Neurology Curriculum

Department: Internal Medicine

Faculty Coordinator: Duc Tran, MD

Hospital: Texas Health Presbyterian Hospital Dallas

Periods offered: All

Length: 4 weeks

Max no. of residents: 2

First Day Contact: Debra Clinard, RN (214-750-9977)

First Day Time: 8:00 a.m.

First Day Place: Contact faculty member one week prior to start of rotation

Requirements: 8:00 a.m. to 5:00 p.m., Monday through Friday

Weekends: 1 weekend/month

I. Course Description:

The residents will be assigned to work with a different neurology attending each week. He/she will be expected to round in the morning on that attending's patients in the hospital. Afterwards he/she will follow the attending in the clinic. He/she will also work up consults and new in-patients with the attending when on-call. The residents may be expected to take calls from home one weekend per month as well.

In general, the resident will be expected from 8:00 a.m. to 5:00 p.m. This may vary according to the attending's schedule somewhat, especially on days that the attending is on-call.

The resident is to leave a message for Dr. Duc Tran one week prior to the start of their rotation (214) 750-9977. The message should include any vacation plans and the resident's choice of weekend to take call. The resident's pager number would also be helpful.

II. Course Goals and Objectives: (based on ACGME competencies for resident education)

Patient Care:

Residents, together with supervising faculty, must be able to provide patient care that is compassionate, appropriate, and effective for the treatment of health problems and the promotion of health.

Objectives:

• Gather accurate, essential information from all sources, including medical interviews, physical examinations, medical records and diagnostic/therapeutic procedures. Examples: The resident will demonstrate a skillful neurologic history and exam which can distinguish normal from abnormal findings, peripheral from central nervous system lesions, static prom progressive, and localize likely area of neurologic dysfunction.

• Perform competently the diagnostic and therapeutic procedures considered essential to the practice of internal medicine. Examples: The resident will be able to safely and competently perform lumbar punctures and analyze cerebrospinal fluid results.

• Make informed recommendations about preventive, diagnostic and therapeutic options and interventions based on clinical judgment, scientific evidence, and patient preference. Examples: The resident will describe therapeutic options and identify the indications for radiologic imaging (CT, MRI) for patients.

Medical Knowledge:

Residents are expected to demonstrate knowledge of established and evolving biomedical, clinical and social sciences, and to apply their knowledge to patient care.

Objectives:

• Apply an open-minded, analytical approach to acquiring new knowledge. Examples: The resident will be able to identify distinguishing features of various types of benign headaces: migraine, tension, cluster.

• Access and critically evaluate current medical information and scientific evidence. Examples: Present reviews or current clinical trails on such topics as: cortical lesions, sub-cortical lesions, brainstem lesions, myelopathies, radiculopathies, myoneural junction and myopathies/neuropathies.

• Develop clinically applicable knowledge of the basic and clinical sciences that underlie the practice of internal medicine. Examples: The resident will understand important clinical issues and communicate them clearly to patients and their families with neurological disorders.

• Apply this knowledge to clinical problem-solving, clinical decision-making, and critical thinking. Examples: Discuss pros/cons of therapeutic options available for Alzheimer's disease.

Practice-Based Learning and Improvement:

Residents are expected to be able to use scientific evidence and methods to investigate, evaluate, and improve patient care practices:

Objectives:

• Identify areas for improvement and implement strategies to enhance knowledge, skills, attitudes and processes of care. Examples: The resident will demonstrate the ability to use medical literature to effectively and cogently evaluate neurology conditions or symptoms.

• Analyze and evaluate practice experiences and implement strategies to continually improve the quality of patient practice. Examples: The resident will modify management plans appropriately based on the information obtained from medical literature and/or medical technology.

• Develop and maintain a willingness to learn from errors and use errors to improve the system or processes of care. Examples: The resident will demonstrate receptiveness to feedback provided during the rotation with appropriate modification of behavior to improve performance.

• Use information technology or other available methodologies to access and manage information, support patient care decisions and enhance both patient and physician education. Example: The resident will use information technology to gather medical information and use this in support of his/her own education.

Interpersonal and Communication Skills:

Residents must be able to demonstrate interpersonal and communication skills that result in effective information exchange and teaming with patients and their families.

Objectives:

• Provide effective and professional consultation to other physicians and health care professionals and sustain therapeutic and ethically sound professional relationships with patients, their families, and colleagues. Examples: The resident will demonstrate effective and collegial communication skills, working closely with the physicians, nurses, technicians, and administrative personnel.

• Use effective listening, nonverbal, questioning, and narrative skills to communicate the patients. Examples: The resident will demonstrate effective communication skills with families and patients referred to the neurology service.

• Interact with consultants in a respectful, appropriate manner. Examples: The resident will use effective listening skills and elicit and provide information using effective nonverbal, explanatory, questioning, and writing skills.

• Maintain comprehensive, timely, and legible medical records. Examples: The resident will maintain comprehensive and concise written consultations and notes on each patient seen.

Professionalism:

Residents must demonstrate a commitment to carrying out professional responsibilies, adherence to etchicial principals, and sensitivity to a diverse patient population.

Objectives:

• Demonstrate respect, compassion, integrity, and altruism in relationships with patients, families, and colleagues. Example: The resident will demonstrate respect, compassion, and integrity; a responsiveness to the needs of patients and society that supersedes self-interest; accountability to patients, society and the profession; and a commitment to excellence and ongoing professional development.

• Demonstrate sensitivity and responsiveness to the gender, age, culture, religion, sexual preference, socioeconomic status, beliefs, behaviors and disabilities of patients and professional colleagues. Example: The resident will demonstrate a commitment to patient care and learning by timeliness, responsibility for patients seen on the service, and sensitivity to cultural diversity.
  
  
• Adhere to principles of confidentiality, scientific/academic integrity, and informed consent. Example: The resident will demonstrate adherence to ethical principals.

• Recognize and identify deficiencies in peer performance. Examples: The resident will respond well to constructive criticism and demonstrate a desire for self-improvement.

Systems-Based Practice:

Residents are expected to demonstrate both an understanding of the contexts and systems in which health care is provided, and the ability to apply this knowledge to improve and optimize health care.

Objectives:

• Understand, access and utilize the resources, providers and systems necessary to provide optimal care. Examples: The resident will understand how patient care and other professional practices affect other health care professionals, the health care organization, and the larger society and how these elements of the system affect their own practice.

• Understand the limitations and opportunities inherent in various practice types and delivery systems, and develop strategies to optimize care for the individual patient. Examples: The resident will practice cost-effective health care and resources allocation that does not compromise quality of care.

• Apply evidence-based, cost-conscious strategies to prevention, diagnosis, and disease management. Examples: The resident will demonstrate understanding of cost issues related to the diagnosis and management of neurological conditions, to include lab tests, radiographic studies, and medications.

• Collaborate with other members of the health care team to assist patients in dealing effectively with complex systems and to improve systematic processes of care. Examples: The resident will advocate for quality patient care and assist patients in dealing with system complexities.
  

Methods of instruction:

A) Didactic (schedule, topic, faculty)

Daily residents conference 12:00-1:00 p.m. - IM Training Room

Wednesday mornings 7:30-8:00 a.m. - Clinical Grand Rounds - IM Training Room

Wednesday afternoons 12:15-1:00 p.m. - IM Update - Haggar Hall

B) Clinical

Residents are assigned to a neurologist. The resident is expected to work with the neurologists seeing primarily outpatients. Residents are expected to attend every noon conference. The attending will evaluate the resident at the conculsion of the rotation. Areas assessed will include the proficiency in evaluating patients with neurologic complains, performance of a detailed neurologic examination, presentation skills, fund of knowledge, participation during weekly informal lectures, interest and motivation, and performance on oral vignettes.

Knowledge objectives of the rotation include:

1) Evaluation of patients for thrombolytics in acute cerebrovascular accident

2) Evaluation of M.S. patients for interferon treatment

3) Discussion of end-of-life issues in a patient with Alzheimer's

4) Have basic understanding of electrodiagnostics used (EMG/NCV) in evaluating a patient with a neuromuscular condition

5) Grasp important issues and be able to discuss with competency to a family issues involving the care of an Alzheimer's patient (living situation, management of behaviors such as psychosis, restriction of activities such as driving, etc.

6) Discuss medical risks/benefits of thereaputic options available concerning Alzheimer's disease

7) Perform LP in the sitting/recumbent position

8) Neuroanatomic localization using elements of history and physical exam:

a) Cortical lesions

b) Sub-cortical lesions

c) Brainstem lesions

d) Myelopathies

e) Radiculopathies

f) Myoneural junction

g) Myopathies/Neuropathies

9) Basic differentiation between types of benign (common) headaches: migraine, tension, cluster

10) Management protocols of patients in status

11) Assamilate basic science issues within realm of Alzheimer 's Disease

12) Weigh different data types in management of back pain:

a) History

b) MRI/myelogram

c) EMG/NCV

13) Evaluation/prognosis of patients in a coma.

14) Have basic understanding of algorhithms for evaluating carotid stenosis.