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4 week block rotation under the supervision of Dr. Kenneth Aronson, Dr. Thomas Laurence and Dr. John Helfrich in the direct experience in progressive responsibility for patient treatment and competent care management.
Additional Neurology training takes place longitudinally throughout all 3 years, specifically, block rotations in Adult Medicine Inpatient. Other Neurology education occurs during weekly conference which includes Grand Rounds, Morbidity and Mortality, and Journal Club.
Demonstrate attitudes, skills and knowledge for diagnosis, treatment and competent care management of Neurology patients, including competency in the performance of the neurologic examination.
A. PATIENT CARE:
Objective 1: Demonstrate clinical skills of comprehensive medical interview, history and physical examination, including functional assessment and mental status as needed.
Objective 2: Demonstrate clinical skills in the thorough performance of the neurologic examination
B. MEDICAL KNOWLEDGE:
Objective 1: Demonstrate knowledge of the natural history, pathophysiology, clinical presentation, diagnosis through differential diagnosis and management of clinical problems as listed.
• Neurological examination/localization
• Stroke
• Brain Hemorrhage
• Seizures and syncope
• Dementia, e.g. Normal Pressure Hydrocephalus (NPH)
• Parkinson's Disease and Extrapyramidal Disorders, e.g. progressive supranuclear palsy (PSP)
• Coma and brain death
• Demyelinating Disease, e.g. multiple sclerosis (MS), Progressive multifocal leukoencephalopathy (PML)
• Movement Disorders, e.g. tardive dyskinesia, essential tremor, hemifacial spasm syndrome, blepharospasm, torticollis, Tourette's, Wilson's Disease, Huntington's Disease
• Headache and facial pain, e.g. temporal arteritis, tic, atypical facial pain
• Neuropathy, e.g. Guillain-Barre' Syndrome
• Central Nervous System tumors
• Neuro-Ophthalmology
• Central Nervous System infections, e.g. herpes zoster, neurosarcoidosis, Acquired Immune Deficiency Syndrome (AIDS)
• Myasthenia and neuromuscular junction disorders, e.g. botulism
• Vertigo and dizziness
• Myopathy
• Alcohol and nutritional disorders
• Drug abuse and neurotoxicology
• Neurology of critically ill patients
• Functional patients
• Sleep disoders
• Syringomyelia
Objective 2: Describe and evaluate a pharmacotherapeutic approach which includes definition of therapeutic objectives and options, selection of dose and parameters to be monitored, and measurement of therapeutic response and outcome.
Objective 3: Perform and record procedures
• Procedure Skills : Perform and become adept at the lumbar puncture skills
• Observe electrodiagnostic procedures, e.g. angiogram, computerized axial tomography (CAT), electroencephalogram (EEG), electromylogram (EMG), electromyography and magnetic resonance imaging (MRI) to gain appreciation of the diagnostic indications, risks and limitations
C. PRACTICE-BASED LEARNING AND IMPROVEMENT
Objective 1: Demonstrate evidenced based practice through appraisal and assimilation of scientific information, e.g. scientific journals, related to patient care
Objective 2: Demonstrate ability in medical decision making, which incorporates medical assessment and patient values and preferences.
D. INTERPERSONAL AND COMMUNICATION SKILLS
Objective 1: Create an atmosphere of positive regard for the patient and family to promote the best medical outcome through accessibility, affability and continuity.
Objective 2: Incorporate psychosocial and ethical concerns of the patient and family in the development of the care management plan.
E. PROFESSIONALISM
Objective 1: Recognize the legal requirements of advanced directives and describe the process of assessing a patient's advance directives, including the patient's perspective.
Objective 2: Model appropriate professional attitudes and behaviors of time management and punctuality, reliability, and ethical behavior.
F. SYSTEM-BASED PRACTICE
Objective 1: Recognize financial issues of heath care, with emphasis on understanding acute and chronic care, and medication coverage and the role of the Centers for Medicare and Medicaid Services (CMS), and other third party payers.
Objective 2: Actively participate in the multidisciplinary approach to caring for patients, including appropriate recognition of other health professional and paraprofessionals' roles and demonstrate competence in team interactions, i.e. pharmacist, advanced practice nurse, nurses, occupational and physical therapist, social worker.
The Neurology rotation is a four-week experience supervised by neurologists, faculty members of the University Of Illinois College Of Medicine at Urbana-Champaign, Department of Internal Medicine. All neurology faculty members are certified by the American Board of Psychiatry & Neurology. Residents work in the Carle Clinic Association Department of Neurology, Carle Foundation Hospital , Christie Clinic, and the Veterans Administration Illiana Health Care System (VAIHCS).
Responsibilities are to the education rotation with progressive responsibility for patient treatment and competent care management, excluding one half day per week at Continuity Clinic and one half day per week at afternoon conference.
Patient care responsibilities extend from Monday through Friday, 0730 to 1700. Hospital consults are assigned, when appropriate, when requests are received in the ambulatory offices. Weekend, holiday, and on-call responsibilities are not scheduled.
Residents work under the direct supervision of an assigned attending neurologist. The residents perform the initial history and physical examination, and present findings and available laboratory data to the attending neurologist. After reviewing patient data and pertinent teaching points, the resident and attending neurologist complete the patient encounter together. Selected components of the examination may be repeated and demonstrated to the resident. Residents are responsible for documenting the patient encounter with a written or dictated note.
According to Accreditation Council of Graduate Medical Education (ACGME), training and evaluation must include the following competencies: Patient Care, Medical Knowledge, Practice – Based Learning and Improvement, Interpersonal and Communication Skills, Professionalism, and System-Based Practice.
Patient Care will be evaluated by assessment of the attending physician. Procedures performed will be documented.
Medical Knowledge will be evaluated by assessment of the attending physician.
Practice-Based Learning and Improvement will be evaluated by assessment of the attending physician.
Interpersonal and Communication Skills will be evaluated by assessment of the attending physician.
Professionalism will be evaluated by assessment of the attending physician.
System-Based Practice will be evaluated by assessment of the attending physician.
The evaluation method is primarily accomplished electronically. Residents' performance in Neurology is evaluated by the attending physician. Evaluations are reviewed with the residents for formal feedback. In addition, ongoing feedback is provided related to residents' patient care responsibilities and activities.
Residents will document the Neurology rotation in portfolios, e.g. procedures performed. This tool will provide individual learning, reflection and assessment. Additionally, residents will evaluate the Neurology rotation.
Residents provide input on the Neurology core lecture series, which is used in scheduling future topics and speakers. Topics include Alzheimer's Disease, Coma, Dizziness, Epilepsy, Headache, Movement Disorders, Multiple Sclerosis, Neurodiagnostic testing, Neuropathy, Pain treatment, Parkinson's Disease, Stroke, the Functional Patient, and Neurological Exam. Periodically, residents are surveyed to evaluate the Neurology curriculum and teaching faculty.
Principles of Neurology , Adams/Victor - Reference
The Neurologic Examination , DeJong, Haerer (current edition)
Diagnoses of Stupor and Coma , Plum/Posner - Reference
Neurology in Clinical Practice , Bradley/Daroff, 2 Vol
Neuro for the House Officer , Weiner/Levitt
The Little Black Book of Neurology , (Yearbook Handbook)
Neuro-Ophthalmology Review Manual , Bajardas & Kline
Merritt's Textbook of Neurology , Rowland (Editor)
Technique of the Neurologic Exam, DeMyer (current edition)
Residents are assigned a month-long neurology rotation focused on the inpatient and outpatient assessment of neurologic conditions. The resident is directly supervised by the attending neurologist. The resident is responsible for initial the office evaluation of patient referred to the neurology department, and in addition, sees hospitalized patients requiring neurologic consultation. Subsequently, the case is reviewed directly with the attending neurologist. The attending neurology staff evaluates the resident at the end of the rotation.
Rev 09.01.05, 07.01.06