Goals and Objectives CLINICAL NEUROPHYSIOLOGY FELLOWSHIP

Transcription

1 Goals and Objectives CLINICAL NEUROPHYSIOLOGY FELLOWSHIP The clinical neurophysiology fellowship program provides a broad exposure to electrodiagnostic tests and patients with a variety of neurological disorders. It consists of two tracks, EEG/Epilepsy and EMG/Neuromuscular disorders that emphasize different areas of clinical neurophysiology depending on the primary interests of the fellow. A third track is also available to our fellows for education and clinical training in sleep issues Fellows wishing to specialize primarily in sleep are now in a separate accredited program The rotations for residents enrolled in the epilepsy track consists of two months of EEG and evoked potential training, four months of adult inpatient epilepsy monitoring, two months of pediatric inpatient epilepsy monitoring, two months of sleep medicine training (or two months of EMG if the resident prefers) and two months of intraoperative monitoring. The rotation for residents enrolled in the neuromuscular track consists of ten months of neuromuscular training and two months of EEG and evoked potential training (or two months of sleep medicine training). All Clinical Neurophysiology fellows are required to attend the clinical neurophysiology didactic lectures every Wednesday morning from 10-11am in the EEG conference room (1B342 UH), and all are required to take the RITE examination for the Added Qualifications in Clinical Neurophysiology offered by the APBN. Key: MK Medical Knowledge C Communication PC Patient Care P Professionalism PBL Practice Based Learning SBP System Based Practice Goals and Learning Objectives for the EEG Rotation are: 1. To acquire the skills needed to independently interpret routine adult electroencephalograms. 2. To become proficient in interpreting pediatric and neonatal electroencephalograms. 3. To gain experience and skill in interpreting emergency portable encephalograms in an inpatient and intensive care setting. 4. To be exposed to and learn diagnostic recording in short-term (1-6 hour) outpatient EEG monitoring. 5. To acquire skills and experience in the interpretation of visual, auditory, and somatosensory evoked potential outpatient recordings. 6. Every EEG and Evoked Potential study has to be reviewed page by page and staffed with an attending physician. The residents will compare their own preliminary thoughts with that of the attending physician. (PBL, MK) 7. Residents are expected to communicate the results of all inpatient EEGs and any unexpected findings that might change outpatient treatment at the time the EEGs are interpreted. (P,C,SBP) 8. Residents are expected to complete reports within 24 hours of the interpretation, and have high professional standards. (P,C) 9. Residents are expected to show signs of initiative in self-education.

2 Goals and Objectives for Outpatient Epilepsy Clinics are: 1. To improve performance and interpretation of the neurologic examination for patients with epilepsy. (PC,PBL) 2. To improve ability to elicit histories from patients, interpret information provided, and communicate effectively with patients and family members. (PC,C) 3. Learn about the pharmacokinetics and side effects of the various antiepileptic drugs. 4. Learn how to initiate and titrate antiepileptic drugs in patients with newly diagnosed epilepsy and for those with medically refractory seizures. (MK,PC) 5. Learn to access available data needed to practice evidence-based medicine. Fellows will be encouraged to continue their own process of self-education. (MK,PBL) 6. Learn careful and timely documentation of history, examination and treatment plan. (P,C) 7. Improve skills in coordinating care: this would include providing continuous care via telephone patients. (SBP,P) 8. Improve ability to understand and accept diversity in cultures, lifestyles and coping strategies a focus on improving overall quality of life for each patient. (P,C,PC) 9. Appropriately code new patients on return visit billing with supervision by attending physician if needed (SBP) 10. Take self-assessment test for social work support and pharmaceutical support services. (SBP) Goals and Objectives for the Adult Epilepsy Rotation are: 1. To know how to use digital EEG including the appropriate use of montage reformatting. 2. Learn to interpret adult inter-ictal EEGs. Know the clinical significance of inter-ictal EEG findings. (MK,PC) 3. Learn to interpret ictal EEG recordings. 4. Learn how to interpret intracranial recordings including depth and subdural electrode recording. 5. Learn how to perform intra and extra-operative functional mapping in patients with brain lesions and patient with epilepsy. (MK,PC,C) 6. Learn how to perform neurologic and EEG assessment during the WADA procedure (MK,PC) 7. Understand what information the WADA procedure provides in the pre-surgical evaluation (MK,SBP) 8. Understand how to use the neuropsychological assessment in the pre-surgical evaluation of refractory epilepsy patients. (MK,PC) 9. Know how to identify seizure semiology and its localizing and lateralizing significance. (MK,PC) 10. Know the clinical features, risk factors and prognosis of psychogenic seizures. Fellows will also learn to present the diagnosis of psychogenic seizures while on this rotation, and get feedback from attendings. (MK,PBL,PC) 11. Know the differential diagnosis of seizure disorders. 12. Learn to diagnose, classify and treat seizure disorders (PC,MK) 13. Know how to identify and treat acute status epilepticus. (PC,SBP) 14. Learn how to interpret MRI, Ictal SPECT and FDG-PET studies in patients with refractory epilepsy. 15. Every diagnostic and presurgical study has to be reviewed and staffed with an attending physician (MK,C,PBL) 16. Every patient seen in the clinic has to be discussed and staffed with an attending physician. (PC,PBL)

3 17. Generate a complete report of the electrographic findings that is available within 7 days of discharge (a summary of this information will be dictated in the resident discharge summary, available within 24 hours). (P,C) Goals and Objectives for the Investigational Drug Trials Clinic are: 1. To learn how to evaluate patients with medically refractory partial epilepsy. (MK,P,C) 2. Learn the design and rationale of various adjunctive and monotherapy trials with newer antiepileptic drugs. (SBP,MK) 3. Learn about the basics of investigational review boards, informed consents, and the ethics of investigational drug trials. (SBP,MK) 4. Learn the pharmacokinetics and safety of a number of newer antiepileptic drugs. 5. Learn how to complete information for case report books, seizure diaries, and adverse event forms. (P,C) 6. The fellows are expected to communicate well with staff and patients and understand the process of discussing informed consent with a patient. (C) 7. Every patient evaluated in the Investigational Drug Trial Clinic has to be discussed and staffed with an attending physician. (PBL,PC) Goals and Objectives for the Pediatric Inpatient Monitoring Rotation are: 1. To learn about pediatric epilepsy syndromes especially those that are unique to the pediatric age group. 2. Understand the issues involved in decisions regarding initiation and termination of treatment for epilepsy in children (MK,PC) 3. Learn normal and abnormal EEG patterns in childhood and understand the maturation of the EEG. 4. Learn ictal recordings and semiologies in children admitted for diagnostic and long-term CCTV- EEG monitoring. 5. Interpret STM studies and 24 hour ambulatory studies. Review with an attending and communicate to referring service same day. (MK,P,C) 6. Learn how to incorporate historical data, findings on neurologic examination, interictal and ictal EEG recordings, neuro-radiological findings, neuro-psychiatrical evaluation in order to formulate a treatment plan including surgical treatment for children with medically refractory epilepsy. (PC,MK,SBP) 7. Understand the social and cultural issues involved in the treatment of diverse pediatric patients with these illnesses and their families, and be able to communicate and coordinate care effectively. (C,P,SBP) 8. Every diagnostic and presurgical study has to be reviewed and staffed with an attending physician. (MK,PBL) Goals and Objectives for the Sleep Laboratory Rotation are: 1. Learn how to interview, examine, test, diagnose, and treat patients with sleep-related complaints. (MK,PC) 2. Acquire familiarity with sleep and circadian rhythm disorders, including their symptoms, signs, causes, consequences, manifestations on tests, and treatment. (MK,PC) 3. Gain experience in interpretation of tests used to evaluate patients with sleep disorders. (MK,SBP) 4. Every sleep related study has to be reviewed and staffed with an attending physician. (MK,PBL) 5. Every patient seen in the clinic has to be discussed and staffed with an attending physician. (MK,PBL,PC)

4 6. The fellows will be able to communicate effectively with patients, technologists and referring physicians. (C,P) 7. The fellows will show evidence of initiative in self-education. 8. The fellows will demonstrate professionalism by following up on results and further tests in a timely fashion. (P) 9. Improve skills in coordinating care: this would include providing continuous care via telephone patients. (SBP,C) 10. Improve ability to understand and accept diversity in cultures, lifestyles and coping strategies a focus on improving overall quality of life. (C,PC) Goals and Objectives for the Electromyography/Neuromuscular Rotation are: 1. To learn how to interview, examine, test, diagnose, and treat patients with neuromuscular-related complaints. (MK,PC) 2. To provide exposure to electrodiagnostic studies, diagnosis, evaluation and treatment of neuromuscular disorders in adults and children. 3. Under attending supervision, to perform and interpret at least 200 electrodiagnostic evaluations. 4. Every electrodiagnostic study has to be reviewed and staffed with an attending physician. (PBL) 5. Every patient seen in the clinic has to be discussed and staffed with an attending physician. (PC,PBL) 6. The fellows will be able to communicate effectively with patients, technologists and referring physicians. (C) 7. The fellows will show evidence of initiative in self-education. 8. The fellows will demonstrate professionalism by following up on results and further tests in a timely fashion. (P,C) 9. Improve skills in coordinating care: this would include providing continuous care via telephone patients. (SBP,P) 10. Improve ability to understand and accept diversity in cultures, lifestyles and coping strategies a focus on improving overall quality of life. (C,PC) Goals and Objectives for the Intraoperative Monitoring Rotation are: 1. To learn how to interpret intraoperative evoked potential and EEG waveforms during spinal and intracranial surgery. 2. To communicate effectively with surgeons, technologists and faculty in a OR setting. (C,P) 3. The fellows will read about intraoperative motor mapping and learn about indications and contraindications for its use. (MK,PC) 4. The fellows will exhibit initiative in getting to as many cases as possible specifically including pediatric cases. (P) 5. Fellows should learn principles of anesthesia in cases of EP and EEG monitoring in the OR. 6. To learn about coordination of preoperative and postoperative care on a variety of services including surgery, anesthesia & nursing. (SBP) 7. Faculty are responsible for all acute and on-site formal interpretations of studies, fellows will be available for review to understand the need for urgent intervention. (MK,PC)

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