Competency Based Curriculum

Program: Internal Medicine

Program Director: Mohamed Siddique, MD, FACP

Specialty/Course: Neurology Rotation PGY2/3

Curriculum Coordinators: 1. Rajika Munasinghe, MD, FACP

Administrative Support: Robin Pastorius

Date Revised: _______ 02/15/2009____________________

Competency	Objectives Specific	Educational Experiences Knowledge/ Skills Integration/Application	Assessment Tools
Patient Care That is compassionate, appropriate, and effective for the treatment of health problems and the promotion of health	To experience and develop competence in bedside evaluation of the the spectrum of disorders commonly seen in a neurology service and learn how to evaluate, workup and treat such conditions under the supervision of board certified neurologist.	In-patient neurology consultative service: Neurology cases morning report. Ambulatory office based neurology.	Mid and end of rotation evaluation by supervising attending. Performance in monthly and annual in-training examinations.
Medical Knowledge About established and evolving biomedical, clinical, epidemiological and social-behavioral sciences and the application of this knowledge to patient care	To learn the pathos-physiology, epidemiology, clinical presentation, laboratory and radiographic evaluation and management of important disorders related to neurology. Detailed history Taking in Neurology Patients along with a full bedside neurologic examination including all Physical Examination Mental status testing, Language testing, Tests of orientation and visual spatial abilities, Cranial nerve examination Motor system, Gait, Coordination, Sensory Become familiar with neuroanatomy and be able to predict the location of lesion based on the type of deficit. Learn different modalities of Neuroimaging available, their advantages and disadvantages along with indications. Learn the uses of different electroneurodiagnostic procedures in the overall management of neurological disorders	Topic based didactic lectures and case based discussions encountered on consultative rounds in the hospital and office based practice to for common neurological conditions. Neurology cases morning reports. Neurology grand rounds	Mandatory participation in educational activity during rotation and evaluation by rounder of resident’s knowledge and clinical skills. Performance at monthly and annual in-training examinations. Chart reviews and audits by attending physicians and chief medical residents to determine quality of care.
Interpersonal and Communication Skills That result in effective information exchange and collaboration with patients, their families, and other health professionals	To communicate effectively with patients, families and the public, as appropriate, across a broad range of socioeconomic and cultural backgrounds.To communicate effectively with physicians, other health professionals and health related agencies. To work effectively as a member or leader of a health care team or other professional health group. To maintain comprehensive, timely and legible medical records	To observe and learn how to communicate the evaluation and management of patients with neurologic disease during rounds with attending physicians and multi-disciplinary team members. To interact and communicate with health care personnel involved in the care of patients with neurologic disease including the following. Radiology: ultrasound and computerized tomography, Biochemistry and serologic laboratories; Speech support service; Social services: Surgery including vascular surgery, Neurosurgery and infectious disease services.	Attending and consultant physician evaluate the trainees interpersonal and communication skills and effectiveness of providing care based on direct observation during rounds, reviewing standard and quality of care and feedback provided by patients and ancillary staff during the middle of the rotation and the end of the rotation
Professionalism As manifested through a commitment to carrying out professional responsibilities, adherence to ethical principles, and sensitivity to a diverse patient population	To demonstrate compassion, respect and integrity for others. To respect patient privacy and autonomy and show responsiveness to patient needs that supersedes self-interest To demonstrate accountability to patients, society and the profession an show sensitivity and responsiveness to a diverse patient population, including but not limited to diversity in gender, age, culture, race, religion, disabilities, and sexual orientation	Incorporate discussion on ethical principles, standards of care and professional conduct as pertinent to the care of patients with neurologic disease. To promote the highest standards of professional care though complete and through assessment of patient, thoughtful and complete workup, and compassionate and caring approach to patients with neurologic disease. Residents receive training in medical ethics and professionalism in the form a dedicated set of conferences delivered at noontime and during the multidisciplinary medicine course.	Evaluate resident performance by direct observation and supervision during rounds and feedback from patients and ancillary staff.
Practice-Based Learning and Improvement That involves investigation and evaluation of their own patient care, appraisal and assimilation of scientific evidence, and improvements in patient care and to continuously improve patient care based on constant self-evaluation and life-long learning	The resident can systemeatically analyze practice using quality improvement methods and implement changes with the goal of practice improvement. The resident can identify strengths, deficiencies, and limits in one’s knowledge and expertise, incorporate formative evaluation feedback into daily practice and set learning and improvement goals. The resident will be able to locate, appraise and assimilate evidence from scientific studies on neurologic disorders. The resident is proefficient is using information technology to optimize learning The resident participates in the education of patients, families, students, residents and other health professionals.	Residents receive specific instruction on clinical epidemiology, statistics and evidence-based medicine during the multi-disciplinary medicine rotation. Residents are required to review a selected topic using principals of evidence-based medicine and develop a critically appraised review during the above month. PGY2 and 3 residents present a topic review at noon conference as part of the resident grand rounds conference series including topics in nephrology. Residents present a review and critique of an article relevant to internal medicine practice including nephrology as part of the journal club conference series.	Evaluation during rounds and case discussion of resident’s performance in self directed learning and capabilities of doing literature searches and critically reviewing selected publications using evidence based medicine concepts. Presentations at regional and national meeting on case reports and research presentations developed during training. Faculty members would review the resident presentations at resident grand rounds and journal club.
Systems-Based Practice As manifested by actions that demonstrate an awareness of and responsiveness to the larger context and system for health care and the ability to effectively call on system resources to provide care that is of optimal value	Understand, access and utilize the resources, providers and systems necessary to provide Optimal care for patients with neurologic disease with special emphasis for reimbursement and coverage of inpatient and outpatient rehabilitative services. To incorporate considerations of cost awareness and risk-benefit analysis in patient and/or population based care as appropriate To advocate of quality patient care and optimal patientcare systems To work in interprofessional teams to enhance patient safety and improve patient care quality and participate in identifying system errors and implementing potential systems solutions	Incorporate discussion on systems based practice related to admission criteria, reimbursement for services and referral to community and state sponsored resources for patients with neurologic diseases. Provide an opportunity for trainees to interact with a multidisciplinary team of professionals experienced in providing care for patients with neurologic disease. Trainees are required to participate in a dedicated series of conferences and seminars delivered throughout the year related to managed care, reimbursement and practice management.	Evaluated resident knowledge on resources available to provide care for patients with neurologic disease. Observe and evaluate resident performance in resource management, interaction with multidisciplinary team members and facilitating appropriate inpatient and ambulatory care of patients with neurologic diseases

Resource Materials

Recommended Textbooks:

1. Harrison’s Principles of Internal Medicine, Fauci, A., 17^th edition. McGraw-Hill, 1997

2. Textbook of Neurology by Victor & Adams, 2001.

3. MKSAP.

Relevant Practice Guidelines: Available at www.guidelines.gov

Topics to be covered during Neurology rotation as part of lectures/Cases/morning reports/grand rounds

Headache,

Cerebral vascular disease,

Dementia,

Movement disorders.

Demyelinating disorders,

Epilepsy,

Altered states of consciousness including coma and toxic and metabolic encephalopathies.

Infections of the Nervous system,

Neurological emergencies including head trauma, acute cord compression, acute stroke

Neuromuscular diseases,

Diseases of the spine.