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UCH: Epilepsy Monitoring Unit Service

Goals and Objectives


 
 

University of Colorado Hospital (UCH): Epilepsy Monitoring Unit (EMU) Service

 

Description of Rotation or Educational Experience

Residents will rotate in the EMU for 1 month assignments. Resident responsibilities will include:

1. Performing a complete interval history and complete neurological exam for all EMU patients (including Phase II monitoring patients) on a daily basis and documenting their findings in a written progress note for each patient each day,

2. Taking a complete history and performing a complete neurological examination on each admission to the EMU, as well as documenting these findings on the appropriate forms,

3. Reviewing overnight EEG studies, baselines, and events with attending and fellow,

4. Rounding with the EMU attending and fellow on the EMU patients,

5. Completing the discharge paperwork on any discharged patients and dictating the discharge

summaries on all discharged EMU patients (it is very helpful to dictate how AEDs were tapered during the hospital admission in case patient has to return in the future to repeat monitoring), and

6. Updating the resident check-out list with new attending each week and daily updates on the EMU patients, prior to signing out with resident on-call at the end of each day.

 

Patient Care

Goals: Residents will

  • Be able to accurately perform a focused, epilepsy-specific, history and examination
  • Be familiar with manipulation of AEDs in the inpatient setting
  • Be able to appropriately assess need for ancillary studies, such as MRI, SPECT or PET in the evaluation and care of the EMU patient

 

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 demonstrate proficiency in problem solving, clinical reasoning and technical skills applicable to the practice of evidence-based medicine.  These proficiencies include appropriate use of biomedical information for decision-making; demonstrate caring and respective behavior in interactions with patients and their families, including counseling and education. Residents will be able to work effectively with healthcare professional, including those from other disciplines in order to develop and implement management plans.

 

Competencies: Residents should

  • Be able to obtain an orderly and detailed history from the patient, conduct a thorough general and neurological examination, and organize and record data
  • Present patient cases and their complete diagnostic and therapeutic plans
  • Be able to correlate the information derived from neurodiagnostic studies with the clinical history and examination in formulating a differential diagnosis and management plan
  • Participate in the care of 20 V-EEG patients in their rotation month
  • Be able to formulate a plan for medication manipulation in the EMU >50% of the time with minimal faculty guidance
  • Be able to formulate a plan for presurgical evaluation incorporating EEG and available ancillary tests >50% of the time with minimal faculty guidance

 

Objectives:

Accurately perform a focused, epilepsy-specific, history and examination

 

Be familiar with manipulation of AEDs in the inpatient setting

 

Be able to appropriately assess need for ancillary studies, such as MRI, SPECT or PET in the evaluation and care of the EMU patient

 

Perform complete and focused case presentations that are accurate and well organized; prepare and maintain complete, accurate, well-organized medical records.

 

Residents should demonstrate interpersonal, oral and written communication skills that enable them to establish and maintain effective professional relationships with patients, families and other members of healthcare teams. 

 

Medical Knowledge

Goals: Residents will demonstrate knowledge  of:

  • Basic brain functional anatomy
  • Basic identification and interpretation of EEG waveforms
  • Basic principles of seizure identification on EEG
  • Basic principles of clinical seizure localization
  • Basic principles of seizure localization by scalp EEG
  • Basic principles of seizure localization by intracranial EEG

 

Competencies: Residents will:

  • Accurately identify and interpret EEG findings >50% of the time with minimal faculty guidance
  • Accurately identify seizure events on EEG recordings >50% of the time with minimal faculty guidance
  • Accurately identify and interpret clinically-meaningful signs during clinical seizures >50% of the time with minimal faculty guidance
  • Accurately localize seizure onset on scalp EEG recordings >50% of the time with minimal faculty guidance
  • Accurately localize seizure onset on intracranial EEG recordings >50% of the time with minimal faculty guidance

 

Objectives

Demonstrate knowledge of:

  • Basic brain functional anatomy
  • Basic identification and interpretation of EEG waveforms
  • Basic principles of seizure identification on EEG
  • Basic principles of clinical seizure localization
  • Basic principles of seizure localization by scalp EEG
  • Basic principles of seizure localization by intracranial EEG

 

Practice- Based Learning and Improvement

Goal: Residents will

  • Recognize the need to engage in lifelong learning to stay current with scientific and technological advances
  • Locate, evaluate, and apply information for solving problems and making decisions that are relevant to the care of individuals and populations
  • Use evidence-based approaches to determine whether to accept new technologies and techniques for incorporation into medical practice

 

Competencies: Residents will

  • Identify strengths, deficiencies and limits in one’s knowledge and expertise
  • Locate, appraise and assimilate evidence from scientific studies related to their patients’ health problems
  • Use information technology to optimize learning
  • Be able to formulate a neurodiagnostic testing plan

 

Objectives

Recognize the need to engage in lifelong learning to stay abreast of medical and other scientific advances.

 

Locate, evaluate and apply information for solving problems and making decisions that are relevant to the care of individuals and populations.

 

Use evidence-based approaches to decide whether to accept new findings, therapies and technologies for incorporation into medical practice.

 

Systems Based Practice

Goals: Residents will

  • Demonstrate an understanding of patient care in the context of the patient, family, and healthcare team in the context of the healthcare system.  Demonstrate an awareness of the specialized role of the epileptologist as a diagnostician and the limitations and responsibilities of this role.
  • Identify and prioritize patients’ problems, formulate appropriate differential diagnoses and develop a cost effective plan to evaluate the possibilities.
  • Demonstrate an understanding of medical-legal responsibilities and act in a manner consistent with those responsibilities.

 

Competencies: Resident will be expected to

  • Be able to formulate a time and cost efficient neurodiagnostic testing plan for evaluating a wide variety of neurological issues
  • Recognizing boundaries in role as interpreting epileptologist versus clinician providing clinical care; sharing only appropriate information with patients at the time of their study
  • Accurately interpreting data and generating a concise report that adheres to medical-legal principles
  • Advocate for quality patient care and optimal patient care systems
  • Work in interprofessional teams to enhance patient safety and improve patient care quality
  • Participate in identifying systems errors and in implementing potential systems solutions

 

Objectives

Demonstrate an understanding of patient care in the context of the patient, family, and healthcare team in the context of the healthcare system.  Demonstrate an awareness of the specialized role of the epileptologist as a diagnostician and the limitations and responsibilities of this role.

 

Identify and prioritize patients’ problems, formulate appropriate differential diagnoses and develop a cost effective plan to evaluate the possibilities.

 

Demonstrate an understanding of medical-legal responsibilities and act in a manner consistent with those responsibilities.

 

Professionalism

Goal: Residents will

  • Display integrity, honesty, and appropriate boundaries and behavior with patients and families
  • Display integrity, honesty, and appropriate boundaries and behavior with peers and coworkers
  • Balance personal needs and values with professional responsibilities
  • Recognize personal limitations of knowledge and skills and seek to overcome those limits through self improvement
  • Demonstrate ability to protect patients’ privacy

 

Competencies: Residents will

  • show compassion, integrity, and respect for others
  • be responsive to patient needs that supersedes self-interest
  • respect for patient privacy and autonomy
  • be expected to be show sensitivity and responsiveness to a diverse patient population, including but not limited to diversity in gender, age, culture, race, religion, disabilities, and sexual orientation

 

Objectives

Act in an ethically responsible manner, displaying integrity, honesty, and appropriate boundaries with patients, their families, patients' representatives, and fellow health care professionals.

 

Demonstrate an understanding of and respect for cultural differences in communication with and management of patients

 

Balance one’s own needs and values with one’s professional responsibilities towards patients and recognize the limits of one’s knowledge, skills, and behavior through self-reflection and seek to overcome those limits.

 

Demonstrate the ability to protect patient’s privacy in discussions, medical records, and interactions with other health care professionals.

 

Interpersonal and Communication Skills

Goal: Residents will

  • demonstrate interpersonal and communication skills that result in the effective exchange of information and teaming with patients, their families, and professional associates 
  • be expected to demonstrate interpersonal, oral and written communication skills that enable them to establish and maintain effective professional relationships with patients, families and other members of healthcare teams 

 

Competencies: Residents will

  • communicate effectively with patients and families across a broad range of socioeconomic and cultural backgrounds
  • communicate effectively with physicians, other health professionals, and health related agencies
  • work effectively as a member of leader of a health care team or other professional group
  • act in a consultative role to other physicians and health professionals
  • maintain comprehensive, timely, and legible medical records

 

Objectives

Communicate effectively, both orally and in writing, with patients, patients’ families, colleagues, and others with whom neurologists must exchange information in carrying out their responsibilities.

 

Develop the skills to discuss sensitive issues including diagnosis, treatment options, and prognosis with patients and their families in an effective, compassionate, non-judgmental manner appropriate to their needs, including counseling on prevention and psychosocial issues.

 

Identify and prioritize patients' problems, formulate appropriate differential diagnoses, and develop appropriate plans for treatment and/or management.

 

Perform complete and focused case presentations that are accurate and well organized; prepare and maintain complete, accurate, well-organized medical records.

 

Residents should demonstrate interpersonal, oral and written communication skills that enable them to establish and maintain effective professional relationships with patients, families and other members of healthcare teams. 

 

Teaching Methods

  • Performance of EMU admissions
  • Presentation all EMU patients to the attending, which includes diagnostic and therapeutic plans  on formal teaching rounds
  • Case based and clinical teaching by the EMU attending to accomplish goals and objectives
  • Review and assimilation of material in EMU syllabus
  • Required attendance at M & Ms, weekly conferences, grand rounds and journal club

Assessment Methods

  • Direct observation by faculty of history, examination and interactions during case presentations
  • Direct observation of  formulation, diagnostic approach, and disposition planning during case
  • Monthly evaluations by attending faculty

 

Assessment Methods (How Program Director Perform Evaluation of Rotation)

  • Monitor all evaluations
  • Semi-annual review with Program Director

Level of Supervision

All program faculty members supervising residents must have a faculty or clinical faculty appointment in the School of Medicine. Faculty schedules will be structured to provide residents with continuous supervision and consultation.

 

Residents must be supervised by faculty members in a manner promoting progressively increasing responsibility for each resident according to their level of education, ability and experience. Residents are expected to formally present all patients to their attending faculty.

 

Neurology resident’s clinical activities will be supervised at all times by a faculty member of the Department of Neurology, of the University of Colorado.

 

Educational Resources

1.      Epilepsy syllabus (available in the EMU)

2.      Additional selected readings from Spehlmann’s EEG Primer.