Header Child Neurology

Child Neurology Residency

UW and VA General Neurology Service

PGY3

UW and VA General Neurology Service

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. Child neurology residents rotate on general neurology during the PGY3 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.

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.

Patient Care

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. Develop competence at inpatient and intensive-care management for a variety of adult neurological conditions.
  6. 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. Independently obtain an accurate and comprehensive medical history.
  2. Independently obtain an accurate and comprehensive general and neurological examination.
  3. Efficiently admit and discharge patients.
  4. Be provided with learning opportunities to manage patients with neurological disease who require intensive care.
  5. Develop skill in discussing end-of-life issues with patients with neurological diseases.
  6. Become proficient in the management of patients with disorders of intracranial pressure.
  7. Learn appropriate work-up for major neurologic symptoms/syndromes/diseases.
  8. Implement a reasonable treatment plan.
  9. Realize long term complications of treatment modalities.

Medical knowledge

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. 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.
  2. Know how to access written materials including clinical practice guidelines related to patients under his or her care.
  3. Impart basic neurology knowledge to rotating medical students and other residents.
  4. Gain knowledge of laboratory and diagnostic studies and their appropriate uses.

Interpersonal and Communication Skills

Goals

  1. Become skillful listeners, and develop specific proficiency in communicating with neurologic patients through non-verbal means.
  2. 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. 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. Demonstrate skills in effective communication (both written and verbal) with patients, their families, colleagues and co-workers in order to better treat neurological disease.
  2. Become proficient in communication with allied health staff in day-to day contacts and during multidisciplinary discharge planning rounds.
  3. Be responsible for teaching basic neurological skills and knowledge to the rotating medical students and residents.
  4. Develop techniques to obtain accurate history from patients, and gain the patients’ confidence and trust.
  5. Create hospital notes that are concise and accurate.
  6. Become adept at presenting patients to faculty concisely and completely.
  7. Become proficient at communicating clearly with the consulting services.
  8. Learn efficient dictating skills so that consulting and inpatient care team services have immediate access to documentation on all patients.

Practice-Based Learning and Improvement

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.

Professionalism

Goals

  1. 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:

  1. 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.
  2. Be presentable—the resident will dress in a manner that signifies professionalism.  The wearing of scrubs is prohibited except after normal business hours.
  3. 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.
  4. 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.
  5. 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.
  6. 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.
  7. Residents will learn ethical, regulatory, and legal aspects of neurologic care, including the difference between standard and investigational treatments.
  8. 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.
  9. They will demonstrate responsiveness to patient needs that supersedes self-interest.
  10. 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.
  11. They will adhere to ethical principles by respecting confidentiality of medical information.

Objectives

Residents will:

  1. Solidify their 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 MedHub.
  11. Learn ethical, regulatory, and legal aspects of care, including the difference between standard and investigational treatments.
  12. Promptly attend case conferences and didactic sessions.

Systems-Based Practice

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. Learn how the health care system functions, especially as relevant to the patient with neurologic disease.
  4. 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.
  5. Be able to individualize evaluations, diagnostic testing, and develop treatment plans with respect to the health delivery systems available to patients. Residents will become knowledgeable of available patient resources including other health care professionals and patient advocacy groups.
  6. Become proficient in the use of the UW Epic electronic record and the VA CPRS systems.
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