Download Memory Disorders/Neurology Contact Information: Dan Kaufer, MD

Geriatric Medicine Curriculum: Memory Disorders/Neurology
Contact Information: Dan Kaufer, MD
Description of Service:
Geriatric fellows will participate in a seminar that will be led by one of our
Neurology faculty with expertise in memory disorders and focuses upon the
evaluation of the older patient with cognitive issues.
Fellows will then train within the memory disorders clinic as part of a
longitudinal learning experience. Fellows will attend clinics on average once a
month for their clinical year, seeing patients that are scheduled for them to
evaluate under the supervision of one of our Neurology faculty with expertise in
memory disorders. Focus will be made on scheduling patients that the fellows
have seen through the Geriatric Evaluation Clinic whom they and their preceptor
feel warrant a consultative visit with the memory disorders clinic.
Expectations: Fellows will be expected to see two new patients or 1 new and 2
follow up patients (minimum expectation) during each half day clinic session.
Fellows will have at least 10 clinic sessions in the neurology clinic during the
course of the year, with the goal of seeing at least 20 new patients with
cognitive disorders by the end of the year. Fellows are expected to log these
cases in their Learning Portfolio for future review with the Program Director and
Neurology Director.
Fellows will also participate in a combined Case Conference Series with
Neurology, Geriatrics, and Psychiatry – monthly conferences will occur on
Fridays at 12:15.
Orientation:
Location: Memory Disorders Clinic through the Department of Neurology with
Dr. Dan Kaufer.
Schedule:
Fellows will work within this clinic for (on average) one half day each month
throughout the course of the year. During rotations such as the inpatient service,
fellows may not have any neurology clinic. During other rotations, fellows may
have 2 clinic sessions for the month.
Goals:
1. Understand the different etiologies of memory disorders in older patients
2. Be able to diagnose and manage an older patient with dementia
3. Understand how to use the different tools available for cognitive
assessment
4. Develop the skills needed to conduct a thorough neurological examination
Objectives and Learning Outcomes:
The fellow is expected to demonstrate an appropriate level of Competency in
the following areas:
1. Patient Care
a. The fellow will be able to diagnose a patient with dementia or cognitive
impairment
b. The fellow will be able to develop a differential for the possible
etiologies of cognitive impairment for the patient they are evaluating
c. The fellow will be comfortable with using several different cognitive
assessment tools, and will understand the benefits and limitations of
each
d. As the year progresses, fellows are expected to be able to diagnose and
develop a management plan for complicated patients with memory
problems
e. Fellows will learn to manage behavioral issues that arise in patients with
dementia, working with other disciplines in the clinic
f. Through the longitudinal experience of seeing patients for the entire
year, fellows will observe the course of dementias and the outcomes of
various management and treatment trials
g. Fellows will demonstrate the ability to work with patients and families in
a caring and thoughtful manner
2. Medical Knowledge
a. Fellows will develop a broad differential for the cause of memory
impairment
b. Fellows will be able to diagnose a patient with dementia, depression,
delirium, or other etiology of memory impairment
c. Fellows will be able to incorporate their knowledge of the
neurological exam, anatomy, imaging studies, and laboratory data
into the evaluation of an individual patient
3. Practice Based Learning and Improvement: Teaching Skills development
a. Fellows will help to educate patients and families about their disease
process
b. Fellows will be able to discuss a consultative evaluation
c. By evaluating patients whom the fellow has initially evaluated in the
Geriatric clinic, the fellow will be able to observe a “second opinion”
for their patient, and will be able to incorporate any changes to the
diagnosis or management plan into their own learning as real, clinical
feedback
4. Interpersonal and Communication Skills
a. Fellows will be able to communicate with patients and families as a
management plan is implemented
b. Fellows will be able to communicate with other physicians in the
discussion of complicated patients with memory issues
c. Fellows will at times act in a consultative role and will be able to relay
the necessary information for continued patient care
d. Fellows will document their evaluations with a complete history and
physical exam in a comprehensive note that will become
incorporated into the electronic medical record. Notes will be
reviewed and signed by the Neurology attending who has precepted
the fellow. Notes are to be completed in a timely fashion as per
standard UNC policy.
5. Professionalism
a. Fellows are expected to maintain compassion and respect for
patients and families who often have very difficult behavioral and
other problems
b. Fellows will make attempts to have their own patients whom they
wish referred to the memory clinic scheduled during their clinic times
c. Fellows are expected to attend all clinics to which they are scheduled
6. Systems Based Practice
a. Fellows will develop an understanding of how a clinic like the
Memory clinic is different from their own, and will learn to work
effectively in various settings and systems
b. Fellows will help to coordinate the care of their primary patients as
they are seen in the Neurology and the Geriatric clinics
c. Fellows will consider cost effectiveness in the evaluation and
management of patients with memory disorders – weighing the need
and cost for such items as the MRI and medications
d. Fellows will incorporate what they have learned in the Memory clinic
into their own practice through the Geriatric evaluation clinic
Specific expectations and responsibilities for the fellow
1. Fellows will be scheduled for, on average, one half day session in the
Memory Disorders clinic each month.
2. Fellows are expected to have their own patients who need further
evaluation scheduled into this clinic during times when they will be there.
3. Patients will be specifically scheduled to see the fellow in clinic. Fellows are
expected to attend every clinic as scheduled unless an emergency arises. If
for some reason a fellow needs to miss a clinic, it is their responsibility to
contact the Neurology attending and the Program Director, and to arrange
a time to make up that clinic.
4. Fellows are expected to have at least 10 clinic sessions per year, and to see
at least 2 new patients in each session (the goal is to have 20 new patient
evaluations for the year).
5. Fellows are expected to record the types of patients they see in a case log
within their Learning Portfolio.
Specific expectations for attendings who work with fellows:
1. A seminar will be held early in the academic year for all fellows to attend.
This seminar will focus upon giving fellows the tools necessary to
understand, diagnose and manage older patients with memory problems.
2. Faculty will supervise each patient evaluated in the clinic by the fellow.
Faculty will teach the fellow how to use the assessment tools and how to
interpret the results.
3. Faculty will watch fellows perform neurological evaluations and give
specific feedback related to this exam.
Evaluations:
1. Given that this rotation is a longitudinal experience, faculty are expected to
give feedback and substantive evaluations of each fellow at least twice a
year. These evaluations will become incorporated into the summative
evaluations of fellows.