Neurology Practice Rotation Curriculum and Orientation
2008-2009
Internal Medicine Residency Program,
Updated: June 17, 2008
Rotation Introduction: Neurology
encompasses the prevention and management of disorders of the central and
peripheral nervous systems. The Neurology
Rotation is a unique rotation in which each resident will be an
active participant in a neurology practice performing consults, following
inpatients and outpatients for a four-week block.
Rotation Logistics:
·
During
this rotation, a resident will be assigned to one of two private practice
Neurology Groups: Neuromedical
Diagnostic Medical Group (Drs. Shey, Lee and Kim) or Southland Neurologic
Associates (Drs. Patel, Omidvar and Ramezan). Based on patient care demands and neurologist
needs, the residents time will be spent doing consults and following patients
in both inpatient and outpatient settings as well as learning about EMG and
nerve conduction studies.
·
The resident will be given pager #3-18884 (access
from outside of the hospital by calling 562-933-7243). At 9:00 each morning, the neurology resident should
call the neurologists’ office in the morning to determine the consults that
have been called into the group and to speak with the neurologist who is
assigned to the teaching service. During
the day, the office personnel or the attending will inform the resident of new
consults.
·
Each neurology attending has volunteered his/her
time to contribute to your education. Resident
attendance each day is REQUIRED and any unexcused absence will be
reported to the residency review committee.
Only in cases of an emergency or illness should the resident be excused. It is the resident’s responsibility to personally
discuss any absence from the rotation with the site Program Director or Chief
Resident, in addition to the Neurologist with whom they are working.
·
Two
outpatient clinics are scheduled into your neurology rotation, but attendance
at these can be adjusted to patient care needs and educational interest. .
·
You
will be REQUIRED to round on the neurology patients with you attending
on the second and fourth Saturdays of the month. These may be changed at the discussion of the
attending and resident during the block.
·
You
will also be REQUIRED to complete The NIH Stroke scale (http://www.nihstrokescale.org) early
on in the rotation and the completion certificate should be turned into the GME
offices to document one of your competencies for the rotation. This is important, since you may be called
for Code Strokes in the hospital to evaluate patients to determine with the
neurologist on call, if they are appropriate for TPA. Angie West, the director of the Stroke
Program on 4 West, can help you with the
protocol.
·
To
identify your learning goals and make the most of the educational experience, please
complete the Neurology MKSAP questions during the first week of the block and
complete the reading during the block.
·
You
will be REQUIRED to give the Neurology attendings a competency
assessment form for the neurological examination to complete before the end of
your block. Please give your attending
the form along with a return envelope for the attending to mail the completed
form to our office.
·
Rehabilitation
is an important part of stroke care. Please
follow your stroke patients when they are in the stroke rehabilitation unit to
gain an understanding of what patients experience during rehabilitation.
·
Resident continuity clinics are scheduled into
the block.
·
Each resident is REQUIRED to take one
MICU call per week and will also have back-up responsibilities
·
Caps: The
resident can complete 5 new consults per day. The
resident can round on up to 12 inpatients per day. These are subject to change,
depending on the feedback from the faculty and residents.
·
Faculty Contact Information:
Neuromedical Diagnostic Medical Group
562-426-3656
Office Manager: Paula Takahashi
pjtakahashi@yahoo.com
Dr Randy Shey
randolphshey@yahoo.com
Dr Tim Lee
timleemd@yahoo.com
Dr Duke Kim
adrenergic@gmail.com
Southland Neurologic Associates
562-430-4513
Office Manager: Letty Santana
Dr Nima Ramezan-Arab
nramezan@gmail.com
Dr. Omid Omidvar
omidvar@myneurologist.net
Dr Nirav Patel
patel@myneurologist.net
Angie West,
RN, CCRN
Neuro/Stroke
Program Manager
4
West
Phone: 562-933-4006
Resident Responsibilities:
1.
Participate as a member of the practice
2.
Evaluate and manage patients whenever appropriate, including the writing
of notes and orders. For admissions, the
Resident should dictate or type a thorough Neurology H & P, which the
faculty will discuss with you on the first day.
3.
Discuss patient status and assessment with appropriate faculty
4.
Evaluate teachers and the rotation at the end of the rotation
5.
Cover the MICU overnight duty once per week and be available for back-up
call on the indicated days.
6.
Round on two Saturday mornings with the Neurology attendings
7.
Complete the NIH Stroke Scale online education program and turn in the
completion certificate to the GME office
8.
Give the neurology competency assessment form to one of your attendings
and arrange for a time to have him evaluate this and fill in the form. We will provide a self-addressed stamped envelope
for him to mail the form to the GME office.
Documentation:
1.
The resident is to dictate or type the initial consult note and place it
in the chart as soon as possible. These
are to be performed and completed right after seeing the patient. 3. This
consult note should include all the elements of a complete History and PE and
should be problem oriented in format
4.
Daily progress notes should be completed for all patients that the resident
is following.
5. Each resident will be required to give a Neurology
attending that has worked with them during the block, a competency assessment
form for the neurological examination to complete before the end of your
block. Please return these forms to the
residency office at LBMMC or UCI.
Faculty Responsibilities:
1. Assure educational value of resident cases
2. Provide resident case based teaching and supervision
3. Involve the residents in patient management decisions and allow autonomy,
appropriately adjusted for level of training
4. Encourage case-based reflection and reference to and application of the
medical literature
5. Allow residents to attend scheduled residency conferences
6. Provide ongoing formative evaluation and feedback to the Resident directly
and report informally to the Program Director as needed before the end of the
rotation
7. Fill out and return written evaluation forms of Resident and the rotation at
the end of the rotation, including the neurology physical examination
competency assessment form.
Rotation Goals, Objectives and Learning
Resources
Patient Care
Overview: The resident
should be competent in the care of common inpatient neurology conditions
including the clinical presentation, diagnosis and treatment
Objectives: Residents should demonstrate competency in the following:
1. Perform and interpret a detailed neurologic
examination.
2. Acute stroke assessment using the NIH stroke
scale
3.
Use of evidence-based order sets
Medical
Knowledge
Overview: Residents should learn the established and
evolving medical knowledge relevant to inpatient
neurology.
Objectives: Residents should have a
thorough grasp of the medical knowledge to care
for patients with the following:
1.
Stroke – evaluation, treatment and prevention
2.
Stroke Rehabilitation
3.
Coma
4.
Epilepsy
5.
Dementia
6.
Delirium
7.
Syncope
8.
Headache
9.
Dizziness
10. Peripheral
Neuropathy
11. Neuromuscular
Disease
12. Brain
Death
13. Imaging of
the Brain and Spinal Cord
14. Neurophysiologic
Tests
15. Vascular
Imaging
Communication
Overview: Residents are expected to communicate in a
way that results in effective
information exchange and provides collaboration with patients, their families, and other health
professionals.
Objectives: Residents should demonstrate competency in
the following:
16. Medical
Consultation Verbal and Written Communication
17. Determining
Code Status
18. Informed
Consent
19. Patient
Education for post-stroke patients
Professionalism
Overview: Residents are expected to carry out
professional responsibilities, adhere to
ethical principles, and maintain sensitivity to diverse patient populations.
Objectives: Residents
should demonstrate competency in the following:
20. Educational
activities necessary for lifelong learning
21. Understand
and respect patient/family confidentiality and informed consent
22. Give
constructive feedback to members of the health care team to improve problems encountered
in the workplace
23. Receive
feedback openly and identify a personal improvement plan
24. Adhere
to the appropriate dress code for a neurology consultant
25. Apply
ethical principles to patient care including:
patient autonomy, do no harm and social justice.
Practice Based Learning and Improvement
Overview: All physicians who
want to deliver high quality and up to date medical care have a commitment to
learn for a lifetime and apply new knowledge in the practice of medicine. This
process begins during residency by assessing the effectiveness of the health
care that they deliver and learning to critically appraise evidence about diagnostic
and treatment effectiveness.
Objectives: During the
neurology block, residents are expected to:
26. Reflect
on their own knowledge, behaviors and mistakes in providing care for patients with
neurology conditions and set appropriate learning and care improvement goals.
27. Apply
the EPB
Learning Cycle to issues relevant to cardiology care. Set appropriate
learning and care improvement goals, seeking high quality evidence to inform
their questions and applying this to patient care.
System Based Improvement
Overview: The quality and
safety of health care depends on how well the systems of health care delivery
function. All physicians should
contribute to the continuous improvement process for the quality and safety of health
care. To improve the efficiency and cost
of health care, new models of health care delivery are necessary.
Objectives: Residents should
learn:
28. How
patients access and receive preventive, acute and chronic care for patients
with neurology conditions.
29. To
identify areas for quality improvement and systematic solutions to gaps in care
delivery. Residents should have a working knowledge of :
·
The role of rehabilitation in common neurology conditions
·
A Comprehensive stroke center
·
Stroke systems of care