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NEUROLOGYCNPFELLOWSH..

  1. 1. NEUROLOGY FELLOWSHIP HANDBOOK Emory University ______________________________________________________________________________________________ CLINICAL NEUROPHYSIOLOGY FELLOW HANDBOOK Emory University School of Medicine Department of Neurology 101 Woodruff Memorial Circle – WMRB Suite 6000 Atlanta, GA 30322 Department Phone: 404.727.3818 fax: 404.727.3157 Education Program Office: 404.727.5004 Page 1 of 26 REVISED AND APPROVED 06/2005
  2. 2. NEUROLOGY FELLOWSHIP HANDBOOK Emory University ______________________________________________________________________________________________ TABLE OF CONTENTS PAGE 3 Neurophysiology Faculty PAGE 6 Core Values PAGE 7 Fellowship Position Description PAGE 8 Rotation Objectives PAGE 16 Evaluations PAGE 22 Teaching Responsibilities PAGE 24 Visiting Professors PAGE 24 Transcription Tips PAGE 24 Department & Medical School Policies PAGE 24 Lecture & Conference Schedules PAGE 26 Patient Telephone Call Guidelines PAGE 27 ACGME Program Requirements for Neurology Page 2 of 26 REVISED AND APPROVED 06/2005
  3. 3. NEUROLOGY FELLOWSHIP HANDBOOK Emory University ______________________________________________________________________________________________ CHAIRMAN ALLAN LEVEY, M.D., PH.D. FELLOWSHIP PROGRAM DIRECTOR JAFFAR KHAN, M.D. PIC: 10039 OFFICE PHONE: 404.616.4013 CELL PHONE: 678.371.9954 jkhan@emory.edu EDUCATION PROGRAM COORDINATOR PAMELA D. JULIEN, M.A. PHONE: 404.712.8899 pjulien@emory.edu FACULTY CLINICIANS & CLINICIAN/SCIENTISTS EPILEPSY CHARLES M. EPSTEIN, M.D. Advanced training: Harvard University; Emory University Research and specialty interests: power spectral EEG; evoked potentials; EEG field theory; magnetic brain stimulation SANDRA HELMERS, M.D. Advanced training: University of Cincinnati; Mayo Clinic; Massachusetts General Hospital Research and specialty interests: epilepsy with special interests in pediatric and elderly populations; vagus nerve stimulation; pharmacologic and surgical treatment of epilepsy THOMAS R. HENRY, M.D. Advanced training: Johns Hopkins University; University of Minnesota; University of California, Los Angeles Research and specialty interests: surgical and pharmacological management of epilepsy; electrophysiology of seizures; neuroimaging of epilepsy; higher cortical function and consciousness ARCHANA. KOGANTI, M.D. Advanced training: Emory University Research and specialty interests: general epilepsy and sleep disorders; surgically treatable epilepsies; vagus nerve stimulation SUZETTE LAROCHE, M.D. Page 3 of 26 REVISED AND APPROVED 06/2005
  4. 4. NEUROLOGY FELLOWSHIP HANDBOOK Emory University ______________________________________________________________________________________________ Advanced training: Indiana University; Emory University Research and specialty interests: Intensive Care Unit Electroencephalographic Monitoring PAGE B. PENNELL, M.D. Advanced training: University of Florida; University of Michigan Research and specialty interests: neurochemical markers in epilepsy; surgically treatable epilepsies; functional neuroimaging in epilepsy NEUROMUSCULAR DISORDERS MICHAEL BENATAR, M.D., Ph.D. Advanced training: Washington University; Jewish Hospital, Washington University Medical Center; Johns Hopkins University; University of Pennsylvania Hospital Research and specialty interests: Peripheral Nerve Hyperexcitability JONATHAN D. GLASS, M.D. Advanced training: University of Vermont; Johns Hopkins University Research and specialty interests: mechanisms of axonal degeneration; pathophysiology of peripheral neuropathy; HIV-related neurological disorders LINTON C. HOPKINS, M.D. Advanced training: University of Virginia; University of Rochester; Emory University Research and specialty interests: Emery Dreifuss muscular dystrophy; myasthenia gravis; demyelinating neuropathy; ALS JAFFAR KHAN, M.D. Advanced training: Louisiana State University; University of Iowa; Emory University Research and specialty interests: Critical Care associated Neuromuscular Weakness; electromyography; electroencephalography; epilepsy; neuromuscular diseases PEDIATRIC NEUROLOGY PHILIP HOLT, M.D. Advanced training: University of Alabama; Maine Medical Center; Emory University Research and specialty interests: epilepsy LARRY OLSON, M.D. Advanced training: University of South Dakota; Michigan State University; Boston University Hospital; University of Virginia Research and specialty interests: epilepsy JOHN SLADKY, M.D. Advanced training: Yale University; Children’s Hospital of Philadelphia; University of Pennsylvania Research and specialty interests: neuromuscular disorders SLEEP DISORDERS DONALD L. BLIWISE, Ph.D. Page 4 of 26 REVISED AND APPROVED 06/2005
  5. 5. NEUROLOGY FELLOWSHIP HANDBOOK Emory University ______________________________________________________________________________________________ Advanced training; University of Chicago; Stanford University Research and specialty interests: sleep in normal aging and dementia; behavioral consequences of sleep apnea; movement during sleep in degenerative neurologic conditions JEFFREY DURMER, M.D., Ph.D. Advanced training: University of Pennsylvania Research and specialty interests: Restless Leg Syndrome DAVID B. RYE, M.D., Ph.D. Advanced training: University of Chicago Research and specialty interests: anatomy, physiology, and pharmacology of brainstem mechanisms underlying behavioral state and motor control; pathophysiology of sleep disorders and comorbidity with movement disorders; neurodegenerative disorders EMORY UNIVERSITY DEPARTMENT OF NEUROLOGY FELLOWSHIP PROGRAM Page 5 of 26 REVISED AND APPROVED 06/2005
  6. 6. NEUROLOGY FELLOWSHIP HANDBOOK Emory University ______________________________________________________________________________________________ Core Values of the Emory Neurology Training Program  We recognize that learning is inherently communal in nature. We strive to promote an environment which nurtures the professional interaction necessary to strengthen our neurologic community.  We believe that students learn best by interacting with a subject and are committed to drawing medical students and junior colleagues into the process of active learning.  We welcome diversity, encourage critical inquiry, and embrace paradox in the constant act of reconciling established concepts with new evidence in the process of life-long learning.  We treat people with respect and believe that individuals who are given respect and responsibility respond by giving their best.  We strive for excellence and require honesty and integrity in all we do.  We recognize that intellectual rigor is required to amass neurological knowledge; likewise, an ethos of trust, compassion, and respect is essential to creating a future neurologist.  We recognize our limits as well as our capabilities and act accordingly at all times. Page 6 of 26 REVISED AND APPROVED 06/2005
  7. 7. NEUROLOGY FELLOWSHIP HANDBOOK Emory University ______________________________________________________________________________________________ FELLOW JOB RESPONSIBILITIES 1POSITION DESCRIPTION FOR FELLOW PHYSICIANS Department of Neurology Emory University School of Medicine Atlanta, Georgia Introduction The RRC-approved fellowship training program at Emory University School of Medicine is under the direction of Dr. Allan Levey, Chairman, and Dr. Jaffar Khan, Program Director. The fellowship training program currently utilizes the following hospitals: Emory University Hospital The Emory Clinic Grady Memorial Hospital Wesley Woods Health Center General Principles of the Training Program for Fellows in Neurology at Emory University 1. The house staff physician meets the qualifications for resident/fellow eligibility outlined in the Essentials of Accredited Residencies in Graduate Medical Education in the AMA Graduate Medical Education Directory. 2. As the position of house staff physician involves a combination of supervised, progressively more complex and independent patient evaluation, management functions and formal educational activities, the competence of the house staff physician is evaluated on a regular basis. The program maintains a confidential record of the evaluations. 3. The position of house staff physician entails provision of care commensurate with the house staff physician’s level of advancement and competence, under the general supervision of appropriately privileged attending teaching staff. This includes:  participation in safe, effective, and compassionate patient care;  developing an understanding of ethical, socioeconomic, and medical/legal issues that affect graduate medical education, and of how to apply cost containment measures in the provision of patient care;  participation in the educational activities of the training program and, as appropriate, assumption of responsibility for teaching and supervising other residents and students, and participation in institutional orientation and education programs and other activities involving the clinical staff;  participation in institutional committees and councils to which the house staff physician is appointed or invited; and  performance of these duties in accordance with the established practices, procedures, and policies of the institution, and those of its programs, clinical departments and other institutions to which the house staff physician is assigned, including among others, state licensure requirements for physicians in training where these exist. Page 7 of 26 REVISED AND APPROVED 06/2005
  8. 8. NEUROLOGY FELLOWSHIP HANDBOOK Emory University ______________________________________________________________________________________________ ROTATION OBJECTIVES Neuromuscular Disorders / Electromyography (EMG) Emory University School of Medicine I. DESCRIPTION: This component of the Clinical Neurophysiology Fellowship will provide basic knowledge and clinical experience in neuromuscular pathophysiology, diagnosis and therapy. The fellow will become proficient with the technical aspects of nerve conduction studies and electromyography, as well as, the interpretation and clinical application of the findings. Exposure to the clinical aspects of neuromuscular disorders in children and adults will be derived from the outpatient clinics and inpatient consultation services. A fundamental knowledge of the histopathology of neuromuscular disease will be obtained through the review of muscle and nerve biopsies in the neurology neuromuscular laboratory. II. NEUROMUSCULAR FACULTY: Jonathan Glass, M.D., Professor of Neurology Michael Benatar, M.D., Assistant Professor of Neurology Linton Hopkins, M.D., Associate Professor of Neurology Jaffar Khan, M.D., Assistant Professor of Neurology John Sladky, M.D., Professor of Neurology Taylor Harrision, M.D., Fellow Associate These faculty members are board certified by the American Board of Psychiatry & Neurology in adult neurology, and are board certified in clinical neurophysiology. III. OBJECTIVES: Upon successful completion of this component of the fellowship, the fellow will be able to: 1) Obtain a comprehensive history of neuromuscular-specific signs and symptoms, from patients and other lay historians, in addition to obtaining comprehensive general historical history and examination. 2) Develop an appropriate differential diagnosis of neuromuscular disease based upon the clinical data. 3) Appropriately order and apply the results of laboratory, genetic and electrophysiologic testing as indicated by the history and physical examination findings. 4) Distinguish the electrophysiological characteristics of myopathy from neuropathy. 5) Distinguish the electrophysiological characteristics of demyelinating neuropathy from axonal neuropathy. 6) Appropriately choose patients that would benefit form a muscle and or nerve biopsy. 7) Distinguish the histopathological findings of a neuropathy from a myopathy. 8) Become familiar with the information obtained from the common stains used for the histopathological analysis of muscle and nerve biopsies. 9) Choose appropriate pharmacologic, physical therapy, and counseling modalities for the neuromuscular diseases. 10) Become familiar with the use, adverse effects and monitoring of the immunomodulatory medications commonly used to treat various neuromuscular diseases. 11) Be able to perform the common motor and sensory nerve conduction studies of the upper and lower extremities. 12) Be able to perform the needle examination (electromyography). 13) Identify and apply the clinical significance of the waveforms analyzed during the needle examination. 14) Become aware of the common technical fallacies and pitfalls of nerve conduction studies. Page 8 of 26 REVISED AND APPROVED 06/2005
  9. 9. NEUROLOGY FELLOWSHIP HANDBOOK Emory University ______________________________________________________________________________________________ Upon successful completion of this rotation, the fellow will have: 1. Completed multiple EMG/NC studies and interpreted the results 2. Been exposed to the clinical and basic science research of the Neuromuscular Faculty 3. Prepared, presented and defended multiple EMG/NCS at the EMG conference on Tuesday Morning IV. DAILY SCHEDULE: Monday Tuesday Wednesday Thursday Friday AM AM AM AM AM Clinic (Benatar) EMG Conf MDA Clinic EMG (Benatar) Grand Rounds (Benatar, Glass, EMG (Benatar) EMG (Harrison) Clinic (Glass) Khan) Clinic (Benatar) EMG (Esper) PM PM PM PM PM EMG (Harrison) EMG (Khan) EMG (Benatar) Peds NM Clinic Pediatric EMG Muscle & Nerve at Dunwoody Neuromuscular (Sladky) Sign-out (Glass, EMG (Benatar) (Sladky) Rounds Sladky) (Glass) Note: On the first Wednesday of every month the fellow may attend the MDA clinic in Dalton, GA for the entire day with Drs. Hopkins and Sladky. On the second Friday of the month the fellow will attend the ALS clinic with Drs. Glass and Khan. Otherwise the fellows will attend the general MDA clinic with Dr. Benatar. V. READING LIST: Required Reading: 1) Griggs RC. Evaluation and Treatment of Myopathies. 2) Mendell JR, Kissel JT, and Cornblath DR. Diagnosis and Management of Peripheral Nerve Disorders 3) Stewart JD. Focal Peripheral Neuropathies. 4) Preston DC, Shapiro BE. Electromyography and Neuromuscular Disorders. 5) Perotto. Anatomic Guide for the Electromyographer. Recommended Reading: 1) Dyck, P. Peripheral Neuropathy 2) Engel AG. Myology: Basic and Clinical Page 9 of 26 REVISED AND APPROVED 06/2005
  10. 10. NEUROLOGY FELLOWSHIP HANDBOOK Emory University ______________________________________________________________________________________________ ROTATION OBJECTIVES Epilepsy/Electroencephalography (EEG) Emory University School of Medicine I. Introduction: This component of the fellowship will provide essential knowledge and clinical experience in epilepsy pathophysiology, diagnosis, and therapy, and in interpretation and application of electroencephalography (EEG). Exposure to clinical neurophysiological techniques derived from EEG will include video-EEG monitoring (in diagnostic and presurgical applications), evoked potentials (including intra-operative monitoring), and functional mapping with direct cortical electrical stimulation. II. Epilepsy Faculty: Charles M. Epstein, M.D., Professor of Neurology Sandra Helmers, M.D., Associate Professor of Neurology Thomas R. Henry, M.D., Professor of Neurology Philip J. Holt, M.D., Assistant Professor of Neurology and Pediatrics Archana Koganti, M.D., Assistant Professor of Neurology Suzette LaRoche, M.D., Assistant Professor of Neurology Larry D. Olson, M.D., Assistant Professor of Neurology and Pediatrics Page B. Pennell, M.D., Associate Professor of Neurology These faculty members are board certified by the American Board of Psychiatry & Neurology in adult or pediatric neurology, and are board certified or eligible in clinical neurophysiology. III. Rotation Environment: The primary sites of the rotation are the Emory University Hospital, the Emory Clinic and Grady Memorial Hospital. Routine EEG, EEG-video monitoring, continuous ICU EEG monitoring, evoked potentials and other procedures are performed at these sites, using digital acquisition units. These procedures are interpreted in reading rooms of the Clinic and Hospitals, which are equipped with high- resolution digital display. The Clinical Neurophysiology Fellows’ Room is available at all sites for on- site access to reference texts and other education materials. Additionally, the fellows have access to the extensive collection of texts and journals of the Emory University School of Medicine Biomedical Library, located in a nearby building. IV. Educational Objectives, Goals and Expectations: After successful completion of this component of the fellowship, the fellow will be able to: 1) Obtain comprehensive history of ictal semiology and other epilepsy-specific signs and symptoms, from patients and other lay historians, in addition to obtaining comprehensive general neurological history and examination. 2) Describe the nature of and commonly occurring abnormalities detected with EEG and other laboratory studies used in initial seizure evaluation, and appropriately order and apply results of these studies in patient care. 3) Classify seizures and epilepsies based on clinical and laboratory data. 4) Choose appropriate anti-epileptic drug (AED) therapy and other therapies for initial treatment of seizures, and describe pharmacokinetics, pharmacodynamics, dosing and important adverse effects of commonly used AEDs. Page 10 of 26 REVISED AND APPROVED 06/2005
  11. 11. NEUROLOGY FELLOWSHIP HANDBOOK Emory University ______________________________________________________________________________________________ 5) Identify AED-refractory seizure disorders, describe applications of diagnostic video-EEG monitoring in evaluation of uncontrolled seizures, and utilize reports of video-EEG in clinical care of patients with epileptic and non-epileptic seizures. 6) Describe epilepsy surgery, vagus nerve stimulation, the ketogenic diet, and other therapies used in AED-refractory epilepsies. 7) Describe the physiological basis of scalp EEG generation. 8) Describe in detail all steps in acquisition of routine EEG (based, in part, on personally undergoing a routine EEG). 9) Describe in general the acquisition and post-acquisition processing of evoked potentials (including intra-operative monitoring), intracerebral and subdural electrocorticography, and functional mapping with direct cortical electrical stimulation. 10) Apply scalp electrodes accurately in the International 10-20 System sites, and obtain a routine EEG. 11) Describe and recognize normal features of waking and sleeping EEG activity in adults and older children, and describe normal features of waking and sleeping EEG activity in infants and young children. 12) Describe and recognize non-epileptiform and interictal epileptiform EEG abnormalities in adults and older children, and describe non-epileptiform and interictal epileptiform EEG abnormalities in infants and young children. 13) Describe common EEG patterns seen in critically ill/comatose patients and their clinical significance. 14) Describe ictal EEG discharges seen associated with different seizure types. 15) Describe and recognize commonly occurring EEG artifacts. 16) Interpret and report routine EEG recordings of adults and older children accurately. On successful completion of this rotation, the Neurology Resident will additionally have: 1) Prepared and presented at a Thursday Conference a one-hour presentation on an important topic of epilepsy or EEG, with topic selection approved by one of the faculty members. 2) Personally run one routine EEG, including electrode application. 3) Been exposed to clinical research studies of the Epilepsy & EEG faculty. V. Reading List: Required Reading: 1. Fisch B (ed.) EEG Primer: Basic Principles of Digital and Analog EEG, 3rd Ed. Amsterdam: Elsevier, 1999. 2. Leppik IE. Contemporary Diagnosis and Management of the Patient with Epilepsy, 3rd Ed. Newtown, PA: Handbooks in healthcare. 1997. Recommended Reading: 1. Ebersole JS, Pedley TA (eds.) Current Practice of Clinical Electroencephalography, 3rd Ed. Philadelphia: Lippincott Williams & Wilkins, 2002. 2. Hughes J (ed.) EEG in Clinical Practice, 2nd Ed. Newton: Butterworth-Heinemann, 1994. 3. Wyllie E (ed.). The Treatment of Epilepsy: Principles and Practice, 2nd Ed. Philadelphia: Lippincott Williams & Wilkins. 2001. Other Recommended Sources: 1. Blume WT, Kaibara M, Young B, (eds.) Atlas of Adult Electroencephalography, 2nd Ed. Philadelphia: Lippincott Williams & Wilkins, 2001 Page 11 of 26 REVISED AND APPROVED 06/2005
  12. 12. NEUROLOGY FELLOWSHIP HANDBOOK Emory University ______________________________________________________________________________________________ 2. Engel J Jr, Pedley TA (eds.). Epilepsy: A Comprehensive Textbook Philadelphia: Lippincott- Raven Publishers. 1998. 3. Lüders HO (ed.) Epilepsy Surgery Philadelphia: Lippincott Williams & Wilkins. 1992. 4. Niedermeyer E, Lopes da Silva F (eds.). Electroencephalography: Basic Principles, Clinical Applications, and Related Fields, 4th Ed. Baltimore: Williams & Wilkins. 1998. 5. Misulis K, Fakhoury T (eds.) Spehlmann’s Evoked Potential Primer, 3rd Ed. Newton: Butterworth-Heinemann, 2001. Page 12 of 26 REVISED AND APPROVED 06/2005
  13. 13. NEUROLOGY FELLOWSHIP HANDBOOK Emory University ______________________________________________________________________________________________ ROTATION OBJECTIVES Sleep Medicine Emory University School of Medicine I. Description: This component of the Clinical Neurophysiology Fellowship will provide basic knowledge and clinical experience in sleep medicine pathophysiology, diagnosis and therapy. The fellow will become proficient with the technical aspects of polysomnography (PSG), multiple sleep latency tests (MSLT) and actigraphy, as well as, the interpretation and clinical application of the findings. Exposure to the clinical aspects of sleep disorders in children and adults will be derived from the outpatient clinics and inpatient consultation services. A fundamental knowledge of the neuroanatomical and neurophysiological systems involved in sleep homeostasis, sleep disorders and circadian rhythm generation will be obtained through weekly research and clinical conferences, as well as monthly sleep grand rounds sponsored by the Emory Healthcare Program in Sleep Medicine. II. Sleep Medicine Faculty: David B. Rye, M.D., Ph.D., Associate Professor of Neurology1* Donald L. Bliwise, Ph.D., Professor of Neurology* Jeffrey S. Durmer, M.D., Ph.D., Assistant Professor of Neurology1* Kathy P. Parker, Ph.D., R.N., Professor of Nursing* Gary Freed, DO, Professor of Pediatrics Michael Decker, R.N., PhD, Assistant Professor of Neurology Glenda Keating, Ph.D., Instructor of Neurology (Board certified by the American Board of Psychiatry & Neurology 1; Board certified by the American Board of Sleep Medicine*) III. Rotation Environment: The primary sites of the rotation are the Emory University Hospital, the Emory Clinic and the Egleston Children’s Hospital of Children’s Healthcare of Atlanta. PSG and MSLT recordings in adults are performed in the Emory University Sleep Laboratory using stationary digital equipment as well as ambulatory equipment for hospital-based consultations. Similar studies with pediatric patients are performed in the Egleston Sleep Laboratory using stationary and portable digital systems. These procedures are interpreted in reading rooms associated with each laboratory, and may be accessed remotely. Actigraphy based studies are performed in patient homes’ using ambulatory units which are returned to the Emory Sleep Laboratory for interpretation. Fellowship trainees have available a wide range of basic and clinical literature and textbook collections for reference within the sleep medicine administrative and faculty offices. Investigative experience is obtained in association with the basic research laboratories of Drs. Rye, Decker and Keating and the clinical research laboratories of Drs. Bliwise and Parker. In addition, fellows have access to the extensive collection of texts and journals of the Emory University School of Medicine Biomedical Library. IV. Objectives: Upon successful completion of this component, the fellow will: 1) Obtain a comprehensive history of sleep and wake symptoms, from patients and other historians, in addition to obtaining comprehensive general historical history and examination. 2) Develop an appropriate differential diagnosis of disorders of sleep and wake based upon the clinical data. Page 13 of 26 REVISED AND APPROVED 06/2005
  14. 14. NEUROLOGY FELLOWSHIP HANDBOOK Emory University ______________________________________________________________________________________________ 3) Appropriately order and apply the results of laboratory, genetic and electrophysiologic testing as indicated by the history and physical examination findings. 4) Distinguish intrinsic and extrinsic sleep disorders in children and adults. 5) Distinguish circadian rhythm disorders in children and adults using a thorough sleep history and sleep log data. 6) Identify patients eligible for clinical research studies in sleep medicine, and be able to discuss sleep research with potential subjects. 7) Appropriately choose patients that would benefit from actigraphy, PSG and/or MSLT. 8) Determine the best therapeutic intervention for particular patients based on diagnosis, severity and associated epidemiological data. 9) Become familiar with non-pharmacologic therapies for sleep disorders such as obstructive sleep apnea, insomnia, parasomnias, narcolepsy, restless legs syndrome, and other common sleep disorders. 10) Become familiar with the use, adverse effects and monitoring of dopamimetic, sedative-hypnotic, anti-depressant and anti-epileptic medications commonly used to treat various disorders of sleep and wake in children and adults. 11) Be able to set-up, score and interpret a PSG, MSLT and actigraphy study in an adult or a child. 12) Identify and apply the clinical significance of PSG, MSLT and actigraphic findings to clinical problems in children and adults. 13) Become aware of the common technical artifacts and limitations of PSG, MSLT and actigraphic testing. Upon successful completion of this rotation, the fellow will have: 1) Completed multiple PSG, MSLT and actigraphic studies and interpreted the results in children and adults. 2) Been exposed to the clinical and basic science research of the Sleep Medicine faculty. 3) Prepared, presented and defended multiple PSG’s and MSLT’s at the Sleep Medicine conference on Wednesday mornings. V. DAILY SCHEDULE: Monday Tuesday Wednesday Thursday Friday AM AM AM AM AM Adult Clinic Pediatric Clinic Sleep Pediatric PSG Neurology (Durmer) (Durmer) Conference interpretation Grand Rounds (Durmer, Freed) PM PM PM PM PM PM PM Adult PSG Adult PSG Adult Clinic Adult PSG Infant Apnea interpretation interpretation (Rye, interpretation Clinic (Freed) (faculty (faculty rotation) Parker, (faculty rotation) Bliwise) rotation) Page 14 of 26 REVISED AND APPROVED 06/2005
  15. 15. NEUROLOGY FELLOWSHIP HANDBOOK Emory University ______________________________________________________________________________________________ Note: On the third Thursday of every month, the Fellow will attend the Sleep Medicine Grand Rounds from 8:30 to 10:30 am. READING LIST: Required Reading: 1. Kryger, Roth, Dement, Principles of Sleep Medicine. 2. Aldrich M.S., Sleep Medicine. 3. Sheldon S., Riter S., Detrojan M, Atlas of Sleep Medicine in Infants and Children. 4. Rechtschaffen A. and Kales A., A Manual of Standardized Terminology, Techniques and Scoring System for Sleep Stages of Human Subjects. Recommended Reading: 1. Chokroverty S., Hening W.A., Walters, A.S., Sleep and Movement Disorders. 2. Hauri P and Linde S., No More Sleepless Nights. 3. Mindell J.A., Sleeping Through the Night. 4. Avidon A.Y. and Roos K.L., Seminars in Neurology: Introduction to Sleep and Its Disorders, 24(3) September, 2004. 5. Avidon A.Y. and Roos K.L., Seminars in Neurology: Sleep in Neurological Practice, February 2005. Page 15 of 26 REVISED AND APPROVED 06/2005
  16. 16. NEUROLOGY FELLOWSHIP HANDBOOK Emory University ______________________________________________________________________________________________ EVALUATIONS Multiple types of evaluation, including both subjective and objective methods, are used to assess knowledge, skills, and attitudes. Written evaluations of fellow performance (see form below) are submitted to the Program Director’s office at the conclusion of each three month block for a total of 4 written evaluations per year. In the event that a fellow was supervised by more than one attending during a rotation, a written evaluation is completed by each attending who supervised the resident for a period of two weeks or longer. Each fellow meets every 6 months with the program director or other teaching faculty member for a performance review. In the event of an unsatisfactory evaluation, the fellow is notified immediately by the Program Director and a plan for remediation is developed. Immediate feedback and performance assessment is provided to the fellow from the teaching faculty on a daily basis. All technical procedures, procedure reports and patient encounters are supervised by a member of the teaching faculty. The fellows are immediately debriefed during and after the performance of the procedure, report generation and patient encounter. A 360 degree written evaluation (see form below) of bedside manner, communication skills and patient rapport will be assessed on at least 2 occasions. The evaluations will be completed by a combination of the teaching physician, clinical neurophysiology technologist, nursing staff, administrative assistant and patient. During the second half of the training year, two standardized clinical neurophysiology in-service examinations will be scheduled. The in-service examinations provided by the American Board of Electrodiagnostic Medicine (“The EMG Board”) and the American Clinical Neurophysiology Society (“The EEG Board”) will be scheduled during the second half of the training year. You will be freed of all clinical duties while taking these examinations and all expenses for the examinations will be paid by the Department of Neurology. In order to monitor the fellowship programs compliance with the duty hour requirements you will be asked to report your work hours for one month every four months. Additionally you will be encouraged to complete an anonymous evaluation on the teaching faculty. These evaluations are available through the Office of Pam Julien, the Education Program Coordinator. Page 16 of 26 REVISED AND APPROVED 06/2005
  17. 17. NEUROLOGY FELLOWSHIP HANDBOOK Emory University ______________________________________________________________________________________________ FELLOW EVALUATION DEPARTMENT OF NEUROLOGY EMORY UNIVERSITY SCHOOL OF MEDICINE PGY-5 FELLOW NAME MONTH / YEAR LEVEL OF TRAINING EMORY – Epilepsy EMORY - Neuromuscular SERVICE : (circle) GRADY - Epilepsy GRADY - Neuromuscular CompetencyDemonstrated Exceeded Competency Not competentFailed - Needs Improvement GENERAL COMPETENCIES PATIENT CARE Fellow must be able to provide patient care that is compassionate, appropriate, and effective for the treatment of health problems and the promotion of health. MEDICAL KNOWLEDGE Fellow must demonstrate knowledge about established and evolving biomedical, clinical, and cognate (e.g. epidemiological and social-behavioral) sciences and the application of this knowledge to patient care. PRACTICE-BASED LEARNING/IMPROVEMENT Fellow must be able to investigate and evaluate their patient care practices, appraise and assimilate scientific evidence, and improve their patient care practices. INTERPERSONAL & COMMUNICATION SKILLS Fellow must be able to demonstrate interpersonal and communication skills that result in effective information exchange and teaming with patients, their patients’ families, and professional associates. PROFESSIONALISM Fellow must demonstrate a commitment to carrying out professional responsibilities, adherence to ethical principles, and sensitivity to a diverse patient population. Page 17 of 26 REVISED AND APPROVED 06/2005
  18. 18. NEUROLOGY FELLOWSHIP HANDBOOK Emory University ______________________________________________________________________________________________ SYSTEMS-BASED PRACTICE Fellow must demonstrate an awareness of and responsiveness to the larger context and system of healthcare and the ability to effectively call on system resources to provide care that is of optimal value. NARRATIVE COMMENTS (Note: This section may be used verbatim in letters of recommendation. Please include strengths and areas of improvement.) ______________________________________________________________________________________________________ ______________________________________________________________________________________________________ ______________________________________________________________________________________________________ ______________________________________________________________________________________________________ ______________________________________________________________________________________________________ ______________________________________________________________________________________________________ ______________________________________________________________________________________________________ Is this individual where he/she should be at this point in training? □ Yes □ No EVALUATOR’S NAME : (please print legibly) PLEASE CIRCLE ONE : FACULTY RESIDENT FELLOW STUDENT STAFF DEPARTMENT : EVALUATOR’S SIGNATURE: ___________________________________________ DATE: ____________________ Page 18 of 26 REVISED AND APPROVED 06/2005
  19. 19. NEUROLOGY FELLOWSHIP HANDBOOK Emory University ______________________________________________________________________________________________ 360° Physician Evaluation Form Emory 1University Department of Neurology Name of Physician: Date of Evaluation: Year of Neurology Training: 1 2 3 More than 3 Peer Attending Patient Evaluator Status: Nurse Ancillary Staff Family/Friends Please put a  check mark in the box that best reflects how the physician named above does the following: Never Sometimes Usually Always Don’t Know Listens and understands Works well with others Considers social, personal differences, and different beliefs Responds quickly Treats others with respect Continues to learn Is aware of services available for patients Provides excellent care Appears tired or stressed Please write down in the space below, what you like best about Dr._______________________. Please write down in the space below what Dr.________________________ needs to improve. Page 19 of 26 REVISED AND APPROVED 06/2005
  20. 20. NEUROLOGY FELLOWSHIP HANDBOOK Emory University ______________________________________________________________________________________________ Faculty Evaluation Form ATTENDING PHYSICIAN EVALUATION EMORY UNIVERSITY SCHOOL OF MEDICINE DEPARTMENT OF NEUROLOGY Attending Physician: ______________________________________________________________________ SATISFACTORY Excellent MARGINAL Very Good Please rate (√) the attending physician on each of the skills described below: Was usually prompt Adhered to rounds and conference schedules AVAILABILITY Kept interruptions to a minimum Devoted enough time to rounds and patient care COMMENTS: Kept discussions focused on case or topic Asked questions in an appropriate manner Used bedside teaching to demonstrate history-taking and examination skills Emphasized problem-solving (thought processes leading to decisions) TEACHING Integrated social/ethical aspects of medicine: cost containment, pain control, etc. as appropriate Encouraged team members to read, research, and review pertinent topics Accommodated teaching to actively incorporate all members of team COMMENTS: Page 20 of 26 REVISED AND APPROVED 06/2005
  21. 21. NEUROLOGY FELLOWSHIP HANDBOOK Emory University ______________________________________________________________________________________________ and Patient CareProfessionalism Always acted in the best interest of the patient Displayed a respectful attitude toward patients Established rapport with team members Showed appropriate regard for other specialties and health care professionals Served as a role model Was enthusiastic and stimulating Recognized own limitations; was appropriately self critical COMMENTS: SATISFACTORY Excellent MARGINAL Very Good Please rate (√) the attending physician on each of the skills Described below: Organization Fund of Knowledge & Continuing Scholarship Demonstrated broad knowledge of neurology Was up-to-date Identified important elements in case analysis Used relevant medical/scientific literature to support decision making COMMENTS: Provided clear expectations at the beginning of rotation Provided useful feedback including constructive criticism to team members Balanced service responsibilities and teaching functions COMMENTS: Page 21 of 26 REVISED AND APPROVED 06/2005
  22. 22. NEUROLOGY FELLOWSHIP HANDBOOK Emory University ______________________________________________________________________________________________ EMORY INPATIENT EMORY CONSULTS RECOMMENDATIONS: GRADY INPATIENT GRADY CONSULTS Please rank order on a scale of 1 (most effective) to 9 (least effective) WESLEY WOODS the services where you believe this OUT-PATIENT CLINIC faculty member would be most effective: VA SUBSPECIALTY ROTATION (e.g. EEG/epilepsy; EMG/neuromuscular) OTHER: • THIS EVALUATION WILL BE HELD IN THE STRICTEST CONFIDENCE. The evaluation form will NOT be given to the attending. Composite information from all evaluations will be abstracted and provided to attendings, in summary form, annually. Information from this evaluation will be used in determining attending assignments. Page 22 of 26 REVISED AND APPROVED 06/2005
  23. 23. NEUROLOGY FELLOWSHIP HANDBOOK Emory University ______________________________________________________________________________________________ TEACHING RESPONSIBILITIES (Adapted from Lecture Handout prepared by Dr. Kate Heilpern and Dr. Alan Otsuki) All fellows teach, and there is no doubt that the instruction received by medical students and residents from fellows is a significant part of their education. In addition, fellows also teach patients as well as their colleagues, both junior and senior. The word doctor comes from the Latin docer, which does not mean healer, but rather teacher. In addition, it is also true that teaching enhances your own learning. Remember that “ to teach is to learn twice.” In an effort to enhance your effectiveness in teaching the medical students and residents assigned to clinical neurophysiology rotation, the Learning Objectives for the Neurology Clerkship and residents, as well as the articles “What should a graduating medical students know about neurology?” are attached for your review. In addition, the following resources are available in the Neurology Library at Grady. Residents as Teachers:A Guide to Educational Practice, 2nd Ed., Schwenk and Whitman, 1993. Preceptors as Teachers: A Guide to Clinical Teaching, 2nd Ed., Whitman and Schwenk, 1995. Creative Medical Teaching, Whitman, 1990. Essential Hyperteaching: Supervising Medical Students and Resident, Whitman, 1997. The Courage to Teach, Parker, PJ, Josey-Bass, Inc., 1998. Please keep in mind the following points with regard to teaching: Goals and Objectives • Recognize the fellow’s responsibility for patient care and teaching: patients, families, colleagues, medical student, and self • Identify opportunities for teaching  on the run  at the bedside, on rounds  during procedures  morning report and conferences  special “teaching moments” • Recognize the special reasons why fellows can be good teachers  availability  near peer  novice learner  role model  do not ever use e-mail to deliver negative commentary  do not shift blame to the student or resident (“the student told me he would check the CT scan/draw the blood/get the records”) Page 23 of 26 REVISED AND APPROVED 06/2005
  24. 24. NEUROLOGY FELLOWSHIP HANDBOOK Emory University ______________________________________________________________________________________________ NEUROLOGY CLINICAL CLERKSHIP FOR MEDICAL STUDENTS Fellows will supervise and teach medical students when they rotate onto the neuromuscular, epilepsy or sleep medicine services each month. At the end of each rotation, fellow may write an evaluation on the students they supervised. Dr. Linton Hopkins is the Clerkship Director. He can be contacted at the Emory Clinic at 404.778-3452 (Shanna Miller). GOALS AND OBJECTIVES:  Learn the 12 major symptoms of neurologic disease. Learn how to localize symptoms and signs to specific places in the brain, spinal cord, peripheral nerves, and muscle.  Perform a competent neurological exam that solves the problems brought out in your history, i.e. is focused toward the complaint of your patient.  Become familiar with the diagnosis and management of ten chronic neurological disorders that are common and treatable (such as carpal tunnel syndrome and migraine), and ten neurologic emergencies (such as TIA, status epilepticus, and spinal epidural abscess).  Produce a vignette and image every week about the patient and subject you think will be of most interest to your peers. You will be writing to enhance your own learning as well as that of your peers.  Consider researching a neurologic topic of interest to you. Submit a ten-page original paper with at least 5 references to the course director for credit.  Learn the skill of asking about your own performance in a way that invites constructive criticism, and seek to understand the reasons for the subjective part of your grade. Everyone can improve in some way. One of your jobs is to find out what we think of you. Page 24 of 26 REVISED AND APPROVED 06/2005
  25. 25. NEUROLOGY FELLOWSHIP HANDBOOK Emory University ______________________________________________________________________________________________ VISITING PROFESSORS Each year the Department of Neurology sponsors a visiting professor noted for both academic excellence and teaching skill to come and spend time with the residents and fellows. Typically, the visiting professor will spend two days in patient-centered educational activities at Grady and Emory in addition to delivering Grand Rounds. TRANSCRIPTION TIPS Please complete all transcriptions for clinic visits and reports for procedures within 24 hours of the patient encounter. • Please use complete words and sentences. Avoid jargon. • Never use abbreviations and avoid contractions. • Speak clearly. • Please spell any words that you think a transcriptionist may not understand. The transcriptionists are general medical transcripitionists who are not necessarily familiar with all neurologic terms. • Please spell the names of all people, including your own. • Please include, at the conclusion of the transcription, the name (and addresses, if readily available) of all physicians to whom a copy of the transcription is to be sent. This should include, at a minimum, the referring physician and any physicians who are to see the patient in follow-up. • Please write the “job number” provided at the end of the transcription in the clinical chart. This will help avoid lost transcriptions. DEPARTMENT AND MEDICAL SCHOOL POLICIES Policies regarding vacation, moonlighting, all forms of leave (e.g., family, medical, disability, etc.), as well as all information pertaining to benefits, may be found in the Housestaff Training Manual published by the Office of Graduate Medical Education (available on the web at http://www.med.emory.edu/GME/index.html). Please be aware that the professional services of the Emory Employee Assistance Program (EEAP), are available to all residents 24 hours per day. CONFERENCE SCHEDULE In addition the clinical neurophysiology lecture series, Grand Rounds and other lecture series provided by the Department of Neurology, there are many lectures provided by the University. These lectures may include global issues in medicine, including ethics, world health policy and the status of the health system in America. Typically you will be notified via email when these lectures are scheduled. Page 25 of 26 REVISED AND APPROVED 06/2005
  26. 26. NEUROLOGY FELLOWSHIP HANDBOOK Emory University ______________________________________________________________________________________________ Emory University Clinical Neurophysiology Fellows 2005-06 Review of Basic Science and Clinical Electrophysiology 8:00 am - 9:00 am, 3rd floor conference room, Emory Clinic Building A Date Topic Faculty July 12 Nerve Conduction Studies T. Harrision July 14 Normal and Non-Epileptiform Abnormal EEG of A. Koganti Adulthood July 19 Interictal Epileptiform EEG Abnormalities P. Pennell July 21 Diagnostic Ictal Video EEG Recording; Seizure & T. Henry Epilepsy Classification July 26 Presurgical Ictal Video EEG Recording & T. Henry Electrocorticography July 28 Electrophysiology in the Operating Room C. Epstein Aug 2 The Needle Examination: Part I J. Khan Aug 4 The EEG of Childhood Epilepsy Syndromes L. Olson Aug 9 The Needle Examination: Part II J. Khan Aug 11 No lecture Aug 16 Evoked Potentials C. Epstein Aug 18 Normal and Non-Epileptiform Abnormal EEG of P. Holt Childhood Aug 23 Electrophysiology of Peripheral Neuropathy and Motor J. Glass Neuron Disease Aug 25 Carpal Tunnel Syndrome M. Benatar Aug 30 Disorders of Neuromuscular Transmission M. Benatar Sept 1 ICU Monitoring S. LaRoche Sept 6 Normal Pediatric & Adult Sleep Architecture; D. Bliwise Instrumentation for Recording Sleep: Polysomnography & Actigraphy Sept 8 Electrophysiologic Correlates of Respiration in Sleep: D. Bliwise Sleep Disordered Breathing Sept 13 Assessment of Daytime Sleepiness: Multiple Sleep D. Rye Latency Testing (MSLT) and Maintenance of Wakefullness (MWT) Sept 15 Electrophysiologic Assessment of Parasomnias: D. Rye Nocturnal Movement Disorders and Epilepsy Sept 20 Technical Aspects of EEG & EEG Artifacts C. Epstein Sept 22 Autonomic Testing* L. Freedman Sept 27 Radiculopathy J. Khan Sept 29 Myopathy T. Harrision Oct 4 Treatment of Epilepsy with VNS S. Helmers Page 26 of 26 REVISED AND APPROVED 06/2005
  27. 27. NEUROLOGY FELLOWSHIP HANDBOOK Emory University ______________________________________________________________________________________________ PATIENT TELEPHONE CALL GUIDELINES On occasion you may receive a telephone call from a patient or you may be asked to make a telephone call to a patient. The following is a list of helpful hints that may help with these telephone calls. 1. Make clear to the patient, in a polite way that you are the fellow and are available for urgent or emergent issues only. 2. If a patient needs an essential prescription refill (i.e., a neurological medication that they take on a regular basis), you should discuss this with the attending physician. If the attending is not immediately available the patient should be given an adequate amount of medication to bridge until their clinic physician can give them a more complete refill. Under certain circumstances (holiday weekends or Christmas), they may need an extra day or two. They should be instructed to call their clinic physician on the next business day. 3. No Narcotics, Refills or Otherwise. Ever! If you have questions about requests for other drugs with abuse potential (e.g., benzos), discuss it with the clinic or on call attending. 4. If they are only calling to leave a message for their clinic physician, they should be instructed to call back during business hours. 5. Do not promise (or suggest) an expedited clinic visit (e.g., “Dr. Glass will see you tomorrow.”). 6. Do not make any major changes in patient management (e.g., changes from dilantin to tegretol) without explicitly discussing it with the attending. 7. Calls from outside physicians should be directed to the attending on call. 8. For non-neurologic issues, the patient should call their primary care physician. 9. Document each phone call on the provided log sheet. Give the log sheet to Shirley Franks on the next business day. 10. Always inform the patient that it is his/her responsibility to call their clinic physician the next day to follow-up an evening call. 11. Always call the attending on call with any question. 12. In general, you are an emergency bridge to allow the patient to make it through to the next business day, when they can call their clinic physician. 13. If it’s a true emergency, they need to go to the emergency room. VACATION/ABSENCE POLICY During the fellowship training year each fellow receives four weeks of absence during each year of fellowship. This period of absence includes time for vacation, interviews, board examinations, personal days and illness. If the fellowship includes more than one service, the leave of absence should be equally distributed throughout the rotations. To obtain vacation time a fellow must complete the Clinical Neurophysiology Fellow Absence Form (see form below). This form should include the first and last dates of the proposed vacation. The faculty member or members who are responsible for supervising the fellow’s training during the time of the proposed absence. After completion, the form should be signed by the fellow and returned to the office of the program director, Dr. Khan. Notification should be made four weeks prior to the intended starting date of the leave of absence. In event of any unexpected illness or absence the faculty member or members responsible for the fellow’s training and the program director should be notified as soon as possible. Page 27 of 26 REVISED AND APPROVED 06/2005
  28. 28. NEUROLOGY FELLOWSHIP HANDBOOK Emory University ______________________________________________________________________________________________ EMORY UNIVERSITY DEPARTMENT OF NEUROLOGY CLINICAL NEUROPHYSIOLOGY FELLOW ABSENCE FORM FELLOW: DATES OF REQUESTED ABSENCE: PURPOSE OF ABSENCE: (e.g., vacation, conference) ROTATION: If the affected rotation has night or weekend call, list the name and obtain the signature indicating agreement of the fellow who will be covering call during this period: Covering Fellow’s Name: Covering Fellow’s Signature: List the name and obtain the signatures of each Clinical Neurophysiology Faculty member who is responsible for training during this period: Faculty Name: Faculty Name: Faculty Signature: Faculty Signature: Faculty Name: Faculty Name: Faculty Signature: Faculty Signature: Please sign, date and deliver to Dr. Jaffar Khan when completed: Fellow’s Signature: Date: Reviewed and Approved: Clinical Neurophysiology Training Program Director’s Signature: Date: Page 28 of 26 REVISED AND APPROVED 06/2005
  29. 29. NEUROLOGY FELLOWSHIP HANDBOOK Emory University ______________________________________________________________________________________________ ACGME PROGRAM REQUIREMENTS FOR RESIDENCY EDUCATION IN NEUROLOGY AND CLINICAL NEUROPHYSIOLOGY All program requirements for the clinical neurophysiology fellowship program can be found on the ACGME website at www.acgme.org. Page 29 of 26 REVISED AND APPROVED 06/2005

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