results in non-renewal of the resident's contract. Residents must take the USMLE part 3 (or COMLEX part 3) before the end of their PGY2 year. They must pass the examination prior to entering PGY4. If this is not completed by the planned end of their training, the certificate is withheld until such time that they have passed the examination and their training is considered unfinished. That means that the resident's training can't be verified and they can't obtain a permanent medical license. The decision to promote a resident to the next level of training in made by the program director with the advice of the Clinical Competency Committee. Data used to make this decision include monthly evaluations, lecture attendance and participation, resident presentation, 360o evaluations, RITE scores and the report of the Clinical Competency Committee. Whenever possible 120 days notice will be given to a resident that they will not be promoted to the next level or that their contract will not be renewed. Residents who are not progressing as expected in their training (e.g. a RITE score < 15 %tile for rank) may be placed on academic remediation. Remediation is a period of intense supervision and guidance to improve the resident's knowledge of Neurology. It is not reported to any credentialing agencies, potential or future employers. It does not appear on the end of residency summative evaluation. Policy on Evaluation of Faculty and of the Residency Program For each rotation the residents are assigned reviews of the appropriate faculty members for their rotation. Tara Logan, Education Coordinator, arranges this. These are confidential reviews. Among the faculty, only Dr. Dubinsky can view the individual level reviews, and he can't view his, only Dr. Pasnoor may view his. These are summarized, comments edited as appropriate, and presented to the Chair each January as a Teaching Report Card for the faculty member's annual evaluation. Through the quarterly Education Committee meetings, yearly program review, and ad lib conversations, the program is reviewed each year and changes implemented. Policy on Support for Resident Travel to Scientific Meetings The Department of Neurology will send each resident to at least one national neurology meeting. From time to time scholarships are available from the AAN or other sources that are condition specific. Generally these scholarships are offered to senior residents. The department will reimburse a resident up to $1,500 to 36
attend a national meeting where they are presenting a poster or platform for work that was performed as part of their neurology residency at KU. Moonlighting Policies No, you may not moonlight. You are here to become a neurologist. All of your professional time for the four years of training should be directed towards this goal. Computer Security In addition to completing the on-line tutorials on computer security, residents may not share their passwords to the computer systems at the University of Kansas Medical Center or affiliated hospitals and clinical sites. They may not sign into these systems with another's password. Doing so may terminate your employment as a resident. Social Media Policy Please see: http://policy.ku.edu/KUMC/information-technology/social-media for the must recent version of the University's social media policy. Ombudsman An ombudsman is available to assist residents. In the GME handbook please see section : 7.9 Ombudsman Guidelines for Residents The Ombudsman is an academic faculty member in good standing without alignment or administrative connection to either program leadership or School of Medicine/GME Leadership. The Ombudsman will serve as a sounding board/resource to residents with questions or concerns about their program, faculty, or school of medicine. Residents may access one of the three Ombudsmen by email [email protected], [email protected] or [email protected] 37
Part 10 Bibliography for Adult Neurology Residents
The Dykes Library collection of electronic journals is accessible through any computer on the KU campus. Through the secure server at my.kumc.edu all the same resources are available off campus. This includes 13,000+ journals, Access Medicine textbooks, and the Cochrane Library. While NEJM is not part of the Dykes E-Journal collection all NEJM articles funded by US Government grants are available for free.
Residents have access to all issues of Neurology, Clinical Neurology, Neurology Podcasts, Continuum and Audio-Continuum through their junior membership in the AAN, provided for all residents.
Strongly Suggested Textbooks:
PGY2
·
Neuroanatomy Through Clinical Cases, 2nd Edition,2011 (Hal Blumenfeld) $65.10
·
Adams and Victor's Principles of Neurology 10th Edition Hardcover ­ 2014 Allan Ropper, Martin
Samuels, Joshua Klein $160.40
·
Manter and Gatz's Essentials of Clinical Neuroanatomy and Neurophysiology, 10th Edition (Gilman and
Newmann), 2002 $40.40
·
Introduction to Neuropsychopharmacology. Iversen, Iverson Bloom and Roth, 2008 $42.09
Total: $307.99 ­plus tax, shipping and handling. Prices from Amazon.com subject to change.
PGY3 and PGY4
·
Escourolle & Poirier's Manual of Basic Neuropathology, 5th Edition, 2013 (Francoise Gray, Charles
Duyckaerts, and Umberto De Girolami editors) $93.58
·
Principles of Neural Science, Eric Kandel, 5th Edition, $98.87
·
Osborn's Brain: Imaging, Pathology, and Anatomy, Anne Osborn, 2012, $331.55
Worth buying if you can find it:
·
Core Text of Neuroanatomy, Malcom Carpenter, 1991 $57.04
General Neurology AAN Practice Parameters cover a broad range of topics and are available at AAN.org. Cochrane Collaboration is available through the Databases section at the Dykes Library web site.
38
Other texts suggested by the faculty: Chertow DS, Tan ES, Maslanka SE, et. al. Botulism in 4 Adults Following Cosmetic Injections With an Unlicensed, Highly Concentrated Botulinum Preparation. JAMA, 1006; 296:2476. Cooper DJ, Rosenfield JV, Murray L, et. al. Decompressive Craniectomy in Diffuse Traumatic Brain Injury. NEJM 2011;364:1493. DeAngelis CD, Fontanarosa PF. Conflicts over Conflicts of Interest. JAMA. 2009 Inzucchi SE. Diagnosis of Diabetes. NEJM. 2012;367:6 Odaka M, Yuki N. Yamada M. et. al. Bickerstaff's brainstem encephalitis: clinical features of 62 cases and a subgroup associated with Guillain Barre Syndrome. Brain 2003; 126: 2279 Vickery BG, Samuels MA, Ropper AH. How Neurologists Think A Cognitive Psychology Perspective on Missed Diagnoses. Ann Neurol 201;67:425. Dementia: McKhann GM, et. al. The diagnosis of dementia due to Alzheimer's disease: Recommendations from the National Institute on Aging-Alzheimer's Association workgroups on diagnostic guidelines for Alzheimer's disease. Alz & Dem.: 2011;263-269 Epilepsy Kwan and Brodie, NEJM, 342: 314-19 Wiebe and Jette, Nature Rev Neurol, 80: 669-677 Brodie and Sills Seizure, 20: 369-75 Wiebe et al., NEJM, 345: 311-18 Movement Disorders: Kurlan R. Tourette's Syndrome. NEJM. 2010;363:2332-8. Robertson, MM. Invited review: Tourette's syndrome, associated conditions and the complexities of treatment. Brain: 2000; 123:425-462 Multiple Sclerosis Kurtzke JF. Rating neurologic impairment in multiple sclerosis: An expanded disability status scale (EDSS). Neurology 1983;33:1444 Neuromuscular Diseases: Continuum issue on Neuromuscular diseases and on ALS. In neuromuscular, it is important for residents to learn about approach to peripheral neuropathy (being published in N Clinics of N Am by Barohn and Amato) and GBS (being published in N Clinics of N Am by Dimachkie and Barohn). There probably should be a third one on MG and MG crisis management Curr Opin Neurol. 2012 Oct;25(5):523-9. doi: 10.1097/WCO.0b013e3283572588. Myasthenia and the neuromuscular junction. Gilhus NE. Intravenous immunoglobulin for myasthenia gravis. 39
Gajdos P, Chevret S, Toyka KV. Cochrane Database Syst Rev. 2012 Dec 12;12:CD002277. doi: 10.1002/14651858.CD002277.pub4. Review. Inclusion body myositis. Dimachkie MM, Barohn RJ. Semin Neurol. 2012 Jul;32(3):237-45. doi: 10.1055/s-0032-1329197. Epub 2012 Nov 1. PMID: 23117948 Idiopathic inflammatory myopathies. Dimachkie MM, Barohn RJ. Semin Neurol. 2012 Jul;32(3):227-36. doi: 10.1055/s-0032-1329201. Epub 2012 Nov 1. PMID: 23117947 Kumar N, Gross JB, Ahlskog JE. Copper deficiency myelopathy produces a clinical picture like subacute combined degeneration. Neurology 2004;63:33. Turner MR, Hardiman O, Benatar M. et. al. Controversies and priorities in amyotrophic lateral sclerosis. Lancet Neurol. 2013;12:310. Baum D. Annals of Epidemiology: Jake Leg. How the Blues diagnosed a medical mystery. The New Yorker Sept. 15, 2003; page 50 Central Neurophysiology: Simons DJ, Cahbris CF. Gorillas in our midst: sustained inattentional blindness for dynamic events. Perception, 1999, volume 28, pages 1059-1074 Stroke and Cerebrovascular disease: Albers GW, Bates VE, Clark WM, et. al. Intravenous tissue-type plasminogen activator for treatment of acute stroke. The standard treatment with altepase to reverse stroke (STARS) study. JAMA 2000;283:1145. Albers GW, Clark WM, Madden KP, Hamilton SA. ATLANTIS Trial Results for Patients Treated Within 3 Hours of Stroke Onset. Stroke. 2002;33:493. Chimowitz MI, Lynn, MJ, Howlett-Smith H, et. al. for the Warfarin­Aspirin Symptomatic Intracranial Disease Trial Investigators. NEJM 2005;352:1305 Clark WM, Wissman S, Albers GW et. al. Recombinant tissue-type plasminogen activator (Altepase) for ischemic stroke 3 to 5 hours after symptom onset. The ATLANTIS study: A randomized controlled clinical trial. JAMA 1999;282:2019. Douglas VC, Johnston CM, Elkins J. et. al. Head computed tomography Findings Predict Short-Term Stroke Risk After Transient Ischemic Attack. Stroke. 2003;34:2894. Easton JD, Saver JL, Alber GW, et. al. Definition and Evaluation of Transient Ischemic Attack A Scientific Statement for Healthcare Professionals From the American Heart Association/American Stroke Association Stroke Council; Council on Cardiovascular Surgery and Anesthesia; Council on Cardiovascular Radiology and Intervention; Council on Cardiovascular Nursing; and the Interdisciplinary Council on Peripheral Vascular Disease. Stroke. 2009;40:2276 Goldstein LB, Bushnell CD, Adams RJ, et. al. Guidelines for the Primary Prevention of Stroke A Guideline for Healthcare Professionals From the American Heart Association/American Stroke Association. Stroke 2011; 42 40
Gurm HS, Yadav JS, Fayad P, et. al, for the SAPPHIRE Investigators. Long-Term Results of Carotid Stenting versus Endarterectomy in High-Risk Patients. NEJM 2008;358:1572 Hartmann A, Rundek T, Mast H, et. al. Mortality and causes of death after first ischemic stroke The Northern Manhattan Stroke Study. Neurology 2001;57:2000. Kelly AG, Rothwell PM. Evaluating patients with TIA To hospitalize or not to hospitalize? Neurology 2011;77:2078 NINDS and the rt-PA Stroke Study Group. Tissue plasminogen activator for acute ischemic stroke. NEJM 1995;333:1581. Nguyen-Huynh MN, MD; Johnston SC. Is hospitalization after TIA cost effective on the basis of treatment with tPA? Neurology 2005;65:1799. Rothwell PM, Giles MF, Flossman E, et. al. A simple score (ABCD) to identify individuals at high early risk of stroke after transient ischaemic attack. Lancet 2005; 366: 29. Sacco RL, et. al. for the PROFESS investigators. Aspirin and Extended-Release Dipyridamole versus Clopidogrel for Recurrent Stroke. NEJM 2008;359:1238-51 You JJ, Singer DE, Howard PA, et. al. Antithrombotic Therapy for Atrial Fibrillation Antithrombotic Therapy and Prevention of Thrombosis, 9th ed: American College of Chest Physicians Evidence-Based clinical practice Guidelines. Chest 2012; 141(Suppl):e531S­e575S Patient Safety and Quality Measures: Bever CT, Holloway RG, Iverson DJ, et. al. Invited Article: Neurology and quality improvement. An introduction. Neurology 2008;70:1636 DePold-HohlerA, Doyle ­Lee J, Schulman AE, et.al. Invited Article: Improving safety for the neurologic patient Evaluating medications, literacy, and abuse. Neurology 2010;75:742. Bingham JW, Quinn DC, et. al. Using a Healthcare Matrix to Assess Patient Care in Terms of Aims for Improvement and Core Competencies. J Quality and Patient Safety. 2005;31:98-105. Other: Dreyfus SA, Dreyfus HI. A Five Stage Model of the Mental Activities involved in Direct Skill Acquisition. UC, Berkeley. 41
Revision History This section is not used for the initial version of each Academic Year 42
Department of Neurology Clinical Faculty
Clinical Area
University of Kansas Medical Center:
Abraham, Michael Vascular/Intensive Care
Aggarwal, Dipika
General and neurophysiology
Phone
Pager
Cell 816-778-9253 917-2661
86963
917-1518
Albadareen, Rawan Barohn, Richard Bittel, Brennen
Neuromuscular General and neurophysiology
86094 80933
917-9542 917-3024
Burns, Jeffrey Dick, Arthur Dimachkie, Mazen Dubinsky, Richard Ford, Deetra
Dementia General neurology Neuromuscular Movement Disorders and neurophysiology General
80682 86041 80649 86984 80994
917-4476 917-1009 917-3198 917-2860 917-0786
Glenn, Melanie
General and neurophysiology
Landon: 80395 Indian Creek: 81186
917-3496
Gronseth, Gary
Vascular and Hospital Neurology 86972
Hairston, Vernita Hammond, Nancy Hegazy, Mohamed Husmann, Kathrin Jawdat, Omar Landazuri, Patrick Lechtenberg, Colleen Lynch, Sharon Mittal, Manoj Nashatizadeh, Muhammad Nowack, Bill Pahwa, Raj
Neurorehabilitation and General Epilepsy and general Epilepsy and general Vascular neurology Neuromuscular Epilepsy and general Vascular and Hospital Neurology Multiple Sclerosis Vascular/Intensive Care Hospitalist
56168 83616 84529 55018 Indian Creek: 81119 Epilepsy: 88944 83210 86978 58586 86782
General Neurology Movement Disorders
86903 86782
Pasnoor, Mamatha Rippee, Michael Rosterman, Lee Rymer, Marilyn Sachen, Fred Sharma, Kartavya Sharma, Vibhash Southwell, James
Neuromuscular Vascular and Hospital Neurology, concussion Vascular and Hospital Neurology Vascular and Dementia General Neurology Vascular/Intensive Care
80668 85240 58538 8-3152 Cell: 913-6480343 86970
Movement Disorders
86970
General and neurophysiology
87455
43
816-3049386 917-0787 917-3630 917-7119 917-3133 917-0785 917-9500 917-5110 917-0125 917-4708 917-3614 913-3752322 917-5154 917-2699 917-5089 917-3905 - 917-0788
Statland, Jeffrey Stevens, M, Suzanne Swerdlow, Russell Ulloa, Carol Uysal, Utka Wang, Yunxia
Neuromuscular Sleep disorders Dementia Epilepsy Epilepsy Vascular and Hospital Neurology
59933 86212 56632 89965 80029 80686
KC VAMC Frederick, Tim Johnson-Hatchett, Kim Nayak, Lipika Singh,Vikas
General neurology General Neurology General Neurology and NP General Neurology
816-861-4700 816-861-4700 816-861-4700 816-861-4700
Leavenworth VAMC
Venkatesh, Ram
General neurology and clinical
neurophysiology
913-682-2000
917-4046 917-2301 917-5152 917-4707 917-1741 917-5085 917-2875 - -
44
Department of Neurology Resident Rotation Schedules 45
Tara lease insert 2016-17 schedule here 46
Important Dates for 2016-2017
Event and date July 1-15, 2016 July 1,7, 8, 14 and 15, 2016 Resident clinics July 30 2016 Welcome party Tuesday August 2, afternoon September 5 2016 Labor Day October 26-29, 2016 November 24,25, 2016 Thanksgiving December 24,25, 31 2016 and January 1 2017 holidays January 16, 2017 MLK Day RITE February 16-17, 2017 Mock Orals May 6, 2017 April 22 through 29, 2017 May 6, 2017 Monday May 29,2 017 Memorial Day June 2 2017 Ziegler Professorship Lecture June 16 2017 Research Day and Graduation (tentative) June 15-30
Action needed No vacations allowed Clinics blocked new residents None Mandatory Resident as teacher training for PGY2 residents Morning report on Tuesday the 6th Child Neurology Society meeting, no vacation for KU resident at CMH Block KUH resident clinics. VA residents have clinic on Friday Block resident clinics Morning report on January 17 Resident Clinics are blocked, no Grand Rounds No vacations No resident vacations AAN, cancel resident clinics Mock Orals, no vacations Morning report on Tuesday 30th None Block all clinics until 2 pm for faculty and residents (No Friday morning clinic for residents) No vacations except for graduating PGY4 residents
47
Appendices: Neurology Milestones NEX forms Chart Documentation 48
History ­ Patient Care
Level 1
Level 2
· Obtains a neurologic · Obtains a complete
history.
and relevant
neurologic history.
Comments:
Neurological Exam ­ Patient Care
Level 1
Level 2
· Performs complete · Performs complete
neurological exam.
neurological exam
accurately.
Comments:
Level 3 · Obtains a complete, relevant, and organized neurologic history.
Level 4
Level 5
· Efficiently obtains a · Efficiently obtains a
complete, relevant,
complete, relevant,
and organized
and organized
neurologic history.
neurologic history
incorporating
subtle verbal and
nonverbal cues.
Level 3
Level 4
Level 5
· Performs a relevant · Efficiently performs · Consistently
neurological exam
a relevant
demonstrates
incorporating some
neurological exam
mastery in
additional
accurately
performing a
appropriate
incorporating all
complete, relevant,
maneuvers.
additional
and organized
· Accurately performs appropriate
neurological exam.
a neurological exam maneuvers.
on the comatose
· Accurately performs
patient.
a brain death
examination.
49
Localization ­ Medical Knowledge
Level 1
Level 2
· Attempts to localize · Localizes lesions to
lesions within the
general regions of
nervous system.
the nervous system.
· Describes basic
neuroanatomy.
Level 3 · Accurately localizes lesions to specific regions of the nervous system.
Level 4
Level 5
· Efficiently and
· Consistently
accurately localizes
demonstrates
lesions to specific
sophisticated and
regions of the
detailed knowledge
nervous system.
of neuroanatomy in
· Describes advanced
localizing lesions.
neuroanatomy.
Comments:
50
Formulation ­ Medical Knowledge
Level 1
Level 2
· Summarizes history · Summarizes key
and exam findings.
elements of history
and exam findings.
· Identifies relevant
pathophysiologic
categories to
generate a broad
differential
diagnosis.
Comments:
Level 3
Level 4
Level 5
· Synthesizes
· Efficiently
· Consistently
information to focus synthesizes
demonstrates
and prioritize
information to focus sophisticated and
diagnostic
and prioritize
detailed knowledge
possibilities.
diagnostic
of pathophysiology
· Correlates the
possibilities.
in diagnosis.
clinical presentation · Accurately
· Effectively educates
with basic anatomy
correlates the
others about
of the disorder.
clinical presentation diagnostic
with detailed
reasoning.
anatomy of the
disorder.
· Continuously
reconsiders
diagnostic
differential in
response to changes
in clinical
circumstances.
· Diagnoses brain
death.
51
Diagnostic Investigation ­ Medical Knowledge
Level 1
Level 2
· Demonstrates
· Discusses general
general knowledge
diagnostic approach
of diagnostic tests in appropriate to
neurology.
clinical presentation.
· Lists risks and
benefits of tests to
patient.
Level 3 · Individualizes diagnostic approach to the specific patient. · Accurately interprets results of common diagnostic tests.
Level 4 · Explains diagnostic · yield and cost effectiveness of testing. · Accurately interprets results of less common diagnostic testing. · Recognizes indications and implications of genetic testing. · Recognizes indications of advanced imaging and other diagnostic studies.
Level 5 Demonstrates sophisticated knowledge of diagnostic testing and controversies.
Comments:
52
Management/Treatment ­ Patient Care
Level 1
Level 2
· Demonstrates basic · Discusses general
knowledge of
approach to initial
management of
treatment of
patients with
common neurologic
neurologic disease.
disorders, including
risks and benefits of
treatment.
· Identifies neurologic
emergencies.
Level 3 · Individualizes treatment for specific patients. · Initiates management for neurologic emergencies and triage patient to appropriate level of care. · Appropriately requests consultations from non-neurologic care providers for additional evaluation and management.
Level 4
Level 5
· Adapts treatment · Demonstrates
based on patient
sophisticated
response.
knowledge of
· Identifies and
treatment
manages
subtleties and
complications of
controversies.
therapy.
· Independently
directs management
of patients with
neurologic
emergencies.
· Appropriately
requests
consultations from a
neurologic
subspecialist for
additional
evaluation or
management.
Comments:
53
Movement Disorders ­ Patient Care
Level 1
Level 2
· Recognizes when a · Identifies movement
patient may have a
disorder
movement disorder. phenomenology and
categories
(hypokinetic and
hyperkinetic).
Level 3
Level 4
· Diagnoses and
· Diagnoses
·
manages common
uncommon
movement
movement
disorders.
disorders.
· Identifies movement · Appropriately refers ·
disorder
a movement
emergencies.
disorder patient for
a surgical evaluation
or other
interventional
therapies.
· Manages movement
disorders
emergencies.
Level 5 Manages uncommon movement disorders. Engages in scholarly activity in movement disorders (e.g., teaching, research).
Comments:
54
Neuromuscular Disorders ­ Patient Care
Level 1
Level 2
· Recognizes when a · Identifies patterns of
patient may have a
neuromuscular
neuromuscular
disease (e.g.,
disorder.
anterior horn cell
disease, nerve root,
plexus, peripheral
nerve,
neuromuscular
junction, muscle).
· Identifies
neuromuscular
disorder
emergencies.
· Orders NCS/EMG
testing
appropriately.
Level 3 · Diagnoses and manages common neuromuscular disorders. · Manages neuromuscular disorder emergencies. · Interprets results of NCS/EMG testing in context of clinical presentation.
Level 4 · Diagnoses uncommon neuromuscular disorders. · Recognizes when tissue biopsy is warranted.
Level 5 · Manages uncommon neuromuscular disorders. · Engages in scholarly activity in neuromuscular disorders (e.g., teaching, research).
Comments:
55
Cerebrovascular Disorders­ Patient Care
Level 1
Level 2
· Recognizes when a · Describes stroke
patient may have a
syndromes and
cerebrovascular
etiologic subtypes.
disorder.
· Identifies
cerebrovascular
emergencies.
· Lists indications and
contraindications for
intravenous
thrombolytic
therapy.
Level 3 · Identifies specific mechanism of patient's cerebrovascular disorder. · Appropriately refers for interventional or surgical evaluation. · Manages common cerebrovascular disorders including appropriate use of thrombolytics.
Level 4 · Diagnoses uncommon cerebrovascular disorders.
Level 5 · Manages uncommon cerebrovascular disorders. · Engages in scholarly activity in cerebrovascular disorders (e.g., teaching, research).
Comments:
56
Cognitive/Behavioral Disorders­ Patient Care
Level 1
Level 2
Level 3
Level 4
Level 5
· Recognizes when a · Identifies common · Diagnoses and
· Diagnoses and
· Engages in
patient may have a
cognitive/behavioral manages common
manages
scholarly activity in
cognitive/behaviora disorders.
cognitive/behaviora uncommon
cognitive/behavior
l disorder.
l disorders,
cognitive/behaviora al disorders (e.g.,
including cognitive
l disorders.
teaching, research).
effects of traumatic
· Demonstrates
brain injury.
sophisticated
· Manages behavioral
knowledge of
complications of
advanced
cognitive/behaviora
diagnostic testing
l disorders.
and controversies.
· Appropriately refers
for
neuropsychological
testing in evaluating
patients with
cognitive/behaviora
l disorders.
Comments:
57
Demyelinating Disorders ­ Patient Care
Level 1
Level 2
· Recognizes when a · Diagnoses and
patient may have a
manages common
demyelinating
demyelinating
disorder.
disorders.
Level 3 · Recognizes uncommon demyelinating disorders. · Manages acute presentations of demyelinating disorders.
Level 4 · Diagnoses uncommon demyelinating disorders.
Comments:
Level 5 · Manages uncommon demyelinating disorders · Engages in scholarly activity in demyelinating disorders (e.g., teaching, research).
58
Epilepsy ­ Patient Care
Level 1
Level 2
· Recognizes when a · Identifies epilepsy
patient may have
phenomenology, and
had a seizure.
classification of
seizures and
epilepsies.
· Diagnoses
convulsive status
epilepticus.
Level 3 · Diagnoses and manages common seizure disorders and provides antiepileptic drug treatment. · Diagnoses nonconvulsive status epilepticus. · Manages convulsive and non-convulsive status epilepticus.
Level 4
Level 5
· Diagnoses
· Manages
uncommon seizure
uncommon seizure
disorders.
disorders.
· Appropriately refers · Engages in
an epilepsy patient
scholarly activity in
for surgical
epilepsy (e.g.,
evaluation or other
teaching, research).
interventional
therapies.
Comments:
59
Headache Syndromes­ Patient Care
Level 1
Level 2
· Recognizes common · Diagnoses and
headache
manages common
syndromes.
headache
syndromes.
· Identifies headache
emergencies.
Comments:
Level 3 · Recognizes uncommon headache syndromes. · Diagnoses and manages headache emergencies.
Level 4 · Diagnoses and manages uncommon headache syndromes.
Level 5 · Engages in scholarly activity in headache syndromes (e.g., teaching, research).
Neurologic Manifestations of Systemic Disease­ Patient Care
Level 1
Level 2
Level 3
· Recognizes when a · Diagnoses and
· Recognizes
patient's neurologic manages common
uncommon
symptoms may be
neurologic
neurologic
due to systemic
manifestations of
manifestations of
illness.
systemic diseases.
systemic disease.
· Identifies neurologic · Diagnoses and
emergencies due to
manages neurologic
systemic disease.
emergencies due to
systemic disease.
Comments:
Level 4 · Diagnoses and manages uncommon neurologic manifestations of systemic disease.
Level 5 · Engages in scholarly activity in neurologic manifestations of systemic disease (e.g., teaching, research).
60
Child Neurology for the Adult Neurologist ­ Patient Care
Level 1
Level 2
Level 3
Level 4
Level 5
· Obtains basic
· Lists the elements of · Obtains a complete · Initiates
· Diagnoses
neurologic history of a neurological
and age-appropriate management of
uncommon
infants and children. examination of
neurologic history
common childhood
childhood
infants and children. of infants and
neurologic
neurologic
· Recognizes broad
children.
disorders.
disorders.
patterns of
· Performs a
· Initiates
neurologic disease
complete and age-
management of
in infants and
appropriate
common neurologic
children.
neurological
emergencies in
· Lists normal
examination of
infants and children.
developmental
infants and children.
milestones.
· Diagnoses common
child neurologic
disorders.
Comments:
61
Neuro-Oncology­ Patient Care
Level 1
Level 2
· Recognizes common · Identifies neuro-
clinical
oncological
presentations of a
emergencies and
brain or spine mass. initiates
management.
Comments:
Level 3
Level 4
Level 5
· Provides differential · Appropriately refers · Engages in
diagnosis of brain or for advanced
scholarly activity in
spine mass.
testing, including
neuro-oncology
· Identifies neurologic biopsy.
(e.g., teaching,
complications due · Manages neurologic
research).
to cancer or the
complications due
treatment of cancer. to cancer or the
treatment of cancer.
62
Psychiatry for the Adult Neurologist ­ Patient Care
Level 1
Level 2
Level 3
Level 4
Level 5
· Recognizes when a · Identifies common · Recognizes when a · Diagnoses common · Engages in
patient may have a
psychiatric
patient's
psychiatric
scholarly activity in
psychiatric disorder. disorders.
neurological
disorders.
psychiatric
· Obtains an
· Identifies psychiatric symptoms are of · Initiates
disorders (e.g.,
appropriate
co-morbidities in
psychiatric origin.
management of
teaching, research)
psychiatric history.
patients with a
· Recognizes when a
psychiatric co-
neurologic disease.
patient's psychiatric morbidities in
symptoms are of
patients with a
neurologic origin.
neurologic disease.
· Identifies major side
effects of psychiatric
medications.
Comments:
63
Neuroimaging­ Patient Care
Level 1
Level 2
· Identifies basic
· Recognizes
neuroanatomy on
emergent imaging
brain MR and CT.
findings on brain MR
and CT.
· Identifies basic
neuroanatomy on
spine MR and CT.
· Identifies major
vascular anatomy on
angiography.
Level 3 · Describes abnormalities of the brain and spine on MR and CT. · Identifies major abnormalities on angiography.
Level 4 · Interprets MR and CT neuroimaging of brain and spine.
Level 5 · Identifies subtle abnormalities on angiography. · Interprets carotid and transcranial ultrasound.
Comments:
64
Electroencephalogram (EEG) ­ Patient Care
Level 1
Level 2
· Explains an EEG
· Uses appropriate
procedure in
terminology related
nontechnical terms. to EEG (e.g.,
montage, amplitude,
frequency).
Level 3 · Describes normal EEG features of wake and sleep states. · Recognizes EEG patterns of status epilepticus. · Recognizes common EEG artifacts.
Level 4 · Interprets common · EEG abnormalities and creates a report. · Recognizes normal · EEG variants.
Level 5 Interprets uncommon EEG abnormalities. Describes normal and some abnormal EEG features of wake and sleep states in children.
Comments:
65
Nerve Conduction Studies (NCS)/Electromyography (EMG)­ Patient Care
Level 1
Level 2
Level 3
Level 4
· Explains an
· Uses appropriate
· Describes NCS/EMG · Interprets NCS/EMG ·
NCS/EMG procedure terminology related
data.
data in common
in nontechnical terms.
to NCS/EMG.
· Lists NCS/EMG
disorders.
findings in common · Describes common
disorders.
pitfalls of NCS/EMG.
· Formulates basic
NCS/EMG plan for
specific, common
clinical
presentations.
Level 5 Performs, interprets, and creates a report for NCS/EMG.
Comments:
Lumbar Puncture­ Patient Care
Level 1
Level 2
· Lists the indications · Lists the
and
complications of
contraindications
lumbar puncture
for lumbar puncture. and their
management.
Comments:
Level 3 · Performs lumbar puncture under direct supervision.
Level 4 · Performs lumbar puncture without direct supervision.
Level 5 · Performs lumbar puncture on patients with challenging anatomy.
66
Compassion, integrity, accountability, and respect for self and others - Professionalism
Level 1
Level 2
Level 3
Level 4
Level 5
· Demonstrates
· Demonstrates
· Demonstrates
· Mentors others in · Engages in
compassion,
appropriate steps to compassionate
the compassionate
scholarly activity
sensitivity, and
address impairment practice of
practice of
regarding
responsiveness to
in self.
medicine, even in
medicine, even in
professionalism.
patients and families.
· Consistently demonstrates
context of disagreement with
context of disagreement with
· Demonstrates non-
professional
patient beliefs.
patient beliefs.
discriminatory
behavior including · Incorporates
· Mentors others in
behavior in all
dress and
patients' socio-
sensitivity and
interactions,
timeliness.
cultural needs and
responsiveness to
including diverse
beliefs into patient
diverse and
and vulnerable
care.
vulnerable
populations.
· Demonstrates
populations.
· Describes effects of
appropriate steps to · Advocates for
sleep deprivation
address impairment quality patient care.
and substance abuse
in colleagues.
on performance.
Comments:
67
Knowledge about, respect for, and adherence to the ethical principles relevant to the practice of medicine;
remembering in particular that responsiveness to patients that supersedes self-interest is an essential aspect of medical practice - Professionalism
Level 1
Level 2
Level 3
Level 4
Level 5
· Describes basic
· Determines
· Analyzes and
· Analyzes and
· Demonstrates
ethical principles.
presence of ethical
manages ethical
manages ethical
leadership and
issues in practice.
issues in
issues in complex
mentorship on
straightforward
clinical situations.
applying ethical
clinical situations.
principles.
Comments:
Relationship development, teamwork and managing conflict - Interpersonal and Communication Skills
Level 1
Level 2
Level 3
Level 4
Level 5
· Develops a positive · Manages simple · Manages conflict in · Manages conflict · Engages in
relationship with
patient/family-
complex situations.
across specialties
scholarly activity
patients in uncomplicated
related conflicts. · Uses easy-to-
· Engages patients in
understand
and systems of care.
regarding teamwork and
situations.
shared decision-
language in all
· Leads team-based
conflict
· Actively
making.
phases of
patient care
management.
participates in
communication.
activities.
team-based care.
Comments:
68
Information Sharing, Gathering and Technology - Interpersonal and Communication Skills
Level 1
Level 2
Level 3
Level 4
Level 5
· Effectively
· Effectively
· Effectively
· Effectively leads · Develops patient
communicates
communicates
communicates the
family meetings.
education
during patient hand overs using a
during team meetings, discharge
results of a neurologic
· Effectively and ethically uses all
materials. · Engages in
structured
planning and other
consultation in a
forms of
scholarly activity
communication
transitions of care.
timely manner.
communication
regarding
tool.
· Educates patients
· Completes
about their disease
documentation in a and management,
timely fashion.
including risks and
· Accurately
benefits of
· Effectively gathers information from collateral sources when necessary. · Demonstrates
· Mentors colleagues in timely, accurate, and efficient documentation.
interpersonal communication.
documents
treatment options.
synthesis,
transitions of care. · Completes all
formulation and
documentation
thought process in
accurately,
documentation.
including use of
EHR, to promote
patient safety.
Comments:
69
Self-Directed Learning ­ Practice Based Learning and Improvement
· Identify strengths, deficiencies, and limits in one's knowledge and expertise.
· Set learning and improvement goals.
· Identify and perform appropriate learning activities.
· Use information technology to optimize learning.
Level 1
Level 2
Level 3
Level 4
· Acknowledges gaps · Incorporates
· Develops an
· Completes an
in knowledge and
feedback.
appropriate
appropriate
expertise.
learning plan based learning plan based
upon clinical
upon clinical
experience.
experience.
Level 5 · Engages in scholarly activity regarding practicebased learning and improvement.
Comments:
Locate, appraise and assimilate evidence from scientific studies related to their patient's health problems - Practice Based Learning and Improvement
Level 1
Level 2
Level 3
Level 4
Level 5
· Uses information · Uses scholarly
· Critically evaluates · Incorporates
· Engages in
technology to
articles and
scientific literature. appropriate
scholarly activity
search and access
guidelines to
evidence-based
regarding evidence
relevant medical
answer patient care
information into
based medicine.
information.
issues.
patient care.
· Understands the
limits of evidence-
based medicine in
patient care.
Comments:
70
Systems Thinking including cost and risk effective practice - Systems-Based Practice
Level 1
Level 2
Level 3
Level 4
Level 5
· Describes basic cost · Describes cost and · Makes clinical
· Incorporates
· Engages in
and risk
risk benefit ratios
decisions that
available quality
scholarly activity
implications of
in patient care.
balance cost and
measures in patient regarding cost and
care.
risk benefit ratios.
care.
risk effective
practice.
Comments:
Residents will work in inter-professional teams to enhance patient safety - Systems-Based Practice
Level 1
Level 2
Level 3
Level 4
Level 5
· Describes team
· Identifies and
· Describes potential · Participates in a
· Engages in
members' roles in
reports errors and
sources of system
team based
scholarly activity
maintaining patient near-misses.
failure in clinical
approach to
regarding error
safety.
care such as minor,
medical error
analysis and patient
major, and sentinel
analysis.
safety.
events.
Comments:
71
72
73
Elements and Style of Notes, Consults, Discharge Summaries and Correspondence General Concepts: · All the notes written in O2 need to be cosigned by the attending physician (regardless the attending physician evaluated the patient at bedside or not). · Patients seen on call, while discussed with the night attending are assigned to the daytime ward/consult/stroke attending for signature (and billing) · Document the physician that you discussed the case with, by name, by service (e.g. vascular neurology) is not acceptable. · If you examined the patient with the physician, state I examined the patient with Dr. X. · Quick update notes are not allowed unless the quick update note is an addendum to a full note. · Impression and plan are separate paragraphs. · No cutting and pasting notes, either yours or someone else's. The conclusion when you copy one of your prior notes is that you did not examine the patient at all, because there is no evidence that you did. Copying someone else's note is plagiarism. Repeated plagiarism is grounds for disciplinary action or dismissal from the program. · Elements and Style of a good History and Physical The purposes of an admission History and Physical note are: · To document why the patient is being admitted and what problems are to be addressed · To communicate with other health care provides, both now and in the future · To document the clinical history and findings at a set point in time · To convey your clinical reasoning through the assessment and plan Before graduation a competent resident should be able to document an admission History and Physical in 10 minutes. History of present illness: What has led to this admission. This must include the complaint, the time course, diagnostic work up and therapeutic trials Medical and Surgical History: Document other illnesses and interventions Social History: Document social aspects of the patient that are important to this problem or their overall health. Medications: Self-evident Review of Systems: Both neurological and general 74
Examination: General Neurological: Mental status: Orientation, ability to comprehend and to express themselves, if appropriate clinic cognitive test results (SLUMS, MOCA, set generation, similarities, apraxia testing); and if not normal, and the level of consciousness. Cranial Nerve Examination Document all 12. Yes it is important to test smell, the function of CN I. While ophthalmoscopes are available in the clinics, resident should have their own. Motor Document: bulk, tone (resistance to passive movement), strength using Medical Research Council of Great Britain (MRC) scale. May also include tests of minimal distal weakness such as a pronator drift of Alter's sign. Sensory Document peripheral modalities: light touch, pinprick, pressure, temperature, 128 Hz tuning fork vibration, and proprioception; and when appropriate central sensation: graphesthesia, stereognosis, finger identification. Documentation must include any abnormalities between sides, proximal vs. distal and the presence of a sensory level. The Romberg test is a test of posterior column proprioception function, by looking for a difference between eyes open and eyes close conditions. Coordination Document postural stability while seated, rapid alternating tasks, stance, gait; and when appropriate finger-to-finger nose, heel-to-shin, standing on tip toes or standing on heels, praxis testing, tandem gait, reverse tandem gait, standing on one leg, and reverse tandem gait on heels. Reflexes: Muscle stretch reflexes from both sides are documented, including the presence or absence of pathological and primitive reflexes (if appropriate). Please remember that historically normal reflexes were documented as ++, not 2+. Abnormal movements: Describe the abnormal movements, if necessary by body region, include the results of distraction. Assessment: What is going on, what might be going on Plan: What is going to happen, why, and that you discussed this with the patient, and when appropriate their family members, and with the attending physician. Include proposed tests and treatments. Progress Notes: Are in a SOAP note format 75
Subjective: of what are the patients complaints are on the day of assessment, and anything of note that has happened since the last note Objective: Physical exam on the that date (not a copied note from the ICU that still says pt on the floor is intubated, see section above on plagiarism) Assessment: Impression of what the patient's current problems are and what is the trend Plan: Plan for the day and potentially the rest of the hospital stay. To benefit the resident's thought processes, this will need to be in a problem based or system based format so as to not over look anything. Elements and Style of a Good Discharge Summary The purposes of a Discharge Summary are: · Document for other health care professionals why the patient was admitted and what happened. · Provide for continuity of care A discharge summary should be brief, but inclusive. With the electronic health record it is easy look up the results of laboratory, imaging, and clinical test results for any given day. Suggested outline: History of Present Illness: Why they were admitted, including the chief complaint, time course of the illness prior to the hospitalization and pertinent findings on admission clinical examination and initial studies. Include relevant admission medications (e.g. phenytoin dose and route if they were admitted for phenytoin toxicity or break through seizures). Hospital course: In general terms, not day-by-day unless this is important for the future care of the patient. Pertinent labs and completed investigation: These are the results of key imaging studies , lipid studies, HgBA1c , CSF etc. Discharge diagnoses: Primary diagnosis first. This should outline the thought process for establishing the diagnosis Discharge medications: self-evident Discharge disposition: where are they going, what follow-up has been arranged or is needed Follow-up appointment: who they are to see, where (LCOA, Indian Creek, etc) and when. Pending studies and results: While this is self evident, you must clearly document these elements: · Pending laboratory or imaging studies, pending therapies, transfer of care to the responsible health care provider, and acknowledgement that the communication has occurred. · If warfarin is started, outline and arrange as to who will follow the INR · Immunotherapies: what follow laboratories are needed, additional treatment, and who has accepted responsibility to follow them · Further testing: e.g. repeat LP, repeat imaging 76
Be certain that the patient's primary care physician, appropriate specialists and any physicians that will be assuming care of the patient are sent copies of the discharge summary. 77
Elements and Style of a good daily Progress Note The purpose of the daily progress note is: · To document what has happened, · How the patient is doing, · What your clinical thinking is and · What is going to happen next. Interval History: what has happened since the last note. Additional medical, family, social history or review of systems: self-evident. Examination: This can be either brief, documenting any changes, or extensive. Do not copy and paste from prior days. Pertinent study results: laboratory, imaging, consult recommendations Pending results: self evident Assessment: What you think is going on Plan: what you are going to do. 78
Elements and Style of a Good Clinic Note The purposes of a clinic note are: · To communicate with other health care provides, both now and in the future · To document the clinical history and findings at a set point in time · To convey your clinical reasoning through the assessment and plan Before graduation a competent resident should be able to document a hospital progress note or a return clinic visit in five to seven minutes; and an admission History and Physical, transfer note, or new patient clinic visit in 10 minutes. History of present illness: What has led up to this visit for a new patient, what has happened since the last visit for a return encounter. For a new patient this must include the complaint, the time course, diagnostic work up and therapeutic trials Medical and Surgical History: Document other illnesses and interventions Social History: Document social aspects of the patient that are important to this problem or their overall health. Medications: Self-evident Review of Systems: Both neurological and general Examination: General Neurological: Mental status: Orientation, ability to comprehend and to express themselves, if appropriate clinic cognitive test results (SLUMS, MOCA, set generation, similarities, apraxia testing); and if not normal, and the level of consciousness. Cranial Nerve Examination Document all 12. Yes it is important to test smell, the function of CN I. While ophthalmoscopes are available in the clinics, resident should have their own. Motor Document: bulk, tone (resistance to passive movement), strength using Medical Research Council of Great Britain (MRC) scale. May also include tests of minimal distal weakness such as a pronator drift of Alter's sign. Sensory Document peripheral modalities: light touch, pinprick, pressure, temperature, 128 Hz tuning fork vibration, and proprioception; and when appropriate central sensation: graphesthesia, stereognosis, 79
finger identification. Documentation must include any abnormalities between sides, proximal vs. distal and the presence of a sensory level. The Romberg test is a test of posterior column proprioception function, by looking for a difference between eyes open and eyes close conditions. Coordination Document postural stability while seated, rapid alternating tasks, stance, gait; and when appropriate finger-to-finger nose, heel-to-shin, standing on tip toes or standing on heels, praxis testing, tandem gait, reverse tandem gait, standing on one leg, and reverse tandem gait on heels. Reflexes: Muscle stretch reflexes from both sides are documented, including the presence or absence of pathological and primitive reflexes (if appropriate). Please remember that historically normal reflexes were documented as ++, not 2+. Abnormal movements: Describe the abnormal movements, if necessary by body region, include the results of distraction. Assessment: What is going on, what might be going on Plan: What is going to happen, why, and that you discussed this with the patient, and when appropriate their family members. Include tests, treatments, next clinic visit or how you are going to be in touch with them. 80
Elements and Style of good correspondence The purpose of medical correspondence to inform other health care practitioners of the results of your clinical encounter with the patient. This is mainly a matter of style. Some choose to send a copy of their complete clinical encounter note. Others prefer an extremely brief summary of just a few sentences. And lastly, some prefer to combine a brief letter with an attached copy of the clinical encounter note. 81
EMG Rotation Curriculum PGY3 or 4 Description of Rotation or Educational Experience Supervising faculty responsible for reviewing Goals and Objectives: Mazen Dimachkie, MD Additional faculty: Richard Barohn, MD, Richard Dubinsky, MD, MPH; Nancy Hammond, MD, April McVey, MD; Mamatha Pasnoor, MBBS, Yunxia Wang, MD, Melanie Glenn MD This one-month rotation is devoted to the technical components of performing nerve conduction studies and electromyograms (EMGs), and to the clinical evaluation and management of patients with neuromuscular disorders. 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 From the RRC: Must have clinical teaching rounds supervised by faculty. These rounds must occur at least five days per week. Residents must present cases and their diagnostic and therapeutic plans; The training must include the indications for and limitations of clinical neurodiagnostic tests and their interpretation. Residents must learn to correlate the information derived from these neurodiagnostic studies with the clinical history and examination in formulating a differential diagnosis and management plan; Must receive instruction in appropriate and compassionate methods of end-of-life palliative care, including adequate pain relief and psychosocial support and counseling for patients and family members about these issues; and, Objectives The PGY3 or PGY4 resident will: Develop a differential diagnosis in the inpatient and out patient setting, based upon the history and clinical examination and to test this differential diagnosis using EMG and NCS. Become proficient in the technical skills of nerve conduction studies and electromyography Improve their technical skills to the point where they can perform these studies independently and with minimal supervision. Become proficient in the evaluation and management of patients with neuromuscular disorders Become proficient in end-of-life and palliative care issues for patients with neuromuscular disorders 1
As measured by GCP, Checklist, Case Stimulated Recall, Focused Observation (Observation of Procedural Skills, 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 Must regularly attend seminars and conferences in the following disciplines: ... neuromuscular disease, EMG case conference, clinical neurophysiology, ... pain management, neuro-genetics, and general neurology. Residents must attend the gross and microscopic pathology conferences and Neuromuscular Journal Club. Must learn the basic sciences on which clinical neurology is founded, including neuroanatomy, basic neurophysiology, molecular biology, genetics, immunology; and, Must receive instruction in the principles of bioethics and in the provision of appropriate and cost-effective evaluation and treatment for patients with neurological disorders Objectives The PGY3 and PGY4 resident will: Attend subspecialty conferences in Neuromuscular medicine including: Journal Club, Biopsy Conference, and clinical neurophysiology and EMG lectures Demonstrate their knowledge and understanding of basic neurophysiology and clinical neurophysiology As measured by GCP, Focused Observation (Observation of Procedural Skills), RITE, and AANEM self assessment examination. All residents that rotate on EMG are required to sit for the AANEM in-service examination in May of the academic year. 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 and perform appropriate learning activities Incorporate formative evaluation feedback into daily practice Objectives The PGY3 and PGY4 resident will: Set learning and improvement goals Demonstrate their ability to identify areas of needed improvement in their knowledge to develop an independent reading plan 2
Incorporate formative evaluation feedback into daily practice The PGY4 resident will be able to do this independently As measured by GCP, CSR, Focused Observation 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 Not applicable Professionalism Goals 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 Respect for patient privacy and autonomy Objectives The PGY3 and PGY4 resident will: Demonstrate compassion and respect for others Demonstrate respect for patient privacy and autonomy As measured by GCP, CSR, 360o Evaluation 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 Maintain comprehensive, timely, and legible medical records Objectives The PGY3 and PGY4 resident will: Demonstrate the ability to communicate effectively with patients and their families Effectively communicate through written reports of EMG studies and clinic encounters As measured by GCP, CSR, Focused Observation, 360o Evaluation, 3
Teaching Methods What teaching methods are you using on this rotation or educational experience? Daily clinics and EMG sessions Presentation, review, and discussion of cases with attending faculty Interactive discussions Assessment Method (residents) How do you measure the resident's performance on this rotation or educational experience? Patient Care: GCP, Checklist, Focused Observation (Observation of Procedural Skills, Observation of Patient Care Encounter (SEGUE)), Case Logs Medical Knowledge: GCP, RITE, AANEM self assessment examination (optional) Practice-Based Learning: GCP, Systems Based Practice: GCP, Professionalism: GCP, 360o Evaluation, Interpersonal and Communication Skills: GCP, 360o Evaluation, Assessment Method (Program Evaluation) How do you evaluate whether this educational experience is effective? Monthly evaluation of the rotation by the resident Yearly program evaluation Twice-yearly evaluation of the resident and solicitation of feedback. Level of Supervision How is the resident supervised on this rotation? Daily direct supervision by faculty Educational Resources List the educational resources Educational CD containing a collection of critical references to the understanding of EMG and Neuromuscular Disorders is available on day 1 of the rotation as well as a loaner brief textbook on EMG and NCS. Please contact Dr. Dimachkie to receive those. Aids to the Examination of the Peripheral Nervous System, Saunders Limited, 4th edition, 2000. Aminoff M., Clinical Neurophysiology, 3rd Ed., Churchill Livingstone. Dawson DM, Hallett M, Wilbourn AJ, Campbell WW, Terrono AL, and Trepman E. Entrapment neuropathies, Lippincott Williams & Wilkins. Kandel ER, Schwarz JH, and Jessell TM. Principles of Neural Science, McGraw- Hill Medical. Kimura, J. Electrodiagnosis in Diseases of Nerve and Muscle, 3rd edition, Oxford University Press, 2001. Misulis KE and Head TC. Essentials of Clinical Neurophysiology, 3rd edition, Butterworth-Heinemann, 2002. 4
Practice Parameters from the American Academy of Neurology, are available for a large range of conditions, therapies, and assessment tools at AAN.com. Stewart JD. Focal Peripheral Neuropathies, 3rd edition, Lippincott Williams & Wilkins, 2000. Strunk W, White EB, and Kalman M. The Elements of Style Illustrated, Illustrate edition, The Penguin Press HC, 2000. Trusse L. Eats, Shoots & Leaves: The Zero Tolerance Approach to Punctuation, Reprint edition, Gotham, 2006. Amato and Russell, Neuromuscular Disorders Engel and Franzini-Armstrong, Myology, Dyck and Thomas, Peripheral Neuropathy, Mendell, Kissel, and Cornblath, Diagnosis and Management of Peripheral Nerve Disorders, Mitsumoto, Przedborski, and Gordon, Amyotrophic Lateral Sclerosis, Engel, Myasthenia Gravis and Myasthenic Disorders, Dumitru and Amato: Electrodiagnostic Medicine, Brown and Bolton, Clinical Electromyography, Levin and Lьders Comprehensive Neuromuscular Medicine, Preston and Shapiro Electromyography and Neuromuscular Disorders, Journals: Neurology Archives of Neurology Annals of Neurology Brain Stroke Journal of Neurology, Neurosurgery and Psychiatry Rev 6/30/2014 5
Epilepsy Curriculum Elective Rotation PGY3 or 4 Description of Rotation or Educational Experience Supervising faculty, responsible for review of Goals and Objectives: Nancy Hammond, MD Additional faculty: Patrick Landazuri, MD; Ivan Osorio, MD; Utku Uysal, MD; This is a one-month elective in the clinical evaluation and management of epilepsy, with exposure to the utility of EEG. The resident attends Epilepsy clinics, rounds with the Neurophysiology Epilepsy fellow, and interprets EEGs with the fellow and attending staff. They attend the scheduled subspecialty, didactic, ad Neurophysiology/Epilepsy conferences. 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 From the RRC: Must have clinical teaching rounds supervised by faculty. These rounds must occur at least five days per week. Residents must present cases and their diagnostic and therapeutic plans; Must have management responsibility for patients with neurological disorders. Objectives The PGY3 or PGY4 resident will: Demonstrate proficiency in the evaluation and treatment of patients with epilepsy or suspected epilepsy Demonstrate the ability to counsel and educate patients and their families As measured by GCP, Checklist, Focused Observation (Observation of Procedural Skills, Observation of Patient Care Encounter (SEGUE)), Case Logs. 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 Must regularly attend seminars and conferences in the following disciplines: ...epilepsy, ... clinical neurophysiology, Must learn the basic sciences on which clinical neurology is founded, including neuroanatomy, neuropathology, neurophysiology, ... 1
Objectives The PGY3 or PGY4 resident will: Attend subspecialty conferences and didactic sessions. Demonstrate their understanding of the basic science aspects of clinical neurophysiology As measured by GCP, Focused Observation, RITE, and the ACNS examination 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 and perform appropriate learning activities Incorporate formative evaluation feedback into daily practice Objectives The PGY3 and PGY4 resident will: Demonstrate their ability set learning and improvement goals Demonstrate the ability to use information technology to optimize learning As measured by GCP 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 Not applicable Professionalism Goals 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 Respect for patient privacy and autonomy Objectives The PGY3 and PGY4 resident will: Demonstrate their compassion and respect for others and their respect for patient privacy and autonomy As measured by GCP, 360o Evaluation 2
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 Maintain comprehensive, timely, and legible medical records Objectives The PGY3 and PGY4 resident will: Communicate effectively with physicians, other health professionals, and health related agencies As measured by Focused Observation, 360o Evaluation, Teaching Methods What teaching methods are you using on this rotation or educational experience? Daily rounds Presentation, review, and discussion of cases with attending faculty Weekly lectures Interactive discussions Assessment Method (residents) How do you measure the resident's performance on this rotation or educational experience? Patient Care: GCP, Checklist Focused Observation (Observation of Procedural Skills,), Case Logs Medical Knowledge: GCP, RITE, ACNS exam Practice-Based Learning: GCP, Systems Based Practice: GCP Professionalism: Focused Observation, 360o Evaluation, Interpersonal and Communication Skills: GCP, 360o Evaluation, Assessment Method (Program Evaluation) How do you evaluate whether this educational experience is effective? Monthly evaluation of the rotation by the resident Yearly program evaluation Twice-yearly evaluation of the resident and solicitation of feedback. Level of Supervision How is the resident supervised on this rotation? Daily direct supervision by ward attending and other faculty Direct supervision by attending and other faculty 3
Direct supervision by clinic attending Educational Resources List the educational resources Aminoff M., Clinical Neurophysiology, 3rd Ed., Churchill Livingstone. Kandel ER, Schwarz JH, and Jessell TM. Principles of Neural Science, McGraw- Hill Medical. Young GB, Ropper AH, and Bolton CF. Coma and Impaired Consciousness: A Clinical Perspective, McGraw-Hill Professional. Journals: Neurology Archives of Neurology Annals of Neurology Brain Epilepsy Stroke Journal of Neurology, Neurosurgery and Psychiatry Rev 6/30/14 4
Kansas City VAMC Consults Curriculum PGY3 and PGY4 Description of Rotation or Educational Experience Supervising Faculty for Rotation, responsible for review of Goals & Objectives: Timothy Frederick, MD Additional faculty:Kimberly Hatchett-Johnson, MD; Lipika Nayak, MBBS; One month rotation providing consultation service, stroke pager activation and Emergency Department (ED) coverage. This is one of the 18 months of inpatient and consult training mandated by the Neurology RRC This month is repeated in PGY3 and PGY4. Overall Goals: During the KU Consult rotation, residents are expected to be able to demonstrate and apply an evidence-based medicine approach to consultant based patient care that reflects an integration of basic science and clinical knowledge. Residents are expected to improve their skills in communication with patients, patients' families, and colleagues. They are expected to improve their skills in team management Residents will gain an understanding of neurological manifestations of systemic diseases and systemic manifestations of neurological diseases. 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 Evaluate patients admitted to other services with neurological disorders, or neurological manifestations of systemic disorders Objectives The PGY3 resident will: Quickly assimilate complex medication information to localize the lesion, Be able to generate and prioritize a differential diagnosis Develop and carry out patient treatment plans Become an effective teacher of medical students and rotating residents The 4 resident will: Counsel and educate patients and their families Collaborate with other health care professionals (including those from different disciplines) to provide patient-focused care 1
Develop and carry out patient treatment plans Demonstrate their proficiency in the evaluation and treatment of patients with neurological diseases in the Emergency Department and in the Intensive Care Unit. Become an effective teacher of medical students and rotating residents Develop competence for the practice of Neurology without direct supervision as measured by global performance evaluation and chart stimulated recall 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 Become proficient in the evaluation of ED patients and inpatients with neurological symptoms. Objectives The PGY3 resident on the neurology consult service will: Attend subspecialty conferences Be able to understand the neurological manifestation of systemic diseases and the systemic complications of neurological diseases Demonstrate level appropriate maturation in their medical knowledge The PGY4 resident on the neurology consult service will: Attend subspecialty conferences Be able to understand the neurological manifestation of systemic diseases and the systemic complications of neurological diseases Be able to incorporate new medical knowledge into their patient evaluations as measured by direct observation and chart stimulated recall. 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 Set learning and improvement goals Locate, appraise and assimilate evidence from scientific studies related to their patients' health problems Objectives The PGY3 residents will Set learning and improvement goals 2
Identify and perform appropriate learning activities Incorporate formative evaluation feedback into daily practice Participate in the education of patients, families, students, residents and other health professionals, as documented by evaluations of a resident's teaching abilities by faculty and/or learners Teach other residents, medical students, nurses, and other health care personnel, formally and informally. The PGY4 residents will Locate, appraise and assimilate evidence from scientific studies related to their patients' health problems Incorporate formative evaluation feedback into daily practice Participate in the education of patients, families, students, residents and other health professionals, as documented by evaluations of a resident's teaching abilities by faculty and/or learners Teach other residents, medical students, nurses, and other health care personnel, formally and informally. as measured by presentation and discussion with the attending faculty on daily basis. And by global clinical performance 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 Coordinate patient care within the health care system relevant to their clinical specialty Work in inter-professional teams to enhance patient safety and improve patient care quality Objectives The PGY3 resident will: Incorporate considerations of cost awareness and risk-benefit analysis in patient care The PGY4 resident will: Work in interprofessional teams to enhance patient safety and improve patient care quality as measured by Chart Stimulated Recall and 3600 evaluation. Professionalism Goal Residents must demonstrate a commitment to carrying out professional responsibilities and an adherence to ethical principles. Residents are expected to demonstrate: 3
Competencies Sensitivity and responsiveness to a diverse patient population, including but not limited to diversity in gender, age, culture, race, religion, disabilities, and sexual orientation Objectives The PGY3 will: Show beginning accountability to patients, society, and the profession The PGY4 will: Demonstrate accountability to patients, society, and the profession, at the level of a fully trained neurologist as measured by global performance evaluation. 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 physicians, other health professionals, and health related agencies Act in a consultative role to other physicians and health professionals Maintain comprehensive, timely, and legible medical records Objectives The PGY3 residents will: Communicate effectively with patients and families across a broad range of socioeconomic and cultural backgrounds Work effectively as a leader of a health care team or other professional group Act in a consultative role to other physicians and health professionals Maintain comprehensive, timely, and legible medical records The PGY4 residents will: Communicate effectively with physicians, other health professionals, and health related agencies Act in a consultative role to other physicians and health professionals Maintain comprehensive, timely, and legible medical records as demonstrated by chart stimulated recall and 360o evaluation. Teaching Methods What teaching methods are you using on this rotation or educational experience? Daily teaching rounds with attending faculty 4
Scheduled lectures Reading assignments Assessment Method (residents) How do you measure the resident's performance on this rotation or educational experience? Checklist: Direct supervision of resident performing history and clinical evaluation (PC, MK, PROF, LCS) RITE (MK) Checklist: Lumbar puncture proficiency (PC) Global Clinical Performance: Discussion of differential diagnosis, use of laboratory, patient management (PC, MK, SBL, PBL, LCS, PROF) Chart Stimulated Recall: (PC, MK, SBL, PBL, LCS) 360o evaluation (LCS, PROF) Chart review (LCS, PROF) Assessment Method (Program Evaluation) How do you evaluate whether this educational experience is effective? Monthly evaluation of the rotation by the resident Yearly program evaluation Twice-yearly evaluation of the resident and solicitation of feedback. Level of Supervision How is the resident supervised on this rotation? Direct supervision by faculty Educational Resources List the educational resources Plum F and Posner J. The Diagnosis of Stupor and Coma, 3rd edition, Oxford University Press, 1982. Practice Parameters from the American Academy of Neurology, are available for a large range of conditions, therapies, and assessment tools at AAN.com. Ropper AH and Brown RH. Adams and Victor's Principles of Neurology, 8th edition, McGraw-Hill Professional, 2005. Samuels MA and Feske SK. Office Practice of Neurology, Churchill Livingstone. Samuels MA. Hospitalist Neurology (Blue Books of Practical Neurology, Volume 19), 1st edition, Butterworth-Heinemann, 1999. Rev 6-30-2014 5
KC VAMC Clinic Rotation Curriculum PGY2 Description of Rotation or Educational Experience Supervising Faculty for Rotation, responsible for review of Goals & Objectives: Timothy Fredricks, MD Additional faculty: Kimberly Hatchett-Johnson, MD; Lipika Nayak, MBBS; One month rotation participating in the out patient clinics at the KC VAMC. The resident rotates through both general neurology and sub-specialty clinics. This rotation is repeated for a total of four months during PGY 2. The assignment to subspecialty clinics may be requested by the resident, but should be designed to have as broad an experience as possible among the many sub-specialty clinics. The resident is at the KC VAMC clinics except for their weekly longitudinal clinic at the Landon Center on Aging, Department of Neurology 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 The resident is to provide thorough, efficient, and compassionate patient care in the out patient setting. Objectives The PGY 2 resident will: Provide out patient care to patients with a wide range of neurological problems Become proficient in the evaluation and management in their care of neurology clinic patients Obtain an orderly and detailed history from the patient, in conducting a thorough general and neurological examination, and in organizing and recording data. Understand the indications for and limitations of clinical neurodiagnostic tests and their interpretation Demonstrate the provision of appropriate and cost-effective evaluation and treatment for patients with neurological disorders. as measured by chart stimulated recall, global clinical performance, case logs, 360o evaluation, and Focused Observation / checklist (NEX exam) 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: 1
Competencies The resident is to understand the basic pathophysiology of diverse neurological disorders and apply this knowledge to their daily management of clinic patients Objectives The PGY2 resident will: Demonstrate beginning knowledge in the organization of the nervous system and the ability to determine the location of the lesion as measured by direct observation 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; Identify and perform appropriate learning activities Use information technology to optimize learning Objectives The PGY2 resident will Demonstrate their ability to direct their learning activities as measured by: GCP, CSR, RITE 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 effectively in various health care delivery settings and systems relevant to their clinical specialty Coordinate patient care within the health care system relevant to their clinical specialty Incorporate considerations of cost awareness and risk-benefit analysis in patient care Advocate for quality patient care and optimal patient care systems Work in inter-professional teams to enhance patient safety and improve patient care quality Participate in identifying systems errors and in implementing potential systems solutions Objectives The PGY2 resident will: Demonstrate their ability to lead a multi-disciplinary consult team as measured by GCP and CSR. 2
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 Responsiveness to patient needs that supersedes self-interest Objectives The PGY2 resident will Compassion and respect towards their patients and be available when needed for clinical duties as measured by GCP and 360o evaluation 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 Act in a consultative role to other physicians and health professionals Maintain comprehensive, timely, and legible medical records Objectives The PGY2 resident will Demonstrate their ability to effectively communicate with other health care professionals through clinic notes and consultation reports as measured by GCP and 360o evaluation Teaching Methods What teaching methods are you using on this rotation or educational experience? Direct supervision by clinic attending Presentation, review and discussion of each case with the clinic attending Assessment Method (residents) How do you measure the resident's performance on this rotation or educational experience? Checklist: Direct supervision of resident performing history and clinical evaluation (PC, MK, PROF, LCS) RITE (MK) Global Clinical Performance: Discussion of differential diagnosis, use of laboratory, patient management (PC, MK, SBL, PBL, LCS, PROF) Chart Stimulated Recall: (PC, MK, SBL, PBL, LCS) 360o evaluation (LCS, PROF) Chart review (LCS, PROF) Assessment Method (Program Evaluation) How do you evaluate whether this educational experience is effective? 3
Monthly evaluation of the rotation by the resident Yearly program evaluation Twice-yearly evaluation of the resident and solicitation of feedback. Level of Supervision How is the resident supervised on this rotation? Direct supervision by clinic attending faculty Educational Resources List the educational resources Brazis PW, Masdeu JC, and Biller J. Localization in Clinical Neurology, 5th edition, Lippincott Williams & Wilkins, 2007. Bradley WG, Daroff RB, Fenichel GM, and Jankovic J. Neurology in Clinical Practice, 4th edition, Butterworth-Heinemann, 2003. Aids to the Examination of the Peripheral Nervous System, Saunders Limited, 4th edition, 2000. Cooper JR, Bloom FE, and Roth RH. The Biochemical Basis of Neuropharmacology, 8th edition, Oxford University Press. Practice Parameters from the American Academy of Neurology, are available for a large range of conditions, therapies, and assessment tools at AAN.com. Ropper AH and Brown RH. Adams and Victor's Principles of Neurology, 8th edition, McGraw-Hill Professional, 2005. Samuels MA and Feske SK. Office Practice of Neurology, Churchill Livingstone. Strunk W, White EB, and Kalman M. The Elements of Style Illustrated, Illustrate edition, The Penguin Press HC, 2000. Trusse L. Eats, Shoots & Leaves: The Zero Tolerance Approach to Punctuation, Reprint edition, Gotham, 2006. Journals: Neurology Archives of Neurology Annals of Neurology Brain Stroke Journal of Neurology, Neurosurgery and Psychiatry Rev 6/30/14 4
KU Consults Curriculum Required Rotation PGY3 and PGY4 Description of Rotation or Educational Experience Supervising Faculty/Chief of Service: Gary Gronseth The faculty who is on rotation the first day of each month is responsible for reviewing the Goals and Objectives at the start of each rotation Additional faculty: Collen Lechtenberg, MD, Yunxia Wang, MD, Kitty Husmann, MD, Michael Abraham, MD, Michael Ripee, MD Nancy Hammond, MD One-month rotation providing consultation service, stroke pager activation and Emergency Department (ED) coverage. This is one of the 18 months of inpatient and consult training mandated by the Neurology RRC This month is repeated in PGY2, PGY3 and PGY4. Overall Goals: During the KU Consult rotation, residents are expected to be able to demonstrate and apply an evidence-based medicine approach to consultant based patient care that reflects an integration of basic science and clinical knowledge. Residents are expected to improve their skills in communication with patients, patients' families, and colleagues. They are expected to improve their skills in team management Residents will gain an understanding of neurological manifestations of systemic diseases and systemic manifestations of neurological diseases. Progressive Responsibility: In PGY4 the resident is expected to become more involved in the teaching of neurology residents, rotating residents, medical students, and supervision of the KUH ward team. 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 Evaluate patients admitted to other services with neurological disorders, or neurological manifestations of systemic disorders Objectives The PGY3 resident will: Be able to localize the lesion Develop a comprehensive differential diagnosis 1
Develop and carry out patient management plans Competently perform all essential medical and invasive procedures Become an effective teacher of medical students and rotating residents The PGY4 resident will: Counsel and education patients and their families Collaborate with other health care professionals (including those from different disciplines) to provide patient-focused care Develop and carry out patient treatment plans Communicate quickly and efficiently with referring health care providers Competently perform all essential medical and invasive procedures Demonstrate their proficiency in the evaluation and treatment of patients with neurological diseases in the Emergency Department and in the Intensive Care Unit. Become an effective teacher of medical students and rotating residents Develop competence for the practice of Neurology without direct supervision As measured by global performance and chart stimulated recall 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 Become proficient in the evaluation of ED patients and inpatients with neurological symptoms. Objectives The PGY3 resident on the neurology consult service will: Be able to understand the neurological manifestation of systemic diseases and the systemic complications of neurological diseases Demonstrate maturation in their knowledge of neurology Provide cost effective care and treatment The PGY4 resident on the neurology consult service will: Demonstrate maturation in their knowledge of neurology Provide cost effective care and treatment As measured by direct observation, RITE, and chart stimulated recall. 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: 2
Competencies Set learning and improvement goals Locate, appraise and assimilate evidence from scientific studies related to their patients' health problems Objectives The PGY3 residents will Set learning and improvement goals Identify and perform appropriate learning activities Incorporate formative feedback into daily practice Participate in the education of patients, families, students, and residents and other health care professionals as determined by the faculty and other learners Teach other residents, medical students, nurses, and other health care personnel, formally and informally. The PGY4 residents will Locate, appraise and assimilate evidence from scientific studies related to their patients' health problems Use information technology to optimize learning Participate in the education of patients, families, students, and residents and other health care professionals as determined by the faculty and other learners Teach other residents, medical students, nurses, and other health care personnel, formally and informally. As measured by presentation and discussion with the attending faculty on daily basis. And by global clinical performance 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 Coordinate patient care within the health care system relevant to their clinical specialty Work in inter-professional teams to enhance patient safety and improve patient care quality Objectives The PGY3 resident will: Incorporate considerations of cost awareness and risk-benefit analysis in patient care Demonstrate comprehensive hand-off of patients to the residents covering on the weekends and holidays The PGY4 resident will: 3
Work in inter-professional teams to enhance patient safety and improve patient care quality Demonstrate comprehensive hand-off of patients to the residents covering on the weekends and holidays As measured by Chart Stimulated Recall and 3600 evaluation. Professionalism Goal Residents must demonstrate a commitment to carrying out professional responsibilities and an adherence to ethical principles. Residents are expected to demonstrate: Competencies Sensitivity and responsiveness to a diverse patient population, including but not limited to diversity in gender, age, culture, race, religion, disabilities, and sexual orientation Objectives The PGY3 residents will: Demonstrate sensitivity and responsiveness to the diverse patient population seen on the neurology consultation service The PGY4 residents will: Demonstrate sensitivity and responsiveness to the diverse patient population seen on the neurology consultation service Demonstrate accountability to patients, society, and the profession As measured by global performance evaluation. 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 physicians, other health professionals, and health related agencies Act in a consultative role to other physicians and health professionals Maintain comprehensive, timely, and legible medical records Objectives The PGY3 residents will: 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 Work effectively as a leader of a health care team or other professional group Act in a consultative role to other physicians and health professionals 4
Maintain comprehensive, timely, and legible medical records The PGY4 residents will: Act in a consultative role to other physicians and health professionals Maintain comprehensive, timely, and legible medical records As demonstrated by chart stimulated recall and 360o evaluation. Teaching Methods What teaching methods are you using on this rotation or educational experience? Assessment Method (residents) How do you measure the resident's performance on this rotation or educational experience? Checklist: Direct supervision of resident performing history and clinical evaluation (PC, MK, PROF, LCS) RITE (MK) Checklist: Lumbar puncture proficiency (PC) Global Clinical Performance: Discussion of differential diagnosis, use of laboratory, patient management (PC, MK, SBL, PBL, LCS, PROF) Chart Stimulated Recall: (PC, MK, SBL, PBL, LCS) 360o evaluation (LCS, PROF) Chart review (LCS, PROF) Assessment Method (Program Evaluation) How do you evaluate whether this educational experience is effective? Monthly evaluation of the rotation by the resident Yearly program evaluation Twice-yearly evaluation of the resident and solicitation of feedback. Level of Supervision How is the resident supervised on this rotation? Direct supervision by faculty on daily rounds. Educational Resources List the educational resources Plum F and Posner J. The Diagnosis of Stupor and Coma, 3rd edition, Oxford University Press, 1982. Practice Parameters from the American Academy of Neurology, are available for a large range of conditions, therapies, and assessment tools at AAN.com. Ropper AH and Brown RH. Adams and Victor's Principles of Neurology, 8th edition, McGraw-Hill Professional, 2005. Samuels MA and Feske SK. Office Practice of Neurology, Churchill Livingstone. Samuels MA. Hospitalist Neurology (Blue Books of Practical Neurology, Volume 19), 1st edition, Butterworth-Heinemann, 1999. Reviewed 6-30-2015 5
KU Stroke Service Curriculum Required Rotation PGY2, 3 and 4 Description of Rotation or Educational Experience KU Stroke Service Supervising Faculty/Chief of Service: Gary Gronseth The faculty who is on rotation the first day of each month is responsible for reviewing the Goals and Objectives at the start of each rotation Additional faculty: Michael Abraham MD, Gary Gronseth, MD, Kitty Husmann, MD, Collen Lechtenberg, MD, Manoj Mittal, MBBS, Michael Rippee, MD, Lee Rosterman, DO, Yunxia Wang, MD, One month long rotation providing medical care to inpatients with cerebrovascular disease on the Neurology service at the University of Kansas Hospital. This is one of the 18 months of inpatient and consult training mandated by the Neurology RRC This month is repeated during PGY2-4. Overall Goals: During the KU Stroke rotation, residents are expected to be able to demonstrate and apply an evidence-based medicine approach to the care of patients with stroke, or suspected stroke, and stroke mimics that reflects an integration of basic science and clinical knowledge. Residents are also expected to improve their skills with the neurological examination, rapid interpretation of neuroimaging studies for suspected stroke, communication skills with patients, patients' families, and colleagues. Residents will gain an understanding of cerebrovascular diseases and the management of cerebrovascular disorders encountered in the Emergency Department and in the inpatient setting. Over the course of neurology residency, the resident will handle increasing responsibility as demonstrated by managing patients with more complex disorders, more thorough and rapid evaluation of patients, providing care for a higher number of patients and effectively teaching rotating residents and medical students about neurology. 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 Evaluate and manage patients with neurological disorders and neurological manifestation of systemic diseases 1
Objectives The PGY2 resident in neurology will: Perform an efficient and thorough general physical examination highlighting stroke risk factors Be NIHSS certified in their first month of training Perform an efficient and thorough neurological examination and NIHSS Interpret urgent neuroimaging studies, primarily CT, CTA and MRI Assess for appropriate acute stroke therapy Provide ongoing inpatient care for the patient who has survived a stroke As measured by checklist (direct observation), global clinical performance, and chart stimulated recall. In addition the PGY3 and 4 residents in neurology will: Triage patients with stroke disorders and stroke mimics Interpret urgent neuroimaging studies including MRA, MRV and carotid, vertebral and cerebral angiograms and venograms. Assess for appropriate acute stroke therapy Initiate stroke therapy including r-tPA and consultation for neuro-invasive procedures As measured by checklist (direct observation), global clinical performance, and chart stimulated recall. 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 The resident must learn the basic sciences on which clinical neurology is founded and integrate them into their evaluation and treatment of patients. This includes knowledge of neuroanatomy, neuropathology, neurophysiology, neuroimaging, neuropsychology, neural development, neurochemistry, neuropharmacology, molecular biology, genetics, immunology, epidemiology, and statistics. Objectives The PGY2-4 resident will; Improve their fund of knowledge appropriate for the level of training Become familiar with modifiable and non-modifiable risk factors for stroke Provide cost effective evaluation and treatment as measured by checklist (witnessed examination), global clinical performance and Resident In-service Training Examination (RITE). 2
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 Set learning and improvement goals Participate in the education of patients, families, students, residents and other health professionals, as documented by evaluations of a resident's teaching abilities by faculty and/or learners Objectives The PGY2-4 resident will Incorporate formative evaluation feedback into their daily practice of neurology Participate in the education of patients, families, students, residents and other health professionals The more advanced residents will counsel patients and family members on the recovery from stroke and the necessary lifestyle and medication changes to make to reduce the chance of secondary stroke As measured by checklist (witnessed examination) global clinical performance 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 Coordinate patient care within the health care system relevant to their clinical specialty Incorporate considerations of cost awareness and risk-benefit analysis in patient care Objectives The PGY2-4 resident will; Coordinate patient care within the health care system Advocate for quality patient care and optimal patient care systems Become familiar with Tele-Stroke As measured by, chart stimulated recall and global clinical performance. Professionalism Goal Residents must demonstrate a commitment to carrying out professional responsibilities 3
and an adherence to ethical principles. Residents are expected to demonstrate: Competencies Respect for patient privacy and autonomy Sensitivity and responsiveness to a diverse patient population, including but not limited to diversity in gender, age, culture, race, religion, disabilities, and sexual orientation Objectives The PGY2-4 resident will demonstrate; In the process of providing care to inpatients, resident to demonstrates sensitivity to patient privacy, autonomy and diversity. Be responsive to patient primary and autonomy As measured by checklist (witnessed examination), global clinical performance, and 360o evaluation. 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 Maintain comprehensive, timely, and legible medical records Objectives The PGY2 resident will: The resident communicates effectively with patients and their families. Work effectively as a member of a health care team The resident maintains the medical record in a comprehensive, timely and legible manner As demonstrated by chart review and global clinical performance. The PGY3 and 4 resident will: The resident communicates effectively with patients and their families. Work effectively as a leader of a health care team The resident maintains the medical record in a comprehensive, timely and legible manner Urgently communicate between team members, attending physicians, radiologists, interventional neuro-radiologist, and ICU nurses and attending physicians. As demonstrated by chart review and global clinical performance. Teaching Methods What teaching methods are used on this rotation or educational experience? 4
Didactic lectures of specific topics, including the neurological examination, localization and evaluation of neurological disorders Assessment Method (residents) How do you measure the resident's performance on this rotation or educational experience? Checklist: Direct supervision of resident performing history and clinical evaluation (PC, MK, PROF, LCS) RITE (MK) Checklist: Lumbar puncture proficiency (PC) Global Clinical Performance: Discussion of differential diagnosis, use of laboratory, patient management (PC, MK, SBL, PBL, LCS, PROF) Chart Stimulated Recall: (PC, MK, SBL, PBL) 360o evaluation (LCS, PROF) Chart review (LCS, PROF) Assessment Method (Program Evaluation) How do you evaluate whether this educational experience is effective? Monthly evaluation of the rotation by the resident Yearly program evaluation Twice-yearly evaluation of the resident and solicitation of feedback. Level of Supervision How is the resident supervised on this rotation? Daily direct supervision by ward attending and other faculty The resident reviews every admission and consultation with the attending in a timely fashion. Attending neurologists are available 24 hours a day, 365.25 days a year.
Educational Resources
List the educational resources
·
Aminoff M., Neurology in General Medicine, Churchill Livingstone.
·
Flaherty, A. The Massachusetts General Hospital Handbook of Neurology,
Lippincott Williams & Wilkins.
·
Marshall RS and Mayer SA. On Call Neurology: On Call Series, Saunders.
·
Plum F and Posner J. The Diagnosis of Stupor and Coma, 3rd edition, Oxford
University Press, 1982.
·
Practice Parameters from the American Academy of Neurology, are available for
a large range of conditions, therapies, and assessment tools at AAN.com.
·
Ropper AH and Brown RH. Adams and Victor's Principles of Neurology, 8th
edition, McGraw-Hill Professional, 2005.
·
Strunk W, White EB, and Kalman M. The Elements of Style Illustrated, Illustrate
edition, The Penguin Press HC, 2000.
·
Trusse L. Eats, Shoots & Leaves: The Zero Tolerance Approach to Punctuation,
Reprint edition, Gotham, 2006.
5
Journals: Neurology Archives of Neurology Journal of Neurology, Neurosurgery, and Psychiatry Annals of Neurology Brain Stroke
Rev. 6/30/2015
6
KU Ward Service Curriculum Required Rotation PGY2 Description of Rotation or Educational Experience KU Ward Service Supervising Faculty/Chief of Service: Gary Gronseth The faculty who is on rotation the first day of each month is responsible for reviewing the Goals and Objectives at the start of each rotation Additional faculty: , Michael Abraham MD; Kitty Husmann, MD; Collen Lechtenberg, Sharon Lynch, MD, Michael Rippee, MD; Lee Rosterman DO; and Yunxia Wang, MD, . One month long rotation providing medical care to inpatients on the Neurology service at the University of Kansas Hospital. This is one of the 18 months of inpatient and consult training mandated by the Neurology RRC This month is repeated during PGY2. Overall Goals: During the KU Ward rotation, residents are expected to be able to demonstrate and apply an evidence-based medicine approach to patient care that reflects an integration of basic science and clinical knowledge. Residents are also expected to improve their skills with the neurological examination, performance of lumbar punctures, communication skills with patients, patients' families, and colleagues. Residents will gain an understanding of neurological diseases and the management of common neurological disorders encountered in the inpatient setting. Over the course of PGY2 the neurology resident will handle increasing responsibility as demonstrated by managing patients with more complex disorders, providing care for a higher number of patients and effectively teaching rotating residents and medical students about neurology. 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 Evaluate and manage patients with neurological disorders and neurological manifestation of systemic diseases Objectives 1
The PGY2 resident in neurology will: Perform an efficient and thorough general physical examination Perform an efficient and thorough neurological examination Competently perform all essential medical and invasive procedures As measured by checklist (direct observation), global clinical performance, and chart stimulated recall. 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 The resident must learn the basic sciences on which clinical neurology is founded and integrate them into their evaluation and treatment of patients. This includes knowledge of neuroanatomy, neuropathology, neurophysiology, neuroimaging, neuropsychology, neural development, neurochemistry, neuropharmacology, molecular biology, genetics, immunology, epidemiology, and statistics. Objectives The PGY2 resident will; Improve their fund of knowledge appropriate for the PGY2 level Become familiar with the principles of bioethics as measured by checklist (witnessed examination), global clinical performance and Resident In-service Training Examination (RITE). 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 Set learning and improvement goals Participate in the education of patients, families, students, residents and other health professionals, as documented by evaluations of a resident's teaching abilities by faculty and/or learners Objectives The PGY2 resident will Incorporate formative evaluation feedback into their daily practice of neurology Participate in the education of patients, families, students, residents and other 2
health professionals As measured by checklist (witnessed examination) global clinical performance 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 Coordinate patient care within the health care system relevant to their clinical specialty Incorporate considerations of cost awareness and risk-benefit analysis in patient care Objectives The PGY2 resident will; Coordinate patient care within the health care system Advocate for quality patient care and optimal patient care systems Provide cost effective evaluation and treatment As measured by, chart stimulated recall and global clinical performance. Professionalism Goal Residents must demonstrate a commitment to carrying out professional responsibilities and an adherence to ethical principles. Residents are expected to demonstrate: Competencies Respect for patient privacy and autonomy Sensitivity and responsiveness to a diverse patient population, including but not limited to diversity in gender, age, culture, race, religion, disabilities, and sexual orientation Objectives The PGY2 resident will demonstrate; In the process of providing care to inpatients, resident to demonstrates sensitivity to patient privacy, autonomy and diversity. Be responsive to patient primary and autonomy As measured by checklist (witnessed examination), global clinical performance, and 360o evaluation. 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 3
professional associates. Residents are expected to: Competencies Communicate effectively with patients and families across a broad range of socioeconomic and cultural backgrounds Maintain comprehensive, timely, and legible medical records Objectives The PGY2 resident will: The resident communicates effectively with patients and their families. Work effectively as a member of a health care team The resident maintains the medical record in a comprehensive, timely (please see the section on Learner Expectations) and appropriate manner As demonstrated by chart review and global clinical performance. Teaching Methods What teaching methods are used on this rotation or educational experience? Didactic lectures of specific topics, including the neurological examination, localization and evaluation of neurological disorders Assessment Method (residents) How do you measure the resident's performance on this rotation or educational experience? Checklist: Direct supervision of resident performing history and clinical evaluation (PC, MK, PROF, LCS) RITE (MK) Checklist: Lumbar puncture proficiency (PC) Global Clinical Performance: Discussion of differential diagnosis, use of laboratory, patient management (PC, MK, SBL, PBL, LCS, PROF) Chart Stimulated Recall: (PC, MK, SBL, PBL) 360o evaluation (LCS, PROF) Chart review (LCS, PROF) Assessment Method (Program Evaluation) How do you evaluate whether this educational experience is effective? Monthly evaluation of the rotation by the resident Yearly program evaluation Twice-yearly evaluation of the resident and solicitation of feedback. Level of Supervision How is the resident supervised on this rotation? Daily direct supervision by ward attending and other faculty The resident reviews every admission and consultation with the attending in a timely fashion. Attending neurologists are available 24 hours a day, 365.25 days a year. 4
Educational Resources
List the educational resources
·
Aminoff M., Neurology in General Medicine, Churchill Livingstone.
·
Flaherty, A. The Massachusetts General Hospital Handbook of Neurology,
Lippincott Williams & Wilkins.
·
Marshall RS and Mayer SA. On Call Neurology: On Call Series, Saunders.
·
Plum F and Posner J. The Diagnosis of Stupor and Coma, 3rd edition, Oxford
University Press, 1982.
·
Practice Parameters from the American Academy of Neurology, are available for
a large range of conditions, therapies, and assessment tools at AAN.com.
·
Ropper AH and Brown RH. Adams and Victor's Principles of Neurology, 8¬th
edition, McGraw-Hill Professional, 2005.
·
Strunk W, White EB, and Kalman M. The Elements of Style Illustrated, Illustrate
edition, The Penguin Press HC, 2000.
·
Trusse L. Eats, Shoots & Leaves: The Zero Tolerance Approach to Punctuation,
Reprint edition, Gotham, 2006.

Aids to the Examination of the Peripheral Nervous System, Saunders Limited, 4th
edition, 2000.
Journals:
Neurology
Archives of Neurology
Journal of Neurology, Neurosurgery, and Psychiatry
Annals of Neurology
Brain
Stroke
Rev. 6/30/15
5
Ward Supervision KUH Curriculum Required Rotation PGY3, and PGY4 Description of Rotation or Educational Experience Supervising Faculty/Chief of Service: Gary Grons eth The faculty who is on rotation the firs t day of each month is responsible for reviewing the Goals and Objectives at the start of each rotation Additional faculty: Michael Abraham, MD; Gary Grons eth, MD; Kathy Hussman, MD; Colleen Lechtenberg, MD; Manoj Mittal, MBBS, Michael Rippee, MD, Lee Rosterman, DO, Yunxia W ang, MD This is a one-month rotation s upervising the ward service at KUH. This rotation is repeated during PGY4. The level of responsibility increases during each year. Patient Care Goal Res idents 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 From the RRC: W ill have a combination of patient care, teaching, and research in their training program. Patient care responsibilities must ensure a balance between patient care and education that achieves for the trainee an optimal educational experience consistent with the best medical care. Patient care responsibilities must include inpatient, outpatient, and consultation experiences; Must have clinical teaching rounds supervised by faculty. These rounds must occur at least five days per week. Residents must present cases and their diagnostic and therapeutic plans; Must have instruction and practical experience in obtaining an orderly and detailed history from the patient, in conducting a thorough general and neurological examination, and in organizing and recording data. The training must include the indications for and limitations of clinical neurodiagnostic tests and their interpretation. Residents must learn to correlate the information derived from these neurodiagnostic studies with the clinical history and examination in formulating a differential diagnosis and management plan; Must participate in the management of patients with acute neurological disorders in an intensive care unit and an emergency department; Must have management responsibility for patients with neurological disorders. Neurology residents must be involved in the management of patients with neurological disorders who require emergency and intensive care 1
Objectives The PGY3 resident will: Assist the junior residents to d evelop a differential diagnosis appropriate for their level Assist the junior residents to develop of plan of evaluation and treatment Collaborate with other health care professionals (including those from different disciplines) to provide patient-focused care Become an effective teacher of medical students, rotating and neurology residents The PGY4 resident will: Demonstrate their proficiency in the supervision and teaching of junior residents Demonstrate their ability to manage a health care team Become an effective teacher of medical students and rotating residents Be able to transition into the independent, unsupervised practice of N eurology Be able to manage a private practice, understand coding and billing, manage w orkload, understand the effects of fatigue and be able to mitigate against fatigue. As measured by GCP, Checklist, Case Stimulated Recall, Focused Observation (Observation of Patient C are Encounter (SEGUE)), Case Logs. Medical Knowledge Goal Res idents must demonstrate knowledge of established and evolving biomedical, clinical, epidemiological, and social-behavioral s ciences, as well as the application of this knowledge to patient care. Residents are expected to: Competencies Must regularly attend seminars and conferences in the following disciplines: neuropathology, neuroradiology, neuro-ophthalmology, neuromuscular disease, cerebrovascular disease, epilepsy, movement disorders, critical care, clinical neurophysiology, behavioral neurology, neuroimmunology, infectious disease, neuro-otology, neuroimaging, neuro-oncology, sleep disorders, pain management, neurogenetics, rehabilitation, child neurology, the neurology of aging, and general neurology. There must be gross and microscopic pathology conferences and clinical pathological conferences. Residents must have increasing responsibility for the planning and s upervision of the conferences. Res idents must learn about major developments in both the basic and clinical s ciences relating to neurology. Res idents must attend periodic seminars, journal clubs, lectures in basic science, didactic courses, and meetings of local and national neurological s ocieties; Must learn the basic s ciences on which clinical neurology is founded, including neuroanatomy, neuropathology, neurophysiology, neuroimaging, neuropsychology, neural development, neurochemistry, neuropharmacology, molecular biology, genetics, immunology, epidemiology, and s tatistics. The didactic curriculum developed to satisfy this requirement must cover basic science and must be organized and complete; and, 2
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Must receive instruction in the principles o f bioethics and in the provision of appropriate and cost-effective evaluation and treatment for patients with neurological disorders Objectives The PGY3 resident will: Demonstrate improvement in their fund of k nowledge Understand the necessity to provide cost effective evaluation and treatment The PGY4 resident will: Demonstrate improvement in their fund of k nowledge Provide cost effective evaluation and treatment within the limits of uncertainty of clinical neurology. As measured by GCP, Focused Observation, RITE, Practice- Based Learning and Improvement Goal Res idents 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; Set learning and improvement goals Teach other residents, medical s tudents, nurses, and other health care personnel, formally and informally. Objectives The PGY3 resident will: Demonstrate the ability to locate, appraise and assimilate evidence from scientific studies related to their patients' health problems, at the intermediate to advanced level Use information technology to optimize learning The PGY4 resident will: Locate, appraise and assimilate evidence from scientific studies related to their patients' health problems Teach and provide instructive feedback to other residents, medical students, nurses, and other health care personnel, formally and informally. Learn from and allow other members of the team to teach. As measured by GCP, CSR, Focused Observation Systems Based Practice Goal
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3
Res idents must demonstrate an awareness of and responsiveness to the larger context and s ystem of health care, as well as the ability to call effectively on other resources in the s ystem to provide optimal health care. Res idents are expected to: Competencies W ork effectively in various health care delivery settings and systems relevant to their clinical s pecialty Participate in identifying systems errors and in implementing potential s ystems s olutions Objectives The PGY3 resident will: Advocate for quality patient care and optimal patient care systems The PGY4 resident will: Advocate for quality patient care and optimal patient care systems Be able to independently lead the Health Care team in the daily huddle As measured by GCP, CSR, Focused Observation Profe ssionalism Goals Res idents 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 Res ponsiveness to patient needs that supersedes self-interest Sensitivity and responsiveness to a diverse patient population, including but not limited to diversity in gender, age, culture, race, religion, disabilities, and s exual orientation Objectives The PGY3 resident will: Demonstrate respect for patient privacy and autonomy Demonstrate sensitivity and responsiveness to a diverse patient population, including but not limited to diversity in gender, age, culture, race, religion, disabilities, and sexual orientation The PGY4 resident will: Sensitivity and responsiveness to a diverse patient population, including but not limited to diversity in gender, age, culture, race, religion, disabilities, and sexual orientation As measured by GCP, CSR, Focused Observation, 360o Evaluation Interpersonal and Communication Skills Goal Res idents must demonstrate interpersonal and communication skills that result in the
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4
effective exchange of information and teaming with patients, their families , and professional associates. Residents are expected to: Competencies Communicate effectively with physicians, other health professionals, and health related agencies Objectives The PGY3 resident will: Demonstrate respect for patient privacy and autonomy Be able to participate in and at times lead meetings w ith patients and their family members. Communicate with consultants and with the patient's other health care providers The PGY4 resident will: Lead family and team meetings. Break bad news to patient and to their family members in a sensitive and caring fashion. As measured by GCP, CSR, Focused Observation, 360o Evaluation, Teaching Methods W hat teaching methods are you using on this rotation or educational experience? Daily rounds Pres entation, review, and discussion of cases with attending faculty W eekly lectures Interactive discussions Assessment Method (residents) How do you measure the resident's performance on this rotation or educational experience? Patient Care: GCP, Checklis t, Case Stimulated Recall, Focused Observation (Observation of Patient Care Encounter (SEGUE)), Cas e Logs Medical Knowledge: GCP, Focused Observation, RITE, W eekly Quizzes , Practice-Based Learning: GCP, CSR, Focused Observation Sys tems Based Practice: GCP, CSR, Focused Observation Professionalism: GCP, CSR, Focused Observation, 360o Evaluation, Interpersonal and Communication Skills : GCP, CSR, Focused Observation, 360o Evaluation, Assessment Method (Program Evaluation) How do you evaluate whether this educational experience is effective? Monthly evaluation of the rotation by the resident Yearly program evaluation Twice-yearly evaluation of the resident and solicitation of feedback. Level of Supervision 5
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How is the resident supervised on this rotation? Daily direct supervision by ward attending and other faculty Direct supervision by attending and other faculty Educational Resources List the educational resources Brazis PW, Masdeu JC, and Biller J. Localization in Clinical Neurology, 5th edition, Lippincott Williams & Wilkins, 2 007. Bradley WG, Daroff RB, Fenichel GM, and Jankovic J. Neurology in Clinical Practice, 4th edition, Butterworth-Heinemann, 2003. Aminoff M., N eurology in General Medicine, C hurchill Livingstone. Marshall RS and Mayer SA. On Call N eurology: On Call Series, Saunders. Miller DH and Raps EC . Critical C are N eurology, Butterworth-Heinemann. Plum F and Posner J. The Diagnosis of Stupor and Coma, 3rd edition, Oxford University Press, 1982. Practice Parameters from the American Academy of N eurology, are available for a large range of conditions, therapies, and assessment tools at AAN.com. Ropper AH and Brown RH. Adams and Victor's Principles of N eurology, 8th edition, McGraw-Hill Professional, 2005. Samuels MA and Feske SK. Office Practice of N eurology, Churchill Livingstone. Samuels MA. Hospitalist Neurology (Blue Books of Practical N eurology, Volume 19), 1st edition, Butterworth-Heinemann, 1999. Weiner WJ and Shulman LM. Emergent and Urgent Neurology, Lippincott Williams & Wilkins. Wijdicks, EFM. Neurologic Catastrophes in the Emergency Department, Butterworth-Heinemann. Wijdicks EFM. The C linical Practice of C ritical C are N eurology, Oxford University Press, USA. Wijdicks, EFM. N eurologic C omplications in Organ Transplant Recipients, 1 st edition, Butterworth-Heinemann, 1999. Young GB, Ropper AH, and Bolton CF. Coma and Impaired Consciousness: A C linical Perspective, McGraw-Hill Professional. Journals: Neurology Archives of N eurology Annals of N eurology Brain Stroke Journal of N eurology, N eurosurgery and Psychiatry Vers ion 6/30/2015
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Leavenworth VAMC Curriculum Required Rotation PGY2, PGY3 Description of Rotation or Educational Experience Supervising Faculty: Ramachadran Venkatesh, MD This one-month rotation is based on the hospital and outpatient evaluation of patients in the VAMC. The Leavenworth VAMC is unique in our VA hospitals because of the domiciliary facilities and the large number of patients with co-existent psychiatric illness This rotation is repeated during PGY2­3 for a total of up to three months. 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 From the RRC: Patient care responsibilities must include inpatient, outpatient, and consultation experiences; Must have instruction and practical experience in obtaining an orderly and detailed history from the patient, in conducting a thorough general and neurological examination, and in organizing and recording data. The training must include the indications for and limitations of clinical neurodiagnostic tests and their interpretation. Residents must learn to correlate the information derived from these neurodiagnostic studies with the clinical history and examination in formulating a differential diagnosis and management plan; Neurological training must include assignment on a consultation service to the medical, surgical, obstetric and gynecologic, pediatric, rehabilitation medicine, and psychiatry services. Objective3 The PGY2 resident will: Perform an efficient and thorough neurological examination Be able to localize the lesion Develop a differential diagnosis appropriate for PGY2 level The PGY3 resident will: Development a plan of evaluation and treatment Collaborate with other health care professionals (including those from different disciplines) to provide patient-focused care Competently perform all essential medical and invasive procedures The PGY4 resident will: 1
Competently perform all essential medical and invasive procedures As measured by GCP, Checklist, Case Stimulated Recall, Focused Observation (Observation of Patient Care Encounter (SEGUE)), Case Logs. 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 Must learn and apply the basic sciences on which clinical neurology is founded, including neuroanatomy, neuropathology, neurophysiology, neuroimaging, neuropsychology, neural development, neurochemistry, neuropharmacology, molecular biology, genetics, immunology, epidemiology, and statistics. The didactic curriculum developed to satisfy this requirement must cover basic science and must be organized and complete; and, Must receive instruction in the principles of bioethics and in the provision of appropriate and cost-effective evaluation and treatment for patients with neurological disorders Objectives The PGY2 resident will: Continue to expand their fund of knowledge in neurology The PGY3 resident will: Continue to expand their fund of knowledge in bioethics The PGY4 resident will: Apply their knowledge of bioethics to their care of patients As measured by GCP, RITE, 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 Locate, appraise and assimilate evidence from scientific studies related to their patients' health problems Use information technology to optimize learning Objectives The PGY2resident will: 2
Beginning ability to identify strengths, deficiencies and limits in one's knowledge and expertise; The PGY3 resident will: Identify strengths, deficiencies and limits in one's knowledge and expertise Identify and perform appropriate learning activities Locate, appraise and assimilate evidence from scientific studies related to their patients' health problems The PGY4 resident will: Use information technology to optimize learning As measured by GCP, CSR, Focused Observation 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 Coordinate patient care within the health care system relevant to their clinical specialty Incorporate considerations of cost awareness and risk-benefit analysis in patient care Advocate for quality patient care and optimal patient care systems Objectives The PGY2resident will: Demonstrate the beginning ability to work effectively in various health care delivery settings and systems relevant to their clinical specialty Coordinate patient care within the health care system relevant to their clinical specialty The PGY3 resident will: Work effectively in various health care delivery settings and systems relevant to their clinical specialty The PGY4 resident will: Demonstrate mastery of being able to work effectively in various health care delivery settings and systems relevant to their clinical specialty As measured by GCP, CSR, Focused Observation Professionalism Goals Residents must demonstrate a commitment to carrying out professional responsibilities 3
and an adherence to ethical principles. Residents are expected to demonstrate: Competencies Compassion, integrity, and respect for others Responsiveness to patient needs that supersedes self-interest Objectives The PGY2 resident will: Demonstrate compassion towards their patients The PGY3 resident will: Be responsive to their patient's needs Respect for patient privacy and autonomy The PGY4 resident will: Demonstrate Accountability to patients, society, and the profession As measured by GCP, CSR, Focused Observation, 360o Evaluation 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 physicians, other health professionals, and health related agencies Act in a consultative role to other physicians and health professionals Objectives The PGY2 resident will: Communicate in an efficient and legible manner as they serve as a consultant The PGY3 resident will: Be able to communicate in an efficient and legible manner as they serve as a consultant, through the use of concise consult and clinic notes The PGY4 resident will: Be able to communicate in an efficient and legible manner, at the level of a fully trained neurologist, as they serve as a consultant As measured by GCP, CSR, Focused Observation, 360o Evaluation, Teaching Methods 4
What teaching methods are you using on this rotation or educational experience? Presentation, review, and discussion of cases with attending faculty Weekly lectures Interactive discussions Assessment Method (residents) How do you measure the resident's performance on this rotation or educational experience? Patient Care: GCP, Checklist, Case Stimulated Recall, Focused Observation (Observation of Patient Care Encounter (SEGUE)), Case Logs Medical Knowledge: GCP, Focused Observation, RITE, Practice-Based Learning: GCP, CSR, Focused Observation Systems Based Practice: GCP, CSR, Focused Observation Professionalism: GCP, CSR, Focused Observation, 360o Evaluation, Interpersonal and Communication Skills: GCP, CSR, Focused Observation, 360o Evaluation, Assessment Method (Program Evaluation) How do you evaluate whether this educational experience is effective? Monthly evaluation of the rotation by the resident Yearly program evaluation Twice-yearly evaluation of the resident and solicitation of feedback. Level of Supervision How is the resident supervised on this rotation? Direct supervision by clinic attending Educational Resources List the educational resources Brazis PW, Masdeu JC, and Biller J. Localization in Clinical Neurology, 5th edition, Lippincott Williams & Wilkins, 2007. Bradley WG, Daroff RB, Fenichel GM, and Jankovic J. Neurology in Clinical Practice, 4th edition, Butterworth-Heinemann, 2003. Aminoff M., Neurology in General Medicine, Churchill Livingstone. Devinsky O. Behavioral Neurology: 100 Maxims (100 Maxims in Neurology Series), Mosby-Year Book. Flaherty, A. The Massachusetts General Hospital Handbook of Neurology, Lippincott Williams & Wilkins. Marshall RS and Mayer SA. On Call Neurology: On Call Series, Saunders. Mendez M and Cummings JL. Dementia: A Clinical Approach, Butterworth- Heinemann Practice Parameters from the American Academy of Neurology, are available for a large range of conditions, therapies, and assessment tools at AAN.com. Ropper AH and Brown RH. Adams and Victor's Principles of Neurology, 8th 5
edition, McGraw-Hill Professional, 2005. Samuels MA and Feske SK. Office Practice of Neurology, Churchill Livingstone. Strunk W, White EB, and Kalman M. The Elements of Style Illustrated, Illustrate edition, The Penguin Press HC, 2000. Trusse L. Eats, Shoots & Leaves: The Zero Tolerance Approach to Punctuation, Reprint edition, Gotham, 2006. Journals: Neurology Archives of Neurology Annals of Neurology Brain Stroke Journal of Neurology, Neurosurgery and Psychiatry Rev. 6/30/2014 6
Longitudinal Clinic Curriculum One half day clinic weekly in PGY2, 3 and 4 Description of Rotation or Educational Experience Supervising faculty responsible for reviewing Goals and Objectives: Fred Sachen, MD Clinic Supervising faculty: Heather Anderson, MD, Richard Barohn, MD, Jeffrey Burns, MD, Arthur Dick, MD, Mazen Dimachkie, MD, Richard Dubinsky, MD, MPH, Nancy Hammond, MD, Sharon Lynch, MD, April McVey, MD, William Nowack, MD, Rajesh Pahwa, MD, Mamatha Pasnoor, MD, Russell Swerdlow, MD, The resident's longitudinal clinic is held one half day each week throughout their training. As they progress through the program they follow larger numbers of patients and the number of patients in each clinic increases. Clinics are held on the mornings and afternoons on Thursday and Fridays. Residents from all levels are in each clinic allowing the more senior residents to teach the junior residents. 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 From the RRC program requirements: Residents must also have outpatient experience which must include a resident longitudinal/continuity clinic with attendance by each resident one half day weekly throughout the program. The continuity clinic may be counted toward the required six months of outpatient experience, assuming that one half day clinic assignment per week for three years is equal to 3.6 months. All clinics may be credited toward the six-month outpatient requirement. Residents may be excused from this clinic when a rotation site is more than one hour's travel time from the clinic site; Must have instruction and practical experience in obtaining an orderly and detailed history from the patient, in conducting a thorough general and neurological examination, and in organizing and recording data. The training must include the indications for and limitations of clinical neurodiagnostic tests and their interpretation. Residents must learn to correlate the information derived from these neurodiagnostic studies with the clinical history and examination in formulating a differential diagnosis and management plan; Must receive instruction in appropriate and compassionate methods of end-of-life palliative care, including adequate pain relief and psychosocial support and counseling for patients and family members about these issues; and, Must received instruction on recognition and management of physical, sexual, and emotional abuse. 1
Must have opportunities for increasing responsibility and professional maturation. Early clinical assignments must be based on direct patient responsibility for a limited number of patients. Subsequent assignments must place residents in a position of taking increased responsibility for patients. Must have management responsibility for patients with neurological disorders. Objectives The PGY2 resident will: Demonstrate the ability to perform an efficient and thorough general physical examination Demonstrate the ability to perform an efficient and thorough neurological examination Demonstrate the ability to localize the lesion The PGY3 resident will: Demonstrate the ability to develop a differential diagnosis Demonstrate the ability to develop a plan of evaluation and treatment Demonstrate the ability to counsel and educate their patients and families The PGY4 resident will: Demonstrate the ability to collaborate with other health care professionals (including those from different disciplines) to provide patient-focused care Demonstrate the ability to develop and carry out patient management plans As measured by Global Clinical Performance and Focused Observation (SEGUE) 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 From the RRC: Residents must receive instruction in the principles of bioethics and in the provision of appropriate and cost-effective evaluation and treatment for patients with neurological disorders Objectives The PGY2 resident will: Start their learning of neurology throughout the training program Begin to understand the reasons to practice cost effective evaluation and treatment of their patients The PGY2­4 resident will: Increase their medical knowledge of neurology throughout the training program Practice cost effective evaluation and treatment of their patients 2
The PGY2­4 resident will: Increase their knowledge of the neurological manifestations of systemic diseases, throughout the training program Master the ability to practice cost effective evaluation and treatment of their patients As measured by their improving yearly sores on the RITE and Case Stimulated Recall. 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 Locate, appraise and assimilate evidence from scientific studies related to their patients' health problems Use information technology to optimize learning Objectives The PGY2 resident will: Set learning and improvement goals Systematically analyze practice, using quality improvement methods, and implement changes with the goal of practice improvement The PGY3 resident will: Systematically analyze practice, using quality improvement methods, and implement changes with the goal of practice improvement Use information technology to optimize learning Participate in the education of patients, families, students, residents and other health professionals, as documented by evaluations of a resident's teaching abilities by faculty and/or learners The PGY4 resident will: Systematically analyze practice, using quality improvement methods, and implement changes with the goal of practice improvement Locate, appraise and assimilate evidence from scientific studies related to their patients' health problems Participate in the education of patients, families, students, residents and other health professionals, as documented by evaluations of a resident's teaching abilities by faculty and/or learners As measured by GCP, CSR. Systems Based Practice 3
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 Coordinate patient care within the health care system relevant to their clinical specialty Incorporate considerations of cost awareness and risk-benefit analysis in patient care Advocate for quality patient care and optimal patient care systems Objectives The PGY2 resident will: Work effectively in various health care delivery settings and systems relevant to their clinical specialty The PGY3 resident will: Coordinate patient care within the health care system relevant to their clinical specialty The PGY4 resident will: Advocate for quality patient care and optimal patient care systems As measured by GCP, CSR, Focused Observation 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 Responsiveness to patient needs that supersedes self-interest Sensitivity and responsiveness to a diverse patient population, including but not limited to diversity in gender, age, culture, race, religion, disabilities, and sexual orientation Objectives The PGY2resident will Sensitivity and responsiveness to a diverse patient population, including but not limited to diversity in gender, age, culture, race, religion, disabilities, and sexual orientation The PGY3 resident will Demonstrate respect for patient privacy and autonomy The PGY4 resident will 4
Demonstrate compassion, integrity, and respect for others Demonstrate accountability to patients, society, and the profession As measured by GCP, CSR, Focused Observation, 360o Evaluation 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 physicians, other health professionals, and health related agencies Maintain comprehensive, timely, and legible medical records Objectives The PGY2 resident will: Maintain complete and legible medical records The PGY3 resident will: Communicate effectively with patients and families across a broad range of socioeconomic and cultural backgrounds Communicate in a timely and efficient manner with other health care professionals Maintain complete and legible medical records, with concise descriptions of the history, clinical examination, differential diagnosis and plan of evaluation and treatment The PGY4 resident will: Act in a consultative role to other physicians and health professionals Maintain timely complete and legible medical records, in particular, letters to referring physicians clearly detailing the results of the consult in a clear concise matter that is not condescending or obscure. As measured by GCP, CSR, Focused Observation, 360o Evaluation, Teaching Methods What teaching methods are you using on this rotation or educational experience? Presentation, review, and discussion of cases with attending faculty Assessment Method (residents) How do you measure the resident's performance on this rotation or educational experience? Patient Care: GCP, CSR, Focused Observation (Observation of Patient Care Encounter (SEGUE)), Case Logs Medical Knowledge: GCP, RITE, Practice-Based Learning: GCP, CSR, Focused Observation Systems Based Practice: GCP, CSR, Focused Observation 5
Professionalism: GCP, CSR, Focused Observation, 360o Evaluation, Interpersonal and Communication Skills: GCP, CSR, Focused Observation, 360o Evaluation, Assessment Method (Program Evaluation) How do you evaluate whether this educational experience is effective? Monthly evaluation of the rotation by the resident Yearly program evaluation Twice-yearly evaluation of the resident and solicitation of feedback. Level of Supervision How is the resident supervised on this rotation? Daily direct supervision by clinic attending and other faculty Educational Resources List the educational resources Brazis PW, Masdeu JC, and Biller J. Localization in Clinical Neurology, 5th edition, Lippincott Williams & Wilkins, 2007. Bradley WG, Daroff RB, Fenichel GM, and Jankovic J. Neurology in Clinical Practice, 4th edition, Butterworth-Heinemann, 2003. Aids to the Examination of the Peripheral Nervous System, Saunders Limited, 4th edition, 2000. Practice Parameters from the American Academy of Neurology, are available for a large range of conditions, therapies, and assessment tools at AAN.com. Ropper AH and Brown RH. Adams and Victor's Principles of Neurology, 8th edition, McGraw-Hill Professional, 2005. Samuels MA and Feske SK. Office Practice of Neurology, Churchill Livingstone. Strunk W, White EB, and Kalman M. The Elements of Style Illustrated, Illustrate edition, The Penguin Press HC, 2000. Trusse L. Eats, Shoots & Leaves: The Zero Tolerance Approach to Punctuation, Reprint edition, Gotham, 2006. Journals: Neurology Archives of Neurology Annals of Neurology Brain Stroke Journal of Neurology, Neurosurgery and Psychiatry Rev. 6/8/2015 6
Neuromuscular Medicine Curriculum Elective Rotation PGY3 or 4 Description of Rotation or Educational Experience This one-month rotation is devoted to the evaluation and management of patients with neuromuscular diseases with limited exposure to the technical components of performing nerve conduction studies and electromyograms. Primary Faculty: Mazen Dimachkie, MD Additional Faculty: Richard Barohn, MD; Arthur Dick, MD; Mamatha Pasnoor, MBBS; Yunxia Wang, MD; This rotation takes place in PGY3 or PGY4. 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 From the RRC: Must have clinical teaching rounds supervised by faculty. These rounds must occur at least five days per week. Residents must present cases and their diagnostic and therapeutic plans; The training must include the indications for and limitations of clinical neurodiagnostic tests and their interpretation. Residents must learn to correlate the information derived from these neurodiagnostic studies with the clinical history and examination in formulating a differential diagnosis and management plan; Must receive instruction in appropriate and compassionate methods of end-of-life palliative care, including adequate pain relief and psychosocial support and counseling for patients and family members about these issues; and, Objectives The PGY3 or PGY4 resident will: Become proficient in the evaluation and management of patients with neuromuscular diseases Become proficient in the use of clinical laboratory tests, including genetic studies in the evaluation of patients with neuromuscular diseases. Become familiar with the utility of nerve conduction studies and electromyography Develop a plan of evaluation and treatment As measured by GCP, Checklist, Case Stimulated Recall, Focused Observation (Observation of Procedural Skills), Case Logs, NEX exam Medical Knowledge 1
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 Must regularly attend seminars and conferences in the following disciplines: ... neuromuscular disease, EMG case conference, clinical neurophysiology, ... pain management, neurogenetics, and general neurology. Residents must attend the gross and microscopic pathology conferences and Neuromuscular Journal Club. Must learn the basic sciences on which clinical neurology is founded, including neuroanatomy, basic neurophysiology, molecular biology, genetics, immunology; and, Must receive instruction in the principles of bioethics and in the provision of appropriate and cost-effective evaluation and treatment for patients with neurological disorders Objectives The PGY3 or PGY4 resident will: Demonstrate their knowledge and understanding of basic science aspects of neuromuscular diseases Demonstrate cost effective evaluation and treatment As measured by GCP, Focused Observation (Observation of Procedural Skills), RITE, and AANEM self assessment examination. 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 and perform appropriate learning activities Incorporate formative evaluation feedback into daily practice Objectives The PGY3 or PGY4 resident will: Demonstrate their ability to set learning and improvement goals Use information technology to optimize learning As measured by GCP, CSR, Focused Observation 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: 2
Competencies Understand the functioning of a multi-specialty clinic Objectives The PGY3 or PGY4 resident will Function as part of a multi-disciplinary clinic in the treatment of people with neuromuscular diseases, including PT, OT, Speech Tx, seating, and respiratory therapy As measured by direct observation of the attending physicians Professionalism Goals 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 Respect for patient privacy and autonomy Objectives The PGY3 or PGY4 resident will: Demonstrate compassion and respect for others Demonstrate respect for patient privacy and autonomy As measured by GCP, CSR, 360o Evaluation 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 Maintain comprehensive, timely, and legible medical records Objectives The PGY3 or PGY4 resident will: Demonstrate the ability to communicate effectively with patients and their families Effectively communicate with physicians and other health care providers, through written reports of EMG studies and clinic encounters As measured by GCP, CSR, Focused Observation, 360o Evaluation, Teaching Methods What teaching methods are you using on this rotation or educational experience? 3
Daily clinics and EMG sessions Presentation, review, and discussion of cases with attending faculty Interactive discussions Assessment Method (residents) How do you measure the resident's performance on this rotation or educational experience? Patient Care: GCP, Checklist, Focused Observation (Observation of Procedural Skills, NEX), Case Logs Medical Knowledge: GCP, RITE, AANEM Neuromuscular self assessment examination (optional) Practice-Based Learning: GCP, Systems Based Practice: GCP, Professionalism: GCP, 360o Evaluation, Interpersonal and Communication Skills: GCP, 360o Evaluation, Assessment Method (Program Evaluation) How do you evaluate whether this educational experience is effective? Monthly evaluation of the rotation by the resident Yearly program evaluation Twice-yearly evaluation of the resident and solicitation of feedback. Level of Supervision How is the resident supervised on this rotation? Daily direct supervision by faculty Educational Resources List the educational resources Educational CD containing a collection of critical references to the understanding of EMG and Neuromuscular Disorders is available on day 1 of the rotation as well as a loaner brief textbook on EMG and NCS. Please contact Dr. Dimachkie to receive those. Aids to the Examination of the Peripheral Nervous System, Saunders Limited, 4th edition, 2000. Aminoff M., Clinical Neurophysiology, 3rd Ed., Churchill Livingstone. Dawson DM, Hallett M, Wilbourn AJ, Campbell WW, Terrono AL, and Trepman E. Entrapment neuropathies, Lippincott Williams & Wilkins. Kandel ER, Schwarz JH, and Jessell TM. Principles of Neural Science, McGraw- Hill Medical. Misulis KE and Head TC. Essentials of Clinical Neurophysiology, 3rd edition, Butterworth-Heinemann, 2002. Practice Parameters from the American Academy of Neurology, are available for a large range of conditions, therapies, and assessment tools at AAN.com. Stewart JD. Focal Peripheral Neuropathies, 3rd edition, Lippincott Williams & 4
Wilkins, 2000. Amato and Russell, Neuromuscular Disorders Engel and Franzini-Armstrong, Myology, Dyck and Thomas, Peripheral Neuropathy, Mendell, Kissel, and Cornblath, Diagnosis and Management of Peripheral Nerve Disorders, Mitsumoto, Przedborski, and Gordon, Amyotrophic Lateral Sclerosis, Engel, Myasthenia Gravis and Myasthenic Disorders, Dumitru and Amato: Electrodiagnostic Medicine, Brown and Bolton, Clinical Electromyography, Levin and Lьders Comprehensive Neuromuscular Medicine, Preston and Shapiro Electromyography and Neuromuscular Disorders, Journals: Neurology Archives of Neurology Annals of Neurology Brain Stroke Journal of Neurology, Neurosurgery and Psychiatry Rev. 6-30-2014 5
KU Night Float / Clinic Curriculum Required Rotation PGY2-4 Description of Rotation or Educational Experience KU Ward Service Supervising Faculty for Rotation, responsible for review of Goals & Objectives: Richard Dubinsky, MD, MPH Additional faculty: All clinical neurology faculty at KU One month long rotation at the University of Kansas Hospital, split as two weeks of night float and two weeks of assigned out patient clinics. Night float occurs every night, from 7 pm to 7 am Monday through Sunday (at 7 am). The clinics are assigned for PGY2 residents by Dr. Dubinsky through Tara Logan and the PGY3 and 4 residents may select subspecialty clinics appropriate to their interests with approval of Dr. Dubinsky. A change-over day is provided when necessary. This is one of the 18 months of inpatient and consult training mandated by the Neurology RRC This rotation is mainly in PGY2 but is repeated during PGY2-4. Overall Goals: During the KU Night Float and Clinic rotation, residents are expected to be able to demonstrate and apply an evidence-based medicine approach to patient care that reflects an integration of basic science and clinical knowledge. This rotation gives the resident to manage patients with neurological disorders over many nights providing continuity of care and enhancing the resident's ability to observe the natural progression of neurological disorders. Residents are also expected to improve their skills with the neurological examination, performance of lumbar punctures, communication skills with patients, patients' families, and colleagues. Residents will gain an understanding of neurological diseases and the management of common neurological disorders encountered in the inpatient setting. Over the course of their training the neurology resident will handle increasing responsibility as demonstrated by managing patients with more complex disorders, providing care for a higher number of patients and effectively teaching rotating residents and medical students about neurology. 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: 1
Competencies Evaluate and manage patients with neurological disorders and neurological manifestation of systemic diseases Objectives The PGY2-4 resident in neurology will: Perform an efficient and thorough general physical examination Perform an efficient and thorough neurological examination Competently perform all essential medical and invasive procedures As measured by checklist (direct observation), global clinical performance, and chart stimulated recall. 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 The resident must learn the basic sciences on which clinical neurology is founded and integrate them into their evaluation and treatment of patients. This includes knowledge of neuroanatomy, neuropathology, neurophysiology, neuroimaging, neuropsychology, neural development, neurochemistry, neuropharmacology, molecular biology, genetics, immunology, epidemiology, and statistics. Objectives The PGY2-4 resident will; Improve their fund of knowledge appropriate for the PGY2 level Become familiar with the principles of bioethics Provide cost effective evaluation and treatment as measured by checklist (witnessed examination), global clinical performance and Resident In-service Training Examination (RITE). 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 Set learning and improvement goals Participate in the education of patients, families, students, residents and other health professionals, as documented by evaluations of a resident's teaching abilities by faculty and/or learners 2
Objectives The PGY2-4 resident will Incorporate formative evaluation feedback into their daily practice of neurology Participate in the education of patients, families, students, residents and other health professionals As measured by checklist (witnessed examination) global clinical performance 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 Coordinate patient care within the health care system relevant to their clinical specialty Incorporate considerations of cost awareness and risk-benefit analysis in patient care Objectives The PGY2-4 resident will; Coordinate patient care within the health care system Advocate for quality patient care and optimal patient care systems As measured by, chart stimulated recall and global clinical performance. Professionalism Goal Residents must demonstrate a commitment to carrying out professional responsibilities and an adherence to ethical principles. Residents are expected to demonstrate: Competencies Respect for patient privacy and autonomy Sensitivity and responsiveness to a diverse patient population, including but not limited to diversity in gender, age, culture, race, religion, disabilities, and sexual orientation Objectives The PGY2-4 resident will demonstrate; In the process of providing care to inpatients, resident to demonstrates sensitivity to patient privacy, autonomy and diversity. Be responsive to patient primary and autonomy As measured by checklist (witnessed examination), global clinical performance, and 360o evaluation. 3
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 Maintain comprehensive, timely, and legible medical records Objectives The PGY2-4 resident will: The resident communicates effectively with patients and their families. Work effectively as a member of a health care team The resident maintains the medical record in a comprehensive, timely and legible manner As demonstrated by chart review and global clinical performance. Teaching Methods What teaching methods are used on this rotation or educational experience? Didactic lectures of specific topics, including the neurological examination, localization and evaluation of neurological disorders Assessment Method (residents) How do you measure the resident's performance on this rotation or educational experience? Checklist: Direct supervision of resident performing history and clinical evaluation (PC, MK, PROF, LCS) RITE (MK) Checklist: Lumbar puncture proficiency (PC) Global Clinical Performance: Discussion of differential diagnosis, use of laboratory, patient management (PC, MK, SBL, PBL, LCS, PROF) Chart Stimulated Recall: (PC, MK, SBL, PBL) 360o evaluation (LCS, PROF) Chart review (LCS, PROF) Assessment Method (Program Evaluation) How do you evaluate whether this educational experience is effective? Monthly evaluation of the rotation by the resident Yearly program evaluation Twice-yearly evaluation of the resident and solicitation of feedback. Level of Supervision How is the resident supervised on this rotation? Daily direct supervision by ward attending and other faculty 4
Indirect supervision provided by attending physicians at night through telephone contact The resident reviews every admission and consultation with the attending in a timely fashion. Attending neurologists are available 24 hours a day, 365.25 days a year.
Educational Resources
List the educational resources
·
Aminoff M., Neurology in General Medicine, Churchill Livingstone.
·
Flaherty, A. The Massachusetts General Hospital Handbook of Neurology,
Lippincott Williams & Wilkins.
·
Marshall RS and Mayer SA. On Call Neurology: On Call Series, Saunders.
·
Plum F and Posner J. The Diagnosis of Stupor and Coma, 3rd edition, Oxford
University Press, 1982.
·
Practice Parameters from the American Academy of Neurology, are available for
a large range of conditions, therapies, and assessment tools at AAN.com.
·
Ropper AH and Brown RH. Adams and Victor's Principles of Neurology, 8¬th
edition, McGraw-Hill Professional, 2005.
·
Strunk W, White EB, and Kalman M. The Elements of Style Illustrated, Illustrate
edition, The Penguin Press HC, 2000.
·
Trusse L. Eats, Shoots & Leaves: The Zero Tolerance Approach to Punctuation,
Reprint edition, Gotham, 2006.

Aids to the Examination of the Peripheral Nervous System, Saunders Limited, 4th
edition, 2000.
Journals:
Neurology
Archives of Neurology
Journal of Neurology, Neurosurgery, and Psychiatry
Annals of Neurology
Brain
Stroke
Rev. 6/20/16
5
6.3 NICU Curriculum Description of Rotation or Educational Experience The resident works in the Neurological Intensive Care unit providing critical care for neurology and neurosurgery patients. Supervising Faculty: Kitty Husmann, MD, Neurology faculty: Michael Abraham, MD, Manoj Mittal, MBBS This one-month rotation is occurs in PGY3 and 4. 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 From the RRC: Must have clinical teaching rounds supervised by faculty. These rounds must occur at least five days per week. Residents must present cases and their diagnostic and therapeutic plans; Must participate in the evaluation of and decision making for patients with disorders of the nervous system requiring surgical management. The existence of a neurosurgical service with close interaction with the neurology service is essential; Must participate in the management of patients with acute neurological disorders in an intensive care unit and an emergency department; Must have experience in neuroimaging that ensures a familiarity with and knowledge of all relevant diagnostic and interventional studies necessary to correlate findings with other clinical information for the care of patients. At a minimum this must include magnetic resonance imaging, computerized tomography and neurosonology; Must receive instruction in appropriate and compassionate methods of end-of-life palliative care, including adequate pain relief and psychosocial support and counseling for patients and family members about these issues; and, Must have opportunities for increasing responsibility and professional maturation. Early clinical assignments must be based on direct patient responsibility for a limited number of patients. Subsequent assignments must place residents in a position of taking increased responsibility for patients. Night call is essential in accomplishing these goals. Adequate faculty supervision is essential throughout the program. Must have management responsibility for patients with neurological disorders. Objectives The PGY3 and 4 resident will: Demonstrate the ability to provide care for patients with neurological and neurosurgical disorders in the setting of the Intensive Care United Provide end-of-life care for patients, and the families, in the Neuro ICU Demonstrate proficiency in therapeutic procedures as measured by GCP, Checklist, Case Stimulated Recall, Focused Observation (Observation of
Procedural Skills, Observation of Patient Care Encounter (SEGUE)), Case Logs. 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 Must regularly attend seminars and conferences in the following disciplines: neuropathology, neuroradiology, neuro-ophthalmology, neuromuscular disease, cerebrovascular disease, epilepsy, movement disorders, critical care, clinical neurophysiology, behavioral neurology, neuroimmunology, infectious disease, neuro-otology, neuroimaging, neurooncology, sleep disorders, pain management, neurogenetics, rehabilitation, child neurology, the neurology of aging, and general neurology. There must be gross and microscopic pathology conferences and clinical pathological conferences. Residents must have increasing responsibility for the planning and supervision of the conferences. Residents must learn about major developments in both the basic and clinical sciences relating to neurology. Residents must attend periodic seminars, journal clubs, lectures in basic science, didactic courses, and meetings of local and national neurological societies; Must learn the basic sciences on which clinical neurology is founded, including neuroanatomy, neuropathology, neurophysiology, neuroimaging, neuropsychology, neural development, neurochemistry, neuropharmacology, molecular biology, genetics, immunology, epidemiology, and statistics. The didactic curriculum developed to satisfy this requirement must cover basic science and must be organized and complete; and, Must receive instruction in the principles of bioethics and in the provision of appropriate and cost-effective evaluation and treatment for patients with neurological disorders Must learn basics of critical care including assessment of volume status, invasive hemodynamic and neurological monitoring, including intracranial pressure monitoring and use of Transcranial Doppler ultrasound, and management of patients on mechanical ventilation. Must participate in critical care procedures including arterial catheter, central venous access catheter placements, and airway management. Objectives The PGY3 and PGY4 resident will: Understand the basic science components of NICU care including, but not limited to, neuropathology, neuroradiology, neuro-ophthalmology, neuromuscular disease, cerebrovascular disease, epilepsy, movement disorders, critical care, clinical neurophysiology, behavioral neurology, neuroimmunology, infectious disease, neuroimaging, and general neurology as measured by GCP, Focused Observation, RITE, Weekly Quizzes
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 Set learning and improvement goals Identify and perform appropriate learning activities Objectives The PGY3 and PGY 4 resident will: Develop an independent plan of learning activities appropriate to Intensive Care medicine as measured by GCP, CSR, Focused Observation 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 Coordinate patient care within the health care system relevant to their clinical specialty Incorporate considerations of cost awareness and risk-benefit analysis in patient care Objectives The PGY3 and PGY4 resident will: Demonstrate the ability to function within the ICU system as part of the larger context of hospital based neurology as measured by GCP, CSR, Focused Observation Professionalism Goals Residents must demonstrate a commitment to carrying out professional responsibilities and an adherence to ethical principles. Residents are expected to demonstrate: Competencies Responsiveness to patient needs that supersedes self-interest Accountability to patients, society, and the profession Objectives The PGY3 and PGY4 resident will: Demonstrate the ability to be responsive to the needs of their patients and their families as measured by GCP, CSR, Focused Observation, 360o Evaluation
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 Maintain comprehensive, timely, and legible medical records Objectives The PGY3 and 4 resident will: Demonstrate the ability to communicate effectively within the healthcare team and with health care professionals on other services as measured by GCP, CSR, Focused Observation, 360o Evaluation Teaching M ethods What teaching methods are you using on this rotation or educational experience? Daily rounds Presentation, review, and discussion of cases with attending faculty Weekly lectures Interactive discussions Assessment Method (residents) How do you measure the resident's performance on this rotation or educational experience? Patient Care: GCP, Checklist, Case Stimulated Recall, Focused Observation (Observation of Procedural Skills, Observation of Patient Care Encounter (SEGUE)), Case Logs Medical Knowledge: GCP, Focused Observation, RITE, Weekly Quizzes, Practice-Based Learning: GCP, CSR, Focused Observation Systems Based Practice: GCP, CSR, Focused Observation Professionalism: GCP, CSR, Focused Observation, 360o Evaluation, Interpersonal and Communication Skills: GCP, CSR, Focused Observation, 360o Evaluation, Assessment Method (Program Evaluation) How do you evaluate whether this educational experience is effective? Monthly evaluation of the rotation by the resident Yearly program evaluation Twice-yearly evaluation of the resident and solicitation of feedback Level of Supervision How is the resident supervised on this rotation? Daily direct supervision by ward attending and other faculty Direct supervision by attending and other faculty Direct supervision by clinic attending
Educational Resources List the educational resources Aminoff M., Neurology in General Medicine, Churchill Livingstone. Benarroch EE. Medical Neurosciences: An Approach to Anatomy, Pathology, and Physiology by Systems and Levels, 4th edition, Lippincott Williams & Wilkins. Cooper JR, Bloom FE, and Roth RH. The Biochemical Basis of Neuropharmacology, 8th edition, Oxford University Press. Flaherty, A. The Massachusetts General Hospital Handbook of Neurology, Lippincott Williams & Wilkins. Haines DE, Bloedel JR, Brown PB, Capra NF, Chronister RB, Armstrong GW, Schenk MP, Kirkman ME, and Ard MD. Fundamental Neuroscience, 2nd edition, Churchill Livingstone, 2002. Miller DH and Raps EC. Critical Care Neurology, Butterworth-Heinemann. Plum F and Posner J. The Diagnosis of Stupor and Coma, 3rd edition, Oxford University Press, 1982. Practice Parameters from the American Academy of Neurology, are available for a large range of conditions, therapies, and assessment tools at AAN.com. Samuels MA. Hospitalist Neurology (Blue Books of Practical Neurology, Volume 19), 1st edition, Butterworth-Heinemann, 1999. Weiner WJ and Shulman LM. Emergent and Urgent Neurology, Lippincott Williams & Wilkins. Wijdicks, EFM. Neurologic Catastrophes in the Emergency Department, Butterworth-Heinemann. Wijdicks EFM. The Clinical Practice of Critical Care Neurology, Oxford University Press, USA. Young GB, Ropper AH, and Bolton CF. Coma and Impaired Consciousness: A Clinical Perspective, McGraw-Hill Professional. Web-based educational tool: www.myneuroicu.com (articles, and presentations pertaining to neuro-ICU rotation) Journals: Neurology Archives of Neurology Annals of Neurology Brain Stroke Journal of Neurology, Neurosurgery and Psychiatry 6.3. a. The following is an outline of relevant pathophysiology and disease states: Pathophysiologic processes: Increased Intracranial Pressure Cerebral Edema Cerebral Ischemia or Perfusion Failure Acute neuromuscular respiratory failure
Metabolic abnormalities Brain death Disease processes: Traumatic brain injury Stroke Intracerebral Hemorrhage Subdural/epidural hemorrhage Subarachnoid hemorrhage Post Operative Care Craniotomy Transsphenoidal pituitary resection Stereotactic Procedures Spine Procedures Head injury Guillain-Barre Syndrome Myasthenia Gravis Status Epilepticus Tumors of the Nervous System Meningitis/Encephalitis Spinal cord injury Epidural/subdural hemorrhage Hydrocephalus
Revised 7-1-2015
Pediatric Neurology Curriculum Required PGY3 or 4 Rotation Description of Rotation or Educational Experience Supervising faculty responsible for reviewing Goals and Objectives: Jean-Baptiste Le Pichon, MD, Ph.D. Additional faculty: Brian Aalbers, DO; Ahmed Abdelmoity,MD; Tyler Allison, MD; Jennifer Bickel,MD; Keith Coffman, MD (associate program director), Fereydoun Dehkharghani, MD; Ara Hall, MD; Gina Jones, MD; Husam Kayyali,MD; Kailash T. Pawar, MD; Heather R. Riordan, MD; Steven Shapiro,MD, MSHA. Three-month rotation in pediatric neurology at Children's Mercy Hospital. This occurs during PGY3 or 4 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 From the RRC: Will have a combination of patient care, teaching, and research in their training program. Patient care responsibilities must ensure a balance between patient care and education that achieves for the trainee an optimal educational experience consistent with the best medical care. Patient care responsibilities must include inpatient, outpatient, and consultation experiences; Must have experience with neurological disorders in children under the supervision of a child neurologist with ABPN certification or suitable equivalent qualifications. This must consist of a minimum of three months FTE in clinical child neurology with management responsibility; Must have clinical teaching rounds supervised by faculty. These rounds must occur at least five days per week. Residents must present cases and their diagnostic and therapeutic plans; Must have instruction and practical experience in obtaining an orderly and detailed history from the patient, in conducting a thorough general and neurological examination, and in organizing and recording data. The training must include the indications for and limitations of clinical neurodiagnostic tests and their interpretation. Residents must learn to correlate the information derived from these neurodiagnostic studies with the clinical history and examination in formulating a differential diagnosis and management plan; Must participate in the evaluation of and decision making for patients with disorders of the nervous system requiring surgical management. The existence of a neurosurgical service with close interaction with the neurology service is essential; Must participate in the management of patients with acute neurological disorders 1
in an intensive care unit and an emergency department; Must have experience in neuroimaging that ensures a familiarity with and knowledge of all relevant diagnostic and interventional studies necessary to correlate findings with other clinical information for the care of patients. At a minimum this must include magnetic resonance imaging, computerized tomography and neurosonology; Must receive instruction in appropriate and compassionate methods of end-of-life palliative care, including adequate pain relief and psychosocial support and counseling for patients and family members about these issues; and, Must received instruction on recognition and management of physical, sexual, and emotional abuse. Must have opportunities for increasing responsibility and professional maturation. Early clinical assignments must be based on direct patient responsibility for a limited number of patients. Subsequent assignments must place residents in a position of taking increased responsibility for patients. Night call is essential in accomplishing these goals. Adequate faculty supervision is essential throughout the program. Neurological training must include assignment on a consultation service to the medical, surgical, obstetric and gynecologic, pediatric, rehabilitation medicine, and psychiatry services. Must have management responsibility for patients with neurological disorders. Neurology residents must be involved in the management of patients with neurological disorders who require emergency and intensive care From Children's Mercy Hospital: Residents must be able to provide patient care that is both appropriate and compassionate and that is effective for the promotion of health and the treatment of health problems and disease. Residents must: · Use all sources to gather essential and accurate information about their patients, including medical interviews, medical examinations, and medical records · Make informed recommendations to patients and their families regarding treatment plans and recommended diagnostic and therapeutic interventions that are based upon patient preference, scientific evidence, and clinical judgment · Develop and carry out patient management plans, counsel and educate patients and their families, and collaborate with other health care professionals (including those from different disciplines) to provide family-centered care · Competently perform all essential medical and invasive procedures Objectives The PGY4 resident will: Demonstrate the ability to perform an efficient and thorough evaluation of the pediatric neurology patient including interviewing the patient and their Family Demonstrate the ability to develop a differential diagnosis for the pediatric neurology patient Demonstrate the ability to develop a plan for evaluation and treatment of the pediatric patient Demonstrate the ability to counsel and educate patients and their families 2
As measured by GCP, Checklist, Case Stimulated Recall, Focused Observation (Observation of Procedural Skills, Observation of Patient Care Encounter (SEGUE)), Case Logs. 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 Must regularly attend seminars and conferences in the following disciplines: neuropathology, neuroradiology, neuro-ophthalmology, neuromuscular disease, 3cerebrovascular disease, epilepsy, movement disorders, critical care, clinical neurophysiology, behavioral neurology, neuroimmunology, infectious disease, neuro-otology, neuroimaging, neuro-oncology, sleep disorders, pain management, neurogenetics, rehabilitation, child neurology, the neurology of aging, and general neurology. There must be gross and microscopic pathology conferences and clinical pathological conferences. Residents must have increasing responsibility for the planning and supervision of the conferences. Residents must learn about major developments in both the basic and clinical sciences relating to neurology. Residents must attend periodic seminars, journal clubs, lectures in basic science, didactic courses, and meetings of local and national neurological societies; Must learn the basic sciences on which clinical neurology is founded, including neuroanatomy, neuropathology, neurophysiology, neuroimaging, neuropsychology, neural development, neurochemistry, neuropharmacology, molecular biology, genetics, immunology, epidemiology, and statistics. The didactic curriculum developed to satisfy this requirement must cover basic science and must be organized and complete; and, Must receive instruction in the principles of bioethics and in the provision of appropriate and cost-effective evaluation and treatment for patients with neurological disorders From Children's Mercy Hospital: Residents must be able to demonstrate knowledge about current and established clinical, biomedical, epidemiological, and social-behavioral sciences and will apply this knowledge to patient care. Residents must: · Learn the clinical aspects of pediatric neurological disorders and the basis for working up these conditions · Utilize readings to learn the causes of neurological conditions and apply this knowledge in a clinical setting · Learn the appropriate use of diagnostic procedures used to detect common and uncommon neurological disorders in children Objectives The PGY4 resident will: Attend all subspecialty conferences 3
Learn the clinical aspects of pediatric neurology disorders and apply these to in the clinical setting. As measured by GCP, Focused Observation, RITE, 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; Identify and perform appropriate learning activities From Children's Mercy Hospital: Residents must be able to use information technology, scientific methods, and scientific evidence to evaluate, investigate, and improve patient care. Residents must: · Identify areas for self-improvement and facilitate learning among students and other health care professionals · Implement strategies to enhance patient care · Analyze practice experience and perform practice-based improvement activities using a systematic methodology · Find an evaluate evidence from scientific studies related to patient health problems and incorporate findings into patient care · Obtain and utilize information about their population of patients as well as the larger population from which their patients are drawn Objectives The PGY4 resident will: Demonstrate their ability to identify strengths, deficiencies and limits in one's knowledge and expertise; Demonstrate the ability to find an evaluate evidence from scientific studies related to patient health problems and incorporate findings into patient care Identify and perform appropriate learning activities As measured by GCP, CSR, RITE 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 effectively in various health care delivery settings and systems relevant to their clinical specialty Incorporate considerations of cost awareness and risk-benefit analysis in patient care From Children's Mercy Hospital: 4
Residents must be able to demonstrate interpersonal and communication skills resulting in effective communication with patients, families, and other medical professionals. Residents must: · Create and sustain a therapeutic and ethically sound relationship with patients · Use listening, nonverbal, explanatory, questioning and writing skills to effectively provide information to and elicit information from patients, families, and other medical professionals · Work effectively with health care teams and other colleagues as a member or as a leader Objectives The PGY4 resident will: Demonstrate their ability to work effectively in various health care delivery settings and systems relevant to their clinical specialty as applied to a pediatric neurology clinic and on the pediatric neurology consult service Demonstrate the ability to incorporate considerations of cost awareness and risk benefit analysis in patient care Demonstrate the ability to create and sustain a therapeutic and ethically sound relationship with patients Demonstrate the ability to use listening, nonverbal, explanatory, questioning and writing skills to effectively provide information to and elicit information from patients, families, and other medical professionals Demonstrate the ability to work effectively with health care teams and other colleagues as a member or as a leader As measured by GCP, CSR, Focused Observation Professionalism Goals Residents must demonstrate a commitment to carrying out professional responsibilities and an adherence to ethical principles. Residents are expected to demonstrate: Competencies Responsiveness to patient needs that supersedes self-interest Sensitivity and responsiveness to a diverse patient population, including but not limited to diversity in gender, age, culture, race, religion, disabilities, and sexual orientation Objectives The PGY4 resident will: Demonstrate their ability to show compassion, integrity, and respect for others Demonstrate respect for patient privacy and autonomy Demonstrate sensitivity and responsiveness to a diverse patient population, including but not limited to diversity in gender, age, culture, race, religion, disabilities, and sexual orientation From Children's Mercy Hospital: Residents have an obligation to professionalism and sensitivity and must adhere to ethical principles within a diverse patient population. Residents must: 5
· Demonstrate accountability, respect, integrity, and empathy toward patients and their families and to society · Demonstrate openness and sensitivity to the culture, age, gender, disabilities, socioeconomic status, beliefs and behaviors of patients, patients' families, and professional colleagues · Adhere to ethical principles concerning the withholding of clinical care, confidentiality of patient information, informed consent, and business practices As measured by GCP, CSR, Focused Observation, 360o Evaluation 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 physicians, other health professionals, and health related agencies Maintain comprehensive, timely, and legible medical records From Children's Mercy Hospital: Residents have an obligation to professionalism and sensitivity and must adhere to ethical principles within a diverse patient population. Residents must: · Demonstrate accountability, respect, integrity, and empathy toward patients and their families and to society · Demonstrate openness and sensitivity to the culture, age, gender, disabilities, socioeconomic status, beliefs and behaviors of patients, patients' families, and professional colleagues · Adhere to ethical principles concerning the withholding of clinical care, confidentiality of patient information, informed consent, and business practices Objectives The PGY4 resident will: Demonstrate their ability communicate effectively with patients and families across a broad range of socioeconomic and cultural backgrounds Work effectively as a member of a health care team or other professional group Maintain comprehensive, timely, and legible medical records As measured by GCP, CSR, Focused Observation, 360o Evaluation, Teaching Methods What teaching methods are you using on this rotation or educational experience? Daily rounds Presentation, review, and discussion of cases with attending faculty Weekly lectures Interactive discussions 6
Assessment Method (residents) How do you measure the resident's performance on this rotation or educational experience? Patient Care: GCP, Checklist, Case Stimulated Recall, Focused Observation (Observation of Procedural Skills, Observation of Patient Care Encounter (SEGUE)), Case Logs Medical Knowledge: GCP, Focused Observation, RITE, Weekly Quizzes, Practice-Based Learning: GCP, CSR, Focused Observation Systems Based Practice: GCP, CSR, Focused Observation Professionalism: GCP, CSR, Focused Observation, 360o Evaluation, Interpersonal and Communication Skills: GCP, CSR, Focused Observation, 360o Evaluation, Assessment Method (Program Evaluation) How do you evaluate whether this educational experience is effective? Monthly evaluation of the rotation by the resident Yearly program evaluation Twice-yearly evaluation of the resident and solicitation of feedback. Level of Supervision How is the resident supervised on this rotation? Daily direct supervision by ward attending and other faculty Direct supervision by attending and other faculty Direct supervision by clinic attending Educational Resources List the educational resources Bradley WG, Daroff RB, Fenichel GM, and Jankovic J. Neurology in Clinical Practice, 5th edition, Butterworth-Heinemann, 2008. Practice Parameters from the American Academy of Neurology, are available for a large range of conditions, therapies, and assessment tools at AAN.com. Ropper AH and Brown RH. Adams and Victor's Principles of Neurology, 8th edition, McGraw-Hill Professional, 2005. Journals: Neurology Archives of Neurology Annals of Neurology Brain Stroke Journal of Neurology, Neurosurgery and Psychiatry Rev. 9-24-2015 7
Neuro-ophthalmology Elective PGY3 and 4 Global Clinical Performance Tool (GCP)
Resident Month/year
Patient Care
Can the resident localize the lesion?
1
2
(Unsatisfactory)
(Satisfactory)
Frequently can't localize Consistently and
the lesion. They give the accurately localizes the
appearance of having no lesion with the available
clue as to where the lesion information.
is.
3 (Exemplary) Excels at localization above the PGY2 level. For example, routinely would localize the lesion to a medullary plate syndrome rather than the more generic brainstem lesion
The resident develops a differential diagnosis based upon the clinical history and
examination that they have obtained.
1
2
3
(Unsatisfactory)
(Satisfactory)
(Exemplary)
Unable to generate an
Consistently generates a Performs and presents the
appropriate differential differential diagnosis that differential diagnosis
diagnosis. Frequently
is comprehensive and
above their level of
leaps to the wrong
they are able to prioritize training. It is exceedingly
diagnosis, or the proper their differential diagnosis rare that the attending is
diagnosis but can not
based upon disease
able to suggest additional
explain why, or can't
prevalence.
items for the differential
generate a differential
that have a high
diagnosis appropriate for
prevalence. Minimal, if
their level of training
any inappropriate items in
their differential.
Can the resident develop a plan of evaluation and treatment?
1
2
3
(Unsatisfactory)
(Satisfactory)
(Exemplary)
Frequently does
Consistently develops an Excels at development of a
everything by rote.
efficient plan of evaluation plan for evaluation and
Shotgun approach without and treatment based on treatment. Makes
narrowing the evaluation their examination and
extensive use of
by likelihood ratios. Must localization. Prioritizes
sensitivity, specificity,
rule out everything rather tests based on sensitivity, disease prevalence, and
than the likely diagnoses specificity, disease
the need for urgent
based on prevalence
prevalence, and the need for emergent intervention. Chooses appropriate therapies.
intervention when developing the evaluation plan. Frequently evaluates the magnitude of benefit vs. the cost and risk of therapies.
Medical Knowledge
Does the resident regularly attend and participate in subspecialty (patient)
conferences?
1
2
3
(Unsatisfactory)
(Satisfactory)
(Exemplary)
Insufficient fund of
Consistently attends and Always attends
knowledge. Does not
participates in
subspecialty conferences
participate in appropriate subspecialty conferences. so that their fund of
subspecialty conferences
knowledge is well above
that of their peers.
Does the resident regularly attend and participate in seminars (lectures)?
1
2
3
(Unsatisfactory)
(Satisfactory)
(Exemplary)
Insufficient fund of
Consistently attends and Always attends
knowledge. Does not
participates in
subspecialty conferences
participate in appropriate subspecialty conferences. so that their fund of
subspecialty conferences
knowledge is well above
that of their peers.
Practice Based Learning
The resident identifies and performs appropriate learning activities.
1
2
3
(Unsatisfactory)
(Satisfactory)
(Exemplary)
Is not able to identify and Consistently identifies and Independently identifies
or to perform appropriate performs appropriate
and performs appropriate
learning activities for their learning activities.
learning activities. Well on
level. Needs constant
their way to establishing a
supervision to find study
pattern of life long
materials. Includes
learning.
looking are advanced
sources when they have
not mastered the basics.
Systems Based Practice Not applicable
Professionalism
The resident demonstrates compassion, integrity and respect for others.
1
2
3
(Unsatisfactory)
(Satisfactory)
(Exemplary)
Does not demonstrate
Consistently demonstrates Always demonstrates
compassion, integrity or compassion, integrity and compassions, integrity,
respect towards others. respect for others.
and respect for others
with proficiency well
above their level of
training.
Interpersonal Communication Skills
The resident works effectively as a member of a health care team or other professional
group
1
2
3
(Unsatisfactory)
(Satisfactory)
(Exemplary)
Does not work effectively Consistently demonstrates Always demonstrates the
as a member of leader of a the ability work effectively ability to work effectively
health care team or other as a member of leader of a as a member of leader of a
professional group. They are unaware of others,
health care team or other professional group.
health care team or other professional group with
unwilling or unable to work
proficiency well above
with them.
their level of training.
Global Assessment
Has the resident shown consistent improvement across all domains during this year
of training? Are they maturing as expected?
1
2
3
(Unsatisfactory)
(Satisfactory)
(Exemplary)
Failure to improve across Consistent improvement Consistently performs as a
all (or most) domains
across all domains as
level above that of their
expected for their level of peers and above what is
training
expected for their level of
training
Additional comments:
Psychiatry Curriculum Required Rotation PGY4 Description of Rotation or Educational Experience Supervising faculty responsible for review of goals and objectives: Angela K. Mayorga, M.D This one month rotation on the Psychiatry Consult service is in PGY4 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 From the RRC: Must participate in the management of patients with psychiatric disorders. The program must include at least one-month full-time equivalent experience in clinical psychiatry, including cognition and behavior. The experience should take place under the supervision of a psychiatrist certified by the American Board of Psychiatry and Neurology, or who possesses qualifications acceptable to the Review Committee. They must learn about the psychological aspects of the patient-physician relationship and the importance of personal, social, and cultural factors in disease processes and their clinical expression. Residents must learn the principles of psychopathology, psychiatric diagnosis, and therapy and the indications for and complications of drugs used in psychiatry; Must received instruction on recognition and management of physical, sexual, and emotional abuse. Objectives The PGY4 resident will: Demonstrate their understanding of common psychiatric problems in both inpatients and in the clinicCollaborate with other health care professionals (including those from different disciplines) to provide patient-focused care Develop and carry out patient management plans As measured by GCP, Focused Observation (Observation of Patient Care Encounter (SEGUE)), Case Logs. 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 1
Must receive instruction in the principles of bioethics and in the provision of appropriate and cost-effective evaluation and treatment for patients with neurological disorders Objectives The PGY4 resident will: Demonstrate their fund of knowledge in the basic science and clinical manifestations of psychiatric problems As measured by GCP, RITE 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 and perform appropriate learning activities Objectives The PGY4 resident will: Demonstrate their ability to identify learning activities in psychiatry As measured by GCP, Focused Observation 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 The PGY4 resident is expected to: Work effectively in various health care delivery settings and systems relevant to their clinical specialty; Objective: The PGY4 resident will: Demonstrate the ability to work within the Psychiatric health care delivery system, as determined by direct observation by the faculty of the Department of Psychiatry Professionalism Goals 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 Sensitivity and responsiveness to a diverse patient population, including but not 2
limited to diversity in gender, age, culture, race, religion, disabilities, and sexual orientation Objectives The PGY4 resident will: Work effectively in various health care delivery settings and systems relevant to their clinical specialty as measured by GCP, 360o Evaluation 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 Objectives The PGY4 resident will: Demonstrate the compassion, integrity, and respect for others As measured by GCP Teaching Methods What teaching methods are you using on this rotation or educational experience? Daily rounds Presentation, review, and discussion of cases with attending faculty Assessment Method (residents) How do you measure the resident's performance on this rotation or educational experience? Patient Care: GCP, Focused Observation (Observation of Patient Care Encounter (SEGUE)), Medical Knowledge: GCP, RITE, Practice-Based Learning: GCP Systems Based Practice: GCP Professionalism: GCP, Interpersonal and Communication Skills: GCP, Focused Observation Assessment Method (Program Evaluation) How do you evaluate whether this educational experience is effective? Monthly evaluation of the rotation by the resident Yearly program evaluation Twice-yearly evaluation of the resident and solicitation of feedback. 3
Level of Supervision How is the resident supervised on this rotation? Daily direct supervision by ward attending and other faculty Direct supervision by attending and other faculty Direct supervision by clinic attending Educational Resources List the educational resources Bradley WG, Daroff RB, Fenichel GM, and Jankovic J. Neurology in Clinical Practice, 4th edition, Butterworth-Heinemann, 2003. Aminoff M., Neurology in General Medicine, Churchill Livingstone. Cooper JR, Bloom FE, and Roth RH. The Biochemical Basis of Neuropharmacology, 8th edition, Oxford University Press. Devinsky O. Behavioral Neurology: 100 Maxims (100 Maxims in Neurology Series), Mosby-Year Book. Mesulam M-M. Principles of Behavioral and Cognitive Neurology, Oxford University Press, USA. Journals: Neurology Archives of Neurology Annals of Neurology Brain Stroke Journal of Neurology, Neurosurgery and Psychiatry Rev. 6-30-2014 4
Research Elective Description of Rotation or Educational Experience This is an elective that must be arranged in advance. To take this elective, the resident must arrange to work with a faculty mentor, to have a well-defined project and a demonstrable product (i.e. completed paper) by the end of the month. This month can be taken in PGY3 or PGY4 Patient Care NA 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 Must regularly attend seminars and conferences in the following disciplines: neuropathology, neuroradiology, neuro-ophthalmology, neuromuscular disease, cerbrovascular disease, epilepsy, movement disorders, critical care, clinical neurophysiology, behavioral neurology, neuroimmunology, infectious disease, neuro-otology, neuroimaging, neurooncology, sleep disorders, pain manageme nt, neurogenetics, rehabilitation, child neurology, the neurology of aging, and general neurology. There must be gross and microscopic pathology conferences and clinical pathological conferences. Residents must have increasing responsibility for the planning and supervision of the conferences. Residents must learn about major developments in both the basic and clinical sciences relating to neurology. Residents must attend periodic seminars, journal clubs, lectures in basic science, didactic courses, and meetings of local and national neurological societies; Must learn the basic sciences on which clinical neurology is founded, including neuroanatomy, neuropathology, neurophysiology, neuroimaging, neuropsychology, neural development, neurochemistry, neuropharmacology, molecular biology, genetics, immunology, epidemiology, and statistics. The didactic curriculum developed to satisfy this requirement must cover basic science and must be organized and complete; and, Must receive instruction in the principles of bioethics and in the provision of appropriate and cost-effective evaluation and treatment for patients with neurological disorders Objectives This is to be developed in collaboration between the resident, mentor and the 1
program director as measured by review of the completed research product Practice- Based Learning and Improvement NA Systems Based Practice NA Professionalism Goals Residents must demonstrate a commitment to carrying out professional responsibilities and an adherence to ethical principles. Residents are expected to demonstrate: Competencies Accountability to patients, society, and the profession Objectives This is developed between the resident, mentor and program director prior to the beginning of the rotation Interpersonal and Communication Skills NA Teaching Methods Determined in conjunction between the resident, mentor and program director Assessment Method (residents) Review of the completed project 2
Assessment Method (Program Evaluation) How do you evaluate whether this educational experience is effective? Monthly evaluation of the rotation by the resident Yearly program evaluation Twice-yearly evaluation of the resident and solicitation of feedback. Level of Supervision How is the resident supervised on this rotation? Daily direct supervision by ward attending and other faculty Direct supervision by attending and other faculty Direct supervision by clinic attending Educational Resources Developed by the resident and the mentor Rev. 6-20-2016 3
Research Elective Request/Approval Department of Neurology University of Kansas Medical Center Research electives are possible for residents in PGY3 and PGY4 and must be arranged in advance. These are not reading months, but true research. You must have a project, a mentor and a product identified before the elective can be approved by the program director and the product must be presented to the program director at the end of the rotation. Resident: Month/Year for proposed elective Mentor (name) Project title:
Description of project (< 200 words) Anticipated product (draft manuscript, abstract, etc.) Signature (and date) of mentor:
Attach to this form
Program director approval and date:
ver 3/12/2015
Truman Medical Center Curriculum Required Rotation PGY 2,3 and 4 Description of Rotation or Educational Experience KU Ward Service Supervising Faculty for Rotation, responsible for review of Goals & Objectives: Sean Gratton, MD Additional faculty: John Sand, MD; Jorge Kawano, MD; Mian Irfy, MD Binod Wagle, MD; Charles Donohoe, MD; One month long rotation providing consultations for inpatients and outpatients at Truman Medical Center, part of the University of Missouri-Kansas City, School of Medicine This is one of the 18 months of inpatient and consult training mandated by the Neurology RRC This month rotation occurs during PGY2-4 Overall Goals: During the TMC rotation, residents are expected to be able to demonstrate their ability to obtain the appropriate history from a patient with neurological disorders, perform the appropriate neurological, and general physical, examinations, formulate a differential diagnosis, determine appropriate evaluation and management of the patient. Residents are expected to improve their skills with the neurological examination, perfect communication skills with patients, patients' families, from varied cultural and social backgrounds and with colleagues. Residents will gain an understanding of neurological diseases and the management of common neurological disorders encountered in an inner city hospital. Over the course of PGY2 the neurology resident will handle increasing responsibility as demonstrated by managing patients with more complex disorders, providing care for a higher number of patients and effectively teaching rotating residents and medical students about neurology. 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 Evaluate and manage patients with neurological disorders and neurological manifestation of systemic diseases Objectives The resident in neurology will: 1
Perform an efficient and thorough general physical examination Perform an efficient and thorough neurological examination Competently perform all essential medical and invasive procedures As measured by checklist (direct observation), global clinical performance, and chart stimulated recall. 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 The resident must learn the basic sciences on which clinical neurology is founded and integrate them into their evaluation and treatment of patients. This includes knowledge of neuroanatomy, neuropathology, neurophysiology, neuroimaging, neuropsychology, neural development, neurochemistry, neuropharmacology, molecular biology, genetics, immunology, epidemiology, and statistics. Objectives The resident will; Improve their fund of knowledge appropriate for the PGY2 level Become familiar with the principles of bioethics Provide cost effective evaluation and treatment as measured by checklist (witnessed examination), global clinical performance and Resident In-service Training Examination (RITE). 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 Set learning and improvement goals Participate in the education of patients, families, students, residents and other health professionals, as documented by evaluations of a resident's teaching abilities by faculty and/or learners Objectives The resident will Incorporate formative evaluation feedback into their daily practice of neurology Participate in the education of patients, families, students, residents and other health professionals 2
As measured by checklist (witnessed examination) global clinical performance 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 Coordinate patient care within the health care system relevant to their clinical specialty Incorporate considerations of cost awareness and risk-benefit analysis in patient care Objectives The resident will; Coordinate patient care within the health care system Advocate for quality patient care and optimal patient care systems As measured by, chart stimulated recall and global clinical performance. Professionalism Goal Residents must demonstrate a commitment to carrying out professional responsibilities and an adherence to ethical principles. Residents are expected to demonstrate: Competencies Respect for patient privacy and autonomy Sensitivity and responsiveness to a diverse patient population, including but not limited to diversity in gender, age, culture, race, religion, disabilities, and sexual orientation Objectives The resident will demonstrate; In the process of providing care to inpatients, resident to demonstrates sensitivity to patient privacy, autonomy and diversity. Be responsive to patient primary and autonomy As measured by checklist (witnessed examination), global clinical performance, and 360o evaluation. 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 3
Communicate effectively with patients and families across a broad range of socioeconomic and cultural backgrounds Maintain comprehensive, timely, and legible medical records Objectives The resident will: The resident communicates effectively with patients and their families. Work effectively as a member of a health care team The resident maintains the medical record in a comprehensive, timely and legible manner As demonstrated by chart review and global clinical performance. Teaching Methods What teaching methods are used on this rotation or educational experience? Didactic lectures of specific topics, including the neurological examination, localization and evaluation of neurological disorders, bedside and clinic teaching Assessment Method (residents) How do you measure the resident's performance on this rotation or educational experience? Checklist: Direct supervision of resident performing history and clinical evaluation (PC, MK, PROF, LCS) RITE (MK) Checklist: Lumbar puncture proficiency (PC) Global Clinical Performance: Discussion of differential diagnosis, use of laboratory, patient management (PC, MK, SBL, PBL, LCS, PROF) Chart Stimulated Recall: (PC, MK, SBL, PBL) 360o evaluation (LCS, PROF) Chart review (LCS, PROF) Assessment Method (Program Evaluation) How do you evaluate whether this educational experience is effective? Monthly evaluation of the rotation by the resident Yearly program evaluation Twice-yearly evaluation of the resident and solicitation of feedback. Level of Supervision How is the resident supervised on this rotation? Daily direct supervision by neurologists at Truman Medical Center The resident reviews every admission and consultation with the attending in a timely fashion. Attending neurologists are available 24 hours a day, 365.25 days a year. Educational Resources List the educational resources 4
·
Aminoff M., Neurology in General Medicine, Churchill Livingstone.
·
Flaherty, A. The Massachusetts General Hospital Handbook of Neurology,
Lippincott Williams & Wilkins.
·
Marshall RS and Mayer SA. On Call Neurology: On Call Series, Saunders.
·
Plum F and Posner J. The Diagnosis of Stupor and Coma, 3rd edition, Oxford
University Press, 1982.
·
Practice Parameters from the American Academy of Neurology, are available for
a large range of conditions, therapies, and assessment tools at AAN.com.
·
Ropper AH and Brown RH. Adams and Victor's Principles of Neurology, 8¬th
edition, McGraw-Hill Professional, 2005.
·
Strunk W, White EB, and Kalman M. The Elements of Style Illustrated, Illustrate
edition, The Penguin Press HC, 2000.
·
Trusse L. Eats, Shoots & Leaves: The Zero Tolerance Approach to Punctuation,
Reprint edition, Gotham, 2006.

Aids to the Examination of the Peripheral Nervous System, Saunders Limited, 4th
edition, 2000.
Journals:
Neurology
Archives of Neurology
Journal of Neurology, Neurosurgery, and Psychiatry
Annals of Neurology
Brain
Stroke
version: 6/19/2015
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