EEG/Clinical Neurophysiology
Clinical Neurophysiology/Epilepsy/Sleep Disorders Elective
RESIDENT EDUCATION CURRICULUM
Description of Rotation
The Clinical Neurophysiology/EEG Section of the Department of Neurology has redefined its educational programs for Neurology
residents. The following rotations are offered:
1. One-month “basic rotation” mandatory for all Adult Neurology residents and for Pediatric Neurology residents.
2. Additional “level 2” one month rotation including EEG, evoked potentials (EPs) and polysomnography (psg).
3. Advanced EEG-EP-psg elective rotation of up to three consecutive months in the EEG Laboratory for residents interested in
learning more about EEG and clinical neurophysiology and those who have a potential interest in fellowship training in
EEG/clinical neurophysiology. Participation in this elective requires prior successful completion of the introductory 2 month
EEG rotation and requires permission from the EEG section head, based on specific request by the interested resident. The
principles of intraoperative monitoring (EEG, EP) will be introduced here
4. Elective in clinical neurophysiology/epilepsy/sleep disorders. This elective month requires permission from the Clinical
Neurophysiology/EEG head, based on specific request by the interested resident.
Educational Purpose
1. To provide an experience that will allow the resident to increase their knowledge of anatomy of the central nervous system and
the clinical presentation and pathophysiology of epilepsy, sleep disorders, and other diagnosable entities.
2. To provide an experience that will allow the resident to achieve understanding of electrodiagnostic studies correlating it with
the basic science of neurophysiology and clinical presentation.
3. To learn the indications for ordering, diagnostic evaluation and interpretation of EEGs, evoked potentials (visual evoked
potentials, brainstem auditory potentials, somatosensory evoked potentials), and sleep studies (polysomnograms, multiple sleep
latency tests, multiple wakefulness test, etc).
4. To provide training and supervision that allows development of skills necessary to provide accurate diagnosis in clinical
neurophysiology studies.
Assessment Summary
The resident will work one-on-one with staff, and get immediate feedback about his/her performance after every patient
encounter/work-up. It is expected that the resident will improve their performance based on the feedback they receive and as the
rotation progresses.
Resident performance will be assessed in the six core competencies:
1. Patient Care (PC)
2. Medical Knowledge (MK)
3. Interpersonal and Communication Skills (ICS)
4. Practice Based Learning and Improvement (PBLI)
5. Professionalism (P)
6. Systems Based Practice (SBP)
By the end of the rotation, the resident should receive and/or complete the following assessments:
1. Verbal feedback from preceptors
2. Global written assessments (METS)
3. Procedure Logs
4. Written examination
5. Testing of residents performance through direct observation and record review
Expectations
Clinical Neurophysiology/Epilepsy/Sleep Disorders Elective
This one-month elective must be approved in advance by the EEG/clinical neurophysiology Section head. The resident will
see patients every half day with members of the Section. Depending on the staff physician, the experience may be as an
observer
during staff encounters with patients. Participation in both private and Charity epilepsy clinic activities is
required. Research projects
Orientation
This occurs on the first day of the rotation by the staff attending assigned to the clinic/lab. Orientation to the EEG machine will
evolve over the first month of the clinical rotation.
Supervision
Residents will actively participate in the clinics/lab supervised both by EEG staff physicians as well as EEG fellows when available.
Mix of Diseases
 Epilepsy including status epilepticus in adults and children
 Encephalopathies (including ICU monitoring of head trauma)
 Coma; persistent vegetative state; electrocerebral inactivity
 Sleep disorders
 Conditions diagnosable by evoked potentials such as hearing screening, multiple sclerosis, surgical monitoring, etc
Patient Characteristics
Patients will be referred to the EEG laboratory from either physicians in the outpatient department or from the inpatient hospital
services for further diagnosis of a wide variety of epilepsy and other disorders. Children and adult, of various ethnic backgrounds and
socioeconomic backgrounds with acute and chronic neurological disorders will be encountered during the EEG rotation. Adults over
the age of 18 will be encountered in the EEG clinic.
Procedural Skill Acquisition
1. Interpretation of EEG and video/EEG monitoring data
2. Reading an EEG report
3. Normal and abnormal findings in EEG and video/EEG monitoring
4. Interpretation of EEG and EEG monitoring findings
5. Interpretation of visual, brainstem auditory and somatosensory evoked potentials (EPs)
6. Analysis of polysomnography (psg) techniques with staff supervision
7. Writing and dictating electrodiagnostic interpretations with clinical correlations
Conferences
The residents should continue to attend the mandatory Neurology conferences including Neurology Grand Rounds. In addition, the
residents are required to attend the weekly EEG/Epilepsy conferences (schedule to be determined)
References:
Resources recommended for learning skills:
Fisch & Spehlmann’s EEG primer
Current Practice of Clinical Encephalography (Ebersole & Pedley), Lippincott Williams & Wilkins
Comprehensive Clinical Neurophysiology by Kerry Levin, Hans O. Luders, Saunders; 2000.
AAN Practice Guidelines: http://www.aan.com/professionals/practice/index.cfm
Your schedule will be as follows:
Mon: Continuity Clinic
Tues: Dr. McGuire at Children’s Hospital
Wed: University EEG readings for adult residents or Children’s Hospital Clinic for pediatric fellows
Thursday AM: Baptist Clinic w/ Dr. Olejniczak
PM: Resident Lectures
Friday: University EEG readings with Dr. Olejniczak (and or sleep disorders and evoked potentials)
PATIENT CARE
Objectives
Clinical Neurophysiology/Epilepsy/Sleep Elective
Through direct observation and instruction, the resident
will gain knowledge of advanced skills in EEG analysis
and interpretation
As the schedule permits, perform initial history and
examination, present to precepting staff, follow through
with work up and follow up during time on the
Epilepsy/Sleep/EEG rotation
Perform interval history and examination on selected
established patients
Teaching Methods
Assessment Strategy
Direct patient care
Recommended readings
Staff instruction
Direct patient care
Recommended readings
Performance feedback
“On-the-fly”observation
of
EEG
interpretation and reporting
Global ratings
EEG, EP, psg (observation of live
performance)
Global ratings
Direct patient care
Recommended readings
Performance Feedback
Teaching Methods
CNP study interpretation (observation of
live performance)
Global ratings
Assessment Strategy
MEDICAL KNOWLEDGE Objectives
Clinical Neurophysiology/Epilepsy/Sleep disorders
Elective
Didactic Lecture
Describe the pathophysiology of epilepsy,
Epilepsy conference
encephalopathies (EEG), sleep disorders (psg) and
Neurology Case Conference (Thurs)
sensory processing (EPs).
Global ratings
In-training examination
Clinical Teaching
Describe the fundamental principles of EEG, psg and EP Didactic Lecture
Epilepsy conference
examination and apply this knowledge in completing a
Neurology Case Conference (Thurs)
thorough history and neurological examination
Global ratings
In-training examination
Didactic Lecture
Epilepsy conference
Neurology Case Conference (Thurs)
Clinical Teaching
Didactic Lecture
Epilepsy conference
Neurology Case Conference (Thurs)
Clinical Teaching
Global ratings
In-training examination
Didactic Lecture
Epilepsy conference
Global ratings
In-training examination
Clinical Teaching
Explain central nervous system anatomical concepts in
relation to EEG, EPs and psgs
Discuss the various treatment and management options
for epilepsy and sleep disorders and apply the latest
knowledge to care of patients
Research a patient’s problem and provide a expanded
Global ratings
In-training examination
clinical neurophysiology/clinical differential diagnoses
Compare and contrast different management strategies
for patients with epilepsy, encephalopathies and sleep
disorders
Neurology Case Conference (Thurs)
Clinical Teaching
Didactic Lecture
Epilepsy conference
Neurology Case Conference (Thurs)
Clinical Teaching
Global ratings
In-training examination
INTERPERSONAL AND COMMUNICATION
Clinical neurophysiology/ EEG Rotation (PGY3 or 4) Interpersonal and Communication
Epilepsy-Sleep
disorders
Clinical Teaching Methods
Neurophysiology Elective
Establish excellent rapport and communication with their
Clinical practice
patients and their families
Assessment Strategy
Modeling
360 degree evaluation
Work as an integrated member of the Epilepsy Center and
EEG/clinical neurophysiology Lab
Clinical practice
Global ratings
Modeling
360 degree evaluation
Present case presentations in an organized and detailed
manner
Clinical practice
Global ratings
Modeling
360 degree evaluation
Educate their patients and their families as appropriate to the
clinical situation in a manner that is geared to the patients
educational level
Direct patient care
Global rating
Objectives
Modeling
Demonstrate the ability to provide consultants with a report that Clinical rounds
can be easily interpreted.
Global ratings
Modeling
Global ratings
PRACTICE BASED LEARNING AND IMPROVEMENT
Clinical Neurophysiology/ EEG Rotation Practice Based Learning and Improvement
Objectives
Clinical
Neurophysiology-Epilepsy-Sleep Teaching Methods
Assessment Strategy
disorders
Research clinical questions regarding their patient’s health
problems using information technology to access on-line
medical information to support their own education and to
improve patient care and education
Electronic medical record
Self assessment
Medline/OVID searches- patient
Global ratings
centered
Case presentations
Evaluate the clinical literature applying knowledge of
Teaching conferences
Global ratings of Journal club
epidemiology, biostatistics, and research study design
Journal Clubs
performance
Integrate the feedback they receive from Staff physicians such that
Modeling
Global ratings (METS)
their performance will improve as the rotation progresses.
PROFESSIONALISM
Clinical Neurophysiology/ EEG Rotation Professionalism
Objectives Clinical Neurophysiology – Epilepsy – Sleep Teaching Methods
Assessment Strategy
Disorders Elective
Demonstrate respect, compassion, integrity, and honesty
Direct patient care
Modeling
Global ratings
Interact responsibly with patients and families taking into
consideration age, disability, culture and gender issues
Modeling
Global ratings
Demonstrate exemplary interaction with their colleagues
Modeling
Global ratings
Demonstrate appropriate use of the EMR in regards to patient Direct patient care
Global ratings
respect and confidentiality
Modeling
Self-assess their performance and the means for
improvement
Recognize mistakes that occur and take measures to learn
from them so that the do not recur
Modeling
Global ratings
Direct patient care
Global rating
Modeling
Self assessment
SYSTEM BASED PRACTICE
Clinical Neurophysiology/ EEG Rotation System Based Practice
ObjectiveClinical Neurophysiology – Epilepsy – Sleep Teaching Methods
Assessment Strategy
Disorders Elective
Utilize appropriate resources to better care for their patients.
Direct patient care
Global ratings
Review of evidence based medicine
Focused Record Review
and guidelines of the AAN
Departmental conferences
Identify obstacles to good patient care, engaging other
members of the health care team such as child-life and social
work, appropriately consulting other subspecialists or
generalists.
Communicate with the specialized services or laboratories in
order to obtain timely information on their patients
Direct patient care
Consider ethical, legal, and cost-effective standards of
practice
Global ratings
360 degree evaluation
Direct patient care
Global ratings
Modeling
360 degree evaluation
Role modeling
Self assessment
Clinical teaching
Focused record review
Focused record review