Introduction and Goals
PGY-1 residents: The field of neurointensive care is developing rapidly, and it’s important for all neurologists to have some familiarity with the contemporary diagnosis and management of critically ill patients with neurological and neurosurgical disease. For junior residents, this rotation complements the neurosurgery experience. Its goals are to offer an initial exposure to inpatient / critical care medicine generally and specifically with respect to those conditions most commonly managed by neurologists, or for which neurologists are frequently asked to consult.
PGY-3-4 residents: Senior residents may choose to pursue additional elective time in the neurocritical care unit to learn in more depth, and assume more primary management responsibility for, conditions such as traumatic brain injury, subarachnoid hemorrhage, malignant brain infarction, status epilepticus, and neuromuscular ventilatory failure.
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 | Perform a rapid, focused, neurological exam in patients with critical illness | PC2 |
| 2 | Triage patients who need immediate attention and those who can wait temporarily | PC1, PC2, PC3, PC6, MK1 |
| 3 | Manage fluids, electrolytes, and blood pressure | PC3, PC5, PC6, MK2 |
| 4 | Describe the principles of ventilator management | PC5, PC6 |
| 5 | Describe the indications for placement of intracranial pressure monitors, external ventricular drains, and multimodality monitors | PC3, PC5, PC6, PC8, MK2 |
| 6 | Describe how to manage acute subarachnoid hemorrhage | PC1, PC2, PC3, PC5, PC6, MK2 |
| 7 | Communicate effectively with requesting clinical services, nurses, and other members of the patient’s team | SP3, SP4, PR1, IC3, IC4 |
| 8 | Participate in family meetings regarding goals of care and help negotiate conflicts among family members and the treatment team | PR1, IC1 |
| Milestones | ||
| Please grade the resident on any of the following milestones you were able to evaluate during this rotation: | ||
| PC7, PC9, PC11, PL1, PL2, PR2 | ||
Schedule
The Neurocritical Care rotation is an inpatient elective involving primary management of patients admitted to the Neurocritical Care service as well as consultations on patients in the Neuro ICU and other clinical environments. The resident will work on a team consisting of a Neurocritical Care attending as well as other learners that may include some combination Neurology interns, Neurosurgery residents, medical students, and/or off-service fellows.
The specific daily schedule will depend on the service and the attending, and should be discussed in advance with the attending on service before the first day of the rotation. Residents will have their usual continuity clinics during this rotation, and will need to ensure appropriate handoff of any outstanding patient care obligations to the Neurocritical Care attending or to another team member during the continuity clinic afternoon.
Residents are also expected to attend Monday afternoon Neurosurgery case conferences at 3:00 and 4:00 pm when scheduled, as well as the Morbidity & Mortality conference at 7:00 am on Wednesday. Residents are encouraged to stay for Neurosurgery Grand Rounds that follow.
Work Hours
The estimated average number of work hours per week is 50. There are no call responsibilities required during these rotations.
It is the responsibility of each resident to communicate with the supervisory attending regarding work hours. In the event that any of the ACGME work hours regulations are in jeopardy of being violated, the supervisory attending physician must be notified immediately. It will be that attending’s responsibility to rectify the situation immediately by appropriate means.
Suggested References
Wijdicks, E. F. M. (2016). The practice of emergency and critical care neurology. New York: Oxford University Press.
Latest revision: 06-30-2021
