Neurology

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

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

Neurology grand rounds

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


IV. Methods of teaching competencies and of competency assessment

Neuro

V. 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


For Seminal Neuro Articles, Check out the Monte Medicine Literature Section!