LSU Neurology Core Curriculum

A. Goal
To prepare physicians to function as effective neurologists, who can
recognize and manage patients with neurologic problems, and who can
provide expert advice to other medical consultants on neurologic matters.
B. Objectives
To teach or reinforce the following analytical skills:
a. To recognize symptoms and signs that suggest neurologic
b. To be able to localize symptoms and signs to the
appropriate anatomic parts of the nervous system.
c. To be able to formulate differential diagnosis, evaluation,
and management strategies based on relevant history,
examination, and laboratory features.
d. To be familiar with the basic tests used to evaluate
neurologic problems (neuroimaging, EEG, EMG, NCV,
evoked potentials, sleep studies), and how to interpret their
The curriculum for a residency training program in neurology should encompass training
and educational experiences to prepare a physician for the independent practice of
neurology. The LSU Neurology training program will require the residents to obtain
competencies in each of six areas defined by the RRC for neurology.
1. Patient care: Ability to perform a comprehensive history and physical examination
of a patient, localize the neurological problem, generate an appropriate differential
diagnosis, and determine an effective, cost-effective plan of further evaluation and
management of the patient. Patient care must be performed in a compassionate,
ethical manner.
2. Medical knowledge: Knowledge of neurological disorders and basic
neurophysiology and genetics. Knowledge of laboratory and diagnostic technology
and ability to utilize this technology safely, effectively, and economically. Critical
ability to assess evolving medical science, technology and epidemiological and
social-behavioral sciences relating to medicine.
3. Practice-based learning and improvement: Recognition of the limits of a
physician's own cognitive and clinical skills and need for life- long learning. This
relates to the ability to obtain current information from science and practice literature
to improve patient care; learning systems to evaluate and improve the physician's own
practice patterns such as obtaining feedback through patient evaluations and analysis
of outcomes; and the ability to critically evaluate the medical literature.
4. Interpersonal and communication skills: The ability to effectively exchange
information with patients, families and ancillary health professionals. This includes
the ability to both listen and understand patients, to recognize the cultural and
religious biases of both the practitioner and patients/families and effective methods to
deal with such, and the ability to communicate with other professionals and
physicians on a consultation basis.
5. Professionalism: A commitment to carrying out professional responsibilities
including timely and responsive communication with patients and other health care
providers, appropriate use of medical records, and coordination of care and patient
coverage if unavailable. The adherence to ethical principles with sensitivity to a
diverse patient population including but not limited to differences of race, gender,
religion, age, cultures, political beliefs and sexual orientation; while always
respecting the confidentiality of medical information.
6. Systems-based practice: Recognition of the workings of the health care system in
the broader setting of society as a whole. This involves recognition of practice
guidelines, local and national resources available to enhance the quality of life of
patients, and ancillary health services available to affect all aspects of a patient's care.
The ability to function effectively within the financial limitations of individual
patients and to utilize effectively the community and national resources available. The
ability to function in the current system of managed health care and recognition of the
legal aspects of the practice of medicine.
Content of Subjects to be Taught
Training in the LSUHSC Neurology residency will be very broad based. It will
encompass both clinical and research aspects of Neurology, including both clinical and
basic science research. There will be significant emphasis on both inpatient and
outpatient practice of clinical Neurology. Ethical decision-making, including end-of- life
decisions and cost effectiveness in Neurology will be taught. Training will include
didactic sessions and practical, hands-on experience. There should be an ascending level
of autonomy in clinical training as the trainee progresses. All content should conform to
program requirements of the Residency Review for Neurology, as outlined in the most
recent version of the Graduate Medical Education Directory. Thus, as a minimum, there
must be at least 18 months of clinical adult Neurology with primary responsibility in
patient care, a minimum of 3 months in clinical pediatric Neurology with primary
responsibility in patient care, and at least six months of clinical Neurology training in an
outpatient setting. Included below are the areas of Neurology which will be included in a
core curriculum of Neurology residency training:
Textbooks that are recommended reading :
Merritt’s Textbook of Neurology: Rowland LP,ed 12th ed. Lea & Febiger,2009.
Principles of Neurology: Adams RD,Victor M, Ropper AH. 7th edition. McGraw-Hill,
Clinical Neurology: Baker AB, Baker LB. Harper & Row. Revised annually.
Neurology in Clinical Practice: Bradley WG, Daroff RB, Fenichel GM, Marden CD. 3rd
ed. Butterworth-Heinemann, 2000.
Pediatric Neurology. Principles and Practice: Swaiman KF, Wright. 3rd ed.
Mosby, 1999.
Harrison’s Principles of Internal Medicine: 15th ed. McGraw-Hill, 2001.
Neurological Differential Diagnosis: Patten, John, Springer-Verlag. 2nd ed. New
York, 1996.
Neurology in General Medicine: Aminoff, M. 3rd ed. 2001.
Diagnostic Radiology: Osborn, A. Mosby, 1994.
Neurology residents must be trained to develop a responsibility for continuing medical
education that should be self-motivated.
The resident will read the focused topic review and complete the testing section.
PGY II- will be required to complete two editions of the continuum, plus one required
PGY III- will be required to complete three editions of the continuum, plus two required
PGY IV – will be required to complete ALL required continuums
Required Continuums
 Headache
 NIH Stroke Scale
 Movement Disorder
 Critical Care
 Ethics
 Neuro-oncology
 Neuro-rehab
 Neuro Otology
Journal Clubs
Goals & Objectives:
Journal club will address a specific topic or important area in the field. Neurology
residents must be able to investigate and evaluate their patient care practices, appraise
and assimilate scientific evidence and improve their patient care practices. Residents are
expected to demonstrate skill in the following areas:
 Case-based learning
 Use of best practices through practice guidelines or clinical pathways
 Participation in Quality Assurance and Improvement
 Collection and analysis of patient data
References to be used for Journal Club:
Annals of Neurology
Archives of Neurology
Journal of Neurology, Neurosurgery and Psychiatry
New England Journal of Medicine
CONTINUUM: AAN publication;
Medline access;
Harrison’s Online Principles of Internal Medicine;
Neurology Critical Care and Emergency Lectures:
Goals & Objectives:
Residents will receive the medical knowledge require to evaluate and treat patients with
the following disorders: Topics were chosen after a survey was conducted of most
common presenting neurological problems in ER.
 Evaluate coma of uncertain etiology
 Diagnose and evaluate acute flaccid paralysis
 Evaluation and treatment of stroke/cerebrovascular diseases
 Assessment of neuromuscular respiratory failure
 Effectively perform emergency consults in adult and pediatric populations
Pain Rounds
Goals and Objectives: This lecture series is required for PGY IV residents
To increase general understanding about the complex nature of pain,
 To improve the evaluation and assessment of representative pain problems,
 To identify weaknesses in initial approaches to management,
 To provide a rational approach to improved analgesia and quality of life,
 To discuss current, evidence-based investigations pertaining to pathophysiology,
pharmacology, and treatment options (conventional and alternative) for the pain
problem that is presented.
The format of the conference is that of patient presentations with occasional didactic
presentations from visiting speakers. Participants are multidisciplinary, including
medical, dental, nursing and graduate students, residents, basic scientists (pharmacology,
physiology, anatomy), clinicians (neurology, psychiatry, physical medicine and
rehabilitation, others with interest in specific topics), and other allied health professionals
(nurses, physical therapists, occupational therapists).
Patient presentations
 A history of the presenting problem including co-morbid presentations,
psychosocial, situational factors, and previous management is provided.
 Physical examination observations are provided.
 Discussion of the initial presentation, clarification of assessment issues, and past
treatments is conducted that leads to diagnosis and prediction of an appropriate
approach to treatment.
 The actual treatment plan with follow-up results is presented and discussed.
 Further recommendations for improved care are offered.
 The topic is discussed from both basic science and clinical perspectives.
* Residents will have articles and biweekly didactics during their rotation in Pain
15 hours
Residents will present monthly an interesting image. All clinical cases presented should
have appropriate imaging included in the presentation.
Lecture Dates
3rd Thursday of the Month in Room 728
Diagnosis, Classification, and the Treatment of New Onset Epilepsy and Status
Therapeutic Approaches in Special Populations and in Medically Refractory
Antiepileptic Drugs
The Role of Surgery and VNS in the Treatment of Epilepsy
The Scientific Basis and Functional Neuroanatomy of Epilepsy (Basic Science)
Epilepsy Case Presentation
Choosing the Right AEDs: Older vs. Newer AEDs - Improving the Risk/Benefit
Test and Review of Epilepsy
Epilepsy Lecture Series
To provide physicians with the knowledge essential for diagnosing and treating epilepsy.
Develop an understanding of the neuroscience of epilepsy
To gain an understanding of the functional neuroanatomy of epilepsy
To understand the diagnosis and classification of seizures and epilepsy.
To understand the role of epilepsy surgery and vagus nerve stimulation in
the treatment of epilepsy and to know when to refer patients for these
To be able to apply special therapeutic considerations in special situations
such as in pregnancy and in the elderly
 Review the basic fundamentals of the diseases involving nerve and muscle
Patients will be presented when possible
Electrophysiology and pathology will be presented when applicable
Review of the subject will be done by the resident rotating on neuromuscular and
or EMG
Multiple Sclerosis
Goals and Objectives:
The resident will recognize common presentations of MS, order appropriate diagnostic
evaluations and provide a differential for other conditions
Lecture Dates (TBA):
MS: Modern Era Trials
MS Grand Rounds
Vision & MS
Devic’s& Other Demyelinating Diseases
MS Clinical
Goals and Objectives:
1. Describe common presentations of MS and provide a differential for other
conditions that may mimic MS
2. Order appropriate diagnostic evaluations
3. Describe the several courses of MS
4. Become familiar with the diagnostic criteria for MS
5. Describe the MRI findings typical of MS and their application to the diagnostic
Chemodenervation Lecture Series& Practical Methods
Goals and Objectives:
Residents will be trained on the use and administration of chemodenervation.The
program will include instruction in the history of Botulinum toxin, as well as its
pharmacological profile, safe handling and storage of Botox, management and treatment
of complications and clinical administration of Botox. Residents will be required to pass
three written exams and a clinical evaluation (part with a dummy, ELVIS and part with a
patient volunteer).
Business and Practice
Module I-Understanding Job Offers: Physician Compensation & Contracts
Goals and Objectives:
The objective of this program is to provide useful information on employment contract
issues, contractual clauses and the need for thorough evaluation before commitment to an
employment offer. The first part of this module will guide the participants through the
three types of assessments that are needed in order to make an informed decision.
Common areas of concern and benchmark measures will be presented. Through the case
study of two physicians, the audience will clearly see the potential impact of making a
decision before knowing all of the facts. The second part of this module focuses on
common contractual clauses and the implications to the potential employee.
Module I-Next Steps to a Successful Practice
Goals and Objectives:
This module’s goals are to provide additional and more detailed information on the
financial aspects and considerations of private practice. The participant will gain an
awareness of data contained on a balance sheet, profit and loss statement and what to use
as benchmark goals. More specific information on employment contracting will be
available for review to clarify contractual clause issues that the audience may have. The
third important aspect of this module is the provision of basic operational and
management information for private practice as well as some tips on becoming clinically
time efficient.
Module III-Essentials of Efficient Practice
Goals and Objectives:
The module will address the provision of basic operational and management information
for private practice as well as tips on becoming clinically time efficient. Module II
content can be used to evaluate potential employment opportunities or manage a practice.
Core Curriculum
Will provide the basic educational database for neurology training. The core knowledge
taught will consist of the neurosciences of neuroanatomy, neurophysiology,
neuropharmacology, neuropsychology, neuropathology, neuroimmunology,
neurogenetics, neuroepidemiology as they pertain to each core section.
Core Didactic Series
To provide the basic educational database for neurology training. The core knowledge
taught will consist of the neurosciences of neuroanatomy, neurophysiology,
neuropsychology, neuropathology, neuroimmunology, neurogenetics, neuroepidemiology
as they pertain to each core section.
Lectures will be given weekly. Discussion will occur on subject, prior reading will be
assigned. Tests will be administered
Required Reading and Case Presentation: Merrit’s Textbook of Neurology
Topics to be covered with assigned test
Focus Topics
Focus topics are specific areas that have been found to need strengthening as a result of
performance on the in-service examination.
 Neuropathology: a series of lectures will be presented
 Neurobehavioral: a series of lectures will be presented and case presentations will
be done monthly
 Pharmacology and Chemistry: a series of reviews will occur
Neuropathology Lectures
20 hours
Residents will attend at least 20 neuropathology conferences. Residents must submit
proof of attendance. Additionally a lecture series will be presented as a focus topic.
1. Identify common neurological conditions on gross anatomy involving brain and
spinal cord
2. Identify microscopic neurological pathology and important inclusions bodies in
brain and spinal cord
3. Know the basic normal structure of muscle and nerve
4. Know the indications for muscle and nerve biopsy
5. Identify major muscle pathological processes: denervation vs. myopathic changes
6. Identify muscle inclusion bodies and their pathological significance
Review current case material from autopsies and biopsies. Present a systematic review of
archival material. Review both microscopic and gross specimen’s of brain, spinal cord.
Residents will review gross and miscroscopic specimens on a daily basis. Residents are
recommended to read ‘Principles and Practice of Neuropathology’ by James S. Nelson.
Mosby. Or ‘Practical Review of Neuropathology’ by Gregory N. Fuller. Lippincott
Williams &Wilkens
Lecture Dates
Conferences are held at Children’s Hospital on Friday at 8am.
It is your responsibility to attend 20 sessions per year. You will be required to get
signatures at each lectures, sign in sheets will be used for verification. Recommended
reading ‘Principles and Practice of Neuropathology” Nelson.
Visual system
Critical Illness
Cognitive & Behavioral Neurology
Cortical Organization & Functional Localization
Goals & Objectives:
1. Understand gross anatomy of the human neocortex – Brodmann’s critical
areasUnderstand the concepts of hemispheric specialization and localization of
2. Understand cognitive process models and the concept of neural networks
3. Describe the major components of the mental status examination in neurology
4. Understand general principles of cortical organization of higher cortical functions
Left Brain Functions – Cases in Aphasia
Goals & Objectives:
1. Understand the overall organization and functions of the left cerebral hemisphere
2. Know the anatomy of language, including the “critical” speech-language areas
3. Learn the functions mediated by specific speech-language areas
4. Understand the deficits produced from lesions to these critical language areas
5. Know the major aphasia subtypes including functional deficits and lesion
Right Brain Functions – Cases in Neglect and Attention
Goals & Objectives:
1. Understand the overall organization and functions of the right cerebral
2. Know the anatomy of attention, including the “critical” neural networks and brain
regions implicated in spatial attention and motor intention (neglect subtypes)
3. Learn the functions mediated by specific frontal-parietal right brain areas
4. Understand the deficits produced from lesions to these critical right brain areas
5. Know two major subtypes of neglect (spatial attentional and motor intentional
neglect) including functional deficits and lesion localization
Cognitive Aging & Dementia – Cases in Alzheimer’s Disease
Goals & Objectives:
1. Understand the definition of dementia and mild cognitive impairment; know the
most common causes of dementia
2. Know the anatomy of memory, including the “critical” brain areas and neural
circuits that mediate learning and memory (Papez and Yakovlev circuits).
3. Learn about Alzheimer’s disease including: the neuropsychological deficits,
localization of the pathology, and structure-function relationships
4. Understand the risk factors for Alzheimer’s disease
5. Know the major treatment approaches and the rationale for treatment in
Alzheimer’s disease
Board Review
To review topics in a focused manner to help residents acquire test taking skills and
pertaining information to successfully pass the board exam. The ultimate goal is to have
the mean RITE review score of our institution be well above the national average.
A weekly didactic event for the neurology house staff which is specifically tailored for
Neurology board preparation. The course is comprised of several lecture series, given by
an expert in that given field. All lecturers are instructed to tailor their lectures in a
practical fashion from the point of view of Neurology Board prep.
Resident Case Presentation PGY III and PGY IV
Goals & Objectives:
Resident Case Presentations are presented to the department head every Thursday at 2pm
for the entire academic year. Residents will present a case based learning venue.
Residents will review the scientific literature pertaining to the case and or practice
Lecture Dates
Weekly: Every Thursday 1pm Room 728
Grand Rounds
Goals & Objectives
Resident (PGY IV) will present 2 topics at a scholarly level. Invited speakers will present
scientific research and new treatment strategies of neurological and pertinent medical
disease. Learn from other residents diagnosis and management of both routine and
unusual neurologic cases.
Evidence Based & Reserch Learning Curriculum
Goals & Objectives:
Residents will participate in a web based program through the AAN. This programs goal
is to teach resident’s how to critically analyze literature. The residents will review articles
and apply the principles they have learned.
 All residents must take the pre test. This is done by logging on to the AAN web
site and finding the EBM tool kit under educational programs.
 Residents will then take the on-line modules as they are released and take
corresponding post-test.
 Articles to deconstruct will be reviewed in a group format with Dr. Gutierrez
serving as the moderator.
Web Based Learning
It is becoming more important for learning to occur using electronic tools. This resource
allows the learning to occur at any time and maximizes the portability of learning.
We will use web based tools to encourage learning and set expectations of completion of
programs by year of training:
 NIH Stroke Scale- must be completed by August 1st
 Institutional curriculum found in Residency Partner
 Complete Core Curriculum in Movement Disorder: The Neurologic Examination:
Neurology Continuum- 2 editions must complete, plus 1 required undereLibrary tab
 Complete 3 editions of Continuum, plus 2 required
 Complete institutional core curriculum
 Complete A Core Curriculum in Movement Disorders: Neurological
Examination, Differential Diagnosis and Pharmacology
 Complete ALL required Continuum
 Complete institutional core curriculum
 Complete Movement Disorder Curriculum
 Complete Case Study: Restless Leg Syndrome and Sleep Apnea
Required Continuums
 Headache
 NIH Stroke Scale
 Movement Disorder
 Critical Care
 Ethics
 Neuro-oncology
 Neuro-rehab
 Neuro Otology
Institutional Web based Learning
These modules can be found at:
Goals & Objectives:
Teach basic fundamental principles that are necessary for all residents to master and
understand. The topic will be present and a test will be administered. Residents must
complete these before promotion to the next year and graduating from the program. They
are as follows:
Competencies Overview
Recognizing Signs of Fatigue
Impaired Physicians
Professionalism – Part I
Professionalism – Part II
Medical Error – Part I
Medical Error – Part II
Teamwork Matters: Hand-offs and Beyond
Breaking Bad News
Patient Safety
Interpretation of Diagnostic Screening Tests
How to Read a Clinical Trial
Intro to Evidence Based Medicine
Study Design 1
Study Design 2
Risk Management and Quality Assurance
Introduction to Biostatistics
The PGY column indicates the Post-Graduate Year in which the corresponding module
should be taken. ALL modules for a given House Officer’s PGY must be completed
before the House Officer will be allowed to graduate or advance to the next year.
Additionally, House Officers in any PGY other than 1 will be required to complete all
modules up to and including the modules for their current PGY (a HO2 must complete all
1 and 2 modules, and fellows must complete all modules).
The modules have been designed to be each completed in approximately 5 to 10 minutes.
They consist of a presentation of several slides (attached to the module in PDF format), in
addition to a short (1 to 5 question) test. The presentation should be viewed before taking
the test. In the event that you do not score at least 80% on any assigned module, that
module must be retaken until at least 80% is achieved.
Reports will be run every few months and delivered to Residency and Fellowship
Program Coordinators indicating the progress of the program’s House Officers.
Neuro ICU
Lecture Dates
Presented the first Thursday of every month at 1pm
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Neuroanatomy Lectures/Clinical Examination
Goals & Objectives:
Residents will receive a series of lectures on neuroanatomy and their clinical relevance to
symptom formation. Residents will be able to identify symptoms and pathological
Lecture Dates
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Methodology of Science & Epidemiology
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Molecular Biology
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Cell Biology
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Palliative Medicine
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