Neurology
I. Rationale
The specialty of family practice is vitally interested in all aspects of neurologic disease. The cost in the
United States for care of nervous system diseases is estimated to be more than $400 billion per year.
Neurologic problems are estimated to comprise 10-15% of a family practitioner's workload. History-taking
in neurology and performance of the neurologic examination are essential skills in family practice. Family
physicians spend a significant amount of care time with patients with neurological diseases in the
ambulatory and impatient setting. As a family physician, graduates must be comfortable with a wide
variety of neurological diseases including diagnosis and treatment, appropriate referral and planning and
interpretation of work-up results.
II. Goals
Medical Knowledge/Patient Care
A. Will develop knowledge and learn the management of the common neurologic problems and
symptoms that will present to a busy family medicine clinic.
B. Will get ample practice in performing both comprehensive as well as focused neurologic exams,
including mental status assessments.
C. Develops a differential diagnosis for neurologic problems.
Interpersonal and Communication Skills
Develops interpersonal and communication skills in interaction with patients, colleagues and other
members of the care team. The resident should demonstrate the ability to communicate with patients,
family, colleagues and other team members effectively, in the pursuit of delivering optimal and
compassionate patient care.
Practice-based Learning and Improvement
The encounter with the patient will trigger the graduates’ lifelong interest in maintaining and updating
skills and knowledge as essential for delivering safe and high quality patient care. Residents must be
able to investigate and evaluate their patient care practices, appraise and assimilate scientific evidence,
and improve their patient care practices. Residents must be proactive in obtaining the skills and
knowledge needed to recognize and diagnose neurological conditions.
Systems-based Practice
A. Learns guidelines regarding tests to investigate diagnoses in a cost-effective, evidence-based medical
approach.
B. Develops insight in personal limitations; learn and apply referral criteria for referral from primary care
to specialty care
Professionalism
The resident must show a commitment to carrying out professional duties, in a responsible manner, and
adhering to ethical principles in order to deliver optimal patient care at all times.
Last updated March 7, 2013
III. Objectives
Medical Knowledge/Skills
A. In the appropriate setting, by the end of the rotation and at time of graduation, the resident
should be able to demonstrate knowledge and the ability to apply the knowledge of:
1.
2.
3.
4.
5.
6.
7.
8.
9.
10.
11.
12.
13.
14.
15.
16.
17.
18.
19.
20.
21.
22.
23.
24.
25.
26.
27.
28.
Alcohol effects and withdrawal syndromes
Anopsias, partial anopsias
Brain death – definition and evaluation, to include coma
Carpal tunnel syndrome and other entrapment syndromes
Delirium
Dementia, pseudo-dementia, and confusion
Demyelinating diseases, to include ALS and Guillian-Barre
Encephalopathy, metabolic, infectious, intoxication
Headache to include tension, migraine, and cluster
Headache secondary to SAH, tumor, temporal arteritis, IIH
Meningitis and encephalitis
Movement Disorders
Multiple sclerosis
Myasthenia gravis and Eaton-Lambert Syndrome
Neuropathies, to include Bell’s palsy and diabetic neuropathy
Pain syndromes to include trigeminal neuralgia and postherpetic neuralgia (PHN)
Parkinson's Disease
Pharmacology of commonly used neurological medications
Radiculopathy, to include herniated disc (HNP), neck pain, back pain
Rehabilitation after stroke
Seizures
Side effects of medications commonly affecting the nervous system
Sleep disorders, to include narcolepsy, PLMD, RLS
Spinal cord disorders
Status epilepticus
Stroke, stroke prevention guidelines
Subdural hematoma
Vestibular conditions, to include labrynthitis
Learning Activities
X
Attending Rounds
Multidisciplinary Rounds
X
Grand Rounds
Sub-Specialty
Conference
Morning Report
X
Didactics
X
Inpatient consultations
Evaluation Methods
X
Attending Evaluation
Program Director
Review
360 ᵒ evaluation
Last updated March 7, 2013
X
X
X
X
Research Conference
Ethics/Comm Conference
Specialty Conference
Noon Conference
X
X
Outpatient Clinics
Direct Patient care
Resident Seminar
Journal Club
Faculty Supervision
Procedures
X
Readings
Directly Supervised
Procedures
In-Training Exam
Videotape Review
Morning Report
X
Faculty Supervision
and Feedback
Quarterly Review
Patient Care
A. Collect information in a focused manner to analyze the patient’s problem. Plan work up
and treatment in a cost-effective, evidence-based manner. Recognize role in providing
continuity and comprehensiveness of care.
1. Perform a thorough, focused examination appropriate to the symptoms or
differential diagnosis.
2. Plan appropriate serial work-up for common conditions utilizing the ambulatory
environment to minimize hospitalizations as appropriate for the patient's condition.
3. Integrate medical, clinical, and environmental data to plan sufficient and cost
effective testing and treatment for the patient.
B. Learn a set of procedural skills appropriate for the practice of neurology in family medicine.
1. Lumbar puncture, adult and pediatric
2. Mental status examination (MSE)
3. Mini-mental status exam (MMSE)
4. Neurological examination
C. Develop competency in describing the indication for and interpretation of the following:
1. Arteriography
2. CT scan of the head and spine
3. MRI/MRA of the head and spine EEG EMG
4. Evoked potentials
5. Skull and spine radiographs
Learning Activities
X
Attending Rounds
Research Conference
X
Multidisciplinary Rounds
Ethics/Comm Conference
X
Grand Rounds
Specialty Conference
Sub-Specialty
Noon Conference
Conference
Morning Report
X
Faculty Supervision
X
X
Didactics
X
Procedures
X
Clinical skills training and evaluation during Orientation/1st block
Evaluation Methods
X
Attending Evaluation
X
X
Directly Supervised
Procedures
In-Training Exam
Outpatient Clinics
Direct Patient care
Resident Seminar
Journal Club
Readings
Morning Report
Program Director
X
X
Faculty Supervision
Review
and Feedback
360 ᵒ evaluation
Videotape Review
Quarterly Review
Clinical skills training and evaluation during Orientation/1st block
Practice-based Learning and Improvement
A. Residents must be able to investigate and evaluate their patient care practices, appraise and
assimilate scientific evidence, and improve their patient care practices. Residents must be
proactive in obtaining the skills and knowledge needed to effectively diagnose and manage
neurological conditions.
B. Learns to identify resources for personal education and develops a plan for ongoing
education.
Last updated March 7, 2013
Learning Activities
X
Attending Rounds
Multidisciplinary Rounds
Grand Rounds
Sub-Specialty
Conference
Morning Report
X
Didactics
Other
Evaluation Methods
X
Attending Evaluation
Program Director
Review
360 ᵒ evaluation
Other
X
X
X
X
Research Conference
Ethics/Comm Conference
Specialty Conference
Noon Conference
X
X
Outpatient Clinics
Direct Patient care
Resident Seminar
Journal Club
Faculty Supervision
Procedures
X
Readings
Directly Supervised
Procedures
In-Training Exam
Morning Report
X
Videotape Review
Faculty Supervision
and Feedback
Quarterly Review
Interpersonal and Communication Skills
A. Develops patient sensitive skills for interviewing that allow accurate, and complete collection
of information regarding symptoms, the family and the community that affect the patient's
health and care.
B. Develops skills in communicating results to patients, their families, other health care
providers.
C. Develops skills in educating patients and their families, in dealing with sensitive issues for
patients and families, and in negotiating a plan of investigation and treatment with the
patient and family.
D. Develops a therapeutic doctor-patient and doctor-family relationship.
E. Develops professional relationships with coworkers, consultants, and other professionals to
enable assembling of health care teams and mobilization of community resources to
optimize care of the patient.
F. Develops and understanding of the role of the neurology consultant, and is able to support
the patient through the process of consultation, neurologic evaluation, treatment,
rehabilitation and long-term care.
Learning Activities
X
Attending Rounds
Multidisciplinary Rounds
Grand Rounds
Sub-Specialty
Conference
Morning Report
X
Didactics
Other
Evaluation Methods
X
Attending Evaluation
Program Director
Last updated March 7, 2013
Research Conference
Ethics/Comm Conference
Specialty Conference
Noon Conference
X
X
X
X
Faculty Supervision
Procedures
Directly Supervised
Procedures
In-Training Exam
Outpatient Clinics
Direct Patient care
Resident Seminar
Journal Club
Readings
X
Morning Report
X
Faculty Supervision
Review
360 ᵒ evaluation
Other
and Feedback
Quarterly Review
Videotape Review
Systems-based Practice
A. Communicates and documents clearly and completely by written and verbal methods.
B. Emphasizes continuity of care for the patients.
C. Communicates and documents clearly and completely by written and verbal methods.
Completes consultations and referrals thoroughly and assures appropriate information is
transmitted to consultants. Obtains consultation urgently as appropriate to diagnosis or
condition.
D. Emphasizes continuity of care for the patients.
E. Communicate regularly with consultants regarding changes in patient status and
modification of care plans.
F. Follows the patient from office, to consultant, hospitalization, long-term care or other
environments.
F. Assists patients and their families in planning for future care needs and care decisions based
on prognosis for the disease. Supports the patient in their decisions.
Learning Activities
X
Attending Rounds
Multidisciplinary Rounds
Grand Rounds
Sub-Specialty
Conference
Morning Report
X
Didactics
Other
X
Evaluation Methods
X
Attending Evaluation
Program Director
Review
360 ᵒ evaluation
Other
X
Research Conference
Ethics/Comm Conference
Specialty Conference
Noon Conference
X
X
Outpatient Clinics
Direct Patient care
Resident Seminar
Journal Club
Faculty Supervision
Procedures
X
Readings
Directly Supervised
Procedures
In-Training Exam
Videotape Review
Morning Report
X
Faculty Supervision
and Feedback
Quarterly Review
Professionalism
Residents must demonstrate a commitment to carrying out professional responsibilities, adherence to
ethical principles, and sensitivity to a diverse patient population. Residents are expected to:
A. Demonstrate respect, compassion, and integrity; a responsiveness to the needs of patients
and society that supersedes self-interest; accountability to patients, society, and the
profession; and a commitment to excellence and on-going professional development.
B. Demonstrate a commitment to ethical principles pertaining to provision or withholding of
clinical care, confidentiality of patient information, informed consent, and business practices.
C. Demonstrate sensitivity and responsiveness to patients' culture, age, gender, and disabilities.
Last updated March 7, 2013
D. Arrive at the rotation in time, in order to utilize the learning environment of the neurology
rotation in full.
E. Work effectively as a member of a team.
F. Respect patient privacy by guarding medical records and discussion of personal information
about patients.
G. Demonstrate professional, respectful demeanor when addressing team members, patients,
ancillary staff, and consultants. Sets own boundaries and respects others.
H. Appear professionally dressed and well groomed.
I. Complete notes, referrals and other forms of communication and documentation in a timely
fashion.
J. Attend required didactics, conferences.
K. Respond to pages and clinic messages in a timely fashion.
Learning Activities
X
Attending Rounds
Research Conference
Multidisciplinary Rounds
Ethics/Comm Conference
Grand Rounds
Specialty Conference
Sub-Specialty
Noon Conference
Conference
X
Morning Report
X
Faculty Supervision
X
Didactics
X
Procedures
X
Resident sign professionalism contract at start of residency
Evaluation Methods
X
Attending Evaluation
X
X
Program Director
Review
360 ᵒ evaluation
Other
X
Directly Supervised
Procedures
In-Training Exam
Videotape Review
X
X
Outpatient Clinics
Direct Patient care
Resident Seminar
Journal Club
X
Readings
Morning Report
X
Faculty Supervision
and Feedback
Quarterly Review
III. Instructional strategies (see above)
A. Direct patient care six half days per week in Neurology outpatient facilities at the office of Dr.
Ellis Hedaya including general neurology, epilepsy, stroke, chronic pain and urgent care.
B. Family Practice Center and Family Practice Service patient care.
C. Completing a focused H&P, assessment, differential diagnosis, and plan to be presented to
the fellow or faculty member as appropriate to the particular setting.
D. Didactics during Neurology Clinic and Family Medicine Conferences.
E. Associated rotations for additional neurology experience: Emergency Room including adult
and pediatric, Family Medicine inpatient Service, Family Medicine Clinic, Pediatric Wards,
Geriatrics
F. Required readings: monographs as listed below
G. Recommended readings – see reading list below
IV. Evaluation strategies (see above)
A.
B.
C.
D.
Observation by Neurology faculty
Observation by Family Medicine faculty in family medicine clinic
Chart critique by faculty
Procedure competence certification
Last updated March 7, 2013
E.
F.
G.
H.
I.
End of rotation evaluations for Neurology
Family Medicine Conference attendance
In-training exam profiles
Resident evaluation of rotation and faculty
Completion of required readings and scoring >90% on open book monograph quizzes
V. Implementation Methods
Neurology clinic block: Neurology experience with Dr. Ellis Hedaya and his colleagues. The rotation
will include both inpatient consultation service and outpatient clinic.
Contact: The resident is expected to arrive at 8:30 a.m. the first day of the rotation and should
ask for Dr. Hedaya.
Ellis Hedaya, MD
Peachtree Neurology
Emory Midtown Hospital
550 Peachtree St., Ste 1200
Atlanta, GA 30308
Assistant: Elizabeth Bockman
b.bockman@peachtreeneuro.com
404-221-1899 ofc
404-221-1343 fax
Clinic Schedule
Monday
AM
Neurology
Tuesday
Neurology
Wednesday
Neurology
Thursday
Didactics
Friday
FMC
PM
FMC
Neurology
Neurology
FMC
Neurology
Family Practice Center: Three half days per week. Didactics: One half day per week
Call/Vacation: Call is on the Family Practice Service from 5:30pm to 8:00am on weekdays and 8:00am
to 8:00am on Saturdays and Sundays. Vacation is allowed on this rotation.
Supervision: Attending faculty will be asked to complete evaluations of Performance.
Procedure documentation should be initialed by the supervising Physician, whether faculty or senior
resident, and must be done with supervision until proficiency is established by an attending or fellow with
use of the competence form.
Conferences: The resident is expected to attend all family medicine conferences and didactic conferences
as designated by Neurology.
Readings:
AAFP monographs
 Stroke #339 (2007)
 Headache #359 (2009)
 Seizure Disorders # 366 (2009)
 Neurodegenerative Disorders update # 386 (2011)
 Dementia # 389 (2011)
Emory E-books:
http://health.library.emory.edu/search/apachesolr_search/neurology?filters=tid%3A3&retain-filters=1
Last updated March 7, 2013
Bates' Visual Guide to Physical Examination, 4th edition, edited by L.S. Bickley, 2005
http://health.library.emory.edu/collections/bates
Guide to Primary Care for Neurological Disorders, Popp A.J., 2nd ed, 2008.
http://health.library.emory.edu/search/apachesolr_search/Guide%20to%20primary%20care%20for%20n
eurological%20disorders?filters=tid%3A3&retain-filters=1
Additional neurology textbook resources can be found in the Emory ebook library.
Last updated March 7, 2013