The overall goal of our training program is to develop superb neurophysiologists. 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. It is the goal of our program to develop life-long self-evaluation and self-improvement skill. To accomplish these goals, the fellow’s progress toward competency throughout their year of training will be evaluated both by faculty, program director, and by the fellow. At the time of each 6-month evaluation with the program director and the fellow will formulate an action plan to move towards competency and proficiency in the following areas:
- Patient Care
- Medical Knowledge
- Interpersonal Communication
- Practice-Based Learning and Improvement
- Systems-Based Practice
- Obtain accurate and sufficient histories to characterize seizures and to define risk factors for developing epilepsy
- Review AAN practice guidelines and learn to incorporate them into the evaluation and treatment of patients with neurological disease including epilepsy and neuromuscular disorders
- Demonstrate communication skills to educate patients and families regarding neurological diagnosis and treatment
- Work with health care professionals (i.e. nursing staff, neurophysiology technologists, ancillary staff) to provide patient-focused care
- Attend subspecialty clinics, admit and manage patients
- Review electrophysiological studies and apply findings to care of neurological patients
- Formulate patient management plans regarding appropriate diagnostic and therapeutic interventions
- Explain the recognition and treatment of status epilepticus, a medical emergency
- Take a personal initiative in self-education (including reading recent literature).
- Review of standard texts of neurophysiological techniques and their application to care of neurological patients, including EEG, EMG/NCS, evoked potentials, and sleep studies.
- Have a breadth of knowledge of neurophysiological technical aspects and application to pass the CNP board examination.
- Describe the importance of EEG patterns and their implications in patient care in both routine and continuous EEG.
- Describe the importance of EMG/NCS in the diagnosis and management of patients with neuromuscular disease.
- Describe the diagnostic utility and application of evoked potentials including for neurological prognosis.
- Verbalize rational approach to the management of epilepsy including choice of appropriate antiepileptic’s
- Describe the principles of EEG generation and recording
- Achieve an orderly approach to the interpretation of EEG studies
- Identify normal and abnormal EEG patterns
- 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
- Achieve skills in creating and dictating neurophysiology reports
- Correlate video recordings of seizures with EEG tracing and interpret scalp EEG findings
- Interpret continuous EEG recordings from patients in the epilepsy monitoring and intensive care units and updating care teams of the record progress
Interpersonal and Communication Skills
- Develop techniques to obtain accurate history from patients, and gain the patients’ confidence and trust
- Create reports that accurately convey neurophysiological findings and relate these findings to the clinical setting
- Interact effectively with other members caring for patients including nursing and technical staff
- Create neurophysiology, clinic, and hospital notes that are concise and accurate
- Show respect, compassion, integrity and ongoing professional development
- Verbalize ethical principles with adherence to confidentiality, HIPAA principles, and appropriate informed consent
- Determine psychosocial issues that complicate care.
- Be punctual and appropriately attired
- Keep patient logs up-to-date
Practice-Based Learning and Improvement
- Appraise literature to better understand neurological disorders and their etiology and clinical presentation
- Assess studies that evaluate treatment options for epilepsy, neuromuscular and other neurological disorders
- Apply and use guidelines from the American Clinical Neurophysiological Society for the practice and interpretation of neurophysiology studies
Systems Based Practice
- Identify the importance for proper diagnosis and treatment of epilepsy as to the effect of diagnosis on insurability and driving privileges
- Assess efficiencies of the UW and VA systems regarding patients referred from other centers, and develop management plans that are effective and not redundant or wasteful of medical resources
- Make decisions regarding the cost considerations of choosing appropriate treatment for neurological disorders including epilepsy
- Identify advocacy programs for patients with neurological disease.
Clinical Training Objectives
- Competence in the indications and interpretation of neurophysiology studies and there application to improve care of patients with neurological disease (Patient Care);
- A rich knowledge base in both clinical and basic neuroscience, as well as the fundamentals of clinical neurophysiology (Medical Knowledge);
- Competence in obtaining an appropriate medical history (including sensitive issues such as sexual history) in a professional and humane manner (Interpersonal and Communication Skills, Professionalism);
- Competence in communicating diagnosis and treatment plans, and competence in communicating potentially sensitive information (Interpersonal and Communication Skills, Professionalism);
- Competence in communicating succinctly and clearly with other healthcare professionals, with a proper respect for the principles of HIPAA regulations (Interpersonal and Communication Skills, Professionalism);
- Skill in self-assessment and self-improvement (Practice-Based Learning and Improvement);
- Skill in practice assessment, as well as both practice- and systems improvement, to enhance quality of care and improve patient safety (Practice-Based Learning and Improvement, Systems-Based Practice).
Specific Academic/Research Objectives
At the end of the training program, the fellow will have developed:
- A scholarly approach to the practice of clinical neurophysiology, including the incorporation of evidence-based medicine into clinical decision-making (Practice Based Learning and Improvement);
- Basic knowledge of clinical trial design and statistical testing, as well as the ability to utilize this knowledge for critical interpretation of medical literature (Medical Knowledge, Practice-Based Learning and Improvement);
- 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), or quality improvement. (Interpersonal and Communication Skills, Professionalism, Practice-Based Learning and Improvement); and
- 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 (Interpersonal and Communication Skills, Medical Knowledge, Professionalism).
1. Clinical Neurophysiology; 4th ed; Daube and Rubin; Oxford
2. Current Practice of Clinical Electroencephalography; 4th ed; Ebersole; Wolters Kluwer
3. Atlas of EEG in Critical Care; 1st ed; Hirsch and Brenner; Wiley Blackwell
4. Neurophysiologic Intraoperative Monitoring; 2nd ed; Husain; demosMedical
5. Electromyography and Neuromuscular Disorders: Clinical-Electrophysiologic-Ultrasound Correlations; 4th ed; Preston and Shapiro; Elsevier