Goals and Objectives Common to Training in Neurology
- To expose the resident to a wide variety of neurologic disorders
- To teach the recognition of neurologic disorders by accurate and specific history taking and physical examination
- To teach the most current pathophysiological explanations for neurologic disorders
- To teach the utility and appropriate use of specialty procedures (especially MR, CT, EEG, evoked potentials, sleep studies, EMG/NCV and CSF evaluations) in the evaluation and management of neurologic diseases
- To teach current concepts of therapy including mechanisms of drug action and available surgical intervention
- To explain and examine the interaction of neurologic diseases with other organ systems and with other medical illnesses
- To assume increasing level of responsibility for planning and executing evaluation and treatment of neurologic disease under appropriate supervision
- To teach fundamental neurologic examination to medical students and rotating physicians
- To learn to prioritize clinical responsibilities, provide timely service, and seek appropriate consultation and support
- To develop all necessary skills required for the independent practice of neurologic care
Evaluation Techniques Common to the Neurology Training Program
- Attending physicians provide oral discussion of performance, and complete a written evaluation (attached)
- Students evaluate performance, particularly related to teaching function
- Senior residents provide feedback on performance to residency director
- Nursing staff will provide periodic evaluation of the professional team
- Residency Director or Associate Director discusses evaluations and career status twice per year at a minimum
- Oral examinations including interviewing and examining a new patient observed by a faculty member, followed by oral examination is performed twice in the first year and once in each subsequent year of training
- Written in-service examinations are taken the spring and reviewed with the residency director in planning subsequent training
GENERAL NEUROLOGY COMPETENCY GOALS
Note: We will teach and embody attention to the six areas of competency that have been identified as unifying fundamental principles in residency education as noted below.
Patient Care
- Perform an accurate and specific history taking and physical examination for recognition of neurological disorders.
- History and physical examination are integrated with medical knowledge for neurological disorders to arrive at a differential diagnosis and plan.
- Make an informed diagnosis using the most current pathophysiological explanations.
- Make evidence-based treatment decisions.
- Prescribe current concepts of therapy including mechanisms of drug action and available surgical intervention.
- To provide timely service and seek appropriate consultation and support in the evaluation and treatment of neurological disease.
Medical Knowledge
- Demonstrate an understanding of the basic and neurological science background of neurological medicine and apply this knowledge to the clinical care of patients.
- Ability to explain and examine the interaction of neurological diseases with other organ systems and with other medical illnesses.
- Knowledge of the most current pathophysiological explanations for neurological disorders.
Interpersonal Skills and Professional Communication
- Communicate effectively with other health care professionals.
- Communicate with patients and their families in easily understood and culture-sensitive language.
- Work effectively as both a member of a professional group and as a group leader.
- Demonstrate the ability to serve as a consultant to colleagues and health care professionals.
- Maintain comprehensive, timely and legible medical records.
Practiced-based Learning and Improvement
- Teach the utility and appropriate use of specialty procedures (MR, CT, EEG, evoked potentials, sleep studies, EMG/NCV and CSF evaluations.
- To prioritize clinical responsibilities, provide timely service, and seek appropriate consultation and support.
- Develop the ability to use information technology to improve the practitioner's fund of knowledge and technical skills to provide better care to patients.
Professionalism
- Understand good and bad communication behavior and leadership characteristics. Demonstrate appropriate nonverbal behavior.
- Commitment to carrying out professional responsibilities.
- Adherence to ethical principles.
- Sensitivity to a diverse patient population, with respect for colleagues and other health professionals.
- Functions well as a team member.
Systems-based Practice
- Describe the responsibility of the individual physician to the patient, the practice and the overall health care system.
- Describe the concepts of cost containment and cost-effectiveness.
- Describe methods for ensuring that the practitioner and the practice group use scarce resources in a sound, thoughtful and cost-effective manner.
- Develop necessary skills required for the independent practice of neurological care.
Medical Internship Experience at Washington University - PGY1
Goals and Objectives
- To pursue the above objectives of the training program by participation in the care of in-patients with medical problems
- To establish fundamentals of medical care essential to the practice of medicine, learning to reliably diagnose and treat medical conditions
- To reliably obtain the history of illness and perform a medical examination
- To learn the utility and limitations of medical testing procedures and diagnostic studies
The Goals and Objects are accomplished by:
- Full participation in PGY1 training organized through the Department of Medicine at Washington University.
- Participation in the care of medical patients primarily in the in-patient services of the Department of Medicine under the close direction of the attending staff of the Department of Medicine, Washington University School of Medicine
- Attending department rounds in the Department of Medicine, Washington University.
Evaluation
- Primary evaluation is performed by the attending physicians of the Department of Medicine. These will be shared with Neurology Residency director routinely.
- Neurology residency director will meet with trainee in the PGY1 year at six month intervals to review evaluations, and assess special issues and career path
- Special evaluations will be arranged as needed
11400 In-patient Service - PGY2
Goals and Objectives
- To pursue the above objectives of the training program by participation in the care of in-patients with neurologic disorders
- To assist attendings and teaching residents by providing primary evaluation of all patients admitted to the neurology service, and executing the agreed upon evaluation and treatment plan for these patients
- To learn proper evaluation of acute, severe, or debilitating neurologic problems requiring hospitalization
The goals and objectives will be accomplished by:
- Initial evaluation and planning for diagnosis and treatment of patients admitted to the neurology service
- Case presentation and discussion with senior resident and/or attending physician immediately on completion of evaluation and planning
- Writing case history, documenting complete neurology exam, and documenting diagnostic considerations, evaluation plan, and differential diagnosis in full admission chart note
- Supervising all chart notes, and writing a personal note on a daily basis for all ward patients
- Dictating discharge summary at conclusion of hospital stay
- Teaching rounds six days per week for case presentation and discussion with attending physicians
- Ordering, reviewing and evaluating all diagnostic testing for patients on the neurology service
- Performance of diagnostic procedures such as lumbar punctures
- Participation in teaching and supervising the medical students and rotators on the rotation and sharing in their evaluation
- Regular attendance in weekly neurology conferences including (1) Grand Rounds (2) Clinical Neuroscience Lecture Series; (3) Research Conference when clinical duties permit
Evaluation
- Primary evaluation by the fulltime faculty attending working with the resident
- Additional assessment by the senior resident, nursing staff, patients and students
Neurocritical Care Unit
Goals and Objectives
- To pursue the general goals of the residency through participation of neurology and neurosurgical patients under supervision by the intensive care staff
- Learn intensive care unit procedures for support of critically ill patients with special emphasis on respirator management, blood pressure management, fluid and electrolyte management
- Develop experience in management of preoperative and post operative neurosurgical conditions including trauma, intracerebral hemorrhage, brain tumor, status epilepticus, and evaluation and management of patients in coma
The goals and objectives will be achieved by:
- Residents obtain history and perform the physical exam patients admitted to the NNICU
- Diagnostic and therapeutic plans are developed and presented to NNICU attending staff for finalization
- Residents order all diagnostic studies and carryout treatment plans, reviewing results as they become available
- Daily work and teaching rounds with the attending physicians are performed daily
Evaluation
- Attending physicians in the NNICU evaluate performance from close daily mentoring during the rotation
PGY2 Specialty Clinic Rotation
Goals and Objectives
- General goals of the residency are pursued through participation in the specialty clinics
- Special appreciation for problem focused examination relative to specialty areas in neurology including neuromuscular diseases, movement disorders, multiple sclerosis, epilepsy and general neurology
- Observation of senior faculty obtaining histories and performing examinations on patients with a wide variety of neurologic diseases
- Exposure to the breadth of subspecialty problems encountered in neurologic care
The goals and objectives will be accomplished by:
- Participating in specialty clinics including at least neuromuscle clinic, movement disorders, multiple sclerosis clinic, epilepsy/sleep disorders clinic, and the resident's regular general neurology continuity clinics at St. Louis ConnectCare and Barnes Jewish Hospital
- Residents will evaluate new and follow-up patients in each of the clinics under the direct observation and supervision of attending doctors with specialty careers in these areas
- Residents will participate in specialty conferences of the specialty groups when they do not conflict with alternate clinics
- Residents will participate in outpatient conferences approximately monthly (Lunch and Learn Series)
- Residents will participate in the regularly scheduled conference series of the department
Evaluation
- Specialty clinic attendings will provide brief written evaluation of performance in the clinics on this rotation
Psychiatry
Goals and Objectives
- To expose the resident to a wide variety of inpatient psychiatric disorders
- To teach the recognition of psychiatric disorders by accurate and specific history taking and physical examination
- To teach the most current pathophysiological explanations for psychiatric disorders
- To teach current concepts of therapy including mechanisms of drug action
- To explain and examine the interaction of psychiatric diseases with other organ systems and with other medical and neurologic illnesses
- To assume initial responsibility for planning and executing evaluation and treatment of inpatient psychiatric disease under supervision of attending physicians
The goals and objectives will be accomplished by:
- Participation on the in-patient psychiatric services of Barnes Jewish Hospital
- Obtaining full histories, performing examinations, and planning diagnostic and therapeutic plans for subjects under supervision by attending psychiatrists
- Participating in teaching conferences of the Department of Psychiatry including Grand Rounds, Research Rounds, daily attending rounds, and other conferences planned by the Department
Evaluation
- The attending psychiatrist provides written evaluation of the resident including skills in history taking, examination, procedures, ability and sensitivity to management of patients
- Residency director will review the evaluations with the resident and if needed with the attending from psychiatry
Night Float
Goals and Objectives
- The general goals of training are emphasized, particularly providing a large experience of initial evaluation of subjects presenting in the emergency ward or on other services requiring neurologic analysis, diagnosis and treatment
- Participation in rapid initial review of patients requiring neurologic evaluation
- Formulation of differential diagnosis and urgent treatment plans for neurologic conditions
- Special experience with neurologic complications of medical and surgical conditions in the consultation setting
The goals and objectives will be accomplished by:
- Providing urgent consultative services through night hours for the emergency room of Barnes-Jewish Hospital
- Providing urgent consultations for hospitalized patients on non-neurologic services
- Performing focused histories, and examinations on patients with neurologic complaints and formulating a plan for immediate management in consultation with senior residents and attendings on the service
- Presenting cases for discussion in the attending conference on the morning following evaluations
- Continued participation in teaching conferences and exercises of the department
Evaluation
- Primary evaluation is performed by the 11400 teaching physicians
- Senior residents perform evaluations since most immediate evaluations are reviewed with them
Consult Service - PGY3
Goals and Objectives
- Further the general goals of the residency by evaluating patients referred to the department for neurologic consultation
- Enhance experience of neurologic complaints complicating medical and surgical in-patient illnesses
- Enhanced independent evaluations for neurologic complaints including obtaining complete history, performing examination, and formulating treatment plans in the setting of a consultative practice
- Learning effective communications skills with professionals from other areas of medical practice including internal medicine, general surgery, and surgical subspecialties.
- Learn to prioritize tasks so as to provide time sensitive appropriate response to subjects with a variety of problems throughout the medical center
- Teach physicians throughout the hospital appropriate responses and treatments for neurologic complications
Rotation Structure
- This resident provides consultative services for the Barnes-Jewish Hospital complex
- Consults are prioritized and organized so as to respond to the concerns of consultants, and to assure that urgent problems are immediately evaluated and treated
- Supervision of students and rotating physicians provides opportunity for teaching neurologic history taking, examination skills, and diagnostic considerations
- Daily attending rounds are arranged with a faculty attending as required to respond to the problems encountered and to provide direct teaching
- Participation in the teaching rounds of the department continues
Evaluation
- Consult attending physician provides oral and written feedback regarding the performance of the resident on this rotation
Pediatric Neurology Rotation
Goals and Objectives
- The general goals of residency training are pursued through evaluation and treatment of pediatric patients
- Special emphasis on normal and abnormal development is included in this rotation
- Age specific interpretation of neurologic examination is emphasized during this rotation
- Special emphasis on congenital and genetic diseases often encountered in childhood
Rotation Structure
- Participation in care of neurologic patients admitted to St. Louis Children's Hospital
- Obtaining histories from parents and children, performing neurologic exams on children of all ages on the in-patient service in the clinics of St. Louis Children's Hospital
- Attending teaching rounds on the pediatric division at St. Louis Children's Hospital including teaching rounds three times per week, weekly neuroradiology rounds, the pediatric neurology journal club, the clinical epilepsy conference, pediatric grand rounds, and the general rounds of the Department of Neurology.
- Participation in clinics at St. Louis Children's Hospital and the Shriner's Hospital out-patient neurology clinic under supervision of attending staff
Evaluation
- The pediatric attending physician provides written evaluation of performance
Neuro-rehabilitation
Goals and Objectives
- General goals and objectives of the residency are pursued by working with patients recovering from neurologic injury
- Evaluation of patients for their prognosis for recovery and for effectiveness of rehabilitation in enhancing recovery
- Understanding modalities of therapy and support available and their appropriate application to patients with neurologic injury
- Special emphasis on rehabilitation for victims of cerebral trauma, stroke, or spinal cord injury
Rotation Structure
- Rotation on the neuro-rehabilitation service at the Rehabilitation Institute of St. Louis
- Residents assist in evaluating patients for referral to rehabilitation and assist in direct care for patients undergoing neuro-rehabilitation
- Attending teaching rounds on a daily basis on the rehabilitation service
- Attending rehabilitation clinics including
- Teaching rounds on a weekly basis with Dr. Thach reviewing pathophysiologic principles underpinning rehabilitation and recovery from injury
Evaluation
- Rehabilitation attendings provide written evaluation on departmental forms
Emergency Ward
Goals and Objectives
- To further the general goals of training through evaluation and management of urgent neurologic problems
- Immediate stabilization of patients with neurologic injury
- Triage techniques to assure that timely evaluation and therapy is accomplished for many patients
- Communication techniques for patients and families in crisis during neurologic emergencies
- Communication skills with a full spectrum of medical staff including physicians, nurses, emergency medical technicians, and support personnel to enhance rapid evaluation and treatment of patients
- Establish appropriate initial evaluation and management for neurologic diseases
Rotation Structure
- Initial evaluation of subjects presenting to the emergency ward of Barnes Jewish Hospital with neurologic complaints
- Consultative evaluations of patients in the emergency wards seen by other medical personnel
- Immediate evaluation of all "stroke" patients to plan necessary acute intervention in conjunction with the stroke service
- Participation in management of all patients with status epilepticus until they are stabilized or placed in house
- Immediate evaluations and plans are supervised by senior residents and/or attendings from the neurology service
Evaluation
- Written evaluation is provided by the Consult/ER attending and reviewed with the residency director
Senior Resident 11400
Goals and Objectives
- The general goals of the residency are furthered by increased leadership and responsibility on the in-patient services of the department
- Responsibility for supervising immediate care of all patients being evaluated or admitted through the emergency ward or directly to the neurology service
- Responsibility for assessing the level of care required for best management of patients being admitted to the hospital and arranging for intensive care admission where warranted
- Teaching essential elements of neurology to medical students and rotating physicians
- Coordinating the teaching services and planning for evaluation and care of all ward patients under the direct supervision of the attending physician
Rotation Structure
- Residents directly supervise junior residents, and provide immediate back-up to the entire service
- Senior residents formulate evaluation and treatment plans, under the direction of the attending
- Junior residents call the senior residents first for planning evaluation and treatment of all patients on the ward service
- Senior residents are aware of private patient issues and assist in teaching the junior residents, rotators and students regarding care of all cases on the service
- Senior residents provide emergency phone contact for attending physicians after hours, referring necessary decisions to attendings when indicated
Evaluation
- Attending physicians provide evaluation
Out-patient Senior Resident
Goals and Objectives
- Further the general goals of residency through active participation in specialty clinics
- To develop cutting edge fund of knowledge on appropriate out-patient evaluation and care of specialty neurologic areas including neuromuscular diseases, multiple sclerosis, epilepsy, movement disorders, neurogenetics, dementing illnesses, headaches and infectious processes
- To assure oversight of out-patient clinics by a senior resident
- To provide exposure to the breadth of problems encountered in neurology
Rotation Structure
- This resident spends time in each of the major specialty clinics
- The patient maintains continuity of care clinics
- The clinic nurse and secretary consult this resident regarding issues arises for patients of residents temporarily unavailable
- Active ongoing participation in specialty conferences not conflicting with clinics is available
Evaluation
- Specialty clinic attendings provide written evaluations
Weekly Outpatient Clinics
Goals and Objectives
- Learn efficient evaluation of out patient neurologic problems
- Learn how neurologic diseases change over time
- Learn how to care for chronic neurologic disorders
- Develop communication skills with referring physician and managed care organizations
- Schedule studies and return appointments appropriately
The goals and objectives will be accomplished by:
- Obtaining complete histories and examinations on new patients
- Obtaining interval histories and appropriate examinations on return patients
- Review of studies ordered
- Presentation of all patients to the clinic attending staff for review of findings and discussion of diagnosis and plan of study and/or treatment
- Seeing patients over the residency years
- Attendance at monthly outpatient conference (Lunch and Learn) the second Tuesday of the month
Evaluation
- "On line" by the clinic attending
- Written evaluation by the clinic attending semiannually
Elective rotations
Goals and Objectives
- Enhance knowledge of special areas of expertise relevant to neurology such as neuromuscular diseases, epilepsy, electrophysiology, sleep medicine, pain, infectious diseases, movement disorders, demyelinating disorders, neuro-ophthalmology, neuro-otology, neuro-oncology or cerebrovascular disease.
Evaluations
- Supervising physicians will provide written feedback regarding diligence and performance of duties assigned during specialty rotations.
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