The educational objectives of the Vanderbilt Senior Rotation are for third year neurology residents to acquire the knowledge, skills, and attitudes to perform a focused neurologic exam and diagnose and manage the complete range of acute and non-acute neurological illness. This is accomplished by providing care to a diverse population of patients presenting with neurological illnesses. The resident will assume an ascending level of responsibility based upon maturation of knowledge, skills and attitudes applicable to the educational goals of this experience. The resident will assume a leadership role for education and patient care. With appropriate faculty supervision, the resident function as an ‘attending physician in training’ and take a leadership role in education and patient care. Specific educational goals for this experience include:
• A practical experience in obtaining an orderly and detailed history from the patient, in conducting a thorough general and neurological examination, and in organizing and recording data
• An understanding of the indications for and the limitations of clinical neurodiagnostic tests and their interpretation
• The ability to correlate information derived from neurodiagnostic studies with the clinical history and examination in formulating a differential diagnosis and management plan
• Participation in the evaluation of and decision making for patients with disorders of the nervous system requiring surgical management
• Participation in the management of patients with a psychiatric or neuro-psychiatric disorders
• Participation in the management of the patient with acute neurological disorders in the medical intensive care unit
• To better understand the principles of bioethics and the provision of appropriate and cost-effective evaluation and treatment of patients with neurologic disorders
• Participation in end-of-life palliative care including adequate pain relief and psycho-social support and counseling for family members about these issues
3rd Year Resident
• Responsible for the overall care of all patients on General Neurology Service.
• Supervise procedures (i.e. lumbar punctures), and provide bedside and didactic teaching to junior neurology residents, interns, and students.
• Write a brief daily note for each patient that summarizes the clinical findings and focuses on diagnostic steps and disease management.
• Neurologic Examination: Senior residents should demonstrate in a one on one setting a complete neurological examination. Subsequent to that instruction, the senior resident should observe the junior resident perform at least two complete neurological examinations over the course of the rotation. Senior residents should provide feedback and instruction based on this observation.
• Didactic Teaching: Senior residents lead morning report four days weekly. Topics are focused on the evaluation and management of patients presenting with acute neurologic illness. Interns rotating on the neurology service attend the same lecture series and schedule as students on the Third Year Neurology Clerkship. This curriculum has recently undergone a complete revision and provides a very broad based overview of neurology on a rotating schedule, appropriate for interns.
• Patient Care: Senior residents teach and demonstrate the delivery of care that is compassionate and appropriate for the condition requiring hospitalization. They should highlight important clinical findings and provide appropriate neuroanatomic and neuroscience correlation.
• Documentation: Review and provide guidance on documentation including admission, daily notes, and discharge summaries. Provide feedback so that residents are able to evaluate their own learning in an effort to improve patient care.
• Medical Knowledge: Encourage reading in standard texts and medical literature to enhance the acquisition of medical knowledge in the neurosciences.
• Professionalism: During the course of the rotation, demonstrate, observe, and provide feedback to the resident to insure adherence to ethical principles, sensitivity to diverse patient populations, and adoption of professional responsibilities.
• Systems-based Practice for Interns Rotating on the Inpatient Service: Encourage residents to effectively call on system resources to provide optimal care. Encourage discussions help residents better understand the role of a neurologist in the larger context of our healthcare system, especially in the area of their effort to aid other physicians in providing optimal care and value.
• Round daily with the attending physician.
• Contact the chief resident or attending physician if there are questions regarding patient care and/or responsibilities.
Attending Faculty Responsibilities
• Hold supervised teaching rounds at least five days per week. Residents present cases with their diagnosis and therapeutic plans during these rounds.
• Identify teaching points from the inpatient clinical caseload.
• Assign appropriate reading and research to residents and students.
• Conduct follow-up discussions at the beginning or end of rounds.
• Faculty members are encouraged to schedule brief presentations by students and residents, reviewing assigned topics.
• Encourage and monitor senior residents in their supervision of junior residents, interns, and students.