Neurology Curriculum

FACULTY REVIEWERS: Robert Richardson, MD, Emmanuel Elueze, MD, Srinivas Merugu, MD RESIDENT REVIEWER: Gitika Dham, MD

Educational Purpose and Goals

The purpose of this rotation is to provide a core of clinical knowledge in neuroscience for internal medicine residents. Internists must be able to evaluate and assess patients with neurological complaints. Residents are, therefore, expected to competently perform a neurological examination and localize a lesion, formulate a differential diagnosis for the lesion, understand the basic laboratory and imaging evaluation of the neurological lesion, and understand the pathophysiology and natural history of common neurological lesions. In this rotation, residents will be exposed to a variety of problems that are frequently seen by internists and learn about diseases more frequently seen by subspecialty neurologists.

II.      Principal Teaching Methods

1. Supervised Direct Patient Care Activities
2. Patient encounters occur at SVCH. All neurological consultations requested in SVCH will be performed by the residents and teaching neurologist on the service. Residents learn the practical aspects of performing a consultation by observing the teaching
3. Teaching rounds are combined with management rounds and occur daily by reviewing consultations with the teaching neurologist. The resident is expected to make a preliminary diagnosis, plan a workup and treatment strategy and document the consultation. Review and approval of the resident's evaluation occurs in a conference room followed by bedside
4. Direct bedside teaching occurs daily at SVCH in addition to daily general neurology rounds. The rotation consists of the resident on the service and by the teaching neurologist including: The neurological examination and lesion localization, seizure disorder, vascular disease, headache, Parkinson's disease and other movement disorders, neurological emergencies, peripheral neuropathy, myoneural junctional lesions, low back pain and spinal cord paralysis, brain and spinal cord tumors, neoplasia and paraneoplastic syndromes, Neuro-ophthalmology, Neuro-imaging and other ancillary tests, CNS infections, chronic degenerative diseases, dementia and evaluation of the comatose patient.On the first day of the rotation, the residents meet the involved Attending Neurologist. They should have relevant examination equipment with them, including the mini-mental status protocol. The exam of the nervous system will be reviewed extensively at this time. In addition, they will be oriented to the rotation and be provided an overview of the collection of articles they have

Case base lectures, in which the resident will present case to the Attending neurologist during the rotation.

Assigned Readings - It is expected that each resident will read and study independently on their patients seen in consultation. An extensive collection of articles will be sent to the resident one week before the rotation. Recommended texts, but not required, are: Aminoff – Neurology in General Medicine; Adams/Victor – Principles of Neurology

III. Educational Content

1. Mix of diseases - Residents on the neurology consultation service sees all the inpatient neurology consultations at SVCH. The disease mix represents a wide spectrum seen in primary and specialty
2. Patient characteristics - Patients range from young adults to elderly with advanced Patients are of diverse race and socioeconomic backgrounds, representing the diverse demographic characteristics of the community.
3. Learning venues:
4. Clinical encounters will be consultations regarding neurological complaints, not management of all general medical issues
5. Procedures Learned:
   1. Residents will reinforce or learn indications as well as techniques for lumbar
   2. Residents will review the indications for and interpret the results of the following tests: CSF analysis, carotid dopplers, CT angiography and MRI MRA, EMG, and nerve conduction studies, EEG and evoked potentials, metabolic and toxic blood
6. Structure of rotation
7. The rotation is a 4-week block with the attending
8. Residents continue to attend mandatory Internal Medicine conferences and continuity clinic.

IV. Principal Ancillary Educational Materials

1. At the beginning of the rotation, each resident receives a copy of the Neurology curriculum’s Goals and Learning
2. Readings from recent and classic neurological journal literature are given to residents for discussion with
3. Four texts are suggested: Neurology for the House Officer, Principles of Neurology, Harrison's Principles of Medicine, and Manter and Ganz

Methods of Evaluation

1. Resident Performance

At the end of each rotation faculty complete a web-based electronic resident evaluation form provided by the Internal Medicine Residency office. The evaluation is competency-based, fully assessing core competency performance. The evaluation is verbally discussed with the resident by the neurology attending, is available for on-line review by the resident at their convenience, and is sent to the residency office for internal review. The evaluation will be part of the resident file and will be incorporated into the semiannual performance review for directed resident feedback.

1. Program and Faculty Performance

Upon completion of the rotation, residents complete a service evaluation form commenting on the faculty, facilities, and service experience. These evaluations are sent to the residency office for review. The neurology supervisor will receive periodic aggregate summaries of completed evaluations. The Training and Evaluation Committee will review results annually.

V.    Rotation Specific Competency Objectives a. Patient Care

Residents should demonstrate ability to apply clinical skills and use the physical examination to localize neurologic lesions. By the end of the rotation, the resident must be able to complete a comprehensive history and must develop the ability to perform a competent neurological examination, including:

1. Mental status: language, memory, attention/concentration, affect, intellect
2. Cranial nerves
3. Motor exam including details on bulk, strength and tone
4. Reflex exam including stretch and pathological reflexes
5. Detailed sensory examination
6. Coordination and gait and balance

The resident will demonstrate ability to develop a rational clinical approach to solving basic clinical neurological problems including:

1. Stupor and coma
2. Seizures
3. Tremor
4. Weakness
5. Dizziness, syncope
6. Vertigo
7. Sensation changes
8. Dementia and delirium
9. Paralysis
10. Headaches
11. Changes in vision or other sensory organs
12. The resident will demonstrate ability to perform lumbar puncture including appropriate pre- and post-procedure counseling and
13. The resident will demonstrate satisfactory skills in clinical documentation of neurologic complaints and general evaluations in the medical
14. Medical Knowledge
15. Residents should demonstrate understanding of neuroanatomy sufficient to localize neurologic
16. By completion of the rotation, the resident must reflect an understanding of the differential diagnosis and natural history of common neurological issues (see above list).
17. The residents will demonstrate understanding of the indications, basic techniques, and basic interpretation of the following tests lumbar puncture and CSF analysis
18. Carotid Dopplers
19. Neuro-imaging including CT scans MRI scans PET scans
20. EMG and nerve conduction studies
21. EEG and evoked potential studies
22. Metabolic testing, testing for autoimmune neurological diseases
23. The residents will understand the pathophysiology, clinical presentations, and achieve competence in the diagnosis and treatment of the following diseases:
24. Stroke
25. TIA/ RIND
26. Meningitis- both acute and chronic
27. Alzheimer’s disease and other causes of dementia
28. Alcohol and drug related neurological disorders
29. Seizure disorder
30. Parkinsonism and other movement disorders
31. MS and other demyelinating diseases
32. Carpal tunnel and other entrapment syndromes
33. CNS tumors and malignancy
34. Peripheral neuropathy and radiculopathies
35. Migraines and other causes of headaches
36. Guillian-Barre Syndrome
37. ALS and other motor neuron diseases
38. Peripheral neuropathy
39. Myopathy
40. Muscular dystrophy
41. Myasthenia gravis and other dystonias
42. Neuro AIDS
43. Residents will reflect satisfactory knowledge of the use of specific neurological drugs.

c. Interpersonal and Communication Skills

1. Residents will appropriately work with other neurological residents and show respect and ability to work well in a team setting
2. Residents will create and sustain a therapeutic and ethically sound relationship with patients and their
3. Residents will demonstrate ability to communicate effectively and demonstrate caring, compassionate, and respectful

d.   Professionalism

1. Residents will demonstrate respect, compassion, and integrity. They will demonstrate commitment to excellence and continuous professional

e.  Practice Based Learning and Improvement

1. Residents will be able to locate, critically appraise, and assimilate evidence from scientific studies and apply this knowledge to patients seen on the neurology consultation
2. Residents will demonstrate ability to use information technology to manage information, access on-line medical resources, and support self-education, patient care decisions and patient

f.   Systems Based Practice

1. Residents will practice cost-effective health care and resource allocation while advocating for
2. Residents will productively and cooperatively participate in Multidisciplinary Treatment Planning.