Overall Goals and Objectives

The overall goal of our training program is to develop superb clinical child neurologists. It is the mission of our training program to ensure that our graduates have demonstrated competency in the six core areas as designated by the ACGME.

1. Patient Care

1.1   Goals

Residents must demonstrate the ability to provide family centered patient care that is developmentally and age appropriate, compassionate, and effective for treatment of neurological problems and the promotion of health.

• Objectives

Child neurology residents will:

1. Provide scientifically based, comprehensive, and effective diagnosis and management for pediatric patients with neurologic disease.
2. Perform a complete history and physical examination, and generate a rational differential diagnosis, workup, and management plan.
3. Understand how to order and interpret appropriate diagnostic tests including imaging studies, neurophysiological, genetic and metabolic tests.
4. Make informed diagnostic and treatment decisions by analyzing and synthesizing information.
5. Demonstrate technical skills that include the ability to identify and describe abnormalities on neuroimaging studies, the ability to perform lumbar punctures and EMGs, and the ability to appropriately interpret the results of imaging, EMG, EEG, and LP in the context of patient care.
6. Demonstrate competence in the comprehensive diagnosis and management of all forms of pediatric neurological disease.
7. Effectively counsel patients and families.
8. Use consultants and referrals appropriately.
9. Understand the limits of their knowledge and expertise.

• Goals and Objectives by Year of Training

PGY-3 (Adult Neurology) 

 Goals 

1. Gather essential and accurate information necessary to provide comprehensive care to adult patients with neurological disorders.
2. Demonstrate effective and appropriate clinical problem solving skills using evidence-based medical knowledge and sound clinical judgment.
3. Recognize the ethical, personal and social implications of many neurological diagnoses as well as the issues surrounding predictive testing and interventions for individuals with severe disabilities.
4. Provide care to patients of varying ages and develop skills necessary to provide longitudinal care throughout the lifespan.
5. The resident will develop competence at inpatient and intensive care management for a variety of adult neurological conditions. In addition, the resident will respond to consultation requests from the UW-ER and the VA and develop skills at triaging patients to the general or one of subspecialty services.

Objectives

             Residents will:

1. Develop skills in obtaining accurate historical information from patients and caregivers, with particular emphasis on ascertaining the time of stroke onset. They will be able to clearly communicate to patients and families the risks, benefits, and alternatives to intravenous and intra-arterial thrombolysis.  They will learn to discuss the mechanisms of stroke and hospital course with patients.  They should also be able to counsel patients on risk factor modification and long-term outcomes.
2. Learn to evaluate acute stroke patient independently, interpret neuroimaging studies including CT, CTA, MRI, MRA, and catheter angiography, meet management decisions regarding IV tPA, IA tPA and thrombectomy, learn the principles of post-thrombolysis care and become familiar with diagnosis and management of a variety of specific cerebrovascular conditions including intracerebral hemorrhage, arterial dissection, and venous sinus thrombosis.
3. Become familiar with basic concepts of stroke rehabilitation, secondary stroke prevention and current research priorities in cerebrovascular diseases.
4. Develop the skills necessary to evaluate, treat, and counsel patients and families with epileptic disorders, learn the principles of electroencephalography, and develop confidence in correctly interpreting EEG studies.
5. Acquire training in diagnostic evaluation and management of patients with a wide spectrum of neuromuscular disease. This will include comprehensive training in electromyography, including advanced techniques. standard motor and sensory nerve conduction studies of upper and lower extremities and cranial nerves;

• • repetitive nerve stimulation techniques;
  • basic autonomic studies;
  • standard concentric needle EMG evaluations;
  • Single Fiber EMG techniques,
  • laryngeal EMG

6. Achieve the following:

• • Learn the indications and clinical utility of muscle and nerve biopsies.
  • Learn how to select the muscle biopsy site to assure the highest diagnostic yield.
  • Understand the basic principles of muscle and nerve specimen processing (histology, histochemistry, immunostaining, electron microscopy, teased fiber analysis).
  • Be able to incorporate the biopsy results into the clinical decision-making process with regard to diagnosis and management of patients with neuromuscular disorders.
  • Have an opportunity to assist in muscle and nerve biopsies (in the operating room, or in the neurology outpatient clinic for needle muscle biopsies).
  • Develop understanding for the clinical utility and limitations of different electrodiagnostic tests in evaluation of patients with various neurological disorders.

7. Acquire a basic working knowledge of the surgical management of diseases of the nervous system, which is essential to the neurologist-in-training. The neurologists must be aware of indications for, limitations of, and possible complications of surgical treatment if they are to make appropriate referrals and counsel their patients wisely.
8. Be provided with learning opportunities to manage patients with neurological disease who require intensive care.
9. Develop skill in discussing end-of-life issues with patients with neurological diseases.
10. Become proficient in the management of patients with disorders of intracranial pressure.
11. Learn to identify and classify abnormal movements (tremor, chorea, myoclonus, etc.), demonstrate working differential diagnosis of all movement disorders and understand distinguishing clinical features.
12. Learn appropriate work-up for major neurologic symptoms/syndromes/diseases.
13. Implement a reasonable treatment plan.
14. Realize long-term complications of treatment modalities.
15. Become familiar with indications for deep brain stimulation (DBS).
16. Demonstrate ability to interrogate DBS patient’s IPG, turn it on/off, and check the battery.
17. Demonstrate knowledge of safety concerns for patients with deep brain stimulators.
18. Learn to identify and classify CNS demyelinating and inflammatory diseases, develop working differential diagnosis of the patient with a demyelinating disease and understand distinguishing clinical features.
19. Become familiar with indications for immune-modulating therapies.
20. Gain basic skills in neuropathology; learn how to relate pathology results to the clinical diagnosis and proper management of patients with all manner of neurologic disease.
21. Become adept at triaging consultations and admissions, focusing care on the most acutely ill patients.
22. Become proficient at managing acute clinical changes in patients under the care of the neurology services, especially the unique challenges of sundowning patients, patients who suffer an acute stroke or acute seizure.
23. Develop skills of arranging follow up care for patients seen in the ER that require further neurological evaluation or treatment.

 PGY-4 (Child Neurology) 

 Goals 

1. Gather essential and accurate information necessary to provide comprehensive care to pediatric patients with neurological disorders.
2. Demonstrate effective and appropriate clinical problem solving skills using evidence-based medical knowledge and sound clinical judgment.
3. Recognize the ethical, personal and social implications of many neurological diagnoses as well as the issues surrounding predictive testing and interventions for individuals with severe disabilities and their families.
4. Provide care to pediatric patients of varying ages and develop skills necessary to provide longitudinal care throughout the lifespan.
5. Develop competence at inpatient and intensive care management for a variety of pediatric neurological conditions. In addition, the resident will respond to consultation requests from the UW-ER and develop skills at triaging patients to the general or one of subspecialty services.
6. The residents will increase their knowledge of the pathophysiology of common neurologic conditions in hospitalized children and will understand how to diagnose and treat these conditions. Additionally, they will be comfortable providing family-centered care in an interdisciplinary setting. 

Objectives 

            Residents will:

1. Develop basic competence in the medical care of children with neurologic disease, and will begin to work on finer points such as improving patient safety, cost-effectiveness of care, and transitioning the patient to outpatient care.
2. Supervise the junior pediatric residents and medical students and both create and direct the care plan for the patient (under the guidance of the supervisory faculty member).
3. Learn how to relate radiology results to the clinical diagnosis and proper management of patients with all manner of neurologic disease.
4. Describe and explain the etiology, symptoms, pathophysiology, treatment options (with risks and benefits) and prognoses of common neurological diseases in childhood and their differential diagnosis.
5. Acquire competency in performing physical examinations of infants and children.
6. Learn to recognize abnormal patterns of neurodevelopment.
7. Learn to interpret neuro-diagnostic studies in infants and children.
8. Learn to diagnose and manage neurological emergencies in children.
9. Develop effective interactions with consulting services and ancillary staff.
10. Acquire effective practice management skills.
11. Learn to take a personal initiative in self-education (including pursuing recent literature) and demonstrate an investigatory and analytic thinking approach to clinical situations. This encompasses reading textbooks as well as review of recent scientific literature.
12. Gather and document essential and accurate information in medical interviews, including relevant illness, past medical, family, social, diet, and developmental history.
13. Perform and document complete physical and neurologic examinations in children of all ages, including developmental assessments.
14. Develop thoughtful and appropriate assessments and plans of care utilizing the principles of evidence-based decision making and problem solving.
15. Facilitate timely evaluation and management of care plans.
16. Provide vigilant and appropriate monitoring of the clinical and neurologic status of hospitalized patients including:

• • Appropriate use of non-invasive monitoring (continuous video EEG)
  • Careful data collection and synthesis
  • Frequent neurologic exam assessment
  • Responsiveness to patient, parent, and nursing concerns
  • Appropriate nutrition, activity and medication orders
  • Safe hand-offs of patient care
  • Prompt identification of and response to changes in patient condition and critically ill patients.

17. Order and interpret labs and studies commonly used in inpatient pediatric neurology patients, taking into account age-related normal values.
18. Use the electronic medical record to facilitate optimal patient care by:

• • Updating permanent parts of the medical record (including problem lists)
  • Writing timely daily notes that convey the thought process involved in patient management decisions and can be easily interpreted by those reading the medical record.
  • Ensuring that the medical record reflects the current situation for each patient (creating addendums to the daily note and entering event notes).

19. Effectively counsel patients and families by:

• • Sharing information about illness and treatment.
  • Encouraging involvement in patient care and clinical decisions.
  • Preparing patients and families for discharge.
  • Utilizing educational resources for patients and families.

20. Facilitate smooth transitions of patient care:

• • Obtain information from and communicate with referring providers.
  • Discuss management and hospital course with primary care provider.
  • Provide thorough and appropriate sign-out to covering residents.
  • Ensure continuity for in-hospital transfers (communicate with other providers/services both verbally and in writing).

21. Facilitate appropriate discharge planning (orders and medication reconciliation, patient education including specific and meaningful verbal and written discharge instructions, scheduled follow-up appointments).

PGY-5 (Child Neurology)

Goals 

1. Develop mature clinical judgment through progressively independent patient care commensurate with the resident’s ability.
2. Demonstrate increasing ability to independently assess, make decisions, counsel families and medically manage pediatric patients with neurological disease, under the supervision of the attending physician.
3. Help patients and families make informed decisions about diagnostic and therapeutic interventions based on patient and family preferences and personal health goals, up-to-date scientific evidence, risk-benefit analysis and clinical judgment.
4. Identify and develop one or more areas of clinical expertise that leads to diagnosis-specific referrals and/or directed clinic scheduling.
5. Develop knowledge base and learn to provide care for pediatric patients with psychiatric disorders.
6. Develop knowledge base and learn to provide care for pediatric patients with neurodevelopmental disorders
7. Develop knowledge base and learn to provide care for pediatric patients with neurometabolic disorders.
8. Become familiar with principles and techniques of pediatric Rehabilitation.

Objectives 

            Residents will: 

1. Meet all objectives listed for PGY4.
2. Critically evaluate current medical information and scientific evidence and modify your knowledge base accordingly.
3. Seek information and guidance from consultants.
4. Effectively triage patients.
5. Anticipate patient needs and obstacles to meeting them when implementing protocols.
6. Function as leader/teacher/reviewer/backup for PL1-PL4 residents.
7. Perform/order procedures (e.g., lumbar puncture, EEG, EMG) needed to deliver effective patient care.
8. Demonstrate competence in all facets of the care provided to children with neurologic disease and that he/she is prepared for practice after graduation.  To this end, the resident should direct all care and practice independent decision making (under the guidance of the supervisory faculty member).
9. Become competent at understanding the health care system, and will be able to work efficiently and effectively within it for the benefit of his/her patients.

• Medical Knowledge

2.1.      Goals

Residents will know, critically evaluate and use current medical information and scientific evidence for patient care.

• Objectives

Residents will:

1. Develop an extensive, detailed body of knowledge regarding the neurosciences, neuroanatomy, neuropharmacology, neurogenetics, neurophysiology and clinical child neurology. It is expected that this knowledge be demonstrated and applied to patient care.  Knowledge will be gained via didactic teaching (required and non-required conferences, educational conferences, national meetings) and by independent study and reading.
2. Demonstrate a rich knowledge base in both clinical and basic neuroscience, as well as the fundamentals of pediatrics.
3. Demonstrate a scholarly approach to the practice of clinical child neurology, including the incorporation of evidence-based medicine into clinical decision-making.
4. Demonstrate basic knowledge of clinical trial design and statistical testing, as well as the ability to utilize this knowledge for critical interpretation of medical information.
5. Acquire first-hand experience at the process of clinical research, ideally via participation in a clinical or translational research project (or even by assisting with patient enrollment into an ongoing project).
6. Acquire first-hand experience at the process of data presentation and peer-review, ideally via submission of one abstract or manuscript during the course of training.
7. Demonstrate habits consistent with life-long learning.

• Goals and Objectives by Year of Training

PGY-3 (Adult Neurology)  

Goals 

1. Develop self-directed learning skills essential to the maintenance of expertise in Neurology.
2. Use internet and printed resources including primary and secondary literature, relevant texts and published databases to acquire, critically evaluate, and use current knowledge regarding diagnostic test availability and applicability, natural history, and management of each disorder with which clinic patients are diagnosed.
3. Develop an adequate knowledge base in neurology and the neurosciences.
4. Continue to learn how the health care system functions, especially as relevant to the patient with neurologic disease.

Objectives 

            Residents will: 

1. Learn how to classify stroke into ischemic vs. hemorrhagic and their various subtypes, and about the vascular pathology underlying them. They will learn basic concepts of cerebral hemodynamics, neuroimaging, and neurointensive care.  They will develop their skills in lesion localization and the formulation of robust differential diagnoses that go beyond cerebral infarction.  They will become proficient in the interpretation of neuroimaging studies including CT and MRI, and the use of such information for clinical decision making.  They will learn about stroke risk factors and how these influence stroke classification and treatment.  They will learn the evidence supporting acute and preventive stroke treatments including tissue plasminogen activator (tPA), antiplatelet agents, anticoagulants, anti-hypertensives, and HMG-CoA reductase inhibitors. They will gain knowledge on laboratory and diagnostic technologies and their appropriate uses.
2. Learn basic concepts of interpretation of muscle and nerve biopsies. They will be introduced to the technique of muscle and nerve biopsy (in the operating room, or in the neurology out-patient clinic for needle muscle biopsies).
3. Understand the clinical utility and limitations of nerve and muscle biopsies in evaluation and management of patients with neuromuscular disorders.
4. Become familiar with the gross and microscopic pathologic findings of normal anatomy as well as neurologic diseases. The resident will become familiar with modern diagnostic pathology techniques (special stains, studies, etc.).
5. Acquire basic working knowledge of the surgical management of diseases of the nervous system, which is essential to the neurologist-in-training.
6. Utilize a systematic approach to the diagnosis of neurological disease, based on the skills of localizing neurological lesions, constructing a sound differential diagnosis, and judicious use of diagnostic tests and treatments.
7. Learn how to access written materials including clinical practice guidelines related to patients under his or her care.
8. Learn to impart basic neurology knowledge to rotating medical students and other residents.

• • Explain the recognition and treatment of status epilepticus, a medical emergency.
  • Describe the principles of EEG generation and recording.
  • Achieve an orderly approach to the interpretation of EEG studies.
  • Identify normal and abnormal EEG patterns.
  • Appraise literature to better understand pediatric and adult epilepsy syndromes and their etiology and clinical presentation.
  • Assess studies that evaluate treatment options for specific seizure types and epilepsy syndromes.
  • Apply and use the International League Against Epilepsy (ILEA) website that aids in understanding epilepsy syndromes and seizure management.

9. Learn clinical skills necessary to diagnose neuromuscular conditions affecting different stations of the motor unit (anterior horn cell diseases, peripheral neuropathies, neuromuscular transmission disorders, myopathies).
10. Understand the principles of clinical genetics and genetic counseling applicable to patients with neuromuscular conditions.
11. Gain knowledge of laboratory and diagnostic studies and their appropriate uses.
12. Learn to verbally describe and visually distinguish major neoplasms of the CNS and PNS including glial neoplasms (all grades of astrocytomas, oligodendrogliomas), neuroectodermal tumors, ependymal tumors, meningiomas, neuronal tumors and nerve sheath tumors, visually identify normal CNS, PNS and muscle slides.
13. Evaluate pathologic slides of major neurodegenerative conditions in children and adults (e.g. storage disorders, mitochondrial encephalomyopathies, Alzheimer’s Dementia, Parkinson’s Disease).
14. Learn how to classify abnormal movements.  They will demonstrate knowledge of the mainstream theories regarding pathophysiological mechanisms of common movement disorder and related diseases/syndromes.  They will know the neuropharmacologic mechanisms of frequently used medications and common side-effects.  They will be familiar with major novel treatments that are under development.
15. Learn how to classify CNS demyelinating diseases.  They will demonstrate knowledge of the mainstream theories regarding pathophysiological mechanisms of common demyelinating diseases.  They will know the neuropharmacologic mechanisms of frequently used medications and common side-effects.  They will be familiar with major novel treatments that are under development.

PGY-4 (Child Neurology) 

Goals 

1. Develop self-directed learning skills essential to the maintenance of expertise in Child Neurology.
2. Use internet and printed resources including primary and secondary literature, relevant texts and published databases to acquire, critically evaluate, and use current knowledge regarding diagnostic test availability and applicability, natural history, and management of each disorder with which inpatients and clinic patients are diagnosed.
3. The resident will develop an adequate knowledge base in Child Neurology and the neurosciences.
4. The resident will continue to learn how the health care system functions, especially as relevant to the pediatric patient with neurologic disease.

Objectives 

            Residents will:

1. Develop competence in basic neurologic knowledge and will begin to attain a sophisticated and deep knowledge base in child neurology and the neurosciences.
2. Describe and explain the etiology, symptoms, pathophysiology, treatment options (with risks and benefits) and prognoses of common neurological diseases in childhood and their differential diagnosis.
3. Acquire competency in performing physical examinations of infants and children.
4. Learn to recognize abnormal patterns of neurodevelopment.
5. Learn to interpret neuro-diagnostic studies in infants and children.
6. Learn to diagnose and manage neurological emergencies in children.
7. Learn to take a personal initiative in self-education (including pursuing recent literature) and demonstrate an investigatory and analytic thinking approach to clinical situations. This encompasses reading textbooks as well as review of recent scientific literature.

PGY-5 (Child Neurology)

Goals

1. The resident will develop an extensive knowledge base in child neurology and the neurosciences that is both broad and deep.

1. Continue to enhance learning skills and knowledge.
2. Further develop skills necessary to search for, identify and critically consider rare disorders in the differential diagnosis for pediatric patients with neurologic disease.

Objectives 

            Residents will:

1. Achieve all objectives listed for PGY-4
2. Critically evaluate current medical information and scientific evidence and modify your knowledge base accordingly.
3. Seek information and guidance from consultants.
4. Develop competence at using the medical literature to guide patient care decisions (evidence based medicine).

• • Describe the developmental features of EEG from infancy to the elderly
  • Recognize abnormal EEG findings and correlate EEG findings with clinical epilepsy syndrome and seizure types in infancy, childhood and adulthood.
  • Achieve skills in creating and dictating neurophysiology reports.
  • Explain the principles of evoked potential generation including visual, brainstem-auditory, and somatosensory evoked potentials.
  • Correlate video recordings of seizures with EEG tracing.
  • Describe the principles of Wada testing.
  • Dictate at least five EEG studies.
  • Review neonatal and pediatric EEGs and video EEG studies with one of the pediatric neurologists.

5. Be able to classify seizure types and pediatric epileptic syndromes.
6. Verbalize rational approach to the management of epilepsy including choice of appropriate antiepileptics.
7. List the pharmacokinetics of antiepileptics and mechanisms of action.
8. Explain the utility of epilepsy monitoring and the evaluation of intractable epilepsy, especially the use of surgical treatment of epilepsy.
9. Verbalize the appropriate restrictions including driving, for patients with epilepsy.
10. Develop a working knowledge of the DSM – IV.
11. Learn basic non-pharmacological treatment of neurological disease.
12. Strengthen knowledge of neuropharmacology with respect to antidepressants and antipsychotics.
13. Incorporate basic concepts of sleep physiology and sleep diagnoses into clinical encounters.
14. Demonstrate a basic understanding of management approaches for common sleep disorders (sleep apnea, insomnia, restless legs syndrome and narcolepsy).
15. Develop an understanding of the principles and methods of neuropsychological testing, especially anatomical localization derived from test results and utility of results in determining neurologic diagnoses. Basic knowledge with regard to the clinical course, diagnostic criteria, and management principles of these diseases will be obtained through clinical interactions, didactic teaching, and background reading, with reading to occur in a patient-specific fashion.
16. Become independent in his or her ability to interpret neuroradiologic studies and generate appropriate differential diagnoses from the findings. Both normal anatomy and pathology will be emphasized.

• Interpersonal and Communication Skills

3.1.      Goals

Excellent physicians communicate clearly and succinctly with patients, families, other physicians, and all other allied health staff.  The ability to successfully interact with others during routine work time as well as during times of stress is crucial for optimal patient care.  This includes maintaining accurate, timely, and legible medical records. Child neurologists must also be able to provide genetic counseling and palliative care when appropriate.  All patient-related communication must remain within the guidelines of HIPAA rules and regulations.

• Objectives

Residents will:

1. Obtain an appropriate medical history (including sensitive issues such as sexual history) in a professional and humane manner.
2. Exhibit communication that is characterized by socio-cultural competence.
3. Communicate respectfully and effectively with other health professionals.
4. Act in a consultative role to other physicians and health professionals.
5. Communicate diagnosis and treatment plans, and potentially sensitive information such as terminal prognosis.
6. Communicate succinctly and clearly with other healthcare professionals, with a proper respect for the principles of HIPAA regulations.
7. Maintain comprehensive, timely, effective and legible medical records.
8. Present scientific data and peer-review, ideally via submission of one abstract or manuscript during the course of training.

• Goals and Objectives by Year of Training

PGY-3 (Adult Neurology)  

Goals 

1. Residents will become skillful listeners, and develop specific proficiency in communicating with neurologic patients through non-verbal means.
2. Residents will learn to communicate rapidly and efficiently with other team members in order to ensure that proper therapies can be provided in a timely manner.
3. Residents will learn to clearly communicate neurological assessments and plans to patients, their families, and members of the multidisciplinary care team. They will become specifically proficient in discussing end of life care. 

Objectives 

            Residents will:

1. Continue to develop skills at interpersonal communication and begin developing basic teaching skills.
2. Demonstrate skills in effective communication (both written and verbal) with patients, their families, colleagues and co-workers in order to better treat neurological disease.
3. Become proficient in communication with allied health staff in day-to day contacts and during multidisciplinary discharge planning rounds.
4. Develop techniques to obtain accurate history from patients, and gain the patients’ confidence and trust.
5. Create reports that accurately convey EEG, EMG and neuroimaging findings and relate these findings to the clinical setting.
6. Interact effectively with other members caring for patients including nursing and technical staff.
7. Create clinic and hospital notes that are concise and accurate.
8. Present neuropatholgical results to faculty succinctly and completely. Learn to create a concise neuropathological report.
9. Become adept at presenting patients to faculty concisely and completely.
10. Become proficient at communicating clearly with the consulting services.
11. Learn efficient dictating skills so that consulting and inpatient care team services have immediate access to documentation on all patients.
12. Develop the skills of teaching basic neurological skills and knowledge to the rotating medical students. 

PGY-4 (Child Neurology) 

Goals 

1. Demonstrate interpersonal and communication skills that result in information exchange and partnering with patients, their families and professional associates.
2. Residents will become skillful listeners, and develop specific proficiency in communicating with pediatric neurologic patients through non-verbal means and with their care providers.
3. Residents will learn to communicate rapidly and efficiently with other team members in order to ensure hat proper therapies can be provided in a timely manner.
4. Residents will learn to clearly communicate neurological assessments and plans to patients and their parents, and members of the multidisciplinary care team.

Objectives 

            Residents will: 

1. Continue to master skills at interpersonal communication and will not only demonstrate professional and ethical practice of medicine, but help more junior residents to foster their professionalism.
2. Be expected to supervise the junior pediatric residents and medical students and both create and direct the care plan for the patient (under the guidance of the supervisory faculty member).
3. Continue to master teaching skills.
4. Effectively communicate in a timely manner with fellow residents, medical students, attending physicians, consulting and transferring services, primary care providers, nurses, ancillary staff members, patients and families.
5. Facilitate safe and efficient patient care via complete but concise presentations (on rounds, when discussing care with consultants, when signing out to co-residents).
6. Appropriately utilize the electronic medical record as a communication tool.
7. Collaborate with case management and nursing to ensure efficient and appropriate discharge plans.
8. Provide effective education, including reassurance, for conditions commonly seen on the inpatient service.
9. Effectively interact with children in a manner that is appropriate for their age/developmental level and promotes comfort and understanding.
10. Communicate with parents/caregivers/families by establishing rapport, inspiring confidence and trust and keeping them informed and involved in clinical care decisions.
11. Demonstrate sensitivity to and respect for patients and families beliefs, religion, ethnicity, and cultural values.
12. Ensure continuity of care by communicating effectively with primary care providers both verbally and through timely, appropriately detailed written discharge summaries.
13. Accept and provide feedback willingly.

PGY-5 (Child Neurology)

Goals 

1. Communicate effectively with patients, families, and the public (as appropriate) across a broad range of socioeconomic, intellectual and cultural backgrounds.
2. Assume leadership of a health care team which also includes counselors, clinic coordinators, other clinic and hospital staff, and other learners.

Objectives 

            Residents will: 

1. Achieve all objectives listed under PGY-4
2. Demonstrate competence at clear and succinct interpersonal communication with colleagues, patients, and families.
3. Demonstrate skill at teaching medical professionals and non-medical persons including patients and families.
4. Be a role model for junior residents and other members of the health care team and demonstrate the ability to adapt to patients and family beliefs and cultural system.
5. Communicate effectively in difficult situations, such as with an angry parent, with a parent who wishes to leave AMA, or in cases of suspected child abuse or neglect.
6. Give feedback to junior residents on the effectiveness of their patient care and skill at communicating with patients, their families and members of the health care team.

• Professionalism

• Goals

It is the expectation of our training program that child neurology residents will behave in a professional manner at all times in which they represent the University of Wisconsin Department of Neurology, the University of Wisconsin Hospital and Clinics, and the William S. Middleton VA Hospital.

This includes the following six essential elements of professionalism:

• Be present—the resident must be in attendance for all patient care duties and for all didactic teaching. If illness or other circumstances prevent attendance, the appropriate persons should be notified.  70% attendance at required conferences will be required for promotion.
• Be presentable—the resident will dress in a manner that signifies professionalism. For example, male residents will wear ties and female residents should wear similarly appropriate professional clothing during regular day time duty hours on days when patient contact will occur.  White coats will be provided by the GME office and residents should wear a clean coat at all times.  Tattoos and body piercings will not be allowed, with the exception of ear piercing or tattoos/piercings with cultural or religious significance.  The wearing of scrubs is prohibited except after normal business hours.
• Be punctual—residents should strive to arrive on time for all clinical duties and didactic sessions. As befits a responsible professional, knowledge that the resident will be late should result in notification of the appropriate persons (i.e. the resident might call ahead to clinic and ask the MA to notify all patients that he/she will be arriving late).  Furthermore, it is appropriate to apologize to those who are inconvenienced by tardiness.
• Be prepared—the resident should accomplish all assigned tasks related to clinical patient care within the limitations of the ACGME duty hour regulations (see below). Paperwork and dictations must be completed in a timely fashion.
• Be positive (and respectful)—the resident shall strive to be respectful of patients, staff, and colleagues at all times. At times, every person experiences emotions such as anger/frustration, etc. that must be successfully suppressed in interactions with patients, families, and with other health care professionals.
• Be proficient—the resident will be expected to consistently demonstrate appropriate knowledge and procedural skills for his/her level of training. The resident must understand his/her limitations and know when to ask for help.

Included in the concept of professionalism are the virtues of integrity, honesty, compassion, ethical behavior and a commitment to the development of cultural humility.

4.2       Objectives 

            Residents will: 

1. Demonstrate integrity, honesty and compassion, empathy and altruism.
2. Acknowledge errors and limitations.
3. Demonstrate responsibility, accountability, dependability, commitment and encourages continuity of care.
4. Exhibit respect for all persons regardless of their cultural, ethnic, religious, and socioeconomic background.
5. Exhibit a commitment to the development of cultural humility.
6. Comply with the regulations set forth by the University of Wisconsin Hospital and Clinics including all training sites.
7. Be remorseful about any breaches in professionalism that occur. Furthermore, it is expected that the resident will use such breaches as lessons to prevent similar problems in the future.

4.3       Goals and Objectives by Year of Training 

PGY-3 (Adult Neurology)  

Goals 

1. Residents will learn ethical, regulatory, and legal aspects of neurologic care, including the difference between standard and investigational treatments.
2. They will demonstrate sensitivity to the personal, cultural, and religious values that influence patients’ medical decisions in the context of neurologic disease, and a compassionate approach to end of life care.
3. They will demonstrate responsiveness to patient needs that supersedes self-interest.
4. Demonstrate compassion, integrity, accountability and respect in all interactions with patients from diverse backgrounds in gender, age, culture, race, religion, physical and cognitive ability and sexual orientation.
5. They will adhere to ethical principles by respecting confidentiality of medical information. 

Objectives 

            Residents will:

1. Solidify his/her foundation of the professional and ethical practice of medicine.
2. Remember that they represent the UW Department of Neurology with their actions and communications. The highest standards of professionalism must be maintained at all times, especially in interactions with patients and their families, with other physicians, and with allied health staff.
3. Respond in a timely and courteous manner to pages, calls and patient inquiries.
4. Adhere to clinic schedules and minimize patient inconvenience.
5. Undergo HIPAA training and comply with HIPAA rules and ethical principles.
6. Be responsible for tracking duty hours.
7. Show respect, compassion, integrity and ongoing professional development.
8. Determine psychosocial issues that complicate care, especially as it relates to the possibility of patient history of physical or sexual abuse and the diagnosis of nonepileptic seizures.
9. Be punctual and appropriately attired.
10. Keep patient logs up-to-date on E-Value.
11. Learn ethical, regulatory, and legal aspects of care, including the difference between standard and investigational treatments.
12. Demonstrate sensitivity to the personal, cultural, and religious values that influence patients’ medical decisions in the context of the wide spectrum of neuromuscular conditions, including end-of-life issues.
13. Promptly attend case conferences and didactic sessions. 

PGY-4 (Child Neurology)  

Goals 

1. Demonstrate continuing commitment to carrying out professional responsibilities, adherence to ethical principles, and sensitivity to diversity.
2. Learn ethical, regulatory, and legal aspects of pediatric neurologic care, including the difference between standard and investigational treatments.
3. Demonstrate sensitivity to the personal, cultural, and religious values that influence patients’ and parents’/caregivers’ medical decisions in the context of neurologic disease.
4. Demonstrate responsiveness to patient needs that supersedes self-interest.
5. Demonstrate compassion, integrity, accountability and respect in all interactions with patients from diverse backgrounds in gender, age, culture, race, religion, physical and cognitive ability and sexual orientation.
6. Adhere to ethical principles by respecting confidentiality of medical information. 

Objectives 

            Residents will:

1. Achieve all objectives listed for PGY-3
2. Place patient needs paramount; always act in the best interest of the patient.
3. Demonstrate personal accountability for the well-being of patients (following up lab results, writing comprehensive notes, seeking answers to patient care questions).
4. Work collaboratively and cooperatively as a member of a health care team, demonstrating a commitment to professional behavior in interactions with staff and professional colleagues.
5. Demonstrate reliability, responsibility, and respect for patients and families, including appropriate verbal and nonverbal communication.
6. Arrive on time for scheduled activities and appointments.
7. Demonstrate a commitment to professional responsibilities, even during periods of stress, by:

• making a personal commitment to a respectful workplace;
• working collaboratively with other members of the health care team;
• engaging in self-assessment; and
• accepting external scrutiny to maintain professional standards.

8. Adhere to ethical and legal principles. 

PGY-5 (Child Neurology)

Goals 

1. Demonstrate continuing commitment and leadership in carrying out professional responsibilities, adherence to ethical principles, and sensitivity to diversity.
2. Be familiar with and teach ethical, regulatory, and legal aspects of pediatric neurologic care, including the difference between standard and investigational treatments.
3. Demonstrate sensitivity to the personal, cultural, and religious values that influence patients’ and parents’/caregivers’ medical decisions in the context of neurologic disease.
4. Demonstrate responsiveness to patient needs that supersedes self-interest. 

Objectives 

            Residents will: 

1. Demonstrate compassion, integrity, accountability and respect in all interactions with patients from diverse backgrounds in gender, age, culture, race, religion, physical and cognitive ability and sexual orientation.
2. Adhere to ethical principles by respecting confidentiality of medical information.
3. Demonstrate Professionalism at all times and act as a role model for medical students, junior residents and other health professionals.
4. Demonstrate self-evaluation skills, continuous desire for self-Improvement, and a life-long learning plan.
5. Recognize and respond to personal stress and fatigue that might interfere with professional duties.
6. Develop a healthy lifestyle, fostering behaviors that help balance personal goals and professional responsibilities.

5. Practice-Based Learning and Improvement

5.1       Goals

Child neurology residents must be able to investigate and evaluate their patient care practices, and appraise and assimilate scientific evidence to improve their patient care practices.  Residents should participate in the collection and analysis of patient data via patient logs and as part of quality assurance projects.

• Objectives 

Residents will:

1. Exhibit skills in self-assessment and self-improvement.
2. Exhibit skill in practice assessment, as well as both practice- and systems improvement, to enhance quality of care and improve patient safety.
3. Demonstrate a scholarly approach to the practice of clinical child neurology, including the incorporation of evidence-based medicine into clinical decision-making.
4. Demonstrate the ability to utilize information obtained from clinical trials for critical interpretation of medical literature.
5. Demonstrate ongoing self-education and habits of life-long learning.
6. Apply these processes to improve patient care.
7. Participate in the education of patients, families, students, residents and other health professionals.

5.3       Goals by Year of Training

PGY-3 (Adult Neurology)  

Goals 

1. Use skills acquired during primary residency training as an initial foundation for medical and ethical decision making.
2. Identify opportunities for improvement in the delivery of quality of patient care.

Objectives

Residents will:

1. Systematically review inpatient and outpatient cases during dedicated conferences and use the feedback generated to improve upon subsequent patients’ care.
2. Learn to critically appraise the neurologic literature, with emphasis on clinical trial design and outcome measures.
3. Become familiar with authoritative sources of neurologic practice guidance, such as American Academy of Neurology scientific statements, and how to access these resources on-line.
4. Maintain a patient log for tracking number and various diagnosis of patients seen to ensure an adequate educational experience.
5. Be responsible for tracking patients and procedures performed via the electronic patient/procedure log. These data can be used by the resident in the 6-month self-evaluation to determine where further patient experience is needed.
6. Incorporate evaluation feedback into daily practice. 

PGY-4 (Child Neurology)  

Goals 

1. Demonstrate knowledge, skills and attitudes needed for continuous self-assessment, using scientific methods and evidence to investigate, evaluate, and improve one’s patient care practice.
2. Identify opportunities for improvement. 

Objectives 

            Residents will: 

1. Regularly utilize the available medical literature to make evidence-based decisions in patient care by:

• Formulating pertinent clinical questions
• Retrieving and critically appraising relevant up-to-date information
• Applying that information to inform clinical decisions.

2. Observe and provide feedback to students about history and exam skills, discussing cases seen together, and writing orders together.
3. Identify personal learning needs, systematically organize relevant information resources for future reference and plan for continuing acquisition of knowledge and skills.
4. Incorporate evaluation feedback into daily practice.
5. Read, analyze and critique journal articles.
6. Systematically review clinical outcomes in order to contribute to the body of knowledge in pediatric neurology.

PGY-5 (Child Neurology): 

Goals 

1. Bring developing knowledge and technology into practice in a responsible manner.
2. Identify opportunities for improvement in the delivery and quality of patient care and work to bring those into practice.

Objectives 

            Residents will:

1. Achieve all objectives listed for PGY-4
2. Demonstrate self-evaluation skills, continuous desire for self-improvement, and a life-long learning plan.
3. Observe and provide feedback to students and interns about history, exam and oral presentation skills, discuss cases seen together, teach about relevant topics, assist with prioritization of tasks and efficiency.
4. Make evidence-based decisions in patient care by formulating pertinent clinical questions, retrieving and critically appraising relevant up-to-date information, and applying that information to formulate clinical decisions.
5. Be prepared to alter one’s practice of medicine over time in response to new discoveries and advances in epidemiology and clinical care.

6. Systems-Based Practice

6.1       Goals

Child neurology residents must be trained to recognize that they are part of a large and intricate health system that has implications for their ability to care for patients and impacts upon their patients’ human needs and financial resources.

6.2       Objectives

Residents will:

1. Recognize the limitation of resources for health care and demonstrates the ability to act as an advocate for patients within their social and financial constraints.
2. Exhibit willingness to participate in utilization review and comply with documentation requirements in medical records.

1. Develop awareness of practice guidelines and utilizes them as appropriate.
2. Develop awareness of local and national resources that may enhance our patients’ quality of life in dealing with chronic neurologic diseases.
3. Develop the ability to lead health care teams and delegate authority in a responsible and appropriate manner.
4. Develop skills for the practice of ambulatory medicine (time management, clinic scheduling, effective communication with referring physicians).

6.3       Goals by Year of Training

PGY-3 (Adult Neurology) 

Goals

The resident recognizes that he/she is part of a large and intricate health system that has implications for his/her ability to care for patients and impacts upon his/her patients’ human needs and financial resources.

Objectives

Residents will: 

1. Demonstrate the ability to work in a multidisciplinary fashion with nurses, case managers, social workers, therapists, primary care physicians, and the various medical and surgical specialties related to adult neurology.
2. Learn how to triage patients and allocate resources such as intensive care unit beds and MRI scans so as to provide high quality, cost-effective care.
3. Become familiar with clinical practice guidelines and participate in the creation and review of stroke program policies and procedures relevant to patient care.
4. Learn how the health care system functions, especially as relevant to the patient with neurologic disease.
5. Learn to interact with allied health services including nursing staff, PT, OT, Speech Pathology, Dietary, Social Work, and PMR/Rehabilitation in caring for the patient and planning post-hospital care.
6. Learn the most efficient manner for completing the necessary workup and develop skills to coordinate neurological care in the outpatient setting.
7. Be able to individualize evaluations, diagnostic testing, and develop treatment plans with respect to the health delivery systems available to patients. Awareness of financial, safety and other psychosocial issues common to patients living with chronic neurological disorders will be demonstrated.  Residents will become knowledgeable of available patient resources including other health care professionals and patient advocacy groups.
8. Learn how to manage the time pressures of outpatient practice while delivering tertiary-level care. The resident will learn how to perform efficient outpatient evaluations and appropriately utilize ancillary services.  Residents will become proficient in the use of the UW Epic electronic record and the VA CPRS systems 

PGY-4 (Child Neurology) 

Goals

Understand how to practice high quality health care and advocate for pediatric patients with neurologic disease within the context of the health care system.

Objectives

Residents will: 

1. Learn how they can best utilize the health care system for the welfare of his/her pediatric patients with acute and chronic neurologic conditions.
2. Identify key aspects of health care systems, cost control, billing, and reimbursement in the inpatient setting.
3. Demonstrate sensitivity to the cost of providing inpatient care and resource allocation, take steps to minimize costs without compromising quality of care.
4. Take steps to avoid medical errors by recognizing the limits of one’s knowledge and expertise; work with the health care team to recognize and address systems errors.
5. Understand the value of appropriate use of laboratory and radiographic testing, as well as their limitations.

PGY-5 (Child Neurology)

Goals

1. Provide care of uniformly high quality within fiscally constrained environment.
2. Navigate various health care delivery and financing systems to provide optimal care. 

Objectives 

            Residents will:

1. Achieve all objectives listed for PGY-4.
2. Become competent at understanding the health care system, and will be able to work efficiently and effectively within it for the benefit of his/her patients.

1. Learn about the unique constraints placed upon on the care of children with neurologic, genetic, developmental and psychiatric disorders.
2. Demonstrate an understanding of the unique ethical and medical-legal circumstances that can impact upon the care of children with neurologic, genetic, developmental and psychiatric disorders.
3. Learn about how to work within the constraints of our current health care system to provide neuropsychometric testing/consultation and rehabilitation in an appropriate fashion.  Neuropsychometric testing and Rehabilitation are not always approved by insurance companies and appropriate use of testing must thus be learned.
4. Optimize use of system resources (clinic, hospital, community, and government) to ensure optimal patient care.
5. Work with health care managers and providers to assess, coordinate, and improve patient care, consistently advocating for high quality.
6. Assist patients in their efforts to navigate complex health care systems.
7. Recognize and advocate for families who need assistance to deal with systems complexities, such as the referral process, lack of insurance, multiple medication refills, multiple appointments with long transport times, or inconvenient hours of service.