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Rotation Specific Goals and Objectives

  1. General Neurology
  2. Stroke Service
  3. Epilepsy
  4. Neuromuscular
  5. Movement Disorders
  6. Speciality Clinics
  7. Inpatient (wards/consults)
  8. Outpatient Clinics
  9. Neuropathology
  10. Neurosurgery
  11. Nightfloat
  12. Electives
    1. Headache
    2. Neuroradiology
    3. Research
    4. Neuropsychology

 
UW and VA General Neurology Service

Patient Care

Goals 

  1. Gather essential and accurate information necessary to provide comprehensive care to adult patients with neurological disorders.
  2. Demonstrate effective and appropriate clinical problem solving skills using evidence-based medical knowledge and sound clinical judgment.
  3. Recognize the ethical, personal and social implications of many neurological diagnoses as well as the issues surrounding predictive testing and interventions for individuals with severe disabilities.
  4. Provide care to patients of varying ages and develop skills necessary to provide longitudinal care throughout the lifespan.
  5. Develop competence at inpatient and intensive-care management for a variety of adult neurological conditions. 
  6. Respond to consultation requests from the UW-ER and the VA and develop skills at triaging patients to the general or one of subspecialty services. 

Objectives
The resident will

  1. Independently obtain an accurate and comprehensive medical history
  2. Independently obtain an accurate and comprehensive general and neurological examination.
  3. Learn how to examine and diagnose patients of all ages with neuromuscular diseases, movement disorders, neurodegenerative diseases, traumatic injury of brain and spinal cord, headaches, seizures, neurocritical illnesses, CNS tumors, neurogenetic disorders, autism, autoimmune and infectious diseases affecting the central and peripheral nervous system.
  4. Efficiently admit and discharge patients.
  5. Be provided with learning opportunities to manage patients with neurological disease who require intensive care.
  6. Develop skill in discussing end-of-life issues with patients with neurological diseases.
  7. Become proficient in the management of patients with disorders of intracranial pressure.
  8. Learn appropriate work-up for major neurologic symptoms/syndromes/diseases.
  9. Implement a reasonable treatment plan.
  10. Realize long term complications of treatment modalities. 

Medical knowledge

Goals

  1. Develop self-directed learning skills essential to the maintenance of expertise in Neurology.
  2. Use internet and printed resources including primary and secondary literature, relevant texts and published databases to acquire, critically evaluate, and use current knowledge regarding diagnostic test availability and applicability, natural history, and management of each disorder with which clinic patients are diagnosed.
  3. Develop an adequate knowledge base in neurology and the neurosciences on which clinical child neurology is founded by applying this knowledge in the care of their patients.  
  4. Continue to learn how the health care system functions, especially as relevant to the patient with neurologic disease. 

Objectives
The resident will

  1. Utilize a systematic approach to the diagnosis of neurological disease, based on the skills of localizing neurological lesions, constructing a sound differential diagnosis, and judicious use of diagnostic tests and treatments.
  2. Learn how to examine and diagnose patients of all ages with neuromuscular diseases, movement disorders, neurodegenerative diseases, traumatic injury of brain and spinal cord, headaches, seizures, neurocritical illnesses, CNS tumors, neurogenetic disorders, autism, autoimmune and infectious diseases affecting the central and peripheral nervous system.
  3. Learn how to access written materials including clinical practice guidelines related to patients under his or her care.
  4. Impart basic neurology knowledge to rotating medical students and other residents. 
  5. Gain knowledge of laboratory and diagnostic studies and their appropriate uses. 

Interpersonal and Communication Skills

Goals
Residents will

  1. Become skillful listeners, and develop specific proficiency in communicating with neurologic patients through non-verbal means. 
  2. Learn to communicate rapidly and efficiently with other team members in order to ensure that proper therapies can be provided in a timely manner. 
  3. Learn to clearly communicate neurological assessments and plans to patients, their families, and members of the multidisciplinary care team.  They will become specifically proficient in discussing end of life care.

Objectives 
The resident will

  1. Demonstrate skills in effective communication (both written and verbal) with patients, their families, colleagues and co-workers in order to better treat neurological disease.
  2. Become proficient in communication with allied health staff in day-to day contacts and during multidisciplinary discharge planning rounds.
  3. Be responsible for teaching basic neurological skills and knowledge to the rotating medical students and residents.
  4. Develop techniques to obtain accurate history from patients, and gain the patients’ confidence and trust.
  5. Create hospital notes that are concise and accurate.
  6. Become adept at presenting patients to faculty concisely and completely.
  7. Become proficient at communicating clearly with the consulting services.
  8. Learn efficient dictating skills so that consulting and inpatient care team services have immediate access to documentation on all patients. 

Practice-Based Learning and Improvement

Goals

  1. Use skills acquired during primary residency training as an initial foundation for medical and ethical decision making
  2. Identify opportunities for improvement in the delivery of quality of patient care. 

Objectives
The resident will…

  1. Systematically review inpatient and outpatient cases during dedicated conferences and use the feedback generated to improve upon subsequent patients’ care. 
  2. Learn to critically appraise the neurologic literature, with emphasis on clinical trial design and outcome measures. 
  3. Become familiar with authoritative sources of neurologic practice guidance, such as American Academy of Neurology scientific statements, and how to access these resources on-line.
  4. Maintain a patient log for tracking number and various diagnosis of patients seen to ensure an adequate educational experience.
  5. Be responsible for tracking patients and procedures performed via the electronic patient/procedure log.  These data can be used by the resident in the 6-month self-evaluation to determine where further patient experience is needed.
  6. Incorporate evaluation feedback into daily practice. 

Professionalism

Goals

  1. It is the expectation of our training program that child neurology residents will behave in a professional manner at all times in which they represent the University of Wisconsin Department of Neurology, the University of Wisconsin Hospital and Clinics, and the William S. Middleton VA Hospital. 
    1. This includes the following six essential elements of professionalism:
      1.  Be present—the resident must be in attendance for all patient care duties and for all didactic teaching.  If illness or other circumstances prevent attendance, the appropriate persons should be notified.  70% attendance at required conferences will be required for promotion.
      2.  Be presentable—the resident will dress in a manner that signifies professionalism.  The wearing of scrubs is prohibited except after normal business hours.
      3. Be punctual—residents should strive to arrive on time for all clinical duties and didactic sessions.  As befits a responsible professional, knowledge that the resident will be late should result in notification of the appropriate persons (i.e. the resident might call ahead to clinic and ask the MA to notify all patients that he/she will be arriving late).  Furthermore, it is appropriate to apologize to those who are inconvenienced by tardiness.
      4. Be prepared—the resident should accomplish all assigned tasks related to clinical patient care within the limitations of the ACGME duty hour regulations (see below).  Paperwork and dictations must be completed in a timely fashion.
      5. Be positive (and respectful)—the resident shall strive to be respectful of patients, staff, and colleagues at all times.  At times, every person experiences emotions such as anger/frustration, etc. that must be successfully suppressed in interactions with patients, families, and with other health care professionals.
      6. Be proficient—the resident will be expected to consistently demonstrate appropriate knowledge and procedural skills for his/her level of training.  The resident must understand his/her limitations and know when to ask for help.
  2. Residents will learn ethical, regulatory, and legal aspects of neurologic care, including the difference between standard and investigational treatments. 
  3. They will demonstrate sensitivity to the personal, cultural, and religious values that influence patients’ medical decisions in the context of neurologic disease, and a compassionate approach to end of life care.
  4. They will demonstrate responsiveness to patient needs that supersedes self interest.
  5. Demonstrate compassion, integrity, accountability and respect in all interactions with patients from diverse backgrounds in gender, age, culture, race, religion, physical and cognitive ability and sexual orientation.
  6. They will adhere to ethical principles by respecting confidentiality of medical information. 

Objectives 
Residents will

  1. Solidify their foundation of the professional and ethical practice of medicine. 
  2. Remember that they represent the UW Department of Neurology with their actions and communications.  The highest standards of professionalism must be maintained at all times, especially in interactions with patients and their families, with other physicians, and with allied health staff.
  3. Respond in a timely and courteous manner to pages, calls and patient inquiries.
  4. Adhere to clinic schedules and minimize patient inconvenience.
  5. Undergo HIPAA training and comply with HIPAA rules and ethical principles.
  6. Be responsible for tracking duty hours.
  7. Show respect, compassion, integrity and ongoing professional development.
  8. Determine  psychosocial issues that complicate care, especially as it relates to the possibility of patient history of physical or sexual abuse and the diagnosis of nonepileptic seizures.
  9. Be punctual and appropriately attired.
  10. Keep patient logs up-to-date on MedHub.
  11. Learn ethical, regulatory, and legal aspects of care, including the difference between standard and investigational treatments.
  12. Promptly attend case conferences and didactic sessions. 

Systems-Based Practice

Goals
The resident recognizes that he/she is part of a large and intricate health system that has implications for his/her ability to care for patients and impacts upon his/her patients’ human needs and financial resources.

Objectives
The residents will

  1. Demonstrate the ability to work in a multidisciplinary fashion with nurses, case managers, social workers, therapists, primary care physicians, and the various medical and surgical specialties related to adult neurology. 
  2. Learn how to triage patients and allocate resources such as intensive care unit beds and MRI scans so as to provide high quality, cost-effective care. 
  3. Learn how the health care system functions, especially as relevant to the patient with neurologic disease.
  4. Learn to interact with allied health services including nursing staff, PT, OT, Speech Pathology, Dietary, Social Work, and PMR/Rehabilitation in caring for the patient and planning post-hospital care. 
  5. Be able to individualize evaluations, diagnostic testing, and develop treatment plans with respect to the health delivery systems available to patients. Residents will become knowledgeable of available patient resources including other health care professionals and patient advocacy groups.
  6. Become proficient in the use of the UW Epic electronic record and the VA CPRS systems.               

UW and VA Stroke Service

Patient Care

Goals

  1. Develop competence at inpatient and intensive-care management for patients with acute stroke. 
  2. Evaluate and treat acute stroke patient independently. 

Objectives
Residents will

  1. Develop their skills in obtaining accurate historical information from patients and caregivers, with particular emphasis on ascertaining the time of stroke onset. 
  2. Be able to clearly communicate to patients and families the risks, benefits, and alternatives to intravenous and intra-arterial thrombolysis. 
  3. Learn to discuss the mechanisms of stroke and hospital course with patients.
  4. Counsel patients on risk factor modification and long term outcomes.
  5. Interpret neuroimaging studies including CT, CTA, MRI, MRA, and catheter angiography, meet management decisions regarding IV tpa, IA tpa and thrombectomy.
  6. Learn the principles of post-thrombolysis care and become familiar with diagnosis and management of a variety of specific cerebrovascular conditions including intracerebral hemorrhage, arterial dissection, and venous sinus thrombosis.
  7. Become familiar with basic concepts of stroke rehabilitation, secondary stroke prevention and current research priorities in cerebrovascular diseases. 

Medical Knowledge

Goals

  1. Develop self-directed learning skills essential to the maintenance of expertise in Neurology.
  2. Use internet and printed resources including primary and secondary literature, relevant texts and published databases to acquire, critically evaluate, and use current knowledge regarding diagnostic test availability and applicability, natural history, and management of stroke patients.
  3. Develop an adequate knowledge base in stroke presentation, treatment and prevention.
  4. Continue to learn how the health care system functions, especially as relevant to the patient with cerebrovascular disease.
  5. Develop adequate knowledge in diagnosis and management of a variety of specific cerebrovascular conditions including intracerebral hemorrhage, arterial dissection, and venous sinus thrombosis.
  6. Understand basic concepts in stroke rehabilitation.
  7. Develop knowledge of current evidence for secondary stroke prevention.
  8. Develop knowledge of current research priorities in cerebrovascular diseases. 

Objectives
The residents will

  1. Learn how to classify stroke into ischemic vs. hemorrhagic and their various subtypes, and about the vascular pathology underlying them.  They will learn basic concepts of cerebral hemodynamics, neuroimaging, and neurointensive care. 
  2. Develop their skills in lesion localization and the formulation of robust differential diagnoses that go beyond cerebral infarction. 
  3. Become proficient in the interpretation of neuroimaging studies including CT and MRI, and the use of such information for clinical decision making. 
  4. Learn about stroke risk factors and how these influence stroke classification and treatment. 
  5. Learn the evidence supporting acute and preventive stroke treatments including tissue plasminogen activator (tPA), antiplatelet agents, anticoagulants, anti-hypertensives, and HMG-CoA reductase inhibitors.
  6. Gain knowledge on laboratory and diagnostic technologies and their appropriate uses.
  7. Learn how to access written materials including clinical practice guidelines related to patients under their care.
  8. Gain knowledge of laboratory and diagnostic studies and their appropriate uses. 

Practice-Based Learning and Improvement

Goals

  1. Use skills acquired during primary residency training as an initial foundation for medical and ethical decision making.
  2. Identify opportunities for improvement in the delivery of quality of patient care. 

Objectives
Residents will

  1. Systematically review recent stroke cases during dedicated conferences and use the feedback generated to improve upon subsequent patients’ care. 
  2. Learn to critically appraise the stroke literature, with emphasis on clinical trial design and stroke outcome measures. 
  3. Become familiar with authoritative sources of stroke practice guidance, such as American Stroke Association scientific statements, and how to access these resources on-line.
  4. Maintain a patient log for tracking number and various diagnosis of patients seen during the rotation to ensure an adequate educational experience. 

Interpersonal and Communication Skills 

Goals

  1. Become skillful listeners, and develop specific proficiency in communicating with neurologic patients through non-verbal means. 
  2. Learn to communicate rapidly and efficiently with other team members in order to ensure that proper therapies can be provided in a timely manner. 
  3. Learn to clearly communicate neurological assessments and plans to patients, their families, and members of the multidisciplinary care team. 
  4. Become specifically proficient in discussing end of life care. 

Objectives
Residents will

  1. become skillful listeners, and develop specific proficiency in communicating with aphasic stroke patients through non-verbal means. 
  2. Learn to ascertain a precise time of stroke symptom. Determining onset or time the stroke patient was last known well is a crucial skill that will be developed during this rotation. 
  3. Learn to communicate rapidly and efficiently with other team members in order to ensure that acute stroke therapies can be provided in a timely manner. 
  4. Learn to clearly communicate neurological assessments and plans to patients, their families, and members of the multidisciplinary care team. 
  5. Discuss end of life care with patients and their families. 

Professionalism

Goals

  1. Learn ethical, regulatory, and legal aspects of neurologic care with emphasis on patients with cerebrovascular disease, including the difference between standard and investigational treatments. 
  2. Demonstrate sensitivity to the personal, cultural, and religious values that influence patients’ medical decisions in the context of cerebrovascular disease, and a compassionate approach to end of life care.
  3. Demonstrate responsiveness to patient needs that supersedes self interest.
  4. Demonstrate compassion, integrity, accountability and respect in all interactions with patients from diverse backgrounds in gender, age, culture, race, religion, physical and cognitive ability and sexual orientation.
  5. Adhere to ethical principles by respecting confidentiality of medical information. 

Objectives
Residents will

  1. Learn ethical, regulatory, and legal aspects of stroke care, including the difference between standard and investigational stroke treatments. 
  2. Demonstrate sensitivity to the personal, cultural, and religious values that influence patients’ medical decisions in the context of stroke, and a compassionate approach to end of life care.
  3. Adhere to ethical principles by respecting confidentiality of medical information. 

Systems-Based Practice

Goals
The resident recognizes that he/she is part of a large and intricate health system that has implications for his/her ability to care for patients and impacts upon his/her patients’ human needs and financial resources.

Objectives
Residents will

  1. demonstrate the ability to work in a multidisciplinary fashion with nurses, case managers, social workers, therapists, primary care physicians, and the various medical and surgical specialties related to stroke. 
  2. Learn how to triage patients and allocate resources such as intensive care unit beds and MRI scans so as to provide high quality, cost-effective care. 
  3. Become familiar with clinical practice guidelines and participate in the creation and review of stroke program policies and procedures relevant to patient care.                                        

Epilepsy Rotation

Patient Care

Goals

  1. Develop the skills necessary to evaluate, treat, and counsel patients of all ages and families with epileptic disorders.
  2. Gather essential and accurate information necessary to provide comprehensive care to adult and pediatric patients with epileptic disorders.
  3. Demonstrate effective and appropriate clinical problem solving skills using evidence-based medical knowledge and sound clinical judgment.
  4. Recognize the ethical, personal and social implications of the diagnosis of epilepsy as well as the issues surrounding predictive testing and interventions for individuals with severe disabilities.
  5. Provide care to patients of varying ages with epilepsy and develop skills necessary to provide longitudinal care throughout their lifespan. 

Objectives
The resident will

  1. Obtain accurate and sufficient histories to characterize seizures and to define risk factors for developing epilepsy.
  2. Review AAN practice guidelines and learn to incorporate them into the evaluation and treatment of patients with epilepsy.
  3. Demonstrate communication skills to educate patients and families regarding epilepsy diagnosis and treatment.
  4. Work with health care professionals (i.e. nursing staff, neurophysiology technologists, ancillary staff) to provide patient-focused care.
  5. Attend Epilepsy clinics, admit and manage monitoring patients.
  6. Review electrophysiological studies and apply findings to care for patients with epilepsy.
  7. Formulate patient management plans regarding appropriate diagnostic and therapeutic interventions 

Medical Knowledge

Goals

  1. Develop self-directed learning skills essential to the maintenance of expertise in Child Neurology.
  2. Use internet and printed resources including primary and secondary literature, relevant texts and published databases to acquire, critically evaluate, and use current knowledge regarding diagnostic test availability and applicability, natural history, and management of epilepsy in all ages.
  3. Develop an adequate knowledge base in epileptology.
  4. Learn how the health care system functions, especially as relevant to the patient with epilepsy. 

Objectives
The resident will

  1. Explain the recognition and treatment of status epilepticus, a medical emergency.
  2. Take a personal initiative in self-education (including perusing recent literature).  This includes review of standard texts of EEG interpretation and epilepsy disorders as includes review of teaching files of normal and abnormal EEGs.
  3. Describe the importance of neuroimaging in the evaluation of patients with epilepsy.
  4. Be able to classify seizure types and epileptic syndromes.
  5. Verbalize  rational approach to the management of epilepsy including choice of appropriate antiepileptics.
  6. List the pharmacokinetics of antiepileptics and mechanisms of action.
  7. Explain the utility of epilepsy monitoring and the evaluation of intractable epilepsy, especially the use of surgical treatment of epilepsy.
  8. Characterize the unique situation of epilepsy in women of child bearing age.
  9. Verbalize the appropriate restrictions including driving, for patients with epilepsy.
  10. Describe the principles of EEG generation and recording.
  11. Achieve an orderly approach to the interpretation of EEG studies.
  12. Identify normal and abnormal EEG patterns.
  13. Describe the developmental features of EEG from infancy to the elderly.
  14. Recognize abnormal EEG findings and correlate EEG findings with clinical epilepsy syndrome and seizure types in infancy, childhood and adulthood.
  15. Achieve skills in creating and dictating neurophysiology reports.
  16. Explain the principles of evoked potential generation including visual, brainstem-auditory, and somatosensory evoked potentials.
  17. Correlate video recordings of seizures with EEG tracing.
  18. Describe the principles of Wada testing.
  19. Dictate at least five EEG studies.
  20. Review neonatal and pediatric EEGs and video EEG studies with one of the pediatric neurologists 

Practice-Based Learning and Improvement

Goals

  1. Use skills acquired during primary residency training as an initial foundation for medical and ethical decision making
  2. Identify opportunities for improvement in the delivery of quality of patient care. 

Objectives
The resident will

  1. Appraise literature to better understand pediatric and adult epilepsy syndromes and their etiology and clinical presentation.
  2. Assess studies that evaluate treatment options for specific seizure types and epilepsy syndromes.
  3. Apply and use the International League Against Epilepsy (ILEA) website that aids in understanding epilepsy syndromes and seizure management. 

Interpersonal and Communication Skills

Goals

  1. Become skillful listeners, and develop specific proficiency in communicating with patients with epilepsy of all ages.
  2. Learn to communicate rapidly and efficiently with other team members in order to ensure that proper therapies can be provided in a timely manner. 
  3. Learn to clearly communicate neurological assessments and plans to patients, their families, and members of the multidisciplinary care team. 

Objectives
The resident will

  1. Develop techniques to obtain accurate history from patients, and gain the patients’ confidence and trust.
  2. Create reports that accurately convey EEG findings and relate these findings to the clinical setting.
  3. Interact effectively with other members caring for patients including nursing and technical staff.
  4. Create clinic and hospital notes that are concise and accurate. 

Professionalism

Goals

  1. Demonstrate continuing commitment to carrying out professional responsibilities, adherence to ethical principles, and sensitivity to diversity.
  2. Learn ethical, regulatory, and legal aspects of care for pediatric and adult patients with epilesy, including the difference between standard and investigational treatments. 
  3. Demonstrate sensitivity to the personal, cultural, and religious values that influence patients’ and parents’/caregivers’ medical decisions in the context of neurologic disease.
  4. Demonstrate responsiveness to patient needs that supersedes self interest.
  5. Demonstrate compassion, integrity, accountability and respect in all interactions with patients from diverse backgrounds in gender, age, culture, race, religion, physical and cognitive ability and sexual orientation.
  6. Adhere to ethical principles by respecting confidentiality of medical information. 

Objectives
The resident will

  1. Show respect, compassion, integrity and ongoing professional development.
  2. Verbalize ethical principles with adherence to confidentiality, HIPAA principles, and appropriate informed consent.
  3. Determine  psychosocial issues that complicate care, especially as it relates to the possibility of patient history of physical or sexual abuse and the diagnosis of nonepileptic seizures.
  4. Be punctual and appropriately attired.
  5. Keep patient logs up-to-date on MedHub. 

Systems Based Practice

Goals

The resident recognizes that he/she is part of a large and intricate health system that has implications for his/her ability to care for patients and impacts upon his/her patients’ human needs and financial resources.
 
Objectives
The resident will

  1. Identify the importance for proper diagnosis and treatment of epilepsy as to the effect of diagnosis on insurability and driving privileges.
  2. Assess efficiencies of the AFCH, UW and VA systems regarding patients referred from other centers, and develop management plans that are effective and not redundant or wasteful of medical resources.
  3. Make decisions regarding the cost considerations of choosing appropriate antiepileptic drug therapy.
  4. Identify advocacy programs for patients with epilepsy. 

Neuromuscular Medicine
 
This encompasses both the Neuromuscular Medicine rotation and the EMG Laboratory rotation. 
 
Patient Care

Goals
 
To provide excellent training in diagnostic evaluation and management of patients with a wide spectrum of neuromuscular diseases.
 
Objectives
Residents will

  1. Learn the unique skills of the neuromuscular exam to accurately predict disease location and diagnosis.
  2. Develop their skills in various electrodiagnostic techniques including:
    1. standard motor and sensory nerve conduction studies of upper and lower extremities and cranial nerves;
    2. repetitive nerve stimulation techniques;
    3. basic autonomic studies;
    4. standard concentric needle EMG evaluations;
    5. Single Fiber EMG techniques,
    6. laryngeal EMG. 
  3. Learn the indications and clinical utility of muscle and nerve biopsies.
  4. Learn how to select the muscle biopsy site to assure the highest diagnostic yield.
  5. Understand the basic principles of muscle and nerve specimen processing (histology, histochemistry, immunostaining, electron microscopy, teased fiber analysis).
  6. Be able to incorporate the biopsy results into the clinical decision-making process with regard to diagnosis and management of patients with neuromuscular disorders.
  7. Have an opportunity to assist in muscle and nerve biopsies (in the operating room, or in the neurology out-patient clinic for needle muscle biopsies).
  8. Actively participate in the Muscle and Nerve Pathology/ Neuromuscular case conference. 

Medical Knowledge 

Goals

  1. Provide excellent, comprehensive training in electromyography, including advanced techniques.
  2. Understand the clinical utility and limitations of different electrodiagnostic tests in evaluation of patients with various neurological disorders.
  3. Gradually increasing responsibility and independence in electrodiagnostic evaluation of patients in the EMG Laboratory.
  4. Introduce residents to basic concepts of interpretation of muscle and nerve biopsies.
  5. Introduce the residents to the technique of muscle and nerve biopsy (in the operating room, or in the neurology out-patient clinic for needle muscle biopsies).
  6. Understand the clinical utility and limitations of nerve and muscle biopsies in evaluation and management of patients with neuromuscular disorders. 

Objectives
Residents will

  1. Learn clinical skills necessary to diagnose neuromuscular conditions affecting different stations of the motor unit (anterior horn cell diseases, peripheral neuropathies, neuromuscular transmission disorders, myopathies).
  2. Understand the principles of clinical genetics and genetic counseling applicable to patients with hereditary neuromuscular conditions.
  3. Gain knowledge of laboratory and diagnostic studies and their appropriate uses.
  4. Acquire the knowledge of the most current concepts in therapies applicable to neuromuscular diseases. 

Practice-Based Learning and Improvement 

Goals

  1. Demonstrate knowledge, skills and attitudes needed for continuous self-assessment, using scientific methods and evidence to investigate, evaluate, and improve one’s patient care practice.
  2. Identify opportunities for improvement. 

Objectives
Residents will

  1. Learn to critically appraise the neuromuscular literature, with emphasis on clinical trial design and outcome measures.
  2. Become familiar with authoritative sources of practice guidance, such as American Association of Electrodiagnostic and Neuromuscular Medicine or American Academy of Neurology, and how to access these resources on-line.
  3. Maintain a log for tracking of patients seen in clinic to ensure an adequate educational experience.
  4. Learn to critically appraise the neurophysiological literature, with emphasis on critical assessment of different electrodiagnostic techniques.
  5. Become familiar with authoritative sources of clinical electromyography practice guidance, such as American Association of Electrodiagnostic and Neuromuscular Medicine statements, and how to access these resources on-line.
  6. Maintain a log for tracking of patients seen in EMG Lab to ensure an adequate educational experience.
  7. Residents will learn to critically appraise the neuropathological literature, with emphasis on assessment of different neuropathological techniques in diagnosis of neuromuscular disorders. 

Interpersonal and Communication Skills

Goals

  1. Demonstrate interpersonal and communication skills that result in information exchange and partnering with patients, their families and professional associates.
  2. Become skillful listeners, and develop specific proficiency in communicating with adult and pediatric neurologic patients with neuromuscular disorders through non-verbal means and with their care providers. 
  3. Learn to communicate rapidly and efficiently with other team members in order to ensure that proper therapies can be provided in a timely manner. 
  4. Learn to clearly communicate neurological assessments and plans to patients and their parents, and members of the multidisciplinary care team.  

Objectives
Residents will

  1. Become skillful listeners, and develop specific proficiency in communicating and examining patients with severe disabilities.
  2. Learn to communicate rapidly and efficiently with other team members in order to ensure that appropriate therapies can be provided in a timely manner.
  3. Learn to clearly communicate neurological assessments and plans to patients, their families, and other health providers involved in evaluation and management of patients with neuromuscular disorders.
  4. Become skillful listeners, and develop specific proficiency in communicating with patients in the EMG Laboratory.
  5. Learn to prepare the EMG test reports and communicate the test results to referring physicians. Learn the terminology used in muscle and nerve pathology reports.
  6. Learn to prepare the muscle or nerve biopsy reports and communicate the test results to referring physicians. 

Professionalism 

Goals

  1. Demonstrate commitment to carrying out professional responsibilities, adherence to ethical principles, and sensitivity to diversity.
  2. Learn ethical, regulatory, and legal aspects of pediatric neurologic care, including the difference between standard and investigational treatments. 
  3. Demonstrate sensitivity to the personal, cultural, and religious values that influence patients’ and parents’/caregivers’ medical decisions in the context of neurologic disease.
  4. Demonstrate responsiveness to patient needs that supersedes self interest.
  5. Demonstrate compassion, integrity, accountability and respect in all interactions with patients from diverse backgrounds in gender, age, culture, race, religion, physical and cognitive ability and sexual orientation.
  6. Adhere to ethical principles by respecting confidentiality of medical information. 

Objectives
Residents will

  1. Learn ethical, regulatory, and legal aspects of care, including the difference between standard and investigational treatments.
  2. Demonstrate sensitivity to the personal, cultural, and religious values that influence patients’ medical decisions in the context of the wide spectrum of neuromuscular conditions, including end-of-life issues.
  3. Adhere to ethical principles by respecting confidentiality of medical information. 

Systems-Based Practice 

Goals

  1. Provide care of uniformly high quality within fiscally constrained environment.
  2. Navigate various health care delivery and financing systems to provide optimal care for patients with neuromuscular disorders. 

Objectives
Residents will

  1. Demonstrate the ability to work in a multidisciplinary fashion with nurses, case managers, social workers, therapists, primary care physicians, and the various medical and surgical specialties related to neuromuscular diseases.
  2. Understand the clinical utility of different laboratory/diagnostic tests and will implement them in a rational, cost efficient way to provide high quality, cost-effective care.
  3. Demonstrate the ability to work in a multidisciplinary fashion with various medical and surgical specialties that refer patients for electromyographic evaluation.

Movement Disorders Clinic

Patient Care

Goals

  1. Gather essential and accurate information necessary to provide comprehensive care to patients with movement disorders.
  2. Demonstrate effective and appropriate clinical problem solving skills using evidence-based medical knowledge and sound clinical judgment.
  3. Demonstrate working differential diagnosis of all movement disorders and understand distinguishing clinical features.
  4. Know appropriate work-up for major symptoms/syndromes/diseases.
  5. Implement a reasonable treatment plan.
  6. Recognize the ethical, personal and social implications of movement disorders as well as the issues surrounding predictive testing and interventions for individuals with severe disabilities.
  7. Provide care to patients of varying ages and develop skills necessary to provide longitudinal care throughout the lifespan.
  8. Demonstrate ability to interrogate DBS pt’s IPG and turn it on/off, check the battery.
  9. Demonstrate knowledge of safety concerns for patients with deep brain stimulators. 

Objectives
Residents will

  1. develop their skills in obtaining historical information specifically related to movement disorders.
  2. Develop descriptive vocabulary of abnormal movements to enhance communication with other professionals. 
  3. Demonstrate thorough work-up of abnormal movements and related syndromes and be able to formulate a rational treatment and management plan. 
  4. Understand basic indications and mechanisms of treatment modalities including medication management, Botox therapy, and surgical treatment. 

Medical Knowledge

Goals

  1. Develop self-directed learning skills essential to the maintenance of expertise in Movement Disorders.
  2. Use internet and printed resources including primary and secondary literature, relevant texts and published databases to acquire, critically evaluate, and use current knowledge regarding diagnostic test availability and applicability, natural history, and management of each disorder with which clinic patients are diagnosed with specific emphasis on Movement Disorders.
  3. Develop an adequate knowledge base in neurology and the neurosciences.
  4. Learn how the health care system functions, especially as relevant to the patients with Movement Disorders.
  5. Identify and classify abnormal movements (tremor, chorea, myoclonus, etc.).
  6. Realize long term complications of treatment modalities.
  7. Be familiar with indications for DBS. 

Objectives
Residents will

  1. learn how to classify abnormal movements. 
  2. Demonstrate knowledge of the mainstream theories regarding pathophysiological mechanisms of common movement disorder related diseases/syndromes. 
  3. Know the neuropharmacologic mechanisms of frequently used medications and common side-effects. 
  4. Be familiar with major novel treatments that are under development. 

Practice-Based Learning and Improvement

Goals

  1. Use skills acquired during primary residency training as an initial foundation for medical and ethical decision making.
  2. Identify opportunities for improvement in the delivery of quality of patient care. 

Objectives
Residents will

  1. Learn to critically appraise movement disorder literature to keep abreast of current diagnostic and treatment developments. 
  2. Become familiar with authoritative sources of movement disorders practice guidelines developed by the American Academy of Neurology and the Movement Disorders Society and how to access these documents on-line. 
  3. Maintain a patient log for tracking number and various diagnoses of patients seen during the rotation to ensure an adequate educational experience. 

Interpersonal and Communication Skills

Goals

  1. Residents will become skillful listeners, and develop specific proficiency in communicating with neurologic patients with movement disorders through verbal and non-verbal means. 
  2. Residents will learn to communicate rapidly and efficiently with other team members in order to ensure that proper therapies can be provided in a timely manner. 
  3. Residents will learn to clearly communicate neurological assessments and plans to patients, their families, and other health providers.  

Objectives
Residents will

  1. become skilled in obtaining a comprehensive history from patients and their family especially related to their level of disability and the impact this has on their independence and daily activities. 
  2. Demonstrate compassion and insight into the patient’s abilities/disabilities that may affect their interaction with the resident in clinic. 
  3. Realize the importance of a multi-disciplinary approach to patient management.  Residents will develop vocabulary specific to movement disorders and create notes that accurately reflect patient’s situation. 
  4. Become familiar with rating scales commonly used by movement disorder specialists.  They will maintain accurate, thorough and timely medical records. 

Professionalism

Goals

  1. Residents will learn ethical, regulatory, and legal aspects of neurologic care, including the difference between standard and investigational treatments. 
  2. They will demonstrate sensitivity to the personal, cultural, and religious values that influence patients’ medical decisions in the context of neurologic disease, and a compassionate approach to end of life care.
  3. They will demonstrate responsiveness to patient needs that supersedes self interest.
  4. Demonstrate compassion, integrity, accountability and respect in all interactions with patients from diverse backgrounds in gender, age, culture, race, religion, physical and cognitive ability and sexual orientation.
  5. They will adhere to ethical principles by respecting confidentiality of medical information. 

Objectives
Residents will

  1. Learn ethical, regulatory, and legal aspects concerning care of the patient with movement disorders. 
  2. Know the difference between FDA approved and off-label uses of medications and interventions. 
  3. Demonstrate sensitivity to the personal, cultural, and religious values that influence patients’ medical decisions in the context of their disease-specific problems and disabilities, including end of life issues. 

Systems Based Practice

Goals

  1. Use skills acquired during primary residency training as an initial foundation for medical and ethical decision making
  2. Identify opportunities for improvement in the delivery of quality of patient care. 

Objectives
Residents will

  1. Be able to individualize evaluations, diagnostic testing, and develop treatment plans with respect to the health delivery systems available to patients. 
  2. Be aware of financial, safety and other psychosocial issues common to patients living with movement disorders. 
  3. Become knowledgeable of available patient resources including other health care professionals and patient advocacy groups.                           

Neurology Specialty Clinics Rotation

Patient Care

Goals

  1. Gather essential and accurate information necessary to provide comprehensive care to adult patient with neurologic symptoms.
  2. Demonstrate effective and appropriate clinical problem solving skills using evidence-based medical knowledge and sound clinical judgment.
  3. Demonstrate increasing ability to independently assess, make decisions, counsel adult patients with neurologic disease and their families, and medically manage patients, under the supervision of the attending physician. 

Objectives
Residents will develop basic skills in the diagnosis, evaluation, and management of neurologic patients in the outpatient specialty clinic setting.
 
Medical knowledge

Goals

  1. Develop self-directed learning skills essential to the maintenance of expertise in Neurology.
  2. Use internet and printed resources including primary and secondary literature, relevant texts and published databases to acquire, critically evaluate, and use current knowledge regarding diagnostic test availability and applicability, natural history, and management of each disorder with which clinic patients are diagnosed.
  3. Develop an adequate knowledge base in neurology and the neurosciences.
  4. Learn how the health care system functions, especially as relevant to the patient with neurologic disease. 

Objectives
Develop basic knowledge with regard to subspecialty care of neurologic diseases through background reading in a subspecialty- and patient-specific fashion.
 
Interpersonal and Communication Skills

Goals

  1. Residents will become skillful listeners, and develop specific proficiency in communicating with neurologic patients through verbal and non-verbal means. 
  2. Residents will learn to communicate rapidly and efficiently with other team members in order to ensure that proper therapies can be provided in a timely manner. 
  3. Residents will learn to clearly communicate neurological assessments and plans to patients, their families, and members of the multidisciplinary care team.  They will become specifically proficient in discussing end of life care.

Objectives
Residents will

  1. present patients to faculty succinctly and completely.
  2. Develop superb skills in the dictation and completion of patient reports. These  reports will be completed in a timely manner in accordance with hospital policies.
  3. Residents will learn to communicate clearly with patients and families. 

Practice-Based Learning and Improvement

Goals

  1. Demonstrate knowledge, skills and attitudes needed for continuous self-assessment, using scientific methods and evidence to investigate, evaluate, and improve one’s patient care practice.
  2. Identify opportunities for improvement. 

Objectives
The residents will

  1. Systematically review outpatient cases and use the feedback generated to improve upon subsequent patients’ care. 
  2. Learn to critically appraise the neurologic literature, with emphasis on clinical trial design and outcome measures. 
  3. Become familiar with authoritative sources of neurologic practice guidance, such as American Academy of Neurology scientific statements, and how to access these resources on-line.
  4. Maintain a patient log for tracking number and various diagnosis of patients seen to ensure an adequate educational experience.
  5. Be responsible for tracking patients and procedures performed via the electronic patient/procedure log.  These data can be used by the resident in the 6-month self-evaluation to determine where further patient experience is needed.
  6. Incorporate evaluation feedback into daily practice. 

Professionalism

Goals

  1. Learn ethical, regulatory, and legal aspects of neurologic care, including the difference between standard and investigational treatments. 
  2. Demonstrate sensitivity to the personal, cultural, and religious values that influence patients’ medical decisions in the context neurologic disease, and a compassionate approach to end of life care.
  3. Demonstrate responsiveness to patient needs that supersedes self interest.
  4. Demonstrate compassion, integrity, accountability and respect in all interactions with patients from diverse backgrounds in gender, age, culture, race, religion, physical and cognitive ability and sexual orientation.
  5. Adhere to ethical principles by respecting confidentiality of medical information. 

Objectives
The residents will

  1. Solidify their foundation of the professional and ethical practice of medicine. 
  2. Remember that they represent the UW Department of Neurology with their actions and communications.  The highest standards of professionalism must be maintained at all times, especially in interactions with patients and their families, with other physicians, and with allied health staff.
  3. Adhere to clinic schedules and minimize patient inconvenience.
  4. Undergo HIPAA training and comply with HIPAA rules and ethical principles.
  5. Be responsible for tracking duty hours.
  6. Show respect, compassion, integrity and ongoing professional development.
  7. Determine psychosocial issues that complicate care, especially as it relates to the possibility of patient history of physical or sexual abuse and the diagnosis of nonepileptic seizures.
  8. Be punctual and appropriately attired.
  9. Learn ethical, regulatory, and legal aspects of care, including the difference between standard and investigational treatments.
  10. Demonstrate sensitivity to the personal, cultural, and religious values that influence patients’ medical decisions in the context of the wide spectrum of neurological conditions, including end-of-life issues.
  11. Promptly attend case conferences and didactic sessions. 

Systems-Based Practice

Goals
 
The resident recognizes that he/she is part of a large and intricate health system that has implications for his/her ability to care for patients and impacts upon his/her patients’ human needs and financial resources.
 
Objectives
The resident will

  1. Learn how to manage the time pressures of outpatient practice while delivering tertiary-level care. 
  2. Learn how to perform efficient outpatient evaluations and appropriately utilize ancillary services. 
  3. Become proficient in the use of the UW Epic electronic record and the VA CPRS systems.
  4. Learn how the health care system functions, especially as relevant to the patient with neurologic disease. 

Inpatient core clinical training in Child Neurology

Pediatric Neurology Rotation Wards/Consults

Patient Care

Goals

  1. Gather essential and accurate information necessary to provide comprehensive care to pediatric patients with neurological disorders.
  2. Demonstrate effective and appropriate clinical problem solving skills using evidence-based medical knowledge and sound clinical judgment.
  3. Recognize the ethical, personal and social implications of many neurological diagnoses as well as the issues surrounding predictive testing and interventions for individuals with severe disabilities and their families.
  4. Provide care to pediatric patients of varying ages and develop skills necessary to provide longitudinal care throughout the lifespan.
  5. Develop competence at inpatient and intensive-care management for a variety of pediatric neurological conditions.  In addition, the resident will respond to consultation requests from the UW-ER and develop skills at triaging patients to the general or one of subspecialty services.
  6. The residents will increase their knowledge of the pathophysiology of common neurologic conditions in hospitalized children and will understand how to diagnose and treat these conditions.  Additionally, they will be comfortable providing family-centered care in an interdisciplinary setting. 

Objectives
The resident will

  1. Develop basic competence in the medical care of children with neurologic disease, and will begin to work on finer points such as improving patient safety, cost-effectiveness of care, and transitioning the patient to outpatient care.  
  2. Supervise the junior pediatric residents and medical students and both create and direct the care plan for the patient (under the guidance of the supervisory faculty member). 
  3. Learn how to relate radiology results to the clinical diagnosis and proper management of patients with all manner of neurologic disease.
  4. Describe and explain the etiology, symptoms, pathophysiology, treatment options (with risks and benefits) and prognoses of common neurological diseases in childhood and their differential diagnosis.
  5. Acquire competency in performing physical examinations of infants and children.
  6. Learn to recognize abnormal patterns of neurodevelopment.
  7. Learn to interpret neuro-diagnostic studies in infants and children.
  8. Learn to diagnose and manage neurological emergencies in children.
  9. Develop effective interactions with consulting services and ancillary staff.
  10. Acquire effective practice management skills.
  11. Learn to take a personal initiative in self-education (including pursuing recent literature) and demonstrate an investigatory and analytic thinking approach to clinical situations.  This encompasses reading textbooks as well as review of recent scientific literature. 
  12. Gather and document essential and accurate information in medical interviews, including relevant illness, past medical, family, social, diet, and developmental history.
  13. Perform and document complete physical and neurologic examinations in children of all ages, including developmental assessments.
  14. Develop thoughtful and appropriate assessments and plans of care utilizing the principles of evidenced-based decision making and problem solving.
  15. Facilitate timely evaluation and management of care plans.
  16. Provide vigilant and appropriate monitoring of the clinical and neurologic status of hospitalized patients including:
    1. Appropriate use of non-invasive monitoring (continuous video EEG).
    2. Careful data collection and synthesis.
    3. Frequent neurologic exam assessment.
    4. Responsiveness to patient, parent, and nursing concerns.
    5. Appropriate nutrition, activity and medication orders.
    6. Prompt identification of and response to changes in patient condition and critically ill   patients.
  17. Order and interpret labs and studies commonly used in inpatient pediatric neurology patients, taking into account age-related normal values.
  18. Use the electronic medical record to facilitate optimal patient care by:
    1. Updating permanent parts of the medical record (including problem lists).
    2. Writing timely daily notes that convey the thought process involved in patient  management decisions and can be easily interpreted by those reading the medical record.
    3. Ensuring that the medical record reflects the current situation for each patient (creating addendums to the daily note and entering event notes)
  19. Effectively counsel patients and families by:
    1. Sharing information about illness and treatment.
    2. Encouraging involvement in patient care and clinical decisions.
    3. Preparing patients and families for discharge.
    4. Utilizing educational resources for patients and families.
  20. Facilitate smooth transitions of patient care
    1. Obtain information from and communicate with referring providers.
    2. Discuss management and hospital course with primary care provider.
    3. Provide thorough and appropriate sign-out to covering residents.
    4. Ensure continuity for in-hospital transfers (communicate with other providers/services both verbally and in writing).
  21. Facilitate appropriate discharge planning (orders and medication reconciliation, patient education including specific and meaningful verbal and written discharge instructions, scheduled follow-up appointments).

Medical Knowledge

Goals

  1. Develop self-directed learning skills essential to the maintenance of expertise in Child Neurology.
  2. Use internet and printed resources including primary and secondary literature, relevant texts and published databases to acquire, critically evaluate, and use current knowledge regarding diagnostic test availability and applicability, natural history, and management of each disorder with which inpatients and clinic patients are diagnosed.
  3. The resident will develop an adequate knowledge base in Child Neurology and the neurosciences.
  4. The resident will continue to learn how the health care system functions, especially as relevant to the pediatric patient with neurologic disease. 

Objectives
The resident will

  1. Develop competence in basic neurologic knowledge and will begin to attain a sophisticated and deep knowledge base in child neurology and the neurosciences. 
  2. Describe and explain the etiology, symptoms, pathophysiology, treatment options (with risks and benefits) and prognoses of common neurological diseases in childhood and their differential diagnosis.
  3. Acquire competency in performing physical examinations of infants and children.
  4. Learn to recognize abnormal patterns of neurodevelopment.
  5. Learn to Interpret neuro-diagnostic studies in infants and children.
  6. Learn to diagnose and manage neurological emergencies in children.
  7. Develop effective interactions with consulting services and ancillary staff.
  8. Acquire effective practice management skills.
  9. Learn to take a personal initiative in self-education (including pursuing recent literature) and demonstrate an investigatory and analytic thinking approach to clinical situations.  This encompasses reading textbooks as well as review of recent scientific literature.  

Interpersonal and communication skills

Goals

  1. Demonstrate interpersonal and communication skills that result in information exchange and partnering with patients, their families and professional associates.
  2. Residents will become skillful listeners, and develop specific proficiency in communicating with pediatric neurologic patients through non-verbal means and with their care providers. 
  3. Residents will learn to communicate rapidly and efficiently with other team members in order to ensure that proper therapies can be provided in a timely manner. 
  4. Residents will learn to clearly communicate neurological assessments and plans to patients and their parents, and members of the multidisciplinary care team.  

Objectives
The resident will

  1. Continue to master skill at interpersonal communication and will not only demonstrate professional and ethical practice of medicine, but help more junior residents to foster their professionalism. 
  2. Supervise the junior pediatric residents and medical students and both create and direct the care plan for the patient (under the guidance of the supervisory faculty member). 
  3. Master teaching skills. 
  4. Effectively communicate in a timely manner with fellow residents, medical students, attending physicians, consulting and transferring services, primary care providers, nurses, ancillary staff members, patients and families.
  5. Facilitate safe and efficient patient care via complete but concise presentations (on rounds, when discussing care with consultants, when signing out to co-residents).
  6. Appropriately utilize the electronic medical record as a communication tool.
  7. Collaborate with case management and nursing to ensure efficient and appropriate discharge plans.
  8. Provide effective education, including reassurance, for conditions commonly seen on the inpatient service.
  9. Effectively interact with children in a manner that is appropriate for their age/developmental level and promotes comfort and understanding.
  10. Communicate with parents/caregivers/families by establishing rapport, inspiring confidence and trust and keeping them informed and involved in clinical care decisions.
  11. Demonstrate sensitivity to and respect for patients and families beliefs, religion, ethnicity, and cultural values.
  12. Ensure continuity of care by communicating effectively with primary care providers both verbally and through timely, appropriately detailed written discharge summaries.
  13. Accept and provide feedback willingly. 

Professionalism

Goals

  1. Demonstrate continuing commitment to carrying out professional responsibilities, adherence to ethical principles, and sensitivity to diversity.
  2. Learn ethical, regulatory, and legal aspects of pediatric neurologic care, including the difference between standard and investigational treatments. 
  3. Demonstrate sensitivity to the personal, cultural, and religious values that influence patients’ and parents’/caregivers’ medical decisions in the context of neurologic disease.
  4. Demonstrate responsiveness to patient needs that supersedes self interest.
  5. Demonstrate compassion, integrity, accountability and respect in all interactions with patients from diverse backgrounds in gender, age, culture, race, religion, physical and cognitive ability and sexual orientation.
  6. Adhere to ethical principles by respecting confidentiality of medical information 

Objectives
The resident will

  1. Place patient needs paramount; always act in the best interest of the patient.
  2. Demonstrate personal accountability for the well being of patients (following up lab results, writing comprehensive notes, seeking answers to patient care questions).
  3. Work collaboratively and cooperatively as a member of a health care team, demonstrating a commitment to professional behavior in interactions with staff and professional colleagues.
  4. Demonstrate reliability, responsibility, and respect for patients and families, including appropriate verbal and nonverbal communication.
  5. Arrive on time for scheduled activities and appointments.
  6. Demonstrate a commitment to professional responsibilities, even during periods of stress, by:
    1. making a personal commitment to a respectful workplace;
    2. working collaboratively with other members of the health care team;
    3. engaging in self-assessment; and
    4. accepting external scrutiny to maintain professional standards.
  7. Adhere to ethical and legal principles. 

Practice-Based Learning and Improvement

Goals

  1. Demonstrate knowledge, skills and attitudes needed for continuous self-assessment, using scientific methods and evidence to investigate, evaluate, and improve one’s patient care practice.
  2. Identify opportunities for improvement 

Objectives

  1. Regularly utilize the available medical literature to make evidence-based decisions in patient care by:
    1.  Formulating pertinent clinical questions.
    2.  Retrieving and critically appraising relevant up-to-date information.
    3.  Applying that information to inform clinical decisions.
  2. Observe and provide feedback to students and junior residents about history and exam skills, discussing cases seen together, and writing orders together.
  3. Identify personal learning needs, systemically organize relevant information resources for future reference and plan for continuing acquisition of knowledge and skills.
  4. Incorporate evaluation feedback into daily practice.
  5. Read, analyze and critique journal articles.
  6. Systematically review clinical outcomes in order to contribute to the body of knowledge in pediatric neurology. 

Systems-Based Practice

Goals

Understand how to practice high quality health care and advocate for patients within the context of the health care system.
 
Objectives
The resident will

  1. Learn how he/she can best utilize the health care system for the welfare of his/her pediatric patients with acute and chronic neurologic conditions.
  2. Identify key aspects of health care systems, cost control, billing, and reimbursement in the inpatient setting.
  3. Demonstrate sensitivity to the cost of providing inpatient care and resource allocation, take steps to minimize costs without compromising quality of care.
  4. Take steps to avoid medical errors by recognizing the limits of one’s knowledge and expertise; work with the health care team to recognize and address systems errors.
  5. Understand the value of appropriate use of laboratory and radiographic testing, as well as their limitations. 

Outpatient core clinical training in Child Neurology

OUTPATIENT CLINICS, RESIDENT CONTINUITY CLINIC
PEDIATRIC NEUROLOGY, METABOLIC GENETICS, DEVELOPMENTAL PEDIATRICS, CHILD PSYCHIATRY, REHABILITATION
 
Patient Care

Goals

  1. Gather essential and accurate information necessary to provide comprehensive care to pediatric patients with neurologic, neurometabolic, neurodevelopmental and psychiatric disorders and their families.
  2. Demonstrate effective and appropriate clinical problem solving skills using evidence-based medical knowledge and sound clinical judgment.
  3. Recognize the ethical, personal and social implications of many diagnoses as well as the issues surrounding predictive testing and interventions for individuals with severe disabilities.
  4. Provide care to pediatric patients of varying ages to develop skills necessary to provide longitudinal care throughout the lifespan.
  5. Develop mature clinical judgment through progressively independent patient care commensurate with the resident’s ability,
  6. Demonstrate increasing ability to independently assess, make decisions, counsel families and medically manage patients, under the supervision of the attending physician.
  7. Help patients and families make informed decisions about diagnostic and therapeutic interventions based on patient and family preferences and personal health goals, up-to-date scientific evidence, risk-benefit analysis and clinical judgment.    
  8. Identify and develop one or more areas of clinical expertise that lead to diagnosis-specific referrals and/or directed clinic scheduling.
  9. Develop knowledge about the principles and practice of Pediatric Rehabilitation for patients with neurologic and neurodevelopmental disorders. 

Objectives

  1. Identify issues of concern on the part of the patient or family and referring physician for each patient seen in clinic.
  2. Obtain a complete 3 generation family history and generate an accurate pedigree for each patient.
  3. Obtain a complete medical history by reviewing the medical record and interviewing the patient or family, with particular attention to issues related to the presenting concern, for each patient seen in clinic.
  4. Perform a general physical examination and a detailed neurological  exam on each patient seen in clinic and accurately describe findings.
  5. Order state of the art diagnostic (neurolphysiologic, neuroimaging, biochemical, cytogenetic, and molecular) tests appropriate for each patient’s clinical presentation and interpret their results in that clinical context.
  6. Develop and apply medical management plans based on knowledge of the natural history of the disorder with which each patient is diagnosed.
  7. Respond appropriately to reports of biochemical abnormalities detected on newborn screening.
  8. Manage patients with metabolic disorders under faculty supervision.
  9. Educate patients and families regarding natural history, recurrence risk, the utility of biochemical, molecular or cytogenetic testing, management options for each diagnosis, the availability of community support, and printed and internet resources for further support and education.
  10. Counsel patients and families to take measures needed to optimize health and function, to prevent disease and injury and to participate actively in their care.
  11. Recognize the limits of his or her expertise and make appropriate use of colleagues, faculty, other consultants and referrals.
  12. As level of training increases, see all patients independently, present findings, impressions and plans for further diagnostic assessment and management to the supervising physician before his or her subsequent assessment of the patient.
  13. Have primary responsibility for patient education and counseling, under faculty supervision.
  14. Give patient concerns and perspectives priority in counseling and decision making unless they clearly and directly conflict with medical care needs in a manner that is likely to have a significant impact on the patient’s well-being.
  15. Deliver painful and sad news to patients and families in a compassionate and supportive manner.
  16. Provide accurate, up-to-date and evidence based information to patients and families in a nondirective manner and empower them to make informed decisions, interpret risk assessments, and determine the value of predictive testing for themselves and family members.
  17. Guide patients and families in a nondirective manner as they consider difficult ethical dilemmas related to the diagnosis in their family, the use of appropriate testing, and management options.
  18. Develop collegial relationships with other physicians and scientists who work in the selected area(s) of expertise.
  19. Residents will learn the basic skills in the diagnosis, evaluation, and management of patients with cerebral palsy, neuromuscular disorders, head and spinal cord injury and other neurologic disorders requiring rehabilitation.
  20. Residents will learn the different testing tools and treatment options available for pediatric patients with neurologic disease and associated disabilities.
  21. Residents will learn to perform botox injections, program baclofen pumps and use orthotic devices to the benefit of pediatric patients with neurologic disease. 

Medical Knowledge

Goals

  1. Develop self-directed learning skills essential to the maintenance of expertise in Child Neurology, Metabolic/Genetics, Developmental Pediatrics, Child Psychiatry, Neurologic Rehabilitation.
  2. Use internet and printed resources including primary and secondary literature, relevant texts and published databases to acquire, critically evaluate, and use current knowledge regarding diagnostic test availability and applicability, natural history, and management of each disorder with which clinic patients are diagnosed.
  3. Further develop skills necessary to search for, identify and critically consider rare disorders in the differential diagnosis for patients assessed in clinic. 

Objectives

  1. Know and apply the basic and clinically supportive sciences which are appropriate to Pediatric Neurology.
  2. Be able to perform a complete neurologic examination on children of all ages, including behaviorally/developmentally/cognitively challenged patients. 
  3. Develop specific knowledge base of metabolic and inherited basis of diseases relevant to child neurology and the basic aspects of genetic counseling of inherited diseases.
  4. Learn specific techniques, such as utilization of the latest molecular modalities available for diagnosis of diseases relevant to child neurology, obtaining genetic history, counseling genetic diagnoses.
  5. Develop specific knowledge base of psychiatric diseases relevant to child neurology and the ability to recognize and manage psychiatric disorders that may have neurological manifestations and vice versa. Specifically, residents should also become familiar with the principles and practice of psychopharmacology.
  6. Learn to obtain a psychiatric history.
  7. Develop specific knowledge base of developmental and psychiatric diseases relevant to child neurology and the ability to recognize and manage developmental disorders that may have neurological manifestations and vice versa. Specifically, residents should also become familiar with the principles and practice of psychopharmacology as it pertains to developmental disorders.
  8. Develop basic understanding of instruments used for neuropsychiatric and neuroeducational testing. Learn to obtain detailed developmental and behavioral history.
  9. Recognize presenting clinical features of the disorders most frequently encountered in the Child Neurology clinic and understand their natural histories.
  10. Identify syndromic and nonsyndromic causes of common, usually isolated congenital anomalies.
  11. Recognize presenting clinical and laboratory features of complex metabolic disorders.
  12. Attend and participate in Neurology and Child Neurology conferences including research seminars and relevant problem conferences and grand rounds.
  13. Attend and participate in Medical Genetics, Child Psychiatry and Developmental Pediatrics conferences including case conference, journal club, didactic sessions.
  14. Lead two major topic discussions in journal club.
  15. Present a Child Neurology topic for one core conference for Neurology and Child Neurology residents.
  16. Identify presenting clinical features of rare neurologic, neurometabolic and neurodevelopmental disorders and understand available information regarding their natural histories and management.
  17. Enhance case conference presentations with literature references relevant to the diagnostic or management issue of interest to the presentation.
  18. Assemble and present lectures on topics related to the selected area(s) of interest to appropriate audiences.
  19. Residents will demonstrate an understanding of the principles and methods of pediatric neurorehabilitation.
  20. Basic knowledge with regard to the clinical course, diagnostic criteria, and management principles of neurologic disabilities will be obtained through clinical interactions, didactic teaching, and background reading which should occur in a patient-specific fashion. 

Practice based learning and improvement:

Goals

  1. Use skills acquired during primary residency training (pediatrics, neurology) as an initial foundation for medical and ethical decision making.
  2. Identify opportunities for improvement in the delivery and quality of patient care
  3. Bring developing knowledge and technology into practice in a responsible manner
  4. Identify opportunities for improvement in the delivery and quality of patient care and work to bring those into practice 

Objectives

  1. Use relevant clinical information resources (PubMed, OMIM, guidelines of the ANA and AAN).
  2. Incorporate evaluation feedback into daily practice.
  3. Systematically review clinical practices and make changes intended to improve quality and effectiveness of care.
  4. Systematically review clinical outcomes in order to contribute to the body of knowledge in Child Neurology.
  5. Apply knowledge gained from literature reviews, meetings and conferences to the improvement of clinical practices.
  6. Read, analyze and critique journal articles relevant to patient care.
  7. Attend and participate in Neurology, Genetics, Psychiatry and Pediatrics conferences including research seminars, relevant problem conferences, and grand rounds.
  8. Attend and participate in Child Neurology conferences including case conference, journal club, relevant colloquium sessions, didactic conferences.
  9. Participate in education of other trainees including medical students and residents in other disciplines as they do electives in Child Neurology.
  10. Present a Child Neurology topic for one core conference for pediatrics residents.
  11. The resident will be responsible for tracking the number and diagnoses of patients seen and number of tests and procedures performed. 
  12. Cases must be entered into the web-based MedHub Case Log.  These data will be used to ensure that an adequate educational experience is obtained in Child Neurology, Child Psychiatry, Developmental Pediatrics, Medical Genetics and Pediatric Neurorehabilitation.  These data can also be used by the resident in their 6-month self-evaluation (in conjunction with in-service scores) to direct further study. 

Professionalism

Goals

  1. Demonstrate a commitment to ethical principles pertaining to provision or withholding of clinical care, confidentiality of patient information, informed consent, and business practice.
  2. Demonstrate a commitment to carrying out professional responsibilities, adherence to ethical principles, and sensitivity to a diverse patient population.
  3. During all patient encounters demonstrate caring and respectful behavior.
  4. Demonstrate respect for patient autonomy

Objectives
Residents will

  1. Show respect, compassion, integrity, commitment to excellence and on-going   professional development. The highest standards of professionalism must be maintained at all times.
  2. Demonstrate sensitivity and responsiveness to patients and their families, culture, age, gender, and disabilities.
  3. Respond in a timely and courteous manner to pages, calls, and patient inquiries.
  4. Respectfully adhere to clinic schedules to minimize patient inconvenience.
  5. Document all patient encounters in a complete, timely and accurate manner.
  6. Undergo HIPAA training and comply with HIPAA rules and ethical principles regarding privacy and confidentiality of personal health information.
  7. Integrate into the medical interview questions that provide insight into the patients’ and families’ decision making practices and their perspectives on sensitive and relevant clinical issues.
  8. Adhere to ethical principles pertaining to the provision or withholding of care, informed consent, conflict of interest, and business practices 

Interpersonal and Communication Skills

Goals

  1. Communicate effectively with physicians and other health providers and agencies
  2. Work effectively as a member of a health care team which also includes clinic coordinators, other clinic and hospital staff, and other learners.
  3. Communicate effectively with patients, families, and the public (as appropriate) across a broad range of socioeconomic, intellectual and cultural backgrounds.
  4. As clinical experience grows, assume leadership of a health care team. 

Objectives
Residents will

  1. Create and sustain a therapeutic and ethically sound relationship with patients and their families.
  2. Use appropriate listening skills and exchange information using effective nonverbal, explanatory, questioning, and writing skills during all interactions with patients and their families.
  3. Work effectively with other health professionals, including other interdisciplinary teams.
  4. Be responsible for tracking the number of patients, the diagnoses involved, and any complications that occur in these patients.  Cases must also be entered into the UW Hospital and Clinics Neurology Case Log.  These data will be used to ensure that an adequate educational experience is obtained in outpatient pediatric neurology.  These data can also be used by the resident in their 6-month self-evaluation (in conjunction with in-service scores) to direct further study.
  5. Communicate with referring physicians and consultants in other disciplines so that questions prompting referral are clearly understood, and recommendations and management plans are effectively articulated.
  6. Show respect and consideration for all members of the care team at all times.
  7. During patient encounters, accurately determine issues of concern to the patient or family, and successfully help them comprehend the nuances and complexity of the information they are given, regardless of their background.
  8. Deliver emotionally difficult news to patients and families in a sensitive and supportive manner. 

Systems based practice

Goals

  1. Demonstrate cost awareness and cost-benefit analysis in patient care.
  2. Work in inter-professional teams to enhance patient safety and improve quality of patient care.
  3. Make appropriate referrals to community and service resources such as birth-to-three programs, support groups and financial assistance agencies.
  4. Provide care of uniformly high quality within a fiscally constrained environment.
  5. Navigate various health care delivery and financing systems to provide optimal care.

Objectives
Residents are expected to:

  1. Communicate with hospital and laboratory personnel to facilitate adherence to procedures required for processing of samples for diagnostic testing.
  2. Understand, appropriately request exceptions to and otherwise work within restrictions on service provision required by third party payers.
  3. Identify system errors that affect quality of care and work with others toward implementing solutions
  4. Assist patients in their efforts to navigate complex health care systems.
  5. Advocate for improvements in health care delivery systems that will promote health and prevent disease and injury.
  6. Neurorehabilitation is not always approved by insurance companies and appropriate use of testing must be learned.  The resident will learn about how to work within the constraints of our current health care system to provide testing/consultation and treatment in an appropriate fashion.                                

Neuropathology Rotation

Patient Care

Goals
 
Develop understanding of the pathologic basis of neurologic diseases and the clinical manifestations of disease, as well as the potential mechanisms of treatment.
 
Objectives
Residents will…

  1. Gain basic skills in neuropathology.
  2. Learn how to relate pathology results to the clinical diagnosis and proper management of patients with all manner of neurologic disease.
  3. Observe at least one brain extraction from a corpse.
  4. Participate in brain cuttings.
  5. Participate in surgical case evaluations with the attending neuropathologist. 

Medical knowledge

Goals

  1. Become familiar with the gross and microscopic pathologic findings of normal anatomy as well as neurologic diseases.
  2. Become familiar with modern diagnostic pathology techniques (special stains, studies, etc.). 

Objectives
Residents will

  1. Learn to verbally describe and visually distinguish major neoplasms of the CNS and PNS including glial neoplasms (all grades of astrocytomas, oligodendrogliomas), neuroectodermal tumors, ependymal tumors, meningiomas, neuronal tumors and nerve sheath tumors.
  2. Learn to visually identify normal CNS, PNS and muscle slides.
  3. Complete all Clinical Pathologic Cases (CPCs).
  4. Complete at least half of the museum cases.
  5. Evaluate pathologic slides of major neurodegenerative conditions in children and adults (storage disorders, mitochondrial encephalomyopathies, Alzheimer’s Dementia, Parkinson’s Disease). 

Interpersonal and Communication Skills

Goals
 
Residents will learn to communicate rapidly and efficiently with other team members
 
Objectives

  1. Present neuropathological results to faculty succinctly and completely.
  2. Learn to create a concise neuropathological report. 

Practice-Based Learning and Improvement
 
Goals

  1. Communicate succinctly and clearly with other healthcare professionals, with a proper respect for the principles of HIPAA regulations.
  2. Maintain comprehensive, timely, effective and legible medical records. 

Objectives
The resident will

Be responsible for tracking the number and diagnoses of pathology cases seen during this rotation. Cases must be entered into the web-based Case Log. These data will also be used to ensure that an adequate educational experience is obtained. These data will be reviewed with the program director during 6-month self-evaluation to direct further study.
 
Professionalism

Goals
 
Demonstrate continuing commitment to carrying out professional responsibilities, adherence to ethical principles, and sensitivity to diversity.
 
Objectives
The resident will

  1. Promptly attend case conferences.
  2. Dress in appropriate attire unique to the pathological suite and present himself or herself in a professional manner at all times.
  3. Document duty hours, and notify the Program Director immediately if there are any situations that could put the resident in violation of work hours restrictions. 

Systems-Based Practice

Goals

Understand how to benefit from Neuropathology services in the context of the health care system.
 
Objectives
Residents will learn the systems issues unique to ordering, the performance of, and reporting results of pathologic tests.
 
Neurosurgery Rotation

Patient Care

Goals

  1. Give child neurology resident a basic working knowledge of the surgical management of diseases of the nervous system, which is essential to the neurologist-in-training.  The neurologist must be aware of indications for, limitations of, and possible complications of surgical treatment if they are to make appropriate referrals and counsel their patients wisely. 
  2. Give child neurology residents a concentrated patient care experience with exposure to patients with neuro-oncological conditions.
  3. Give the child neurology resident learning opportunities to manage patients with neurological disease who require intensive care. 

Objectives
The resident will

  1. Develop skills of history-taking and examining patients with neurosurgical diseases.
  2. Develop skill in discussing end-of-life issues with patients with neuro-oncological diseases.
  3. Become proficient in the management of patients with disorders of intracranial pressure. 

Medical Knowledge

Goals

  1. Develop self-directed learning skills.
  2. Use internet and printed resources including primary and secondary literature, relevant texts and published databases to acquire, critically evaluate, and use current knowledge regarding diagnostic test availability and applicability, natural history, and management of neurosurgical patients.
  3. The resident will develop an adequate knowledge base in neurosurgery. 

Objectives
The resident will

  1. Attend clinical conferences and didactic sessions.

  2. Read selected works during the rotation.
  3. Learn the neuro-radiographical appearance of neurosurgical trauma and oncology.
  4. Learn the indications for surgical intervention in patients with neurovascular disorders. 

Interpersonal and Communication Skills

Goals
Communicate effectively and concisely with other health care providers, the patients and the patient’s family.
 
Objectives
The resident will

  1. prepare concise clinical notes and discharge summaries for patients under his/her care.
  2. Present patient clinical information to faculty and other residents in a concise orderly manner. 

Practice-based Learning and Improvement
 
Goals

  1. Demonstrate knowledge, skills and attitudes needed for continuous self-assessment, using scientific methods and evidence to investigate, evaluate, and improve one’s patient care practice.
  2. Identify opportunities for improvement. 

Objectives
The resident will

  1. Enter all patient encounters into the electronic patient log to be reviewed with the program director at the semi-annual evaluation.
  2. Attend and participate in Neurosurgical Morbidity and Mortality Conference.
  3. Identify personal learning needs, systemically organize relevant information resources for future reference and plan for continuing acquisition of knowledge and skills.
  4. Incorporate evaluation feedback into daily practice.
  5. Read, analyze and critique journal articles. 

Professionalism
 
Goals

  1. Demonstrate commitment to carrying out professional responsibilities, adherence to ethical principles, and sensitivity to diversity.
  2. Learn ethical, regulatory, and legal aspects of neurosurgical care, including the difference between standard and investigational treatments. 
  3. Demonstrate sensitivity to the personal, cultural, and religious values that influence patients’ and parents’/caregivers’ medical decisions in the context of neurologic disease.
  4. Demonstrate responsiveness to patient needs that supersedes self interest.
  5. Demonstrate compassion, integrity, accountability and respect in all interactions with patients from diverse backgrounds in gender, age, culture, race, religion, physical and cognitive ability and sexual orientation.
  6. Adhere to ethical principles by respecting confidentiality of medical information. 

Objectives
The resident will

  1. Promptly attend clinical conferences, clinics and patient care rounds.
  2. Dress in appropriate attire unique to the neurosurgical service and present himself or herself in a professional manner at all times.
  3. Document duty hours, and notify the Neurology Residency Program Director immediately if there are any situations that could put the resident in violation of work hours restrictions.
  4. Work collaboratively and cooperatively as a member of a health care team, demonstrating a commitment to professional behavior in interactions with staff and professional colleagues.
  5. Demonstrate reliability, responsibility, and respect for patients and families, including appropriate verbal and nonverbal communication. 

Systems-based practice
 
Goals
The resident recognizes that he/she is part of a large and intricate health system that has implications for his/her ability to care for patients and impacts upon his/her patients’ human needs and financial resources.
 
Objectives
The resident will

  1. Learn to function as an integral member of the neurosurgical team.
  2. Understand the limitations of surgical intervention for a variety of neurological issues.

Nightfloat Rotation

Patient Care
 
Goals

  1. Provide emergency care to adult and pediatric patients with acute onset neurological problems.
  2. Provide consultative services and other inpatient services.
  3. Develop independence in clinical decision making.

Objectives
The resident will

  1. Develop skills of history-taking and examining patients with neurological disease.
  2. Become adept at triaging consultations and admissions, focusing care on the most acutely ill patients.
  3. Become proficient at managing acute clinical changes in patients under the care of the neurology services, especially the unique challenges of sundowning patients, patients who suffer an acute stroke or acute seizure.
  4. Develop skills of arranging follow up care for patients seen in the ER that require further neurological evaluation or treatment.
  5. Ensure that patient calls to the after-hours line are answered in a timely manner. 

Medical knowledge

Goals

  1. Develop self-directed learning skills essential to the maintenance of expertise in Neurology.
  2. Use internet and printed resources including primary and secondary literature, relevant texts and published databases to acquire, critically evaluate, and use current knowledge regarding diagnostic test availability and applicability, natural history, and management of each disorder with which clinic patients are diagnosed.
  3. The resident will develop an adequate knowledge base in neurology and the neurosciences.
  4. The resident will continue to learn how the health care system functions, especially as relevant to the patient with neurologic disease. 

Objectives
The resident will

  1. Keep up on reading the same material required of all residents for Wednesday Book Club, although the night float resident will not be physically present for the session.
  2. Attend the clinical and didactic conferences. 

Interpersonal and Communication Skills
 
Goals

  1. Residents will become skillful listeners, and develop specific proficiency in communicating with neurologic patients through non-verbal means. 
  2. Residents will learn to communicate rapidly and efficiently with other team members in order to ensure that proper therapies can be provided in a timely manner. 
  3. Residents will learn to clearly communicate neurological assessments and plans to patients, their families, and members of the multidisciplinary care team.  They will become specifically proficient in discussing end of life care.

Objectives
Residents will

  1. Become adept at presenting patients to faculty concisely and completely, typically via telephone.
  2. Become proficient at communicating clearly with the consulting services.
  3. Learn efficient dictating skills so that consulting and inpatient care team services have immediate access to documentation on all patients.
  4. Continue to develop the skills of teaching basic neurological skills and knowledge to the rotating medical students. 

Practice-Based Learning and Improvement 
 
Goals

  1. Use skills acquired during primary residency training as an initial foundation for medical and ethical decision making.
  2. Identify opportunities for improvement in the delivery of quality of patient care. 

Objectives
The resident

  1. Will log all patient encounters into the electronic patient log to be reviewed with the program director at the semi-annual evaluation.
  2. Incorporate evaluation feedback into daily practice. 

Professionalism
 
Goals

  1. Residents will learn ethical, regulatory, and legal aspects of neurologic care, including the difference between standard and investigational treatments. 
  2. They will demonstrate sensitivity to the personal, cultural, and religious values that influence patients’ medical decisions in the context of neurologic disease, and a compassionate approach to end of life care.
  3. They will demonstrate responsiveness to patient needs that supersedes self interest.
  4. Demonstrate compassion, integrity, accountability and respect in all interactions with patients from diverse backgrounds in gender, age, culture, race, religion, physical and cognitive ability and sexual orientation.
  5. They will adhere to ethical principles by respecting confidentiality of medical information.

Objectives
Residents

  1. Must remember that they represent the University of Wisconsin’s Department of Neurology with all of their actions and communications.  The highest standards of professionalism must be maintained at all times, in interactions with patients and their families, allied health care workers and with other physicians.
  2. Will be responsible for tracking duty hours and logging them in the electronic record, and notify the program director of any situation that could put the resident in violation of work hours restrictions. 

Systems-Based Practice
 
Goals
The resident recognizes that he/she is part of a large and intricate health system that has implications for his/her ability to care for patients and impacts upon his/her patients’ human needs and financial resources.
 
Objectives
The resident…

  1. Will be responsible for patients with a variety of neurological conditions ranging from chronic to emergent.
  2. Is required to make efficient and cost-effective use of the limited ancillary services available after hours.
  3. Is required to triage and prioritize consultation requests.
  4. Should recognize situations in which the help and expertise of a back up resident is needed, and call for that backup assistance without delay.                                            

ELECTIVES

Headache Clinic
 
Patient Care
 
Objectives

  1. Excellent training and exposure to various headache and pain syndromes and appropriate management techniques.
  2. Learn and develop skills in diagnosis and management of patients with headache syndromes. The supervising attending physicians will evaluate clinical competence at the end of the rotation in the electronic evaluation. 

Medical Knowledge
 
Goals
Residents will acquire knowledge in different aspects of the headache medicine through background reading, review of the relevant literature in the course of evaluation of specific patients, and interaction with the Headache clinic staff physicians.
 
Objectives

  1. Resident will be able to identify, properly classify, and understand treatment approaches to primary headache disorders.
    1. Migraine (with and without aura)
    2. Tension-type headache
    3. Cluster headache and other trigeminal autonomic cephalgias.
  2. Resident will be able to identify history and physical exam red flags that are characteristic of secondary headache disorders, and the appropriate steps to evaluate these headaches.
  3. Resident will be able to identify chronic daily headache syndromes, and establish appropriate treatment plans for management of these syndromes including:
    1. Medication overuse headache
    2. Transformed chronic  migraine
    3. Chronic tension-type headache
    4. Hemicrania continua
    5. New daily persistent headache (NDPH).
  4. Resident will be able to identify situations in which neuroimaging and diagnostic testing is warranted for headache evaluation.
  5. Resident will be able to identify treatment approaches available for status migrainosus.
  6. Resident will understand the indications, risks and benefits, side effects, and monitoring required for commonly used headache medications, including but not limited to:
    1. Beta Blockers
    2. Tricyclic antidepressants
    3. Antiepileptic medications including topiramate, valproic acid, and gabapentin
    4. Calcium channel blockers
    5. NSAIDS
    6. Combination abortive medications
    7. Triptans
    8. SSRIs
    9. Supplements/Herbals including magnesium, riboflavin, Co-enzyme Q10, feverfew, and butterbur.
  7. Resident will be able to identify indications for re-evaluation of patient with a chronic history of headaches.
  8. Resident will gain exposure to alternative treatments for headaches, including chemodenervation, trigger point injections, physical therapy, and cognitive behavioral therapy.

Practice-based Learning and Improvement
 
Goals
Identify opportunities for improvement in the delivery of quality of patient care.
 
Objectives

  1. Patient encounters will be logged in the resident Patient Log for review with the Program Director. 
  2. Residents will receive frequent feedback from staff physicians working with them. Learning and improvement goals will be periodically reviewed.
  3. Residents will incorporate all available learning sources, including information technology to optimize their learning of all aspects of headache treatment. 

Interpersonal and Communications Skills
 
Goals

  1. Residents will become skillful listeners, and develop specific proficiency in communicating with patients with headache syndromes. 
  2. Residents will learn to communicate rapidly and efficiently with other team members in order to ensure that proper therapies can be provided in a timely manner. 
  3. Residents will learn to clearly communicate neurological assessments and plans to patients, their families, and members of the multidisciplinary care team.  

Objectives
Residents will

  1. Demonstrate professional, effective interpersonal and communication skills when communicating with supervising physicians, other health care providers, patients and families.
  2. Maintain comprehensive and timely medical records.
  3. Their communication skills will be periodically assessed by supervising staff physicians.

Professionalism
 
Goals

  1. The resident demonstrates integrity, honesty and compassion, empathy and altruism.
  2. The resident acknowledges errors and limitations.
  3. The resident demonstrates responsibility, accountability, dependability, commitment and encourages continuity of care.
  4. The resident exhibits respect for all persons regardless of their cultural, ethnic, religious, and socioeconomic background.
  5. The resident exhibits a commitment to the development of cultural humility.
  6. The resident complies with the regulations set forth by the University of Wisconsin Hospital and Clinics including all training sites. 
  7. Any breaches in professionalism that occur are met with remorse on the part of the resident.  Furthermore, it is expected that the resident will use such breaches as lessons to prevent similar problems in the future. 

Objectives
Residents will demonstrate compassion, integrity, patient privacy and be respectful for patients, their colleagues and other health care providers. Competence in professionalism will be assessed by supervising staff physicians.
 
System-based Practice
 
Goals
The resident recognizes that he/she is part of a large and intricate health system that has implications for his/her ability to care for patients and impacts upon his/her patients’ human needs and financial resources.
 
Objectives
Residents will

  1. Coordinate optimal diagnostic evaluations and patient management with cost awareness within the available health care delivery systems. 
  2. Learn to utilize available resources for patients with headaches. 
  3. Advocate for quality patient care and work with other health care professionals to enhance patient safety. Competence in system-based medicine will be evaluated by staff physicians.                                                            

Neuroradiology (elective)

Patient Care
 
Goals
Develop the ability to properly interpret neuroradiologic studies and correlate with clinical neurologic findings.
 
Objectives
The resident will

  1. Learn how to relate radiology results to the clinical diagnosis and proper management of patients with all manner of neurologic disease.
  2. Become independent in his or her ability to interpret neuroradiologic studies. 

Medical knowledge

Goals

  1. Develop a methodological approach to film interpretation and understand the limitations of each imaging technique.
  2. Generate appropriate differential diagnoses from the findings. 

Objectives
Residents will

  1. learn the basic physics of neuroimaging, especially CT and MRI.  Normal imaging as well as pathological abnormalities will be emphasized.
  2. Methodically evaluate neuroradiologic studies and identify all pertinent findings.
  3. Generate appropriate differential diagnoses based upon neuroradiologic findings. 

Interpersonal and Communication Skills
 
Goals
Demonstrate interpersonal and communication skills that result in information exchange and partnering with patients, their families and professional associates.
 
Objectives
Residents will learn what constitutes an accurate radiology report of findings.  While neurology residents are not expected to prepare radiology reports, they should be familiar with the structure of such reports.
 
Practice-Based Learning and Improvement
 
Goals

  1. Demonstrate knowledge, skills and attitudes needed for continuous self-assessment, using scientific methods and evidence to investigate, evaluate, and improve one’s patient care practice.
  2. Identify opportunities for improvement. 

Objectives
The resident will be responsible for tracking the number and diagnoses of radiology cases seen during this rotation. Cases must be entered into the electronic patient log.  These data will also be used to ensure that an adequate educational experience is obtained.
 
Professionalism
 
Goals
Demonstrate continuing commitment to carrying out professional responsibilities, adherence to ethical principles, and sensitivity to diversity.
 
Objectives
Residents will

  1. Act in a professional manner while interacting with radiology faculty and staff.
  2. Be responsible for tracking duty hours via the electronic monitoring system. 

Systems-Based Practice
 
Goals
Understand how to practice high quality health care and advocate for pediatric patients with neurologic disease within the context of the health care system.
 
Objectives
Residents will

  1. Learn the systems issues related to ordering, performance, and reporting results of radiologic tests. 
  2. Learn how to most effectively work with radiology services to provide effective evaluation and management to their patients.

Research (elelctive)

A written proposal for what is to be accomplished during this elective must be generated prior to starting, such that the resident will gain the experience of designing an experiment. During the elective, the resident will learn and practice the scientific method and rigorous scientific technique while carrying out their project/experiment. Techniques learned may include laboratory skills (molecular and genetic studies, animal experiments, chemical/biochemical experiments, etc.) or clinical research skills (clinical trial methodology, epidemiology, biostatistics, etc.). Ideally, the resident's work will result in authorship on manuscript(s) or abstract(s).  Residents will learn about the informed consent process and develop an understanding of HIPAA’s impact upon clinical research. In accordance with NIH Clinical Research standards, any resident participating in clinical research will be required to participate in Human Subjects Protection training (obtaining a Certificate of Completion for Web Based Course on Protection of Human Research Subjects). 
 
Patient Care
 
Goals
Learn how to contribute to the understanding of the pathophysiology of neurologic disease and/or the development of novel treatments.
 
Objectives
Patient care may be developed in clinical research projects.  Residents will learn to care for patients within the confines of a clinical research study if applicable.
 
Medical knowledge
 
Goals
Build a broad and deep knowledge base in a research topic relevant to the pathophysiology of neurologic disease and/or the development of novel treatments.
 
Objectives
Medical knowledge will be obtained through background literature review in the research topic of interest.  Residents will develop practical knowledge of statistical analysis.
 
Interpersonal Communication
 
Goals
Present scientific data and peer-review, ideally via submission of one abstract or manuscript during the course of training.
 
Objectives
Good communication with other researchers is necessary for collaboration in research.  The resident will learn how to obtain informed consent, enroll the patients, and communicate with regulatory personnel. 
 
Practice-Based Learning and Improvement 
 
Goals
Identify ways to improve scientific practice.
 
Objectives
The resident will be responsible for working with supervisory staff and co-participants in troubleshooting the methods of the proposed research. 
 
Professionalism
 
Goals
The resident will demonstrate ongoing self-education and habits of life-long learning.
 
Objectives
Residents will maintain the highest standards of professionalism, especially in interactions with patients or with other research colleagues.  The resident will be responsible for tracking duty hours and reporting them to the supervisory attending. 
 
Systems-Based Practice
 
Goals

  1. The resident recognizes that he/she is part of a research team.
  2. The resident develops knowledge for regulatory guidelines in basic, translational and clinical research. 

Objectives
Research requires absolute compliance with regulatory guidelines such as HIPAA for patient based research and animal safety regulations for basic science research.  The resident will learn how to complete projects within this regulatory environment.                                                                        

Neuropsychology (elective)

Patient Care
 
Goals
Acquire an understanding of brain-behavior relationships, the proper use of neuropsychological testing in children and the different roles of a clinical neuropsychologist.
 
Objectives
Residents will

  1. Learn the basic skills in the diagnosis, evaluation, and management of patients with neurocognitive and neuropsychiatric diseases.
  2. Learn the different testing tools available for neurocognitive testing in toddlers and children with neurodevelopmental disorders, including autism spectrum disorders and attention deficit hyperactivity disorder. 

Medical knowledge
 
Goals
Learn and understand the various neuropsychological tools available for testing of children of different ages.
 
Objectives
Residents will

  1. Demonstrate an understanding of the principles and methods of neuropsychological testing, especially anatomical localization derived from test results and utility of results in determining neurologic diagnoses.
  2. Obtain basic knowledge with regard to the clinical course, diagnostic criteria, and management principles of these diseases through clinical interactions, didactic teaching, and background reading, with reading to occur in a patient-specific fashion. 

Interpersonal and Communication Skills 
 
Goals
Communicate effectively with patients, families, and the public (as appropriate) across a broad range of socioeconomic, intellectual and cultural backgrounds.
 
Objectives

  1. Residents will become proficient in communicating clearly with patients, families, staff, and colleagues the results of neuropsychological tests. 
  2. Residents will learn the basics of creating comprehensive test reports that will be reviewed by the staff attending.

Practice-Based Learning and Improvement
 
Goals

  1. Bring developing knowledge and technology into practice in a responsible manner.
  2. Identify opportunities for improvement in the delivery and quality of patient care and work to bring those into practice.

Objectives
The resident will be responsible for tracking the number and diagnoses of patients seen and number of tests performed.  Cases must be entered into the web-based  MedHub.  These data will be used to ensure that an adequate educational experience is obtained in neuropsychometric testing.  These data can also be used by the resident in their 6-month self-evaluation (in conjunction with in-service scores) to direct further study.
 
Professionalism
 
Goals

  1. Demonstrate continuing commitment and leadership in carrying out professional responsibilities, adherence to ethical principles, and sensitivity to diversity.
  2. Be familiar with and teach ethical, regulatory, and legal aspects of pediatric neurologic care, including the difference between standard and investigational treatments. 
  3. Demonstrate sensitivity to the personal, cultural, and religious values that influence patients’ and parents’/caregivers’ medical decisions in the context neurologic disease. 

Objectives

  1. The resident must maintain the highest standards of professionalism at all times, especially in interactions with patients and with other health care providers. 
  2. The resident will be responsible for tracking duty hours and reporting them to the supervisory attending.  

Systems-Based Practice
 
Goals

  1. Provide care of uniformly high quality within fiscally constrained environment.
  2. Navigate various health care delivery and financing systems to provide optimal care. 

Objectives
 
Neuropsychometric testing is not always approved by insurance companies and appropriate use of testing must thus be learned.  During this rotation, the resident will learn about how to work within the constraints of our current health care system to provide neuropsychometric testing/consultation in an appropriate fashion.