Department of Neurology

Veterans Administration Senior Rotation

The educational objectives of the Senior Resident Rotation at the Nashville Veterans Administration Hospital are:

1) To acquire the knowledge, skills, and attitudes to perform a focused neurologic exam

2) To 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. 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 [patient care, medical knowledge]

· An understanding of the indications for and the limitations of clinical neurodiagnostic tests and their interpretation [patient care, medical knowledge, systems-based practice]

· The ability to correlate information derived from neurodiagnostic studies with the clinical history and examination in formulating a differential diagnosis and management plan [patient care, medical knowledge]

· Participation in the evaluation of and decision making for patients with disorders of the nervous system requiring surgical management [patient care, medical knowledge, communication skills]

· Participation in the management of patients with psychiatric or neuro-psychiatric disorders [patient care, medical knowledge, interpersonal and communication skills]

· Participation in the management of the patient with acute neurological disorders in the medical intensive care unit [patient care, medical knowledge, interpersonal and communication skills]

· To better understand the principles of bioethics and the provision of appropriate and cost-effective evaluation and treatment of patients with neurologic disorders [practice based learning and improvement, professionalism, systems-based practice]

· Participation in end-of-life palliative care including adequate pain relief and psycho-social support and counseling for family members about these issues [patient care, professionalism, interpersonal and communication skills]

Service Schedule

Rounds on consultation patients will occur as soon as inpatient service round have concluded.

Morning rounds are expected to conclude at 10:50 on Tuesdays, 11:50 on other weekdays in order to facilitate residents ability to attend didactic conferences.

Resident Responsibilities
Senior (2^nd or 3^rd Year) Resident: The resident on this rotation is principally responsible for accepting all neurology consultations within the VA Medical Center (inpatient services, triage, and ambulatory clinics) during daytime hours. As the senior most resident of the team, the senior resident will take a leadership, educational, and supervisory role concerning medical students, medicine/psychiatry interns, and first year neurology residents.

· Staff all patients seen as consults with the attending on service. [patient care]

· Follow all inpatient consults initially seen by the consult resident or by the night call resident(s) as needed, as determined by the resident and attending. [patient care, medical knowledge, interpersonal and communication skills, systems-based practice]

· Attend all General Neurology Outpatient Clinics (See “Ambulatory VA rotation” goals and objectives), and assist in a supervisory role to students and junior residents. The resident may be excused from the clinic only for emergency consultations. [patient care, medical knowledge, practice-based learning and improvement, interpersonal and communication skills, professionalism]

· Interpret and dictate reports for all EEGs and sleep studies performed at the VAMC during the rotation. [patient care, medical knowledge, systems-based practice]

· As time permits, assist with neurophysiology studies (e.g. EMG) performed in the VA diagnostics lab. [patient care, medical knowledge]

· Supervise procedures (i.e. lumbar punctures), and provide bedside and appropriate didactic teaching. [patient care, medical knowledge, practice-based learning and improvement, interpersonal and communication skills]

· Cover the duties of the 1st year neurology resident assigned to the VA General Neurology Service during absence due to days off, continuity clinic or duty hours limits.

· At the conclusion of service time complete comprehensive evaluations on the attending, junior resident, intern, and student performances [practice-based learning and improvement]

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. [medical knowledge, practice-based learning and improvement, interpersonal and communication skills]

· Identify teaching points from the inpatient clinical caseload. [medical knowledge, practice-based learning and improvement]

· Assign appropriate reading and research to residents and students. [medical knowledge]

· Conduct follow-up discussions at the beginning or end of rounds. [medical knowledge]

· Faculty members are encouraged to schedule brief presentations by students and residents, reviewing assigned topics. [medical knowledge, practice-based learning and improvement, interpersonal and communication skills]

· Encourage and monitor teaching by senior residents to junior residents, interns, and medical students. [practice-based learning and improvement]

· Complete rounds by 10:50 on Tuesdays, 11:50 on other weekdays, so as to facilitate residents ability to attend scheduled didactics.

· At the conclusion of service time complete comprehensive evaluations on the resident, intern, and student performances [practice-based learning and improvement]