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EEG/Clinical Neurophysiology Clinical Neurophysiology/Epilepsy/Sleep Disorders Elective RESIDENT EDUCATION CURRICULUM Description of Rotation The Clinical Neurophysiology/EEG Section of the Department of Neurology has redefined its educational programs for Neurology residents. The following rotations are offered: 1. One-month “basic rotation” mandatory for all Adult Neurology residents and for Pediatric Neurology residents. 2. Additional “level 2” one month rotation including EEG, evoked potentials (EPs) and polysomnography (psg). 3. Advanced EEG-EP-psg elective rotation of up to three consecutive months in the EEG Laboratory for residents interested in learning more about EEG and clinical neurophysiology and those who have a potential interest in fellowship training in EEG/clinical neurophysiology. Participation in this elective requires prior successful completion of the introductory 2 month EEG rotation and requires permission from the EEG section head, based on specific request by the interested resident. The principles of intraoperative monitoring (EEG, EP) will be introduced here 4. Elective in clinical neurophysiology/epilepsy/sleep disorders. This elective month requires permission from the Clinical Neurophysiology/EEG head, based on specific request by the interested resident. Educational Purpose 1. To provide an experience that will allow the resident to increase their knowledge of anatomy of the central nervous system and the clinical presentation and pathophysiology of epilepsy, sleep disorders, and other diagnosable entities. 1 2. To provide an experience that will allow the resident to achieve understanding of electrodiagnostic studies correlating it with the basic science of neurophysiology and clinical presentation. 3. To learn the indications for ordering, diagnostic evaluation and interpretation of EEGs, evoked potentials (visual evoked potentials, brainstem auditory potentials, somatosensory evoked potentials), and sleep studies (polysomnograms, multiple sleep latency tests, multiple wakefulness test, etc). 4. To provide training and supervision that allows development of skills necessary to provide accurate diagnosis in clinical neurophysiology studies. Assessment Summary The resident will work one-on-one with staff, and get immediate feedback about his/her performance after every patient encounter/work-up. It is expected that the resident will improve their performance based on the feedback they receive and as the rotation progresses. Resident performance will be assessed in the six core competencies: 1. Patient Care (PC) 2. Medical Knowledge (MK) 3. Interpersonal and Communication Skills (ICS) 4. Practice Based Learning and Improvement (PBLI) 5. Professionalism (P) 6. Systems Based Practice (SBP) By the end of the rotation, the resident should receive and/or complete the following assessments: 1. Verbal feedback from preceptors 2. Global written assessments 3. Procedure Logs 2 4. Written examination 5. Testing of residents performance through direct observation and record review Expectations Clinical Neurophysiology/Epilepsy/Sleep Disorders Elective This one-month elective must be approved in advance by the EEG/clinical neurophysiology Section head. The resident will see patients every half day with members of the Section. Depending on the staff physician, the experience may be as an observer during staff encounters with patients. Participation in private and epilepsy clinic activities is required. Research projects are encouraged. s Orientation This occurs on the first day of the rotation by the staff attending assigned to the clinic/lab. Orientation to the EEG machine will evolve over the first month of the clinical rotation. Supervision Residents will actively participate in the clinics/lab supervised both by EEG staff physicians as well as Neurophysiology fellows when available. Mix of Diseases Epilepsy including status epilepticus in adults and children Encephalopathies (including ICU monitoring of head trauma) Coma; persistent vegetative state; electrocerebral inactivity Sleep disorders Conditions diagnosable by evoked potentials such as hearing screening, multiple sclerosis, surgical monitoring, etc 3 Patient Characteristics Patients will be referred to the EEG laboratory from either physicians in the outpatient department or from the inpatient hospital services for further diagnosis of a wide variety of epilepsy and other disorders. Children and adult, of various ethnic backgrounds and socioeconomic backgrounds with acute and chronic neurological disorders will be encountered during the EEG rotation. Adults over the age of 18 will be encountered in the EEG clinic. Procedural Skill Acquisition Basic Rotation in EEG 1. Interpretation of EEG and video/EEG monitoring data 2. Reading an EEG report Additional one Month Rotation in EEG/ additional Advanced Electives in EEG-EP-psg 1. Normal and abnormal findings in EEG and video/EEG monitoring 2. Interpretation of EEG and EEG monitoring findings 3. Interpretation of visual, brainstem auditory and somatosensory evoked potentials (EPs) 4. Analysis of polysomnography (psg) techniques with staff supervision 5. Writing and dictating electrodiagnostic interpretations with clinical correlations Conferences The residents should continue to attend the mandatory Neurology conferences including Neurology Grand Rounds. In addition, the residents are required to attend the weekly EEG/Epilepsy conferences (schedule to be determined) References: Resources recommended for learning skills: 4 Fisch & Spehlmann’s EEG primer Current Practice of Clinical Encephalography (Ebersole & Pedley), Lippincott Williams & Wilkins Comprehensive Clinical Neurophysiology by Kerry Levin, Hans O. Luders, Saunders; 2000. AAN Practice Guidelines: http://www.aan.com/professionals/practice/index.cfm You schedule will be as follows: Mon: Continuity Clinic Tues: Dr. McGuire at Children’s Hospital Wed: University EEG readings for adult residents or Children’s Hospital Clinic for pediatric fellows Thursday AM: Baptist Clinic w/ Dr. Olejniczak PM: Resident Lectures Friday: University EEG readings with Dr. Olejniczak (and or sleep disorders and evoked potentials) PATIENT CARE Objectives Teaching Methods Assessment Strategy Clinical Neurophysiology/Epilepsy/Sleep Elective Through direct observation and instruction, the resident will gain knowledge of advanced skills in EEG analysis and interpretation As the schedule permits, perform initial history and examination, present to precepting staff, follow through with work up and follow up during time on the Epilepsy/Sleep/EEG rotation Direct patient care Recommended readings Staff instruction Direct patient care Recommended readings Performance feedback “On-the-fly”observation of EEG interpretation and reporting Global ratings EEG, EP, psg (observation of live performance) Global ratings Perform interval history and examination on selected established patients Direct patient care Recommended readings Performance Feedback Clinical neurophysiology study interpretation (observation of live performance) Global ratings 5 Teaching Methods Assessment Strategy Didactic Lecture Epilepsy conference Neurology Case Conference (Thurs) Clinical Teaching Global ratings In-training examination Describe the fundamental principles of EEG, psg and EP Didactic Lecture Epilepsy conference examination and apply this knowledge in completing a Neurology Case Conference (Thurs) thorough history and neurological examination Global ratings In-training examination Didactic Lecture Epilepsy conference Neurology Case Conference (Thurs) Clinical Teaching Didactic Lecture Epilepsy conference Neurology Case Conference (Thurs) Clinical Teaching Global ratings In-training examination Didactic Lecture Epilepsy conference Neurology Case Conference (Thurs) Clinical Teaching Didactic Lecture Epilepsy conference Neurology Case Conference (Thurs) Clinical Teaching Global ratings In-training examination MEDICAL KNOWLEDGE Objectives Clinical Neurophysiology/Epilepsy/Sleep disorders Elective Describe the pathophysiology of epilepsy, encephalopathies (EEG), sleep disorders (psg) and sensory processing (EPs). Clinical Teaching Explain central nervous system anatomical concepts in relation to EEG, EPs and psgs Discuss the various treatment and management options for epilepsy and sleep disorders and apply the latest knowledge to care of patients Research a patient’s problem and provide a expanded clinical neurophysiology/clinical differential diagnoses Compare and contrast different management strategies for patients with epilepsy, encephalopathies and sleep disorders Global ratings In-training examination Global ratings In-training examination 6 INTERPERSONAL AND COMMUNICATION Clinical neurophysiology/ EEG Rotation (PGY3 or 4) Interpersonal and Communication Objectives Teaching Methods Assessment Strategy Establish excellent rapport and communication with their patients and their families Clinical practice Global ratings Modeling 360 degree evaluation Work as an integrated member of the Epilepsy Center and EEG/clinical neurophysiology Lab Clinical practice Global ratings Modeling 360 degree evaluation Present case presentations in an organized and detailed manner Clinical practice Global ratings Modeling 360 degree evaluation Educate their patients and their families as appropriate to the clinical situation in a manner that is geared to the patients educational level Direct patient care Global rating Epilepsy-Sleep disorders - Clinical Neurophysiology Elective Modeling Demonstrate the ability to provide consultants with a report that Clinical rounds can be easily interpreted. Global ratings Modeling PRACTICE BASED LEARNING AND IMPROVEMENT Clinical Neurophysiology/ EEG Rotation (PGY3 or 4) Practice Based Learning and Improvement 7 Objectives Teaching Methods Assessment Strategy Research clinical questions regarding their patient’s health Electronic medical record Self assessment problems using information technology to access on-line medical Medline/OVID searches- patient Global ratings information to support their own education and to improve patient centered care and education Case presentations Evaluate the clinical literature applying knowledge of Teaching conferences Global ratings of Journal club epidemiology, biostatistics, and research study design Journal Clubs performance Integrate the feedback they receive from Staff physicians such that Modeling Global ratings (METS) Clinical Neurophysiology-Epilepsy-Sleep disorders their performance will improve as the rotation progresses. 8 PROFESSIONALISM Clinical Neurophysiology/ EEG Rotation (PGY3 or 4) Professionalism Objectives Teaching Methods Clinical Neurophysiology – Epilepsy – Sleep Disorders Elective Demonstrate respect, compassion, integrity, and honesty Direct patient care Assessment Strategy Global ratings Modeling Interact responsibly with patients and families taking into consideration age, disability, culture and gender issues Modeling Global ratings Demonstrate exemplary interaction with their colleagues Modeling Global ratings Demonstrate appropriate use of the EMR in regards to patient Direct patient care Global ratings respect and confidentiality Modeling Self-assess their performance and the means for improvement Modeling Global ratings Recognize mistakes that occur and take measures to learn from them so that the do not recur Direct patient care Global rating Modeling Self assessment 9 SYSTEM BASED PRACTICE Clinical Neurophysiology/ EEG Rotation (PGY3 or 4) System Based Practice Objective Teaching Methods Clinical Neurophysiology – Epilepsy – Sleep Disorders Elective Utilize appropriate resources to better care for their patients. Direct patient care Review of evidence based medicine Assessment Strategy Global ratings Focused Record Review and guidelines of the AAN Departmental conferences Identify obstacles to good patient care, engaging other members of the health care team such as child-life and social work, appropriately consulting other subspecialists or generalists. Communicate with the specialized services or laboratories in order to obtain timely information on their patients Direct patient care Consider ethical, legal, and cost-effective standards of practice Global ratings 360 degree evaluation Direct patient care Global ratings Modeling 360 degree evaluation Role modeling Self assessment Clinical teaching Focused record review Focused record review 10