Introduction and Goals
This is an outpatient clinical rotation that provides the opportunity to focus on neurodegenerative disorders such as Parkinson’s disease, as well as a variety of other movement disorders.
For PGY-2 residents, the goals of this rotation are for the resident to:
- Refine his or her skills in classifying movement abnormalities
- Begin to manage common neurodegenerative disorders, such as Parkinson’s disease
For PGY-3-4 residents, the goals are to:
- Manage neurodegenerative disorders such as Parkinson’s disease in their more advanced stages, including their neuropsychiatric and other complications
- Become familiar with the indications for, and operation of, deep brain stimulators (DBS)
Objectives and Evaluation Matrix
As with all of the neurology rotations, the specific objectives are reflected in the entrustable professional activities and individual milestones listed below. These form the basis for the end-of-rotation evaluation. (Please see the section End-of-Rotation Evaluations above for the list of milestone abbreviations).
|Upon completion of the curriculum, residents will . . .|
|1||Classify the major movement abnormalities such as tremors, tics, chorea, and myoclonus||PC1, PC2, PC4, MK1|
|2||Evaluate and manage idiopathic Parkinson’s disease||PC1, PC2, PC3, PC4, MK1|
|3||Evaluate and manage PD-related motor fluctuations||PC1, PC2, PC3, PC4, MK1|
|4||Articulate the indications and contraindications for deep brain stimulation||PC3, PC4|
|5||Interrogate a patient’s implantable pulse generator and turn it on and off||MK2|
|6||Recognize features suggestive of atypical Parkinsonian disorders||PC1, PC2, PC4, MK1|
|7||Evaluate and manage patients with hyperkinetic movement disorders||PC1, PC2, PC3, PC4, MK1|
|8||Evaluate and manage the cognitive and behavioral complications of neurodegenerative disease||PC1, PC2, PC3, PC4, PC12, MK1, MK2|
|9||Counsel patients and their families regarding their diagnoses, prognoses, and treatment options||SP3, SP4, PR1, IC1|
|10||Participate in interdisciplinary case conferences||SP3, SP4, IC3, IC4|
|Please grade the resident on any of the following milestones you were able to evaluate during this rotation:|
|PL1, PL2, PR2, PR3, IC2|
Below is a sample schedule for this rotation. This schedule is subject to attending availability; accordingly, this elective may not be able to be offered during weeks when multiple attendings are out of clinic (for example, national conference weeks or holidays).
If a resident is interested in observing placement of deep brain stimulator and the role of the neurologist in facilitating this procedure, Dr. Dent is in the OR on some Thursdays. If an OR experience is a desired part of this elective, please discuss with Dr. Dent before selecting it to confirm there is a patient scheduled for surgery that week.
The below schedule can, within certain parameters, be adjusted to address specific resident learning goals for the rotation. If there are specific requests for scheduling, these should be included in the elective request form and sent to Sara Nagel and Sam Engeldinger.
An individualized schedule will be emailed to the resident the week before the rotation.
|Dr. Dent||Dr. Mangin||Dr. Dent (Botox)||Dr. Gallagher (VA Botox)||Dr. Dent|
|Reading/Admin||Dr. Mangin||Reading/Admin||Continuity Clinic||Dr. Shannon|
The estimated number of work hours per week is 32. There is no call responsibility during this rotation.
Fahn, S., Jankovic, J., & Hallett, M. (2011). Principles and practice of movement disorders. Edinburgh: Elsevier.
Miyasaki, J. M., Shannon, K., Voon, V., Ravina, B., Kleiner-Fisman, G., Anderson, K., … Weiner, W. J. (2006). Practice Parameter: evaluation and treatment of depression, psychosis, and dementia in Parkinson disease (an evidence-based review): report of the Quality Standards Subcommittee of the American Academy of Neurology. Neurology, 66(7), 996–1002. doi:10.1212/01.wnl.0000215428.46057.3d
Pahwa, R., Factor, S. A., Lyons, K. E., Ondo, W. G., Gronseth, G., Bronte-Stewart, H., … Weiner, W. J. (2006). Practice Parameter: treatment of Parkinson disease with motor fluctuations and dyskinesia (an evidence-based review): report of the Quality Standards Subcommittee of the American Academy of Neurology. Neurology, 66(7), 983–95. doi:10.1212/01.wnl.0000215250.82576.87
Zesiewicz, T. A., Elble, R., Louis, E. D., Hauser, R. A., Sullivan, K. L., Dewey, R. B., … Weiner, W. J. (2005). Practice parameter: therapies for essential tremor: report of the Quality Standards Subcommittee of the American Academy of Neurology. Neurology, 64(12), 2008–20. doi:10.1212/01.WNL.0000163769.28552.CD
Also, the International Parkinson and Movement Disorder Society has an excellent video library. Access to some of the videos requires a subscription, but many are available for free. If you search for “psychogenic”, you’ll find a bunch of excellent teaching videos: http://www.movementdisorders.org/MDS/Resources/Videos/Video-Library.htm
Latest revision: 05-14-2021