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    A. Resident Evaluation.doc.doc.doc A. Resident Evaluation.doc.doc.doc Document Transcript

    • University of Arkansas for Medical Sciences Department of Neurology Neurology Resident’s Handbook 2006-2007 Chairman: Sami Harik, M.D. Vice-Chairman: James Schmidley, M.D. Program Director: Walter S. Metzer, M.D. Index I. Introduction A. Mission Statement B. Duration and Scope of Training 1- The PGY-1 year 2- The PGY-2, -3, and –4 years 3- Neurology Continuity Clinics at UAMS and VA C. Goals and Objectives for Residency Education D. Resident’s Job Description & Progressive Responsibility II. Administration and Organization A. Appointment of Residents Externship and Observership Application to the residency program and candidate selection B. Leave and Vacation Policies C. Policy on Raising and Resolving Issues (Complaints and Concerns) in a confidential manner D. Policy on duty hours monitoring E. Policy on counteracting fatigue III. Faculty & Other Program Personnel Qualifications and Responsibilities A. Program Director B. Teaching Staff C. Attending Clinical Supervisory Responsibilities D. Mentors Supervisory Responsibilities E. Chief Resident F. Program Coordinator IV. Facilities and Resources A. Patient Population B. Facilities V. Educational Program A. Basic Curriculum B. Teaching Rounds C. Clinical Teaching 1
    • D. Progressive Responsibility E. Basic and Related Science F. Electives G. Seminars and Conferences H. Educational Policies I. Resident Participation in Research J. Resident Responsibility for Teaching VI. Evaluation A. Resident Evaluation B. Program Evaluation C. Board Certification VII. Appendices: Appendix 1: Faculty Members Listing. Appendix 2: PGY-1 Neurology Resident Rotation Yearly Schedule and Continuity Clinic Monthly Schedule. Appendix 3: PGY-2, -3 & -4 Neurology Resident Rotation Yearly Schedule and Continuity Clinic Monthly Schedule. Appendix 4: Neurology Department Scheduled Weekly Conferences. Appendix 5: Learning Objectives for PGY-1, 2, 3 and 4. Appendix 6: Rotation-Specific Learning Objectives. Appendix 7: Criteria and Processes on Reappointment, Evaluation, Promotion, and Academic and Other Disciplinary Actions. Appendix 8: ACGME general requirements and ACGME Neurology requirements. Appendix 9: Evaluation forms. Appendix 10: Residency-Related Deadlines. Revised in June 2006 2
    • University of Arkansas for Medical Sciences Department of Neurology Neurology Resident’s Handbook 2006-2007 I. Introduction A. Mission Statement The neurology residency training program at UAMS aims at developing competent neurologists through a 4-year intensive training program that enables graduating residents to assume the role of principal care physician of patients with neurologic diseases. Toward this end, the resident is required to assume a progressive responsibility and independence as he/she develops his/her professional maturation in the 6 areas of general clinical competencies as defined by the Accreditation Council for Graduate Medical Education (ACGME). These areas are: -Patient care, -Medical knowledge, -Practice-based learning and improvement, -Interpersonal and communication skills -Professionalism, and -System-based practice. Refer to Appendix 8 for the listing of the ACGME requirements common to all residency-training programs and those for neurology residency training programs. B. Duration and Scope of Training The UAMS neurology residency-training program is a 4-year (48-months) program. It includes 12 months of internship (PGY-1) and 36 months of neurology residency training (PGY-2, -3, and –4). The participating institutions are: -The University of Arkansas for Medical Sciences Hospital (UAMS), -The Central Arkansas Veterans Healthcare System Medical Center (VA), -The Arkansas Children’s Hospital (ACH), UAMS is located across the street from the VA (1/16 miles) and 1.5 miles from ACH. Candidates of the UAMS neurology residency program who match through the Electronic Residency Application Service (ERAS) are automatically provided with a post-graduate year 1 (PGY-1) at UAMS under the supervision of the Department of Neurology. Exceptionally, candidates may join the training program as a PGY-2 neurology resident after completing a PGY-1 year in another ACGME-accredited institution in the United States or Canada. 3
    • The resident is required to devote his/her full-time toward his/her residency training and is forbidden from participating in any other medical training/practice without the written permission of the program director (including, but not limited to, moonlighting). The program director may withdraw such permission at any time if he recognizes that such activity is affecting negatively the resident’s residency training. The resident is expected to render all levels of care commensurate with his/her training and is required to abide by departmental and UAMS College of Medicine policies. All the UAMS-College of Medicine policies are available on the UAMS website at www.uams.edu/gme and each resident is required to be familiar with them or at least know how to refer to them. 1- The PGY-1 year: The first year includes a broad clinical experience in general internal medicine. Residents are supervised by faculty from the corresponding departments and by the neurology residency program director. A typical rotation schedule includes: o 8 months in internal medicine with primary responsibility in patient care (at UAMS and VA) that includes:  4 months of VA ward rotations  2 months intensive care rotations (one at UAMS and the other at VA),  1-month rotation in emergency medicine (at UAMS), and  1-month rotation in infectious diseases (at UAMS); o 1 month rotation in psychiatry (at UAMS); o 1-month rotation in general pediatrics (at ACH); o 1-month rotation in neurosurgery (at UAMS and VA); and o 1-month rotation in neurology (at UAMS). In addition, the PGY-1 resident attends ½ day/week of continuity neurology clinic, alternating between UAMS and the VA (see Appendix 2: PGY-1 Neurology Resident Continuity Clinic Monthly Schedule). 2- The PGY-2, -3, and –4 years: The PGY-2, -3, and –4 years are undertaken at UAMS, VA and ACH under the supervision of the neurology faculty and the neurology residency program director. In general, rotations are assigned as follows: -PGY-2 residents: primarily neurology ward rotations at UAMS and VA, 1-2 months of elective, 2 months of pediatric neurology; -PGY-3 residents: primarily neurology consult rotations at UAMS and VA, 2 months of elective rotations, 1 month of pediatric neurology; -PGY-4: supervising senior resident at UAMS and VA, and 5-6 months of elective rotations. During the PGY-2, -3, and -4 years, the resident attends two ½ day of continuity neurology clinic each week at UAMS (on Tuesday pm or Thursday am) and at the VA (on Tuesday am or Thursday pm respectively) (see Appendix 3: PGY-2, -3 & -4 Neurology Resident Rotation Yearly Schedule). Three months of pediatric neurology training are required but the resident may be able to take additional pediatric neurology elective rotations at ACH. The ACH rotation includes 2 months of ACH-neurology clinic and 1 month of ACH-neurology ward. Both types of rotations include consultation duties on the ACH ward as instructed by the supervising attending. The resident is required to notify the program director by May 1st of the preceding academic year about his/her choices of specific elective rotations after securing the permission of the faculty supervising that rotation. 3- Neurology Continuity Clinics at UAMS and VA: 4
    • The am clinic starts at 8:30am and usually ends at 12:30pm. The pm clinic starts at 12:30pm and usually ends at 4:30pm. The resident is required to start his/her clinic on time. The nurse in charge of the clinic is Deborah M Johnson, R.N. at UAMS and Maka Hammock, R.N. at the VA. Each resident will keep a log of the number of patients he/she sees and the diagnosis. All patients seen by the residents should be staffed by one of the 2 faculty members available in each clinic. With the traditional show-up rate at about 70-80%, the resident should have ample time to evaluate/staff the patient, write a note and enter orders. The nurse in charge of the clinic may assign additional patients to any resident, as she or the supervising faculty deems necessary. A typical patient half-a-day clinic load consists of Level of training New patients/half day clinic Follow-up patients/half day clinic PGY-1 1-2 patients (2 hours/patient) 0-2 patients (1 hour/patient) PGY-2 (first 6 months) 1-2 patient (1hour/patient) 4 patients (45 minutes/patient) PGY-2 (second 6 months), -3 and –4 1-2 patients (45 minutes/patient) 6-8 patients (30 minutes/patient) C. Goals and Objectives for Residency Education Overall Program Goals: Neurology training at UAMS is dedicated to provide each resident with the six areas of competencies defined by the ACGME (Appendix 8) and the skills to be a fully qualified and competent clinician, motivated to pursue self-education after training and well founded in the basic neuroscientific principles that form the foundation of this clinical discipline. There is a large body of knowledge that one must master to become an excellent neurologist. To aid in learning that material, we have designed a comprehensive curriculum to guarantee a strong education. To accomplish this, the program integrates extensive practical exposure to all aspects of current clinical neurology with a firm grounding in underlying scientific principles and the methods of clinical investigation. 1. This definition shapes the direction of medical education at UAMS and our residency-training program. The UAMS neurology training program system is rich in its diversity of clinical experiences and provides the opportunity to fulfill the first of the training program goals, that is, excellence in patient care and clinical skills. 2. We seek to provide all resident trainees with the fundamentals of basic and clinical neuroscience. The challenges of neurological practice in the future will require familiarity with a rapidly expanding body of neuroscience information, sound clinical judgment, communication skills and appreciation of medical ethics and economics. 3. Residents will be given ample exposure to neuroscientific research and the opportunity to investigate research interest in elective rotations. The extensive elective time during our residency program (8-9 months) and the resources available within the department allow residents with a research background to continue pursuing their interests during residency. Independent research is not a requirement of the program, though there is an emphasis on scientific basis of neurology throughout training and research is encouraged. Our residents frequently present their own work at national academic meetings. 4. Residents in our training program will learn to be good teachers. Through teaching, one learns the skills of communication and the importance of interpersonal interactions. There is ample opportunity to explore the depths of one’s knowledge in a given topic. Teaching medical students, colleagues and co-workers is an important part of our training program. 5
    • 5. We seek to engender a climate of continuous self-education that begins early in the residency program, and should extend throughout the professional life of the trained physician. Residents achieve academic success in an atmosphere of friendship, cooperation, personal guidance and intellectual curiosity. There is a great deal of camaraderie amongst the residents in our program, who work well together and frequently socialize together and with the faculty. 6. Lastly, but most importantly, we seek to develop clinical neurologists with humanistic qualities. That includes integrity, respect and compassion. Integrity is the commitment to the highest standards of professional conduct in searching for the truth and understanding of a patient’s illness. Respect is the personal commitment to honor others’ choices and rights regarding themselves and their medical care. Compassion is an appreciation that suffering and illness engender special needs for comfort and help without evoking excessive emotional involvement, which could undermine professional responsibility for the patient. We intend to train the best neurologists in the country, whether they intend to be clinicians treating patients or researchers studying complex diseases. We give residents great freedom to shape their own program and their own careers. This flexibility coupled with our superior research and clinical resources are essential for our program’s success. All educational components of our residency program are related to the general and rotation-specific program goals. The rotation-specific objectives are listed in Appendix 5/6 of this Neurology Resident’s Handbook that is handed to each resident at the beginning of each academic year and updated at least at the end of each academic year. D. Resident’s Job Description & Progressive Responsibility This is a general overview of the roles, responsibilities and functions as a neurology resident at the UAMS Department of Neurology. It is meant to address issues relating to degrees of independent clinical practice, interactions with and supervision by faculty, performance of procedures and interactions with or supervision of other housestaff or medical students. It is expected that residents will demonstrate ongoing maturity during each training year and will progressively transition into the next level by the end of prior academic year (see Appendix 7: Criteria and Processes on Reappointment, Evaluation, Promotion, and Academic and Other Disciplinary Actions). Supervision of Residents: Residents are under supervision of attending faculty physicians who are members of the active medical staff with appropriate credentials. There are explicit written descriptions of supervisory lines of responsibility for the care of patients developed by the residency training program director and communicated to all residents and all attending physicians within the program. Residents have reliable systems for communication and interaction with supervisory attending physicians. Residents are supervised in such a way that the resident assumes progressively increasing responsibility according to their level of education, ability and experience. On-call schedules for attending physicians are structured to ensure that supervision is readily available to residents on duty. Resident Roles and Clinical Responsibilities: a) Post-Graduate Year-1 (Internship) Roles and Clinical Responsibilities: The purpose of this year is for the resident to acquire an excellent background of general medical knowledge. 6
    • 1. Evaluate and provide care to a broad spectrum of patients with medical illnesses, in order of presentation of assignment by senior resident or attending. 2. Serve as the attending’s principal resource for day-to-day reliable clinical data of the service. 3. Participate in all aspects of patient care, including history taking, physical examination, diagnostic and therapeutic planning, procedures, writing orders, and counseling with patients and their family. It is the responsibility of the residents to write patient care orders. "Do Not Resuscitate", "Comfort Care", or "Withdrawal of Cardiopulmonary Support" should conform to hospital policy ML.3.03 Care of Hopeless/Moribund Patients (refer to http://www.uams.edu/UH/policy/Medical%20Legal/ml303.htm). 4. Discuss in-depth all cases with the senior resident and/or attending prior to initiation of all but the most basic diagnostic studies or therapeutic interventions. At any time, if unsure of his/her assessment, the resident may request the senior resident or the attending to re-evaluate in person patients prior to initiating diagnostic studies and interventions. 5. Learn and perform procedures with complete approval and supervision of senior resident or attending (depending on the complexity of the procedure). 6. Attend to in-house call as assigned on the monthly call schedule (prepared by the chief resident of the corresponding rotation and approved by the program director). The resident is required to be physically present in the assigned hospital(s) for the duration of the call. 7. Attend one half-day of neurology continuity clinic every week as assigned by the program director. 8. Attend all required conferences. 9. Learn basic principles of general medicine especially through reading major reference books and pertinent peer-reviewed literature. 10. Maintain medical records in a timely manner. 11. Supervise medical students rotating on the same service. b) Post-Graduate Year-2 Roles and Clinical Responsibilities: 1. Evaluate and provide care to a broad spectrum of patients with neurological illnesses, in order of presentation of assignment by senior resident or attending with emphasis on the neurology in- patient service. 2. Serve as the attending’s principal resource for day-to-day reliable clinical data of the neurology in- patient service. 3. Participate in all aspects of patient care, including history taking, physical examination, diagnostic and therapeutic planning, procedures, writing orders, and counseling with patients and their family. It is the responsibility of the resident to write patient care orders. "Do Not Resuscitate", "Comfort Care", or "Withdrawal of Cardiopulmonary Support" should conform to hospital policy ML.3.03 Care of Hopeless/Moribund Patients (refer to http://www.uams.edu/UH/policy/Medical%20Legal/ml303.htm). 7
    • 4. Discuss in-depth all cases with the senior resident and/or attending prior to initiation of all but the most basic diagnostic studies or therapeutic interventions. At any time, if unsure of his/her assessment, the resident may request the senior resident or the attending to re-evaluate in person patients prior to initiating diagnostic studies and interventions. 5. Learn and perform procedures with complete approval and supervision of senior resident or attending (depending on the complexity of the procedure). 6. Attend to in-house call as assigned on the monthly call schedule (prepared by the chief resident and approved by the program director). The resident is required to be physically present in the assigned hospital(s) for the duration of the call. 7. Attend two half-days of continuity clinic every week (one at the VA and the other at UAMS). 8. Sit for the yearly Residency In-Service Training Examination (RITE). A score that is less than the 25th national percentile as compared to residents of the same level of training may be used as a basis for dismissal from the training program. 9. Attend all required conferences. 10. Learn basic principles of neurology practice especially through reading major reference books. 11. Maintain medical records in a timely manner. 12. Supervise medical students and interns/residents from other departments rotating on the neurology service. c) Post-Graduate Year-3 Roles and Clinical Responsibilities: 1. Evaluate and provide care to a broad spectrum of patients with neurological illnesses, in order of presentation of assignment by senior resident or attending with emphasis on the neurology consult service. 2. Serve as the attending’s principal resource for reliable day-to-day clinical data of the neurology consult service. 3. Participate in all aspects of patient care, including history taking, physical examination, diagnostic and therapeutic planning, procedures, writing orders, and counseling with patients and their family. It is the responsibility of the resident to write patient care orders. "Do Not Resuscitate", "Comfort Care", or "Withdrawal of Cardiopulmonary Support" should conform to hospital policy ML.3.03 Care of Hopeless/Moribund Patients, (refer to http://www.uams.edu/UH/policy/Medical%20Legal/ml303.htm). 4. Discuss in-depth all cases with the senior resident and/or attending prior to initiation of all but the most basic diagnostic studies or therapeutic interventions. At any time, if unsure of his/her assessment, the resident may request the senior resident or the attending to re-evaluate in person patients prior to initiating diagnostic studies and interventions. 5. Refine his/her skills performing procedures with complete senior resident or attending supervision and approval. May initiate common diagnostic studies and therapeutic interventions in straightforward patients, prior to attending presentation. Decisions regarding complex invasive 8
    • procedures, change in plans, discharge, and use of consultants are discussed in-depth with senior resident and/or the attending. 6. Attend to in-house call as assigned on the monthly call schedule (prepared by the chief resident and approved by the program director). The resident is required to be physically present in the assigned hospital(s) for the duration of the call. 7. Attend two half-days of continuity clinic (one at the VA and the other at UAMS). 8. Sit for the yearly Residency In-Service Training Examination (RITE). A score that is less than the 25th national percentile as compared to residents of the same level of training may be used as a basis for dismissal from the training program. 9. Attend all required conferences. 10. Learn advanced principles of neurology practice especially through reading major reference articles in the neurological literature. Emphasis should be placed on learning how to conduct focused literature searches, gaining experience with full spectrum of patient procedures, honing proficiency, and balancing quality of patient evaluation and care with improved overall efficiency. 11. Maintain medical records in a timely manner. 12. Supervise medical students and interns/residents from other departments rotating on the neurology service. May take selected presentations from them with attending approval. d) Post-Graduate Year-4 Roles and Clinical Responsibilities: 1. Continue to evaluate and provide care to a broad spectrum of patients with neurological illnesses, but with emphasis on those with highest acuity or greatest critical illness. 2. Play supervisory role with increased teaching, consultative and research activities, assuming the role of “an acting-attending” in charge of the neurology in-patient and consult service. It is the responsibility of the resident to make sure that patient care orders are adequately written. Insure that "Do Not Resuscitate", "Comfort Care", or "Withdrawal of Cardiopulmonary Support" conform to hospital policy ML.3.03 Care of Hopeless/Moribund Patients (refer to http://www.uams.edu/UH/policy/Medical%20Legal/ml303.htm). 3. Emphasize on time, resource and efficiency management. Goal is to gain competence in managing administrative, patient flow and team coordination activities. 4. Discuss all cases with the attending prior to disposition decisions. May initiate common diagnostic studies and therapeutic interventions prior to attending discussion. May also initiate more sophisticated diagnostic studies, therapeutic interventions with attending approval. At any time, if unsure of his/her assessment, the resident may request the attending to re-evaluate in person patients prior to initiating diagnostic studies and interventions. 5. Refine proficiency with full range of neurological procedures. May attempt or initiate procedures with attending approval. 6. Serve as a second (back-up) call resident as assigned on the monthly call schedule (prepared by the chief resident and approved by the program director). The call is taken from home but the resident 9
    • is required to present promptly to the assigned hospital(s) if requested by the junior resident on call or by the attending. 7. Attend two half-days of continuity clinic (one at the VA and the other at UAMS). 8. Sit for the yearly Residency In-Service Training Examination (RITE). A score that is less than the 25th national percentile as compared to residents of the same level of training may be used as a basis for dismissal from the training program. 9. Attend all required conferences. 10. Refine his/her knowledge of the advanced principles of neurology practice through conducting thorough searches in the neurological literature. Emphasis should be placed on developing clinical practice independence through perfecting focused literature searches, gaining experience with full spectrum of patient procedures with little supervision, honing proficiency, and balancing quality of patient evaluation and care with improved overall efficiency. 11. Maintain medical records in a timely manner. 12. Supervise junior neurology residents, medical students and interns/residents from other departments rotating on the neurology service as well as assist in their patient care management (including supervising attempt or initiation of procedures). May take presentations from them with attending approval. II. Administration and Organization A. Appointment of Residents The program director aims at recruiting 4 residents per year through the Electronic Residency Application Service (ERAS). A resident-to-faculty ratio of at least 1:1 will be maintained (excluding PGY-1 residents that are primarily supervised by non-neurology faculty). Applicants are required to apply online; http://www.aamc.org/audienceeras.htm. Externships and Observerships: Neurology externships and observerships are not available at the Department of Neurology at UAMS. Application to the residency program and candidate selection: Applications from eligible candidates are accepted exclusively through the Electronic Residency Application Service (ERAS). See web address above. All applications should be received before November 15th proceeding match day. To be considered for an appointment in our program, the following qualifications are required: • Successful completion of an MD degree (after at least 4 credit years) from a medical school listed in the World Directory of Medical School (published by the World Health Organization); • Passing the step 1 and 2 of the United States Medical Licensing Examination (USMLE); a score of less than 80 on either exam will lower substantially the chance of an applicant to be invited for an interview; • Demonstrating proficiency in the spoken and written English language. For foreign medical graduates, a valid certificate from the Educational Commission for Foreign Medical Graduates (ECFMG) and a valid 10
    • visa are also required. Applicants must have a negative drug screen and are selected according to policy on selection. • A complete ERAS application form that includes adequate personal information, medical school transcripts, Dean’s letter, personal statement, and 3 letters of recommendation. The program director and chairman of the department review all applications and select for interview those eligible applicants who appear to have adequate academic credentials (including scholarly activities such as published papers, etc…) and a clear commitment to a career in neurology. Applicants are interviewed by members of the neurology faculty (always including the program director and/or the chairman of the department). Interviewers complete a written evaluation form for each interviewee and submit it to the program director by the end of the interview day. The chairman, the vice-chairman, and the program director make decisions regarding rank orders of the applicants after considering the totality of the applications and the interview impressions. All applicants are recruited exclusively through the NRMP match. Candidates of the UAMS neurology residency program who match through the NRMP match are contacted by phone on match day (usually in March) by the program director and are provided with a post-graduate year 1 (PGY-1) at UAMS under the supervision of the Department of Neurology. Accordingly, the program director will require them to withdraw from the National Residency Matching Program (NRMP). Exceptionally, such candidates may join the training program as a PGY-2 neurology resident after completing a PGY-1 year in another ACGME-accredited training in the United States or Canada. Candidates to the residency-training program who match through the NRMP match are required to assume their clinical duties on July 1st. Their appointment in our program cannot be guaranteed should they fail to do so for any reason (including, but not limited to, failure to secure a valid USA visa). B. Leave and Vacation Policies Leave and vacation policies follow the UAMS-College of Medicine corresponding policies. (Refer to www.uams.edu/gme ). Each resident is allowed 15 working days. Neurology department specific vacation policies include: • The chief resident and the program director are responsible for approving or declining all vacation requests. Some may be declined because of conflicts with the call schedule. Requests will be granted on a first-come, first-serve basis. The program coordinator, Athena Ozment, will arrange for the cancellation of the clinics of the resident on leave, but it is the responsibility of the resident as professional courtesy to notify the supervising faculty. • Vacation day’s requests must be submitted to the program director by July 15th for days requested in the first 6 months of the academic year, and by January 15th for days requested in the second 6 months of the academic year. • At least a 30-day advance notice is required for all vacation days request. • Vacation days cannot be taken when the resident is on the in-patient ward or consult service except when these are the only rotations the resident has on his/her yearly schedule. Accordingly, the PGY-2, -3 and –4 residents are required to notify the chief resident by February 1 of the preceding academic year about which months they would like to take their vacation days. Failure to do so will result in random assignment of rotations. • PGY-1 cannot take vacation during their ER, VA ward and ICU rotations. • No vacation day will be approved in the first week of July and last week of June (because of the overlap with orientation sessions) except for PGY-4 residents who are required to save the last few days of June 11
    • (from the last weekend of June till June 30) as vacation since most exiting residents need to make moving arrangements during that week. • Each PGY-4 resident is granted up to 5 days of professional leave for job interviews (1 day/interview). Additional time off needed to attend interviews is considered vacation time. It is the responsibility of the resident to save the appropriate amount of vacation time for this purpose. Fridays are the recommended days for interviews. • Unused vacation days cannot be carried over to the next academic year. Failure to select vacation time appropriately (as outlined above) will result in loss of vacation time. Neurology department-specific sick leave policies include: • The resident is required to notify the chief resident and/or the program director, as well as the program coordinator, as soon as the resident anticipates taking a sick leave (this includes, but is not limited too, health–related medical appointments and maternity leave). Failure to do so within 24 hours of the time the resident is expected to report to his clinical responsibility is considered abandonment of duty and may be used as a basis for immediate dismissal. • The resident is required to request in writing from the program director family medical leave. • The program coordinator will arrange for the cancellation of the clinics of the resident on sick leave, but it is the responsibility of the resident as professional courtesy to notify the supervising faculty. Neurology department-specific professional leave policies include: • The chief resident and the program director are responsible for approving or declining all professional leave requests. Some may be declined because of conflicts with the call schedule. Requests will be granted on a first-come, first-serve basis. The program coordinator will arrange for the cancellation of the clinics of the resident on leave, but it is the responsibility of the resident as professional courtesy to notify the supervising faculty. • At least a 30-day advance notice is required for all professional leave requests. • Time off needed to sit for professional exams, to attend national and regional educational meetings is considered professional leave at the discretion of the program director. The resident is required to schedule his/her exam on days Mondays, Wednesdays or Fridays to avoid conflicts with the clinic schedule. The resident is required to notify the chief resident and the program coordinator to make sure he/she is not given calls or clinic duties during his/her leave of absence. C. Policy on Raising and Resolving Issues (Complaints and Concerns) in a confidential manner Should a neurology resident have a complaint or concern regarding any aspect of their residency experience or should a dispute arise which he/she feels requires discussion or action, there is an established mechanism for handling conflict. In general, these situations should be handled at the “lowest” level, which is appropriate to the situation, and if resolution cannot be achieved at that level, it can be discussed at the next higher level. The following sequence of levels should be followed: 1. Program coordinator, Athena Ozment (vacation, paperwork, required residency-related matters…) 2. Chief Resident (scheduling problems, vacation, conference coverage,) 3. Attending physician at each hospital (scheduling problems, problems with nurses/technicians…) 4. Neurology Residency Program Director (substance abuse in self or others, personal problems, problems with curriculum, job preferences, problems with faculty members…) 5. Chairman of Neurology Department (problems with program director, problems with faculty if not solved by program director…) 12
    • 6. Dr. Jim Clardy, Assistant Dean for Graduate Medical Education (problem not solved in the department) 7. Residents’ council (any problem which has not been solved by the department or related to Graduate Medical Education…) 8. Formal Grievance Committee of UAMS (any problem which has not been solved at other levels). III. Faculty & Other Program Personnel Qualifications and Responsibilities The director and teaching staff of a program prepare, comply with and review at least annually the written educational goals for the program. They are responsible for the general administration of a program, including those activities related to the recruitment, selection, instruction, supervision, counseling, evaluation, and advancement of residents, and the maintenance of records related to program accreditation. A. Program Director: Dr. Walter S. Metzer is the program director. He can be reached at all time at: University of Arkansas for Medical Sciences Department of Neurology 4301 W. Markham St, Slot#500 Little Rock, AR 72205 USA Tel: (501) 296-1165 (office) Pager: (501) 257-1022 #1289 Email: WMetzer@uams.edu Responsibilities of the program director include: a) Monitoring the content and ensuring the quality of the program. b) Preparation of a written statement outlining the educational goals and objectives of the program with respect to knowledge, skills and other attributes of residents at each level of training and for each major rotation or other program assignment. A copy of this handbook (including the goals and objectives of the program) is distributed to residents and faculty members at the beginning of each academic year (or more often, as deemed necessary) and will be available on the website of the department. c) Selection of residents for appointment to the program. d) Selection and supervision of the teaching staff and other program personnel at each institution participating in the program. e) The program director and chief resident prepare: 1. The yearly rotation schedule (that includes the names of the supervising staff of each rotation), 2. The weekly conference schedule, and 3. The biannual teaching staff evaluation, conducted confidentially by all residents. f) Supervision of residents through explicit written descriptions of supervisory lines of responsibility (as outlined in the section “I.D. Resident’s Job Description & Progressive Responsibility” of this handbook) for the care of patients. g) Evaluation of resident's knowledge, skills, and overall performance, including the development of professional attitudes and ethical behavior consistent with being a capable neurologist. The program director and the faculty members, shall: 1. Semiannually evaluate the knowledge, skills, and professional growth of the residents (in late fall and late spring of each academic year). 2. Discuss the summary of the resident’s performance on a one-on-one meeting with the chairman and program director. 3. Advance residents to positions of higher responsibility only on the basis of evidence of their satisfactory progressive scholarship and professional growth. 13
    • 4. Maintain a permanent record of evaluation for each resident and have it accessible to the resident and other authorized personnel. h) Provision of a written final evaluation for each resident who completes the program. The evaluation shall include a review of the resident's performance during the final period of training and should verify that the resident has demonstrated sufficient professional ability to practice competently and independently. i) Implementation of fair procedures as established by the UAMS College of Medicine regarding academic discipline and resident complaints or grievances (these policies are available on the UAMS-College of Medicine website at www.uams.edu/gme). j) Monitoring resident stress, including mental or emotional conditions inhibiting performance or learning and drug- or alcohol-related dysfunction. Program directors and teaching staff shall be sensitive to the need for timely provision of confidential counseling and psychological support services to residents. Training situations that consistently produce undesirable stress on residents shall be evaluated and attended to through a monthly meeting between the residents and program director on the first Monday of each month at noon. The program director shall discuss such issues in the biweekly faculty meeting as well as during Quality Assurance (Mortality & Morbidity) meeting on every first Wednesday of each month (at 7:30am). k) Preparation of an accurate statistical and narrative description of the program, as requested by the Residency Review Committee (RRC) and the UAMS-Graduate Medical Education (GME) committee for the purpose of the regular external (program accreditation) and internal program review, respectively. B. Teaching Staff Resident-to-faculty ratio of at least 1:1 will be maintained (excluding PGY-1 residents that are primarily supervised by non-neurology faculty). The faculty members’ listing is in Appendix 1. All neurologists with teaching responsibilities at UAMS are certified by the American Board of Psychiatry & Neurology (ABPN) or have equivalent qualifications. The faculty members at each participating institution have diverse interests and expertise in multiple neurological subspecialties ensuring adequate clinical opportunities for residents (see Faculty Members Listing). These include neuro-ophthalmology, neuromuscular diseases, cerebrovascular diseases, epilepsy, movement disorders, clinical neurophysiology, behavioral neurology, neuroimmunology, neuroimaging, neuro-oncology, pain management, child neurology, and the neurology of aging. All residents are required to rotate for at least 1 month on the psychiatry service (typically in the PGY-1 year). All faculty members: • Are readily accessible to residents. • Have a strong interest in the education of residents, sound clinical and teaching abilities, support of the goals and objectives of the program, and a commitment to their own continuing medical education. They provide continued instruction through seminars, conferences, and teaching rounds. • Actively pursue scholarly activity in neurosciences. • Encourage residents to engage in scholarly activity. • Participate as mentors to residents (as selected by residents). C. Attending Clinical Supervisory Responsibilities: The attending physician is required to: 14
    • 1. See every patient and write an “attending admission note” within 24 hours of admission (required at UAMS and the VA). 2. Write a note describing and confirming the patient’s history, physical examination, problem list and management plan. Countersign "Do Not Resuscitate", "Comfort Care", or "Withdrawal of Cardiopulmonary Support" orders within 24 hours after insuring that they conform to hospital policy ML.3.03 Care of Hopeless/Moribund Patients, http://www.uams.edu/UH/policy/Medical %20Legal/ml303.htm 3. Select safe, cost-effective diagnostic procedures and therapeutic interventions. 4. See every patient on the neurology in-patient service daily and write a daily progress note (required daily at UAMS but not at the VA). 5. Evaluate every new and follow up patient seen by the residents in the clinic and write consult note or a progress note, respectively (required at UAMS but not at the VA, where all residents notes shall be countersigned by the attending). 6. See every patient on the neurology consult service and write an initial consult note as well as follow-up notes as warranted by the complexity of the consult. 7. Teach residents how to perform and document a comprehensive evaluation. 8. Teach residents how to arrive at clinically-sound decisions through discussing the pathophysiology, the differential diagnosis and the treatment options of the encountered disease processes with neurology residents, medical students and interns/residents from other departments rotating on the neurology service. 9. Conduct clinical round that are balanced between patient care delivery and bedside teaching. 10. Take full responsibility of all clinical decisions and the promptness of their implementation. 11. Maintain high standards of ethical behavior. The attending physician is encouraged to: 1. Discuss topics relevant to the patients on the neurology service with neurology residents, medical students and interns/residents from other departments rotating on the neurology service. 2. Give the opportunity to residents to make supervised clinically sound decisions as competence is proven. 3. Write orders if necessary (which should be written by residents). 4. Decrease his/her private clinic load to a minimum when attending the ward. 5. Starts rounds no later than 8 or 9am and completes it no later than noon. 6. Make decision and order the initiation of patients’ discharge before 9am. 7. Release the residents from clinical duties/rounds during conferences required to be attended by the residents. The supervising faculty in each participating institution assumes responsibility for the day-to-day activities of the program at that institution, with overall coordination by the program director. Additional supervision is provided by: -Dr. Sami Harik at UAMS. -Dr. Sarkis Nazarian at the VA. -Dr. Michelle Moss at ACH. The faculty members meet biweekly to discuss faculty-related matters as well as to evaluate the residency program including, but not limited to, the use of the resources available to the program, the contribution of each institution participating in the program, the financial and administrative support of the program, the volume and variety of patients available to the program for educational purposes, the performance of members of the teaching staff, and the quality of supervision of residents. The faculty members also review at least yearly, usually in May of each academic year, the program goals and objectives as well as program effectiveness in achieving them. The current chief resident and the future chief resident shall participate in these reviews as resident representatives. 15
    • D. Mentor Supervisory Responsibilities: Each resident is required to notify the program director about his/her three top choices of the faculty he/she would like to have as a mentor. PGY-3 and 4 are required to do so by July 15th of each year while the PGY-2 may elect to do so by July 30th (which should give them the time to become familiar with the faculty members). The program director shall be exclusively the mentor of all the PGY-1 residents. Residents may change their mentor in the first 2 weeks of each academic year in order to have a wider exposure to the different styles of mentorship. As mentors, faculty members shall: • Assist the resident in preparing and implementing a plan of study for his/her residency. • Teach the resident how to conduct a comprehensive literature search and how to write a research project. • Assist the resident to handle his/her professional weaknesses and strengths, including but not limited to those pointed out in the biannual residents’ performance evaluation. • Assist the resident in making career decisions including choosing subspecialty training, type of clinical practice and research track. This includes teaching the resident about the different types of health care systems from the practitioner’s (such as the mentor’s) standpoint. • Monitoring the resident’s stress, including mental or emotional conditions inhibiting performance or learning and drug- or alcohol-related dysfunction. The mentor shall be sensitive to the need for timely provision of confidential counseling and psychological support services to residents. • Meet with the resident at least 3 times per year and as needed. Recommended dates of meeting with the resident are first week of August, first week of December, first week of April. The mentor is recommended to: • Discuss any resident-related matter that he/she deems constructive to the resident performance and emotional comfort. • Review the resident file before or during each meeting with the resident. • Avoid judgmental comments but to encourage resident’s initiative to choose the best means of improving his/her performance. • Reinforce striving for scholarly activities, ethical behavior and advocacy to patient care. • Meet with the resident in any location they deem appropriate. Such location does not have to be in the hospital (especially the location of the first meeting). A suggested, but not required, approach to these meetings may be the following: First meeting: (first week of August) 1. Personal introduction of resident and mentor. 2. Establish what the resident needs (i.e., plan of work, research tendency, and personal interests...). Second meeting: (first week of December) 1. Discuss biannual evaluation - Commend areas of strength. - Identify plan to improve areas of weakness. 2. Identify resident’s personal needs (emotional and professional, career orientation). Third meeting: (first/second week of April) 1. Assess achievements in the last 9 months (e.g., adherence to plan of work discussed in first meeting...), and establish plan for fine-tuning performance. 2. Identify resident’s personal needs (emotional and professional). - Identify plan to improve areas of weakness. - In-service training examination performance detailed review. 16
    • E. Chief Resident The chief resident for the year 2006-2007 is Dr.Ashish Nanda as elected by the residents. When not available, his duties shall be covered by the program director and/or the chairman of the department. His responsibilities include: a. Assisting the program director in monitoring the content and ensuring the quality of the program. b. Assisting the program director in the preparation and review of a written statement outlining the educational goals and objectives of the program with respect to knowledge, skills and other attributes of residents at each level of training and for each major rotation or other program assignment. c. Acting as the residents’ representative in terms of participating in departmental meetings, and identifying training situations that consistently produce undesirable stress (including mental or emotional conditions) inhibiting performance or learning and drug-/alcohol-related dysfunction. d. Assisting the program director in the selection, evaluation and supervision of the teaching staff. The Chief resident shall collect the forms of faculty evaluation by residents at the end of each rotation and forward them to the program coordinator to compile them anonymously. e. Assisting the program director in the supervision of residents’ responsibilities for the care of patients (as outlined in the section “I-D. Resident’s Job description and Progressive Responsibility” of this handbook). f. Assisting the program director in implementing departmental and UAMS-College of Medicine policies (the later policies are listed at www.uams.edu/gme). g. Issuing the monthly residents’call schedule by the 25th of each month and assisting the program director in preparing: a. The yearly residents’ rotation schedule (with the future chief resident) due by end of February, b. The weekly conference schedule, and c. The biannual faculty evaluation, conducted confidentially by all residents (first week of December and first week of June)… h. Assisting the program director in the implementation of fair procedures as established by the UAMS College of Medicine regarding academic discipline and resident complaints or grievances (these policies are available on the UAMS-College of Medicine website at www.uams.edu/gme). i. Being a role model to residents in every respect of their training. j. Collecting attendance to all conferences and submitting them in a timely manner to the program coordinator. F. Program Coordinator When not available, the duties shall be covered by the chief resident and/or the program director. Responsibilities include: a. Coordinating the application process of residency candidates and their interviews as well as responding to applicant’s phone and email inquiries. b. Assist residents in the preparation of their job-related paperwork (including residents’ contracts, ECFMG documents, housing, ACLS/BLS and computer training course scheduling…) c. Processing resident payroll and keeping a log of residents’ vacation, professional and sick leave (in a spreadsheet form). d. Maintaining up-to-date residents’ personal information database (in a spreadsheet form) and individual resident’s files. e. Generating and sending residency-related letters/memos as needed (including but not limited to weekly conference schedule/memo, making copies of syllabi for residents conferences, end of training letter to the ABPN, residents’ rotation lists…). f. Collecting and compiling biweekly or monthly residents’ evaluation forms completed by the appropriate faculty (within a week of the end of the rotation with that particular faculty). g. Collecting and compiling clinical evaluation exercise forms from faculty monthly and compiling them in a spreadsheet. 17
    • h. Collecting and compiling patient and healthcare personnel (nurses, social workers) surveys geared toward residents’ evaluation. i. Collecting and compiling residents’ continuity clinic evaluation forms from faculty supervising the clinics (UAMS and VA) every 3 months. j. Collecting daily residents’ patient-load forms and compiling them in a spreadsheet database. k. Compiling biannual residents’ evaluation forms and end of training evaluation. l. Reminding the program director and chief resident about appropriate residency-related deadlines, as outlined in Appendix 11: Residency-Related Deadlines. IV. Facilities and Resources A. Patient Population The diversity of the patient population as to age and sex, short-term and long-term neurologic problems, and inpatients and outpatients is ensured by the multiple clinical settings in which the resident is required to encounter patients. Each of the three participating institutions have different patient population attributes (UAMS: general adult neurology, VA: high-risk adult and geriatric neurology, and ACH: pediatric neurology). These diverse clinical set-ups include: a. The general inpatient ward including neurology ICU care (at UAMS, VA and ACH). b. The consult rotations including neurology and non-neurology ICU care (at UAMS, VA and ACH). c. The elective rotations that includes inpatient and outpatient exposure. d. The outpatient continuity clinics. e. The on-call duties, which include after hours in-patient emergencies and outpatient ER department consults. All of these clinical settings are required for residents rotating in each of the three participating institutions that have different patient population attributes. All these activities are supervised by faculty with interest and expertise in multiple subspecialties. B. Facilities 1. Faculty/Residents Offices, Wards & Clinics: Each institution has a designated area for the in-patient neurology service and outpatient clinics: -At UAMS, the neurology ward is located on 2B ward of the main hospital, which includes two rooms dedicated for continuous EEG/video monitoring. We have access to ICU rooms in the Ward tower as needed. On the second floor of the Jackson T. Stephens Spine and Neurosciences Institute, we have access to 12 examination rooms and 2 conference rooms. An EMG suite is equipped with 2 digital EMG machines. An EEG suite is equipped with 2 digital EEG machines, which can be wheeled to any patient unit. EEG technicians are available on-call 24 hours/day, 7 days/week (the call schedule is issued monthly). -At the VA, patients are seen in the clinic area (red atrium, specialty II clinic) in 7 examination rooms, each of which is equipped with a computer terminal for access to the electronic chart system. Staff and residents discuss patient care and review radiological studies in a conference room located in the clinic area. An EMG suite is equipped with one digital EMG machine. An EEG suite is equipped with 2 digital EEG machines. -At ACH, there is a dedicated neuroscience unit and designated outpatient clinic space. The in-patient service offers an 11-bed neuroscience unit, shared with neurosurgery, with 9 private rooms and 2 semi-private rooms. Four of these rooms are wired with video EEG equipment, as is one PICU bed. The outpatient child neurology 18
    • facilities consist of a 20-room, 6,216 square foot neuroscience clinic, which is shared with neurosurgery, rehabilitation and spina bifida. The electrodiagnostic units for EEG and EMG are contiguous with patient care space as is the EEG reading room. EEG offers state-of-the-art digital EEG and also four 24-hour portable continuous digital EEG monitoring units. All the faculty, secretary and residents offices are on the 7th and 8th floors of the Jackson T. Stephen Spine and Neuroscience Institute. A large departmental library is on the 8th floor and it is available for meetings and conferences (contact Mrs. Miranda Allen at 686-6504 to reserve it). It also holds a number of journals and reference books in addition to audiovisual equipment (slide projector, overhead projector, TV and video). Dictation rooms are located in the Medical Records Department in the ground floor of the Shorey Building. Each hospital has its own medical records department for the patients’ medical records. The neurology call room is located in the main hospital on the 8th floor. The VA Hospital has successfully computerized its charts. With the appropriate pass codes, the electronic charts can be accessed from any of the computer terminals located on the wards, in the clinic examination rooms and in faculty and secretarial offices. UAMS is working on computerizing its charts and record keeping systems to move to a “paperless” record keeping system. 2. Conference Facilities: - At UAMS, a large conference/seminar room and departmental library is located on the neurology department floor. It accommodates about 25 persons. The conference room is equipped for slide presentations, overhead projector presentations and for viewing of educational material on TV video. Computer terminals are available for literature reviews via a service provided by the medical library at UAMS. The Grand Rounds are held weekly in the Fred W. Smith Conference Center or the Hamlen Boardroom; both are located on the 12th floor of the Jackson T. Stephens Spine Institute and are superbly equipped with audiovisual aids. - At the VA, a conference room that can accommodate 20 participants is adjacent to the Neurology offices and ward area. -At ACH, conference facilities include a 177-square foot conference room, which also serves as a physician's work area in the neuroscience clinic. Multiple other conference rooms including a 495-square foot room in close proximity to the neurology office suite are available, but are shared with other services. 3. Clinical Laboratory Facilities: UAMS, the VA and ACH all have fully accredited comprehensive medical laboratory services. The same laboratories coordinate mail out of other tests. In each institution, test results can be accessed from computer terminals located on the wards, in the clinics, and in the faculty offices. Printout of laboratory results is placed in the patients’ charts. Results are communicated between institutions by internal mail. Additional facilities specific to each institution include the following: UAMS: Dr. Juhasz-Pocsine performs autonomic nervous system (ANS) studies in a new clinical ANS laboratory. Dictated radiology reports can be accessed from any telephone and are reported by internal mail. VA: Full pathology facilities, including electron microscopy, are also available with neuropathologic analysis. Radiological studies can be viewed on any computer terminals located in clinic areas, wards, and offices. 19
    • ACH: The clinical laboratory offers full toxicology services and a metabolic laboratory where many metabolic tests are performed on site. There is also a complete cytogenetics laboratory with full chromosomal testing, DNA analysis and cell culture capabilities. 4. Basic Research Facilities: All faculty and residents are encouraged to participate in scholarly activities including research. Office space and computer terminals are available for those interested in retrospective research including chart reviews. Prospective clinical studies are also encouraged. We have laboratory space for basic scientific research under the direction of Gerald A. Dienel, Ph.D. who worked at the laboratory of cerebral metabolism at the National Institute of Health (NIH). With the help of NIH and NSF grants, Dr. Dienel has built this laboratory de novo. We have strong neuroscience programs at UAMS. Residents are encouraged to spend elective time with neuroscientists on campus. The department of Neurology has excellent relationships with several basic science departments including the department of Anatomy and Cell Biology and Neuroscience, the department of Physiology and Biophysics, and the department of Pharmacology. Some of the faculty participates in the teaching of medical school courses. 5. Library Facilities: UAMS has an excellent library for both clinical and basic science books and journals. It consists of three and a half floors amounting to a total surface of 44,000 square feet, enough to accommodate 325 people. Its collection includes 1381 current print journal subscriptions, 519 electronic journal subscriptions, 46,120 book volumes, 125,821 bound journal volumes, 31 databases, and 6,532 audiovisual and educational computer software items. Journals available in the online format are accessible from any computer terminal in the hospital as well as from remote sites via the internet. Its computer capabilities are up to date, as it includes numerous computer terminals and audiovisual workstations. The library can obtain journals and books by interlibrary loans. It is run by 11 professional librarians and 30 paraprofessionals and technical staff. Library access is available through regular library hours and also on an extended basis 24 hours a day through hospital security. The residents can access Medline and online catalogs from their conference rooms or from the library and even from home through the UAMS website at no charge. A short course in proper use of computers in literature search is available for residents upon request. The libraries at the VA Hospital and the Children’s Hospital are smaller but residents can access all services of the UAMS library through the network. The library at the VA hospital has 6 computer terminals that access to several health sciences databases (including Medline, PsychLit, CINAHL), 375 journals and 2,780 books. It has a full time librarian and can be accessed after hours. The library at Children’s hospital has 5 computer terminals (with Ovid database, Internet access, word processing software and resident training programs), 2,000 medical books and 120 journals. A pediatric resident badge can open the library door after hours. In addition to the above, the neurology department has its own departmental library as mentioned before. This library contains major reference books and major clinical neurology journals such as Neurology, Annals of Neurology, Archives of Neurology, Clinical Neuroscience, and Stroke, in addition to basic neuroscience journals such as: Science, Journal of Neurochemistry, Journal of Cerebral Blood Flow and Metabolism, Microcirculation, and Neurochemical Research. V. Educational Program 20
    • A. Basic Curriculum We provide an adequate and excellent balance between patient care and education that achieves for the trainee an optimal educational experience consistent with the best medical care. The resident’s working hours on average is limited to 80 hours/week maximum. A night float system is implemented this year starting at 5 pm ending at 7 am. The consult/ward residents will share weekend/holiday calls starting at 7 am ending at 7 am. A typical workday starts at 8am and ends at 5pm. As described in the section “I.B. Duration and Scope of Training” of this handbook, patient care responsibilities are adequately divided between inpatient, outpatient, and consultation experiences, including the longitudinal/ continuity clinic (one half-days/week in the PGY-1 year and 2 half days/week over the remaining 36 months of training). The residents are required to rotate for 3 months at ACH (typically in the PGY-2 and –3 years) and are supervised by child neurologists with ABPN certification or suitable equivalent qualifications. Additional pediatric neurology electives may be selected by the resident. B. Teaching Rounds Weekday clinical teaching rounds are supervised by faculty 5 days per week. The resident is required to present cases and generate sound diagnostic and therapeutic plans as described in the section “I.D. Resident’s Job Description & Progressive Responsibilities”. Weekend rounds are also supervised by faculty but are primarily management rounds. C. Clinical Teaching 1. At least once a year, the resident shall undergo a practical clinical skills exam (CSE) under direct observation of the faculty. The faculty chooses an appropriate patient preferably that the faculty and the resident have never evaluated. This may be in any clinical setting (including the ward, clinic, or the ER). The CSE should include:  Part I: a 30 minute time period during which the resident obtains a complete history in an orderly and detailed fashion, then performs a thorough neurological exam with a focused general exam (this will include a warning when 5 minutes are left)  Part II: a 30 minute time period during which the resident leads an organized discussion guided by the supervising faculty that includes: a) A summary of pertinent findings in the history & exam, b) A localization of the nervous system lesion(s), c) A differential diagnosis, d) A sound diagnostic plan that includes the indications for and the limitation of clinical neurodiagnostic tests and their interpretation. e) A cost-effective treatment plan. The resident documents his/her encounter with the patient and hands his comprehensive note to the faculty who evaluates each step of this exercise. 2. The resident will participate in the evaluation of and decision making for patients with disorders of the nervous system requiring surgical management. 3. The resident will participate in the management of patients with psychiatric disorders. He/She is required to rotate for at least one month on the psychiatry service during which he/she learns the principles of psychopathology, psychiatric diagnosis, and therapy and the indications for and complications of drugs used in psychiatry. This enables him/her to assume throughout his/her residency training the responsibility 21
    • of evaluating and treating psychiatric disorders that often co-exist with neurological disorders. Such responsibility also teaches him/her about the psychological aspects of the patient-physician relationship and the importance of personal, social, and cultural factors in disease processes and their clinical expression. 4. The resident will learn the basic principles of rehabilitation for neurological disorders through interacting with the rehabilitation service on the ward. 5. The resident will participate in the management of patients with acute neurological disorders in intensive care units and the emergency room when on the consult/ward service and when on call. 6. The resident will receive instruction in the principles of bioethics and in the provision of appropriate and cost-effective evaluation and treatment for patients with neurologic disorders while on the consult/ward service and in conferences. Each resident is required to complete successfully the “bioethics module” provided by the UAMS-Graduate Medical Education (available on the UAMS website at www.uams.edu/gme). 7. The resident will receive instruction in appropriate and compassionate methods of end-of-life palliative care, including adequate pain relief and psychosocial support and counseling for patients and family members about these issues. This is achieved on the consult/ward rounds and in conferences as well as in the “bioethics module” provided by the UAMS-Graduate Medical Education (available on the UAMS website at www.uams.edu/gme). D. Progressive Responsibility The progressive responsibility of the resident in patient care management is described in the section “I-D. Resident’s Job Description & Progressive Responsibility” of this handbook. Adequate faculty supervision is provided as outlined in section “III. C. Attending Clinical Supervisory Responsibilities” of this handbook. The resident is assigned in-house night/weekend calls as outlined in the section “V.A. Basic Curriculum”. The neurology consult service and in-house calls cover the medical, surgical, obstetric and gynecologic, pediatric, rehabilitation medicine, and psychiatry services. E. Basic and Related Science The resident shall learn the basic sciences on which clinical neurology is founded during teaching rounds and required conferences. The covered neurosciences include neuroanatomy, neuropathology, neurophysiology, neuroimaging, neuropsychology, neural development, neurochemistry, neuropharmacology, molecular biology, genetics, immunology, epidemiology and statistics. The resident is required to rotate for 2 months on neuropathology. F. Electives The resident shall choose his/her elective rotations to fit his/her interests. All residents are required to notify the chief resident about their choice of specific elective rotations by the last week of March. PGY-4 residents have at least 5 months of electives while PGY-2 and –3 residents have 1-3 months. G. Seminars and Conferences The resident is required to attend conferences as outlined in Appendix 4: Neurology Department Scheduled Weekly Conferences. These cover the following disciplines: neuropathology, neuroradiology, neuro- ophthalmology, neuromuscular disease, cerebrovascular disease, epilepsy, movement disorders, critical care, clinical neurophysiology, behavioral neurology, neuroimmunology, infectious disease, neuro-otology, neuroimaging, neuro-oncology, pain management, neurogenetics, rehabilitation, child neurology, the neurology of aging, and general neurology. The resident has increasing responsibility for the planning, presentation and supervision of the conferences: • PGY-1 residents are required to read the assigned readings related to conferences. • PGY-2, -3 & -4 residents are required to read the assigned readings related to conferences, and present the discussion of the neuropathology, neuroradiology, journal club and basic neuroscience lectures. 22
    • • PGY-3 residents, in addition, prepare the list of patients that will be presented in neuroradiology with a brief history/exam that they forward to the neuroradiologist. • PGY-4 residents are required to present one grand round lecture in the second half of their last year of training. They also prepare all the cases that are discussed in the neurological emergency conferences in the first 2 months of each year. • Any resident involved in a research project is encouraged to present a grand rounds about his/her project. • The Chief Resident selects the topics of the basic neuroscience lecture and assigns equitably, lecture preparation to PGY-2, -3 & -4 residents. Through all the required conferences, the resident learns about major developments in both the basic and clinical neurosciences. Residents in addition attend meetings of local and national neurological societies: • Each resident attends at least once during his/her training the week-long American Academy of Neurology (AAN) Annual Meeting and another national meeting (i.e., the American Neurological Association-ANA- Annual Meeting, other neurological subspecialty annual meetings or didactic courses offered out of state). The program will cover $1000 per resident attending the AAN and ANA annual meetings and all the costs of other meetings at the program director discretion (usually the costs that are covered are the airline ticket fee, registration fee, food -within a specified limit-, hotel accommodation, and transportation; recreational expenses are not covered). • All residents are invited at no expense to them to the Arkansas Neurological Society Meeting and other didactic courses/lectures prepared by UAMS for neurologists practicing in Arkansas (including the Epilepsy Symposium, the Dementia Symposium, and other lectures offered by the UAMS College of Medicine). • Any resident who presents a poster, an abstract or an oral presentation at any national meeting will be reimbursed the full cost of his expenses up to $1000. H. Educational Policies The resident’s working hours on average is limited to 80 hours/week. If unexpected patient care needs create resident fatigue sufficient to jeopardize patient care during or following on- call periods, adequate coverage shall be provided by the senior PGY-4 resident on the ward/consult with the help of rotating residents and medical students. Should these personnel not be available for any reason, the supervising faculty is required to provide such coverage. In extreme cases, a resident on an elective rotation may be asked (but is not required to) contribute to this effort. I. Resident Participation in Research The residency training program at UAMS takes place in an environment of inquiry and scholarship in which the resident is required to participate in the development of new knowledge, learn to evaluate research findings, and develop habits of inquiry as a continuing professional responsibility. The teaching staff establishes and maintains such environment. Our neurology department is active in both clinical and basic neuroscience research. This activity includes: • Active participation of the teaching staff and residents in scholarly activities that promotes a spirit of inquiry and scholarship. Such activities are defined as experiences or products of inquiry and in-depth learning of the basic mechanisms of normal and abnormal states and the application of current knowledge to practice. Examples include: o Participation in clinical discussions, rounds and conferences. o Participation in journal clubs and research conferences. o Participation in regional or national professional and scientific societies and presentations at their meetings. 23
    • o Publications. o Participation in research, particularly in projects that are funded following peer review and/or result in publications or presentations at regional and national scientific meetings. o Case reports. o Review of assigned clinical and research topics. o Participation in courses of design/interpretation of research studies. o Providing teaching sessions to students, junior residents, faculty and the public. o Preparation for community service projects. o Developing curricula or evaluations for general competencies or other educational requirements of the program. o Preparing and presenting board review sessions or courses. o Offering of guidance and technical support (e.g., research design, statistical analysis) for residents involved in research. o Provision of support for research opportunities for the resident who is expected to initiate and pursue research projects with the guidance of the teaching staff. J. Resident Responsibility for Teaching Teaching of other residents, medical students, nurses, and other health care personnel, formally and informally, are required aspects of the resident's education in neurology. VI. Evaluation A. Resident Evaluation 1. The residency program assesses the resident’s performance throughout the program and utilizes such assessment to improve resident’s performance. This assessment includes: a) Assessing the resident's competence in patient care, medical knowledge, practice-based learning and improvement, interpersonal and communication skills, professionalism, and systems-based practice, b) Providing regular and timely performance feedback to residents and means to improve competence. This is achieved through:  Faculty evaluation forms for each rotation (accessible to the resident during working hours)  Biannual resident’s performance written evaluation that is reviewed during a one-on-one meeting with the resident, the program director and the chairman.  Immediate verbal feedback during each rotation as needed.  Mentor/resident meetings to discuss performance and design a plan for improving performance.  Clinical skills examinations (to PGY-2, -3, & -4 residents) and oral mock board examination (to PGY-4 residents). 2. Final Evaluation a) At the conclusion of the resident's period of training in the program, the program director prepares a detailed, written evaluation of the resident's performance in relation to the program's learning and performance objectives and discuss this evaluation with the resident. 3. Records 24
    • a) A written record of the contents of the semiannual review session is prepared and filed in the resident's permanent record. The resident signs the written record of the evaluation and the review. The resident has the opportunity to append a written response to the written record of the evaluation and review. b) The resident's file is available for the resident review during working hours in the program coordinator office. Alteration of such file by a resident will be considered unethical behavior and may be used as basis for immediate dismissal. It includes:  Biannual performance review forms  Clinical skills examination results  360 evaluation  Residency in-service training examination (RITE) results  Mentor/resident meeting reports  End of residency training final evaluation form  Original application to the residency and related forms (including CV, US visa or proof of citizenship,ECFMG certificate, recommendation letters, USMLE or equivalent exams results,)  When applicable, commendations, disciplinary actions, incident reports, and other pertinent communications. B. Program Evaluation The educational effectiveness of a program is evaluated in: - Faculty meetings (twice per month), - Monthly quality assurance meetings (first Wednesday of every month) - The residents’ meetings with the program director (first Monday of every month). - The annual Residency Program Improvement Committee Meeting. These meetings include the assessment of the quality of the curriculum and the extent to which residents have met the educational goals. In addition, the residents evaluate faculty members at the end of each rotation anonymously. The appropriate forms are collected by the chief resident who forwards them to the program coordinator who compiles them. The program director and chairman review them and forward them to the faculty members at the end of the academic year (or earlier if deemed necessary). Other objective measures of such assessment includes: a) The UAMS-Graduate Medical Education Annual Survey (which is completed confidentially by the residents and summarized by the UAMS-GME to include the results of the previous year evaluation and comparative scores of other UAMS departments). b) The Residency In-Service Training Examination (RITE) scores, which includes comparative scores to other neurology residency training programs in the USA. c) The American Board of Psychiatry & Neurology (ABPN) scores. C. Board Certification One of the goals of the residency program at UAMS is to achieve a 100% pass rate on the written (part I) and oral (part II) parts of the American Board of Psychiatry & Neurology examination. To this end, in addition to a comprehensive educational curriculum, all residents are required to sit for the Residency In-Service Training Examination (RITE) and clinical skills examinations in the PGY-2, -3 &-4 years, and to be subjected to mock- Board oral examinations in their PGY-4 year (conducted by visiting lecturers and UAMS faculty). One measure of the quality of a training program is the proportion of its residents that takes the examinations of the ABPN and the proportion that passes those examinations. This information must be used in the evaluation of the educational effectiveness of the program. 25
    • For individuals beginning the Neurology Residency Program in July 2006, an oral board examination will not take place. This will be replaced by structured evaluations, examinations of live neurological patients by housestaff. They will be conducted as follows:  One examination, evaluation during second half of PGY2 training.  Two examinations, evaluations during PGY3 training.  Two examinations, evaluations during PGY4 training. Evaluations will be formally conducted by faculty members to ensure adequate development of clinical skills, including the six core competencies. This handbook was revised by Dr. Walter S. Metzer in June 2006. All copyrights reserved. 26