Goals and Objectives: Postgraduate Year 4 (PGY4):

 

The goals for the PGY4 include:

• To master the skill in neurological formulation, diagnostic evaluation, and management to enter independent practice sufficiently.

• To mentor junior residents, rotating residents, and medical students.

 

PGY4 Competencies:

 

Patient Care:

• Efficiently obtains a complete, relevant, and organized neurologic history.

• Efficiently performs a relevant neurological exam accurately incorporating all additional appropriate maneuvers.

• Accurately performs a brain death examination.

• Adapts treatment based on patient response.

• Identifies and manages complications of therapy.

• Independently directs management of patients with neurologic emergencies.

• Appropriately requests consultations from a neurologic subspecialist for additional evaluation or management.

• Engage in scholarly activity.

• Movement Disorders:

  • Diagnoses uncommon movement disorders.

  • Appropriately refers a movement disorder patient for a surgical evaluation or other interventional therapies.

  • Manages movement disorders emergencies.

• Neuromuscular Disease:

  • Diagnoses uncommon neuromuscular disorders.

  • Recognizes when tissue biopsy is warranted.

• Cerebrovascular Disorders:

  • Diagnoses uncommon cerebrovascular disorders.

• Cognitive/Behavioral Disorders:

  • Diagnoses and manages uncommon cognitive/behavioral disorders.

• Demyelinating Disorders:

  • Diagnoses uncommon demyelinating disorders

• Epilepsy:

  • Diagnoses uncommon seizure disorders.

  • Appropriately refers an epilepsy patient for surgical evaluation or other interventional therapies.

• Headache Syndromes:

  • Diagnoses and manages uncommon headache syndromes.

• Systemic Disease:

  • Diagnoses and manages uncommon neurologic manifestations of systemic disease

• Child Neurology:

  • Initiates management of common childhood neurologic disorders.

  • Initiates management of common neurologic emergencies in infants and children.

• Neuro-Oncology:

  • Appropriately refers for advanced testing, including biopsy.

  • Manages neurologic complications due to cancer or the treatment of cancer.

• Psychiatry:

  • Diagnoses common psychiatric disorders.

  • Initiates management of psychiatric co-morbidities in patients with a neurologic disease.

• Neuro-Imaging:

  • Interprets MR and CT neuroimaging of brain and spine

• Electroencephalography (EEG):

  • Interprets common EEG abnormalities and creates a report.

  • Recognizes normal EEG variants.

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

  • Interprets NCS/EMG data in common disorders.

  • Describes common pitfalls of NCS/EMG.

  • Formulates basic NCS/EMG plan for specific, common clinical presentations.

• Lumbar Puncture:

  • Performs lumbar puncture without direct supervision

 

Medical Knowledge:

• Localization:

  • Efficiently and accurately localizes lesions to specific regions of the nervous system.

  • Describes advanced neuroanatomy.

• Formulation:

  • Efficiently synthesizes information to focus and prioritize diagnostic possibilities.

  • Accurately correlates the clinical presentation with detailed anatomy of the disorder.

  • Continuously reconsiders diagnostic differential in response to changes in clinical circumstances.

  • Diagnoses brain death.

• Diagnostic Investigation:

  • Explains diagnostic yield and cost-effectiveness of testing.

  • Accurately interprets results of less common diagnostic testing.

  • Recognizes indications and implications of genetic testing.

  • Recognizes indications of advanced imaging and other diagnostic studies.

 

Systems Based Practice:

• Systems thinking, including cost and risk effective practice.

• Work in inter-professional teams to enhance patient safety.

• Incorporates available quality measures in patient care.

• Participates in a team- based approach to medical error analysis.

 

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.

• Completes an appropriate learning plan based upon clinical experience.

• Incorporates appropriate evidence- based information into patient care.

• Understands the limits of evidence-based medicine in patient care.

 

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.

• Mentors others in the compassionate practice of medicine, even in context of disagreement with patient beliefs.

• Mentors others in sensitivity and responsiveness to diverse and vulnerable populations.

• Advocates for quality patient care.

• Analyzes and manages ethical issues in complex clinical situations.

 

Interpersonal and Communications Skills:

• Relationship development, teamwork, and managing conflict.

• Information sharing, gathering, and technology.

• Manages conflict across specialties and systems of care.

• Leads team-based patient care activities.

• Effectively leads family meetings.

• Effectively and ethically uses all forms of communication.

• Mentors colleagues in timely, accurate, and efficient documentation.