Outpatient Child Neurology Clinics

Outpatient core clinical training in Child Neurology

OUTPATIENT CLINICS, RESIDENT CONTINUITY CLINIC

Introduction

During the PGY4 and 5 years, the primary outpatient clinical experience occurs during the clinic months. This rotation includes exposure to both general pediatric neurology clinics and subspecialty clinics in pediatric neurology. These occur either in the UW Neurology Clinics or the AFCH clinics, depending on the assigned clinic. Subspecialty clinics during this rotation include, but are not limited to; neuromuscular, neurooncology, neurocutaneous, epilepsy, ketogenic diet, and cerebral palsy clinics. During each clinic the resident is expected to discuss which patients they should see with the supervising attending.

Schedule

Prior to each outpatient clinic rotation the resident will receive a schedule tailored to deliver the best clinical experience among the multiple general and specialty clinics. Administrative half days are included in that schedule and allow for time to document, return patient phone calls, or complete other administrative tasks.

Patient Care

Goals

Gather essential and accurate information necessary to provide comprehensive care to pediatric patients with neurologic disorders.
Demonstrate effective and appropriate clinical problem solving skills using evidence-based medical knowledge and sound clinical judgment.
Recognize the ethical, personal and social implications of many diagnoses as well as the issues surrounding predictive testing and interventions for individuals with severe disabilities.
Provide care to pediatric patients of varying ages to develop skills necessary to provide longitudinal care throughout the lifespan.
Develop mature clinical judgment through progressively independent patient care commensurate with the resident’s ability,
Demonstrate increasing ability to independently assess, make decisions, counsel families and medically manage patients, under the supervision of the attending physician.
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.
Identify and develop one or more areas of clinical expertise that lead to diagnosis-specific referrals and/or directed clinic scheduling.

Objectives

Residents will:

Identify issues of concern on the part of the patient or family and referring physician for each patient seen in clinic.
Obtain a complete 3 generation family history and generate an accurate pedigree for each patient.
Obtain a complete medical history by reviewing the medical record and interviewing the patient or family, with particular attention to issues related to the presenting concern, for each patient seen in clinic.
Perform a general physical examination and a detailed neurological exam on each patient seen in clinic and accurately describe findings.
Order state of the art diagnostic (neurophysiologic, neuroimaging, biochemical, cytogenetic, and molecular) tests appropriate for each patient’s clinical presentation and interpret their results in that clinical context.
Develop and apply medical management plans based on knowledge of the natural history of the disorder with which each patient is diagnosed.
Respond appropriately to reports of biochemical abnormalities detected on newborn screening.
Manage patients with metabolic disorders under faculty supervision.
Educate patients and families regarding natural history, recurrence risk, the utility of biochemical, molecular or cytogenetic testing, management options for each diagnosis, the availability of community support, and printed and internet resources for further support and education.
Counsel patients and families to take measures needed to optimize health and function, to prevent disease and injury and to participate actively in their care.
Recognize the limits of his or her expertise and make appropriate use of colleagues, faculty, other consultants and referrals.
As level of training increases, see all patients independently, present findings, impressions and plans for further diagnostic assessment and management to the supervising physician before his or her subsequent assessment of the patient.
Have primary responsibility for patient education and counseling, under faculty supervision.
Give patient concerns and perspectives priority in counseling and decision making unless they clearly and directly conflict with medical care needs in a manner that is likely to have a significant impact on the patient’s well-being.
Deliver painful and sad news to patients and families in a compassionate and supportive manner.
Provide accurate, up-to-date and evidence based information to patients and families in a nondirective manner and empower them to make informed decisions, interpret risk assessments, and determine the value of predictive testing for themselves and family members.
Guide patients and families in a nondirective manner as they consider difficult ethical dilemmas related to the diagnosis in their family, the use of appropriate testing, and management options.
Develop collegial relationships with other physicians and scientists who work in the selected area(s) of expertise.
Residents will learn the basic skills in the diagnosis, evaluation, and management of patients with cerebral palsy, neuromuscular disorders, head and spinal cord injury and other neurologic disorders requiring rehabilitation.
Residents will learn the different testing tools and treatment options available for pediatric patients with neurologic disease and associated disabilities.

Medical Knowledge

Goals

Develop self-directed learning skills essential to the maintenance of expertise in Child Neurology.
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.
Further develop skills necessary to search for, identify and critically consider rare disorders in the differential diagnosis for patients assessed in clinic.

Objectives

Residents will:

Know and apply the basic and clinically supportive sciences, which are appropriate to Pediatric Neurology.
Be able to perform a complete neurologic examination on children of all ages, including behaviorally/developmentally/cognitively challenged patients.
Develop specific knowledge base of metabolic and inherited basis of diseases relevant to child neurology and the basic aspects of genetic counseling of inherited diseases.
Learn specific techniques, such as utilization of the latest molecular modalities available for diagnosis of diseases relevant to child neurology, obtaining genetic history, counseling genetic diagnoses.
Recognize presenting clinical features of the disorders most frequently encountered in the Child Neurology clinic and understand their natural histories.
Identify syndromic and nonsyndromic causes of common, usually isolated congenital anomalies.
Recognize presenting clinical and laboratory features of complex metabolic disorders.
Attend and participate in Neurology and Child Neurology conferences including research seminars and relevant problem conferences and grand rounds.
Lead two major topic discussions in journal club.
Present a Child Neurology topic for one core conference for Neurology and Child Neurology residents.
Enhance case conference presentations with literature references relevant to the diagnostic or management issue of interest to the presentation.
Assemble and present lectures on topics related to the selected area(s) of interest to appropriate audiences.
Basic knowledge with regard to the clinical course, diagnostic criteria, and management principles of neurologic disabilities will be obtained through clinical interactions, didactic teaching, and background reading which should occur in a patient-specific fashion.

Practice based learning and improvement:

Goals

Use skills acquired during primary residency training (pediatrics, neurology) as an initial foundation for medical and ethical decision making.
Identify opportunities for improvement in the delivery and quality of patient care
Bring developing knowledge and technology into practice in a responsible manner
Identify opportunities for improvement in the delivery and quality of patient care and work to bring those into practice

Objectives

Residents will:

Use relevant clinical information resources (PubMed, OMIM, guidelines of the ANA and AAN).
Incorporate evaluation feedback into daily practice.
Systematically review clinical practices and make changes intended to improve quality and effectiveness of care.
Systematically review clinical outcomes in order to contribute to the body of knowledge in Child Neurology.
Apply knowledge gained from literature reviews, meetings and conferences to the improvement of clinical practices.
Read, analyze and critique journal articles relevant to patient care.
Attend and participate in Neurology, Genetics, Psychiatry and Pediatrics conferences including research seminars, relevant problem conferences, and grand rounds.
Attend and participate in Child Neurology conferences including case conference, journal club, relevant colloquium sessions, didactic conferences.
Participate in education of other trainees including medical students and residents in other disciplines as they do electives in Child Neurology.
Present a Child Neurology topic for one core conference for pediatrics residents.
The resident will be responsible for tracking the number and diagnoses of patients seen and number of tests and procedures performed.

Professionalism

Goals

Demonstrate a commitment to ethical principles pertaining to provision or withholding of clinical care, confidentiality of patient information, informed consent, and business practice.
Demonstrate a commitment to carrying out professional responsibilities, adherence to ethical principles, and sensitivity to a diverse patient population.
During all patient encounters demonstrate caring and respectful behavior.
Demonstrate respect for patient autonomy

Objectives

Residents will:

Show respect, compassion, integrity, commitment to excellence and on-going professional development. The highest standards of professionalism must be maintained at all times.
Demonstrate sensitivity and responsiveness to patients and their families, culture, age, gender, and disabilities.
Respond in a timely and courteous manner to pages, calls, and patient inquiries.
Respectfully adhere to clinic schedules to minimize patient inconvenience.
Document all patient encounters in a complete, timely and accurate manner.
Undergo HIPAA training and comply with HIPAA rules and ethical principles regarding privacy and confidentiality of personal health information.
Integrate into the medical interview questions that provide insight into the patients’ and families’ decision making practices and their perspectives on sensitive and relevant clinical issues.
Adhere to ethical principles pertaining to the provision or withholding of care, informed consent, conflict of interest, and business practices

Interpersonal and Communication Skills

Goals

Communicate effectively with physicians and other health providers and agencies
Work effectively as a member of a health care team which also includes clinic coordinators, other clinic and hospital staff, and other learners.
Communicate effectively with patients, families, and the public (as appropriate) across a broad range of socioeconomic, intellectual and cultural backgrounds.
As clinical experience grows, assume leadership of a health care team.

Objectives

Residents will:

Create and sustain a therapeutic and ethically sound relationship with patients and their families.
Use appropriate listening skills and exchange information using effective nonverbal, explanatory, questioning, and writing skills during all interactions with patients and their families.
Work effectively with other health professionals, including other interdisciplinary teams.
Communicate with referring physicians and consultants in other disciplines so that questions prompting referral are clearly understood, and recommendations and management plans are effectively articulated.
Show respect and consideration for all members of the care team at all times.
During patient encounters, accurately determine issues of concern to the patient or family, and successfully help them comprehend the nuances and complexity of the information they are given, regardless of their background.
Deliver emotionally difficult news to patients and families in a sensitive and supportive manner.

Systems based practice

Goals

Demonstrate cost awareness and cost-benefit analysis in patient care.
Work in inter-professional teams to enhance patient safety and improve quality of patient care.
Make appropriate referrals to community and service resources such as birth-to-three programs, support groups and financial assistance agencies.
Provide care of uniformly high quality within a fiscally constrained environment.
Navigate various health care delivery and financing systems to provide optimal care.

Objectives

Residents will:

Communicate with hospital and laboratory personnel to facilitate adherence to procedures required for processing of samples for diagnostic testing.
Understand, appropriately request exceptions to and otherwise work within restrictions on service provision required by third party payers.
Identify system errors that affect quality of care and work with others toward implementing solutions
Assist patients in their efforts to navigate complex health care systems.
Advocate for improvements in health care delivery systems that will promote health and prevent disease and injury.