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  • 1. Goals and Objectives Evaluation Table Rotation: Neurology Goal: #1 Develop professional competencies under the guidance of neurological specialists while working with patients, doing neurologic examinations and using evidence based medicine for treatment. Objectives Priority Teaching Evaluation Domain Skills PGY Yes/No Who Where Method Who Where Method 1a. Patient Care: provide patient care that is Y Neurology Clinic, A, B, D, Attending Clinic, a, c, n, PC, 1, 3, 4, 5, 2, 3 appropriate for age and Attendings Floor(ward) J, H Floor(ward) b, g MK, 6, 7, 8, 9, development, geared to , , PBLI, 10, 11, family needs, compassionate, ICU, NICU ICU, NICU COM, 12, 16, effective for treatment of SBP, 17, 19, problems and promotion of PRO 20, 21, help, using 22, 23 1b. Apply principles of general indications for Y Neurology Clinic, A, B, C, Neurology Clinic, a, b, c, PC, 1, 2, 3, 5, 2, 3 procedures and describe them Attendings Floor, ER, D, G, H, Attendings Conference d, g, I, MK, 6, 7, 8, 9, and interpret results for ICU, J Room, ER, k, n SBP, 10, 11, patients and their families. Nurseries ICU, ward COM, 17, 20, (CT, MRI, EEG, EMG, LP, PBLI 21, 23 Labs) Goal: #2 Differentiate normal states of childhood development from pathological conditions. Objectives Priority Teaching Evaluation Domain Skills PGY Yes/No Who Where Method Who Where Method 2a. Learn normal developmental states Y Neurology Clinic, A, B, C, Attending Clinic, a, b, c, PC, 1, 2, 3, 2, 3 (language, motor skills, fine Attendings Floor, ICU, D, E, G, Floor, ICU, e, g, i, l MK, 7, 8, 9, motor skills, and social NICU, H, J, K NICU, PBLI, 11, 12, interaction, reflexes, and EEG radiology, radiology, COM 16, 22, patterns, imaging findings) for EEG EEG, 23 children and adults at various conference ages. room 2b. Perform a useful neurologic & family history, Y Attendings, Clinic, A, B, C, Attendings Clinic, a, b, c, PC, 1, 2, 3, 2, 3 physical examination and Nurses conferences, D, H, J, conferences, e, g, i, l MK, 6, 7, 8, neurologic/developmental Wards, K Wards, PBLI, 9, 10,
  • 2. examination. ICU, NICU ICU, NICU COM 11, 12, 17 2c. Recognize some major signs and symptoms of disease First Attendings Clinics, A, B, C, Neurology Clinics, a, b, c, PC, 1, 2, 3, 2, 3 states (altered consciousness, order in Ward, ICU, D, E, G, attendings ward, ICU, e, g, i, l, MK, 6, 7, 8, headaches, meningeal signs, of neurology, ER, NICU J, K ER, NICU, n PBLI, 9, 10, signs of intracranial priority Patients classroom COM, 11, 12, hypertension, ataxia, PRO 17, 22, dizziness, seizures (partial and 23 generalized), weakness (in various distributions), sensory loss (various modalities and patterns), learning disabilities, autism, attention deficit, tics, tremors, chorea, spasticity, floppiness, static encephalopathies (cerebral palsies, mental retardation), dyomorphic and neurocutaneous syndromes, brain tumors, vascular malformations, hydroceplated strokes and traumatic lesions). Goal: #3 Recognize and initiate treatment and evaluations for neurologic emergencies in a timely and effective way including: (a)status epilepticus (convulsive and subtle), (b)CNS infections (meningitis, encephalitis, abscess, empyema, etc.), (c)stroke (of cardiac, vascular, hematologic, metabolic, infectious origins), (d)intracranial hypertension (tumors, hydrocephalus, problems in shunts, venous sinus thrombosis, trauma, pseudotumor cerdon, infections, etc.), (e)toxic/metabolic encephalopathy (poisonings, inborn errors of metabolism, asphyxia, fluid and electrolyte disturbance, hypoglycemia, Reye Syndrome, diabetic ketoacidosis, etc.), (f)acute neuromuscular weakness with respiratory or autonomic/cardiac compromise (infant botulism, Guillain-Barre Syndrome, Myasthenia Gravis, sporral muscular atrophy, polio, etc.). (g)spinal cord compression (trauma,tumor,hematoma,etc.) Objectives Priority Teaching Evaluation Domain Skills PGY Yes/No Who Where Method Who Where Method 3a. Recognize such an emergency quickly. Utmost Neurology ER, ICU, A, B, C, Neurology ICU, a, b, c, PC, 1, 2, 3, 4, 2, 3 attendings, clinics D, J, K attendings, clinics, d, e, g, i, MK, 5, 6, 7, 8, ER, outcomes conferences, k, l PBLI, 9, 10, 11, patients M&M COM, 12, 14, PRO, 17, 19, SBP 21, 23
  • 3. 3b. Initiate support, treatment and evaluation. Utmost Neurology ER, ICU, A, B, C, Neurology ICU, a, b, c, PC, 1, 2, 3, 4, 2, 3 Attendings, clinics D, J, K attendings, clinics, d, e, g, i, MK, 5, 6, 7, 8, ER, outcomes conferences, k, l PBLI, 9, 10, 11, Patients M&M COM, 12, 14, PRO, 17, 19, SBP 21, 23 Goal: #4 Effectively and faithfully, with interest and commitment, manage chronic and degenerative conditions affecting patients including (but not limited to): (a)Cerebral palsy (spasticity, athetosis, ataxia), (b)Mental Retardation and Inborn Errors of Metabolism, (c)Autistic Spectrum Disorders (autism, Asperger, savants), (d)Attention Deficit Disorder and Learning Disabilities (dyslexia, Ataxia), (e)Movement Disorders (tics, Tourette Syndrome, Chorea, Wilson Disease, Parkinson Disease), (f)Neuromuscular Diseases (Muscular Dystrophy, other Myopathies, Myasthenic Syndromes, Charcot-Marie-Teoth Disease, other neuropathies, spiral muscular atrophy, spastic paraplegia), (g)Neurocutaneous Syndromes and other Dysmorphisms. Objectives Priority Teaching Evaluation Domain Skills PGY Yes/No Who Where Method Who Where Method 4.1 Use history, family history, physical examination, Y Neurology Clinics, A, B, C, Attendings, Clinics, a, b, c, PC, 5, 1-4, 2, 3 imaging studies, and attendings, inpatient D, E, G, nursing, conferences e, g, i, k, PRO, 6-12, 13, laboratory examinations to staff, settings, H, J, K Social l SBP, 14, 15, help determine correct Social classrooms Svcs., COM, 16, 17, diagnosis, disease Svcs., patients MK, 19, 21, mechanisms, prognosis and patients PBLI 22, 23, available treatments. 18, 24 4.2 Effectively and in a supportive way communicate Y Neurology Clinics, A, B, C, Attendings, Clinics, a, b, c, PC, 5, 1-4, 2, 3 this information to patients attendings, inpatient D, E, G, nursing, conferences e, g, i, k, PRO, 6-12, 13, and their families to enlist staff, settings, H, J, K Social l SBP, 14, 15, their support in ongoing care. Social classrooms Svcs., COM, 16, 17, Svcs., patients MK, 19, 21, patients PBLI 22, 23, 18, 24 4.3 Utilize laboratory resources where needed to Y Neurology Clinics, A, B, C, Attendings, Clinics, a, b, c, PC, 5, 1-4, 2, 3 confirm diagnosis. attendings, inpatient D, E, G, nursing, conferences e, g, i, k, PRO, 6-12, 13, staff, settings, H, J, K Social l SBP, 14, 15, Social classrooms Svcs., COM, 16, 17, Svcs., patients MK, 19, 21, patients PBLI 22, 23, 18, 24
  • 4. 4.4 Utilize community and voluntary organization help as Y Neurology Clinics, A, B, C, Attendings, Clinics, a, b, c, PC, 5, 1-4, 2, 3 well as Social Services and attendings, inpatient D, E, G, nursing, conferences e, g, i, k, PRO, 6-12, 13, support groups for the staff, settings, H, J, K Social l SBP, 14, 15, improvement of quality of life Social classrooms Svcs., COM, 16, 17, of the patient and family. Svcs., patients MK, 19, 21, patients PBLI 22, 23, 18, 24 Goal: #5 Learn about (a)the types of seizures, (b)the types of epilepsies and epileptic syndromes, (c)the methods of their correct diagnosis (and differentiating them from nonepileptic events), (d)techniques for their safe and effective treatment (medications, diet, stimulators and surgery) and (e)recognition of complications (depression, medication toxicity, injuries, effects on quality of life). Objectives Priority Teaching Evaluation Domain Skills PGY Yes/No Who Where Method Who Where Method 5.1 Learn of types of seizures and spectrum of various Y Attendings, Clinics, A, B, C, Attendings, Clinics, a, b, c, PC, 1-24 2, 3 anticonvulsants (neonatal patients, wards, D, E, G, patients, conferences, e, i, j, k, MK, seizures, infantile spasms, parents, ICU, on H, J, K Social ward, ICU l PBLI, partial seizures, generalized Social the street Svcs. COM, seizures, epileptic Svcs. PRO, encephalopathies; SBP phenobarbital, lorazqam phenytoin, fosphenytoin, ethosuximide, primidone, carbamazepine, oxcarbazepine, felbamate, gabapentin, topiramate, lamotrigine, tiagabine, zonisamide, valproicacid, divalproex, levetiracetam, piracetam, clobazam, vigabatrin 5.2 Learn of criteria for initiating nonpharmacological Y Attendings, Clinics, A, B, C, Attendings, Clinics, a, b, c, PC, 1-24 2, 3 treatment for intractable patients, wards, D, E, G, patients, conferences, e, i, j, k, MK, seizures (ketogenic diet, vagus parents, ICU, on H, J, K Social ward, ICU l PBLI, nerve stimulator, surgery for Social the street Svcs. COM, seizure focus). Svcs. PRO, SBP 5.3 Uses of EEG and MRI in
  • 5. epilepsy and nonepileptic Y Attendings, Clinics, A, B, C, Attendings, Clinics, a, b, c, PC, 1-24 2, 3 events. patients, wards, D, E, G, patients, conferences, e, i, j, k, MK, parents, ICU, on H, J, K Social ward, ICU l PBLI, Social the street Svcs. COM, Svcs. PRO, SBP 5.4 Identify risks and side effects and pharmacodynamic Y Attendings, Clinics, A, B, C, Attendings, Clinics, a, b, c, PC, 1-24 2, 3 and pharmacokinetic patients, wards, D, E, G, patients, conferences, e, i, j, k, MK, interactions of anticonvulsant parents, ICU, on H, J, K Social ward, ICU l PBLI, drugs. Social the street Svcs. COM, Svcs. PRO, SBP 5.5 Contact the feelings of patients with epilepsy and Y Attendings, Clinics, A, B, C, Attendings, Clinics, a, b, c, PC, 1-24 2, 3 their families about quality of patients, wards, D, E, G, patients, conferences, e, i, j, k, MK, life issues (depression, parents, ICU, on H, J, K Social ward, ICU l PBLI, seizures, limitations, Social the street Svcs. COM, ostracism, discrimination, etc.) Svcs. PRO, raised by the seizures and the SBP drugs. Goal: #6 Learn to evaluate and treat headaches (migraine and secondary headaches with an underlying pathological process). Objectives Priority Teaching Evaluation Domain Skills PGY Yes/No Who Where Method Who Where Method 6.1 Get a history of the headaches (triggers, onset, Y Attendings, Clinics A, B, C, Attendings, Clinics, a, b, c, PC, 1-24 2, 3 temp, nausea, vomiting, patients D, J, K patients conferences e, g, i, l MK, quality of pain, location of PBLI, pain, severity, complications COM, [of ophthalmoplegia, paresis, PRO, numbness, ataxia; etc.], SBP ameliorating factors, duration), family history, medical hx. 6.2 Differentiate types of headaches (secondary vs. Y Attendings, Clinics A, B, C, Attendings, Clinics, a, b, c, PC, 1-24 2, 3 migraine vs. muscle tension) patients D, J, K patients conferences e, g, i, l MK, and especially exclude PBLI, intracranial hypertension and COM,
  • 6. meningeal irritation. PRO, SBP 6.3 Choose to do imaging appropriately. Y Attendings, Clinics A, B, C, Attendings, Clinics, a, b, c, PC, 1-24 2, 3 patients D, J, K patients conferences e, g, i, l MK, PBLI, COM, PRO, SBP 6.4 Treat with supportive care to allay fears and relieve pain. Y Attendings, Clinics A, B, C, Attendings, Clinics, a, b, c, PC, 1-24 2, 3 patients D, J, K patients conferences e, g, i, l MK, PBLI, COM, PRO, SBP 6.5 Appreciate risk of rebound headache with analgesics. Y Attendings, Clinics A, B, C, Attendings, Clinics, a, b, c, PC, 1-24 2, 3 patients D, J, K patients conferences e, g, i, l MK, PBLI, COM, PRO, SBP 6.6 Understand use of triptans and prophylactic agents Y Attendings, Clinics A, B, C, Attendings, Clinics, a, b, c, PC, 1-24 2, 3 (tricyclics, beta blockers, patients D, J, K patients conferences e, g, i, l MK, topiramate, valproate, PBLI, cyproheptadma, etc.). COM, PRO, SBP Goal: #7 Learn the uses and limitations of some common diagnostic procedures and how to do them including: (a)Neurologic Examination with Developmental Assessment (b)Electroencephalogram and Monitoring (c)Brainstem Auditory Evoked Responses (d)Visual Evoked Responses (e)Somatosensory Evoked Responses and Intraoperative Monitoring (f)Electromyography and Nerve Conduction Studies (g)CT scan of head and spine (h)MRI scan of head and spine (i)Lumbar Puncture and CSF pressure and CSF studies (j)Genetic Studies (DNA and chromosomes) (k)muscle biopsy. Objectives Priority Teaching Evaluation Domain Skills PGY Yes/No Who Where Method Who Where Method 7.1 Learn limitations and uses of each of the above for Y Attendings Clinics, A, B, C, Attendings Clinics, a, b, e, i, PC, 1-24 2, 3
  • 7. different levels of neurologic ER, ICU, D, H, J, seminars l MK, involvement, e.g.: -muscle wards, K PBLI, biopsy for disease of muscle or nurseries COM, nerve –CSF for intracranial PRO, infection, meningeal metastasis, SBP CNS autoimmune and demyelinating disease, neuropathies –brainstem auditory evoked responses in brainstem disease, demyelinating disease, screening for infant hearing loss –EMG, Nerve conductions in diseases of muscle, myoneural junctions (repetitive stimulation in botulism, myasthenia gravis), nerves (axenal and demyelinating) and lower motor neurons (spiral muscular atrophy, polio, etc.) –EEG and monitoring in epilepsy (characterization, localization)and in nonepileptic events. 7.2 Be aware of risks in these tests (herniation in LP, x-rays in Y Attendings Clinics, A, B, C, Attendings Clinics, a, b, e, i, PC, 1-24 2, 3 CT and contrast reactions, ER, ICU, D, H, J, seminars l MK, sedation in MRI) wards, K PBLI, nurseries COM, PRO, SBP 7.3 Learn of the costs of these studies and their value in Y Attendings Clinics, A, B, C, Attendings Clinics, a, b, e, i, PC, 1-24 2, 3 accurate diagnosis and effective ER, ICU, D, H, J, seminars l MK, treatment and care (e.g. CSF wards, K PBLI, studies in CNS infection; nurseries COM, monitoring in epilepsy; genetic PRO, studies in chronic diseases). SBP 7.4 Discuss with families, patients, and parents the reasons Y Attendings Clinics, A, B, C, Attendings Clinics, a, b, e, i, PC, 1-24 2, 3
  • 8. for doing specific tests and the ER, ICU, D, H, J, seminars l MK, implications for treatment in a wards, K PBLI, supportive, comprehensible nurseries COM, way. PRO, SBP Goal: #8 Learn about some of the medications commonly used in neurology, their uses, dangers, side-effects, costs, pharmacology (metabolism, half life, efficacy, and interactions). Objectives Priority Teaching Evaluation Domain Skills PGY Yes/No Who Where Method Who Where Method 8.1 Learn about features favoring the choice of Y Attendings Clinics, A, B, C, Attendings Clinics, a, b, c, PC, 2, 3, 4, 5, 2, 3 anticonvulsant drugs for wards, D, J, K wards, e, g, k, l MK, 6, 7, 11, specific epilepsies or epileptic ICU, ICN conferences PBLI, 12, 15, syndromes (including efficacy, SBP 17, 19, tolerability [retention], side 22, 23 effects, risks and costs for phenobartintal, phenytoin, topiramate, zoniamide, carbamazephine, excarbagepine, valproate and divalproex, lomotrigine. 8.2 Learn empirical drugs for early treatment of meningitis Y Attendings Clinics, A, B, C, Attendings Clinics, a, b, c, PC, 2, 3, 4, 5, 2, 3 and when to treat before doing wards, D, J, K wards, e, g, k, l MK, 6, 7, 11, imaging on lumbar pucture. ICU, ICN conferences PBLI, 12, 15, SBP 17, 19, 22, 23 8.3 Learn of risks and monitoring in drugs for Y Attendings Clinics, A, B, C, Attendings Clinics, a, b, c, PC, 2, 3, 4, 5, 2, 3 epilepsy, headaches, and ADD. wards, D, J, K wards, e, g, k, l MK, 6, 7, 11, ICU, ICN conferences PBLI, 12, 15, SBP 17, 19, 22, 23 8.4 Learn of appropriate use and context for use as well as Y Attendings Clinics, A, B, C, Attendings Clinics, a, b, c, PC, 2, 3, 4, 5, 2, 3 risks of migraine drugs wards, D, J, K wards, e, g, k, l MK, 6, 7, 11, (triptans, beta blocker, ICU, ICN conferences PBLI, 12, 15, antidepressants, and SBP 17, 19, anticonvulsants) and compare 22, 23
  • 9. with nonpharmacologic approaches (or both). 8.5 Learn of indications for and risks of stimulant and Y Attendings Clinics, A, B, C, Attendings Clinics, a, b, c, PC, 2, 3, 4, 5, 2, 3 tranquilizing agents in ADD, wards, D, J, K wards, e, g, k, l MK, 6, 7, 11, behavioral disorders, autism ICU, ICN conferences PBLI, 12, 15, and compare with SBP 17, 19, nonpharmacologic approaches 22, 23 (or both). Goal: #9 Develop an appreciation for the importance of prevention and screening (e.g. for trauma, accidents, poisonings, preventable CNS infections, prenatal diagnosis, newborn metabolic screening, genetic counseling for those at risk) to reduce the burden of neurologic disease. Objectives Priority Teaching Evaluation Domain Skills PGY Yes/No Who Where Method Who Where Method 9.1 Emphasize great improvement with vaccinations Very Attendings, Clinics, A, B, C, Attendings Clinics, a, b, e, g PC, 1-24 2, 3 against pathogens and high Social wards, D, E, G, wards, MK, importance of getting children Svcs. ICU, H, J, K conferences PBLI, vaccinated. BAER lab COM, PRO, SBP 9.2 Recal history of toxins (e.g. lead in housepaints, aspirin in Very Attendings, Clinics, A, B, C, Attendings Clinics, a, b, e, g PC, 1-24 2, 3 Reye Syndrome, etc.) now high Social wards, D, E, G, wards, MK, preventable and for which Svcs. ICU, H, J, K conferences PBLI, children are screened. BAER lab COM, PRO, SBP 9.3 Promulgate the new Texas inborn error of metabolism Very Attendings, Clinics, A, B, C, Attendings Clinics, a, b, e, g PC, 1-24 2, 3 screening. high Social wards, D, E, G, wards, MK, Svcs. ICU, H, J, K conferences PBLI, BAER lab COM, PRO, SBP 9.4 Emphasize need for protective gear (e.g., infant Very Attendings, Clinics, A, B, C, Attendings Clinics, a, b, e, g PC, 1-24 2, 3 seats, bicycle helmets). high Social wards, D, E, G, wards, MK, Svcs. ICU, H, J, K conferences PBLI, BAER lab COM,
  • 10. PRO, SBP 9.5 Teach parents safety precautions (seat belts, keep Very Attendings, Clinics, A, B, C, Attendings Clinics, a, b, e, g PC, 1-24 2, 3 toxins locked up, avoid drugs, high Social wards, D, E, G, wards, MK, keep guns unloaded and locked Svcs. ICU, H, J, K conferences PBLI, up). BAER lab COM, PRO, SBP 9.6 Outline early hearing screening and Brainstem Very Attendings, Clinics, A, B, C, Attendings Clinics, a, b, e, g PC, 1-24 2, 3 Auditory Evoked Response high Social wards, D, E, G, wards, MK, Testing in those at risk Svcs. ICU, H, J, K conferences PBLI, (premature, asphyxiated, BAER lab COM, hyperbilirubimic, exposed to PRO, ototoxic drugs, failed screen), SBP to identify hearing loss early. 9.7 Early habilitative therapy should be made available to Very Attendings, Clinics, A, B, C, Attendings Clinics, a, b, e, g PC, 1-24 2, 3 those at risk for developmental high Social wards, D, E, G, wards, MK, difficulties with stimulation Svcs. ICU, H, J, K conferences PBLI, and programs for home use. BAER lab COM, PRO, SBP 9.8 Advocate for public safety (especially vehicular and Very Attendings, Clinics, A, B, C, Attendings Clinics, a, b, e, g PC, 1-24 2, 3 motorcycle safety). high Social wards, D, E, G, wards, MK, Svcs. ICU, H, J, K conferences PBLI, BAER lab COM, PRO, SBP
  • 11. Legend Teaching Methods RRC Domains A. Clinical encounter PC – Patient Care B. Lecture MK – Medical Knowledge C. Seminar or a small group PBLI – Practice-based Learning and Improvement D. Assigned reading COM – Interpersonal Skills and Communication E. Case conference PRO – Professionalism F. Morning report SBP – Systems-based Practice G. Grand rounds H. Presentation I. AV media module J. Web-based module K. Journal reading/presenting L. M&M conference M. Portfolio N. Quality improvement activity O. Supervised activity Evaluation Methods Basic Clinical and Professional Skills 1. Perform an appropriate clinical exam 13. Effective teaching of students, colleagues, a. Global rating 2. Appropriately use diagnostic studies, procedures other professionals and lay groups. and labs 14. Develop and demonstrate effective b. Direct observation with checklist 3. Apply sound decision-making and clinical leadership and collaboration skills. c. Consensus opinion/multiple raters judgment 15. Function as a consultant to other physicians d. 360 rating 4. Use medications and therapies safely and and health professionals e. Written examination effectively 16. Use consultations and referrals effectively f. Patient survey 5. Manage and advocate for the whole patient 17. Develop responsible and productive work 6. Skillfully and empathically manage patient’s habits and professional responsibility. g. Case/procedure log acute or terminal illness, or death. 18. Develop personal responsibility and balance h. Conference attendance log 7. Effectively and empathically communicate with personal and professional interests. i. EBM activity log patients and families. 19. Understand basic principles in medical ethics j. QI activity assessment 8. Effective data gathering from history and and identify issues. k. Systems error activity/discussion interview. 20. Understand legal issues in pediatric practice 9. Promotion of patient education and counseling. l. Self assessment 21. Develop skills in life-long learning and self- 10. Effective use of telephone communications. assessment. m. Individual learning plan 11. Professional communication and collaboration 22. Responsible use of information technology in n. Critical incident discussion in healthcare teams. decision-making and patient management. 12. Maintain accurate, legible, timely and legally appropriate medical records when caring for 23. Critically read and apply scientific patients. evidence/research to patient care. 24. Formulate career plans.

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