Introduction
The general neurology service cares for patients with a variety of neurological conditions requiring hospitalization. Examples include seizure, acute neuromuscular disease such as Guillain-Barre, and multiple sclerosis relapse. Neurology residents rotate on general neurology during the PGY-2 and PGY-3 years for blocks of 2 weeks.
The General Neurology team consist of an attending neurologist, the neurology resident rotating on service, an advanced practice provider (nurse practitioner or physician’s assistant), and several medical students. Occasionally there may be internal medicine interns or other off-service residents pursuing elective rotations. Pharmacy residents and other observers may rotate on the service as well.
Goals
PGY-2 Residents: The junior resident on the General Neurology Service will develop competence at emergency neurological assessment and triage and begin to develop skills in inpatient and intensive-care management for a variety of neurological conditions as listed above.
PGY-3-4 Residents: Senior residents will develop more refined, evidence- and guideline-based, skills in inpatient and ICU care while assuming leadership of the interdisciplinary team. Senior residents will also refine their patient-centered communication skills.
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 | Evaluate and manage seizures and status epilepticus | PC1, PC2, PC3, PC5, PC6, PC9, PC12, MK1, MK2 |
| 2 | Evaluate and manage acute neuromuscular conditions such as Guillain-Barré syndrome and myasthenia gravis | PC1, PC2, PC3, PC5, PC6, PC10, MK1, MK2 |
| 3 | Evaluate and manage patients with acutely altered consciousness, cognition, and behavior | PC1, PC2, PC3, PC5, PC6, PC8, PC9, PC12, MK1, MK2 |
| 4 | Evaluate and manage patients with MS relapse and other acute demyelinating disorders | PC1, PC2, PC3, PC5, PC8, PC12, MK1, MK2 |
| 5 | Evaluate and manage patients with acute or intractable headache | PC1, PC2, PC3, PC5, PC8, MK1, MK2 |
| 6 | Appropriately select and interpret neuroimaging studies | PC8 |
| 7 | Lead morning interdisciplinary rounds, interacting respectfully with the other team members while advocating for appropriate patient care | SP3, SP4, PR1, PR2, IC3, IC4 |
| 8 | Lead family meetings regarding goals of care and negotiate conflicts among family members and the treatment team | SP4, PR1, IC1, IC2 |
| 9 | Discharge patients in a manner that ensures smooth transitions from inpatient to outpatient care | SP3, SP4, PR2, IC3, IC4 |
| Additional Milestones | ||
| Please grade the resident on any of the following milestones you were able to evaluate during this rotation: | ||
| PC11, PL1, PL2, PR3, IC2 | ||
Schedule
The resident of the General Neurology Service will receive sign-out from the night float resident around 7:00 – 7:30 am daily M-F and preround on service patients. Attendance at Friday 8:00 am morning report is expected when this is scheduled. Interdisciplinary rounds begin around 9:00 am each weekday except Wednesdays, when they begin at 9:30 due to neuropathology conferences. These take place in the work room next to the D6/4 nursing station. Teaching rounds follow thereafter, usually ending around 11:00 am, depending on service volume.
After rounds, the resident will write notes and enter orders on current patients. The General Neurology service resident is also on call for new consults in the UW and VA emergency departments from 8:00 am until 4:00 pm. At 4:00 pm, the short call resident takes over the call pager for new consults and receives in-person signout from the service resident shortly thereafter.
The General Neurology service resident is expected to attend regularly scheduled educational lectures at 12:00 pm (Monday – Friday) and 8:00 am morning report (Friday) unless addressing urgent or emergent clinical issues for service patients. Resident are also expected to attend Neuropathology conferences on Wednesday mornings at 8:30 am (on the 1st, 3rd, and 5th Wednesdays of the month) and Neuroradiology conference on Wednesday morning at 7:30 am (on the 4th Wednesday of the month).
On Saturday, the service resident will receive sign-out from the overnight call resident around 7:30 and will round with the attending on the team patients at 8:00.The General Neurology service resident will also hold the call pager and cover new general and stroke consults (including stroke codes) and cross-cover issues on service patients until 8 pm.
Sunday is the service resident’s day off.
Work Hours
The estimated hours per week is 60 hours. Residents are required to document work hours and notify the attending physician and program director if he or she is in danger of exceeding the work hour limits.
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.
Wijdicks, E. F. M., & Wijdicks, E. F. M. (2010). The practice of emergency and critical care neurology. New York: Oxford University Press.
Latest revision: 05-14-2021
