OutpatientChild NeurologyRotation
at
Children’s Hospital
Goal:Child neurology residents must progressively learn the principles of providing comprehensive, scientifically based and effective outpatient care for pediatric patients with neurological disease. This goal can be attained utilizing six areas of specific competencies: patient care, medical knowledge, interpersonal communication, practice based learning and improvement, professionalism and systems based practice.
Overview of Objectives: The objectives of your learning will change as you develop in your career. You will be expected to master different skills at different points in your training. These have been identified in the grid provided in this document.
Site Responsibilities: You will spend all of your time in the outpatient clinic setting located at Children’s Hospital. This rotation will closely reproduce real life neurological practice.
Faculty Clinics:
Dr Conravey:
Monday: AM Clinic, PM Clinic
Tuesday: Metairie Clinic (1st and 3rd)
Wednesday: AM Fellows Teaching Clinic
Thursday: AM Clinic (1st, 2nd, 3rd), EMG (4th)
Friday: PM Clinic
Dr Deputy:
Monday: PM Clinic
Tuesday: AM Clinic. PM Movement Disorders (usually 1st and 3rd)
Wednesday: AM Fellows Teaching Clinic
Thursday: AM Clinic
Friday: AM Clinic
Dr McGuire:
Monday: EEG interpretation/ or Surgery
Tuesday: AM clinic, PM clinic
Wednesday: AM clinic
Thursday: AM clinic, PM clinic
Friday: CSHS New Orleans (2nd AM), Padua House (AM, variable)/ or Surgery
Dr Tilton:
Monday: AM clinic (1st, 3rd,4th), MDA Clinic (2nd)
Tuesday: AM Spasticity Clinic (1st,2nd,4th), Baclofen Pump Clinic (3rd),
(some PM’s for add ons or emergency patients)
Wednesday: AM clinic
Thursday: AM MDA Clinic (4th AM), PM Botox Clinic (Every Thursday PM)
Intrathecal Baclofen Trials Also Scheduled
Friday: Neuromuscular Clinic (4th AM)
Dr Weimer:
Monday: AM clinic (1st,3rd,4th), MDA Clinic (2nd, AM), PM clinic (all)
Tuesday: AM clinic, PM clinic
Wednesday: AM Fellows Teaching Clinic
Thursday: AM EMG (1st, 2nd) ,CSHS ThibodauxClinic (3rd)
MDA Clinic (4thAM)
Friday: AM Clinic (2nd), Neuromuscular Clinic (4thAM)
AM (1st, 3rd) EMG
Dr Wong:
Monday: CSHS Thibodaux (1st), MDA Clinic (2nd AM), clinic (3rd AM), CSHS
Lafayette (4th)
Tuesday: AM clinic, PM clinic
Wednesday: High Risk Developmental Clinic (1st, 2nd AM)
Spasticity Clinic (3rd or 4th, AM)
Thursday: AM clinic (1st, 2nd, 3rd), MDA Clinic (4th, AM)
PM Botox Clinic
Friday: AM Botox Clinic (1st, 2nd, 3rd), Neuromuscular Clinic (4th, AM)
ROTATION EXPERIENCE: Outpatient Clinic Rotations
PATIENT CARE
Outpatient Neurology Service (CN 2)Objectives / Teaching Methods / Assessment Strategy
Gather essential and accurate information on patients with subacute and chronic neurological symptoms. / Direct Patient Care
Performance Feedback
Clinical case conference / Global ratings
Focused Record Review
Gather essential and accurate information about patients with common neurological problems, including headache, developmental delay, and seizures as well as chronic neurological conditions and neurodegenerative disorders. / Direct Patient Care
Performance Feedback
Clinical Case Conference / Global ratings
Focused Record Review
Perform a extensive neurological examination and to be able to summarize their findings and localize the lesion in the central or peripheral nervous system / Clinical Teaching
Clinical Experience
Performance Feedback
Clinical Case Conference / Global ratings
Formulate a differential diagnosis and management plan based upon their neurological assessment / Clinical Teaching
Direct Patient Care
Clinical Case Conference / Global ratings
Focused record review
Identify and describe abnormalities seen in common neurological disorders on radiographic testing / Clinical Teaching
Performance Feedback
Radiology Conference / Global rating of live performance
PATIENT CARE
Outpatient Neurology Service (CN 3)Objectives / Teaching Methods / Assessment Strategy
To become proficient in managing tertiary neurology patients with subacute neurological symptoms and conditions / Direct Patient Care
Performance Feedback
Clinical case conference / Global ratings
Focused record review
To become proficient in managing patients with chronic neurological conditions/neurodegenerative disorders and common neurological problems, including headache, developmental delay seizures, movement disorders and neuromuscular diseases. / Direct Patient Care
Performance Feedback
Clinical case conference / Global ratings
Focused record review
Make informed decisions about diagnostic and therapeutic interventions based on patient information and preferences, up-to-date scientific evidence and clinical judgment. / Direct Patient Care
Performance Feedback
Clinical case conference / Global ratings
Focused record review
Develop supervisory skills, fair distribution of workloads and supervision of junior residents including unscheduled patients, and dealing with clinic emergencies / Direct Patient Care
Performance Feedback
Clinical case conference / Global ratings
360 degree evaluation
Screen patients for acute neurological disorder that may need emergent intervention. / Direct Patient Care
Performance Feedback / Global ratings
Perform comprehensive assessment consultations. / Direct Patient care
Performance Feedback / Global ratings
Performance feedback
MEDICAL KNOWLEDGE
Outpatient Neurology Service (CN 2)Objectives / Teaching Methods / Assessment Strategy
Compare and contrast the medical and surgical approaches to different neurological disease and explain the conditions under which each would be most efficacious. / Review of evidence based guidelines and practice parameters proposed by the AAN and CNS
Clinical teaching
Departmental Conferences / Global ratings
In-training examination
Demonstrate the approach to assessing general neurological symptoms and distinguish between different etiologies such as metabolic, genetic, toxic, infections, or vascular. / Reading list
Clinical rounds
Departmental conferences / Global ratings
In-training examination
Focused record review
Describe the underlying pathophysiology, diagnostic criteria and common treatment protocols for different neurological disorders. / Review of evidence based guidelines and practice parameters proposed by the AAN and CNS
Didactic lectures / Global ratings
In-training examination
Understand the uses and risks of anticonvulsant drugs in the treatment of acute and chronic epilepsy. / Review of evidence based guidelines and practice parameters proposed by the AAN and CNS
Clinical teaching
Departmental Conferences / Global ratings
In-training examination
Demonstrate and analytical thinking approach to a patient presenting with weakness in order to distinguish whether the lesion can be attributable to the central nervous system (brain or spinal cord) or peripheral nervous system (nerve root, peripheral nerve, neuromuscular junction or muscle) based upon assessment of upper or lower motor neuron signs. / Review of neuroanatomy
Clinical teaching / Global ratings
In-training examination
Demonstrate knowledge of relevant neuroanatomy and underlying pathology found in multiple sclerosis, cerebral palsy, congenital brain malformations, movement disorders and cerebrovascular disease. / Review of neuroanatomy
Departmental conferences
Pathology lectures and brain cutting conference / Global ratings
In-training examination
MEDICAL KNOWLEDGE
Inpatient Neurology Service (CN 3)Objectives / Teaching Methods / Assessment Strategy
Describe the underlying pathophysiology, presenting signs and symptoms and common treatment protocols for subacute neurological conditions. / Review of evidence based guidelines and practice parameters proposed by the AAN and CNS
Clinical teaching
Departmental Conferences / Global ratings
NEX exam
Demonstrate an investigatory and analytic thinking approach to a patient with new onset seizure, developmental delay, neurodegenerative disorders and cerebral palsy. / Review of evidence based guidelines and practice parameters proposed by the AAN and CNS
Clinical teaching
Departmental Conferences / Global ratings
In-training examination
Critically evaluate and judiciously apply the latest knowledge to the care of patients. / Review of evidence based guidelines and practice parameters proposed by the AAN and CNS
Clinical teaching
Departmental Conferences / Global ratings
In-training examination
Develop an approach to investigating and verifying new knowledge needed to care for patients. / Review of evidence based guidelines and practice parameters proposed by the AANand CNS
Clinical teaching
Departmental Conferences / Global ratings
In-training examination
INTERPERSONAL AND COMMUNICATION
Outpatient Neurology Service (CN 2)Objectives / Teaching Methods / Assessment Strategy
Demonstrate the ability to obtain, interpret and evaluate consultations from other medical specialties and to provide consultants with a diagnostic and management plan. / Presentation to staff
Modeling / Global ratings
Provide patients and families explanations of neurological disorders and treatment that is geared to their educational level, as well as respecting the patient’s cultural, ethnic, religious and economic backgrounds. / Direct patient care
Modeling / Global rating
Patient surveys
Work collaboratively with the multidisciplinary team involved in the patient care of neurological patients. / Referral letters
Modeling / Global ratings
360 assessments
Demonstrate effective communication with other physician or healthcare providers with regards to patient’s current or change in neurologic status, anticipated problem, therapeutic regimen and diagnostic tests to be reviewed. / Return letters to other physicians
Sign-out rounds / Global ratings
Outpatient Neurology Service (CN 3)
Objectives / Teaching Methods / Assessment Strategy
Clearly describe a diagnostic and/or a therapeutic plan to a patient and family. / Case Discussion
Direct patient care / Global ratings
360 degree evaluations
Teach junior residents and medical students effectively. / Case Discussion
Direct patient care
Modeling / Global ratings
360 degree evaluations
Provide distressing news to patients and families clearly and compassionately. / Direct patient care
Modeling / Global ratings
Develop effective strategies for interacting with “stressed” or angry patients and or families. / Direct patient care
Modeling / Global ratings
Listen and evaluate the contributions of other members of the healthcare team. / Clinical Rounds
Direct patient care
Modeling / Global ratings
360 degree evaluations
PRACTICE BASED LEARNING AND IMPROVEMENT
Outpatient Neurology Service (CN 2)Objectives / Teaching Methods / Assessment Strategy
Research clinical questions regarding their patient’s health problems using information technology to access on-line medical information to support their own education and to improve patient care and education. / Electronic medical record
Medline/OVID searches- patient centered
Case presentations / Self assessment
Global ratings
Evaluate the clinical literature applying knowledge of epidemiology, biostatistics, and research study design. / Teaching conferences including Grand Rounds
Journal Clubs / Global ratings of Journal club performance
Facilitate the learning of medical students. / Role Modeling
Oral presentations
Patient Centered instruction / Peer Assessments
Outpatient Neurology Service (CN 3)
Objectives / Teaching Methods / Assessment Strategy
Use appropriate computer databases and online educational materials to assist in “real time” medical decision making. / Electronic medical record
Medline/OVID searches- patient centered
Case presentations / Self assessment
Global ratings
Apply knowledge of study designs and statistical methods to the appraisal of clinical studies and other information on diagnostic and therapeutic effectiveness. / Teaching conferences including Grand Rounds
Journal Clubs / Global ratings of Journal club performance
Evaluations of Grand Rounds presentation
Facilitate the learning of junior neurology residents, medical interns, anesthesia interns and neurosurgery interns. / Role Modeling
Oral presentations
Patient Centered instruction / Peer assessment
360 degree evaluations
Demonstrate and teach medical students to access medical information on their patient for record review as well as online information/medical databases to assist in their evaluations of patients. / Electronic medical record
Medline/OVID searches- patient centered
Case presentations / Global ratings
PROFESSIONALISM
Outpatient Neurology Service (CN 2)Objectives / Teaching Methods / Assessment Strategy
Interact responsibly with patients, families and co-workers taking into consideration age, disability, culture and gender issues. / Direct patient care
Modeling / Global ratings
Demonstrate appropriate use of respect and confidentiality to all involved parties. / Direct patient care
Modeling / Global ratings
Outpatient Neurology Service (CN 3)
Objectives / Teaching Methods / Assessment Strategy
Interact responsibly with patients, families and co-workers taking into consideration age, disability, culture and gender issues. / Direct patient care
Modeling / Global ratings
Demonstrate appropriate use of respect and confidentiality as well as understanding the scope and limits of patient confidentiality. / Direct patient care
Modeling / Global ratings
Discuss the differences of withdrawal of care, termination of care, and non-initiation of care and assist patients and their families in choosing these options in the appropriate clinical setting. / Direct patient care
Modeling
Review of Fast Facts learning modules / Global rating
Self assessment
Understand the scope and limits of living wills and DNR status. / Direct patient care
Ethics conferences / Global ratings
Evaluate a patient’s capacity to make informed decisions and factors that would limit patient autonomy. / Direct patient care
Ethics conference / Global ratings
SYSTEM BASED PRACTICE
Outpatient Neurology Service (CN 2) System Based PracticeObjectives / Teaching Methods / Assessment Strategy
Identification of psychosocial factors and their impact of care of progressive and disabling neurodegenerative disorders such as multiple sclerosis, leukodystrophies, neuromuscular disorders, and neurogenetic disorders. / Direct patient care
Clinical Rounds / Global ratings
Efficiently refer patients to appropriate allied health and social services to assist in rehabilitation, long term management or home care assistance / Direct patient care
Modeling
Clinical rounds / Global ratings
Focused record review
Develop an understanding of cost-effective health care that does not impact quality of care / Role modeling
Clinical teaching
Focused record review / Self assessment
Focused record review
Outpatient Neurology Service (CN 3) System Based Practice
Objectives / Teaching Methods / Assessment Strategy
Advocate for patients when dealing with resource allocation issues and complex payer systems problems. / Direct patient care
Clinical teaching / Global ratings
Focused record review
Access quality allied health care and social services resources as they apply to patients with neurological disorders/disabilities. / Direct patient care
Clinical teaching / Global ratings
Focused record review
Practice high quality cost effective medical care across all practice venues. / Direct patient care
Clinical teaching / Global ratings
Focused record review
Understand how their patient care and professional practices affect other health professionals, organizations and society. / Direct patient care
Clinical teaching / Global ratings
Focused record review