Introduction and Goals
The MS and clinical neuro-immunology elective is an outpatient clinical rotation with the following goals:
PGY-2 residents:
- Identify and classify CNS demyelinating and inflammatory diseases
- Demonstrate working differential diagnosis of the patient with a demyelinating disease and understand distinguishing clinical features
- Know appropriate work-up for major symptoms/syndromes/diseases
PGY-3-4 residents will additionally:
- Be familiar with, and know how to initiate, immunomodulating therapy for MS and related disorders
- Recognize long term complications of treatment modalities
- Demonstrate knowledge of the management of symptoms of MS and chronic disease
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).
| Rotation Objectives | ||
| Upon completion of the curriculum, residents will . . . | ||
| # | Description | Milestones |
| 1 | Explain the diagnostic criteria, including the 2017 McDonald criteria, for clinically isolated syndromes, relapsing-remitting MS, and other forms of the disease | PC8, MK2 |
| 2 | Present a differential diagnosis and plan for evaluation of CNS demyelinating disease and its mimics | PC1, PC2, PC3, PC4, PC8, PC12, MK1, MK2 |
| 3 | Describe the different classes of MS disease modifying therapies and their main side effects | PC4 |
| 4 | Evaluate and manage MS-related symptoms such as spasticity, neuropathic pain, neurogenic bladder, fatigue, etc. | PC1, PC2, PC3, PC4, MK1, MK2 |
| 5 | Counsel patients and their families regarding their diagnoses, prognoses, and treatment options | SP3, SP4, PR1, IC1 |
| 6 | Work with the interdisciplinary team to incorporate patients’ financial and psychosocial situations into their care plans | SP3, SP4, PR1, IC3, IC4 |
| Milestones | ||
| Please grade the resident on any of the following milestones you were able to evaluate during this rotation: | ||
| PL1, PL2, PR2, PR3, IC2 | ||
Schedule
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).
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 the program coordinators. An individualized schedule will be emailed to the resident the week before the rotation.
| Monday | Tuesday | Wednesday | Thursday | Friday | |
| AM | MS | MS | MS | MS | MS |
| Dr. Frost | SELF STUDY | Dr. Luzzio | Dr. Frost | Dr. Luzzio | |
| UW | UW | UW | UW | ||
| PM | MS | MS | MS | MS | MS |
| Dr. Luzzio | Dr. Frost | Continuity Clinic | Dr. Frost | SELF STUDY | |
| UW | UW | UW |
Work Hours
The estimated number of work hours per week is 32. There is no call responsibility during this rotation.
Suggested References
Multiple Sclerosis Review, New England Journal of Medicine 2018, Riech et al. https://www.nejm.org/doi/full/10.1056/NEJMra1401483
The Prevalence of MS in the United States, Neurology 2019, Wallin et al. https://n.neurology.org/content/92/10/e1029
2017 Revisions to the McDonald Criteria, The Lancet Neurology 2017. https://www.thelancet.com/journals/laneur/article/PIIS1474-4422(17)30470-2/fulltext
Differential Diagnosis of Suspected Multiple sclerosis: a Consensus approach, Multiple Sclerosis 2008, Miller et al. https://pubmed.ncbi.nlm.nih.gov/18805839/
Diagnosis and Treatment of Multiple Sclerosis A Review, JAMA Feb 2021, Gineley et al, https://pubmed.ncbi.nlm.nih.gov/33620411/
Radiographically Isolated Syndrome: A Review for Neuroradiologists, American Journal of Neuroradiology August 2020, Hosseiny et al. http://www.ajnr.org/content/early/2020/08/06/ajnr.A6649
The Tension Between Early Diagnosis and Misdiagnosis of Multiple Sclerosis, Nature Reviews Neurology 2017, Solomon and Corboy. https://www.nature.com/articles/nrneurol.2017.106
Cognition in Multiple Sclerosis: State of the Field and Priorities for the Future, Neurology 2018, Sumowski et al. https://pubmed.ncbi.nlm.nih.gov/29343470/
Latest revision: 05-14-2021
