Elective in Neurology

Rotation/Educational Purpose:

Internists commonly see patients with neurologic disorders in practice.Therefore, Internal Medicine Residents must develop the knowledge and skills necessary to diagnose, follow, and treat patients with common neurologic disorders. Further, they must gain the skills necessary to recognize the indications for referral to a Neurologist.

Goal:  Residents must be able to provide patient care that is compassionate, appropriate, and effective for the treatment of health problems and the promotion of health.

Residents are expected to:

PGY 1

1. To increase exposure to neurological disorders commonly encountered in inpatient and outpatient settings.
2. To increase competence in performance of the neurological history and physical exam.

PGY 2 and 3

1. To increase exposure to neurological disorders commonly encountered in inpatient and outpatient settings.
2. To increase competence in performance of the neurological history and physical exam.

Medical Knowledge Goals and Objectives:

Goal: Residents must demonstrate knowledge of established and evolving biomedical, clinical, epidemiological, and social-behavioral sciences, as well as the application of this knowledge to patient care. 

Residents are expected to:

PGY 1

1. To evaluate/understand the impact of medical disease processes on the central and peripheral nervous system.
2. To learn application of neurodiagnostic studies including MRI, CT, NCV/EMG, EEG, and evoked potentials.
3. To review pathophysiology, diagnosis and treatment of major neurological disease processes commonly encountered in the inpatient and outpatient settings.

PGY 2 and 3

1. To evaluate/understand the impact of medical disease processes on the central and peripheral nervous system.
2. To learn application of neurodiagnostic studies including MRI, CT, NCV/EMG, EEG, and evoked potentials.
3. To review pathophysiology, diagnosis and treatment of major neurological disease processes commonly encountered in the inpatient and outpatient settings.

Practice-Based Learning and Improvement Goals and Objectives:

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 and life long learning.

Residents are expected to develop skills and habits to be able to:

PGY 1

PGY 2 and 3

Systems Based Practice Goals and Objectives:

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.

Residents are expected to:

PGY 1

PGY 2 and 3

Professionalism Goals and Objectives:

Goal:  Residents must demonstrate a commitment to carrying out professional responsibilities and an adherence to ethical principles. 

Residents are expected to demonstrate:

PGY 1

PGY 2 and 3

Interpersonal and Communication Skills Goals and Objectives:

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. 

Residents are expected to:

PGY 1

PGY 2 and 3

Teaching Methods:

The majority of teaching on this rotation occurs in a case-based fashion. The Internal Medicine PGY 1, 2, or 3 resident is supervised on this rotation by upper level Neurology residents with overall supervision by the Neurology attending physician. In the inpatient setting, the medicine resident will perform initial consults and discuss the findings with the Neurology resident. This interaction provides the initial opportunity for teaching on the case. Subsequently, the patient is presented to the attending physician on consult rounds allowing for case-based education on history, physical examination, pathophysiology, neurodiagnostic imaging, diagnosis or treatment. The medicine resident also attends 1 to 2 Neurology clinics per week where they present to the Neurology attending physician. The Medicine residents are also welcome to attend departmental conferences in Neurology on this rotation.

Mix of Diseases and Pathological Material:

Residents are exposed to a wide variety of neurologic disorders on this rotation which could include cerebrovascular accidents, intracranial hemorrhages, delirium, dementia, movement disorders, peripheral neuropathies, demyelinating illnesses, headaches, syncope, and others.

Patient Characteristics:

Residents care for a diverse patient population with respect to age, ethnicity, and gender.

Types of Clinical Encounters:

Residents will evaluate new consults from a variety of inpatient Medical and Surgical services. Residents are expected to develop a care plan for each patient encounter to discuss with their fellow and attendings. In addition, there are several opportunities to participate in outpatient clinics as well.

Procedures and Services:

Residents will participate in performance and interpretation of NCS/EMG/EEG’s, interpretation of CT scans and MRI’s. Residents will also have the opportunity to perform lumbar punctures.

Supervision:

Internal Medicine PGY 1, 2, or 3 residents rotate through this experience. They are supervised by the Neurology upper-level resident and the neurology attending physician.

Educational Resources to be Used and Reading Lists:

Major Neurology texts and journals are available in the departmental library. The MUSC library site has online journals and texts available as well. Residents are provided with patient-specific references as well.

Method of Evaluation of Resident Competence:

The resident is evaluated by the attending physician with input from the Neurology resident. Evaluations assess each of the Core Competencies based on direct observation of the resident’s performance on the service. Patient Care is assessed based on direct observation and complete review of all records. Medical Knowledge is assessed through direct questioning and observation. Interpersonal Skills and Communication is assessed by observation of interactions with patients and families. The attending physician evaluates Professionalism through direct interaction and observation of the resident. The nurses also evaluate resident professionalism. Systems-Based Practice is evaluated based on interactions with the primary team and the ability to provide medical care in the clinical setting. Practice-Based Learning is evaluated based on the ability to consult the literature and to improve their performance over time. Residents receive formative evaluation throughout the year. The summative evaluation is entered into E*Value and is subsequently reviewed by the Internal Medicine program director. 

The resident also evaluates the rotation and the attending physician. These anonymous evaluations are shared with the Neurology Department.