Department of Neurology

The following five rotations will comprise seven months of required training in the outpatient or inpatient setting for Adult Neurology residents in the first, second or third year. The order of the rotations can be selected by the resident and chief resident to accommodate the individual resident when planning their research experience or elective rotations.

Neuropathology/Neuro-oncology
The educational objectives of the Neuropathology/Neuro-oncology rotation at the VUH are for the second and third year Neurology resident to acquire the knowledge, skills, and attitudes to perform a focused neurological exam and diagnose and manage a broad range of cancers of the nervous system in both children and adults. The resident will participate in two one-half day adult neuro-oncology or child neuro-oncology clinics. During this rotation, the second or third year Neurology resident will participate in intensive review and study of neuropathology. Residents will participate in lectures and reading of neuropathological specimens as well as attend weekly brain cutting sessions. The resident will assume an ascending level of responsibility (with appropriate faculty supervision) based upon maturation of knowledge, skills and attitudes applicable to the educational goals of this experience. The specific educational goals for this experience include:
• A practical experience in the diagnosis and management of cancers of the nervous system in both children and adults
• A practical experience in obtaining an orderly and focused history from the patient, in conducting a focused neurological examination, and in organizing and recording data
• To better understand the principles of bioethics and the provision of appropriate and cost-effective evaluation and treatment of patients with cancers of the nervous system
• Participation in end-of-life palliative care including adequate pain relief and psycho-social support and counseling for family members about these issues
• An intensive review and study of neuropathology
• A practical experience in the gross, histological, and immunohistochemical examination of tissue or fluids submitted for neuropathological investigation

Resident Responsibilities
2nd Year Resident
The resident will participate in those activities sponsored by the faculty in Neuropathology (lectures, analysis of neuropathological specimens, etc.) Attendance at the weekly brain cutting sessions and weekly muscle biopsy conference is required. In addition, the resident will attend two half-day adult neuro-oncology clinics.
Attending Faculty Responsibilities
• Supervise residents in the neuropathology laboratory and provide instruction on the collection, processing, and analysis of specimens.
• Supervise residents in the neuro-oncology outpatient clinics, in which the resident interviews and examines patients, presents them to the attending, and the attending reviews the history, physical findings, impression, and treatment plan with the resident.
• Identify teaching points from pathology specimens or outpatient 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 to junior residents and junior residents to student teaching.

Neuroradiology
The educational objectives of the neuro-radiology selective at the VUH are for the second or third year Neurology residents to acquire the knowledge and skills necessary to interpret neuroradiologic investigations by participating in the interpretation of neuroradiologic investigations from a diverse population of adult and pediatric patients presenting with a broad range of neurologic illness. The resident will assume an ascending level of responsibility (with appropriate faculty supervision) based upon maturation of knowledge, skills and attitudes applicable to the educational goals of this experience. The specific educational goals for this experience include:
• A practical experience in the interpretation of a broad range of neuroradiologic investigations
• Acquiring the ability to formulate a differential diagnosis of radiographic abnormalities identified on neuroradiologic investigations
• An understanding of the indications for and the limitations of clinical neuroradiologic tests and their interpretation
• The ability to correlate information derived from neuroradiologic studies with the clinical history and examination in formulating a differential diagnosis and management plan
• The ability to identify normal variance as well as abnormalities identified on neuro-radiologic investigations

Resident Responsibilities
2nd Year Resident
The resident will have the opportunity to read daily neuroimaging studies with the Neuroradiology faculty for eight half-days each week. This leaves a half-day for his/her continuity clinic and a half-day for personal study.

Epilepsy/Electroencephalography (Two Months)
The educational objectives of the Epilepsy/EEG selective at the TVC and VUH are for the second or third year adult Neurology resident to acquire the knowledge, skills and attitudes to perform a focused neurologic exam, interpret EEGs, and to diagnose and provide management of acute and non-acute epilepsies by providing care to a diverse yet defined, population of adult and pediatric patients presenting with a broad range of epilepsies. The resident will participate in 2 half day epilepsy clinics per week and participate in daily training for reading EEGs. Additionally, residents will participate in the care of inpatients on the Epilepsy service. The resident will assume an ascending level of responsibility (with appropriate faculty supervision) based upon maturation of knowledge, skills and attitudes applicable to the educational goals of this experience. The specific educational goals for this experience include:
• A practical experience in the diagnosis and management of epilepsies.
• A practical experience in obtaining an orderly and focused history from the patient, in conducting a focused neurological examination, and in organizing and recording data
• Proficient use of all anticonvulsants
• A practical experience in the management of status epilepticus and refractory epilepsy
• To better understand the principles of bioethics and the provision of appropriate and cost-effective evaluation
• A comprehensive review of the basic clinical neurophysiology that provides the foundation for the acquisition and interpretation of EEGs
• A practical experience in performing an EEG
• The interpretation of EEGs, formulation of the differential diagnoses based on the results of an EEG, and the correlation of the information derived with the clinical history and examination in formulating a management plan

Resident Responsibilities
1st Year Resident
The resident will spend the first half of the month in the EEG lab and the second half of the month in the Epilepsy Monitoring Unit (EMU).

Resident responsibilities on this rotation include the following:

• While in the EEG lab, read all ambulatory and inpatient EEGs (except long-term studies) with the fellow prior to attending rounds.
• Create a preliminary report on each study prior to attending rounds, which will be held each weekday afternoon in the EEG reading room.
• On the EMU rotation, report to the EMU ward (4th floor Round Wing) at 8 AM each Monday morning. There, he/she will be assigned a patient to follow for the week by the supervising fellow. Patients are typically scheduled for admission on Monday and discharged by Thursday or Friday.
• Responsible for performing and documenting (via StarChart/StarPanel) a complete H&P as well as daily progress notes.
• Once the H&P is completed, present the patient to one’s supervising fellow or attending for final recommendations, especially regarding antiepileptic medications.
• Responsible for all orders, including admission orders, via WizOrder.
• Each day, review the patient’s continuous EEG recording with any correlating video and create a report.
• Attending rounds are typically held each afternoon where the resident will present his/her patient to the team.
• Finally, residents are responsible for the discharge orders and Discharge Summary at the end of the patient’s hospital course.

The Neuromuscular Disease - Electromyography/Nerve Conduction Studies (Two Months)
The educational objectives of the Neuromuscular/EMG/NCS rotation are for the second or third year adult Neurology resident to acquire the knowledge, skills, and attitudes to perform a focused neurological exam, EMG, NCS, and to diagnose and provide long-term management of non-acute neuromuscular illness by providing care to a diverse, yet defined population of adult and pediatric patients presenting with a broad range of neuromuscular illnesses. The resident will attend 1 - 2 half-day neuromuscular disease ambulatory clinics. The resident will assume an ascending level of responsibility (with appropriate faculty supervision) based upon maturation of knowledge, skills and attitudes applicable to the educational goals of this experience. The specific educational goals for this experience include:
• A practical experience in the diagnosis and management of neuromuscular disease in both children and adults
• A practical experience in obtaining an orderly and focused history from the patient, in conducting a focused neurological examination, and in organizing and recording data
• To better understand the principles of bioethics and the provision of appropriate and cost-effective evaluation and treatment of patients with neuromuscular disease
• Participation in end-of-life palliative care including adequate pain relief and psycho-social support and counseling for family members about these issues
• A comprehensive review of the basic clinical neurophysiology that provides the foundation for the acquisition and interpretation of EMG/NCVs
• A practical experience in performing and interpreting EMG/NCVs
• A practical experience in the interpretation of EMG/NCVs, formulation of the differential diagnoses based on the results, and the correlation of the information derived with the clinical history and examination in formulating a differential diagnosis and management plan

Resident Responsibilities
2nd Year Resident
The resident will participate in all activities necessary to perform, interpret, an report EMG/NCV studies. The list of an updated clinic schedule can be obtained from the chief resident.

Psychiatry
The educational objectives of the Psychiatry rotation at the Vanderbilt affiliated facilities are for the neurology resident to acquire the knowledge, skills, and attitudes to perform a focused psychiatric exam and become better able to diagnose and manage a broad range psychiatric illness children or adults. The resident will participate in a month-long rotation that may include inpatient and outpatient experiences under the direction of a board certified psychiatrist. During this rotation, the neurology resident will participate in an intensive review and study of psychiatry. Residents will participate in lectures and conferences at the direction of the psychiatry residency program director. The resident will assume an ascending level of responsibility (with appropriate faculty supervision) based upon maturation of knowledge, skills and attitudes applicable to the educational goals of this experience. The specific educational goals for this experience include:
• A practical experience in the diagnosis and management of psychiatric illness in either children or adults
• A practical experience in obtaining an orderly and focused history from the patient, in conducting a focused psychiatric examination, and in organizing and recording data
• To better understand the principles of bioethics and the provision of appropriate and cost-effective evaluation and treatment of patients with psychiatric illness
• Participation in psychiatric care including psycho-social support and counseling for family members
• An intensive review and study of psychiatry

Resident Responsibilities
1st Year Resident
• Write a complete history and physical exam note that includes chief complaint, history of present illness, past medical history, allergies, medications, family history, social history, complete review of systems, general medical examination, neurologic examination, psychiatric examination, impression, differential diagnosis, and plan of evaluation, management and treatment.
• Be knowledgeable of all patients under one’s care, including the latest laboratory and/or imaging data.
• Write complete progress notes on all inpatients daily. The neurology resident should independently write a complete daily progress note on every patient that includes patient complaints, physical and neurologic examination, psychiatric examination, medications, laboratory and diagnostic results, impression and plan.
• Never hesitate to contact the senior resident or attending physician if there are questions regarding patient care and/or responsibilities.

Electives
The educational objectives of the elective rotations are for the second and third year adult and child neurology resident to expand their knowledge of the neurosciences through faculty mentored research or structured clinical rotations.
With the approval of the faculty advisor, the resident and faculty mentor may formulate a coherent and comprehensive plan of research or clinical service that becomes an integral part of the second and third year of training and serves to round out the educational experience of the entire program. This may be accomplished through participation in existing rotations at the affiliated hospitals or participating in a faculty-mentored research program in the clinical or basic neurosciences. Elective clinical rotations may include:
• EEG, EMG, Sleep, Neuroradiology, Neurotoxin Injection, and Neurosonology.
• Movement Disorders, Neuroimmunology, Child Neurology, Headache / Neuro-ophthalmology, Neuro-oncology, Neurocritical care, Psychiatry, Neuropathology, General Neurology, Epilepsy, Neuromuscular Disease, Neurorehabilitation, and Autonomic Dysfunction.

Residents may pursue electives at institutions other than those that are affiliated with Vanderbilt University if a similar course study is not available within the program.