Goals and Objectives: Postgraduate Year 3 (PGY3):

 

The goals for the PGY3 include:

• To develop more refined neurological formulation and management skills in the inpatient and outpatient setting.

• To begin managing complex patients with more independence.

• To provide supervision to the junior residents, rotating residents, and medical students.

• To become more proficient at interpreting and performing electrophysiological diagnostic testing (electroencephalogram, electromyogram, nerve conduction, autonomic testing, etc).

• To consider clinical care from a multi-systems perspective.

 

PGY3 Competencies:

 

Patient Care:

• Obtains a complete, relevant, and organized neurologic history

• Performs a relevant neurological exam incorporating some additional appropriate maneuvers.

  • Visualizes papilledema

  • Accurately performs a neurological exam on the comatose patient

• Individualizes treatment for specific patients

• Initiates management for neurologic emergencies and triages patient to appropriate level of care

• Movement Disorders:

  • Diagnoses and manages common movement disorders

  • Identifies movement disorder emergencies

• Neuromuscular Disease:

  • Diagnoses and manages common neuromuscular disorders

  • Manages neuromuscular disorder emergencies

  • Interprets results of NCS/EMG testing in context of clinical presentation

• Cerebrovascular Disorders:

  • Identifies specific mechanism of patient's cerebrovascular disorder

  • Appropriately refers for interventional or surgical evaluation

  • Manages common cerebrovascular disorders including appropriate use of thrombolytics

• Cognitive/Behavioral Disorders:

  • Diagnoses and manages common cognitive/behavioral disorders, including cognitive effects of traumatic brain injury

  • Manages behavioral complications of cognitive/behavioral disorders

  • Appropriately refers for neuropsychological testing in evaluating patients with cognitive/behavioral disorders

• Demyelinating Disorders:

  • Recognizes uncommon demyelinating disorders

  • Manages acute presentations of demyelinating disorders

• Epilepsy:

  • Diagnoses and manages common seizure disorders and provides antiepileptic drug treatment

  • Diagnoses non- convulsive status epilepticus

  • Manages convulsive and non-convulsive status epilepticus

• Headache Syndromes:

  • Recognizes uncommon headache syndromes

  • Diagnoses and manages headache emergencies

• Systemic Disease:

  • Recognizes uncommon neurologic manifestations of systemic disease

• Child Neurology:

  • Obtains a complete and age-appropriate neurologic history of infants and children

  • Performs a complete and age-appropriate neurological examination of infants and children

  • Diagnoses common child neurologic disorders

• Neuro-Oncology:

  • Provides differential diagnosis of brain or spine mass

  • Identifies neurologic complications due to cancer or the treatment of cancer

• Psychiatry:

  • Recognizes when a patient's neurological symptoms are of psychiatric origin

  • Recognizes when a patient's psychiatric symptoms are of neurologic origin

  • Identifies major side effects of psychiatric medications

• Neuro-Imaging:

  • Describes abnormalities of the brain and spine on MR and CT

  • Identifies major abnormalities on angiography

• Electroencephalography (EEG):

  • Describes normal EEG features of wake and sleep states

  • Recognizes EEG patterns of status epilepticus

  • Recognizes common EEG artifacts

• Nerve Conduction Studies (NCS)/Electromyography (EMG):

  • Describes NCS/EMG data

  • Lists NCS/EMG findings in common disorders

• Lumbar Puncture:

  • Performs lumbar puncture under direct supervision

 

Medical Knowledge:

• Localization:

  • Accurately localizes lesions to specific regions of the nervous system

• Formulation:

  • Synthesizes information to focus and prioritize diagnostic possibilities

  • Correlates the clinical presentation with basic anatomy of the disorder

• Diagnostic Investigation:

  • Individualizes diagnostic approach to the specific patient

  • Accurately interprets results of common diagnostic tests

 

Systems Based Practice:

• Makes clinical decisions that balance cost and risk benefit ratios

• Describes potential sources of system failure in clinical care such as minor, major, and sentinel events

 

Practice Based Learning and Improvement:

• Identify strengths, deficiencies, and limits in one's knowledge and expertise.

• Set learning and improvement goals Identify and perform appropriate learning activities.

• Use information technology to optimize learning.

• Locate, appraise, and assimilate evidence from scientific studies related to the patient's health problems

• Incorporates feedback.

• Uses scholarly articles and guidelines to answer patient care issues.

 

Professionalism:

• Compassion, integrity, accountability, and respect for self and others.

• Knowledge about, respect for, and adherence to the ethical principles relevant to the practice of medicine, remembering in particular that responsiveness to patients that supersedes self-interest is an essential aspect of medical practice.

• Demonstrates compassionate practice of medicine, even in context of disagreement with patient beliefs.

• Incorporates patients' socio-cultural needs and beliefs into patient care.

• Demonstrates appropriate steps to address impairment in colleagues.

• Analyzes and manages ethical issues in straightforward clinical situations.

 

Interpersonal and Communications Skills:

• Relationship development, teamwork, and managing conflict.

• Information sharing, gathering, and technology.

• Manages conflict in complex situations.

• Uses easy-to-understand language in all phases of communication.

• Effectively communicates the results of a neurologic consultation in a timely manner.

• Effectively gathers information from collateral sources when necessary.

• Demonstrates synthesis, formulation, and thought process in documentation.