Continuity Clinics

Introduction

Each resident will have outpatient clinical practices at both the University Hospital and the VA. There is one half-day clinic each week, alternating each week between the two sites. In order to achieve the necessary number of half-day clinics each year, additional continuity clinics may be scheduled during neuromuscular and elective rotations.

As regards the issue of keeping up with inbox messages regarding outpatients, we set the following expectations:

• Notes: Should be dictated or written within 24 hours of the patient encounter
• Test results: Should be communicated to the patient or surrogate via MyChart message, letter, phone call, or request for the clinic nurse to phone the patient within 3 days of the result
• Patient queries: Should be answered by one of the above methods within 24 hours of the query

At the UW, residents work under the direct supervision of an attending neurologist, meaning that the attending sees each patient with the resident after the resident completes his or her initial assessment.

At the VA, residents work under indirect supervision with direct supervision immediately available. This means that the attending may or may not see each patient, particularly the well-established ones, but is always in-house to see any patient when clinically indicated. This allows for graded responsibility over time, as residents become more proficient neurologists. Each resident will have a mix of 1-2 new patients and 2-4 follow up patients per clinic, with the numbers starting lower and increasing slightly with experience and efficiency.

Goals

All levels of training: The main goal of the continuity clinics is for residents to learn to provide longitudinal care to patients with a wide variety of neurological diseases, as occurs in a general outpatient practice.

PGY-2 residents: The primary goals for junior residents are to learn how to take a neurologic history, perform a neurologic exam, and formulate cases, including localization and differential diagnosis. Junior residents will begin to learn how to recognize functional disorders.

PGY-3-4 residents: For senior residents, the focus shifts to the development of more robust differential diagnoses, including less common entities. Senior residents are expected to refine their counseling skills regarding “organic” and functional neurological disorders. They are expected to incorporate into their practices health system-related considerations such as cost and distance.

Objectives and Evaluation Matrix

As with all of the individual neurology rotations described in this section, the specific objectives of the continuity clinic are reflected in the entrustable professional activities and individual milestones listed below. These form the basis for the resident’s evaluation, which is completed by his or her clinic attending twice each year. (Please see the section End-of-Rotation Evaluations above for the list of milestone abbreviations).

Schedule

Each resident will be provided his or her own individual schedule, showing the days of the week for the UW and VA clinics. Should the resident need to miss clinic due to illness, there is a phone number to call to inform the staff:

• For UW:
  • Before 6:30 am: 608-890-6750
  • After 6:30 am: 608-516-3648
• For VA: 888-478-8321
  • Cynthia Branch: x17728
  • Joe Peterson: x17858
  • Cathy Gallagher: x17728

Suggested References

Daroff, R. B., & Bradley, W. G. (2012). Bradley’s neurology in clinical practice. Philadelphia, Pa.: Elsevier/Saunders.

Brazis, P. W., Masdeu, J. C., & Biller, J. (2007). Localization in clinical neurology. Philadelphia: Lippincott Williams & Wilkins.

Patten, J. (1996). Neurological differential diagnosis. London; New York: Springer.

Victor  1920-2001, M., Ropper, A. H., & Adams  1911-2008, R. D. (Raymond D. (n.d.). Principles of neurology. New York: McGraw-Hill, Health Professions Division.

 Latest revision: 05-14-2021