After completion of the preliminary year in Internal Medicine, your PGY2 year will consist primarily of experiences on the various inpatient services, including stroke, consultative, epilepsy monitoring unit and pediatric neurology. There will be opportunity for rotations on the subspecialty services, primarily in the PGY3 and 4 years, including clinical neurophysiology, neuropathology, neuroradiology, movement disorders, behavioral neurology, research and others for which you may have particular interest. Throughout the 3 years of residency, you will participate in the outpatient continuity clinic. On clinical assignments, you will be the primary physician seeing several new neurology patients each day. During hospital assignments, you will supervise and teach junior neurology residents, medical residents and medical students. You will evaluate and manage both routine and emergency admissions, and provide consultations for other services.
Throughout your residency, you will receive regular didactic and clinical instruction in neurology as well as subspecialty experiences. As your knowledge and skill increase during your residency, you will be given greater responsibility in both patient management and resident education.
GOALS: Become familiar with evaluation and management of serious and complex neurologic disorders. Learn appropriateness of diagnostic testing modalities and how to interpret data gained from diagnostic studies. Learn to interact with consultant staff, patients’ families, nursing staff and aftercare coordinator. Become adept at handling of consultations from the Emergency Department and other inpatient hospital services.
OBJECTIVES: The resident should be capable of assuming clinical responsibility for the care of patients with neurologic disorders under the supervision of senior neurology residents and/or faculty.Patient Care:
- Be able to perform detailed neurologic history-taking and examination.
- Be able to develop a reasonable differential diagnosis with special regard for emergent neurologic situations and disorders for which treatment is available.
- Be able to develop a tentative treatment plan to be reviewed with senior resident and attending neurologist.
- Be able to identify problems for which emergent intervention is needed.
- Be able to use clinical pathways, e.g., Ischemic Stroke Pathway; brain death determination.
- Be able to employ a rational and judicious approach to diagnostic studies.
- Come to understanding of pertinence of results of diagnostic tests.
- Be able to identify effects of medication which may have potential for neurologic manifestations.
- Learn indications for requests for consultations.
- Be knowledgeable in the appropriateness of requests for specific treatment modalities, e.g., Physical Therapy, Occupational Therapy, and Speech Therapy.
Interpersonal and Communication Skills:
- Develop skills at interaction with patients and family members.
- Be able to dictate a concise and comprehensive discharge summary.
- Be able to teach rotating residents and senior medical students.
- Observe and critique neurologic examinations performed by senior medical students.
- Learn to be a “team player” with other members of the care team, i.e., nursing staff, case manager, and social worker.
- Be able to communicate effectively with patients and families.
- Demonstrate concern for patients, which supercedes self-interest.
- Be committed to the highest standards of excellence in the practice of Neurology.
- Possess the personal attributes, behavior and skills for the successful practice of Neurology: honesty, integrity, rational planning, effective communication and the ability to perform under stress.
- Be reliable, neat, clean, conscientious, careful, cooperative and flexible.
- Demonstrate ethical behavior
- Be sensitive to a culturally diverse patient population, including issues of ethnicity, race and religion.
Systems Based Practice:
- Become familiar with patterns of after-hospital care.
- Be aware of costs and provide cost-effective care
- Learn use of specialized support and referral avenues, e.g., request for help from Medical Ethics Committee, other consultants, etc.
- Learn VA-specific criteria for eligibility for inpatient and continuing outpatient care.
- Be able to utilize electronic chart (VA).
Practice-Based Learning and Improvement:
- Apply research and statistical methods as they relate to patients under the resident’s care
- Utilize information technology
- Facilitate learning of others
- Maintain patient log