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PGY-2 Subspecialty Clinics

University of Colorado Hospital


 
 

PGY-2 Subspecialty Clinics – University of Colorado Hospital

 

Description of Rotation or Educational Experience

 

Residents will attend outpatient neurology subspecialty clinics at the UCH neurology outpatient clinic facility. Residents will be involved in neurological subspecialty clinics in the outpatient clinic setting including behavioral neurology, epilepsy, movement disorders, multiple sclerosis, neuromuscular disease, and neuro-ophthalmology.

 

Patient Care

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 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 will

  • have instruction and practical experience in obtaining an orderly and detailed history from the patient, in conducting a thorough general and neurological examination, and in organizing and recording data
  • have training that includes the indications for and limitations of clinical neurodiagnostic tests and their interpretation
  • will learn to correlate the information derived from neurodiagnostic studies with the clinical history and examination in formulating a differential diagnosis and management plan
  • will participate in the evaluation of and decision making for patients with disorders of the nervous system requiring surgical management when appropriate and close interaction with the neurosurgical service will occur when appropriate
  • will have experience in neuroimaging that ensures a familiarity with and knowledge of all relevant diagnostic and interventional studies necessary to correlate findings with other clinical information for the care of patients – this will include, at a minimum, magnetic resonance imaging, computerized tomography and neurosonology.
  • will receive instruction in appropriate and compassionate discussion of end-of-life palliative care (where appropriate), including adequate pain relief and psychosocial support and counseling for patients and family members about these issues
  • will receive instruction on recognition and management of physical, sexual, and emotional abuse (where appropriate)
  • will have opportunities for increasing responsibility and professional maturation during the month

 

Objectives

Accurately perform and document complete and focused histories and physical examinations with a special emphasis on the neurological examination that are based on the pathophysiology of presenting complaints, and that address relevant psychosocial and family 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.

 

Perform selected diagnostic and therapeutic procedures including, but not limited to lumbar puncture, mental status testing, EEG interpretation, and Tensilon testing.

 

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

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 demonstrate their knowledge of core concepts and principles neurological illnesses.  This includes disease pathogenesis and treatment as well as health maintenance, disease prevention, and an understanding of the broad range of factors that impact the origin and progression of disease.

 

Competencies: Residents will

  • regularly attend seminars and conferences in the following disciplines during this rotation: neuropathology, neuroradiology, neuro-ophthalmology, neuromuscular disease, cerebrovascular disease, epilepsy, movement disorders, critical care, clinical neurophysiology, behavioral neurology, neuroimmunology, infectious disease, neuro-otology, neuroimaging, neuro-oncology, sleep disorders, pain management, neurogenetics, rehabilitation, child neurology, the neurology of aging, and general neurology; there will be gross and microscopic pathology conferences and clinical pathological conferences (M&Ms) as well as conferences dedicated to the basic sciences on which clinical neurology is founded, including neuroanatomy, neuropathology, neurophysiology, neuroimaging, neuropsychology, neural development, neurochemistry, neuropharmacology, molecular biology, genetics, immunology, epidemiology, and statistics
  • receive instruction in the principles of bioethics and in the provision of appropriate and cost-effective evaluation and treatment for patients with neurological disorders when specific situations arise
  • begin a reading program of functional neuroantatomy, clinical neurology and current literature
  • learn about major developments in both the basic and clinical sciences relating to neurology

 

Objectives

Demonstrate knowledge of the scientific principles that underlie the current understanding of neurological illnesses affecting the central and peripheral nervous system including, but not limited to, stroke, epilepsy, Parkinson’s disease, tremor and other movement disorders, multiple sclerosis, peripheral neuropathy, Alzheimer’s disease and other dementias, delirium, and malignancies and infectious diseases involving the nervous system.  Apply these principles in the discussion of health maintenance and common disease processes, and in the evaluation and management of patients.

 

Demonstrate an understanding of the cultural, ethnic, and societal beliefs and behaviors that influence a patient’s response to health and disease. 

 

Demonstrate knowledge of common neurological problems and differences across age, gender, and other groups.

 

Demonstrate an understanding of the scientific basis and appropriate interpretation of common diagnostic methods including computerized axial tomography, magnetic resonance imaging, Doppler studies, catheter angiography, electroencephalography, electromyography, and lumbar puncture.

 

Demonstrate an understanding of medical-legal responsibilities and how they relate to the duty and ability to act within the legal parameters, including abiding by those duties to protect and respect patient confidentiality.

 

Demonstrate knowledge of the theories and principles that govern ethical decision-making for patients with diseases of the central and peripheral nervous system and how these apply to major ethical dilemmas in medicine.

 

Practice- Based Learning and Improvement

Goal: Residents will

  • 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 
  • be expected to develop skills and habits for self-directed and life-long learning, incorporating the practice of evidence-based medicine

 

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
  • participate in the education of patients, families, students, residents and other health professionals
  • teach other residents, medical students, nurses, and other health care personnel, formally and informally

 

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

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 demonstrate the understanding of patient care and the interaction with the patient, family, and healthcare team in the context of the healthcare system. This includes and appreciation of issues of referral, confidentiality and the delivery of cost-effective health care.

 

Competencies: Residents will

  • be expected to work effectively in the UCH health care delivery setting and system relevant to neurology specialty
  • coordinate patient care within the health care system relevant to neurology specialty
  • incorporate considerations of cost awareness and risk-benefit analysis in patient care
  • 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

Identify and prioritize patients' problems, formulate appropriate differential diagnoses, and develop cost-effective diagnostic plans as well as evidence-based plans for treatment and/or management.

 

Demonstrate an understanding of medical-legal responsibilities and how they relate to the duty and ability to act within the legal parameters, including abiding by those duties to protect and respect patient confidentiality.

 

Demonstrate an appreciation of the overall care of the patient with an understanding of the interaction of primary care and specialty care. This includes the roles and responsibilities of the various members of the healthcare team.

 

Professionalism

Goal

Residents must demonstrate a commitment to carrying out professional responsibilities and an adherence to ethical principles.  Residents are expected to demonstrate the highest standards of professional integrity and exemplary behavior, as reflected by a commitment to continuous professional development, ethical practice, and an understanding of and sensitivity to diversity.  This includes a responsible attitude toward patients and their families, health care professionals and other staff members.

 

Competencies: Residents will

  • be expected to show compassion, integrity, and respect for others
  • be responsiveness to patient needs that supersedes self-interest
  • show respect for patient privacy and autonomy
  • be accountable to patients, society, and the profession
  • be sensitive and responsiveness to a diverse patient population, including but not imited 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 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 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
  • learn to 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 designated neurology outpatient clinic evaluations
  • Presentation of all patients to the attending, which includes diagnostic and therapeutic plans
  • Case based and clinical teaching by attending in outpatient clinics to accomplish goals and objectives
  • there will be a gradual assumption of more responsibility by the PGY-2 residents as the month progresses on this rotation
  • Residents will be expected to fill out a systems based practice/practice-based learning matrix regarding patient case encountered (twice a year)
  • Specific literature review may be assigned by attending faculty
  • Required attendance at M & Ms, weekly conferences, grand rounds and journal club

Assessment Method (residents)

  • Direct observation by faculty of history, examination and interactions during case presentations
  • Direct observation of  formulation, diagnostic approach, and disposition planning during case
  • Clinical records will be reviewed by supervising faculty member
  • Monthly evaluations by attending faculty
  • Evaluation by other providers, staff, and patients
  • Performance on in-service examination

 

 

Assessment Methods (How Program Director Performs Evaluation of Rotation)

  • Monitor all evaluations
  • Semi-annual review with Program Director
  • RITE exam scores
  • ABPN Clinical Evaluation exercises (oral)
  • Number of residents who have passed ABPN certification

Level of Supervision

Attending supervision:

All patient interactions and clinical activities will be supervised at all times by a faculty member of the Department of Neurology, of the University of Colorado. All program faculty members supervising residents have a faculty or clinical faculty appointment in the School of Medicine. Faculty schedules will be structured to provide residents with continuous supervision.

 

Residents must be supervised by faculty members in a manner promoting progressively increasing responsibility for each resident as the month progresses.

 

Lines of responsibility for neurology residents:

Residents perform the initial assessment of patients and then discuss with the attending physician. As always, ultimate responsibility resides with the attending physician. Outpatient lab and study orders will be typically written by the resident. Dictation of the history, examination, and plan will be the responsibility of the resident in nearly all circumstances.

 

Educational Resources

  1. Office Practice of Neurology. 2nd Edition. 2003. M. Samuels, S. Feske. Excellent textbook of basic outpatient clinical neurology. 
  2. Adams and Victor’s Principles of Neurology. 9th Edition. Eds: A. Ropper and M. Samuels Excellent basic textbook of clinical neurology.
  3. The Little Black Book of Neurology. Alan J. Lerner. Mosby. Good to carry on call or in clinic for quick reference for differential diagnosis and treatment basics.
  4. Localization in Clinical Neurology. 4th Edition. 2001. P. Brazis, J.C. Masdeu, J. Biller. Text for localization. Excellent source for clinical anatomy – localization based on clinical presentation; includes expected findings of various clinical disorders. Authors have been instrumental in designing ABPN (Board Examination) material.