HERMANN HOSPITAL

                            THE ...
2. To learn to distinguish abnormal from normal patterns of development in the
      examination of infants and children.
3. Practice-Based Learning and Improvement

        Residents are expected to be able to use scientific evidence and metho...
sensitivity to diversity and a responsible attitude toward their patients, their
   profession and society, and
      o   ...
o   Seizure disorders
          o   Pediatric epilepsy surgery
          o   Degenerative neurologic diseases
          o ...
core areas will be assessed. Semi-annual evaluation will also be performed, using New
Innovations, a 360◦ evaluation will ...
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  1. 1. PEDIATRIC NEUROLOGY ROTATION-CHILDRENS’ MEMORIAL HERMANN HOSPITAL THE METHODIST HOSPITAL NEUROLOGY RESIDENCY PROGRAM Faculty: Ian Butler, M.D. Pedro Mancias, M.D. John Slopis, MD Richard Frye, MD, Ph.D. Charles Dreyer, MD Institution: Childrens’ Memorial Hermann Hospital MD Anderson Cancer Hospital Shriners’ Childrens Hospital Length: 3 months Level of Training: PGY3 Type of Experience: 50% inpatient;50% outpatient GOALS 1. To provide a concentrated exposure to neurologic disorders commonly encountered in pediatrics, including nervous system disorders requiring surgical or psychiatric evaluation and management. 2. To increase the resident's skills at diagnosing infantile and pediatric seizure disorders and selecting appropriate anticonvulsant therapy. 3. To provide an opportunity for residents to pursue directed readings that focus on pathophysiology of pediatric neurologic disease processes. OBJECTIVES 1. To develop a logical approach in the evaluation and decision-making for children with neurologic problems. Following the rotation, residents should be able to obtain a detailed history, as it pertains to the pediatric population, and conduct comprehensive general and neurological examinations. Patient data should be documented in an organized fashion.
  2. 2. 2. To learn to distinguish abnormal from normal patterns of development in the examination of infants and children. 3. To learn the indications for and interpretations of cranial CT and MRI scans of pediatric neurologic disorders. 4. To learn to manage pediatric patients with neurological problems, especially those with intractable epilepsy, neurogenetic disorders, neuromuscular disorders and neurobehavioral disorders. This will include exposure to basic EEG interpretation (routine and long-term monitoring). 5. To learn to evaluate mental retardation developmental disabilities, headache movement disorders, and neurovascular disease. Pediatric Neurology Resident Responsibilities: 1. Patient Care Residents are expected to provide patient care that is compassionate, appropriate and effective for the promotion of health, prevention of illness, treatment of disease and at the end of life. To that end, residents will: o Gather accurate, essential information from all sources, including medical interviews, physical examinations, medical records and diagnostic/therapeutic procedures. o Make informed recommendations about preventative, diagnostic and therapeutic options and interventions that are based on clinical judgment, scientific evidence, and patient preference. o Develop, negotiate and implement effective patient management plans and integration of patient care. 2. Medical Knowledge Residents are expected to demonstrate knowledge of established and evolving biomedical, clinical and social sciences, and the application of their knowledge to patient care. Residents will apply an open minded, analytical approach to acquiring new knowledge, access and critically evaluate current medical information and scientific evidence and apply this knowledge to clinical problem- solving, clinical decision making and critical thinking.
  3. 3. 3. Practice-Based Learning and Improvement Residents are expected to be able to use scientific evidence and methods to investigate, evaluate and improve patient care practices, and o Identify areas for improvement and implement strategies to enhance knowledge, skills, attitudes and processes of care. o Analyze and evaluate practice experiences and implement strategies to continually improve the quality of patient practice. o Develop and maintain a willingness to learn from errors and use errors to improve the system of processes of care. o Use information technology or other methodologies to access and manage information, support patient care decisions and enhance both patient and physician education. 4. Interpersonal and Communication Skills Residents are expected to demonstrate interpersonal and communication skills that enable them to establish and maintain professional relationships with patients, families, and other members of health care teams, and o Provide effective and professional consultation to other physician and health care professionals and sustain therapeutic and ethically sound professional relationships with patients, their families and colleagues. o Use effective listening, nonverbal, questioning, and narrative skills to communicate with patients and families. o Interact with referring physicians in a respectful, appropriate manner. o Maintain comprehensive, timely, and legible medical records. o Complete evaluations of the attending, staff and rotation. o Learn to give guidance and instruction to families regarding the management of their children with neurological disease. 5. Professionalism Residents are expected to demonstrate behaviors that reflect a commitment to continuous professional development, ethical practice, an understanding and
  4. 4. sensitivity to diversity and a responsible attitude toward their patients, their profession and society, and o Demonstrate respect, compassion, integrity and altruism in relationships with patients, families and colleagues. o Demonstrate sensitivity and responsiveness to the gender, age, culture, religion, sexual preference, socioeconomic status, beliefs, behaviors and disabilities of patients and professional colleagues. o Adhere to principles of confidentiality, scientific/academic integrity, and informed consent. 6. Systems-Based Practice Residents are expected to demonstrate both an understanding of the contexts and systems in which health care provided, and the ability to apply this knowledge to improve and optimize health care, and o Understand, access and utilize the resources, providers and systems necessary to provide optimal care. o Understand the limitations and opportunities inherent in various practice types and delivery systems, and develop strategies to optimize care for the individual patient. o Apply evidence-based, cost-conscious strategies to prevention, diagnosis and disease management. o Collaborate with other members of the health care team to assist patients in dealing effectively with complex systems and to improve systematic processes of care. 7. Specific Topics Residents should become familiar with the following topics during their time on the rotation through experience, didactic sessions or reading: o Examination of the newborn, child and adolescent o Intracranial hemorrhage o Brain tumors o Pediatric movement disorders o Coma and stupor o CNS infections o Febrile seizures
  5. 5. o Seizure disorders o Pediatric epilepsy surgery o Degenerative neurologic diseases o Demyelinating disorders o Neuromuscular diseases o Neurocutaneous diseases (Tuberous sclerosis, Neurofibromatosis) o Headaches o School problems, learning disabilities and Attention Deficit disorders o Cerebral palsy and management of spasticity o Critically ill child 8. Residents have access to the Pediatric Library located on the 7th floor of the Neurology Department of University of Texas Medical School and computers with internet access. 9. Online Learning centers include the: • Child Neurology Society homepage – • Gene Tests homepage – • Online Mendelian Inheritance of Man (OMIM) – ( • Neuromuscular Disease Center – Methods of Evaluation Evaluation of resident performance (see PR VI.A. and III.A.2) The supervising teaching faculty will discuss expectations with the each resident at the initiation of the rotation. At each clinical encounter the attending will discuss performance with each resident, providing verbal feedback regarding strengths areas for improvement and suggesting educational goals for subsequent outpatient experiences. Supervising faculty are encouraged to notify the program director at any time during the rotation with either commendation or concern regarding the resident performance. Formal evaluation will include an individual monthly evaluation performed by the attending faculty. Faculty members directly supervising residents will complete a computer based evaluation form using the residency management software system (New Innovations) monthly. This evaluation will be reviewed personally with each resident by the supervising faculty member at the end of a one month rotation. Competency in six
  6. 6. core areas will be assessed. Semi-annual evaluation will also be performed, using New Innovations, a 360◦ evaluation will be implemented. Assessors will include peer and other residents, medical students, selected nursing and ancillary personnel, and administrative personnel. Quarterly evaluation by the program director will also be performed in which the resident will meet with the residency program director to review a summary report of the resident’s assessment and performance in the core competencies. Individual counseling regarding strengths and potential weakness will be provided. Future career development will be discussed and each resident will have an opportunity to discuss their concerns. The summary report will be signed by both the resident and the program director and will become part of the permanent record. Evaluation of faculty/educational program Neurology faculty involved in teaching the residents will be evaluated anonymously by the residents using the electronic residency management software system. Rotation evaluations (monthly) will include specific items about the rotation, clinical experience, and the faculty’s teaching activities. The evaluations are confidential and are reviewed by the program director and departmental chair. Feedback on faculty performance is used to improve teaching. Residents will evaluate the program on a monthly basis using the electronic residency management software system (New Innovations). Residents will have the opportunity to evaluate and comment on services formally on the Methodist GME-administered Annual Survey of Residents’ Educational and Clinical Experiences, which is also administered via New Innovations. The residents will have informally opportunities to provide feedback about the program to faculty, Program Director, and the chief Resident. CONFERENCES Trainees will actively participate in weekly pediatric neurology grand rounds Suggested readings and references: Fenichel’s Textbook of Pediatric Neurology Menkes Textbook of Child Neurology Textbook of Pediatric Neurology, G. Golden Pediatric Epilepsy: Diagnosis and Therapy, by John, Pellock, Edwin, Dodson, Blaise, and Bourgeois Swaiman, KF & Wright FS (ed): The Practice of Pediatric Neurology. 3rd edition, Vol. l & 2, Mosby, St. Louis, 1989. Swaiman, KF: Pediatric Neurology: Principles and Practice, Vol. l & 2, CV Mosby, St. Louis, 1993.