The objectives of the first year of the residency are to become familiar with the principles of neurological localization, the evaluation of patients with altered level of consciousness, the differentiation of structural and metabolic neurological diseases, the neurological presentation of systemic diseases, and the disorders of higher cortical function as they pertain to the adult nervous system. These goals are described in more detail in the Adult Residency section. During the first year, residents also rotate in pediatric neurology inpatient services and the goals are described below.
SECOND AND THIRD YEAR
- Acquire competence in neurological examination of infants and children
- Plan appropriate diagnostic evaluations and subsequent therapy for children with serious neurological disorders including: epilepsy, cerebrovascular disease, neuromuscular disorders, central nervous system trauma, brain tumors, movement disorders, neurodegenerative diseases, and neurobehavioral disorders
- Become comfortable with diagnosis and management of neurological disorders in the intensive care setting, including: status epilepticus, coma, increased intracranial pressure, neurological complications of cardiac and thoracic surgery, peripheral neuropathies, metabolic encephalopathies, and central nervous system infections
- Become experienced in evaluation and management of premature and term infants in the newborn intensive care unit with neurological problems including: intracranial hemorrhage, neonatal seizures, neonatal meningitis, hypoxic/ischemic encephalopathy, brachial plexus palsy, feeding difficulties, hypotonia/weakness, metabolic encephalopathies, structural nervous system malformations, and congenital infections
- Develop experience seeing neurological consultations on other floors of the hospital involving: neurological complications of systemic disease (hematological, cardiac, pulmonary), developmental delay, mental retardation, learning disabilities, headaches, and alterations of consciousness
- Develop expertise in neurological consultations in the emergency room for problems including: seizure management, central and peripheral nervous system trauma, headache, altered mental status, differentiation of acute neurological and psychiatric illness, acute weakness, and pain
- Become familiar with principles of neurological rehabilitation including: appropriate splinting and casting, pharmacological therapy for spasticity, timing of physical, occupational, and speech therapy, bladder/bowel care, and transition from hospital to home and school
- Develop competence in interpreting results of laboratory tests and imaging
- Become adept at diagnosing and treating the more common childhood neurological problems including: migraine and other headache disorders, seizure disorders, attentional problems, learning disabilities, developmental delay, mental retardation, movement disorders, muscular dystrophy, ataxia, cerebral palsy, syncope, and neurocutaneous syndromes
- Develop competence in long term outpatient management and communicating with patients and families – in person and through phone contacts
- Become familiar with communicating with referring physicians by phone and letter
- Develop strategies for organizing outpatient diagnostic evaluations and setting priorities for laboratory tests and imaging studies
- Gain subspecialty outpatient experience: epilepsy, cerebral palsy, neuromuscular diseases, movement disorders, tuberous sclerosis, neurofibromatosis, Rett syndrome, multiple sclerosis and demyelinating diseases, stroke, sleep neurorehabilitation clinics are available for the residents to attend during their clinic rotations.
- Become primary pediatric neurologist for your patients.
Elective Clinical Rotations
Residents may work on subspecialty services in epilepsy/EEG, neuromuscular disease/EMG/muscle biopsy, neurorehabilitation, neuro-opthalmology, and movement disorders. On each of these rotations there may be a mix of both children and adults and clinics and inpatient consultations. In addition to acquiring greater expertise in each of these areas of clinical neurology, these rotations can provide the opportunity to become familiar with the standard clinical neurophysiological tests used in clinical neurology, EEG and EMG. The purpose of these rotations is to provide in-depth exposure to single areas of neurology and allow time for focused reading and participation in daily subspecialty attending rounds.