SUB-SPECIALTY: Neurology - Residency Programs
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Kenner Outpatient Neurology Experience Neurology Clinics Goal: Neurology residents must progressively learn the principles of providing comprehensive, scientifically based and effective outpatient care for patients with neurological disease. This goal can be attained utilizing six areas of specific competencies: patient care, medical knowledge, interpersonal communication, practice based learning and improvement, professionalism and systems based practice. Focus: You will provide General neurology consultations to practices of LSU Family Medicine, LSU Hospitalist, LSU Orthopedics and LSU Carcinoid Tumor program. You will attend general neurology private clinics. Overview of Objectives: The objectives of your learning will change as you develop in your career. You will expect to master different skills at different points in your training. These have been identified in the grid provided at the end of this document. Site Responsibilities: You will be expected to spend the majority of your time in the outpatient clinic setting. You will provide hospital consultation as needed. These two sites are community based hospital with a low volume of patients. This rotation will closely reproduce real life neurological practice. Clinics are held at Baptist on the adjoining medical office bldg- 2820 Napoleon, Suite 700. Clinics begin at 8:30 am unless otherwise specified Monday Continuity Clinic-Lord & Taylor Tuesday Wednesday Dr. Santana’s general neurology clinic Thursday Didactics Fridays Dr. Gutierrez general neurology clinic Required reading: Merritt’s Textbook of Neurology SUB-SPECIALTY: Neurology ROTATION EXPERIENCE: Outpatient Clinic Rotations PATIENT CARE Outpatient Neurology Service (PGY2) Patient Care Objectives Gather essential and accurate information on patients with subacute and chronic neurological symptoms. Perform a extensive neurological examination and to be able to summarize their findings and localize the lesion in the central or peripheral nervous system Formulate a differential diagnosis and management plan based upon their neurological assessment Identify and describe abnormalities seen in common neurological disorders on radiographic testing Demonstrate technical skills in performing basic EMG, basic trigger point injections, botox injections Teaching Methods Direct Patient Care Performance Feedback Clinical case conference Clinical Teaching Clinical Experience Performance Feedback Clinical Case Conference Clinical Teaching Direct Patient Care Clinical Case Conference Clinical Teaching Performance Feedback Radiology Conference Review of learning module Staff and resident instruction and supervision Assessment Strategy Global ratings Focused Record Review Global ratings Global ratings Focused record review Global rating of live performance Global rating of live performance Self and peer assessment Case Logs PATIENT CARE Outpatient Neurology Service (PGY 3) Patient Care Objectives To become proficient in managing tertiary neurology patients with subacute neurological symptoms and conditions To become proficient in managing patients with chronic neurological conditions such as pain disorders & spine disorders Make informed decisions about diagnostic and therapeutic interventions based on patient information and preferences, up-to-date scientific evidence and clinical judgment Outpatient Neurology Service (PGY 4) Patient Care Objectives Develop supervisory skills regarding senior resident responsibilities in clinic , including organization of dealing with clinic emergencies, unscheduled patients, fair distribution of workloads and supervision of junior residents Screen patients for acute neurological disorder that may need emergent intervention Perform comprehensive assessment consultations Teaching Methods Direct Patient Care Performance Feedback Clinical case conference Direct Patient Care Performance Feedback Clinical case conference Direct Patient Care Performance Feedback Clinical case conference Assessment Strategy Global ratings Focused record review Teaching Methods Direct Patient Care Performance Feedback Clinical case conference Assessment Strategy Global ratings 360 degree evaluation Direct Patient Care Performance Feedback Global ratings Direct Patient care Performance Feedback Global ratings Performance feedback Global ratings Focused record review Global ratings Focused record review MEDICAL KNOWLEDGE Outpatient Neurology Service (PGY 2) Medical Knowledge Objectives Compare and contrast the medical and surgical approaches to different neurological disease and explain the conditions under which each would be most efficacious Demonstrate the approach to assessing general neurological symptoms and distinguish between different etiologies such as metabolic, toxic, infections, or vascular Describe the underlying pathophysiology, diagnostic criteria and common treatment protocols for different neurological disorders Outpatient Neurology Service (PGY 3) Medical Knowledge Objectives Understand the uses and risks of anticonvulsant drugs in the treatment of acute and chronic epilepsy Demonstrate and analytical thinking approach to a patient presenting with weakness and or pain in order to distinguish whether the lesion can be attributable to the central nervous system (brain or spinal cord) or peripheral nervous system (nerve root, peripheral nerve, neuromuscular junction or muscle) based upon assessment of upper or lower motor neuron signs. Demonstrate knowledge of relevant neuroanatomy and underlying pathology found in complex regional pain syndromes, postoperative disc surgery, nerve entrapments, orthopedic complications Teaching Methods Review of evidence based guidelines and practice parameters proposed by the AAN Clinical teaching Departmental Conferences Reading list Clinical rounds Departmental conferences Review of evidence based guidelines and practice parameters proposed by the AAN Didactic lectures Assessment Strategy Global ratings In-training examination Teaching Methods Review of evidence based guidelines and practice parameters proposed by the AAN Clinical teaching Departmental Conferences Review of neuroanatomy Clinical teaching Assessment Strategy Global ratings In-training examination Review of neuroanatomy Departmental conferences Pathology lectures and brain cutting conference Global ratings In-training examination Global ratings In-training examination Focused record review Global ratings In-training examination Global ratings In-training examination MEDICAL KNOWLEDGE Inpatient Neurology Service (PGY 4) Medical Knowledge Objectives Describe the underlying pathophysiology, presenting signs and symptoms and common treatment protocols for acute neurological conditions seen in the context of orthopedic patients, patients with carcinoid tumor and sport medicine. Demonstrate an investigatory and analytic thinking approach to a patient with new weakness Critically evaluate and judiciously apply the latest knowledge to the care of patients Develop an approach to investigating and verifying new knowledge needed to care for patients Teaching Methods Review of evidence based guidelines and practice parameters proposed by the AAN Clinical teaching Departmental Conferences Review of evidence based guidelines and practice parameters proposed by the AAN Clinical teaching Departmental Conferences Review of evidence based guidelines and practice parameters proposed by the AAN Clinical teaching Departmental Conferences Review of evidence based guidelines and practice parameters proposed by the AAN Clinical teaching Departmental Conferences Assessment Strategy Global ratings NEX exam Global ratings In-training examination Global ratings In-training examination Global ratings In-training examination INTERPERSONAL AND COMMUNICATION Outpatient Neurology Service (PGY 2) Interpersonal and Communication Objectives Demonstrate the ability to obtain, interpret and evaluate consultations from other medical specialties and to provide consultants with a diagnostic and management plan Provide patients and their families explanations of neurological disorders and treatment that is geared to their educational level, as well as respecting the patient’s cultural, ethnic, religious and economic backgrounds Outpatient Neurology Service (PGY 3) Interpersonal and Communication Objectives Work collaboratively with the multidisciplinary team involved in the patient care of neurological patients Demonstrate effective communication with other physician or healthcare providers with regards to patient’s current or change in neurologic status, anticipated problem, therapeutic regimen and diagnostic tests to be reviewed Outpatient Neurology Service (PGY 4) Interpersonal and Communication Objectives Clearly describe a diagnostic and/or a therapeutic plan to a patient and family Teach junior residents and medical students effectively Provide distressing news to patients and families clearly and compassionately Develop effective strategies for interacting with “stressed” or angry patients and or families Listen and evaluate the contributions of other members of the healthcare team Teaching Methods Presentation to staff Modeling Assessment Strategy Global ratings Direct patient care Modeling Global rating Patient surveys Teaching Methods Referral letters Modeling Return letters to other physicians Sign-out rounds Assessment Strategy Global ratings 360 assessments Global ratings Teaching Methods Case Discussion Direct patient care Case Discussion Direct patient care Modeling Direct patient care Modeling Direct patient care Modeling Clinical Rounds Direct patient care Modeling Assessment Strategy Global ratings 360 degree evaluations Global ratings 360 degree evaluations Global ratings Global ratings Global ratings 360 degree evaluations PRACTICE BASED LEARNING AND IMPROVEMENT Outpatient Neurology Service (PGY2) Practice Based Learning and Improvement Objectives Teaching Methods Research clinical questions regarding their patient’s health problems Electronic medical record using information technology to access on-line medical information to Medline/OVID searches- patient centered support their own education and to improve patient care and education Case presentations Evaluate the clinical literature applying knowledge of epidemiology, Teaching conferences including Grand Rounds biostatistics, and research study design Journal Clubs Facilitate the learning of medical students Role Modeling Oral presentations Patient Centered instruction Outpatient Neurology Service (PGY 3) Practice Based Learning and Improvement Objectives Teaching Methods Use appropriate computer databases and online educational materials Electronic medical record to assist in “real time” medical decision making Medline/OVID searches- patient centered Case presentations Outpatient Neurology Service (PGY 4) Practice Based Learning and Improvement Objectives Teaching Methods Apply knowledge of study designs and statistical methods to the Teaching conferences including Grand Rounds appraisal of clinical studies and other information on diagnostic and Journal Clubs therapeutic effectiveness Facilitate the learning of junior neurology residents, medical interns, and orthopedic interns Role Modeling Oral presentations Patient Centered instruction Demonstrate and teach medical students to access medical information Electronic medical record on their patient for record review as well as online information/medical Medline/OVID searches- patient centered databases to assist in their evaluations of patients Case presentations Assessment Strategy Self assessment Global ratings Global ratings of Journal club performance Peer Assessments Assessment Strategy Self assessment Global ratings Assessment Strategy Global ratings of Journal club performance Evaluations of Grand Rounds presentation Peer assessment 360 degree evaluations Global ratings PROFESSIONALISM Outpatient Neurology Service (PGY 2) Professionalism Objectives Interact responsibly with patients, families and co-workers taking into consideration age, disability, culture and gender issues Demonstrate appropriate use of respect and confidentiality to all involved parties Teaching Methods Direct patient care Modeling Direct patient care Modeling Assessment Strategy Global ratings Outpatient Neurology Service (PGY 3) Professionalism Objectives Interact responsibly with patients, families and co-workers taking into consideration age, disability, culture and gender issues Demonstrate appropriate use of respect and confidentiality as well as understanding the scope and limits of patient confidentiality Evaluate a patient’s capacity to make informed decisions and factors that would limit patient autonomy Teaching Methods Direct patient care Modeling Direct patient care Modeling Direct patient care Ethics conference Assessment Strategy Global ratings Outpatient Neurology Service (PGY 4) Professionalism Objectives Interact with administrative teams in a respectful manner Responsible diligently to the needs of systems and families Teaching Methods Modeling Involvement with treatment teams Assessment Strategy Global rating Global ratings/360’s Global ratings Global ratings Global ratings SYSTEM BASED PRACTICE Outpatient Neurology Service (PGY 2) System Based Practice Objectives Identification and performance of appropriate preventive care measures for the adult patient and the impact of preventive medicine on societal health Identification of psychosocial factors and their impact of care of progressive and disabling neurological disease. Outpatient Neurology Service (PGY 3) System Based Practice Objectives Efficiently refer patients to appropriate allied health and social services to assist in rehabilitation, long term management or home care assistance Develop an understanding of cost-effective health care that does not impact quality of care Outpatient Neurology Service (PGY 4) System Based Practice Objectives Advocate for patients when dealing with resource allocation issues and complex payer systems problems Access quality allied health care and social services resources as they apply to patients with neurological disorders/disabilities Practice high quality cost effective medical care across all practice venues Understand how their patient care and professional practices affect other health professionals, organizations and society Teaching Methods Direct patient care Review of evidence based medicine and guidelines of the AAN Departmental conferences Direct patient care Clinical Rounds Assessment Strategy Global ratings Focused Record Review In-training examination Teaching Methods Direct patient care Modeling Clinical rounds Role modeling Clinical teaching Focused record review Assessment Strategy Global ratings Focused record review Teaching Methods Direct patient care Clinical teaching Direct patient care Clinical teaching Assessment Strategy Global ratings Focused record review Global ratings Focused record review Direct patient care Clinical teaching Direct patient care Clinical teaching Global ratings Focused record review Global ratings Focused record review Global ratings Self assessment Focused record review
