NEUROLOGY RESIDENT HANDBOOK Emory University
_____________________________________________________________________________________
EMORY UNIVERSITY DEPARTMENT OF NEUROLOGY
RESIDENCY PROGRAM HANDBOOK
TABLE OF CONTENTS
PAGE 2 Core Values
PAGE 3 Resident Job Responsibilities
PAGE 5 Rotation Objectives
PAGE 53 Evaluations
PAGE 63 Teaching Responsibilities
PAGE 65 Neurology Clinical Clerkship
PAGE 65 Visiting Professors
PAGE 66 Discretionary Funds and Support
PAGE 67 Transcription Tips
PAGE 68 Morning Report Presentations
PAGE 69 Department & Medical School Policies
PAGE 71 Faculty/Staff Assistance & Wellness Program (FSAP)
PAGE 73 Patient Telephone Call Guidelines
PAGE 74 Lecture & Conference Schedules
PAGE 76 ACGME Program Requirements for Neurology
EMORY UNIVERSITY DEPARTMENT OF NEUROLOGY
Core Values of the Emory Neurology Residency Training Program
v 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.
v 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.
v 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.
v We treat people with respect and believe that individuals who are given respect and responsibility respond by giving their best.
v We strive for excellence and require honesty and integrity in all we do.
v 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.
v We recognize our limits as well as our capabilities and act accordingly at all times.
RESIDENT JOB RESPONSIBILITIES
POSITION DESCRIPTION FOR RESIDENT PHYSICIANS
Department of Neurology
Emory University School of Medicine
Atlanta, Georgia
Introduction
The RRC-approved residency-training program at Emory University School of Medicine is under the direction of Dr. Allan Levey, Chairman, Dr. Jonathan Glass, Program Director, and Dr. Jane Gilmore, Associate Program Director. The residency-training program currently utilizes the following hospitals:
Emory University Hospital and Emory Clinic
Grady Memorial Hospital
Veterans Affairs Medical Center
Egleston Children’s Hospital
Wesley Woods Health Center
General Principles of the Training Program for Residents in Neurology at Emory University
1. The house staff physician meets the qualifications for resident 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 and 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:
q participation in safe, effective, and compassionate patient care;
q 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;
q 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;
q participation in institutional committees and councils to which the house staff physician is appointed or invited; and
q 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.
q each resident will maintain a one half day per week outpatient continuity clinic at Grady Hospital.
Position Description for Resident Physicians Specific to PGY Level
1. PGY-2
A. The PGY-2 neurology resident rotates through the inpatient neurology services at Emory and Grady Hospitals, including rotations in Neuro-ICU at Emory Hospital. They will typically spend one month on an elective service, such as rotating through different neurology subspeciality clinics, or on the Wesley Woods Neurology Consultation service.
B. Fundamental duties include the performance and documentation of the history and physical examination; writing of orders and otherwise carrying out the care plan for their patients as directed by the attending and senior resident. They also perform minimally invasive techniques such as lumbar puncture.
C. Direct supervision of the PGY-2 neurology resident occurs on a regular basis. Each patient seen by the resident is also personally evaluated by the attending and/or the senior resident. The exception is at night at Emory Hospital where any patient seen is discussed with the attending by phone. Those admitted to the hospital will then be seen by the attending the following day.
2. PGY-3
A. The PGY-3 neurology resident rotates through subspeciality rotations and electives such as Neuromuscular, Epilepsy, Child Neurology, Neuro-ophthalmology, and Neuropathology. They will also begin to rotate on the Inpatient and Consult services at Emory and Grady Hospitals where they will have a more supervisory and teaching role.
B. Fundamental duties are the same as the PGY-2 neurology resident, except they will be expected to be able to formulate a diagnostic and therapeutic care plan for the patients they see.
C. Direct supervision of the PGY-3 neurology resident continues as the attending will see and evaluate the vast majority of the patients seen by the resident.
3. PGY-4
A. The PGY-4 neurology resident rotates through Inpatient and Consult services at Emory and Grady Hospitals, as well as the Veterans Affairs Medical Center. They will complete any remaining required subspeciality rotations such as Child Neurology. The remaining months will be spent in elective rotations in subspecialty services in the Department of Neurology.
B. Fundamental duties are the same as those of PGY-2 and PGY-3 neurology residents
C. Direct supervision of the PGY-4 neurology resident by an attending neurologist
continues, although it is expected that it should be more to confirm the impression and care plan for patients evaluated by the resident, rather than have it dictated by the attending as would be the case for more junior residents.
D. Two or three of the PGY-4 neurology residents will be selected as Chief Residents. They have the additional duties of developing the resident rotation schedules, setting up Grand Rounds and other administrative, as well as teaching activities.
Approved, Neurology Education Committee, September, 2005
ROTATION OBJECTIVES
Emory University Hospital Neurology Inpatient Service
Emory University School of Medicine
I. Introduction
This document provides guidelines for neurology resident training while on the inpatient service at Emory University Hospital. The patient population consists of patients with both emergent and non-emergent problems. Patients with primary neurologic problems are evaluated and managed in the Emergency Department, the inpatient neurology service, and in the intensive care units. A broad range of problems are cared for in this setting including, but not limited to coma, encephalopathy, dementia, seizures, and weakness. The resident must learn to assign specific diagnoses and management strategies, represented by such entities as stroke, epilepsy, neuromuscular diseases, movement disorders, and degenerative diseases.
II. Description
During the first year of neurology training, 3 first-year neurology and 1 senior neurology resident are assigned to the inpatient service each month. The senior resident (second or third year of training) functions as the team leader for 3 junior residents and 1 or 2 medical students.
In addition to the 3 neurology residents assigned to the in-patient service, an additional resident may be assigned to the Neurology/Neurosurgery ICU for one month rotations. At least one month of ICU experience is required of each resident during the three years of training.
III. Rotation Directors and Faculty
Jane Gilmore, M.D., Associate Program Director, coordinates the resident’s experience on the inpatient service.
Department of Neurology faculty are assigned to attending roles on the inpatient service on a monthly basis. These individuals have been selected for their excellence in both patient care and teaching. There is also a dedicated neurology/neurosurgery ICU attending who has completed neurology training, a stroke fellowship, and a neurology/neurosurgery intensive care fellowship.
IV. Rotation Environment
Emory University Hospital provides care to the surrounding community and referral care to the metro-Atlanta area as well as the state of Georgia and surrounding region. There is an active Emergency Department with full-time emergency physician faculty coverage, a 14-bed neurology/neurosurgery ICU, and 24 beds on the dedicated neurology/neurosurgery floor. A full-spectrum of highly sophisticated support facilities are available as well as physician consultative services.
V. Educational Objectives/Expectations
· Obtain an orderly and detailed history from the patient, reliably eliciting appropriate information
· Conduct a thorough general and neurological examination, reliably detecting abnormal findings
· Correctly integrate the findings from the history and physical examination to localize the neurological problem and generate etiologic hypotheses
· Formulate a diagnostic plan incorporating appropriate laboratory, imaging, and physiologic tools to further refine the diagnostic impression
· Define a logical and comprehensive management plan for the patient’s problem
· Critically analyze and interpret biomedical data
· Participate in the ongoing management of the patient, including discharge planning
· Participate in the evaluation and decision-making for patients requiring surgical management
· Participate in the evaluation and decision-making for patients with neurologic presentations of psychiatric disease
· Understand the importance of personal, social, and cultural factors in disease processes and their clinical expression
· Participate in the evaluation and management of the patient in the Emergency Department or ICU
· Learn the indications for and basic principles of rehabilitation for neurologic disorders
· Appreciate the parameters for appropriate and cost-effective patient evaluation
· Understand the management of end-of-life palliative care, pain relief, and counseling of patients and families, including issues related to brain death and the vegetative state
· Communicate and interact effectively and appropriately with patients, medical staff, and colleagues, including acting as a role model for the health care team
VI. Evaluation
The residents will be evaluated by the attending physicians as well as by each other. The attending physician will give the resident formal feedback at such times as the faculty member thinks is appropriate, but certainly at the end of the rotation. A written evaluation will be filed with the residency program director’s office.
ROTATION OBJECTIVES
Emory University Hospital Neurology Consultation Service
Emory University School of Medicine
I. Introduction
This document provides guidelines for neurology resident training while on the neurology consultation service at Emory University Hospital. The patient population consists of patients with comorbid or secondary neurologic problems occurring in the setting of primary medical or surgical illnesses. Patients are evaluated and managed in the Emergency Department; intensive care units; and on various medical, surgical, psychiatry, and rehabilitation services. A broad range of problems are cared for in this setting, including but not limited to coma, encephalopathy, dementia, stroke, seizures, movement disorders, and weakness. The resident must learn to assign specific diagnoses and management strategies, represented by such entities as stroke, epilepsy, neuromuscular diseases, movement disorders, and degenerative diseases.
II. Description
During the second and/or third year of neurology training, the resident is assigned to the neurology consultation service where he/she functions as the team leader for medical and (occasionally) junior neurology residents and 1 or 2 medical students.
III. Rotation Directors and Faculty
Jane Gilmore, M.D., Associate Program Director, coordinates the resident’s experience on the consultation service.
Department of Neurology faculty are assigned to attending roles on the neurology consultation service for two-week blocks. These individuals have been selected for their excellence in both patient care and teaching.
IV. Rotation Environment
Emory University Hospital provides care to the surrounding community and referral care to the metro-Atlanta area as well as the state of Georgia and surrounding region. There is an active Emergency Department with full-time emergency physician faculty coverage and a full range of specialty and subspecialty services and ICUs. A full-spectrum of highly sophisticated support facilities are available as well as physician consultative services.
V. Educational Objectives and Expectations
· Obtain an orderly and detailed history from the patient, reliably eliciting appropriate information
· Conduct a thorough general and neurological examination, reliably detecting abnormal findings
· Correctly integrate the findings from the history and physical examination to localize the neurological problem and generate etiologic hypotheses
· Formulate a diagnostic plan incorporating appropriate laboratory, imaging, and physiologic tools to further refine the diagnostic impression
· Define a logical and comprehensive management plan for the patient’s problem
· Critically analyze and interpret biomedical data
· Communicate clearly with the patient’s primary service and other consulting services,
and participate in the ongoing management of the patient, as appropriate to the
situation
· Participate in the evaluation and decision-making for patients requiring surgical management
· Participate in the evaluation and decision-making for patients with neurologic presentations of psychiatric disease
· Understand the importance of personal, social, and cultural factors in disease processes and their clinical expression
· Participate in the evaluation and management of the patient in the Emergency Department or ICU
· Learn the indications for and basic principles of rehabilitation for neurologic disorders
· Appreciate the parameters for appropriate and cost-effective patient evaluation
· Understand the management of end-of-life palliative care, pain relief, and counseling of patients and families, including issues related to brain death and the vegetative state
· Communicate clearly and interact effectively with patients, medical staff, and
colleagues
VI. Evaluation
The residents will be evaluated by the attending physicians as well as by each other. The attending physician will give the resident formal feedback at such times as the faculty member thinks is appropriate, but certainly at the end of the rotation. A written evaluation will be filed with the residency program director’s office.
ROTATION OBJECTIVES
Grady Memorial Hospital Neurology Inpatient Service
Emory University School of Medicine
I. Introduction
This document provides guidelines for neurology resident training while on the inpatient service at Grady Memorial Hospital. The patient population is made up of both emergent and elective admissions. A broad array of neurologic problems are evaluated and cared for at Grady.