UTMB Internal Medicine Residency
Neurology
Goals, Competencies, Methods, and Assessments
Overall Goal
To make physicians into specialists in Internal Medicine by equipping them with
requisite knowledge, skills, and attitudes essential for them to demonstrate competence in
patient care, knowledge, practice-based learning and improvement, systems-based
practice, professionalism, and interpersonal and communication skills relevant to the
knowledge and skills of Neurology.
Patient Care
Goal
Residents must be able to provide patient care that is compassionate, appropriate, and
effective as it overlaps with the patient care skills relevant to Neurology.
Competencies - Residents are taught how to:
 Demonstrate accurate, complete, and relevant history-taking related to the
diagnosis and treatment of neurologic diseases. MPC, LSC/DO
 Demonstrate the ability to perform an accurate physical examination related to the
diagnosis and treatment of neurologic diseases. MPC, LSC/DO
 Demonstrate the ability to generate a differential diagnosis for neurologic
diseases. MPC, LSC/DO
 Demonstrate the ability to effectively present the results of a patient encounter
orally and in writing and to defend the clinical assessment, differential diagnosis,
and diagnostic and management plans for neurologic diseases. MPC, LSC/DO
 Demonstrate familiarity with indications for and limitations of clinical
neurodiagnostic/neuroimaging tests and their interpretation. MPC, LSC/DO
 Demonstrate familiarity with the diagnosis and management of patients with
neuromuscular disease, cerbrovascular disease, epilepsy, movement disorders,
infectious neurological diseases, dementia, headache, multiple sclerosis,
intractable pain, degerative neurologic diseases, and neoplastic neurologic
diseases. MPC, LSC/DO
 Demonstrate familiarity with the diagnosis and management of patients with
diseases involving the central, peripheral, and autonomic nervous systems,
including their coverings, blood vessels, and all effector tissue, such as muscle. .
MPC, LSC/DO
 Demonstrate familiarity with the management of patients with acute neurological
disorders in an intensive care unit or an emergency department. PTRMDPC,
MPC, LSC/DO
Medical Knowledge
Goal
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Residents must demonstrate knowledge of established biomedical, clinical,
epidemiological, and social-behavioral sciences, as well as the application of this
knowledge to the care of patients with neurologic diseases.
Competencies – Residents are taught how to:
 Demonstrate a core fund of knowledge of the basic sciences on which clinical
neurology is founded, including neuroanatomy, neuropathology, neurophysiology,
neuroimaging, neuropsychology, neurochemistry, and neuropharmacology. MPC,
LSC/DO
 Demonstrate a core fund of knowledge of the fundamental aspects of neurology
and the diagnosis and treatment of all categories of disease involving the central,
peripheral, and autonomic nervous systems, including their coverings, blood
vessels, and all effector tissue, such as muscle. MPC, LSC/DO
 Demonstrate a core fund of knowledge of the disciplines related to neurology
including neuro-ophthalmology, neuromuscular disease, cerbrovascular disease,
epilepsy, movement disorders, behavioral neurology, neuroimmunology,
infectious disease, neuroimaging, neuro-oncology, pain management, the
neurology of aging, and psychiatry. MPC, LSC/DO
Practice- Based Learning and Improvement
Goal
Residents must demonstrate the ability to investigate and evaluate their care of patients,
to appraise and assimilate scientific evidence, and to continuously improve patient care
based on constant self-evaluation, life long learning, and continuous quality or practice
improvement.
Competencies – Residents are taught how to:
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Demonstrate the ability to identify strengths, deficiencies and limits in their
knowledge and access and assess the neurology literature to remediate
deficiencies. MPC, LSC/DO
Demonstrate the ability to incorporate formative evaluation feedback into daily
practice. MPC, LSC/DO
Systems-Based Practice
Goal
Residents must demonstrate an awareness of and responsiveness to the larger context and
system of health care, as well as the ability to call effectively on other resources in the
system to provide optimal health care.
Competencies - Residents are taught how to
 Demonstrate the ability to work effectively in various health care delivery settings
and systems. MPC, LSC/DO
Professionalism
Goal
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Residents must demonstrate a commitment to carrying out professional responsibilities
and an adherence to ethical principles that they know.
Competencies - Residents are taught how to:
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Demonstrate an understanding of and commitment to all elements of
professionalism, including respect, compassion and integrity toward their patients,
patient families, and other health care professionals. MPC, LSC/DO
Interpersonal and Communication Skills
Goal
Residents must demonstrate interpersonal and communication skills that result in the
effective exchange of information and teaming with patients, their families, and
professional associates.
Competencies – Residents are taught how to:
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Demonstrate the ability to generate and maintain appropriate medical records,
procedure reports, and other written communication. MPC, LSC/DO
Teaching Methods
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MPC – Mentored Patient Care: Practical teaching and role modeling during direct
patient care during clinical rotations.
LSC - Lectures/Seminars/Conferences
 Grand Rounds
 Noon Conference
 Residents Conference
 Clinic Conference
 Morning Report
 Journal Club
 Morbidity and Mortality
 Clinical-Pathological Conference
 Board Review Sessions
 Quality Improvement Course
 Palliative Care Course
 Ultrasound Course
 Procedure Simulation
 Coding Course
 Professionalism
WRT - Weekly Reading/Testing/Feedback
Methods and Tools for Assessing Residents
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WT – Weekly Tests evaluating knowledge base for all competencies and
subspecialties.
DO - Direct Observation of competency-based performance by qualified faculty
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guided by PGY-specific, milestone-based assessment tools. Included in MSF.
DO –P - Direct Observation by Peers evaluation of competency-based
performance, guided by PGY-specific, milestone-based assessment tools.
Included in MSF.
ITE - In-Training Exam
Duty Hours for Residents
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The residency program follows the ACGME Duty Hour Requirements.
Duty hours are limited to 80 hours per week, averaged over a four-week period,
inclusive of all in-house call and moonlighting activities.
Residents must be scheduled for a minimum of one day free of duty every week
(when averaged over four weeks). At-home call cannot be assigned on these free
days.
Duty periods of PGY-1 residents must not exceed 16 hours in duration.
Duty periods of PGY-2 residents and above may be scheduled to a maximum of
24 hours of continuous duty in the hospital. Programs must encourage residents to
use alertness management strategies in the context of patient care responsibilities.
Strategic napping, especially after 16hours of continuous duty and between the
hours of 10:00p.m. and 8:00 a.m., is strongly suggested.
It is essential for patient safety and resident education that effective transitions in
care occur. Residents may be allowed to remain on-site in order to accomplish
these tasks; however, this period of time must be no longer than an additional four
hours.
Residents must not be assigned additional clinical responsibilities after 24 hours
of continuous in-house duty.
In unusual circumstances, residents, on their own initiative, may remain beyond
their scheduled period of duty to continue to provide care to a single patient.
Justifications for such extensions of duty are limited to reasons of required
continuity for a severely ill or unstable patient, academic importance of the events
transpiring, or humanistic attention to the needs of a patient or family. Under
those circumstances, the resident must: appropriately hand over the care of all
other patients to the team responsible for their continuing care; and, document the
reasons for remaining to care for the patient in question and submit that
documentation in every circumstance to the program director.
PGY-1 residents should have 10 hours, and must have eight hours, free of duty
between scheduled duty periods.
Residents in the final years of education (PGY2 and 3) must be prepared to enter
the unsupervised practice of medicine and care for patients over irregular or
extended periods. This preparation must occur within the context of the80-hour,
maximum duty period length, and one-day off-in-seven standards.
While it is desirable that residents in their final years of education have eight
hours free of duty between scheduled duty periods, there may be circumstances
when these residents must stay on duty to care for their patients or return to the
hospital with fewer than eight hours free of duty.
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In unusual circumstances, residents may remain beyond their scheduled period of
duty or return after their scheduled period of duty to provide care to a single
patient. Justifications for such extensions of duty are limited to reasons of
required continuity of care for a severely ill or unstable patient, academic
importance of the events transpiring, or humanistic attention to the needs of the
patient or family. Such episodes should be rare, must be of the residents’ own
initiative, and need not initiate a new ‘off-duty period’ nor require a change in the
scheduled ‘off duty period.’
Residents must not be scheduled for more than six consecutive nights of night
float.
PGY-2 residents and above must be scheduled for in-house call no more
frequently than every-third-night.
Responsibilities, Supervision, Lines of Authority
Outpatient and Consultation Rotations
1. Team Composition:
Attending (Faculty)
Fellow
Resident
Medical Students
Other team members such as Case Managers, Social Workers, etc.
2. Responsibilities of Members:
a. Attending:
Oversees clinic/consultation function and overall patient care
Teaches house staff and medical students
Monitors assessment and care of patient
Accepts ultimate legal responsibility for patient's welfare
Learns from other team members
Assures attendance of team members at all required conferences.
b. Fellow:
Is accountable to the attending for the service.
Provides leadership for clinic and consultation services.
Supervises and teaches the resident.
Coordinates patient follow-up
Assures attendance of self and team members to all required conferences.
c. Resident:
Directly accountable to the attending for the clinic/consult service.
Writes a Resident note on each patient encounter.
Presents diagnosis and plan of care to the attending for discussion and
feedback.
Communicates diagnosis and plan of care to the patient's primary care
physician.
Plans, with attending and fellow, patient follow-up.
Teaches students, and sometimes fellow and faculty
Assures attendance of self and team members to all required conferences.
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Faculty Notification: It is the responsibility of the resident to contact faculty
immediately for the following issues:
 Potentially unstable patients
 Transfers to intensive care
 Deaths (expected and unexpected)
 Changes in patient status
 Procedures
 Unpleasant social issues
 Risk management issues
 Patients declining urgent treatment against medical advice
Educational Resources
UTMB Homepage
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