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Neurology

Reviewed: 2014

ALBERT EINSTEIN COLLEGE OF MEDICINE

MONTEFIORE MEDICAL CENTER

INTERNAL MEDICINE RESIDENCY PROGRAM:  CURRICULUM

NEUROLOGY:  PGY2 ROTATION 

I.   Goals:

Familiarize residents with the neurological history and physical examination and enable them to synthesize these findings into a working diagnosis to make them more effective clinicians.

House officers will rotate through the general neurology service and/or stroke service at MMC where they will be supervised by full-time and voluntary neurology attendings. 

House officers will become more familiar with the approach to the patient with neurological disease and hone their skills in eliciting history, performing neurological physical exam, ordering appropriate tests and integrating these parts into a cohesive diagnostic and treatment plan.

Level based rotation objectives (All are PGY2:)

Patient Care:  Perform in - depth medical and neurological history and physical exams while acting as the primary housestaff provider for patients on the inpatient neurological service.  Prioritize the daily work and recognize the acuity levels of illness.  Formulate a diagnostic and therapeutic plan for a variety of neurological problems.  Order appropriate tests and utilize information technology to obtain results and support patient care decisions.

Medical knowledge:  Attend all scheduled neurology conferences as permitted by duty hour regulations. Use literature and reference sources to increase knowledge base and better understand neurological disorders.  Develop deeper understanding of neurologic disease states and their relationship to the patients’ overall condition.  Gain increased knowledge of the underlying brain pathophysiology and neuroanatomy that relates to the clinical manifestations of disease states.    Apply this increased knowledge in the treatment of patients.

Professionalism:    Demonstrate reliability and establish a sense of responsibility for patient care.  Work as a cooperative member of the health care team.  Demonstrate respect for patients and establish trust and a productive patient- physician relationship.  Learn to ask supervisors for help when indicated. 

Attend conferences

Interpersonal skills:  Create and sustain a therapeutic relationship with patients.  Work as a dependable and productive member of the health care team.  Hone communication skills to better interact with patients and colleagues.  Develop leadership skills.

Practice-based learning and improvements:  Recognize your limitations of   knowledge in neurological disease states and use literature to improve practice patterns.  Learn from outcomes of patients under your care and those of the other doctors on the neurological service discussed on rounds to improve your care and level of practice.   Watch and elicit feedback from neurology attendings to improve ability to perform a thorough neurologic exam and history.

Systems-based practice:  Work with social workers, home care specialists, nurses and other members of the care team to provide high quality and efficient health care. Improve ability to utilize ancillary services and clinical information systems to optimize patient care.

II. Disciplines covered during rotation
A) Approach to the Comatose Patient
B) Headache
C) Seizure and Status Epilepitcus
D) Disorders of Gait and Coordination
E) Disorders of Mentation and Language
F) Acute Intracranial Catastrophes
G) Extrapyramidal Catastrophes
H) Demyelinating Diseases
I) Central Nervous System Infections
J) Neurologic Complications of Aids
K) Neurologic Complications of Neoplasms
L) Localization of Disorders to the Brain or Spine
M). Consideration of Psychogenic Disorders with Neurologic presentation.
N) Myasthenia Gravis, Guilianne Barre and other Neurologic Disorders that may cause respiratory impairment.
O) Introduction to Interpretation of CT and MRI scans

III.             Rounds, conferences and curriculum

            A.   Daily attending rounds

            1.   Participants:   PGY-2 med residents, neurology residents, neurology

                              chief residents and monthly neurology ward/stroke attending.

            2.   Objectives:   Direct patient management.  Direct didactic and

                               interactive  learning.

            3.   Time:   M-F,   9:30am-11:30,   

neuroradiology rounds 11:30-noon

Sat/Sun-9am-11AM.

 

Introductory summer lecture series

1.   Participants:   PGY-2 med residents, neurology residents with

presentations by neurology attendings and other specialists.

2.   Objectives:   Review of basic neurosciences and clinical neurology.

3.   Time:   M-F,   8am-9am.

 

Neurology case conference

1.   Participants:   PGY-2 med residents, neurology residents, neurology attending, neuroradiology, neuropathology and, neurosurgery.

2.   Objectives:   Review interacting cases and facilitate discussions on key

areas of neurology and related fields of neurosurgery, neuropathology and neuroradiology.   Improve the  residents’ ability to generate differential diagnosis and improve ability to make diagnoses after the synthesis of  complex data.

3.   Time:   Friday, 8am-9am

 

Monday neuroanatomy conference

  1. Participants: PGY2 medical residents, neurology residents, neurology chief residents, medical students
  2. Objectives: Review clinical applications of neuroanatomy in a systemic manner, utilizing the textbook “Neuroanatomy through clinical cases”.
  3. Time: Monday 12:30-1:30 PM

 

Tuesday stroke conference

1.   Participants: PGY-2 medical residents, neurology residents, stroke       attendings.

2.   Objectives:   Review all aspects of the clinical presentation, diagnosis and treatment of stroke.

3.   Time:   Tuesday 5:30 PM

 

Wednesday noon conference

Participants:  PGY-2 medical residents, neurology residents, neurology attendings as presenters.

Objectives:   Improve clinical knowledge and understanding of a variety of topics relevant to general neurology, neuroradiology, neuro-oncology, neuro- psychology, neuropathology, and medical ethics.

Time:   Wednesdays 12-1 pm

 

Neurology grand rounds – (2011-12 schedule attached)

1.   Participants:   Neurology faculty, fellows, residents and rotating medicine residents.

2.   Objectives:   Increase understanding of neurological diseases with focus on up to date,  new and emerging areas of interest.  Presentation by local , national and international speakers.

3.   Time:   Thusday 8-9 am weekly

 

Morbidity and Mortality conference

1.  Participants:   PGY-2 medical residents, neurology residents, neurology      attendings and invited guests from risk management and      bioethics.

2.  Objectives:   Following the guidelines presented by the AAN ethics      curriculum, both end of life issues and palliative care topics will be explored in general and in respect to difficult patient issues.  The goal is for residents to develop a greater understanding of these complex issues and to apply them to their own patient care.

3.   Time:   Quarterly, Friday 8AM-9AM

 

Neuro ophthalmology conference

1.   Participants:   Run by neuro- ophthalmology attending and attended by            PGY-  2 medical residents and neurology residents.

2.   Objectives:   Develop greater understanding of neuro- ophthalmology,        neuroanatomy and the localization of disease processes to particular  areas of the  brain.

3.   Time:   Friday, 12:30-1:30 PM

 

 

IV.   Methods of teaching competencies and of competency assessment

Competencies

Venues

Assessment method

Patient care

Daily attending rounds.  Introductory summer lecture series.

Neurology case conference.

Neurology grand rounds

Monthly evaluations, daily chief resident feedback

Med knowledge

Daily attending rounds.  Introductory summer lecture series.

Wednesday noon conference

Tuesday stroke conference Neuro-ophthalmology. conference, Neurology grand rounds, neuroanatomy conference

Monthly evaluations

Professionalism

Attending rounds

M and M conference

Neurology grand rounds.

Monthly evaluations

Interpersonal skills

Attending rounds.

 

Monthly evaluations

PBL + I

Attending rounds.

 

Monthly evaluations

Systems-based practice

M and M, Case conference

Attending rounds

Monthly evaluation


Reading List

Neurology Resources for Medical Rotators

A Good Start
  1. 1) Rolak. Neurology Secrets, 5th Edition 
  2. 2) Plum and Posner. The Diagnosis of Stupor and Coma, 4th Edition 
  3. 3) Roland. Merritt’s Neurology, 12th Edition 
  4. 4) Bradley, Daroff. Neurology in Clinical Practice, 6th Edition 

The Neurologic Examination/Localization
  1. Brazis, Masdeu. Localization in Clinical Neurology, 6th Edition 
  2. Campbell, Dejong. Dejong’s The Neurologic Examination, 7th Edition 
  3.  Brian. Aids to the Examination of the Peripheral Nervous System, 5th Edition 
  4. Strub, Black. The Mental Status Examination of Neurology, 4th Edition 
  5.  Patten. Neurological Differential Diagnosis, 2nd Edition 

Neuromuscular Disease
  1. Herskovitz, Scelsa, et al. Peripheral Neuropathy in Clinical Practice, 2nd Edition 
  2. Amato, Russell. Neuromuscular Disorders 

Dementia/Degenerative Disorders
  1. Strub, Black. The Mental Status Examination of Neurology, 4th Edition 
  2. Masur. Scales and Scores in Neurology 

Headache
  1.  Silberstein, Lipton, Goadsby. Headache in Clinical Practice, 2nd Edition 
  2. Robbins, Grosberg, Lipton. Headache 

Neuropathology
  1. Greenfield, Graham. Greenfield’s Neuropatholgoy, 8th Edition 
  2. Poirier, Gray, Escourolle. Escourolle and Poirier’s Manual of Basic Neuropathology, 5th Edition 

Seizures and Epilepsy
  1. Rowan. Primer of EEG 
  2. Wyllie. The Treatment of Epilepsy: Principles and Practice, 5rd Edition 

Cerebrovascular Disease
  1. Mohr. Stroke: Pathophysiology, Diagnosis, and Management, 5th Edition 
  2. Caplan. Caplan’s Stroke: A Clinical Approach, 4th Edition 

Neuroradiology 
  1. Osborn. Diagnostic Neuroradiology, 1st Edition 
  2. Yousem. Neuroradiology: The Requisites, 3rd Edition 

Coma / Neurocritical Care
  1. Plum, Posner. The Diagnosis of Stupor and Coma, 4th Edition 
  2. Wijdicks. The Practice of Emergency and Critical Care Neurology 

Cerebrospinal Fluid
  1. Irani. Cerebrospinal Fluid in Clinical Practice


view a more extensive list here.
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David de Gijsel,
Mar 5, 2012, 12:46 PM
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