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1 Child Neurology Residency Manual Latest update: 2/13/2020

Child Neurology Residency Manual...2020/02/13  · Neurology and the Division of Pediatric Neurology. The Pediatric Neurology Residency Program is fully ACGME accredited with a current

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    Child Neurology Residency Manual Latest update: 2/13/2020

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    Letter from the Chair .................................................................................................................4

    Letter from the Child Neurology Residency Director .............................................................5

    Program Overview ....................................................................................................................6

    Program Aims and Values Statement ......................................................................................6

    Overall Goals and Objectives ..................................................................................................8

    Program Leadership and Committee Structure ......................................................................28

    Resident Eligibility and Selection Process .............................................................................31

    Emergency Neurology Prerequisites for Incoming PGY3 Residents ......................................34

    Rotation and Call Schedules .................................................................................................37

    Work Hours, Leave, and Moonlighting ...................................................................................41

    Transitions of Care ................................................................................................................47

    Interprofessional Communication ..........................................................................................50

    Supervision Policy .................................................................................................................53

    Medical Records ....................................................................................................................58

    Teaching Responsibilities ......................................................................................................59

    Research and Other Scholarly Activities ................................................................................60

    Faculty Mentoring ..................................................................................................................62

    Evaluation and Promotion......................................................................................................63

    Academic Improvement .........................................................................................................69

    Misconduct ............................................................................................................................70

    Resident Well-Being ..............................................................................................................71

    Salary and Benefits ...............................................................................................................75

    Required Rotations .................................................................................................................80

    UW and VA General Neurology Service ................................................................................80

    UW and VA Stroke Service ....................................................................................................86

    Epilepsy rotation ....................................................................................................................91

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    Neuromuscular Medicine .......................................................................................................96

    Neurology Specialty Clinics Rotation ................................................................................... 101

    Neuropathology Rotation ..................................................................................................... 104

    Neurosurgery Rotation ........................................................................................................ 107

    Night Float Rotation ............................................................................................................. 110

    Inpatient Child Neurology (PGY4/5) ..................................................................................... 113

    Outpatient Child Neurology Clinics ...................................................................................... 120

    Pediatric Epilepsy Monitoring Unit (PEMU) rotation ............................................................. 126

    Metabolics/Genetics Rotation .............................................................................................. 130

    Child Psychiatry ................................................................................................................... 133

    Developmental Pediatrics .................................................................................................... 135

    Elective Rotations ................................................................................................................. 140

    Headache Clinic .................................................................................................................. 140

    Neuroradiology .................................................................................................................... 143

    Research ............................................................................................................................. 145

    Neuropsychology ................................................................................................................. 147

    Educational Conferences ..................................................................................................... 150

    Introduction.......................................................................................................................... 150

    Mandatory Educational Conferences (PGY3) ...................................................................... 153

    Mandatory Administrative Conferences (PGY 3) ................................................................. 155

    Pediatric Neurology Lecture Series (Required PGY3-5) ...................................................... 156

    PEMU/Pediatric Neurology Case Conference (Required PGY4 & 5) ................................... 157

    Journal Club (Required PGY4 & 5) ...................................................................................... 158

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    Letter from the Chair

    Thank you for your interest in the Neurology Residency Training Program at the University of Wisconsin. Our program seeks physicians in training who are dedicated to the care of people with diseases of the nervous system, have demonstrated interest in clinical and basic neuroscience, and show promise of future achievement. For more than 50 years, the Department has been dedicated to training highly motivated physicians in an atmosphere that emphasizes teamwork, close interaction with attending physicians and resident colleagues, independence, and

    development of sophisticated skills in history taking and neurological examination.

    The residency program is a major focus of effort for our faculty and is closely integrated with our clinical services and clinical research programs. The current structure and organization of the training program was developed in 2003 and was designed to address several important needs, which were identified by the faculty as challenges for neurology training in the contemporary environment. These challenges include the increasing trend toward therapeutic subspecialty care for neurological disorders, the importance of learning in the continuity of patient care across inpatient and outpatient settings, and the value of placing resident trainees in close working relationships with teaching faculty in their areas of major expertise. These are not easy challenges to address, especially with the emphasis on short admissions and increasing outpatient care for neurological disorders, as well as the constraint of the 80-hour workweek for resident trainees.

    The training program organization that emerged from our efforts to address these challenges has remained in place with minor refinements during the last few years, and includes five major combined inpatient-outpatient services in epilepsy, neuromuscular diseases, pediatric neurology, stroke, and general neurology. Residents on these services provide care for both inpatients and outpatients and work closely with faculty subspecialists in each of the areas. The epilepsy and neuromuscular services also include clinical neurophysiology experience in EEG and EMG as a part of patient care in those areas. The residents on the general neurology service also care for inpatients and outpatients through coverage of the emergency room during the day and a night float resident.

    With a rich program of noontime didactic and case conferences, weekly bedside teaching rounds, neuroimaging and subspecialty case conferences, and exposure to the breadth and depth of clinical and basic neuroscience at the University of Wisconsin, our residency training program has been an interactive and interdisciplinary experience for both our trainees and faculty. We appreciate your interest and if you visit, look forward to introducing you in more detail to the program and the Department.

    Kathleen Shannon, M.D., FAAN

    Professor and Chair

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    Letter from the Child Neurology Residency Director

    Welcome to the University of Wisconsin’s Department of Neurology and the Division of Pediatric Neurology. The Pediatric Neurology Residency Program is fully ACGME accredited with a current 3 year cycle. The entire training program is based at the University of Wisconsin Hospital and Clinics, the American Family Children’s Hospital, and the William S. Middleton VA Hospital. Attached to the Medical Center are state of the art facilities which include the Health Sciences Learning Center and

    the Ebling Library at the University of Wisconsin School of Medicine and Public Health. The Pediatric Neurology Division at the Department of Neurology works very closely with the Department of Pediatrics and provides neurological care for children in the Neurology outpatient clinics and at the American Family Children’s Hospital. This hospital is a very busy regional tertiary referral center which provides experience in a wide range of neurological conditions. Built in 2007 and expanded in 2014, the facilities are comfortable and modern. Inpatient units consistently run near capacity and additional intensive care units are currently being built. Pediatric neurology faculty participates in multidisciplinary clinics including Comprehensive Epilepsy, Neuro-oncology, Headache, Metabolic Genetics, Brain Care, and Neuromuscular. A very active ketogenic diet program and a recently updated pediatric epilepsy monitoring unit provide excellent opportunities to gain experience in the management of complex epilepsy patients.

    The pediatric neurology faculty is consistently rated highly for teaching, and neurology residency graduates have an exceptionally high rate of passing their board exams on their first try with very high scores.

    The University of Wisconsin, one of the top Universities in the country, offers competitive compensation and benefits, and the city of Madison is consistently ranked as one of the best places to live in the US, with natural beauty and limitless recreational opportunities. Interested candidates should apply through the National Resident Matching Program (NRMP). Your training with us will be a very enjoyable and rewarding experience,

    Please contact us at [email protected] for additional questions. Our program offers a categorical position (1779185C0) guaranteeing a full 5 year course of training. As such, the Department of Pediatrics provides the first two years of preliminary training in accordance with ABPN requirements. For questions regarding the preliminary pediatric training, please contact the Pediatric Residency Coordinator, Kari Bruckner.

    Adam Wallace, MD

    Program Director

    http://www.neurology.wisc.edu/http://www.neurology.wisc.edu/http://www.uwhealth.org/http://www.uwhealthkids.org/http://www.madison.va.gov/http://www.madison.va.gov/https://www.med.wisc.edu/our-campus/hslc/http://ebling.library.wisc.edu/http://www.med.wisc.edu/mailto:[email protected]:[email protected]

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    Program Overview

    Program Aims and Values Statement

    Child Neurology

    Program Aims

    The UW Child Neurology Residency Program aims to:

    1. Attract and Train residents from a diverse set of medical schools to become clinically

    adept child neurologists a. 100% fill rate for NRMP Match for reserved positions available b. Institutional RITE Exam Score > 50%tile for same year in training or documented

    yearly improvement of at least 10% c. Board Pass Rate > 90%

    2. Instill habits of professionalism and lifelong learning

    a. % Completing a research or QI project b. % Attending a professional conference c. % Requiring a corrective action plan

    3. Prepare residents for clinical or academic careers per their own preferences

    a. % Pursuing fellowship training b. Post-graduation survey

    i. Practice type ii. Preparedness

    c. % of residents practicing in Wisconsin after graduation

    4. Maintain a healthy and diverse intellectual culture a. ACGME survey questions:

    i. Residents can raise concerns without fear ii. Culture reinforces patient safety responsibility

    b. % of residents receiving formal patient safety training Values Statement

    Faculty and residents will strive to provide the highest quality of care to every patient. It is our unwavering view that the patient comes first, and must be offered with the compassion and professionalism that we would expect for ourselves and our families.

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    Our program emphasizes a team approach, with close interaction among attending physicians, residents, advanced practicing providers, and other health care professionals. We highly value our culture of safety, wherein anyone can feel free to ask questions, make suggestions, or raise concerns without fear of reprisal.

    Finally, we value intellectual curiosity and rigor. We eschew hasty conclusions in favor of the traditional form of neurological case formulation and reject reflexive decision-making in favor of critical reasoning and the application of sound science to patient care.

    Latest revision: 04/26/2018

    Adam Wallace

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    Overall Goals and Objectives Child Neurology

    The overall goal of our training program is to develop superb clinical child neurologists. It is the mission of our training program to ensure that our graduates have demonstrated competency in the six core areas as designated by the ACGME. 1. PATIENT CARE 1.1 Goals

    Residents must demonstrate the ability to provide family centered patient care that is developmentally and age appropriate, compassionate, and effective for treatment of neurological problems and the promotion of health.

    1.2 Objectives

    Child neurology residents will: 1. Provide scientifically based, comprehensive, and effective diagnosis and management for

    pediatric patients with neurologic disease. 2. Perform a complete history and physical examination, and generate a rational differential

    diagnosis, workup, and management plan. 3. Understand how to order and interpret appropriate diagnostic tests including imaging

    studies, neurophysiological, genetic and metabolic tests. 4. Make informed diagnostic and treatment decisions by analyzing and synthesizing

    information. 5. Demonstrate technical skills that include the ability to identify and describe abnormalities

    on neuroimaging studies, the ability to perform lumbar punctures and EMGs, and the ability to appropriately interpret the results of imaging, EMG, EEG, and LP in the context of patient care.

    6. Demonstrate competence in the comprehensive diagnosis and management of all forms of pediatric neurological disease.

    7. Effectively counsel patients and families. 8. Use consultants and referrals appropriately. 9. Understand the limits of their knowledge and expertise.

    1.3 Goals and Objectives by Year of Training PGY-3 (Adult Neurology) Goals

    1. Gather essential and accurate information necessary to provide comprehensive care to

    adult patients with neurological disorders. 2. Demonstrate effective and appropriate clinical problem solving skills using evidence-

    based medical knowledge and sound clinical judgment.

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    3. Recognize the ethical, personal and social implications of many neurological diagnoses as well as the issues surrounding predictive testing and interventions for individuals with severe disabilities.

    4. Provide care to patients of varying ages and develop skills necessary to provide longitudinal care throughout the lifespan.

    5. The resident will develop competence at inpatient and intensive care management for a variety of adult neurological conditions. In addition, the resident will respond to consultation requests from the UW-ER and the VA and develop skills at triaging patients to the general or one of subspecialty services.

    Objectives Residents will:

    1. Develop skills in obtaining accurate historical information from patients and caregivers, with particular emphasis on ascertaining the time of stroke onset. They will be able to clearly communicate to patients and families the risks, benefits, and alternatives to intravenous and intra-arterial thrombolysis. They will learn to discuss the mechanisms of stroke and hospital course with patients. They should also be able to counsel patients on risk factor modification and long-term outcomes.

    2. Learn to evaluate acute stroke patient independently, interpret neuroimaging studies including CT, CTA, MRI, MRA, and catheter angiography, meet management decisions regarding IV tPA, IA tPA and thrombectomy, learn the principles of post-thrombolysis care and become familiar with diagnosis and management of a variety of specific cerebrovascular conditions including intracerebral hemorrhage, arterial dissection, and venous sinus thrombosis.

    3. Become familiar with basic concepts of stroke rehabilitation, secondary stroke prevention and current research priorities in cerebrovascular diseases.

    4. Develop the skills necessary to evaluate, treat, and counsel patients and families with epileptic disorders, learn the principles of electroencephalography, and develop confidence in correctly interpreting EEG studies.

    5. Acquire training in diagnostic evaluation and management of patients with a wide spectrum of neuromuscular disease. This will include comprehensive training in electromyography, including advanced techniques. standard motor and sensory nerve conduction studies of upper and lower extremities and cranial nerves; - repetitive nerve stimulation techniques; - basic autonomic studies; - standard concentric needle EMG evaluations; - Single Fiber EMG techniques, - laryngeal EMG

    6. Achieve the following: - Learn the indications and clinical utility of muscle and nerve biopsies. - Learn how to select the muscle biopsy site to assure the highest diagnostic yield. - Understand the basic principles of muscle and nerve specimen processing (histology,

    histochemistry, immunostaining, electron microscopy, teased fiber analysis). - Be able to incorporate the biopsy results into the clinical decision-making process with

    regard to diagnosis and management of patients with neuromuscular disorders. - Have an opportunity to assist in muscle and nerve biopsies (in the operating room, or in

    the neurology outpatient clinic for needle muscle biopsies).

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    - Develop understanding for the clinical utility and limitations of different electrodiagnostic tests in evaluation of patients with various neurological disorders.

    7. Acquire a basic working knowledge of the surgical management of diseases of the nervous system, which is essential to the neurologist-in-training. The neurologists must be aware of indications for, limitations of, and possible complications of surgical treatment if they are to make appropriate referrals and counsel their patients wisely.

    8. Be provided with learning opportunities to manage patients with neurological disease who require intensive care.

    9. Develop skill in discussing end-of-life issues with patients with neurological diseases. 10. Become proficient in the management of patients with disorders of intracranial pressure. 11. Learn to identify and classify abnormal movements (tremor, chorea, myoclonus, etc.),

    demonstrate working differential diagnosis of all movement disorders and understand distinguishing clinical features.

    12. Learn appropriate work-up for major neurologic symptoms/syndromes/diseases. 13. Implement a reasonable treatment plan. 14. Realize long-term complications of treatment modalities. 15. Become familiar with indications for deep brain stimulation (DBS). 16. Demonstrate ability to interrogate DBS patient’s IPG, turn it on/off, and check the battery. 17. Demonstrate knowledge of safety concerns for patients with deep brain stimulators. 18. Learn to identify and classify CNS demyelinating and inflammatory diseases, develop

    working differential diagnosis of the patient with a demyelinating disease and understand distinguishing clinical features.

    19. Become familiar with indications for immune-modulating therapies. 20. Gain basic skills in neuropathology; learn how to relate pathology results to the clinical

    diagnosis and proper management of patients with all manner of neurologic disease. 21. Become adept at triaging consultations and admissions, focusing care on the most

    acutely ill patients. 22. Become proficient at managing acute clinical changes in patients under the care of the

    neurology services, especially the unique challenges of sundowning patients, patients who suffer an acute stroke or acute seizure.

    23. Develop skills of arranging follow up care for patients seen in the ER that require further neurological evaluation or treatment.

    PGY-4 (Child Neurology) Goals

    1. Gather essential and accurate information necessary to provide comprehensive care to pediatric patients with neurological disorders.

    2. Demonstrate effective and appropriate clinical problem solving skills using evidence-based medical knowledge and sound clinical judgment.

    3. Recognize the ethical, personal and social implications of many neurological diagnoses as well as the issues surrounding predictive testing and interventions for individuals with severe disabilities and their families.

    4. Provide care to pediatric patients of varying ages and develop skills necessary to provide longitudinal care throughout the lifespan.

    5. Develop competence at inpatient and intensive care management for a variety of pediatric neurological conditions. In addition, the resident will respond to consultation requests from the UW-ER and develop skills at triaging patients to the general or one of subspecialty services.

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    6. The residents will increase their knowledge of the pathophysiology of common neurologic conditions in hospitalized children and will understand how to diagnose and treat these conditions. Additionally, they will be comfortable providing family-centered care in an interdisciplinary setting.

    Objectives Residents will:

    1. Develop basic competence in the medical care of children with neurologic disease, and

    will begin to work on finer points such as improving patient safety, cost-effectiveness of care, and transitioning the patient to outpatient care.

    2. Supervise the junior pediatric residents and medical students and both create and direct the care plan for the patient (under the guidance of the supervisory faculty member).

    3. Learn how to relate radiology results to the clinical diagnosis and proper management of patients with all manner of neurologic disease.

    4. Describe and explain the etiology, symptoms, pathophysiology, treatment options (with risks and benefits) and prognoses of common neurological diseases in childhood and their differential diagnosis.

    5. Acquire competency in performing physical examinations of infants and children. 6. Learn to recognize abnormal patterns of neurodevelopment. 7. Learn to interpret neuro-diagnostic studies in infants and children. 8. Learn to diagnose and manage neurological emergencies in children. 9. Develop effective interactions with consulting services and ancillary staff. 10. Acquire effective practice management skills. 11. Learn to take a personal initiative in self-education (including pursuing recent literature)

    and demonstrate an investigatory and analytic thinking approach to clinical situations. This encompasses reading textbooks as well as review of recent scientific literature.

    12. Gather and document essential and accurate information in medical interviews, including relevant illness, past medical, family, social, diet, and developmental history.

    13. Perform and document complete physical and neurologic examinations in children of all ages, including developmental assessments.

    14. Develop thoughtful and appropriate assessments and plans of care utilizing the principles of evidence-based decision making and problem solving.

    15. Facilitate timely evaluation and management of care plans. 16. Provide vigilant and appropriate monitoring of the clinical and neurologic status of

    hospitalized patients including: - Appropriate use of non-invasive monitoring (continuous video EEG) - Careful data collection and synthesis - Frequent neurologic exam assessment

    - Responsiveness to patient, parent, and nursing concerns - Appropriate nutrition, activity and medication orders - Safe hand-offs of patient care - Prompt identification of and response to changes in patient condition and critically ill patients.

    17. Order and interpret labs and studies commonly used in inpatient pediatric neurology patients, taking into account age-related normal values.

    18. Use the electronic medical record to facilitate optimal patient care by: - Updating permanent parts of the medical record (including problem lists) - Writing timely daily notes that convey the thought process involved in patient

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    management decisions and can be easily interpreted by those reading the medical record.

    - Ensuring that the medical record reflects the current situation for each patient (creating addendums to the daily note and entering event notes).

    19. Effectively counsel patients and families by: - Sharing information about illness and treatment. - Encouraging involvement in patient care and clinical decisions. - Preparing patients and families for discharge. - Utilizing educational resources for patients and families.

    20. Facilitate smooth transitions of patient care: - Obtain information from and communicate with referring providers. - Discuss management and hospital course with primary care provider. - Provide thorough and appropriate sign-out to covering residents. - Ensure continuity for in-hospital transfers (communicate with other providers/services

    both verbally and in writing). 21. Facilitate appropriate discharge planning (orders and medication reconciliation, patient

    education including specific and meaningful verbal and written discharge instructions, scheduled follow-up appointments).

    PGY-5 (Child Neurology)

    Goals

    1. Develop mature clinical judgment through progressively independent patient care commensurate with the resident’s ability.

    2. Demonstrate increasing ability to independently assess, make decisions, counsel families and medically manage pediatric patients with neurological disease, under the supervision of the attending physician.

    3. Help patients and families make informed decisions about diagnostic and therapeutic interventions based on patient and family preferences and personal health goals, up-to-date scientific evidence, risk-benefit analysis and clinical judgment.

    4. Identify and develop one or more areas of clinical expertise that leads to diagnosis-specific referrals and/or directed clinic scheduling.

    5. Develop knowledge base and learn to provide care for pediatric patients with psychiatric disorders.

    6. Develop knowledge base and learn to provide care for pediatric patients with neurodevelopmental disorders

    7. Develop knowledge base and learn to provide care for pediatric patients with neurometabolic disorders.

    8. Become familiar with principles and techniques of pediatric Rehabilitation.

    Objectives Residents will:

    1. Meet all objectives listed for PGY4. 2. Critically evaluate current medical information and scientific evidence and modify your

    knowledge base accordingly. 3. Seek information and guidance from consultants. 4. Effectively triage patients.

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    5. Anticipate patient needs and obstacles to meeting them when implementing protocols. 6. Function as leader/teacher/reviewer/backup for PL1-PL4 residents. 7. Perform/order procedures (e.g., lumbar puncture, EEG, EMG) needed to deliver effective

    patient care. 8. Demonstrate competence in all facets of the care provided to children with neurologic

    disease and that he/she is prepared for practice after graduation. To this end, the resident should direct all care and practice independent decision making (under the guidance of the supervisory faculty member).

    9. Become competent at understanding the health care system, and will be able to work efficiently and effectively within it for the benefit of his/her patients.

    2 MEDICAL KNOWLEDGE

    2.1. Goals

    Residents will know, critically evaluate and use current medical information and scientific evidence for patient care.

    2.2 Objectives

    Residents will: 1. Develop an extensive, detailed body of knowledge regarding the neurosciences,

    neuroanatomy, neuropharmacology, neurogenetics, neurophysiology and clinical child neurology. It is expected that this knowledge be demonstrated and applied to patient care. Knowledge will be gained via didactic teaching (required and non-required conferences, educational conferences, national meetings) and by independent study and reading.

    2. Demonstrate a rich knowledge base in both clinical and basic neuroscience, as well as the fundamentals of pediatrics.

    3. Demonstrate a scholarly approach to the practice of clinical child neurology, including the incorporation of evidence-based medicine into clinical decision-making.

    4. Demonstrate basic knowledge of clinical trial design and statistical testing, as well as the ability to utilize this knowledge for critical interpretation of medical information.

    5. Acquire first-hand experience at the process of clinical research, ideally via participation in a clinical or translational research project (or even by assisting with patient enrollment into an ongoing project).

    6. Acquire first-hand experience at the process of data presentation and peer-review, ideally via submission of one abstract or manuscript during the course of training.

    7. Demonstrate habits consistent with life-long learning. 2.3 Goals and Objectives by Year of Training PGY-3 (Adult Neurology) Goals

    1. Develop self-directed learning skills essential to the maintenance of expertise in Neurology.

    2. Use internet and printed resources including primary and secondary literature, relevant texts and published databases to acquire, critically evaluate, and use current knowledge

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    regarding diagnostic test availability and applicability, natural history, and management of each disorder with which clinic patients are diagnosed.

    3. Develop an adequate knowledge base in neurology and the neurosciences. 4. Continue to learn how the health care system functions, especially as relevant to the

    patient with neurologic disease. Objectives Residents will:

    1. Learn how to classify stroke into ischemic vs. hemorrhagic and their various subtypes, and about the vascular pathology underlying them. They will learn basic concepts of cerebral hemodynamics, neuroimaging, and neurointensive care. They will develop their skills in lesion localization and the formulation of robust differential diagnoses that go beyond cerebral infarction. They will become proficient in the interpretation of neuroimaging studies including CT and MRI, and the use of such information for clinical decision making. They will learn about stroke risk factors and how these influence stroke classification and treatment. They will learn the evidence supporting acute and preventive stroke treatments including tissue plasminogen activator (tPA), antiplatelet agents, anticoagulants, anti-hypertensives, and HMG-CoA reductase inhibitors. They will gain knowledge on laboratory and diagnostic technologies and their appropriate uses.

    2. Learn basic concepts of interpretation of muscle and nerve biopsies. They will be introduced to the technique of muscle and nerve biopsy (in the operating room, or in the neurology out-patient clinic for needle muscle biopsies).

    3. Understand the clinical utility and limitations of nerve and muscle biopsies in evaluation and management of patients with neuromuscular disorders.

    4. Become familiar with the gross and microscopic pathologic findings of normal anatomy as well as neurologic diseases. The resident will become familiar with modern diagnostic pathology techniques (special stains, studies, etc.).

    5. Acquire basic working knowledge of the surgical management of diseases of the nervous system, which is essential to the neurologist-in-training.

    6. Utilize a systematic approach to the diagnosis of neurological disease, based on the skills of localizing neurological lesions, constructing a sound differential diagnosis, and judicious use of diagnostic tests and treatments.

    7. Learn how to access written materials including clinical practice guidelines related to patients under his or her care.

    8. Learn to impart basic neurology knowledge to rotating medical students and other residents. - Explain the recognition and treatment of status epilepticus, a medical emergency. - Describe the principles of EEG generation and recording. - Achieve an orderly approach to the interpretation of EEG studies. - Identify normal and abnormal EEG patterns. - Appraise literature to better understand pediatric and adult epilepsy syndromes and

    their etiology and clinical presentation. - Assess studies that evaluate treatment options for specific seizure types and epilepsy

    syndromes. - Apply and use the International League Against Epilepsy (ILEA) website that aids in

    understanding epilepsy syndromes and seizure management. 9. Learn clinical skills necessary to diagnose neuromuscular conditions affecting different

    stations of the motor unit (anterior horn cell diseases, peripheral neuropathies, neuromuscular transmission disorders, myopathies).

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    10. Understand the principles of clinical genetics and genetic counseling applicable to patients with neuromuscular conditions.

    11. Gain knowledge of laboratory and diagnostic studies and their appropriate uses. 12. Learn to verbally describe and visually distinguish major neoplasms of the CNS and PNS

    including glial neoplasms (all grades of astrocytomas, oligodendrogliomas), neuroectodermal tumors, ependymal tumors, meningiomas, neuronal tumors and nerve sheath tumors, visually identify normal CNS, PNS and muscle slides.

    13. Evaluate pathologic slides of major neurodegenerative conditions in children and adults (e.g. storage disorders, mitochondrial encephalomyopathies, Alzheimer’s Dementia, Parkinson’s Disease).

    14. Learn how to classify abnormal movements. They will demonstrate knowledge of the mainstream theories regarding pathophysiological mechanisms of common movement disorder and related diseases/syndromes. They will know the neuropharmacologic mechanisms of frequently used medications and common side-effects. They will be familiar with major novel treatments that are under development.

    15. Learn how to classify CNS demyelinating diseases. They will demonstrate knowledge of the mainstream theories regarding pathophysiological mechanisms of common demyelinating diseases. They will know the neuropharmacologic mechanisms of frequently used medications and common side-effects. They will be familiar with major novel treatments that are under development.

    PGY-4 (Child Neurology) Goals

    1. Develop self-directed learning skills essential to the maintenance of expertise in Child Neurology.

    2. Use internet and printed resources including primary and secondary literature, relevant texts and published databases to acquire, critically evaluate, and use current knowledge regarding diagnostic test availability and applicability, natural history, and management of each disorder with which inpatients and clinic patients are diagnosed.

    3. The resident will develop an adequate knowledge base in Child Neurology and the neurosciences.

    4. The resident will continue to learn how the health care system functions, especially as relevant to the pediatric patient with neurologic disease.

    Objectives Residents will:

    1. Develop competence in basic neurologic knowledge and will begin to attain a

    sophisticated and deep knowledge base in child neurology and the neurosciences. 2. Describe and explain the etiology, symptoms, pathophysiology, treatment options (with

    risks and benefits) and prognoses of common neurological diseases in childhood and their differential diagnosis.

    3. Acquire competency in performing physical examinations of infants and children. 4. Learn to recognize abnormal patterns of neurodevelopment. 5. Learn to interpret neuro-diagnostic studies in infants and children. 6. Learn to diagnose and manage neurological emergencies in children.

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    7. Learn to take a personal initiative in self-education (including pursuing recent literature) and demonstrate an investigatory and analytic thinking approach to clinical situations. This encompasses reading textbooks as well as review of recent scientific literature.

    PGY-5 (Child Neurology) Goals

    1. The resident will develop an extensive knowledge base in child neurology and the neurosciences that is both broad and deep.

    2. Continue to enhance learning skills and knowledge. 3. Further develop skills necessary to search for, identify and critically consider rare

    disorders in the differential diagnosis for pediatric patients with neurologic disease.

    Objectives Residents will:

    1. Achieve all objectives listed for PGY-4 2. Critically evaluate current medical information and scientific evidence and modify your

    knowledge base accordingly. 3. Seek information and guidance from consultants. 4. Develop competence at using the medical literature to guide patient care decisions

    (evidence based medicine). - Describe the developmental features of EEG from infancy to the elderly - Recognize abnormal EEG findings and correlate EEG findings with clinical epilepsy

    syndrome and seizure types in infancy, childhood and adulthood. - Achieve skills in creating and dictating neurophysiology reports. - Explain the principles of evoked potential generation including visual, brainstem-auditory,

    and somatosensory evoked potentials. - Correlate video recordings of seizures with EEG tracing. - Describe the principles of Wada testing. - Dictate at least five EEG studies. - Review neonatal and pediatric EEGs and video EEG studies with one of the pediatric

    neurologists. 5. Be able to classify seizure types and pediatric epileptic syndromes. 6. Verbalize rational approach to the management of epilepsy including choice of

    appropriate antiepileptics. 7. List the pharmacokinetics of antiepileptics and mechanisms of action. 8. Explain the utility of epilepsy monitoring and the evaluation of intractable epilepsy,

    especially the use of surgical treatment of epilepsy. 9. Verbalize the appropriate restrictions including driving, for patients with epilepsy. 10. Develop a working knowledge of the DSM – IV. 11. Learn basic non-pharmacological treatment of neurological disease. 12. Strengthen knowledge of neuropharmacology with respect to antidepressants and

    antipsychotics. 13. Incorporate basic concepts of sleep physiology and sleep diagnoses into clinical

    encounters. 14. Demonstrate a basic understanding of management approaches for common sleep

    disorders (sleep apnea, insomnia, restless legs syndrome and narcolepsy).

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    15. Develop an understanding of the principles and methods of neuropsychological testing, especially anatomical localization derived from test results and utility of results in determining neurologic diagnoses. Basic knowledge with regard to the clinical course, diagnostic criteria, and management principles of these diseases will be obtained through clinical interactions, didactic teaching, and background reading, with reading to occur in a patient-specific fashion.

    16. Become independent in his or her ability to interpret neuroradiologic studies and generate appropriate differential diagnoses from the findings. Both normal anatomy and pathology will be emphasized.

    3 INTERPERSONAL AND COMMUNICATION SKILLS 3.1. Goals

    Excellent physicians communicate clearly and succinctly with patients, families, other physicians, and all other allied health staff. The ability to successfully interact with others during routine work time as well as during times of stress is crucial for optimal patient care. This includes maintaining accurate, timely, and legible medical records. Child neurologists must also be able to provide genetic counseling and palliative care when appropriate. All patient-related communication must remain within the guidelines of HIPAA rules and regulations.

    3.2 Objectives

    Residents will” 1. Obtain an appropriate medical history (including sensitive issues such as sexual history)

    in a professional and humane manner. 2. Exhibit communication that is characterized by socio-cultural competence. 3. Communicate respectfully and effectively with other health professionals. 4. Act in a consultative role to other physicians and health professionals. 5. Communicate diagnosis and treatment plans, and potentially sensitive information such

    as terminal prognosis. 6. Communicate succinctly and clearly with other healthcare professionals, with a proper

    respect for the principles of HIPAA regulations. 7. Maintain comprehensive, timely, effective and legible medical records. 8. Present scientific data and peer-review, ideally via submission of one abstract or

    manuscript during the course of training. 3.3 Goals and Objectives by Year of Training PGY-3 (Adult Neurology) Goals

    1. Residents will become skillful listeners, and develop specific proficiency in communicating with neurologic patients through non-verbal means.

    2. Residents will learn to communicate rapidly and efficiently with other team members in order to ensure that proper therapies can be provided in a timely manner.

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    3. Residents will learn to clearly communicate neurological assessments and plans to patients, their families, and members of the multidisciplinary care team. They will become specifically proficient in discussing end of life care.

    Objectives Residents will:

    1. Continue to develop skills at interpersonal communication and begin developing basic

    teaching skills. 2. Demonstrate skills in effective communication (both written and verbal) with patients, their

    families, colleagues and co-workers in order to better treat neurological disease. 3. Become proficient in communication with allied health staff in day-to day contacts and

    during multidisciplinary discharge planning rounds. 4. Develop techniques to obtain accurate history from patients, and gain the patients’

    confidence and trust. 5. Create reports that accurately convey EEG, EMG and neuroimaging findings and relate

    these findings to the clinical setting. 6. Interact effectively with other members caring for patients including nursing and technical

    staff. 7. Create clinic and hospital notes that are concise and accurate. 8. Present neuropatholgical results to faculty succinctly and completely. Learn to create a

    concise neuropathological report. 9. Become adept at presenting patients to faculty concisely and completely. 10. Become proficient at communicating clearly with the consulting services. 11. Learn efficient dictating skills so that consulting and inpatient care team services have

    immediate access to documentation on all patients. 12. Develop the skills of teaching basic neurological skills and knowledge to the rotating

    medical students.

    PGY-4 (Child Neurology) Goals

    1. Demonstrate interpersonal and communication skills that result in information exchange

    and partnering with patients, their families and professional associates. 2. Residents will become skillful listeners, and develop specific proficiency in communicating

    with pediatric neurologic patients through non-verbal means and with their care providers. 3. Residents will learn to communicate rapidly and efficiently with other team members in

    order to ensure that proper therapies can be provided in a timely manner. 4. Residents will learn to clearly communicate neurological assessments and plans to

    patients and their parents, and members of the multidisciplinary care team.

    Objectives Residents will:

    1. Continue to master skills at interpersonal communication and will not only demonstrate professional and ethical practice of medicine, but help more junior residents to foster their professionalism.

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    2. Be expected to supervise the junior pediatric residents and medical students and both create and direct the care plan for the patient (under the guidance of the supervisory faculty member).

    3. Continue to master teaching skills. 4. Effectively communicate in a timely manner with fellow residents, medical students,

    attending physicians, consulting and transferring services, primary care providers, nurses, ancillary staff members, patients and families.

    5. Facilitate safe and efficient patient care via complete but concise presentations (on rounds, when discussing care with consultants, when signing out to co-residents).

    6. Appropriately utilize the electronic medical record as a communication tool. 7. Collaborate with case management and nursing to ensure efficient and appropriate

    discharge plans. 8. Provide effective education, including reassurance, for conditions commonly seen on the

    inpatient service. 9. Effectively interact with children in a manner that is appropriate for their

    age/developmental level and promotes comfort and understanding. 10. Communicate with parents/caregivers/families by establishing rapport, inspiring

    confidence and trust and keeping them informed and involved in clinical care decisions. 11. Demonstrate sensitivity to and respect for patients and families beliefs, religion, ethnicity,

    and cultural values. 12. Ensure continuity of care by communicating effectively with primary care providers both

    verbally and through timely, appropriately detailed written discharge summaries. 13. Accept and provide feedback willingly.

    PGY-5 (Child Neurology) Goals

    1. Communicate effectively with patients, families, and the public (as appropriate) across a

    broad range of socioeconomic, intellectual and cultural backgrounds. 2. Assume leadership of a health care team which also includes counselors, clinic

    coordinators, other clinic and hospital staff, and other learners.

    Objectives Residents will:

    1. Achieve all objectives listed under PGY-4 2. Demonstrate competence at clear and succinct interpersonal communication with

    colleagues, patients, and families. 3. Demonstrate skill at teaching medical professionals and non-medical persons including

    patients and families. 4. Be a role model for junior residents and other members of the health care team and

    demonstrate the ability to adapt to patients and family beliefs and cultural system. 5. Communicate effectively in difficult situations, such as with an angry parent, with a parent

    who wishes to leave AMA, or in cases of suspected child abuse or neglect. 6. Give feedback to junior residents on the effectiveness of their patient care and skill at

    communicating with patients, their families and members of the health care team.

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    4 PROFESSIONALISM 4.1. Goals

    It is the expectation of our training program that child neurology residents will behave in a professional manner at all times in which they represent the University of Wisconsin Department of Neurology, the University of Wisconsin Hospital and Clinics, and the William S. Middleton VA Hospital. This includes the following six essential elements of professionalism: 1.) Be present—the resident must be in attendance for all patient care duties and for all

    didactic teaching. If illness or other circumstances prevent attendance, the appropriate persons should be notified. 70% attendance at required conferences will be required for promotion.

    2.) Be presentable—the resident will dress in a manner that signifies professionalism. For example, male residents will wear ties and female residents should wear similarly appropriate professional clothing during regular day time duty hours on days when patient contact will occur. White coats will be provided by the GME office and residents should wear a clean coat at all times. Tattoos and body piercings will not be allowed, with the exception of ear piercing or tattoos/piercings with cultural or religious significance. The wearing of scrubs is prohibited except after normal business hours.

    3.) Be punctual—residents should strive to arrive on time for all clinical duties and didactic sessions. As befits a responsible professional, knowledge that the resident will be late should result in notification of the appropriate persons (i.e. the resident might call ahead to clinic and ask the MA to notify all patients that he/she will be arriving late). Furthermore, it is appropriate to apologize to those who are inconvenienced by tardiness.

    4.) Be prepared—the resident should accomplish all assigned tasks related to clinical patient care within the limitations of the ACGME duty hour regulations (see below). Paperwork and dictations must be completed in a timely fashion.

    5.) Be positive (and respectful)—the resident shall strive to be respectful of patients, staff, and colleagues at all times. At times, every person experiences emotions such as anger/frustration, etc. that must be successfully suppressed in interactions with patients, families, and with other health care professionals.

    6.) Be proficient—the resident will be expected to consistently demonstrate appropriate knowledge and procedural skills for his/her level of training. The resident must understand his/her limitations and know when to ask for help.

    Included in the concept of professionalism are the virtues of integrity, honesty, compassion, ethical behavior and a commitment to the development of cultural humility.

    4.2 Objectives Residents will:

    1. Demonstrate integrity, honesty and compassion, empathy and altruism. 2. Acknowledge errors and limitations. 3. Demonstrate responsibility, accountability, dependability, commitment and encourages

    continuity of care. 4. Exhibit respect for all persons regardless of their cultural, ethnic, religious, and

    socioeconomic background. 5. Exhibit a commitment to the development of cultural humility.

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    6. Comply with the regulations set forth by the University of Wisconsin Hospital and Clinics including all training sites.

    7. Be remorseful about any breaches in professionalism that occur. Furthermore, it is expected that the resident will use such breaches as lessons to prevent similar problems in the future.

    4.3 Goals and Objectives by Year of Training PGY-3 (Adult Neurology) Goals

    1. Residents will learn ethical, regulatory, and legal aspects of neurologic care, including the difference between standard and investigational treatments.

    2. They will demonstrate sensitivity to the personal, cultural, and religious values that influence patients’ medical decisions in the context of neurologic disease, and a compassionate approach to end of life care.

    3. They will demonstrate responsiveness to patient needs that supersedes self-interest. 4. Demonstrate compassion, integrity, accountability and respect in all interactions with

    patients from diverse backgrounds in gender, age, culture, race, religion, physical and cognitive ability and sexual orientation.

    5. They will adhere to ethical principles by respecting confidentiality of medical information. Objectives Residents will:

    1. Solidify his/her foundation of the professional and ethical practice of medicine. 2. Remember that they represent the UW Department of Neurology with their actions and

    communications. The highest standards of professionalism must be maintained at all times, especially in interactions with patients and their families, with other physicians, and with allied health staff.

    3. Respond in a timely and courteous manner to pages, calls and patient inquiries. 4. Adhere to clinic schedules and minimize patient inconvenience. 5. Undergo HIPAA training and comply with HIPAA rules and ethical principles. 6. Be responsible for tracking duty hours. 7. Show respect, compassion, integrity and ongoing professional development. 8. Determine psychosocial issues that complicate care, especially as it relates to the

    possibility of patient history of physical or sexual abuse and the diagnosis of nonepileptic seizures.

    9. Be punctual and appropriately attired. 10. Keep patient logs up-to-date on E-Value. 11. Learn ethical, regulatory, and legal aspects of care, including the difference between

    standard and investigational treatments. 12. Demonstrate sensitivity to the personal, cultural, and religious values that influence

    patients’ medical decisions in the context of the wide spectrum of neuromuscular conditions, including end-of-life issues.

    13. Promptly attend case conferences and didactic sessions.

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    PGY-4 (Child Neurology) Goals

    1. Demonstrate continuing commitment to carrying out professional responsibilities, adherence to ethical principles, and sensitivity to diversity.

    2. Learn ethical, regulatory, and legal aspects of pediatric neurologic care, including the difference between standard and investigational treatments.

    3. Demonstrate sensitivity to the personal, cultural, and religious values that influence patients’ and parents’/caregivers’ medical decisions in the context of neurologic disease.

    4. Demonstrate responsiveness to patient needs that supersedes self-interest. 5. Demonstrate compassion, integrity, accountability and respect in all interactions with

    patients from diverse backgrounds in gender, age, culture, race, religion, physical and cognitive ability and sexual orientation.

    6. Adhere to ethical principles by respecting confidentiality of medical information. Objectives Residents will:

    1. Achieve all objectives listed for PGY-3 2. Place patient needs paramount; always act in the best interest of the patient. 3. Demonstrate personal accountability for the well-being of patients (following up lab results,

    writing comprehensive notes, seeking answers to patient care questions). 4. Work collaboratively and cooperatively as a member of a health care team, demonstrating

    a commitment to professional behavior in interactions with staff and professional colleagues.

    5. Demonstrate reliability, responsibility, and respect for patients and families, including appropriate verbal and nonverbal communication.

    6. Arrive on time for scheduled activities and appointments. 7. Demonstrate a commitment to professional responsibilities, even during periods of stress,

    by: - making a personal commitment to a respectful workplace; - working collaboratively with other members of the health care team; - engaging in self-assessment; and - accepting external scrutiny to maintain professional standards.

    8. Adhere to ethical and legal principles.

    PGY-5 (Child Neurology) Goals

    1. Demonstrate continuing commitment and leadership in carrying out professional responsibilities, adherence to ethical principles, and sensitivity to diversity.

    2. Be familiar with and teach ethical, regulatory, and legal aspects of pediatric neurologic care, including the difference between standard and investigational treatments.

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    3. Demonstrate sensitivity to the personal, cultural, and religious values that influence patients’ and parents’/caregivers’ medical decisions in the context of neurologic disease.

    4. Demonstrate responsiveness to patient needs that supersedes self-interest. Objectives Residents will:

    1. Demonstrate compassion, integrity, accountability and respect in all interactions with patients from diverse backgrounds in gender, age, culture, race, religion, physical and cognitive ability and sexual orientation.

    2. Adhere to ethical principles by respecting confidentiality of medical information. 3. Demonstrate Professionalism at all times and act as a role model for medical students,

    junior residents and other health professionals. 4. Demonstrate self-evaluation skills, continuous desire for self-Improvement, and a life-long

    learning plan. 5. Recognize and respond to personal stress and fatigue that might interfere with

    professional duties. 6. Develop a healthy lifestyle, fostering behaviors that help balance personal goals and

    professional responsibilities. 5. PRACTICE-BASED LEARNING AND IMPROVEMENT 5.1 Goals

    Child neurology residents must be able to investigate and evaluate their patient care practices, and appraise and assimilate scientific evidence to improve their patient care practices. Residents should participate in the collection and analysis of patient data via patient logs and as part of quality assurance projects.

    5.2 Objectives

    Residents will:

    1. Exhibit skills in self-assessment and self-improvement. 2. Exhibit skill in practice assessment, as well as both practice- and systems improvement,

    to enhance quality of care and improve patient safety. 3. Demonstrate a scholarly approach to the practice of clinical child neurology, including the

    incorporation of evidence-based medicine into clinical decision-making. 4. Demonstrate the ability to utilize information obtained from clinical trials for critical

    interpretation of medical literature. 5. Demonstrate ongoing self-education and habits of life-long learning. 6. Apply these processes to improve patient care. 7. Participate in the education of patients, families, students, residents and other health

    professionals. 5.3 Goals by Year of Training PGY-3 (Adult Neurology)

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    Goals

    1. Use skills acquired during primary residency training as an initial foundation for medical and ethical decision making.

    2. Identify opportunities for improvement in the delivery of quality of patient care. Objectives

    Residents will: 1. Systematically review inpatient and outpatient cases during dedicated conferences and

    use the feedback generated to improve upon subsequent patients’ care. 2. Learn to critically appraise the neurologic literature, with emphasis on clinical trial design

    and outcome measures. 3. Become familiar with authoritative sources of neurologic practice guidance, such as

    American Academy of Neurology scientific statements, and how to access these resources on-line.

    4. Maintain a patient log for tracking number and various diagnosis of patients seen to ensure an adequate educational experience.

    5. Be responsible for tracking patients and procedures performed via the electronic patient/procedure log. These data can be used by the resident in the 6-month self-evaluation to determine where further patient experience is needed.

    6. Incorporate evaluation feedback into daily practice.

    PGY-4 (Child Neurology) Goals

    1. Demonstrate knowledge, skills and attitudes needed for continuous self-assessment, using scientific methods and evidence to investigate, evaluate, and improve one’s patient care practice.

    2. Identify opportunities for improvement. Objectives Residents will:

    1. Regularly utilize the available medical literature to make evidence-based decisions in patient care by: - Formulating pertinent clinical questions - Retrieving and critically appraising relevant up-to-date information - Applying that information to inform clinical decisions.

    2. Observe and provide feedback to students about history and exam skills, discussing cases seen together, and writing orders together.

    3. Identify personal learning needs, systematically organize relevant information resources for future reference and plan for continuing acquisition of knowledge and skills.

    4. Incorporate evaluation feedback into daily practice. 5. Read, analyze and critique journal articles. 6. Systematically review clinical outcomes in order to contribute to the body of knowledge in

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    pediatric neurology. PGY-5 (Child Neurology): Goals

    1. Bring developing knowledge and technology into practice in a responsible manner. 2. Identify opportunities for improvement in the delivery and quality of patient care and work

    to bring those into practice.

    Objectives Residents will:

    1. Achieve all objectives listed for PGY-4 2. Demonstrate self-evaluation skills, continuous desire for self-improvement, and a life-long

    learning plan. 3. Observe and provide feedback to students and interns about history, exam and oral

    presentation skills, discuss cases seen together, teach about relevant topics, assist with prioritization of tasks and efficiency.

    4. Make evidence-based decisions in patient care by formulating pertinent clinical questions, retrieving and critically appraising relevant up-to-date information, and applying that information to formulate clinical decisions.

    5. Be prepared to alter one’s practice of medicine over time in response to new discoveries and advances in epidemiology and clinical care.

    6. SYSTEMS-BASED PRACTICE 6.1 Goals

    Child neurology residents must be trained to recognize that they are part of a large and intricate health system that has implications for their ability to care for patients and impacts upon their patients’ human needs and financial resources.

    6.2 Objectives

    Residents will: 1. Recognize the limitation of resources for health care and demonstrates the ability to act

    as an advocate for patients within their social and financial constraints. 2. Exhibit willingness to participate in utilization review and comply with documentation

    requirements in medical records. 3. Develop awareness of practice guidelines and utilizes them as appropriate. 4. Develop awareness of local and national resources that may enhance our patients’ quality

    of life in dealing with chronic neurologic diseases. 5. Develop the ability to lead health care teams and delegate authority in a responsible and

    appropriate manner. 6. Develop skills for the practice of ambulatory medicine (time management, clinic

    scheduling, effective communication with referring physicians). 6.3 Goals by Year of Training

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    PGY-3 (Adult Neurology) Goals

    The resident recognizes that he/she is part of a large and intricate health system that has implications for his/her ability to care for patients and impacts upon his/her patients’ human needs and financial resources.

    Objectives

    Residents will: 1. Demonstrate the ability to work in a multidisciplinary fashion with nurses, case managers,

    social workers, therapists, primary care physicians, and the various medical and surgical specialties related to adult neurology.

    2. Learn how to triage patients and allocate resources such as intensive care unit beds and MRI scans so as to provide high quality, cost-effective care.

    3. Become familiar with clinical practice guidelines and participate in the creation and review of stroke program policies and procedures relevant to patient care.

    4. Learn how the health care system functions, especially as relevant to the patient with neurologic disease.

    5. Learn to interact with allied health services including nursing staff, PT, OT, Speech Pathology, Dietary, Social Work, and PMR/Rehabilitation in caring for the patient and planning post-hospital care.

    6. Learn the most efficient manner for completing the necessary workup and develop skills to coordinate neurological care in the outpatient setting.

    7. Be able to individualize evaluations, diagnostic testing, and develop treatment plans with respect to the health delivery systems available to patients. Awareness of financial, safety and other psychosocial issues common to patients living with chronic neurological disorders will be demonstrated. Residents will become knowledgeable of available patient resources including other health care professionals and patient advocacy groups.

    8. Learn how to manage the time pressures of outpatient practice while delivering tertiary-level care. The resident will learn how to perform efficient outpatient evaluations and appropriately utilize ancillary services. Residents will become proficient in the use of the UW Epic electronic record and the VA CPRS systems

    PGY-4 (Child Neurology) Goals

    Understand how to practice high quality health care and advocate for pediatric patients with neurologic disease within the context of the health care system.

    Objectives Residents will: 1. Learn how they can best utilize the health care system for the welfare of his/her pediatric

    patients with acute and chronic neurologic conditions.

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    2. Identify key aspects of health care systems, cost control, billing, and reimbursement in the inpatient setting.

    3. Demonstrate sensitivity to the cost of providing inpatient care and resource allocation, take steps to minimize costs without compromising quality of care.

    4. Take steps to avoid medical errors by recognizing the limits of one’s knowledge and expertise; work with the health care team to recognize and address systems errors.

    5. Understand the value of appropriate use of laboratory and radiographic testing, as well as their limitations.

    PGY-5 (Child Neurology) Goals

    1. Provide care of uniformly high quality within fiscally constrained environment. 2. Navigate various health care delivery and financing systems to provide optimal care.

    Objectives Residents will:

    1. Achieve all objectives listed for PGY-4. 2. Become competent at understanding the health care system, and will be able to work

    efficiently and effectively within it for the benefit of his/her patients. 3. Learn about the unique constraints placed upon on the care of children with neurologic,

    genetic, developmental and psychiatric disorders. 4. Demonstrate an understanding of the unique ethical and medical-legal circumstances that

    can impact upon the care of children with neurologic, genetic, developmental and psychiatric disorders.

    5. Learn about how to work within the constraints of our current health care system to provide neuropsychometric testing/consultation and rehabilitation in an appropriate fashion. Neuropsychometric testing and Rehabilitation are not always approved by insurance companies and appropriate use of testing must thus be learned.

    6. Optimize use of system resources (clinic, hospital, community, and government) to ensure optimal patient care.

    7. Work with health care managers and providers to assess, coordinate, and improve patient care, consistently advocating for high quality.

    8. Assist patients in their efforts to navigate complex health care systems. 9. Recognize and advocate for families who need assistance to deal with systems

    complexities, such as the referral process, lack of insurance, multiple medication refills, multiple appointments with long transport times, or inconvenient hours of service.

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    Program Leadership and Committee Structure Child Neurology

    Program Director The Residency Program Director is appointed by the department chair. He/she is responsible for the supervision of the residents' education and training. He/she chairs the Recruitment and Clinical Competency committees and also functions as a liaison between the faculty and the residents. The program director serves as a readily available resource for any resident encountering a professional or personal problem. Program Coordinator The Residency Program Coordinator is a staff administrator who assists the Program Director in the day-to-day and long-range operations of the residency program. A small sample of the specific duties include: submitting time sheets to the GME office, communicating with residents and faculty (by phone, e-mail or memo) regarding clinical assignments, organizing educational conferences, proctoring in-service examinations, managing resident orientation, and assisting with resident recruitment. Recruitment Committee This committee is responsible for reviewing applications to the program, interviewing candidates, and developing the rank list. See Resident Evaluation and Promotion below. The committee is chaired by the program director and other members include the program coordinator, the neurology department chair, and various faculty representing different divisions of the department. Clinical Competency Committee (CCC) The main purpose of the CCC is to review resident performance and ensure that each resident is progressing in the program and on track to sit for the neurology boards. See the section Resident Evaluation below. Twice each year, the CCC evaluates each resident with respect to the six core competencies defined by the ACGME: Patient care, medical knowledge, interpersonal and communication skills, practice-based learning and improvement, systems-based practice, and professionalism. In addition, residents are expected to achieve specific milestones developed, in the case of neurology, in a joint venture between the ACGME and the ABPN. The CCC’s mission includes the assessment of each resident’s progress toward these milestones.

    http://www.acgme.org/acgmeweb/Portals/0/PDFs/FAQ/CCC_PEC_FAQs.pdfhttp://www.acgme.org/acgmeweb/Portals/0/PDFs/Milestones/NeurologyMilestones.pdf

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    The CCC reviews residents’ NEX exams, evaluations submitted by faculty and ancillary staff, patient feedback, mentor comments, conference attendance, RITE Exam scores, and duty hours. The CCC will also consider issues that affect resident performance, such as fatigue, stress, affective disturbance, and substance abuse. After considering all of the above, the CCC will determine if the resident will be promoted to next level or graduate, or whether he/she requires remediation, non-promotion, or dismissal. Adverse actions taken by the CCC will comply with both departmental and UWHC policies regarding such. See the Grievance Policy and UWHC policies Resident Expectations and Discipline and Academic Improvement. The CCC is chaired by the program director; the other members are key faculty who are involved in resident education. Program Evaluation Committee This committee is responsible for monitoring and addressing a variety of matters related to overall quality of the residency program. These include:

    • Curricular goals and objectives • Aggregate resident performance • Faculty development • Graduate performance (e.g. board pass rates) • Compliance with ACGME standards • Conducting an annual program evaluation • Developing an annual program improvement plan

    The committee is chaired by the program director and other members include at least one resident, the program coordinator, and various faculty representing different divisions of the department. Each year, both residents and faculty are electronically surveyed regarding their assessments of the residency program. These are confidential (i.e. the faculty will not know which resident provided which assessment). In addition, the resident/s meet as a group meet on an annual basis to review the program, leading to a report written by the resident/s. The Program Evaluation Committee then conducts its annual program evaluation, reviewing:

    • The prior year’s improvement plan • Internal resident and faculty surveys • Resident milestones and RITE scores

    http://www.abpn.com/wp-content/uploads/2015/01/ABPN_NEX_form_v2.pdf

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    • Performance of program graduates on the board certification examination • Minutes from the program’s most recent meeting with UW’s GME Office • ACGME resident and faculty surveys • Other communications from the ACGME

    The committee prepares an annual improvement plan of action, which is shared with the teaching faculty at the next faculty meeting. Grievance Committee

    This is an ad hoc committee created for those rare circumstances when a grievance is filed by a resident per the Grievance Policy. Latest Revision: 6/5/18, Adam Wallace

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    Resident Eligibility and Selection Process Child Neurology

    Resident recruitment and selection

    1. Qualifications required for resident appointment:

    The University of Wisconsin Hospital and Clinics (UWHC) and its affiliates are committed to provide a training program for Residents that meets all requirements for programs accredited by the Accreditation Council for Graduate Medical Education (ACGME).

    The University of Wisconsin Department of Neurology seeks well-rounded candidates with a track record of academic success and great potential for the future. Desirable attributes include strong intellectual abilities as documented by success in past academic performance, sincere interest in a career in child neurology, and excellent interpersonal and communication skills.

    To enter the child neurology training program candidates must complete either (a) two years of training in pediatrics, in a program accredited by the Accreditation Council for Graduate Medical Education (ACGME) in the United States or the Royal College of Physicians and Surgeons in Canada; (b) one year of education in pediatrics and one year of education in family medicine or internal medicine or (c) one year of pediatrics plus one year of basic neuroscience training, whereby the program director must review and determine the acceptability of these initial two years of training.

    2. Procedures for evaluation and selection of applicants to the program:

    Applications to our program are only accepted via ERAS. All applications are reviewed in their entirety by the Admissions Committee, who will objectively rate each application with regard to: academic performance in college and medical school, performance on USMLE or COMLEX, interpersonal communication (personal statement, etc.), extracurricular activities, research accomplishments, and letters of recommendation. This serves as a screening process; the most highly rated applicants are invited for in-person interviews. Applicants accepted for interview will be presented to the Department of Pediatrics for consideration for PGY1 and PGY2 years. The program director for Pediatrics will communicate to the program director of Child Neurology which candidates are acceptable to Pediatrics.

    The candidates are invited for a dinner on the night before the interview, so as to meet the residents and learn about the program from them. On the following day, candidates have a structured interview day which includes a breakfast meeting with the Program Director of Pediatrics for an overview of the program. This is followed by a neurology resident led morning report. A brief overview of the child neurology residency program is then given by the Program Director. Candidates will then meet with no less than 3 selected pediatric neurology faculty members. A tour of the hospital and lunch is provided. Candidates will then meet with selected pediatric faculty.

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    The final rank list is created in a multi-step process. A preliminary ranking is completed by the program director after review of the resident and interview evaluations. The Residency Committee will then have a closed-door discussion to create the final rank list by consensus.

    All candidates must meet the UWHC “Qualifications for Appointment,” and attest to this by signing an agreement form provided by GME office.

    Application Process Applications to our program are only accepted via the Electronic Residency Application Service (ERAS). Our ACGME ID# is 1855618109 and the NRMP program code is 1779185C0. All applications are reviewed by the Recruitment Committee, which will evaluate each application with regard to the following:

    • Academic transcript • Medical Student Performance Evaluation (Dean’s letter—once available) • Letters of recommendation • Research experience • Personal statement • USMLE (at minimum, step 1) or COMLEX-USA (at minimum, level 1) scores

    The most highly-rated applicants are invited for in-person interviews. Those accepted for interviews will then have their applications reviewed by the Pediatrics residency program director for consideration of eligibility for a PGY1 appointment. The candidates are invited for a dinner on the night before the interview to meet the residents and learn about the program. On the following day, candidates join us for morning report to gain a first-hand look at how we conduct our teaching conferences. Following this is a short introduction to the program by the program director, followed by a series of interviews with our faculty. Intercalated with the interviews are tours of our facilities. Following the interviews and tours, applicants, residents, and faculty gather for an informal lunch, providing an opportunity to meet additional members of our department, ask follow-up questions, etc. Post-Interview Communications It is axiomatic that applicants and programs need complete and reliable information about each other in order to best determine the ordering of their respective rank lists. Regrettably, there is ample literature showing that both applicants and residency programs often exaggerate their

    https://www.aamc.org/students/medstudents/eras/http://www.usmle.org/http://www.nbome.org/comlex-cbt.asp?m=canhttps://www.pediatrics.wisc.edu/education/residency-program/

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    interest in one another. In order to promote the most fair and transparent matching process possible, our program has chosen to adopt the suggestions of Grimm, et al.:1

    • We request that post-interview communications be limited to requests for objective information.

    • Our faculty and staff will not personally respond to correspondence expressing thanks or volunteering ranking preferences. This is not to be taken to mean that our program lacks appreciation for our applicants’ interest generally or that a particular candidate is disfavored! Rather, we seek to minimize the possibility of misleading communication by limiting our correspondence to the exchange of objective information.

    • If post-interview communication is required, it should occur via the program coordinator; the faculty have been requested not to directly respond to post-interview communications from applicants.

    • To further safeguard our ethical standards, the program coordinator will log all post-interview communications.

    Latest Revision: 2/14/20, Adam Wallace

    1 Lars J. Grimm, Carolyn S. Avery, and Charles M. Maxfield (2016) Residency Postinterview Communications: More Harm Than Good?. Journal of Graduate Medical Education: February 2016, Vol. 8, No. 1, pp. 7-9.

    http://www.jgme.org/doi/full/10.4300/JGME-D-15-00062.1

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    Emergency Neurology Prerequisites for Incoming PGY3 Residents Child Neurology

    In order to help ensure that incoming residents have a good foundation for handling medical and neurological emergencies, we require incoming residents to complete several training modules prior to September 1 of the PG3 year:

    • ACLS certification.

    • NIHSS certification. The NIH Stroke Scale is the most widely-used measure of stroke severity. Knowing how to administer the NIHSS exam prior to the beginning of the PGY3 year will facilitate your running of stroke codes.

    • ASPECTS scoring. The Alberta Stroke Program Early CT Score is a validated way to assess the extent of early infarction visible on non-contrast head CT. It plays a role in patient selection for acute endovascular therapies and so having some familiarity with it will, like the NIHSS, help the incoming resident become prepared to run stroke codes. There’s no formal certification for ASPECTS, but incoming residents are encouraged to peruse the website and work through the training materials.

    • PALS certification.

    http://www.heart.org/HEARTORG/CPRAndECC/HealthcareProviders/AdvancedCardiovascularLifeSupportACLS/Advanced-Cardiovascular-Life-Support-ACLS_UCM_001280_SubHomePage.jsphttps://secure.trainingcampus.net/uas/modules/trees/windex.aspx?rx=nihss-english.trainingcampus.nethttps://www.mdcalc.com/alberta-stroke-program-early-ct-score-aspectshttp://cpr.heart.org/AHAECC/CPRAndECC/Training/HealthcareProfessional/Pediatric/UCM_476258_PALS.jsp

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    • ENLS certification. Emergency Neurology Life Support is a new program loosely modeled on ACLS. It focuses on the first few hours of neurological emergencies such as:

    o Acute ischemic stroke o Intracerebral hemorrhage o Subarachnoid hemorrhage o Status epilepticus o Bacterial meningitis o Acute non-traumatic weakness (Guillain-Barre syndrome)

    ENLS training is composed of ~ 14 modules on these topics, each of which consists of a short review article, some slides, and a management algorithm. It is a very interesting (for neurologists!) and worthwhile course—a good way to get up to speed on neurological emergencies so that when you start encountering these problems as PGY3s, you’ll have a good foundation from which to start learning and caring for patients. We’ll register each incoming resident for the course and pay the fee on your behalf.

    http://www.neurocriticalcare.org/education-training/emergency-neurological-life-support-enlshttp://www.aspectsinstroke.com/

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    Latest Revision: 6/5/18, Adam Wallace

    http://www.neurocriticalcare.org/education-training/emergency-neurological-life-support-enls

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    Rotation and Call Schedules Child Neurology

    Rotation Schedule Most rotations occur in blocks of 4 weeks; there are 13 blocks each year. In addition, each resident has continuity clinics at the UW; see the section Continuity Clinics below for details. The following rotation schedule is typical, but there may be minor changes from year-to-year. Further, the schedule can be modified at any time by the Chair or Residency Director to meet service requirements or catastrophic emergencies. The training requirements mandated by the ACGME will be maintained at all times.

    Training year Rotation No. of Blocks

    PGY3

    Neurology Specialty Clinics

    2

    Neuropathology 1

    Epilepsy 2

    General Neurology /C

    1

    Stroke 2

    Night Float 1

    Neurosurgery 1

    Neuromuscular 1

    Movement Disorders

    1

    Elective 1

    PGY4

    Peds Neurology Inpatient 5-6

    Peds Neurology Outpatient 5-6

    Elective 2

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    PGY5

    Peds Neurology Outpatient 2-3

    Peds Neurology Inpatient 2-3

    Developmental Pediatrics 1

    Metabolic Genetics 1

    Child Psychiatry 1

    Rehabilitation 1

    Peds EMU /Epilepsy 1

    Elective 2

    * Night float may not be assigned for more than 2 consecutive weeks, as per ACGME regulation. Night float blocks are therefore split and shared with neuromuscular and other outpatient experiences. Call Schedule- PGY3 On-Service Residents The main services that are always covered by a resident are Stroke, General, Consults, Pediatric Neurology (Peds), and Epilepsy. Stroke and General work 6 day weeks, and the rest work 5 day weeks. On weekends, the residents don’t cover peds or epilepsy, and the consults needing weekend rounding are seen by the stroke or general teams as appropriate. Usual work hours are 8am – 4pm. For at least the first 6 weeks of the year, the Stroke and General teams have a senior resident working side-by-side with the junior for orientation and mentoring.

    Day Float A somewhat unique feature of our program is the day float role. The day float is a late-PG2 or more senior resident who arrives each day at noon, attends conference, and then is available to help out any of the inpatient teams who need it. After 4pm, when the teams sign out to the short call resident (see below), the day float remains in-house to assist with short call. This ensures that there are always two residents in-house in the sometimes busy 4pm – 8pm window, after which the night float takes over. Because the day float doesn’t need to return to the hospital until noon the next day, it is he or she who stays later if needed to finish pending consults, whereas the on-service short call resident will leave the hospital shortly after 8pm. Examples of the day float’s responsibilities include:

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    • Seeing inpatient or ED consults when the on-service resident has a high caseload

    • Responding to stroke codes and other emergent consults, particularly when there are multiple emergencies at once, and helping the junior resident learn to triage these

    • Helping the junior residents with procedures such as lumbar punctures

    • Teaching the medical students (bedside or lecture)

    • Answering after-hours phone calls from patients and families

    Night Float There are two residents on the Night Float rotation and they alternate nights on call. Work hours are 4pm – 8am on weekdays, with the post-call resident off from 8am on their post-call day until 4pm the following day (16 hours on / 32 hours off). On weekends, the post-call resident makes rounds with whichever service (Stroke or General) does not have their regular resident. This system ensures that on-service residents have no overnight calls, off-service residents are not pulled