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PGY-3 and 4 Neuropathology rotation


PGY-3-4 Neuropathology rotation


Description of Rotation or Educational Experience

The neuropathology elective offers the opportunity to acquire more in-depth training in areas of neuropathology, including review of gross and microscopic neuropathology of common CNS and PNS diseases, and to become acquainted with the role of the neuropathologist in the work-up of neurologic diseases


Patient Care

Goals: Residents will

  • develop competency in the required areas of neuropathology, including clinico-pathological correlation, basic neuropathological features and techniques used in assisting the diagnosis of common neurological disorders
  • acquire competency in the technical generation and interpretation of laboratory data and in the formulation of clinicopathologic correlations, so as to provide appropriate and effective consultation in the context of pathology services
  • understand the role of the neuropathologist, appropriate use of the information from the clinical history and the electronic medical record as they pertain to neurological abnormalities or neurologic symptoms in patients.

·         learn how to work effectively within a multidisciplinary health care team, participating as appropriate in informed decision-making and clinical management.


Residents are expected to demonstrate proficiency in problem solving, clinical reasoning and technical skills applicable to the practice of evidence-based medicine in the diagnosis of common neurological disorders.  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 practical experience in obtaining an orderly and detailed history from medical records, organizing and recording data
  • present patient cases, their diagnostic and therapeutic plans and any clinical diagnosis
  • have training that includes the indications for and limitations of clinical neurodiagnostic tests and their interpretation
  • begin to learn 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 evaluation of and decision making for patients with disorders of the nervous system requiring surgical interventions in order to obtain tissue samples
  • have close interaction with the neurosurgery service in the appropriate circumstance
  • 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 - at a minimum this must include magnetic resonance imaging, and computerized tomography and neurosonology
  • receive instruction in appropriate and compassionate methods of end-of-life palliative care, and psychosocial support and counseling for patients and family members about these issues



  • preview history and neuroimaging studies with direct faculty guidance.
  • review cases, record observations, formulate differential diagnosis
  • residents should demonstrate interpersonal, oral and written communication skills that enable them to establish and maintain effective professional relationships with peers, faculty members, patients, families and other members of healthcare teams
  • determine either the neurologic symptoms at the time of biopsy or death or determine any past history of neurologic abnormality

·         in those situations where the resident has direct interaction with patients, families or donors, the resident will perform such interviewing, examination and counseling as may be required with caring and respect.

Medical Knowledge

Goals: Residents will

  • be 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)
  • acquire knowledge about established and evolving biomedical, clinical, and clinically related sciences and will apply this knowledge to the understanding of basic pathologic processes in neurology
  • apply concepts of investigational and analytic thinking to the interpretation of laboratory data
  • acquire knowledge of morphology and immunophenotype of normal brain, muscle and nerve
  • acquire knowledge of multiparameter approach to diagnosis of neurological disorders
  • be expected to demonstrate knowledge on basic criteria for major neoplastic and non-neoplastic neuropathological entities
  • further increase neuropathology knowledge base in terms of rare entities and variations within more common entities
  • learn more about the type of cases that lack a definitive diagnosis
  • understand basic immunophenotypic/genotypic/molecular features where appropriate
  • understand basic components of CSF analysis and how they correlate with neuropathological processes


Competencies: Residents will

  • regularly attend seminars and conferences in neuropathology, neuroradiology, nnd general neurology
  • attend 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



  • 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.
  • Formulate differential diagnoses for CNS lesions based on clinical information.
  • Diagnose common CNS neoplasms at frozen section.
  • Know the spectrum of neoplasia involving the CNS in adult and pediatric populations.
  • Apply the histologic criteria for diagnosing and grading adult and pediatric CNS. neoplasms.
  • Know the clinical setting and histopathologic criteria or diagnosing nonneoplastic lesions of the CNS which may be expected as surgical pathology
  • Interpret basic patterns of peripheral nerve and muscle pathology.
  • Know basic cellular responses to injury; review inclusions seen in neurons, glia.
  • Understand basic histology techniques and stains used in neuropathology.
  • Understand basic and unusual types of vascular disease.
  • Know common infections that affect the CNS, including the morphological appearance of the organisms.
  • Understand basic and latest updates on demyelinating diseases of the central nervous system, especially MS and NMO.
  • Be able to understand basic features of toxic metabolic diseases that affect CNS
  • Know grading system and biological behavior of common tumors that affect the CNS/PNS.
  • Understand principles of muscle, nerve and neurodegenerative diseases including mode of inheritance where applicable.



Practice- Based Learning and Improvement

Goal: Residents will

  • Understand application of immunohistochemical and other techniques commonly used in pathology to diagnose and assist in the care of patients with neurological disorders
  • 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 in the field of neuropathology
  • locate, appraise and assimilate evidence from scientific studies, neuropathological findings, knowledge of underlying pathophysiological mechanisms of common neurological disorders 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



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


Systems Based Practice

Goals: Residents will

  • 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
  • be 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)
  • gain experience providing care for individuals in a “safety-net” health care system (i.e. for people with low socioecomonic status)


Competencies: Resident will be expected to

  • work effectively in various health care delivery settings and systems relevant to their clinical specialty
  • coordinate patient care within the health care system relevant to their clinical 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



  • 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.



Goal: Residents will

  • demonstrate a commitment to carrying out professional responsibilities and an adherence to ethical principles 
  • be 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

  • 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



  • 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



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

  • Read the Prayson textbook of Neuropathology in its entirety
  • Review neuroanatomy on computer-based learning material and perform at least 2 brain dissections
  • Attend weekly Brain Tumor Board and bi weekly Pediatric Brain Tumor Board
  • Attend once monthly Pituitary Tumor Board
  • Read/review AFIP notebook on neuropathology
  • Read articles assigned by Dr. DeMasters
  • Review glass slides assigned by Dr. DeMasters
  • Attend lectures to residents by Dr. DeMasters/Boyer


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
  • Clinical records review by program director
  • Monthly evaluations by attending faculty
  • Evaluation by other providers, staff, and patients
  • Performance on in-service examination
  • Direct observation of history, examination and interactions during case presentations
  • Program director review of clinical case matrices (twice a year)


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 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.      Richard Prayson.  Neuropathology review. Second Edition. Humana Press