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Copyright © 2013, by Department of Neurology, University of Rochester



and descriptions of specific evaluation instruments used to evaluate neurology residents at the University of Rochester. rotation guidelines and policies included in this handbook. education and research. 2013 iv . residents and administrative staff. • Research Initiatives and Conferences: This section includes information about the resident research experience and descriptions of several of the neurology conference series. • Schedules: The final section of this handbook contains all of the rotation and clinic schedules for neurology residents and faculty for the current academic year. as mandated by the ACGME. • Outpatient Rotation Guidelines: This section contains guidelines for the resident firms and the Chief Resident Faculty Practice clinics. Ralph F. A thorough understanding of these goals. MD Residency Program Director Department of Neurology July 1. • Inpatient Rotation Guidelines: This section contains guidelines for the neurology residents for all of the core inpatient rotations. All neurology faculty and residents should be familiar with the goals and objectives. The handbook is divided into seven sections as follows: • ACGME Core Competency Project: This section contains specific program goals and objectives for the neurology residency. guidelines and policies will help insure that our residency program runs smoothly and meets its mission of excellence in patient care. the neurology core competencies that are part of the ACGME core competency project. • Elective Guidelines: This section contains guidelines for the neurology residents for departmental and inter-departmental electives. • Bibliography: This section contains a bibliography for adult neurology and should be used as a guide to reading for neurology residents. Józefowicz. The Residency Review Committee for Neurology mandates that we collate all of this information and distribute it annually to all clinical faculty and residents in our department.FOREWORD This Neurology Resident Handbook is intended as a handy reference for all Neurology clinical faculty. • Policies: This section contains all of the specific policies that involve neurology residents.

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Resident Portfolio 16. Neurology Resident Evaluation Form 11. Chief Resident Faculty Practice Clinics 91 97 Part 5 – Elective Guidelines 35. Rochester General Hospital Residency Rotation 29. Patient Management Conference Series 37 39 40 41 41 42 43 Part 3 – Inpatient Rotation Guidelines 24. Neuro-ophthalmology Elective 40. Palliative Care Elective 99 101 105 109 113 117 119 121 125 vi . Neuropathology Elective 41. Integrated Neuromuscular Disease – EMG Rotation 32. Neurology Resident Chart Review Form 13. Resident Journal Club 23. Neuroradiology Elective 42. History of Neurology Conference Series 22. Pain Management Elective 43. Inpatient Attending Physician’s Responsibilities 27.TABLE OF CONTENTS Page Part 1 – ACGME Core Competency Project 1. Guidelines for the Resident Firms 34. Clinical Neurophysiology and Epilepsy Rotations 45 55 56 59 63 67 73 77 83 Part 4 – Outpatient Rotation Guidelines 33. Resident and Fellow Research Symposium 20. Neurology Conference Schedule 26. ACGME Core Competency Project Summary Tables 1 7 8 19 21 23 24 25 26 27 29 30 31 32 33 34 Part 2 – Research Initiatives and Conferences 17. Headache Elective 36. Neuro-oncology Elective 39. Chart Review 12. Memory Care Program Elective 37. Resident Evaluation Instruments 5. Residency In-service Training Examination 6. ACGME Outcome Project 3. Program Goals 2. Clinical Skills Evaluation 7. Medical Student Assessment 9. Resident Case Log 14. General Guidelines for the Activity of the Neurology Resident at SMH 25. Psychiatry Rotation 31. ABPN Clinical Skills Evaluation of Residents 8. Resident Research Experience 19. Highland Hospital Residency Rotation 28. Movement Disorders Elective 38. Neurology Core Competencies 4. Neuroscience Conference Series 21. Child Neurology Resident Rotation 30. Attending Global Assessment 10. Resident Mentoring Program 18. 360° Evaluation 15.

Bibliography for Adult Neurology 149 Part 8 – Schedules 57. Important Dates for 2009-2010 66. Department of Neurology Child Neurology Resident Schedules 60. Policy on Resident Work Hours 51. Department of Neurology Attending Schedule 64. Neurology Ambulatory Block Rotation Schedules 63. 45. Child Neurology Weekend Coverage 65. Department of Neurology Clinical Faculty 58. Neurology Resident Committee Assignments 153 154 160 161 163 164 166 167 168 168 168 vii . Department of Neurology Resident Block Schedules 59. Neurology Resident Firm Assignments 62. Policy on Moonlighting 54. Policy on Resident Supervision 48. Neurology Resident Vacation Schedules 61. Policy on Hand-offs 50. Policy on Selection of Residents 47. Residency Steering Committee 135 136 138 139 141 142 144 145 146 147 Part 7 – Bibliography 56. Policy on Progressive Responsibility for Patient Management 49.44. Policy on Evaluation of Faculty and of the Residency Program 53. Private Neurology Practice Elective Sleep Medicine Elective 129 131 Part 6 – Policies 46. Policy on Evaluation and Promotion of Residents 52. Policy on Support for Resident Travel to Scientific Meetings 55. Chief Resident Responsibilities 67.

Participate in the education of patients. and must demonstrate understanding of the basic sciences through application of this knowledge in the care of their patients and by passing clinical skills examinations. students. Supervise other residents. Residents must demonstrate competency in the management of outpatients and inpatients with neurological disorders across the lifespan. and other health care personnel 1 . and implement changes with the goal of practice improvement 5. families. Locate. Set learning and improvement goals 3. medical students. including those who require emergency and intensive care. and to continuously improve patient care based on constant self-evaluation and life-long learning. Incorporate formative evaluation feedback into daily practice 6. nurses. Use information technology to optimize learning 8. and assimilate evidence from scientific studies related to their patients’ health problems 7. to appraise and assimilate scientific evidence. and effective for the treatment of health problems and the promotion of health. Practice-based Learning and Improvement Residents must demonstrate the ability to investigate and evaluate their care of patients. appraise. appropriate.GOALS OF THE NEUROLOGY RESIDENCY TRAINING PROGRAM Overall Competency-Based Program Goals Patient Care Residents must be able to provide patient care that is compassionate. Residents are expected to develop skills and habits to be able to meet the following goals: 1. Residents must demonstrate understanding about major developments in the clinical sciences relating to neurology. residents and other health professionals 9. clinical. Systematically analyze practice using quality improvement methods. Identify and perform appropriate learning activities 4. as well as the application of this knowledge to patient care. Medical Knowledge Residents must demonstrate knowledge of established and evolving biomedical. deficiencies. Identify strengths. epidemiological and social-behavioral sciences. and limits in one’s knowledge and expertise 2.

Interpersonal and Communication Skills Residents must demonstrate interpersonal and communication skills that result in the effective exchange of information and collaboration with patients. Work effectively as a member or leader of a health care team or other professional group 4. and legible medical records Professionalism Residents must demonstrate a commitment to carrying out professional responsibilities and an adherence to ethical principles. Work effectively in various health care delivery settings and systems relevant to their clinical specialty 2. integrity. other health professionals. and respect for others 2. Act in a consultative role to other physicians and health professionals 5. Responsiveness to patient needs that supersedes self-interest 3. Residents are expected to demonstrate: 1. families. Residents are expected to: 1. timely. Participate in identifying system errors and implementing potential systems solutions 2 . and health professionals. and health related agencies 3. and the public. Maintain comprehensive. race. Sensitivity and responsiveness to a diverse patient population. across a broad range of socioeconomic and cultural backgrounds 2. Respect for patient privacy and autonomy 4. including but not limited to diversity in gender. religion. society and the profession 5. disabilities. Residents are expected to: 1. age. and sexual orientation Systems-based Practice Residents must demonstrate an awareness of and responsiveness to the larger context and system of health care. Accountability to patients. Communicate effectively with physicians. Coordinate patient care within the health care system relevant to their clinical specialty 3. Incorporate considerations of cost awareness and risk-benefit analysis in patient and/or population-based care as appropriate 4. Advocate for quality patient care and optimal patient care systems 5. their families. as well as the ability to call effectively on other resources in the system to provide optimal health care. Compassion. Communicate effectively with patients. culture. Work in inter-professional teams to enhance patient safety and improve patient care quality 6. as appropriate.

including honesty. PC 2. To acquire the many personal attributes necessary for becoming an effective physician. central nervous system infections. To diagnose. back and neck pain. PC • Common outpatient neurological problems: Headache. PC. ICS Goals for the First Year 1. evoked potentials. PC 4. dementia. CT and MR imaging of the brain and spinal cord. PC 3. MK. To demonstrate effective written and oral communication skills. To prepare the physician for the independent practice of clinical neurology by providing training based on supervised clinical work with increasing responsibility for outpatients and inpatients. To appropriately evaluate and treat common neurological problems: • Neurological Emergencies: Coma and mental status changes. evaluate and treat multiple sclerosis. MK 3. EMG. To acquire an appreciation for the history of neurology and the rich traditions of our specialty. dizziness. To provide an opportunity to develop and maintain an investigative career in the basic neurosciences and in clinical neurology. lumbar puncture. P. reliability. compassion. To provide a foundation of organized instruction in the basic neurosciences. neuromuscular diseases. Parkinson's disease and other movement disorders. SBP 5. MK. MK 4. To perfect the resident’s history-taking skills and neurologic exam in infants and children. PBLI 3 .Overall Program Goals 1. PC 4. stroke. nerve conduction studies. peripheral neuropathies. and tumors of the nervous system. To interrelate abnormalities of the nervous system with normal growth and development of the nervous system. To provide the resident with an exposure to and a forum for discussion of a wide variety of neurologic problems in adults and pediatric patients. PC 2. MK 3. and effective communication skills. To elicit an accurate neurologic history and to perform and interpret a neurological examination on patients presenting with neurological symptoms. To appropriately order laboratory studies in neurology: EEG. PC 2. seizures. ICS Goals for the Second Year 1.

PC 2. To participate as a laboratory instructor in the Medical Student Nervous System Course. To acquire in-depth knowledge of major categories of neurological disease. MK 3. To perform and interpret EMG’s. especially concerning blood pressure management. tumors of the nervous system. Neurovascular testing. PBLI Goals for the SMH General Neurology Rotation 1. head trauma and dementia. To utilize current treatment guidelines for ischemic stroke. To develop and improve written and oral communication skills. PC.Goals for the Third Year 1. Nerve Conduction Studies. To independently evaluate and manage patients presenting with a wide variety of inpatient and outpatient neurological disorders. and EMG and nerve conduction studies. SBP 4. MK 3. PC. To utilize current recommendations for the use of anti-platelet agents and oral anticoagulants in stroke prevention. To identify common risk factors for stroke. MK 5. EEG. To recognize the signs and symptoms of acute ischemic stroke. To gain experience in the appropriate ordering and interpretation of neurodiagnostic tests. in performing accurate neurological examinations. Evoked Potential Testing. infections of the nervous system. To develop skills in obtaining complete neurological histories. PC 2. MK 4. with special emphasis on epilepsy. SBP 4. movement disorders. ICS Goals for the SMH Stroke Rotation 1. PBLI. To supervise junior residents on the inpatient neurology services at Strong Memorial Hospital. EEG’s and evoked potential testing. demyelinating disorders. and in selecting appropriate therapies on a general neurology consultation service in a tertiary referral center. and use of thrombolytic therapy. PC 2. including head and spine CT and MR scans. SBP 4 . neuromuscular disorders. MK 6. To perform and record the National Institutes of Health Stroke Scale. PC. To utilize strategies for preventing and treating increased intracranial pressure. anticoagulation. MK 3. coma and mental status changes.

PC 2. PBLI. SBP 3. To develop administrative skills with respect to organizing and scheduling teaching conferences for the department of neurology. SBP Key to Core Competencies: PK MK PBLI ICS P SBP Patient care Medical knowledge Practice-based learning and improvement Interpersonal and communication skills Professionalism Systems-based practice Goals for other rotations and electives are included with the specific rotation guidelines below.Goals for the SMH Chief Resident Rotation 1. 5 . To become independent in the evaluation and management of patients presenting with a wide variety of inpatient and outpatient neurological disorders. To gain experience supervising junior residents on the inpatient neurology services at Strong Memorial Hospital.

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All evaluation instruments are keyed to the following core competencies: 7 .ACGME OUTCOME PROJECT At its February 1999 meeting. the ACGME endorsed general competencies for residents in the areas of • • • • • • Patient care Medical knowledge Practice-based learning and improvement Interpersonal and communication skills Professionalism Systems-based practice Identification of general competencies is the first step in a long-term effort designed to emphasize educational outcome assessment in residency programs and in the accreditation process. As of July 2002. The following Neurology Core Competencies were developed by the American Board of Psychiatry and Neurology. the ACGME’s Residency Review and Institutional Review Committees have incorporated the general competencies into their Requirements. and represent what each graduate of the adult neurology residency training program at the University of Rochester is expected to learn by the end of his/her residency.

including the following: i. Based on a comprehensive neurological assessment.AMERICAN BOARD OF PSYCHIATRY & NEUROLOGY NEUROLOGY CORE COMPETENCIES I. A family history f. A situationally germane general and neurologic examination 2. Perform screening psychiatric examination c. Chief complaint b. differential diagnosis. or psychsomatic illness) b. and caloric testing d. If a patient's symptoms are the result of a disease affecting the central and/or peripheral nervous system or are of another origin (e. neurologists shall demonstrate the following abilities: 1. isotope. A developmental history (especially for children) h. To perform and document a relevant history and examination on culturally diverse patients to include as appropriate: a. including plain films. To determine: a. To evaluate. Perform lumbar puncture. Perform comprehensive neurological examination b. Identify and describe abnormalities seen in common neurological disorders on radiographic testing. and MRI e. angiography. A comprehensive review of systems e. myelography. of a systemic. Motor and nerve conduction studies iii.. assess. Past medical history d. A sociocultural history g. Evaluate the application and relevance of investigative procedures and interpretation in the diagnosis of neurological disease. Patient Care and Procedural Skills A. and recommend effective management of patients B. CT. Electromyography 8 . psychiatric. To develop and maintain the technical skills to: a. and management plan 2. Electroencephalogram ii. A formulation. laboratory investigation.g. Neurologists shall demonstrate the following abilities: 1. History of present illness c. edrophonium. To delineate appropriate differential diagnoses 3.

gender. including considerations relating to age. Imaging with ultrasound (Duplex. Neurologists shall demonstrate knowledge of the following: 9 . based on the literature and standards of practice. and sociocultural factors c. Audiometry ix. race. Psychometrics xi. Knowledge of healthcare delivery systems. and explanation of the illness for the patient and family. This knowledge shall include: a. including medical. Electronystagmogram viii. CSF analysis xii. Medical Knowledge A. The experience. Knowledge of the application of ethical principles in delivering medical care 5. including the influence of cultural factors and culture-bound syndromes f. Neurologists shall demonstrate the following: 1. Identify and describe gross and microscope specimens taken from the normal nervous system and from patients with major neurologic disorders II. Systems-based Practice 4. The phenomenology of the disorder d. and ethnicity. Radiographic studies as outlined above f. Perimetry x.iv. Polysomnography vi. Ability to reference and utilize electronic systems to access medical. Autonomic function testing vii. An understanding of the impact of physical illness on the patient’s functioning e. The epidemiology of the disorder b. Knowledge of major disorders. Effective treatment strategies g. Course and prognosis 2. genetic. Evoked potentials v. and patient information B. including patient and family counseling 3. transcranial Doppler) xiii. The etiology of the disorder. meaning. scientific.

Dementia and behavioral neurology disorders b. Neuroimmunology/neurovirology g. Changes in mental state second to therapy m. including treatment for the following: a. Neurologic disorders and diseases across the lifespan. Neuropathology c. Basic neuroscience that is critical to the practice of neurology 2.1. including abnormalities caused by drugs 10 . Demyelinating and dysmyelinating disorders of the central nervous system e. Epilepsy and related disorders c. Child neurology m. Neuroimaging j. Neurophysiology e. Coma and brain death o. Infectious diseases of the nervous system g. Geriatric neurology n. Neurogenetics/molecular neurology and neuroepidemiology h. Acute. Movement disorders. Headache and facial pain p. Sleep disorders l. Neuromuscular disorders d. Neuroendocrinology i. Neuropharmacology f. Neuroanatomy b. Nervous system trauma i. chronic pain k. Pathophysiology and treatment of major psychiatric and neurological disorders and familiarity with the scientific basis of neurology. Cerebrovascular disorders f. Interventional neurology (basic principles only) 3. Toxic and metabolic disorders of the nervous system j. including: a. Neoplastic disorders and tumors of the nervous system h. Neuro-otology l. Critical care and emergency neurology n. Neuro-ophthalmology k. Neurochemistry d.

g. diagnostic criteria. Probable diagnoses and differential diagnoses i. Side effects of drugs used for treatment. epidemiology. childhood. Factitious disorders vii. and/or physical abuse xiv. Neurologic disorders associated with vitamin deficiency or excess 4. In adults ii.. The nature of patients’ histories and physical findings and the ability to correlate the findings with a probable localization for neurologic dysfunction b. amnestic. Sexual and gender identity disorders ix. Disorders usually first diagnosed in infancy. mood stabilizers ii.. Psychopathology. neuroleptic malignant syndrome 11 . e. In children c. Eating disorders x. and clinical course for common psychiatric disorders. Mood disorders iv. Adjustment disorders xi. including i. Psychiatry. End of life care and palliative care r. Disorders of higher cortical function b.g. sexual. antipsychotics. including: a. Patient evaluation and treatment selection. antianxiety agents. Dissociative disorders viii. Schizophrenic and other psychotic disorders iii. and other cognitive disorders xii. Somatoform disorders vi. Delirium. Potential risks and benefits of potential therapies. antidepressants. Anxiety disorders v. or adolescence ii. motor. Psychopharmacology i. Substance-related disorders xv. including surgical procedures 5. Neurologic presentations following emotional. acute. Major drugs used for treatment.q. dementia. e. including: a. Mental disorders due to general medical conditions xiii. Planning for evaluation and management d.

their families. and professionals about medical. Respect the knowledge and expertise of the requesting professionals 12 . Communicate effectively with the requesting party to refine the consultation question 2.iii. nonverbal. To listen to and understand patients and to attend to nonverbal communication 2. Discussing the consultation findings with the patient and family C. Neurologists shall demonstrate the ability to obtain. Neurologists shall demonstrate the following competencies: 1. To preserve patient confidentiality B. Maintain the role of consultant 3. To communicate effectively with patients using verbal. interpret. and comfort in the relationship with physicians 4. To develop and maintain a therapeutic alliance with patients by instilling feelings of trust. Iatrogenic disorders in psychiatry and neurology. Knowing when to solicit consultation and having sensitivity to assess the need for consultation 2. rapport. To educate patients. and written skills as appropriate 3. Formulating and clearly communicating the consultation question 3. openness. psychosocial. and community agencies by demonstrating the abilities to: 1. Nonpharmacologic treatments and management 6. Neurologists shall serve as an effective consultant to other medical specialists. To communicate effectively and work collaboratively with allied healthcare professionals and with other professionals involved in the lives of patients and families 8. and movement disorders iv. and evaluate consultations from other medical specialties. Discussing the consultation findings with the consultant 4. Interpersonal and Communications Skills A. honesty. Communicate clear and specific recommendations 4. This shall include: 1. Employment of principles of quality improvement in practice III. To understand the impact of physicians’ own feelings and behavior so that it does not interfere with appropriate treatment 7. To partner with patients to develop an agreed upon healthcare management plan 5. changes in mental status. and behavioral issues 9. To transmit information to patients in a clear and meaningful fashion 6.

Elicit needed information from team members 3. Integrate information from different disciplines 4. Neurologists shall demonstrate the ability to communicate effectively with patients and their families by: 1. Consideration and compassion for the patient in providing accurate medical information and prognosis 5. including possible side-effects of medications and/or complications of non-pharmacologic treatments 13 . and economic backgrounds 6. and they must be useful to health professionals outside neurology. The results of the assessment 2. The risks and benefits of the proposed treatment plan. including being able to: 1. Providing explanations of psychiatric and neurological disorders and treatment that are jargon-free and geared to the educational/intellectual levels of patients and their families 4. These records must capture essential information while simultaneously respecting patient privacy. F. Manage conflict 5. Neurologists shall demonstrate the ability to communicate effectively with patients and their families while respecting confidentiality. Use of informed consent when considering investigative procedures 3. Demonstrating sociocultural sensitivity to patients and their families 3. Listen effectively 2. and end-of-life issues when appropriate 4. Responding promptly to electronic communications when used as a communication method agreed upon by neurologists and their patients and patients’ families E. Developing and enhancing rapport and a working alliance with patients and their families 7. ethnic. Providing preventive education that is understandable and practical 5. Genetic counseling. Matching all communication to the educational and intellectual levels of patients and their families 2. palliative care. Respecting patients' cultural. Neurologists shall demonstrate the ability to effectively lead a multidisciplinary treatment team. Clearly communicate an integrated treatment plan G. Neurologists shall maintain up-to-date medical records and write legible prescriptions. Such communication may include: 1. Ensuring that the patient and/or family have understood the communication 8.D. religious.

Neurologists shall evaluate caseload and practice experience in a systematic manner. Active participation. treatment approaches with established effectiveness. its prognosis. Using knowledge of common methodologies employed in neurologic research 2. Use of information technology. and prevention strategies IV. as appropriate.g. Obtaining evaluations from patients. Practice-Based Learning and Improvement A. e. 14 . Neurologists shall demonstrate the ability to critically evaluate relevant medical literature. Researching and summarizing a particular problem that derives from their own caseloads E. Alternatives (if any) to the proposed treatment plan 7. Review and critically assess scientific literature to determine how quality of care can be improved in relation to one's practice. practice parameter adherence.g. Obtaining appropriate supervision and consultation 7. and understand and address the need for lifelong learning. Review of patient records 4. This may include: 1. Neurologists shall demonstrate the abilities to: 1. conferences. Use of drug information databases 4.6.. This shall include. Neurologists shall demonstrate appropriate skills for obtaining and evaluating up-to-date information from scientific and practice literature and other sources to assist in the quality care of patients. Case-based learning 2.. and other organized educational activities both at the local and national levels C. outcomes and patient satisfaction 5. B. Employment of principles of quality improvement in practice 6. Maintaining a system for examining errors in practice and initiating improvements to eliminate or reduce errors D. in educational courses. reliable and valid assessment techniques. including Internet-based searches and literature databases 3. This may include: 1. Neurologists shall recognize limitations in their own knowledge base and clinical skills. Use of medical libraries 2. Appropriate education concerning the disorder. Use of best practices through practice guidelines or clinical pathways 3. but not be limited to: 1. e. Within this aim.

Evaluation and implementation. disabilities. Develop and pursue effective remediation strategies that are based on critical review of the scientific literature V. and conflict of interest. ethnicities. transfer.g. compassion. F. Responding to communication from patients and health professionals in a timely manner 2. VI. Neurologists shall demonstrate responsibility for their patients' care. where indicated. Providing coverage if unavailable. Neurologists shall review their professional conduct and remediate when appropriate. Coordinating care with other members of the medical and/or multidisciplinary team 6. and their colleagues as persons. including how to seek emergent and urgent care when necessary 3. including their ages. genders. and understand how to use the systems as part of a comprehensive system of care in general and as part of a comprehensive. C. and sexual orientations. of the use of practice guidelines 15 . professional conduct. Professionalism A. Neurologists shall demonstrate ethical behavior. honesty. This shall include the: 1. Providing for continuity of care. individualized treatment plan. political leanings. when out of town or on vacation 5. Neurologists shall demonstrate understanding of and sensitivity to end of life care and issues regarding provision of care and clinical competence. Neurologists shall demonstrate respect for patients and their families. cultures.neurologists shall be able to assess the generalizability or applicability of research findings to one’s patients in relation to their sociodemographic and clinical characteristics 2. Systems-Based Practice A. including: 1. religious beliefs. E. Neurologists shall participate in the review of the professional conduct of their colleagues. Neurologists shall have a working knowledge of the diverse systems involved in treating patients of all ages. including matters of informed consent/assent. Establishing and communicating back-up arrangements. Using medical records for appropriate documentation of the course of illness and its treatment 4. D. integrity. e. including appropriate consultation. or referral if necessary B. socioeconomic backgrounds. and confidentiality in the delivery of care.

2. and allied health professional resources that may enhance the quality of life of patients with chronic neurologic and psychiatric illnesses 3. Working with a culturally diverse population requires knowledge about cultural 16 . Participating in utilization review communications and. This requires knowledge of treatment settings in the community. acute care. sociocultural class. E. Neurologists shall demonstrate knowledge of the organization of care in each relevant delivery setting and the ability to integrate the care of patients across such settings. country of origin. and efficient communication with referring physicians 5. neurologists shall: 1. partial hospital. rehabilitation. clinical scheduling. substance abuse facilities. and physical disability. including time management. religious/spiritual beliefs. consulting. Recognize the limitation of healthcare resources and demonstrate the ability to act as an advocate for patients within their sociocultural and financial constraints 2. and hospice organizations. Neurologists shall demonstrate knowledge of community systems of care and assist patients to access appropriate care and other support services. Demonstration of the ability to lead and work within health care teams needed to provide comprehensive care for patients with neurologic and psychiatric disease and respect professional boundaries 4. C. nursing homes and home care facilities. Neurologists shall be aware of safety issues. Neurologists shall demonstrate knowledge of different health care systems. educational/intellectual levels. 1 Cultural diversity includes issues of race. including: 1. which include ambulatory. Use of accurate medical data in the communication with and effective management of patients B. Educating patients concerning such systems of care D. gender. advocating for quality patient care 3. national. should they occur. including acknowledging and remediating medical errors. Demonstration of awareness of the importance of adequate crosscoverage 7. sexual orientation. Working within the system of care to maximize cost effective utilization of resources 2. skilled care. Demonstration of skills for the practice of ambulatory medicine. language. Demonstrate knowledge of the legal aspects of neurologic diseases as they impact patients and their families 3. Demonstrate an understanding of risk management. when appropriate. Use of appropriate consultation and referral mechanisms for the optimal clinical management of patients with complicated medical illness 6. age. In the community system. Ability to access community.

factors in the delivery of health care. For the purposes of this document, all patient and peer
populations are to be considered culturally diverse.

For the purposes of this document, “family” is defined as those having a biological or otherwise
meaningful relationship with the patient. Significant others are to be defined from the patient’s
point of view.



Valid evaluation systems must employ several different instruments, since no single
evaluation instrument can assess each of the six ACGME Core Competencies. The
following seven evaluation instruments will be used to evaluate University of Rochester
Neurology Residents’ mastery of the Core Competencies:

RITE (Residency In-service Training Examination)
Clinical Skills Evaluation
Attending Global Assessment
Medical Student Assessment
Chart Review
Resident Case Log
360° Assessment
Resident Portfolio

Each of these evaluation instruments is described below. In addition, three tables
delineate where the six core competencies are taught during the residency program, and
how they will be evaluated.


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in-depth examination featuring questions in each of the following areas of neurology and neuroscience: o Anatomy o Behavioral/Psychiatry o Clinical adult o Clinical pediatric o Contemporary issues o Neuroimaging o Pathology o Pharmacology/Chemistry o Physiology Graphics that include: o CT scans o MR images o EEG’s o Full color pathologic representations A review by a committee of recognized experts to ensure: o Content clarity o Question relevance o Topical balance A scanning and scoring process conducted by a professional data systems company to ensure the highest quality data collection with an accuracy rate in excess of 99.THE RESIDENCY IN-SERVICE TRAINING EXAM (RITE) Objective The American Academy Neurology (AAN) Residency In-service Training Examination (RITE) is a self-assessment tool designed to gauge knowledge of neurology and neuroscience. identify areas for potential growth. Examination Features • • • • • A carefully weighted. 21 . including percent correct. and percentile rankings compared to others in the same level of training Scores Results are delivered electronically and examinees will receive an email with a password to access a secure portal to view their score reports. and provide references and discussions for each.9 percent A downloadable discussion and reference manual accessible to all examinees identifying: o Discussions of answer options and rationale for correct responses of all questions o References for further information RITE Scores • Each examinee receives an individual report of his/her scores. percentile rankings compared to entire examinee population.

and is given in two sessions during the same day.• • Each program director receives a composite of the individuals' scores in his/her program as well as a summary report with averages for the entire population of examinees Scores are released approximately six weeks after the examination RITE Content Questions on the RITE are distributed according to the following blueprint: Content Area Number of Items Percentage of Exam Clinical Adult 70 16% Physiology 65 15% Neuroimaging 60 14% Behavioral/Psychiatry 50 11% Pathology 50 11% Anatomy 45 10% Clinical Pediatrics 45 10% Pharmacology/Chemistry 45 10% Contemporary Issues 15 3% TOTAL 445 100% Test Dates The examination is scheduled for the first Friday and Saturday in March. 22 . Each session lasts three and a half hours.

each resident is observed taking a history and performing a neurologic examination on a patient. • Evaluation and Feedback: A numeric grade is assigned by each faculty member for each component of the patient evaluation and for each vignette. Feedback is then provided to each resident by the faculty. The examination takes place on two Saturday mornings in April. • Patient Hour: During the patient hour. • Vignette Hour: During the vignette hour. interpersonal and communication skills. The patient hour incorporates the ABPN Clinical Skills Evaluation of residents (see below) and counts for three of the five required patient evaluations. evaluation and treatment plan. • Failure: Residents who fail any hour of the examination must successfully re-take and pass that hour of the examination before the end of the academic year.CLINICAL SKILLS EVALUATION The Clinical Skills Evaluation is an Objective Structured Clinical Examination (OSCE) that has two components: a patient hour and a vignette hour. Some of the vignettes will evaluate the core competencies of professionalism. One of these vignettes is a child neurology vignette. 23 . The faculty members then quiz the resident as to the differential diagnosis. each resident is asked to discuss six short vignettes with two faculty members. and systems based practice. under the direct supervision of two faculty members.

The ABPN requires that residents demonstrate competency in the following areas: • • • Medical interviewing Neurological examination Humanistic qualities. professionalism. 24 . Competency in these skills should be achieved during residency. The critical care patient evaluation will occur in the PGY-3 year during the general neurology or stroke rotations. The child patient evaluation will occur in the PGY-3 year during the pediatric neurology rotation. such as dementia. ambulatory and neurodegenerative) will be completed during the Clinical Skills Evaluation (one per year). a movement disorder. Ambulatory: One adult patient with an episodic disorder.ABPN CLINICAL SKILLS EVALUATION OF RESIDENTS The American Board of Psychiatry and Neurology (ABPN) mandates that demonstration of clinical skills competency is a basic requirement in order to apply for certification in the specialties of neurology and neurology with special qualification in child neurology. and counseling skills Demonstration of competency in evaluating a minimum of five different patients during residency training is required. Neurodegenerative: One adult patient with a neurodegenerative disorder. Retrospective completion of the evaluation form by the attending is not allowed by the ABPN. Residency training requirements will not be considered satisfied until all five clinical skills evaluations are successfully completed. Child patient: One child patient with a neurological disorder (most likely in an outpatient setting) Three of these patient evaluations (neuromuscular. Critical care: One critically ill adult patient with neurological disease (may be in either an intensive care unit or emergency department setting or an emergency consultation from another inpatient service) 2. such as seizures or migraine (most likely in an outpatient setting) 4. or multiple sclerosis (most likely in an outpatient setting) 5. Neuromuscular: One adult patient with a neuromuscular disease (may be in either an inpatient or outpatient setting) 3. • All five clinical skills evaluations must be successfully completed prior to the end of residency training. as follows: 1. NB: • The clinical skills evaluation session must be scheduled with the attending in advance and the evaluation form must be completed by and discussed with the attending immediately following the encounter.

MEDICAL STUDENT ASSESSMENT UR medical students complete evaluation forms on neurology residents using the E*Value system. In addition. Brain and Behavior course. The program director reviews this medical student feedback with each resident during the semi-annual evaluation meetings. where the residents function as laboratory instructors and PBL tutors. This feedback is also filed in each resident’s evaluation folder. 25 . All neurology residents are evaluated by 3rd year medical students for their teaching efforts during the 3rd year neurology clerkship. the neurology chief residents are evaluated by the 2nd year medical students for their teaching efforts in the Mind.

All rating forms contain scales that the evaluator uses to judge knowledge.g. satisfactory =2. The Program Director reviews the Global Rating Forms with each resident during his/her semi-annual evaluation meeting. end of a clinical rotation) derived from multiple sources of information (e. and is found on-line at https://www. and behaviors listed on the form. A Global Rating Form has been constructed for neurology residents.e-value.g. and (b) the ratings are completed retrospectively based on general impressions collected over a period of time ( Written comments are important to allow evaluators to explain the ratings. which must be completed by each attending at the end of his two-week rotation with a specific resident.. review of work products or written materials). or patients. This Global Rating Form addresses all six Core Competencies. fair = 3. Typical rating scales consist of qualitative indicators and often include numeric values for each indicator. patient care skills. residents. good =2. Scoring rating forms entails combining numeric ratings with comments to obtain a useful judgment about performance based upon more than one rater. medical knowledge. interpersonal and communication skills) instead of specific skills.ATTENDING GLOBAL ASSESSMENT Global rating forms are distinguished from other rating forms in that (a) a rater judges general categories of ability (e. skills. for example.g. or (b) superior =1. 26 . tasks or behaviors. unsatisfactory =3.. input from other faculty. direct observations or interactions. poor =4. Global rating forms are most often used for making end of rotation and summary assessments about performance observed over days or weeks. (a) very good = 1.

narrative or nonverbal skills. and colleagues. skills and attitudes expected from the clearly satisfactory resident at this stage of training. use as your standard the level of knowledge. does not provide education or counseling to patients. resists or ignores feedback. Global adjectives or remarks. always “interpersonally” engaged 1. mechanisms of disease ‫ ٱ‬Insufficient contact to judge 1 2 3 4 5 6 ‫ ٱ‬Performance needs attention 3. accurate. demonstrates excellent relationship building through listening. fails to use information technology to enhance patient care or pursue selfimprovement ‫ ٱ‬Insufficient contact to judge 1 2 3 4 5 6 ‫ ٱ‬Performance needs attention 4. sound judgment. Unsatisfactory Satisfactory Superior 1 4 7 8 9 Superb. neurological examinations. families. inaccurate medical interviews. including reports of critical incidents and/ or outstanding performance. comprehensive understanding of complex relationships. always makes diagnostic and therapeutic decisions based on available evidence. initiative. comprehensive medical interviews.” do not provide meaningful feedback to the resident. incorporates feedback into improvement activities. Patient Care Incomplete. Medical Knowledge Limited knowledge of basic and clinical sciences. For any component that needs attention or is rated a 4 or less. and review of other data. effectively uses technology to manage information for patient care and self-improvement 7 8 9 Establishes a highly effective therapeutic relationship with patients and families. excellent education and counseling of patients. minimal interest in learning. please provide specific comments and recommendations on the back of the form. Be as specific as possible. Practice. and procedural skills. Interpersonal and Communication Skills Does not establish even minimally effective therapeutic relationships with patients and families. does not understand complex relations. fails to analyze clinical data and consider patient preferences when making medical decisions ‫ ٱ‬Insufficient contact to judge 2 3 5 6 ‫ ٱ‬Performance needs attention 2. lacks insight. families.Based Learning Improvement Fails to perform self. highly resourceful development of knowledge. and patient preferences 7 8 9 Exceptional knowledge of basic and clinical sciences.evaluation.NEUROLOGY RESIDENT EVALUATION FORM Resident’s Name Rotation Name Attending’s Name Rotation Period Evaluation Date In evaluating the resident’s performance. or colleagues ‫ ٱ‬Insufficient contact to judge 1 2 3 4 5 6 ‫ ٱ‬Performance needs attention 27 . review of other data. does not demonstrate ability to build relationships through listening. such as “good resident. narrative and nonverbal skills. neurological examinations. mechanisms of disease 7 8 9 Constantly evaluates own performance. incompetent performance of essential procedures.

families.Unsatisfactory Satisfactory Superior 1 4 7 8 9 Always demonstrates respect. does not consider needs of patients. willingly acknowledges errors. colleagues. disregards need for self. always considers needs of patients. compassion. honesty.assessment. does not display responsible behavior ‫ ٱ‬Insufficient contact to judge 2 3 5 6 ‫ ٱ‬Performance needs attention 6. colleagues 7 8 9 Effectively accesses/ utilizes outside resources. total commitment to self. integrity.assessment. fails to acknowledge errors. honesty. families. Professionalism Lacks respect.Based Learning Unable to access/ mobilize outside resources. effectively uses systematic approaches to reduce errors and improve patient care. compassion. actively resists efforts to improve systems of care. System. integrity. teaches/ role models responsible behavior. enthusiastically assists in developing systems’ improvement 7 8 9 5. does not use systematic approaches to reduce error and improve patient care ‫ ٱ‬Insufficient contact to judge 1 Resident’s Overall Clinical Competence in Neurology on Rotation 1 2 3 4 5 6 ‫ ٱ‬Performance needs attention 2 3 4 5 6 ‫ ٱ‬Performance needs attention Attending’s Comments: Signatures: Resident’s __________________________________________ Attending’s __________________________________________________________ 28 .

.g. The neurology attendings will complete the form below and will also provide verbal feedback to the resident concerning the written notes. and appropriate use of clinical facilities and resources (e. and one new outpatient clinic note semi-annually and submit these to the supervising attendings for their review.CHART REVIEW Chart review can provide evidence about clinical decision-making. The following items from each note will be specifically reviewed by the attending: • • • • • • Chief complaint or reason for consultation History of the Present Illness Past medical history Neurological examination Assessment and differential diagnosis Diagnostic and treatment plan 29 . follow-through in patient management and preventive health services. Each resident will select one new patient consultation or admission note. appropriate laboratory tests and consultations).

and one new outpatient clinic note quarterly and submit these to the supervising attendings for their review. Satisfactory Unsatisfactory Chief complaint or reason for consultation History of the Present Illness Past medical history Neurological examination Assessment and differential diagnosis Diagnostic and treatment plan Comments: Attending signature Date Resident signature Date Please return to Clara Vigelette by 30 . The neurology attendings will complete the form below and will also provide verbal feedback to the resident concerning the written notes.Department of Neurology University of Rochester Resident Chart Review Resident Year in training Attending physician Rotation Patient ID number Date of review Each resident will select one new patient consultation or admission note.

the numbers reported do not necessarily indicate competence. The Neurology Resident Inpatient Database is available on-line. Regular review of logs can be used to help the resident track what cases must be sought out in order to meet residency requirements or specific learning objectives. 31 . sorted by diagnosis. Logs of types of cases seen are useful for determining the scope of patient care experience. The Program Director will review the Case Logs with each resident during his/her semiannual evaluation meeting. Patient encounters that should be included in this database are: • • • • • ED consultations Hospital adult consultations Hospital pediatric consultations 5-1600 inpatients Highland Hospital consultations Semi-annual reports will be generated from this database that include a listing of all patients seen by each resident for the preceding 6-month period. Patient case logs involve recording of some number of consecutive cases in a designated time frame. Each resident will include these semi-annual case log summaries in his/her portfolio.RESIDENT CASE LOG Case logs document each patient encounter by medical conditions seen. Patient logs documenting clinical experience for the entire residency can serve as a summative report of that experience. Each resident is responsible for logging all inpatients seen by the resident into this database on a daily basis.

peers and others. other healthcare providers. and lead behavioral change. subordinates. Multisource feedback (also known as 360 degree feedback) is a process in which individuals are evaluated by supervisors. increased adherence to treatment recommendations.. The resulting feedback reports are expected to help our residents gain insight into their strengths and developmental needs. a scale of 1 to 5. Most 360-degree evaluations use rating scales to assess how frequently a behavior is performed (e. The 360-degree evaluation emphasizes observable behaviors rather than attitudes or motivations. and two free-text comment areas to record behaviors that merit commendation and behaviors that may be a focus for improvement. Evaluators completing rating forms in a 360-degree evaluation usually are superiors. teamwork. one global evaluation item. A 360-degree evaluation can be used to assess interpersonal and communication skills. and de-identified feedback data. and administrative staff. The focus is on those behaviors that support positive outcomes such as improved experience of care. and improved patient safety. communication.g. and patients and families. The program director reviews the survey results with each resident individually during their semi-annual evaluation meetings in January and June. peers. management skills. The 360-degree evaluation survey instrument includes 25 behavioral items rated on a five-point frequency scale.. decision-making). The ratings are summarized for all evaluators by topic and overall to provide feedback. In the aggregate.g. professional behaviors. without the names of the evaluators. the evaluators (observers) include nurses. with 5 meaning “all the time” and 1 meaning “never”). are provided to the individual resident and to the program director. and some aspects of patient care and systems-based practice.360-DEGREE EVALUATION 360-degree evaluations consist of measurement tools completed by multiple people in a person’s sphere of influence. Most 360-degree evaluation processes use a survey or questionnaire to gather information about an individual’s performance on several topics (e. The survey is uploaded onto the E*value evaluation system that is used to evaluate our residents. 32 . subordinates. For the UR neurology 360-degree evaluation. these feedback reports may provide a basis for evaluating system-wide strengths and weaknesses.

ethical dilemmas faced and how they were handled. a computer program that tracks patient care outcomes. The ACGME Core Competency Project includes a resident portfolio as a valid assessment method. Each neurology resident receives a three-ring binder with dividers at the beginning of his/her residency. and other forms of information. remaining learning needs. a quality improvement project plan and report of results. photographs. Reflecting upon what has been learned is an important part of constructing a portfolio. Items to be included in the Neurology Resident Portfolio are: • • • • • • • • • Neurology Grand Rounds PowerPoint presentations Medical student lectures and presentations Case Log. What are your strengths? 2. What are areas for your development? 3. reported semi-annually Resident research project results Abstracts presented at national meetings Papers published during the residency Listing of meetings attended each year Curriculum vitae Written one-page semi-annual self-reflection with an individualized learning plan. during his semi-annual evaluation meeting with the resident. the portfolio can include statements about what has been learned. a summary of the research literature reviewed when selecting a treatment option. In graduate medical education. including answers to the following three questions: 1. The resident is responsible for maintaining the portfolio. What are your plans to achieve these goals? The Neurology Residency Program Director reviews the Portfolio with the resident every six months. and how they can be met. or a recording or transcript of counseling provided to patients.or audio-recordings. In addition to products of learning. a portfolio might include a log of clinical procedures performed. A portfolio typically contains written documents but can include video. 33 . its application.RESIDENT PORTFOLIO A portfolio is a collection of products prepared by the resident that provides evidence of learning and achievement related to a learning plan.

ACGME Core Competency Project University of Rochester Neurology Residency Training Program Methods of Evaluation Competency RITE Patient Care Medical Knowledge X Clinical Skills Evaluation Chart Review Resident Case Log Attending Global Assessment X X X X X X X X X Practice-Based Learning and Improvement 360° Evaluation X X X X Interpersonal & Communication Skills X Professionalism X X X Systems-Based Practice X X X X 34 Resident Portfolio X .

ACGME Core Competency Project University of Rochester Neurology Residency Training Program Methods of Instruction .Sites Inpatient Neurology Rotation Inpatient Consultation Rotation HH and RGH Rotations ED Consultations Neurology Firm Chief Resident Clinics Resident Conferences and Rounds Patient Care X X X X X X X Medical Knowledge X X X X X X X Practice-Based Learning and Improvement X X X X X X X Interpersonal & Communication Skills X X X X X X X Professionalism X X X X X X X Systems-Based Practice X X X X X X X Competency 35 .

Conferences Morning Report Attending and Professor Rounds Patient Care X Medical Knowledge Practice-Based Learning and Improvement Competency Journal Club Resident Noon Conferences Health Team Rounds Grand Rounds X X X X X X X X X X X X X X X X X Interpersonal & Communication Skills X X Professionalism X X Systems-Based Practice X X 36 X MBB Course X X X .ACGME Core Competency Project University of Rochester Neurology Residency Training Program Methods of Instruction .

Incoming residents will be assigned to a career faculty mentor by the program director at the start of their intern year. Formal career mentoring will help to provide residents with early exposure to academic neurologists as potential role models. review CVs. beginning in the first (preliminary) year.DEPARTMENT OF NEUROLOGY RESIDENT MENTORING PROGRAM I. II. If these resident-mentor pairings are inappropriate based on interests or personalities. The activities produced by this partnership will be presented at the end-of-year resident research poster session. Introduction and Objectives The objective of the neurology resident mentoring program is to establish a formal career mentoring system throughout the Department of Neurology. III. and assist residents in identifying a research mentor. Career mentoring The first major component of the mentoring program will be a formal one-on-one mentoring program between selected faculty and individual residents. Faculty will help residents make decisions about elective choices. In addition. residents will select a research mentor by the end of their PGY-1 year. The neurology resident mentoring program is a two-fold resident mentoring system that will provide our residents with career mentoring as well as research mentoring. as well as selfidentified role models in their chosen career paths. To increase exposure of our residents to active research projects and scholarly activities currently available. based on their research interests and with the guidance of their faculty career mentor. This website will list research mentors who either have 37 . as well as to increase resident exposure to research and academic projects within the department. a research website will be created that lists ongoing small research projects within the department. they can be changed. When residents who have entered the program in their first and second years reach PGY3 and 4 years. these mentors will serve as role models for our residents in the academic and practice arenas. To meet this requirement. Faculty mentors will meet with residents at least twice yearly. and will help to streamline the identification of interests and research mentors. likely in the fall and spring. with the responsibility of identifying a new mentor placed equally on the faculty mentor and the resident. Research mentoring Current residency program requirements state that residents must identify a research project or a scholarly pursuit to be completed under the guidance of a research mentor during their time in residency. they will no longer be required to have documented meetings with their career mentor. they may continue the relationship if desired. as they will have established research mentorships. The goals of this pairing of residents and faculty are two-fold.

reviews.projects available or who are willing to serve as guides for scholarly pursuits such as case reports. and chart views. In addition. and to expose our residents to the language of research and the common complications and thought processes surrounding active and successful projects. The purpose of these presentations is to introduce our residents to researchers in the department with active projects. these researchers will be invited to give 10-15 minute presentations regarding their current or ongoing projects during Friday resident business lunch meetings over the course of the year. 38 .

and reporting relevant to the research project. up to a total of two months. residents are required to participate in a clinical or basic research project during their residency. Many internationally recognized clinician-researchers are members of the faculty. implementation. The Residency Review Committee in Neurology also mandates resident participation in scholarly pursuits. Accordingly. A suggested timeframe for this research experience is as follows: • First year: Identify a faculty mentor and meet to discuss possible projects Inform the Program Director of your project and mentor • Second year: Begin research project during an elective block or longitudinally • Third year: Complete research project Submit an abstract to a national meeting Prepare a Grand Rounds presentation based on the research Drs. or a subspecialty meeting is also highly encouraged. The department consistently ranks as one of the top five neurology departments in the United States for extramural research funding from the National Institutes of Health. The philosophy of the Department of Neurology is that research should be part of each resident’s educational experience.DEPARTMENT OF NEUROLOGY RESIDENT RESEARCH EXPERIENCE The Department of Neurology has a strong tradition of both basic and clinical research. Marc Halterman and Jonathan Mink will serve as faculty coordinators for the Neurology resident research experience. funding. the American Neurological Association. Each resident will choose a faculty mentor to support this project. Examples of research projects include the following: • Basic and translational science • Clinical research • Outcomes and health care utilization research • Education research • Clinical case presentation with review of the literature Elective time may be used for research projects. Abstract submission to the American Academy of Neurology. culminating in a formal departmental presentation. the mentor will instruct the resident in more general issues of study design. Research may be conducted during a block rotation or longitudinally. In addition to overseeing the specific project. 39 .

and research missions in both departments. The symposium highlights a very broad range of basic. or the equivalent. The residents should submit an abstract summarizing their presentation (maximum 250 words) via email to Clara Vigelette by late May.DEPARTMENT OF NEUROLOGY RESIDENT AND FELLOW RESEARCH SYMPOSIUM This annual Steven R. All Neurology residents are expected to prepare a poster presentation for this symposium. and clinical research performed in the departments of neurology and neurosurgery. This program is an excellent way to work toward integrating the clinical. Prizes will be awarded for the best clinical and basic science posters. 40 . Funds are available to support printing charges for the residents. Schwid. Marc Halterman or Jonathan Mink with questions. a case report. MD Neurology/Neurosurgery Resident and Fellow Research Symposium occurs each June and is scheduled to coincide with the annual Insley Lecture. educational. describing an aspect of their current research. translational. Please contact Drs.

pharmacology. A series of lectures is offered to the residents every other year in the history of neuroscience. Our department is fortunate in that many members have made major contributions to chronicling the history of our specialty. Basic science faculty will be the lecturers for this series. DEPARTMENT OF NEUROLOGY HISTORY OF NEUROLOGY CONFERENCE SERIES The specialty of neurology arose in the mid-19th century. genetics and molecular biology. 41 .DEPARTMENT OF NEUROLOGY NEUROSCIENCE CONFERENCE SERIES The purpose of this conference is to supplement residency education in areas of neuroscience. the topics to be covered are anatomy. It has a rich and varied history with contributions by many notable physicians and scientists. physiology (cellular and systems). development. neuropathology and neurochemistry. In particular. Twelve topics will be selected per year.

Neurology faculty members host Journal Club at their homes on a rotating basis. impact and applicability The first Journal Club of the year will be devoted to a review of evidence based principles. 42 . in consultation with the chief resident organizing Journal Club for the year. and also provides an informal setting for the discussion of journal articles with the active involvement of attendings.DEPARTMENT OF NEUROLOGY RESIDENT JOURNAL CLUB Journal Club occurs monthly. The reference book for Journal Club is Biller and Bogousslavsky’s Clinical Trials in Neurologic Practice: The Blue Books of Practical Neurology #25. The faculty member provides a light supper and refreshments. the hosting faculty member selects a journal article for discussion. For each subsequent Journal Club. One resident will be asked to review the article using evidence based principles. This resident will also lead the discussion. The purpose of Journal Club is to review a clinically relevant journal article and to consider: • Study design (clinical question and selection of germane evidence) • Potential areas of bias and error in design and execution • Evidence validity. This will be a chance for the faculty member to bring his/her own clinical interests into a forum of discussion with the neurology house staff. and will be asked to prepare a one-page summary analyzing the quality of the evidence. This enhances the practical understanding of evidence-based neurology. usually on a Thursday at 6:30 pm.

but is not limited to the diagnosis. interpretation of laboratory and radiographic findings. The scope of the conference includes. If the patient is unable to attend. The schedule of this series is as follows: • First and third Thursdays Neuromuscular unit • Second. These conferences occur weekly on Thursdays at noon in the Garvey Room. The format involves the attendance of a patient at the conference. the conference facilitator will simply present the case for discussion. a videotape of the patient can be shown that demonstrates the relevant history and physical exam findings. casebased conferences that provide guidance on practical issues that arise during the routine outpatient care of patients with specific neurological disorders.DEPARTMENT OF NEUROLOGY PATIENT MANAGEMENT CONFERENCE SERIES The patient management conference series is designed as clinically oriented. at which time relevant historical points are discussed and relevant physical exam findings are demonstrated. fourth (and fifth) Thursdays Other subspecialties 43 . and management of neurological patients. If neither of the above two options are possible. It is strongly preferable that the discussion be focused primarily on issues that arise in the outpatient setting.

44 .

The Neurology Chief Resident provides support to the “on-call” neurology resident. which are divided among three teams: the Red and Blue Teams (Neurology Inpatient Service). The epilepsy team consists of the Epilepsy Attending.GENERAL GUIDELINES FOR THE ACTIVITY OF THE NEUROLOGY RESIDENT AT SMH Organization of the Neurology Inpatient Service (5-1600) Organization: • The Adult Neurology Inpatient Unit consists of twenty-four beds. and for providing daily teaching. a neurology. Each team consists of a neurology PGY-2.m. The Neurology Unit is responsible for the care of all patients with neurologic disorders admitted from the emergency department. they must be readily available between 7:30 am and 5:00 p. psychiatry or anesthesiology PGY-1. a 3rd year medical student and. Outpatient clinics are not to be scheduled for the attendings when they are on service. a 4th year neurology extern. In order to do this. Neuroimmunology and Movement Disorders Attendings are available on a consultative basis only. 45 . daily for patient care and teaching activities. In addition. Neuromuscular. The organization of the Red and Blue Teams (Neurology Inpatient Service) is described below. • The Red and Blue Teams follow all patients admitted to the neurology inpatient service. he/she conducts daily sign-out rounds with the Red and Blue Teams. feedback and a final evaluation for each house officer whom they supervise. and the Green Team (Epilepsy Service). and an epilepsy fellow or a neurology PGY-2. or electively. from the neurology outpatient clinics. These Attendings are ultimately responsible for all decisions regarding the care of their patients. with the exception of those admitted to the Epilepsy Service for longterm video EEG monitoring. Pre-scheduled meetings are to be kept to a minimum and should be easily canceled if necessary. He or she makes work rounds with the Red and Blue Teams on an alternating basis and participates in attending rounds. The neurology PGY-4 (chief resident) supervises both of these teams. Personnel: • Attending: The Red and the Blue inpatient teams each have their own dedicated General Neurology Attendings who supervise the care of all of the patients on their teams. Neuro-oncology. on occasion. Each team alternates admitting patients to their respective team. The General Neurology Attendings are responsible for making daily teaching rounds with the Red and Blue Teams. • Neurology Chief Resident: The Neurology Chief Resident (PGY-4) is responsible for the smooth running of the neurology inpatient and consultation services. • The Epilepsy Service (Green Team) follows all patients admitted to the Strong Epilepsy Center for long-term EEG monitoring and treatment of seizures.

Decisions as to which team admits a patient are made by the neurology chief resident. • Elective admissions: Elective admissions that arrive on the floor by 4:00 p. They also write progress notes daily on all inpatients on their teams. are included elsewhere in this handbook. on an alternating basis. and are responsible for assisting the neurology PGY-2’s in managing their floor teams. • Third Year Medical Student: The third year medical students work directly under the neurology PGY-2’s. They admit patients every day. Admissions called to the floor after 4:00 p. and for presenting each assigned patient as needed on rounds. generating a differential diagnosis and formulating a plan of treatment for approximately three new patients per week. 46 . are admitted by the team that is up for the next admission.Weekdays: • The Red and Blue Teams admit non-acute stroke or general neurology patients every day. are evaluated by the on-call neurology resident and are picked up the following day by the team that is up for the next admission. He/she will be responsible for completing the work-up on the same day that the patient is evaluated. performing a complete general and neurological examination. Admission Guidelines . They function as a substitute intern (PGY-1). as follows: Monday 10:00 am – 12:00 pm Attending Rounds Tuesday 11:00 am – 12:00 pm Professor’s Rounds Wednesday 10:00 am – 12:00 pm Attending Rounds Thursday 10:00 am – 12:00 pm Attending Rounds Friday 9:00 am – 10:30 am Neurology Grand Rounds The goals and objectives for Attending Rounds. up to the 10 patient cap mandated by RRC guidelines.m. between 8:00 a. Each student is responsible for obtaining a complete history.m. and 4:00 p.Fri. • Neurology.m. Psychiatry and Anesthesiology PGY-1: The PGY-1’s work together with the Neurology PGY-2’s on the Red or Blue Teams.• Neurology PGY-2: The Neurology PGY-2’s are responsible for all admissions to the neurology inpatient service. Mon . Progress notes are to be written daily on all inpatients that are followed by the student. as well as guidelines for conducting them. taking into consideration team size and who is in clinic that afternoon. The PGY-1’s write progress notes daily on all inpatients on their teams. on an alternating basis. • Fourth Year Medical Extern: The fourth year medical externs work together with the Neurology PGY-2’s on the Red or Blue Teams.m.. Teaching Rounds: • Teaching Rounds are held daily. splitting the patients and admissions on their team. They are also responsible for writing daily progress notes for all patients above the 10 patient intern cap.

but only after signing out to the medicine evening float.m. • The neurology PGY-2 can sign out his/her team to the other floor team’s neurology. the neurology PGY-1 resident may be asked to assist with consults in the ED or hospital at the discretion of the on-call neurology resident and the neurology chief resident. the neurology PGY-2 rounds with the medical student on one weekend day.m. anesthesiology. On occasions when floor responsibilities are light. The neurology PGY-2 picks up all overnight admissions on the weekend day that he/she is rounding. This intern is expected to cross-cover both teams until 5:00 p. • ED admissions: Patients seen in the ED prior to 4:00 p. The consulting resident who knows the patient should inform the neurology inpatient team that the patient may be called out. when he or she may sign out both teams to the medicine weekend float intern. Patients seen in the ED after 4:00 p. or on a non-neurological service may be transferred to the neurology service.m. anesthesia. 47 .m. the Red or Blue team will assume care of the patient. Once the patient has arrived in a bed covered by the neurology inpatient team. For each team. The neurology. the step down units. by the on-call neurology resident and subsequently admitted to Neurology are picked up by the appropriate team the following day. the oncall neurology resident will assume care of the patient.• Callout admissions: Hospitalized patients who are in the ICU. and receive sign out each morning prior to 7:00 am. and the medicine night float covers any emergencies between 8:30 pm and 7:00 am the following morning.Weekends: • The neurology PGY-2.. and the patient will be assigned to a neurology inpatient team the following morning. and subsequently admitted to Neurology are picked up that day by the admitting team that is up for the next admission. Admission Guidelines . If this occurs after 4:00 p. If this occurs before 4:00 p. The PGY-1’s must let their PGY-2 know that they have signed out.m. the PGY-1 and the medical student on the Red and Blue teams each have one day off every weekend.. or psychiatry intern starting at 11:00 a.. The neurology on-call resident provides back-up supervision to the medicine evening float and medicine night float for all neurology inpatients on 51600. he/she will begin to be covered by the neurology service. and the PGY-1 rounds with the neurology chief resident on the other weekend day.m. Evening and Night Call: • The medicine evening float covers any medical emergencies on 5-1600 between 4:30 pm and 8:30 pm. and psychiatry PGY-1’s must sign out to the evening float prior to leaving the hospital each evening. • The PGY-1’s may leave the hospital at any time following sign-out rounds if they have finished all of their work.

the most stable stroke patients will be transferred to the stroke nurse practitioner on service. a PM&R resident. An attending neurologist. who will follow these patients together with the Red or Blue team neurology PGY-2 until discharge. including reviewing their patient work-ups. • The neurology acting chief resident. in R wing. a neurology PGY-3. the PGY-4 will see patients who are in excess of this cap. the medical PGY-1’s and all medical students on the Red and Blue Teams are expected to be present at sign-out rounds which are held at 4:00 p. in the ED. These patients are first seen by the neurology PGY-3 on the stroke service and are then staffed with the general neurology consult attending.m.Teaching Responsibilities: • The neurology PGY-2 is responsible for running work rounds. • The neurology PGY-1’s attend their afternoon outpatient clinic once per week. which begin at 8:00 am Monday through Thursday. A medicine resident. • The neurology PGY-2’s on each team cross-cover for one another when either of them is in clinic. Organization of the Neurology Consult Services • Organization: There are two adult neurology consultation services at SMH: the general neurology service and the acute stroke service. • General neurology service: The general neurology service provides general neurology consultations on the adult hospital wards. Work rounds on the weekends begin immediately following 8:00 AM neurology sign-in rounds. due to medicine RRC program requirements. • The intern teams will be capped at 10 patients per team. • The neurology PGY-2 is responsible for supervising any medical students assigned to their team. Monday – Friday. 48 . When the number of patients on the red or blue teams exceeds 10 patients. The neurology PGY-2’s provide patient care and help write progress notes on those afternoons when their PGY-1 is in clinic. Miscellaneous Considerations: • The neurology PGY-2 is responsible for obtaining consults from other services. and two 3rd year medical students staff each service. and at 7:30 am on Friday. an anesthesiology resident or a neurosurgery resident may be assigned to one of the consultation services on occasion. and in the ICU's. On the weekends. the neurology PGY-2’s.

and the ICU's. etc. the majority of these patients will be assigned to the NNICU service. Evening and Night Call • Since July 2004. as well as adult and pediatric neurology consultations in the hospital. • Weekend coverage: The neurology PGY-3’s cross-cover for one another each weekend.) not requiring intensive medical care (unstable cardiovascular.• Acute stroke service: The acute stroke service provides consultations for patients suspected of having an acute stroke. Monday through Friday. • Consult rounds: Each consultation team will round with the Attending daily at a mutually convenient time. The stroke service may still play a consultative role in managing some of the more complicated patients. the neurology PGY-3 is responsible for writing the admission note and orders for that patient. All new patient consultations should be formally presented to the Attending on rounds that day. • Consultation hours: 8:00 am . as well as any other ICU patients with cerebrovascular disease (intracerebral hemorrhage. Transfer orders also need to be written. The residents mutually agree upon the exact schedule. and may be entered by either the consult resident or the accepting team.4:00 p. intracerebral hemorrhage or subarachnoid hemorrhage. 2013. etc. • The neurology evening and night float residents are responsible for all adult ED patients triaged to neurology. for the first 24 hours of their admission. • Admission Notes and orders: When a patient seen in consultation will be admitted to the Red or Blue team. the UR Neurology Residency program has had an evening and night float system to improve continuity of care and to comply with the New York State and ACGME guidelines on resident work hours. After the Neurological/Neurosurgical ICU goes live in October. Deferring or “handing-off” consults called late in the day to the evening call resident is not appropriate. The neurology PGY-3 should then communicate the pertinent information regarding the patient’s presentation and plan to the appropriate inpatient team. This allows each neurology resident to have one day off every weekend. • Cross-Coverage: The neurology urgent care resident cross-covers for the stroke and general neurology consult residents when either of them is in clinic. They may be called 49 .m. • Transfer notes and orders: The neurology PGY-3’s on each consultation service are responsible for writing a transfer note for any of their patients who are being transferred to 5-1600 from the ICU or another service. Follow-up patients may be seen by the Attending as needed. respiratory status.). the ED. Any consultation called to the general or stroke neurology PGY-3 during those hours is seen by the resident that day. The acute stroke service also attends. on all acute stroke patients in the ICU who receive thrombolytic therapy. TIA.

Monday through Friday. On average. while simultaneously decreasing the workload of the residents covering the stroke and general consultation services during the day and during evening and night shifts. neurology consultations are becoming more complex and time-consuming. they provide back-up coverage to the medicine evening float and night float covering neurology inpatients on 5-1600. and to schedule the patient. and PGY-3 residents will spend one 2-week block on this rotation. The UCEF rotation is organized as follows: • The resident on the UCEF rotation works five days per week. • All first and second year neurology residents alternate taking weekend call. and neurology PGY-3’s do one block as night float. the neurology weekend and night float residents are responsible for all neurology consultations and admissions. on average.concerning problems with patients already being followed on the consult services. the Neuroradiology Conference on Thursdays. • On Saturdays and Sundays. • The night float rotation is 2 weeks in length. If the patient cannot obtain an outpatient appointment within an acceptable amount of time. or believe it is acceptable to have a patient seen within a week of their ED visit. • If the ED requests that a patient be seen in the Urgent Care Clinic. • The night float is expected to attend morning report on Mondays. • During the afternoon hours (1-5 PM). • The UCEF resident will attend the noon conference each day (11:00 AM conference on Friday). then the on-call resident should call the Neurology Acting Chief Resident in order to verify that an opening is available in Urgent Care Clinic. Given the advances in stroke care and the increased complexity of neurologic consultations due to advances in transplantation medicine and oncology treatments. • The Neurology Chief Residents are responsible for constructing the Evening Float and Weekend call schedules. and Saturday morning sign-in rounds. Urgent Care – Evening Float Rotation The Urgent Care – Evening Float (UCEF) Rotation was instituted in 2011 to address the increased volume and acuity of general neurology consultations in the afternoon and evening hours as well as the lack of outpatient appointments for new patients with urgent neurologic complaints. the UCEF resident will have the following responsibilities: 50 . then the consult should be completed while the patient is in the ED. neurology PGY-2’s do three blocks as night float. Tuesdays and Wednesdays. The rotation is two weeks in length. • PGY-2 residents will spend. from 12:00 noon until 10:00 PM. In addition. This rotation is planned to provide a rich educational experience for the resident. three 2-week blocks on the UCEF rotation. including direct admissions to 5-1600.

• The firm attending of the day will be responsible for staffing these patients with the UCEF resident when there are three or fewer residents in the Firm that afternoon. If there are four residents scheduled for the Firm that afternoon. UCEF Rotation Hours: 12:00 – 1:00 PM Noon conference (11:00 AM conference on Friday) 1:00 – 5:00 PM Cross cover general neurology and stroke consult residents when they are in clinic (2 afternoons per week) See urgent new outpatients in the neurology OPD. the UCEF resident will assist the evening float resident in performing inpatient consults. Follow-up appointments for new patients seen by the UCEF resident will be made in that resident’s Firm. up to 3 new patients per afternoon (2 afternoons per week) Attend his/her resident firm (1 afternoon per week) 5:00 – 10:00 PM Inpatient consultations – shared with the evening float Evening and Night float hours: Night float: Sunday through Friday: Saturday evening: 8 PM – 8 AM (home by 9 AM) Off Evening float: Monday through Friday: 4 PM – 8 PM (off by 9:30 PM) UCEF Monday through Friday: 5 PM – 10 PM Weekends: Saturday call: Saturday night call: Sunday call: 8 AM – 8 PM 8 PM – 8 AM 8 AM – 8 PM 51 . • During the evening hours (4-10 PM). The evening float or night float will receive all consult calls and will divide these consults with the UCEF resident. Acute stroke consultations should be handled by the UCEF resident after 7 PM in order to allow the evening float resident to leave at the appropriate time. or in the relevant subspecialty clinic if more appropriate.o Provide cross coverage for the stroke and general neurology consult residents when they are in clinic two afternoons per week o Attend their own resident firm one afternoon per week o See up to three urgent new outpatients in the neurology OPD two afternoons per week. • The UCEF resident will staff new patient consultations with the stroke and general neurology attendings by telephone or in person. as per current policy. the general inpatient attendings will staff these patients. The attending physician who staffed the patient will make this determination.

• The general neurology consult attending or stroke attending should be notified of any new ICU consults shortly after the patient is seen. locations. the on-call resident pages the EEG attending for approval and then the EEG technician through the page office. • The evening float should receive sign-out from each floor team and consult team regarding any active patients. • The general neurology consult attendings and stroke attendings are available for help with any adult patients seen in consultation by the on-call resident. The EEG technician will be called in to perform the study. the consult residents and the floor residents. • The on-call pediatric neurology attending or fellow should be notified of all pediatric consultations seen. • All consults seen during a particular shift must be discussed with the attending by the resident prior to leaving the hospital following the evening or night float shift. listing the names of the patients seen. 52 . Miscellaneous considerations: • The on-call resident can order an after-hour emergency EEG to verify brain death for organ donation. in cases of suspected herpes encephalitis. Deferring non-emergent consults for the following day is not appropriate. • The chief resident should be informed of all overnight admissions before morning report. Westfall Road general neurology patients. and the EEG attending will then read the tracings. The chief resident is available 24 hours a day for telephone back-up for the on-call resident. In these cases. and in cases of suspected non-convulsive status epilepticus. • The on-call resident is responsible for answering patient calls from neurology firm patients. their medical record numbers. diagnoses and the date seen.Attending and Chief Resident Back-up: • The general neurology inpatient attending should be notified of all patients admitted to the 5-1600 inpatient service at the time of admission. subspecialty neurology patients (with several exceptions). The attending neurologist on call for each of these services is always available for consultation if necessary. • All consultations during the night and on weekends are to be seen at that time. An email or e-record note should be sent to each practitioner regarding patient calls after-hours. and child neurology patients. their ages. • The neurology web-based patient log should always be updated daily by the oncall residents.

This allows the Chief Resident to monitor the progress of all patients admitted to 5-1600. he/she must contact the appropriate residents first thing in the morning to discuss the patients seen the prior evening. All patients seen the previous night by the on-call resident should be discussed briefly at this time. In addition. • Availability: The Chief Resident is expected to be available at all times. which usually occur daily from approximately 4:00 p. until 4:30 p. This is particularly crucial for the neurology PGY-2’s. He/she should briefly see and evaluate all patients admitted to the unit. • The on-call resident is responsible for handing-off any new patients that need follow-up to the appropriate consult resident via face-to-face sign-out or a detailed email. Admissions to and consultations from the ICU’s should also be reviewed at that time with the PGY3’s. hand-offs should be communicated to all residents on-call that weekend and to the covering chief resident during 8 AM sign-in rounds on Saturday and Sunday. monitor their work-ups and management. the neurology PGY-2’s and Medicine PGY-1’s on the Red and Blue teams. • Sign-in Rounds: The neurology Chief Resident is responsible for meeting each morning at 8:00 am (following morning report) with the resident on-call the previous night. Responsibilities of the Neurology Chief Resident • General Responsibilities: The neurology Chief Resident is responsible for the smooth operation of the Neurology Inpatient Service on 5-1600. the PGY-3’s on the stroke and general neurology services. on an alternating basis. sign-out rounds are a prime opportunity for the Chief Resident to teach the residents and medical students about interesting patients on the service. provide guidance to the house staff on 5-1600. Although most of these consultations will occur via telephone. the neurology PGY2’s and all medical students on the Red and Blue teams.• If the evening float resident is on an off-site rotation and is unable to attend morning report. on 5-1600. • Weekend Cross-coverage: The chief residents "cross-cover" for one another each weekend.m. and the pediatric neurology resident. All patients on 51600 should be reviewed briefly with the medicine PGY-1’s. the Chief Resident may be required to see patients in the emergency room.m. For patients seen over the weekend. or in the Intensive Care Units if necessary. including weekends. and especially during the first six months of their residency. • Work rounds on 5-1600: The Chief Resident makes work rounds at 8:00 AM each morning with the Red and Blue teams. and provided feedback and evaluations concerning the performance of the house staff. • Support for the on-call Resident: The Chief Resident provides primary support for the neurology on-call resident. • Afternoon sign-out rounds: The Chief Resident runs sign-out rounds. The acting chief resident will be on-call every other weekend for 53 .

• Urgent Outpatient Consultations: The Chief Resident is responsible for arranging to see any outpatients who need to be evaluated urgently and who cannot be scheduled with the Urgent Care resident or in the Firms within a week. in consultation with the Program Director. The General Neurology Attendings are responsible for staffing these patients with the chief resident. with consultation from the Chair of Neurology. The chief residents mutually agree upon the exact schedule and provide this schedule to the Program Director. • Monday and Friday Resident Conferences. Journal Club and Neuroscience Course: The Chief Residents are responsible for organizing and scheduling these conferences. and adhering to the time schedule. Weekend chief resident cross-coverage begins at 4 PM on Friday and ends at 8 AM on Monday. Patient Management Conference. • Morning Report: The Chief Resident is responsible for running Morning Report on rare occasions when the Neurology Department Chair or Associate Chair for Education is unavailable. He/she will have a room reserved in the neurology OPD one afternoon each week for these patients. Grand Rounds Resident Cases. The acting Chief Resident is also responsible for the smooth running of Grand Rounds. with the alternate weekends being covered by one of the other chief residents. moderating the discussion. including introducing the speaker.the entire weekend. • Grand Rounds: The Chief Residents are responsible for scheduling Grand Rounds. • On-call Schedule: The Chief Residents are responsible for creating the neurology resident on-call schedule for the year. 54 .

m.m.m.12:00 p. 4:00 – 4:30 p. 12:00 ..8:00 a.m. Morning Report Brain Cutting Professor’s Rounds Functional Neuroimaging Conference Sign-out Rounds 5-5220 1-6428 (K-1) 5-5220 5-5220 5-2555 Wednesday 7:30 . 12:00 . 11:00 ..m. Wednesday and Thursday from 8:00 until 10:00 a. 10:00 – 11:00 a.m. 4:00 – 4:30 p.12:00 p.m. 55 . Sign-in Rounds 5-2555 Sunday 8:00 – 8:30 a.m.m. Morning Report Attending Rounds EEG Conference Sign-out Rounds 5-5220 5-1600 5-5220 5-2555 Thursday 7:30 . Sign-in Rounds 5-2555 Work rounds are held on Monday. Neurology Grand Rounds Resident Case Presentation Neurology Clinical Conference Resident Lunch Sign-out Rounds K-307 K-307 5-5220 5-5220 5-2555 Saturday 8:00 – 8:30 a.m.m.m. 4:00 – 4:30 p.m.12:00 p.m. 11:00 .8:00 a. 4:00 – 4:30 p. on Friday from 7:30 until 9:00 a.m. Neuroradiology Conference Attending Rounds Patient Management Conference Sign-out Rounds G-3270 5-1600 5-5220 5-2555 Friday 9:00 .m.m. 10:00 – 10:30 a.m. 10:00 .m.m.10:00 a.12:00 p.12:00 p.m. Tuesday.m. 12:00 .m.1:00 p.Neurology Conference Schedule Monday 7:30 .1:00 p. 4:00 – 4:30 p. 10:00 .m. and on Saturday and Sunday from 8:30 until 10:30 a.m.8:00 a.1:00 p.8:00 a.1:00 p.m. Morning Report Attending Rounds Neurology Clinical Conference Sign-out Rounds 5-5220 5-1600 5-5220 5-2555 Tuesday 7:30 .m. 12:00 . 10:00 . 12:00 – 1:00 p.

Where there is an acute problem needing attention. residents should defend logically their diagnostic and therapeutic plans. A variable approach to Rounds is encouraged which will depend on the problems the patient presents. 5. and management discussions with the team. Attending Rounds will include formal case presentations by the intern or medical student. Interruption of Rounds should be kept to a minimum. preventive medicine. and follow-up plans for the patient. appropriate use of consultants. 7. differential diagnosis. personal and social problems of the patient. 6. individualized therapy and knowledge of drug action. each resident team will spend two hours with the general neurology attending assigned to their team. the chief resident should excuse him or herself and see the patient allowing the PGY-1 and PGY-2 to remain at Rounds. up-to-date description of disease entities. Patient presentations should take place at the bedside. During Attending Rounds. 56 . A focal point of this teaching are the Attending Rounds and Professor’s Rounds. medical ethics. diagnostic reasoning. Residents are asked to be well prepared for Attending and Professor’s Rounds and to meet promptly at the appointed hour. when possible. Cost-effectiveness and evidence-based medicine should be stressed. Each resident is expected to be at Rounds unless an acutely ill patient needs immediate attention. Primary data should be challenged as to their accuracy and completeness. The primary responsibility of the Stroke and General Neurology Attending Physicians is to teach the House Staff on the inpatient and consultation services. 4. Areas to be covered include: basic science correlation and pathophysiology of disease. and they should be stimulated to acquire new knowledge. 3.INPATIENT ATTENDING PHYSICIAN'S RESPONSIBILITIES Teaching Responsibilities 1. including give-and-take Socratic teaching. which occur daily according to the following schedule: Monday 10:00 am – 12:00 pm Attending Rounds Tuesday 11:00 am – 12:00 pm Professor’s Rounds Wednesday 10:00 am – 12:00 pm Attending Rounds Thursday 10:00 am – 12:00 pm Attending Rounds Friday 9:00 am – 10:30 am Neurology Grand Rounds 2. Attending Rounds should be directed actively by the Attending with appropriate challenge to the residents. discriminative laboratory utilization. clinical skills used to acquire and record clinical data. bedside teaching by the attendings. Rounds should be built around the patient's central problem with teaching directed primarily at the first year neurology residents.

In addition. and medical students on an ongoing basis. It is important to write at least 2 or 3 sentences at the bottom of the form summarizing the resident's performance. print this note and submit it to the attending for his/her review.g. the PGY-1 or PGY-2 should be asked to demonstrate for 5-10 minutes at the bedside.. at the end of his or her residency training. the attending is expected to meet individually with each resident and medical student at the end of his/her rotation to provide verbal feedback. Ongoing evaluation is required of faculty members who teach and supervise residents. In order to provide more accurate evaluations. selected interview and physical diagnosis skills. Global Assessment Forms evaluating all six ACGME Core Competencies are available through the E*value system and must be filled out by the Attending for each resident with whom he/she has worked for at least one week. and appropriate use of clinical facilities and resources (e. At least one medical record must be reviewed by the Attending to determine the quality of record keeping. appropriate laboratory tests and consultations). PGY-2’s. including clinical decision-making. Feedback should be provided to the PGY-1’s. PGY-3’s. The attending should direct teaching not only to enhance medical knowledge and clinical judgment. but also to improve individual clinical skills. 57 . 3. the attending should keep notes on the performance of each resident throughout the attending period. 2. 4. The Residency Program Director should be contacted personally if any particular Neurology resident is performing unsatisfactorily. Ideally. The neurology attending will complete the resident chart review form and provide verbal feedback to the resident concerning the written note. the attending should meet briefly immediately after Attending Rounds with the resident who presented the case. is clinically competent in each of the six ACGME Core Competencies in order to be qualified to sit for the ABPN Certifying Examinations. Chief Residents. Each neurology resident will select a new patient consultation note or admission note. The Residency Program Director is required to certify that each resident. follow-through in patient management and preventive health services. 5.Evaluation Responsibilities 1. During the attending period. 6.

Teaching Medical Facts _____________________________ 8. Stimulating Acquisition of New Knowledge _____________________________ 10. Appropriate Involvement of all on Rounds _____________________________ 9. Ability to Teach Outside Own Specialty _____________________________ 3. Interest in Teaching Low High 1 2 3 4 5 _____________________________ 2. Bedside Teaching of Interview and Physical Dx _____________________________ 5. Basic Science Correlation _____________________________ 6. Demonstrating Appropriate Physician Attitudes _____________________________ 4. Review of Medical Records with Comments _____________________________ OVERALL RATING _____________________________ Attendings are encouraged to review their own evaluation file kept in the Chairman's office. 58 . Teaching Diagnostic Reasoning _____________________________ 7.Evaluation of Attendings Each resident is asked to evaluate the attending on the following 10 areas: 1.

women’s health. The intern also gains experience supervising and teaching medical students. Highland Hospital is a New York State designated Stroke Center. All patients who present to the Emergency Department with symptoms of acute stroke are first evaluated by a well-trained and coordinated stroke team comprised of emergency medicine physicians. While it is part of a major medical center. as well as interacting with residents from other services. is located in the Professional Office Building. obstetrics. One goal of this rotation is to use Highland’s “community hospital” atmosphere to simulate the consultative feel of the private general neurology practice environment in which most neurologists work. It became part of the University of Rochester Medical Center in 1997. first. The Department of Neurology office. 59 . In many departments. The URMC Department of Neurology began providing full consultative neurological services at Highland Hospital in 2004. The “Stroke Team” page refers to a patient with symptoms of acute stroke either in the ED or inpatient on a medical/surgical floor. First responders to an inpatient Stroke Team page are Internal Medicine or Critical Care Physician’s Assistants who are trained to perform the NIH stroke scale and evaluate patients with acute symptoms. During weekday business hours. Room 040 (on level BA. also referred to as the Garden level). A core group of department faculty provides the bulk of attending coverage on the neurology consult service. Last year. patient-centered. in particular Internal Medicine and Family Practice. a 22-bed Neuromedicine Unit opened on East 7. the medical staff is comprised of physicians in private practice as well as physicians who are employed by URMC. On nights and weekends. PAs. which includes work space and full computer access for both residents and medical students.year residents on service at Highland should expect to encounter the full spectrum of neurological disease. and nurses. full service hospital established in 1889. This combined neurology and neurosurgery unit contains 6 stepdown beds and provides coordinated services for patients and families with a variety of neurological conditions. community-based hospital. Highland Hospital has been able to maintain its identity and important role as a smaller. and joint replacement surgery. and has developed centers of excellence in geriatric medicine. There is no neurology attending service at Highland Hospital at this time. bariatric surgery.HIGHLAND HOSPITAL 1 YEAR NEUROLOGY RESIDENT ROTATION st Highland Hospital 1000 South Avenue Rochester. NY 14620 Highland Hospital is a 261-bed. all acute stroke cases are staffed with the city-wide stroke attending neurologist prior to initiating acute therapies. Keys for access can be obtained from Christy Clary (276-5550). With the exception of neonatal and child neurology. the in-house neurology team is responsible for working up acute strokes and making acute treatment decisions with the ED providers.

obstetrics). MD. The resident will attend Neurology Grand Rounds on Friday morning at 9 AM at SMH. the attending neurologist will be responsible for taking new consults and triaging calls. 2. especially with respect to the populations represented at Highland Hospital (i. 3. MD. The actual times that the workday begins and ends will vary depending on the case load. Become familiar with changes in the neurologic exam associated with normal and abnormal aging. PhD Goals for the 1st Year Highland Hospital Rotation 1. and between 1 PM and 5 PM on Friday. Gain aptitude at communicating recommendations for evaluation and treatment of patients with neurological disease to the healthcare providers on attending medical and surgical teams. During weeks that a categorical medicine intern is on service at Highland Hospital. Director. 60 . 4.e. Chief of Neurology and Director. Become familiar with special considerations in the evaluation and treatment of common neurological disorders (i. There is no overnight neurology resident coverage.Core Neurology Faculty • • • • • Adam Kelly. and selecting appropriate therapies. Education Site Coordinator Irene Richard. seizure. followed by the resident didactic conference at 11 AM. 6. Become comfortable performing neurological consults in an emergency department setting in a timely and efficient manner. 2. peripheral neurology) during pregnancy. except on the afternoon that he or she sees patients in the resident firm. 5.e. Room K-307. MD Michelle Burack. Develop skills in the following areas: obtaining complete neurological histories. MD. Expectations of Residents 1. The resident will be available to see new consults between 8 AM and 5 PM Monday through Thursday. Stroke Center Anthony Maroldo. performing accurate neurological examinations. MD Davender Khera. as well as working with those providers in an ongoing consultative role during a patient’s hospital stay. Gain in-depth knowledge of major categories of neurological disease. developing appropriate and complete differential diagnoses. geriatrics. migraine.

journals. 5. and can usually be expected to be out by noon. and online materials. The resident will educate himself or herself about the neurological disorders encountered on the consult service by reading appropriate texts. The resident will supervise and teach the 3rd year medical student who is rotating on the inpatient consult service. 4. 61 .3. The resident will round with the attending and see new consults from the previous night on one morning each weekend (usually Saturday).

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ROCHESTER GENERAL HOSPITAL 1 YEAR NEUROLOGY RESIDENT ROTATION st Phone: Back line: Fax: Rochester General Hospital Department of Neurology 1425 Portland Ave. In 2013. Patients are attended by the medical service with close consultation from the neurology stroke service. PGY1 RGH medical residents also rotate with neurology as a mandatory rotation. Psychiatry residents from the UR do part of their mandatory neurology rotations at RGH as well. It is the second largest hospital in Monroe County and is recognized for its cardiology services. There are 63 . The overall focus of RGH is to provide high-quality patient-centered and service-oriented clinical care. enrolls appropriate patients into approved stroke pathways. and infectious diseases). Children are consulted on by the on-call pediatric neurology team at SMH. and follow signs to “Neurology”. Adolescents may be seen and evaluated by the neurology team at the discretion of the attending neurologist. The Department of neurology provides both inpatient and outpatient services. RGH sees the most stroke admissions of any hospital in Monroe County. neurology attendings serve the role as consultants. weekend and some weekday additional patient coverage. Inpatient services are busy and see a wide range of neurologic disorders. On this unit. and admits patients to a designated stroke unit (7800). For many patients who do not get regular medical care. and the University of Rochester (neurology. Attendings do not currently serve on an admitting service. Rochester General Hospital is a New York State designated Primary Stroke Center. there may be a stroke fellow who will rotate with the stroke service. neurosurgery. On the inpatient side. pediatrics. turn left. suite B-4016. The stroke service at RGH consistently wins national recognition for quality. The neurology consult service includes both a general and stroke service. The inpatient neurology team often includes additional team members. nurses maintain their stroke credentialing. Starting in July 2013. It has recently formed an affiliation with the Rochester Institute of Technology (RIT) with respect to its physician assistant and biomedical engineering programs. PGY 3 RGH medical residents frequently take Neurology as an elective and will join the inpatient team. The RGH emergency department maintains an eye on stroke scale qualifications. Rochester General Hospital (RGH) is a 521-bed. their interaction with neurology is often the first time they may see a neurologist for long-standing neurological problems. full service hospital that serves the northeast community of Rochester as well as Webster and Irondequoit. A biplanar endovascular suite has been opened which will allow for endovascular treatment of acute stroke. oncology services and nursing magnet status. Box 220 Rochester NY 14621 585-922-4371 585-922-4227 585-338-7485 Directions to the Neurology Unit: Take green elevators to 4th floor. four midlevel providers have been added to the team to provide evening. The percentage of eligible patients who receive TPA is almost double national standards. Roswell Park (oncology). For at least part of the year. there will be a PGY2 URMC Neurology resident rotating on the service for approximately 9 of the 12 months of the year. It has affiliations with Cleveland Clinic (cardiothoracic surgery).

Obtain complete neurological histories. unit chief / movement disorders Jeff Burdett. Learn how to communicate recommendations for evaluation and treatment of patients with neurological disease to the healthcare providers on attending medical and surgical teams. and perform emergency department and inpatient neurological consultations in an efficient and professional manner. 6. Clinical research trials are currently underway at RGH for stroke and dementia. PhD. MD / multiple sclerosis Mia Weber. but expansion into other realms is being considered. or are actively involved in research at the University. MD.also two nurse practitioners from the stroke floor (7800) who may accompany the team on rounds as well. MD. develop appropriate and complete differential diagnoses. The department has a wide range of inpatient procedures available. All attendings are either positioned at or rotate through SMH subspecialty clinics. 4. EEG and EMG. PhD / movement disorders Amy Chen. Learn how to accept. MD. director of stroke services / stroke Refat Assad. MD. 3. Outpatient services at RGH include general and several subspecialty services. MD.PhD / hospitalist Todd Holmquist. 2. Learn about the unique complications affecting neurological patients on the rehabilitation service. RGH Neurology Faculty • • • • • • • • • • • • • Richard L Barbano. perform accurate neurological examinations. MBA /hospitalist Charles Duffy. Evaluate and assess patients with neurological disorders for appropriateness for transfer to the rehabilitation service. including Neuropsychological evaluations. and select appropriate therapies for patients presenting with neurological symptoms. including an excellent accredited ultrasound service. PhD / neuromuscular disorders Michael Chilungu.PhD / dementia Marc Halterman. MD / stroke Larry Samkoff. MD/ hospitalist Michelle Burack. and learn how to work with those providers in an ongoing consultative role during a patient’s hospital stay. triage. dementia Ann Ford-Fricke. 5. Third year UR medical students on the neurology clerkship also rotate at RGH. Gain experience in stroke management and ultrasound technique and usage. MD. 64 . NP / stroke Goals for the Rochester General Hospital Rotation 1. MD. PhD / neuropsychology. NP / general neurology Cheryl Wood.

the resident will spend two weeks on the general neurology service and two weeks on the stroke service.Expectations of Residents 1. and on-line materials 6. 3. The resident will supervise and teach the 3rd year medical students that are rotating on the inpatient consult service. The actual times that the workday begins and ends will vary depending on the case load. the resident will attend endovascular rounds on Monday afternoons via teleconference in Dr Burgin’s office. During the first four-week block. The resident will attend and present as necessary at RGH Neuroradiology Rounds. Weekends: The resident will round with the attending and see new consults from the previous night on one morning each weekend (8:30 AM – 12:30 PM). Friday: 1:30 PM – 5:30 PM (except on the afternoon of the resident’s SMH firm). 65 . Hours: Monday through Thursday: 8:30 AM – 5:30 PM. journals. If time allows. the resident will spend two weeks on the rehabilitation service and two weeks on the general neurology service. There is no overnight neurology resident coverage. During the two-week rotation on the rehabilitation service. 8. which take place on Wednesday morning from 8-9 AM. 4. The resident will educate himself or herself about the neurological disorders encountered on the consult service by reading appropriate texts. 2. the resident will write admission notes and daily progress notes on each patient that he/she is following. 5. 7. During the second four-week block.

66 .

CHILD NEUROLOGY RESIDENT ROTATION Objectives The overall goal for the three-month rotation in Child Neurology is for the neurology resident to be proficient in obtaining histories and performing neurologic examinations on infants and children. Perinatal Problems in Premature and Full Term Infants • Perinatal asphyxia • Intracranial hemorrhage and hydrocephalus • Hypotonia • Seizures • Birth injuries to the nervous system (including to the brachial plexus) 2. Developmental Delay and Intellectual Disability • Global Developmental Delay • Delayed motor development (including cerebral palsy) • Delayed speech/language development • Delayed cognitive development • Abnormal social development (including autism) 3. These include: 1. In order to achieve these goals. Childhood Seizures • Neonatal Seizures • Febrile Seizures • Idiopathic Generalized Epilepsies (including childhood absence and juvenile myoclonic) • Idiopathic and Symptomatic Focal Epilepsies (including Benign Rolandic) • Infantile Spasms (West Syndrome) • Lennox-Gastaut syndrome 4. the resident should have an opportunity to discuss and read about the problems he/she is seeing. The common neurologic problems of childhood are to be emphasized. Headaches • Migraine and variants in childhood including: o Benign paroxysmal torticollis o Benign paroxysmal vertigo of childhood o Hemiplegic migraine o Abdominal migraine / cyclic vomiting o Ophthalmoplegic migraine • Idiopathic Intracranial Hypertension 67 . Furthermore. the resident should be involved in the work-up and management of infants and children of various ages in both the inpatient and outpatient settings. Additional goals include learning about normal growth and development and understanding the interrelationship between development and abnormalities of the nervous system.

there will also be opportunities for the resident to evaluate children with less common problems. including strokes in infancy and childhood. • The resident is expected to teach medical students and residents who are rotating from other services. he/she should speak with the child neurology chief resident or attending as soon as possible to assist in establishing coverage. and Behavioral Disorders • Attention Deficit Hyperactivity Disorder • Learning disabilities (including dyslexia) 6. and pediatric demyelinating disorders. General Expectations • The resident is expected to actively participate in patient care. Learning. Head injuries • Acute and subacute care • Sequelae and rehabilitation 8. at any time during the rotation. and the neurologic complications of both childhood systemic diseases and immunizations. This includes the outpatient portion of the rotation as frequently attendings are double-booked and require a second provider. and epilepsy • Chromosomal disorders • Inborn errors of metabolism Ideally. Attention. CNS tumors. physical medicine and rehabilitation. central nervous system malformations. including pediatrics. Each resident will spend approximately 8 weeks on inpatient/urgent and 4 weeks on outpatient.held each Thursday (July-May) from 8 AM to 9 AM in the Garvey Room. and outpatient. the resident cannot be present. Neurogenetics • Genetic considerations in developmental disability. CNS malformation. Child Neurology Rotation Overview The Child Neurology rotation is divided into two services: inpatient/urgent. and psychiatry. as this leads to the best learning experience. • If. • The resident is expected to attend conferences including: o Patient of the Week (POW) Conference . The Neurology resident will be expected to participate in discussion of complicated patient cases in a manner similar to Professor Rounds.5. 68 . Movement Disorders • Tics • Dystonia/Chorea • Ataxia 7.

He/she should attend other conferences (e. • While on the Child Neurology service. o The resident should also attending morning report. • Patients seen in consultation by the Child Neurology service should have notes written at intervals appropriate to the nature of the patient’s problem. o Child Neurology Lecture series – held approximately every other Thursday from September through June from Noon – 1 PM. When 2 residents are present. • The neurology resident will be expected to read about the problems he/she is seeing. A suggested reading list with links to articles is available on the Neurology intranet page under Pediatric Neurology at http://intranet. When 1 resident is present. both in the standard pediatric neurology texts and in the literature. Rounds are usually held in the late morning and/or late afternoon. Professor Rounds) when possible. • Attending Rounds – The attending on-service will designate a time for rounding with the entire team. The Neurology resident will be expected to present at least one journal article and at least one clinical case over the 3 months of the rotation. and Grand Rounds. • Work Rounds . that resident will be responsible for all of the above duties.o Child Neurology Conference .rochester. Adult neurology residents rotating in Child Neurology will not be responsible for taking pager call. the resident will be assigned to round on inpatients three weekends over the course of his/her pediatric rotations.g. Responsibilities of the Neurology Resident Inpatient/Urgent Service Workflow • There will be 1-2 residents working on this service. Inpatient Service: • Patients admitted to the Child Neurology service should have a daily note written by the neurology resident.urmc-sh. These responsibilities will be switched mid-way through the rotation. Weekend rounds will be scheduled in coordination with the Child Neurology attending physician. noon conference lectures. one will be first call for inpatient and ED consultations.held each Tuesday (September – May) from 8 AM to 9 AM in the Garvey Room. and the other will triage calls from primary care physicians who wish to refer patients for urgent consultation. As patients are admitted to or consulted on by the service. these conferences should not interfere with the resident’s clinical responsibilities. 69 . brain cutting. each resident will alternate accepting onto their team. The team will round together on all patients.The residents should conduct daily work rounds with the medical students.

If there is only one resident covering the service. 2. Urgent Service: • There will be two urgent clinics held each week – on Tuesday and Thursday afternoons. the resident should sign-out any patients who are ill or who need to be checked on overnight to the 1st call adult neurology resident and to the pediatric neurology resident who is on pager call. and 3 PM) when there are 2 residents on the rotation. If a consult call is received overnight. When 1 resident is rotating. as well as Child Neurology clinic calls during the lunch hour. tests have been done. • The residents may also be required to work-up and follow pediatric SEC (epilepsy) inpatients at the discretion of the epilepsy service. and one resident is covering the urgent clinic. Each resident will be responsible for one of the two urgent clinics booked throughout the week (mainly this will be dictated by resident’s firm schedules). and the team has gathered information. Pediatric patients and consults are on three pediatric units (4-1400. and 4-1600). The residents will also field phone calls from outside hospitals. as well as all consults from the floors. and otherwise should 70 . the patient should be evaluated by the 1st call adult neurology resident who is in-house and then should be seen by the inpatient resident the following day.when lab values are back. • Consults should be completed on the day that the consult request is received. • When 2 residents are rotating. • Direct cross-coverage of patients admitted to the child neurology service is covered by the pediatric teams. 4-3600. there should be 1-2 patients scheduled on Tuesday and Thursday. • The Child Neurology attending on-service will provide back-up if the resident needs assistance triaging a patient and will supervise the urgent visits. If there is a neurological concern that arises after hours. Sign-out/Call • In the morning. and other days of the week could be utilized if needed on a case-by-case basis. or admissions from the previous night or weekend. Neonatal ICU. including Rochester General Hospital. the pediatric residents should contact a child neurology resident on-call if available. consults. the other resident will cover inpatient and ED consults as well as floor issues on all patients. the resident should communicate with the evening/night float and/or with the pediatric neurology resident on pager call to find out about any problems. There should be up to 3 urgent patients scheduled in each clinic (1. that resident will be responsible for both urgent patients and inpatient/ED consults in conjunction with the attending. as well as the Pediatric ICU. and Child & Adolescent Psychiatry inpatient unit (4-9200). Consults • The resident is expected to work-up all patients who are admitted to the Child Neurology service. • At the end of the day. The exact schedule for urgent patients should be confirmed with the attending at the beginning of the rotation.

and should staff the question with a child neurology resident or attending if needed. Outpatient Service Clinic • The neurology resident will receive a clinic schedule for the month that he/she is on the outpatient rotation. perform a physical examination. • The resident should obtain a history. occasionally the 1st call adult neurology resident may be contacted. However. • The resident will not have his/her own patient schedule. We do not divide our patients by mechanism of payment for medical care. • The resident is expected to see both new and follow-up patients. 71 . and then present his/her findings and plan to the attending. he/she will see the attending neurologist’s patients. Rather. or may direct the pediatric resident to page the attending.g. The resident is responsible for looking at the schedule ahead of time and showing up on time for clinic (e. • The resident is responsible for writing a complete and timely note (within 48 hours) for each patient seen and staffed. The resident will see patients with all of the child neurology attendings over the course of the rotation. formulate a plan. The attending will review the plan and then see the patient in conjunction with the resident. some clinics start at 8:30 AM and other at 9 AM).contact the attending.

72 .

73 . Descriptions of each component of the rotation. CPEP usually sees approximately 9000 patients each year. This rotation will consist of two 2-week experiences: the SMH Comprehensive Psychiatric Emergency Program [CPEP].PSYCHIATRY ROTATION For Neurology Residents Director Glenn Currier. social workers. as well as specific learning objectives. 275-4501 Faculty: CPEP Attendings Rotation Hours: Monday-Friday 8:00 AM – 5:00 PM Program Description The Emergency Department of Strong Memorial Hospital maintains a dedicated Psychiatric Emergency Department with its own rooms. Psychiatric emergency physicians provide emergency consultation to the general hospital and inpatient services. M. EMERGENCY PSYCHIATRY (CPEP) ROTATION Director: Elizabeth Santos. This new rotation was established as a result of the new neurology RRC guidelines.D. and the SMH Inpatient Consult Liaison Service. Attending psychiatrists staff the department around the clock and directly supervise psychiatry and neurology residents during their rotation. MPH 275-5249 Location SMH Comprehensive Psychiatric Emergency Program (CPEP) SMH Psychiatry Consultation Liaison Service (PCLS) Description The four-week psychiatry rotation for neurology residents has been designed to teach fundamentals of psychiatry most beneficial for the practice of neurology. which mandate a one-month rotation in Psychiatry. In providing emergency psychiatric evaluations for adults and children of Monroe County and its outlying areas. are listed below. secretarial staff. under the direction of a board-certified psychiatrist. psychiatric nurses. and physicians. MD.

Each resident will be assigned an ED preceptor who will meet regularly with the resident to discuss his or her performance on the rotation. along with an experienced staff of psychiatric nurses and social workers. Develop an understanding of substance abuse emergencies. 3. particularly civil commitment. confidentiality. Perform risk assessments including suicide.The resident plays a primary role in the evaluation of a wide range of individuals with varying degrees of pathology. and competency. With direct supervision by attending psychiatrists. Manage seclusions and restraints. 2. right to refuse treatment. Learning Objectives 1. Develop an understanding of the legal issues of emergency psychiatry. homicide and self-injury. 4. 8. 74 . violence. the resident will develop emergency room skills. 6. Develop proficiency in pharmacotherapy of psychiatric emergencies. Manage crisis intervention and crisis family intervention. The challenge is to evaluate and intervene effectively in as comprehensive a biopsychosocial way as possible. Evaluate and mange violent behavior in the ER. 5. 7. Discuss aspects of general medicine and neurology as they relate to Psychiatric Emergency presentation. The resident will perform primary emergent psychiatric assessments and consultations to the medical emergency department. Responsibilities The neurology resident will work closely with the attending in the Emergency Department learning how to function as a vital member of a multidisciplinary team. such as rapid acquisition of data through directive interview techniques.

. neurology residents will develop skills in the assessment of psychiatric problems in a medical setting. Rotation Hours: Monday-Friday 8:00 AM – 5:00 PM Program Description The Psychiatric Consultation–Liaison Service (PCLS) provides evaluation and assistance with the management of psychiatric disorders occurring in medically ill inpatients throughout SMH. M. C. forensic and psychosomatic problems are frequently encountered on the C/L Service..P. MD 275-3592 Faculty: Michael Privitera. including: • • • • • • • • • • • Acute confusional states and delirium Dementing disorders Depression in the elderly or medically ill Capacity to make informed decisions Suicide attempts and suicidality on the medical floors Somatoform and factitious disorders Pseudoseizures Anxiety/agitation in the medically ill Secondary anxiety.S.. During their C/L rotation. MD Clinical Coordinator: Barbara Olesko.N. and begin to develop the skills of a specialty consultant. master the understanding of the interaction of medical and neurological conditions with psychiatric disorders. MD Lisa Boyle.PSYCHIATRY CONSULTATION/LIAISON SERVICE (PCLS) Director: Jennifer Richman. A wide variety of neuropsychiatric. R. N. MD Eric Brewer. mood and psychotic disorders AIDS-related secondary mental disorders Substance abuse 75 .S.

Develop knowledge of potential risks/benefits of using psychotropic medications in the medically ill and geriatric patient. depression and anxiety in the elderly and the medically ill patient. Conduct comprehensive and accurate psychiatric interviews and review of data. delirium. 3. Develop the ability to make informed decisions about the management of primary mental disorders and mental disorders secondary to medical conditions in the medical setting. Weekly Schedule 8:30 AM 9:00 AM (8:45 AM on Wednesday) 9:00 AM – 5:00 PM 1:00 PM “Bed” meeting Triage meeting Thaler Room.Learning Objectives 1. The resident will perform primary psychiatric assessments and consultations on the SMH inpatient hospital units. 2. Responsibilities The neurology resident will work closely with the Attending Psychiatrist on the C/L Service learning how to function as a vital member of a multidisciplinary team. 1-8136 Inpatient consultations Inpatient units Triage meeting Thaler Room. 4. psychosomatic disorders. 1-8136 76 . Develop knowledge about suicide assessment and management on the medical floor. The C/L Attending Psychiatrist will meet regularly with the resident to discuss his or her performance on the rotation. 5. Develop a knowledge base of psychiatric and neurologic aspects of psychiatry.

D. Neuromuscular clinics . MD (Neuromuscular Pathology Laboratory Director. Faculty and Staff • • • • • • • • • • Allison Woodard (Rotation coordinator) David Herrmann.3 half days/week 3.D. MD Rabi Tawil. (Applicable when resident is scheduled in EMG) 6.D (Neuromuscular/EMG Rotation Director. Weekly EMG conference . Those residents who are interested in a further neuromuscular disease experience are encouraged to spend an additional 4 weeks on this rotation. Co-Director Muscular Dystrophy Association Clinic) Marlene G Downs (EMG technician) Nicole Rheinwald (EMG technician) Michele Ferguson (EMG technician) General Overview of the 2 or 3-Month Rotation The following components will run concurrently for the rotation: 1. M.daily 4 – 5 PM. Eric Logigian.INTEGRATED NEUROMUSCULAR DISEASE/EMG ROTATION Overview of the Rotation PGY-4 Neurology Residents spend two 4-week blocks on the Neuromuscular/ EMG rotation. Continuity experience: 77 .5 half days/week 2. Neuromuscular Unit Chief) Michael Stanton.Friday mornings . resulting in a 3-month integrated Neuromuscular Disease/EMG rotation. M. M.D (Clinical Neurophysiology Program Director. EMG laboratory . University of Rochester EMG Laboratory Director. M. Co-Director Muscular Dystrophy Association Clinic) Chad Heatwole. Peripheral Neuropathy Clinic Director) Emma Ciafaloni.1 hour didactic teaching in EMG 5. (Neuromuscular Medicine Fellowship Program Director. Thursday lunchtime neuromuscular conference 4. Sign out conference in the EMG lab .

Learn as much peripheral anatomy as possible. To learn the detailed spatial anatomy of the peripheral nervous system with reference to surface landmarks. Demyelinating iii. Objectives of the EMG Laboratory Component 1. Learn the basic physiology of nerve conduction and EMG. 6. To gain a basic understanding of the electrical signature of the various neuromuscular diseases affecting anterior horn cell. Axonal ii. and muscle. Polyneuropathy i. motor. severity and prognosis. autonomic e. Disorder of muscle membrane c. Overall Goals of the Neuromuscular/EMG Rotation 1. Disease of NMJ d. Residents will interact with all members of the neuromuscular faculty during their rotations. the same afternoon where possible. and to determine their pathophysiology. To learn basic needle electromyography techniques and motor unit analysis. nerve. 3. 3. Understand the strategy to rule in or out: a. Sensory.a. To learn to perform nerve conduction studies for common nerves using surface electrodes and percutaneous nerve stimulation. 2. Residents who rotate through neuromuscular/MDA and Peripheral Neuropathy clinics will participate in and perform electromyography studies on their clinic patients (from the morning). 4. Mononeuritis multiplex 78 . To localize peripheral nerve lesions precisely. Myopathy b. 5. neuromuscular junction. b. 2. To learn the fundamentals of neuromuscular diseases.

followed by needle electromyography. Entrapment neuropathy g. This is accomplished as follows: A directed history and a neurological examination are performed and recorded. the hypothesis may be changed and the study may be redesigned as necessary. understanding of normal and abnormal electrophysiology of nerve and muscle. and demonstrate that they are technically competent in placement of electrodes. detailed knowledge of anatomy of the peripheral nervous system. and determine its pathophysiology. A diagnostic hypothesis is generated. needle electromyography. stimulation of nerves. they will gain a basic understanding of the electrical signature of the various neuromuscular diseases affecting nerve. and use of the EMG machine. Patients are typically seen in 60-90 minute time slots. They will begin to learn to perform nerve conduction studies using surface electrodes and percutaneous nerve stimulation. Detailed Description of the EMG laboratory Component Patients are seen in EMG laboratories At University of Rochester Medical Center and at Westfall Road daily. Sensory neuropathy 4. late responses. neuromuscular junction. 79 . and muscle. residents will begin to learn the detailed spatial anatomy of the peripheral nervous system with reference to surface landmarks. and only after they pass a test documenting basic knowledge of peripheral anatomy. At the end of the study. and an individualized electrodiagnostic study is then planned and performed. under direct supervision. 5. During the EMG rotation. It follows that clinical electrodiagnosis requires knowledge of neuromuscular diseases. The goals of each electrophysiologic study are to localize the lesion precisely. Be able to perform needle electromyography and recognize common abnormal waveform patterns.f. In addition. As the results of the study come in. Radiculopathy i. The resident rotation in EMG is designed to teach the fundamentals in these various areas. the electrophysiologic abnormalities must be internally consistent and correlate closely with the patient’s signs and symptoms. electrophysiological abnormalities of the most important neuromuscular diseases. Be able to perform basic nerve conduction studies independently but understand advanced conduction studies. and repetitive stimulation. severity and prognosis. reflex studies. technical expertise in performing the various tests and ability to differentiate abnormal from normal electrical signals. Residents will have the opportunity to perform common nerve conduction studies on patients referred to the laboratory. Nerve conduction studies are performed first. Plexopathy h. Motor neuron disease j.

Chapters 1-4. Continue to practice and perform routine nerve conduction studies. view videotapes of EMG activity. Read chapter 9: Routine Upper Extremity Nerve Conduction Techniques. Second Week 1. Practical test. 4. Observe for 1-2 days 2. There is a daily EMG sign-out at which time pertinent cases from the day are reviewed and reports are generated. 13. ulnar neuropathy. cervical radiculopathy. Read chapter 8: Artifacts and Technical factors. Learn surface anatomy for nerves and muscles in the arm (See Aids to the Examination of the PNS). in which the basic principles of electrodiagnosis. and lumbosacral radiculopathy. Perform median.In addition to the supervised evaluation of patients. 2. 14 on needle EMG. and tibial nerve conduction studies with supervision in patients with carpal tunnel syndrome. Practice on self/Fellows/Technicians: learn to perform median. Read chapters 12. and peroneal motor and sensory nerve conduction studies and F responses. peripheral neuropathy. ulnar. This is a recommended didactic lecture series. 80 . There is also an EMG conference once per week from 11:00 am to noon on Fridays after Grand Rounds. and the clinical and electrophysiologic findings of the major neuromuscular diseases are reviewed. 5. there are other teaching opportunities. 2. Begin needle examination with supervision. 3. Read relevant chapters in Preston & Shapiro on each patient seen. Resident Responsibilities and Expectations in the EMG Laboratory First Week 1. Third Week 1. peroneal. ulnar. 3. 3. tibial. 4. Read introductory chapters in Preston & Shapiro. given by EMG/Neuromuscular staff and Fellows.

Fourth Week
1. Perform 3 Hz repetitive stimulation of the ulnar nerve.
2. Read chapter 15: Clinical and Electrophysiologic Correlations: Overview and Common

Months 2 and 3
1. Residents will be assigned cases in the electromyography laboratory, and will perform all
aspects of the electrodiagnostic evaluation on their cases.
2. Residents will be given cases of increasing complexity during the latter part of the rotation.
3. Residents will learn to perform independent electrodiagnostic examinations for cases of lowmoderate complexity.
4. Residents perform electrodiagnostic examinations on cases they refer from the
neuromuscular clinics.

Description of the Neuromuscular Clinic
and Muscle/Nerve Pathology Component
Residents will spend approximately three, 1/2 days of the week rotating through the
neuromuscular/MDA/ALS and peripheral neuropathy clinics at University Rochester Medical
Center during their rotation. Residents will participate fully in these clinics and conduct both
new patient and interesting follow-up patients in conjunction with a neuromuscular attending.
With possible, residents will also be involved in any electrodiagnostic testing that is conducted
on these patients during the rotation. Residents will be responsible for following up on patient
seen during the rotation under the supervision of a neuromuscular attending.

Learning Objectives of the Neuromuscular Clinic
and Muscle/Nerve Pathology Component
1. To expose the resident to a wide variety of acquired and inherited disorders of muscle,
nerve, neuromuscular junction and anterior horn cells.
2. To develop a comfort level in the clinical evaluation, selection and interpretation of
diagnostic testing and management of neuromuscular disorders.
3. To develop a comfort level in decision making in neuromuscular disorders – e.g. when to
admit a myasthenic patient, when to use plasma exchange or IVIg in myasthenia gravis.


4. To gain experience in the use and indications for various immune therapies in
neuromuscular disorders (steroids, azathioprine, methotrexate, mycophenolate,
cyclosporine, IVIg, plasma exchange).
5. To gain experience in the supportive management of patients with chronic neuromuscular
disorders (e.g. ALS, CMT, muscular dystrophy).
6. To learn basic histopathology of common neuromuscular disorders.
7. To develop a sound theoretical knowledge base in neuromuscular disorders through
targeted reading, clinical exposure and faculty teaching.

Neuromuscular/EMG Rotation Schedule










NMD/MDA/ALS Neuropathy
clinic or EMG

Grand Rounds
EMG Lecture
EMG Westfall

Residents will participate in their own continuity clinic rather than on the NMD/EMG rotation on
their assigned firm ½ day.

Rotation Conclusion
A multiple choice examination will be administered to test knowledge of neuromuscular
disorders, neuroanatomy and principles of electromyography.


Lynn Liu, M.D.
Olga Selioutski, D.O.
David Wang, M.D
Thomas Wychowski, MD

James Fessler, M.D.
Michel Berg, M.D.
James Burchfiel, Ph.D.
Giuseppe Erba, M.D.
Robert Gross, M.D., Ph.D.

The Clinical (central) Neurophysiology Laboratory is part of the epilepsy unit and is under the
leadership of Jim Fessler, MD. The laboratory structure is highly integrated with the clinical
operation. The neurophysiology laboratory includes out-patient and in-patient EEG and EP
laboratories, intraoperative monitoring and long term EEG monitoring services. Lynn Liu, MD
supervises the fellow and residency training.

SEC Resident Rotations:
General Guidelines

Each of the first year neurology residents (PGY-2) spends a 2 two-week blocks on the
inpatient SEC service. They will also have the opportunity to spend 2 weeks in the EEG lab
and read some EEGs with the neurophysiology fellow and attending.

Each of the second year neurology residents (PGY-3) may spend a 2-4 week block on the
EEG service and is directly supervised by the neurophysiology fellow and attending.

Each of the third year neurology residents (PGY-4) optionally spends a 6-8 week block on
the advanced neurophysiology rotation, which may consist of a mixture of the clinical
epilepsy service and/or the EEG service.

While on the EEG service the residents have no other epilepsy service clinical
responsibilities (specifically they have no outpatient or in-patient direct care responsibilities),
except for their weekly outpatient resident firm or Westfall Road Clinic.

Performance is evaluated at the end of each resident rotation by the supervising attending,
based on the direct observation of the resident to achieve the goals of the rotation.


Objectives: 1. Follow up appointments are scheduled 6-8 weeks (adjusting for a surgical PRC 84 . 5. • Develop the plan for the day and enter e-Record orders and document in the daily progress notes any events and EEG findings. 4. and surgical approaches. MRI findings. Improve basic understanding of the etiologies and pathophysiology of seizures and their clinical implications. psychosocial. be able to competently formulate and implement treatment plans for patients with seizures. 3. including all aspects of neurophysiological. During this rotation the resident will be introduced to the field of epilepsy and basic EEG. psychosocial dynamics. medication. • Admit all scheduled patients to the SEC service on 5-1600 and see the patients on 41600. and write a standard admission note. Learn the characteristics of seizures and epilepsy syndromes including differentiating types and determining appropriate treatment options. Display a thorough understanding of the psychosocial implications and limitations of a diagnosis of epilepsy and develop an empathetic approach towards these patients. • Complete the Discharge Instructions and Summary summarizing the events of the hospitalization and the preliminary EEG conclusions as they were discussed with the patient. take a history and perform a physical exam. Management of SEC inpatients: • Pre-round on the SEC inpatient service with the Epilepsy Fellow and/or the SEC attending every week day morning. The resident presents each case briefly and makes note of the video-EEG findings. Participate in the diagnosis and treatment of psychogenic events (conversion disorders). By the end of the rotation. thoroughly discuss the plan with attending.First Year Neurology Resident (PGY-2) SEC Rotation Description: The neurology resident on the SEC service is responsible for care of all epilepsy service inpatients with the Epilepsy Fellow and the SEC attending. Demonstrate competency in the evaluation and management of patients with epilepsy. • Attend the daily LTM conference (5-2530 typically 11:00 AM Monday through Thursday and at 1:00 PM on Fridays) in the LTM room. by learning the etiologies. 2. and approaches to interactions. Responsibilities: 1. 6. epilepsy and the differential diagnoses of paroxysmal events. and discussion in their daily progress note.

Attend Wednesday Noon Clinical Neurophysiology conferences (Garvey Room) 4. Recommended Reading List: Initial Management of Epilepsy. 2.French and T. J. Call 341-7500 to make the appointment. Volume 359:166-176 85 . As cases allow. Evaluate and discuss the plan for the patient with the SEC attending. attend Wednesday 3:00 PM Patient Review Conference (PRC) discussion of patient being evaluated for surgical resection. Pedley. NEJM. • See urgent inpatient or outpatient SEC consultations. • Observe at least one LTM patient hook-up.if necessary) after admission with the outpatient SEC attending. attend: • Intraoperative electrocorticography during craniotomy for epilepsy surgery • Brain mapping sessions in patients with subdural grids admitting for monitoring • Intracarotid amobarbital procedures (Wada tests) for memory and language localization 3. and review LTM data with the technologists and the LTM fellows. As time permits.

Understand the variety of sources responsible for artifacts. Be able to recognize common abnormal EEG patterns including: • Gross focal features and asymmetries • Encephalopathy and coma • Epileptiform discharges and ictal patterns 4. contact Steve Erickson. and stimulus evoked K-complexes. mu rhythm. 6. • Portable EEG (Coma. Attend from start to finish at least one: • Inpatient EEG adult and child • Have an EEG done and demonstrate reactivity of occipital rhythm. intraoperative). Be able to recognize normal adult and child recordings and their various patterns in all normal states. 3. Understand the basic neurophysiological generators of the EEG patterns. Objectives: 1. Introduction to the EEG machine • Learn to run a study with one of the EEG technologist • Learn electrode placement system on mannequins • If interested. Become familiar with EEG recording techniques and equipment in all age groups and conditions. Become familiar with other applications of EEG and Evoked Potentials (e. During the first two weeks: 1. 5.g. 2. place electrodes on a human with the assistance of an EEG technologist 3. Mona Heisig or Lynn Liu to arrange access to EEG reading room and login to the EEG computer system. Demonstrate competence generating normal EEG reports using ACNS guidelines. lambda waves.Second Year Neurology Resident (PGY-3) EEG Elective Description: The purpose of the Second Year EEG rotation is to provide an introduction to EEG and other neurophysiological procedures. r/o status epilepticus. Writing Reports 86 . Responsibilities: On your first day. ECI) • Neonatal EEG • Evoked potential study 2.

and Related Fields: Chapters 5: Chapters 6: Chapters 45: EEG recording and operation of the apparatus The EEG signal: Polarity and Field Determination Neonatal EEG 87 . Clinical Application. Recommended reading list: 1.LTM room (5-2530) • Wednesday 3:00-5:30 PM Patient Review Conference (PRC) – Garvey room • Wednesday Noon Clinical Neurophysiology . Learn basic approach to EEG interpretation. Current Practice of Clinical Encephalography: Chapters 2: Chapters 4: Chapters 6: Chapters 8: Chapters 9: Electrical Fields & Recording Techniques Artifacts An Orderly Approach to Visual Analysis: Characteristics of the Normal EEG of Adults & Children Benign EEG Variants & Patterns of Uncertain Clinical Significance An Orderly Approach to the Abnormal EEG 3. 2. tilt table test with EEG or electrocorticography • One intraoperative EP recording during complex spine surgery 3.EEG conference . study daily outpatient and inpatient EEGs with EEG fellows and attending. Attend weekly conferences: • Monday thru Friday daily LTM conference 11:00 AM .• Write reports on EEGs assigned by the EEG fellow • Receive feedback on each report from an Neurophysiology attending • Read about the EEG finding and associated epilepsy syndrome or clinical condition During the entire session: 1. Electroencephalography. Handouts • ACNS Guidelines for writing an EEG report 2. Niedermeyer. Attend at least: • One intraoperative monitoring during carotid endarterectomy. Ebersole and Pedley.Garvey room Spend all other time in the EEG reading room.

3. By the end of the rotation.Third Year Neurology Resident (PGY-4) SEC Rotation Advanced SEC/ Neurophysiology Description: • The third year neurology resident may work either as a junior fellow on the SEC service or in the EEG lab. and write a standard admission note. thoroughly discuss the plan with attending. and discussion in their daily progress note. Participate in diagnosis and treatment of psychogenic seizures (conversion disorders). • In the neurophysiology lab. • Attend the mandatory daily LTM conference (typically 11:00 AM) in the LTM room. psychosocial dynamics. be able to competently formulate and institute treatment plans for patients with seizures. • On the SEC service. take a history and perform a physical exam. MRI findings. learning the etiologies. Objectives: 1. Responsibilities on the SEC service: • Pre-round on the SEC inpatient service with the Epilepsy Fellow and the SEC attending every week day morning. Solidify knowledge of seizures and epilepsy (improve on all the objectives expected forPGY-2 year). epilepsy and related conditions. Expand skills in the evaluation of patients with seizures and epilepsy. Improve basic foundation of reading and interpreting EEG or LTM. • Complete the Discharge Instructions and Summaries summarizing the events of the hospitalization and the preliminary EEG conclusions as they were discussed with the patient. and approach to interactions. • Admit all scheduled patients to the SEC service on 5-1600 and see the patients admitted to 4-1600. • Develop the plan for the day and enter e-Record orders and in daily progress notes document events and EEG findings. Follow up appointments are scheduled 6-8 weeks (adjusting for a surgical PRC 88 . The resident presents each case briefly and makes note of the video-EEG findings. 5. 6. 2. the resident is expected to improve EEG skills by reviewing daily EEGs and focus on increasingly difficult EEGs and act as a junior fellow in the EEG lab reading and writing EEG reports under the supervision of the EEG fellow and attending. 4. the resident will be responsible for direct supervision of inpatient care in consultation with the Epilepsy Fellow and the SEC attending. Demonstrate competence in generating normal and abnormal EEG reports.

Call 341-7500 to make the appointment. • Generate EEG reports of normal and abnormal EEGs using ACNS guidelines. Other States of Altered Responsiveness and Brain Death Drug Effects Long-Term Monitoring Chronic Intracranial Recording and Electrocorticography Intraoperative Monitoring 89 . Attend LTM. Responsibilities on the EEG rotation: On your first day. Current Practice of Clinical Encephalography: Chapter 5: Chapter 7: Chapter 10: Chapter 11: Chapter 12: Chapter 13: Chapter 14: Chapter 15: Chapter 16: Chapter 17: Chapter 23: Physiological Basic of the EEG Electroencephalography of the Newborn Epilepsy and Syncope Focal Brain Lesions Diffuse Encephalopathies Organic Brian Syndromes and Dementias Coma. Ramona Heisig. Daily reading of EEGs with EEG fellow and Neurophysiology attending: • Daily review of outpatient and inpatient EEGs as directed by EEG fellow. • See urgent inpatient or outpatient SEC consultations. • Observe at least one LTM patient set-up and several hours of LTM playback with the Technologist and LTM Fellow. Attend at least: • One intraoperative electrocorticography monitoring during a craniotomy for resection • One intracarotid amobarbital procedure (Wada test) for memory and language lateralization • One intraoperative monitoring during carotid endarterectomy or tilt table test with EEG or PET scan if available • One intraoperative EP recording during complex spine surgery 3. 1.if necessary) after admission with the outpatient SEC attending. Recommended reading list: Ebersole and Pedley. Evaluate and discuss the plan for the patient with the SEC attending. • Review the study with the Neurophysiology attending. 2. contact Steve Erickson. or Lynn Liu to arrange access to EEG reading room and login to the EEG computer system. • Daily review LTM with the LTM fellow and the LTM attending. PRC & EEG Conferences.

Clinical Application. Electroencephalography. as directed by the SEC attending. and Related Fields: Chapter 9: Chapter 10: Chapter 11: The Normal EEG of the Waking Adult Sleep and EEG Maturation of the EEG: Development of Waking and Sleep Patterns Pedley/Engel or Wyllie chapters on seizures and epilepsy.Niedermeyer. 90 .

please email the staff with the change and the name of the person covering. since they provide a continuity experience for learning how to care for a cohort of patients. and will have a 30-minute break in their schedule for paperwork.GUIDELINES FOR THE RESIDENT FIRMS Philosophy of the Firms The neurology resident firms were established in 1987 to provide the best possible patient care and resident education in a hospital-based neurology continuity clinic. In order to ensure that the firms operate as efficiently as possible. even though residents change every four years. written approval from their firm attending. The neurology resident must personally schedule a follow-up clinic appointment in his/her firm for any 5-1600 inpatient or ED patient who needs follow-up at the time of discharge. Hence. Appointments are made by the Scheduling Center in the Department of Neurology. according to the following rules: • PGY-1 residents are allotted one hour for both new and follow-up patients from July through September. The firms were set up in such a way as to simulate. Starting in October. for their entire four years of their residency. Residents should also task one of the schedulers in the scheduling office with 91 . Appointment length summary: New 60 minutes Follow-up 30 minutes (60 minutes for PGY-1’s for the first 3 months) Break 30 minutes for PGY-1’s only Residents may not change their schedules without prior. a private-practice setting. PGY-3 and PGY-4 residents will be allotted one hour for new patients and 30 minutes for follow up patients with no breaks.m. they will be allotted one hour for new patients and 30 minutes for follow up patients. as much as possible. In addition. Once a change is approved. a unique mentoring relationship develops between the residents and the firm attendings over four years. the following guidelines have been developed: Appointments Patient appointments for the Neurology Resident Firms at Strong Memorial Hospital are scheduled from 1:00 . Also. In this way. residents are assigned to a specific firm.5:00 p. We view the firms as the most important outpatient activity for the neurology residents. the patients are maintained as much as possible in the same firm. headed by two attending neurologists. during the week. • PGY-2. Residents are expected to personally follow in their own firm those patients they treated as inpatients or in the ED. Patients should not be expected to arrange their own follow-up appointments upon discharge. the firm attendings will be familiar with the more complex firm patients and smooth the transition of resident turnover. Continuity of patient care and resident education were a high priority in the design of the firms.

The resident must also return the patient’s call personally. 92 . No appointments can be scheduled for patients with private insurance unless they have a valid referral number. Occasionally no information is available at the time of the visit (but this should be a rare occurrence). No exceptions can be made. The resident will be messaged through e-record and paged with any urgent messages. working collaboratively with the residents to meet patient needs. The patients’ primary care physicians provide referral numbers. The RN/ techs can triage these questions and concerns. Patients should not be turned away because a resident is running behind schedule. If the hour is late and an appointment cannot be scheduled at checkout. Checkout staff cannot schedule tests without a properly entered order for a test. Being paged to the office should alert the resident that it is necessary to personally respond to a message. Test scheduling: An order must be placed in e-record by the resident before any test can be scheduled. Every effort is made to obtain the medical record and/or medical information for every patient. The GNU does send out reminder appointment cards. the name of the resident with whom the patient should be scheduled.the name of the patient. This page should be returned as soon as possible. Residents are responsible for checking and addressing their in-basket messages throughout the day. Follow-up appointments are scheduled at checkout at the convenience of the patient. Messages Routine patient messages and messages concerning prescription renewals are sent to the inbasket of the resident as soon as they are received. Patients are to be seen whether or not a medical record is available at the time of the appointment. and therefore cannot relay urgent messages to the patient for the resident. please ask the patient to call the scheduling office the following day for an appointment. It is the responsibility of the resident to see patients in a timely manner. and when the patient needs to be seen. All non-urgent messages should be addressed within 24 hours. Reminder calls are made to each patient prior to a regularly scheduled appointment. Residents should inform waiting patients if they are running late. The support staff is not medically qualified. This includes patients being scheduled for follow-up after a 5-1600 admission. A Registered Nurse in the infusion center and or the clinic techs are available as a resource for the support staff to refer clinical questions or concerns for triaging.

These lists will be audited and the resident will be notified if the lists are incomplete. and PMH must also be entered into e-record for all new patients and should be updated at each visit.) Be sure that you are using the correct form for a timely response to the request. This line is for hospital staff only and should NEVER be given out to patients or to the public. Disability. physician’s office to hospital. 93 . Whenever any new medication is prescribed. Medication reconciliation: Medication reconciliation is a hospital and Joint Commission requirement. Other useful numbers: Support staff/schedulers Direct line to secretaries (not for patient use) Check-in Check-out Administrator Staffing room Fax 5-1201 5-0275 5-7198 5-1247 5-8796 5-1202 5-7199 756-5189 Correspondence/Forms All mail (in-house and out-of-hospital) should be placed in the mail bin located in the scheduling office. All inter-office mail should go in a blue envelope or in a large tan interoffice mail envelope. All patient notes must be entered electronically into the medical record using e-record. etc.. Please complete all forms (DMV.Phone Numbers The patient appointment number is: 275-1200.0275. mailed and scanned into the record by the support staff. which include errors of omission. duplication of therapy. Updated medication lists will be listed on the After Visit Summary (AVS) that will be printed at check-out desk and handed to the patient at the completion of the visit. The HPI and Assessment and Plan should be complete. Medication lists in e-record should be reviewed by the resident to insure that they are correct and that all medications prescribed are appropriate. Forms awaiting completion are filed in the scheduling office and must be checked regularly. Please do not use pre-stamped envelopes for inter-office mail. The medications. Changes should be noted in the clinic note.e. the patient needs to receive a handout about the drug and this fact needs to be documented in e-record. organized and typed in prose into the electronic patient record. allergies. The in-house line is: 275. and drug-drug and drug-disease interactions.) in a timely fashion. etc. The purpose of medication reconciliation is to avoid medication errors. hospital to patient. A copy of the completed form will be faxed. There are various consent/ release of information forms (i.

The checkout desk will verify that the encounter form is completely filled out. Imaging CD’s containing neuroimages that need to be uploaded into the Imagecast system should be placed in the folder in the physicians’ work room with the appropriate form completed. An Encounter Form will be provided for every patient seen in the clinic. Coverage Residents must arrange for coverage of their patients whenever they are away. If you want the CD’s returned. The resident needs to take an active part in rescheduling the patients. The support staff and firm attending must both be informed by email as to which resident is providing coverage. please note that on the form. primary physician and type of insurance. This includes one week of conference time. Vacations may not be taken during the first year SMH inpatient rotations. If this occurs. stroke. the patient will be informed of the error and will be given the option of rescheduling the appointment or being seen later that afternoon by a resident as soon as a time slot is available. If a resident requests that his/her clinic be rescheduled for any reason other than a true emergency. In general. including any medication renewals. This form must be returned to checkout. coverage is best provided by another resident in the same firm. the residency program director must be notified and must approve the schedule change. Vacations and Cancellation of Clinic According to department policy. and all vacation requests must be approved by the Program Director. pediatric neurology or psychiatry rotations. A resident's clinic should only be canceled in the event of an emergency. diagnosis. or during the third year chief resident or MBB rotations. second year general neurology. including length of visit. working collaboratively with the scheduling office staff. It is the resident’s responsibility to complete the billing portion of this form. residents receive four weeks of vacation per year. If information (CPT and ICD-9 code) is missing. This form includes demographic information about the patient. No patient should be turned away from clinic due to a scheduling error without being seen! 94 . Please review and update this list at each visit. The covering resident must monitor and respond appropriately to in-basket messages for the resident whom he/she is covering. All vacations must be scheduled annually in advance. the charge cannot be entered. Scheduling Errors A scheduling error may occur on occasion. and next appointment. Allergies: All allergies need to be documented in the medical record. resulting in a patient arriving in clinic without an appointment. and should open up a non-clinic day to reschedule patients if necessary. home telephone. including home address.Summary List: It is a hospital and Joint Commission requirement for ambulatory care areas to maintain an updated summary list for each patient that contains significant medical diagnoses. The firm attending will decide which resident will see that patient. and operative and invasive procedures. The back office staff will deliver the CD’s to the radiology department for uploading.

please do not assume that this time slot will be free the next day. the patient will be given the option to be worked in by the end of the day. 95 . or to reschedule. If the schedule that you receive the day before clinic has an open slot. the provider will discuss this directly with the patient. Patient Cancellations If a patient cancels a clinic appointment. Every effort is made to insure that clinics are fully booked. If concern is expressed over the emergent nature of the visit.Policy for Providers when Patients Arrive Late for Appointment Patients who arrive within 15 minutes of their scheduled appointment will be given the opportunity to be seen by their provider. Patients who have been “lost” in the medical center will be given special consideration. every effort is made by the scheduling staff to fill the open slot. Patients who travel from a distance will also be given special consideration. If the provider is unable to see the patient in sequence. Patients who are more than 15 minutes late may need to be rescheduled. Please note that an open slot on a resident’s schedule may be filled as late as 12:00 noon on the clinic day.

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follow-up appointments are to be scheduled with the attending physician. The resident will see new patients only. • Attending’s responsibilities: The patient is considered the attending’s private patient. 97 . messages. the resident may see the patient in follow-up with the attending. and not the resident’s. and this note must be done before the resident leaves for the day. The attending will have this 10-minute block of time prescheduled to review the patient with the resident. The Faculty Practice Clinics are located at University of Rochester Neurology at Westfall Road. • Attending absence: If a faculty practice attending is away on vacation or at a meeting. Bldg C. • Faculty Practice Clinics: Third year residents will be assigned to work with a particular WR attending or in a subspecialty clinic for a three-month period. communications with the referring physician. • Follow-up appointments: In general. Suite 220 Patient Telephone: 341-7500 Front Desk Secretary: 341-7513 Scheduling Secretary: 341-7512 Fax: 341-7510 • Chief Resident Clinics: Third year neurology residents will have two afternoon clinics per week: a resident firm and a Faculty Practice/Subspecialty clinic. If the resident is still working with the same attending when the follow-up visit is scheduled. All telephone calls. The acting chief resident will not have a faculty practice/subspecialty clinic. All residents will have three patients scheduled for each afternoon. the resident assigned to that attending will have no WR patients that day. and these will be scheduled for 1 hour and 10 minutes – 1 hour for the resident to see the patient and 10 minutes for the resident to review the patient with the attending. The Subspecialty Clinics are located at two sites: SMH Neurology OPD and University of Rochester Neurology at Westfall Road. review of laboratory data and paperwork concerning the patient will be the responsibility of the attending physician. The first new patient is scheduled at 1:20 PM.Chief Resident (PGY-4) Faculty Practice/Subspecialty Clinics University of Rochester Neurology 919 Westfall Road. • Patient notes: The resident will be responsible for the e-record note on the patient. The attending should nonetheless provide an update to the resident about patients whom they have seen together. and not with the resident.

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Become familiar with the diagnosis of cluster headaches and other trigeminal autonomic cephalalgias and learn the appropriate acute treatment and preventive treatment strategies 6. The majority of the patients you will see in a specialized headache practice are chronic and have difficult to treat migraines and other primary headache disorders. Learn the treatment protocol for botulinium toxin injections for chronic migraine 8. exertional headaches. Learn when further work-up is needed for certain headache types and what work-up is indicated. Learn how take an effective headache history 3. 7. Become familiar with other primary headache disorders such as: new daily persistent headache. MD Description Headaches of all types. Become familiar with the diagnosis of migraine with and without aura and the appropriate preventive and acute treatment strategies 5. The goal of this rotation is to teach residents how to effectively diagnose and treat various headache disorders and to learn about the underlying pathophysiology of these disorders. hemicrania continua. Become familiar with the headache classification system 2. A solid understanding of the primary headache disorders and some of the more common secondary headache disorders and their treatments is an invaluable skill for any neurologist planning to practice clinical neurology. You will have an opportunity to learn how to do botulinum toxin injections for the treatment of migraines as well as various nerve blocks for acute treatment of severe headaches. both primary and secondary. hypnic headache and thunderclap headache. auriculo-temporal nerve blocks and supra-orbital nerve blocks 99 . It is also a very rewarding specialty because there is an opportunity to make a significant impact upon the quality of life of your patients. Learning Objectives 1. Headache is a specialty within neurology that is rapidly expanding in terms of our understanding of the pathophysiology of migraine and other primary headaches. MD Heidi Schwarz.nd For 2 HEADACHE ELECTIVE and 3rd year Neurology Residents Faculty • • Catherine Lavigne. Learn how to perform occipital nerve block. play an important role in the practice of general neurology. 4.

Schwarz to discuss a journal article or a headache case of interest to be mutually decided upon. Morris Levin. Conferences: The resident will meet once per week with Dr. and will be heavily weighted upon your level of interest and involvement. Lipton and Dodick. Call Schedule: There is no call on this rotation. The resident will attend clinic at the Unity Headache Center Monday afternoon and Tuesday through Thursday for morning and afternoon sessions. Lavigne and/or Dr. Evaluation Your evaluation will be completed on the standard form provided by the Department of Neurology. Silberstein. Required Reading 1) International Headache Society Classification 2) Journal articles to be decided during the rotation depending up on the interests of the resident 3) Comprehensive Review of Headache Medicine. 3. 2.Resident Responsibilities 1. There may be a Friday morning clinic but this is variable. 100 . 4) Wolff’s Headache.

MEMORY CARE PROGRAM ELECTIVE For 2nd and 3rd year Neurology Residents Location: Clinton Crossings. translational studies. and collaboration with the Alzheimer’s Association will be stressed. residents will focus on the clinical assessment of patients. 919 Westfall Road. Identify the indications and limitations of the cognitive-enhancing medications. Residents will gain exposure to a wide range of neurobehavioral syndromes and will benefit from the varying clinical perspectives of the MCP faculty. 2. Recognize the importance and variability of psychological. MD (Psychiatry) • Carol Podgorski. development of treatment plans. In addition. Suite 210 585-273-5454 Director: Fred Marshall. and formal neuropsychological testing in the evaluation of individuals presenting with cognitive disorders. NP (Psychiatry Nurse Practice) • Lisa Boyle. social. laboratory. The importance of care-givers in the provision of patient care. and familial factors in the care and management of patients with dementing illness. residents will become familiar with the array of natural history studies. and clinical experimental therapeutic trials currently conducted by program faculty. pager 3836) Faculty: • Marie Bilinski. (Neurology. 4.D. Building C. During the elective. PhD (Marriage and Family Therapy) • Susan Ruhlin. NP (Psychiatry Nurse Practice) • Mark Mapstone. electrophysiology. MD (Psychiatry) • Charles Duffy. MD. M. 101 . Outline the appropriate use of imaging. and demonstrate familiarity with their prescribing information. 3. Understand the differential diagnosis. PhD (Neuropsychology) • Anton Porsteinsson. PhD (Neurology) • Michael Hasselberg. Learning Objectives 1. LMSW (Social Work) Description The Memory Care Program is a multidisciplinary out-patient practice devoted to the diagnosis and management of patients with a variety of dementias. counseling and coordination of patient care. epidemiology and diagnostic criteria for common dementing illnesses. familiarity with community support services.

Richard L Strub and F William Black (eds.. psychiatry. Norton. 4th Ed. 4th Edition. The Mental Status Examination in Neurology. 939-944. neuropsychology. Taylor & Francis. evaluating patients and meeting with families along with the primary MCP clinician(s) assigned. Michael S Gazzaniga.). Price DL. and Memory Loss. Evaluation Your evaluation will be completed on the standard form provided by the Department of Neurology. Once familiar with the assessment approach and care-team model. the resident will have an opportunity to round with each of the disciplines represented within the MCP (neurology. Diane B Howeison. 2011 3. Related Dementing Illnesses. Stadlan EM: Clinical diagnosis of Alzheimer's disease—report of the NINCDS–ADRDA work group under the auspices of Department of Health and Human Services Task Force on Alzheimer's disease. as well as appropriate literature searches triggered by specific patients evaluated. social-work and family-therapy). 2004 Selected Journal Articles for Review Alzheimer Disease • McKhann G. Drachman DA. Richard B. Nancy L Mace and Peter V Rabins. Murial Lezak. 2006 4. Oxford. Ivry. Reading should include the following. 3rd Ed. 2009 5. David Ames. John O’Brien. FA Davis. Neurology 34.). and will be weighted on your level of interest and involvement. The 36-Hour Day: A Family Guide to Caring For Persons with Alzheimer Disease. Folstein M. Neuropsychological Assessment. References 1. David W Loring. nurse-practice. the resident will perform independent outpatient assessment of MCP patients and formulate diagnostic and treatment plans with close faculty supervision.Responsibilities of the Resident The resident will initially participate as an observer in the outpatient clinic. 5th Ed. Dementia with Lewy Bodies and Parkinson’s Disease Dementia. Ian McKeith. In this capacity. Johns Hopkins Press. General Guidelines The rotation is intended to be two to four weeks in duration. Edmond Chiu (eds. George R Mangun. 2000 2.1984 102 . Cognitive Neuroscience: the Biology of the Mind.. Katzman R.

• Dubois B. Brain 2011:134. Hodges JR. Neurology 2005.2456-2477 • Seelaar H. Dickson DW. Sachdev P. genetic and pathological heterogeneity of frontotemporal dementia: a review. Rohrer JD. J Neurol Sci. Third report of the DLB consortium. et al. et al. Sensitivity of revised diagnostic criteria for the behavioural variant of frontotemporal dementia. Grabli D. Lowe J.27:248-253.65:1863-1872 Frontotemporal Dementia: • Rascovsky K. Feldman HH.81-87. Knopman D. J Neurol Neurosurg Psychiatry 2011. Clinical validation of Movement Disorder Societyrecommended diagnostic criteria for Parkinson’s disease with dementia. Research criteria for the diagnosis of Alzheimer’s disease: revising the NINCDS-ADRDA criteria. Jacova C. et al. et al. Parkinson Dementia • Barton B. Clinical. Vascular cognitive disorder: a new diagnostic category updating vascular cognitive impairment and vascular dementia.82:476-486. Dementia with Lewy Bodies • McKeith IG. Pijnenburg YAL. 103 . Vascular Dementia/ Vascular Cognitive Disorder • Roman GC. 2004:226. et al. Royall DR. Bernard B. Movement Disorders 2011. Lancet Neurol 2007:6:734-746. Diagnosis and management of dementia with Lewy bodies. et al.

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dystonia and drug-induced movement disorders. Other movement disorders include Parkinson’s plus syndromes (such as multisystem atrophy. Learning Objectives 1. paroxysmal dyskinesias..g.. periodic limb movements of sleep. rhythmicity and supressibility) • Determining whether it is an isolated movement disorder or is associated with other neurological signs (e. prognosis and treatment options for Parkinson’s disease and other parkinsonian syndromes. chorea.g. relation to posture or action. 2nd and 3rd Year Neurology Residents Faculty • • • • Richard Barbano Kevin Biglan Michelle Burack Irene Richard Overview of Movement Disorders Movement Disorders can refer to a physical sign of an abnormal movement (e. myoclonus) or can be used to describe the syndrome that causes the abnormal movement (e. Some would also consider the ataxic disorders (such as spinocerebellar atrophies) within the realm of a movement disorder specialist.g. Determining the probable etiology (e. tics. drug-induced) • Essential tremor is the most common movement disorder. dystonia. speed. Movement disorders are typically conceptualized as either hypokinetic (paucity of voluntary and automatic movement) or hyperkinetic (excess movement). Many diseases are associated with more than one type of abnormal movement (tremor. tic disorder. Huntington’s disease. Become familiar with the diagnosis. restless legs syndrome. movement disorders involve abnormalities of the form.MOVEMENT DISORDER ELECTIVE For 1st. Parkinson’s disease or Huntington’s disease). dystonia and Huntington’s disease 105 .g. progressive supranuclear palsy.. and I.g. followed by Parkinson’s disease. essential tremor). Tourette’s syndrome. dementia with Lewy bodies). essential tremor. myoclonus in CJD). Diagnosis of a patient with a movement disorder includes: • Identifying the type and pattern of the movement (noting the specific distribution. sporadic. corticobasal ganglionic degeneration. rigidity and bradykinesia in Parkinson’s disease) or abnormal movements may be the only manifestation of the disease (e. hereditary. velocity or control of movement. tremor. painful legs and moving toes and Wilson’s disease. In general.

There are no specific conferences outside of those already scheduled for residents (video conference and movement disorder lecture series) Clinics • Movement disorder clinics currently take place on Monday morning. Suite 220.g. speech/swallowing) and when to refer for further evaluation and treatment (e. tics and occasionally other conditions such as tardive dyskinesia. Become familiar with the medications typically used to treat common movement disorders as well as non-medical approaches including botulinum toxin injections and deep brain stimulation surgery 3. tic disorders as well as assorted other conditions (e. There are generally no inpatient activities and there will be no call responsibilities. 106 . myoclonus. ET. Building C.g. ataxia) • HD clinic takes place twice per month. tremor. gait/balance. • Deep brain stimulation multidisciplinary clinic (occurring 3rd Tuesday of the month) includes evaluation of new patients being considered for surgery and programming of implanted stimulators. on the 2nd and 4th Tuesdays of the month (afternoons) • Botulinum toxin injections are generally performed on Tuesday and Thursdays (by Drs.. Barbano and Burack) and include patients being treated for dystonia. etc. physical therapy. • The general clinics will involve a mix of new evaluations and follow-up visits for patients with PD and related parkinsonian disorders. Wednesday morning and all day Thursday. Become familiar with other areas of impairment experienced by patients with movement disorders (psychiatric. Biglan conducts telemedicine visits from his office (Saunders 240) on Wednesday mornings Research Residents are welcome to join attendings for clinical research trial related activities which will vary based on scheduled study visits. all day Tuesday. cognitive. RLS. Residents are expected to attend unless they are scheduled for their own continuity clinic. Biglan. The resident should also plan to observe a DBS surgery if one is scheduled during the rotation (these occur on Monday mornings at SMH) • Dr. speech therapy) Resident Responsibilities Most of the clinical activity during the movement disorders elective will take place in the outpatient setting at 919 Westfall Road.2. neuropsychological evaluation.

Jankovic J. Current Opinion in Neurology. 351(24):2498-508. Update on Dystonia (review) Current Opinion in Neurology 2012. Practice Parameter: Diagnosis and prognosis of new onset Parkinson’s disease (an evidence-based review): Report of the Quality Standards Subcommittee of the American Academy of Neurology O. Ma Q. Rudolph A. Kieburtz K.Evaluation Your evaluation will be completed on the standard form provided by the Department of Neurology. J. Poewe W.66. 2012. Shoulson I. et al. DATATOP: a multicenter controlled clinical trial in early Parkinson’s disease. Kieburtz K. Therapies in Parkinson’s disease. New England Journal of Medicine. 25: 433–447 3. Deuschl et al. Levodopa and the progression of Parkinson's disease. Advances in Understanding and Treatment of Tourette’s Syndrome. 2012. 24:15-24 Essential Tremor: 8. Veneto CS. McNaught KS.968 2. 27:31-41 107 . 46:1052-60 (landmark multicenter trial for disease modifying therapy) Dystonia: 5. Albanese A. McGarry A. Pharmacologic approaches to the treatment of Huntington's disease. and will be heavily weighted upon your level of interest and involvement. Movement Disorders. Reich. Parkinson Study Group. Movement Disorders 2009. Kurlan R. Lalli S. Suchowersky. Tanner C. S. 1989. Oakes D. Nature Reviews Neurology 2011. Lang A. Treatment of patients with essential tremor (review) Lancet Neurol 2011. Parkinson Study Group (Site Investigator). Shprecher D. Fahn S. Neurology 2006. Mink JW. 4. Olanow CW. The Management of Tics. Perlmutter.10: 148–61 Huntington’s Disease: 9. Arch Neurol. 2004 (trial designed to assess whether or not levodopa hastens progression of PD) II. Recommended Reading Parkinson’s Disease: 1. 7:667-76 7. Marek K. 25:483-90 Tourette’s Syndrome: 6.

Arch Neurol (now JAMA neurol) 2011. Weaver et al. 68. Neurology 2012. Deep brain stimulation for Parkinson’s disease: an expert concensus and review of key issues.Deep Brain Stimulation: 10. Bronstein et al.165-171 11.79:55–65 108 . Randomized trial of deep brain stimulation for Parkinson disease: Thirtysix-month outcomes.

Become familiar with the diagnosis and management of common neurological complications of cancer including neuropathy. Wilmot Cancer Center. 12. and advance directives with patients and families. and treatment of patients with this disease can be challenging. goals of care. pertinent texts or papers will be provided. and steroid myopathy. 13. Become familiar with the diagnosis. Inpatient: Residents will see new inpatient and ED consults during the day (8am-4pm). MD Adilia Hormigo. Outpatient: The resident will attend neuro-oncology clinic on Tuesday afternoon and Wednesdays at the James P. Residents are encouraged to evaluate patients independently. Priority will be given to seeing new patients or follow-up patients with active problems and unique diagnoses. radiation necrosis. Residents are encouraged to read relevant literature and when appropriate. prognosis and treatment options for brain metastases. prognosis and treatment options for gliomas and other primary brain tumors. 109 . Become familiar with the diagnosis. Resident Responsibilities 1. and our plan is to be readily available so that patients are discussed and seen together. 2. The goal of this rotation is to introduce residents to a growing field in neurology. and staff them with the attending on-service.NEURO-ONCOLOGY ELECTIVE For 2nd and 3rd year Neurology Residents Faculty • • Nimish Mohile. Become familiar with appropriate palliative interventions and treatments. They will do this under the guidance of the attending on-service. seizures. In addition patients with cancer present with a gamut of neurological diseases and symptoms. 10. The most common malignant tumor in adults is glioblastoma. Gain experience with discussing prognosis. They will also see follow-up consults as needed. and formulate assessments and plans for treatment on their own. MD. 11. Patients with primary brain tumors and neurological complications are seen in both the inpatient and outpatient setting. and feedback is immediate. PhD Description The practice of neuro-oncology involves the diagnosis and treatment of primary and metastatic intracranial tumors as well as the neurological complications of cancer. Learning Objectives 9. cord compression.

5. Current opinion in oncology. 2005.25(30):4722. Molecular targeted therapies and chemotherapy in malignant gliomas. and vincristine improves progression-free survival but not overall survival in newly diagnosed anaplastic oligodendrogliomas and oligoastrocytomas: A randomized European organisation for research and treatment of cancer phase III trial.25(26):4127. MGMT gene silencing and benefit from temozolomide in glioblastoma. Call Schedule: There is no evening. Stupp R. lomustine. The. 4.63(18):5821. Evaluation Your evaluation will be completed on the standard form provided by the Department of Neurology. Bevacizumab plus irinotecan in recurrent glioblastoma multiforme. 2007. Martin J. New England Journal of Medicine. Suggested Reading Glioblastoma Multiforme 1.356(15):1527. 2006. 110 . Adjuvant procarbazine. 6. 2. Journal of clinical oncology. Journal of clinical oncology. These will be discussed weekly with the attending physician. Anaplastic Oligodendroglioma and Low grade Gliomas 8. The. 2007.3.19(6):598. 2007. Phase III trial of chemotherapy plus radiotherapy compared with radiotherapy alone for pure and mixed anaplastic oligodendroglioma: Intergroup radiation therapy oncology group trial 9402. Singh SK. Journal of clinical oncology. Vredenburgh JJ. 2005. van den Bent. Journal of clinical oncology. 3. Brandsma D.352(10):987. Readings: There will be assigned readings covering major topics and particular interests of the residents. Radiotherapy for glioblastoma in the elderly. New England Journal of Medicine. 2006. 2007. 7. Cairncross G. 2003. Radiotherapy plus concomitant and adjuvant temozolomide for glioblastoma.24(18):2707. 4. Hegi ME. Identification of a cancer stem cell in human brain tumors.352(10):997. The. Stupp R. Keime-Guibert F.24(18):2715. 5. 9. Conferences: Residents will attend the weekly multi-disciplinary Brain Tumor Conference on Thursday mornings at 8:00am and the Neuro-Oncology academic conference at 11AM on Friday. Chemoradiotherapy in malignant glioma: Standard of care and future directions. weekend or overnight call on this rotation. and will be heavily weighted upon your level of interest and involvement. Cancer research. New England Journal of Medicine.

Shah GD. Successful chemotherapy for newly diagnosed aggressive oligodendroglioma. 15. Abrey LE. Treatment for primary CNS lymphoma: The next step. 2004. Lancet.27(5):573.) Oxford University Press. DeAngelis LM and Posner JB Neurologic Complications of Cancer (2nd ed. Radiosurgery plus whole-brain radiation therapy for brain metastases. DeAngelis LM. Annals of neurology. Whole brain radiation therapy with or without stereotactic radiosurgery boost for patients with one to three brain metastases: Phase III results of the RTOG 9508 randomised trial. The. Diagnosis and Treatment. Brain Metastases 12. Schiff D. 2006. Patchell RA. 2000. Gutin PH. 2007.322(8):494. Journal of clinical oncology. 1990. Patchell RA et al. Outcome in adult low-grade glioma: The impact of prognostic factors and treatment. 13. Primary CNS Lymphoma 16.295(21):2483. Patchell RA.10. JAMA. Neurology.25(30):4730. Metastatic Epidural Spinal Cord Compression 18. 366: 643–48 Reference Texts 1. 2009 111 . Combined immunochemotherapy with reduced whole-brain radiotherapy for newly diagnosed primary CNS lymphoma. Stereotactic radiosurgery plus whole-brain radiation therapy vs stereotactic radiosurgery alone for treatment of brain metastases: A randomized controlled trial. 17. 11. 2007. 14.18(17):3144. 2006.. Martin Dunitz. A randomized trial of surgery in the treatment of single metastases to the brain. Andrews DW. Leibel SA and Posner JB Intracranial Tumors. Lancet 2005. Journal of clinical oncology. JAMA. The. 1995 2.363(9422):1665. New England Journal of Medicine. Direct decompressive surgical resection in the treatment of spinal cord compression caused by metastatic cancer: a randomised trial. 1990. Macdonald DR.69(13):1366. Aoyama H.296(17):2089.

112 .

Learn about common neuro-ophthalmic disorders including optic neuritis. nystagmus. The faculty in the neuro-ophthalmology section at U of R is multifaceted. Learn to differentiate optic nerve disease from other ophthalmic causes of visual loss based on the history and exam. Williams’ primary research interest is in optic neuropathies. Become familiar with ophthalmic terminology and documentation. Dr. neuro-muscular junction and muscle. and a myriad of other clinical specialties. ischemic optic neuropathy. Dr. MD Faculty: Steven E. an understanding of neuro-ophthalmology is crucial for a neurologist. Although Dr. There is also considerable interface with general medicine. Williams. 2. Feldon’s practice includes a high volume of orbital surgery to which rotating residents will be exposed on a weekly basis. Williams are both ophthalmology-trained. Become proficient in identifying normal optic nerve anatomy. PNS. visual field defects. MBA Zoë R. Williams. 5. MD 275-1126 276-5482 Location: Strong Memorial Hospital Department of Ophthalmology Description About 1/3 of brain structure is related to the afferent or efferent visual pathways. Learning Objectives 1. 113 . Feldon is a world expert in thyroid eye disease research whereas Dr. MD. Feldon.NEURO-OPHTHALMOLOGY ELECTIVE For 2nd and 3rd year Neurology Residents Director: Zoë R. and cranial neuropathies. there are many research faculty members interested in vision disorders related to the nervous system. thus offering exposure to the field from unique perspectives. focusing on examination techniques that are useful in a general neurologic practice (rather than emphasizing the use of ophthalmic equipment that is generally unavailable to neurologists). Neuro-ophthalmic disorders can occur with diseases at any level of the nervous system. In addition. Therefore. or the cortical processing of visual input. 4. Gain exposure to the techniques and interpretation of manual and automated visual field testing. Feldon and Dr. idiopathic intracranial hypertension. including CNS. and optic atrophy. pupillary abnormalities. Perform a neuro-ophthalmic history and examination. optic disc edema. 6. they have different research interests. papilledema. 3. internuclear ophthalmoplegia. pediatrics.

5.. 2008. 2006. A Manual for the Beginning Ophthalmology Resident. Other reading material. and discuss with the attending physician. It is expected that after a day or two of observation. eyelid procedures and temporal artery biopsies) Responsibilities of the Resident 1. optic nerve sheath decompression.g. the resident will start seeing patients as the initial examiner and will be able to perform most of the relevant ophthalmic examination. Miller NR. Lippincott Williams & Wilkins. 114 .. Serve as the initial examiner for new and follow-up patients. 2nd ed. Follow neuro-ophthalmology inpatients with neurology service. published by the American Academy of Ophthalmology. the resident should contact Dr. The Neuro-Ophthalmology Survival Guide. will be incorporated as relevant to patient exposure. including journal articles. Burdon M.. 2. In the last week of the rotation. Attend other conferences in the ophthalmology department that are relevant to neuroophthalmology. The Neurology of Eye Movements. Kerrison JB.g. • Pane A. Walsh and Hoyt’s Clinical NeuroOphthalmology : The Essentials. See in-patient hospital neuro-ophthalmology consultations initially. 2006. Prior to scheduling the rotation. Newman NJ. is also helpful for understanding various ophthalmic procedures and examination techniques that will be encountered on service. 4th ed. Biousse V. strabismus. Observe surgical procedures relevant to neuro-ophthalmology (e.7. • Leigh J and Zee D. Grand Rounds). The resident should plan to read one of the following recommended textbooks while on service: • Miller NR. General Guidelines The rotation is 4 weeks in duration and primarily involves outpatient neuro-ophthalmology. Feldon and Williams and attend neuro-ophthalmology conferences. 6. if scheduled during the rotation (e. Williams to make sure that there is not a major conflict with faculty travel during that time block. Attend neuro-ophthalmology conference (Tuesdays at 7-8 AM) 4. the resident should plan to present an interesting patient seen on the rotation with an overview of their diagnosis and management for the resident neuro-ophthalmology conference (Tuesdays 7-8 am). Mosby. 3. Oxford University Press. New York. The residents will see patients with both Drs. trans-antral orbital decompression.. as appropriate.

Neuro-Ophthalmology Rotation Schedule

8 AM – 5 PM

Outpatient clinic


7AM – 8 AM
8 AM – 12 PM
1PM – 5 PM

Neuro-ophthalmology teaching conference
Outpatient clinic
Dr. Williams
Outpatient clinic
Dr. Feldon


8 AM – 12 PM
1PM – 5 PM

Outpatient clinic
Resident Neuroophthalmology clinic
5:30 – 6:30 PM Problem rounds

Dr. Williams
Dr. Williams


8 AM – 12 PM
1PM – 5 PM

Outpatient clinic
Consults as needed

Dr. Feldon


8 AM- 12 PM

Outpatient clinic

Dr. Feldon
Dr. Williams
(if not scheduled with Dr.
Feldon in the OR)

Dr. Williams

The evaluation will be completed on the standard form used by the department and will be
heavily weighted on level of interest, quality of work-ups and presentations, ability to generate a
neuro-ophthalmic diagnosis and treatment plan, motivation and effort, and patient rapport.



For 2nd and 3rd Year Neurology Residents

Gabrielle Yeaney MD

Mahlon Johnson MD PhD



During this elective, the neurology resident will acquire a basic understanding of the reactions of
the central nervous system and will formulate a diagnosis for the most common and classical
neuropathologic lesions encountered at autopsy and at the surgical bench, with particular
attention to the diagnosis of brain tumors, cerebrovascular diseases, Alzheimer disease and
common neuromuscular diseases. The neurology resident will gain insight into how the
neuropathologist completes his/her diagnostic workup.

Learning Objectives
Brain cutting conferences
1. To become familiar with the gross neuroanatomical landmarks and areas to be sampled.
2. To describe the gross abnormalities using pathologic terminology.
3. To understand the basic concept of tissue processing (i.e. what happens from the bench to
the slide).
4. To review the slides upon their completion prior to the sign-out.
5. To recognize and articulate the microscopic abnormalities and formulate a clinical pathologic
diagnosis on each case.
Neurosurgical Specimens
1. To understand the process of intraoperative evaluation of tissue samples.
2. To formulate a differential diagnosis based on the clinical history and CT/ MR imaging
findings, and to correlate this with the gross and histologic specimens during intraoperative
3. To participate in the evaluation of the cytologic and histologic preparations at the time of the
examination of the specimen with the attending.
4. To formulate a diagnosis prior to the reviewing the slides with the attending.
5. To manage the cases from the medical and cost effective point of views; to learn which
specialized techniques such as immunohistochemistry or electron microscopy should be
used to help formulate/solidify a diagnosis.
6. To interpret the special studies which have been requested on specific neurosurgical or
autopsy brain cases.


Chapters 11. AFIP Fascicle: Tumors of the CNS (hardcover) American Registry of Pathology (2007) 4. WHO Classification of Tumours of the Central Nervous System (paperback) (2007) 9. Sternberg SS: Histology for Pathologists. A. et al. Abbas A. Scheithauer BW. et al. and will be weighted for your level of interest and involvement. Ellision DW. 1997. 2 ed (2003) 6. Louis DN. Prayson. Perl D. 28 8. Love S. References 1. Vogel FS. 8th Edition (2 Volume) (hardcover) Oxford University Press. Fausto N. Escourolle and Poirier's Manual of Basic Neuropathology (paperback) Butterworth-Heinemann. R. Burger PC. Scheithauer BW. Kumar V. Evaluation Your evaluation will be completed on the standard form provided by the Department of Neurology. 12 118 .. Robbins and Cotran Pathologic Basis of Disease 7th Ed (Hardcover) (2004)—Chapters 27.. et al. Love S.Responsibilities of the Resident • Review neuropathologic autopsy and surgical slides and formulate diagnoses independently prior to meeting with the attending and then review with the attending. Burger PC. • Attend Brain-cutting Conference. Oppenheimer's Diagnostic Neuropathology: A Practice Manual (hardcover) Hodder Arnold Publication (2006) 7. Greenfield's Neuropathology. Neuropathology: A Reference Text of CNS Pathology (hardcover) Mosby. Neuropathology: A Volume in the Foundations in Diagnostic Pathology Series (2005) 3. Ellison D. Surgical Pathology of the Nervous System and Its Coverings (hardcover) Churchill Livingstone. Ohgaki H. • Review the next day’s OR schedule and look up history on potential neurosurgical cases that may require intraoperative evaluation and then review the history/ imaging with the attending on call. 4 ed (2004) 2. Louis DN. USA (2008) 10. 4 ed (2002) 5. • Attend calls for intraoperative evaluation of neurosurgical cases during weekdays from 8 am-5 pm. Gray F. Esiri M.

Daily Schedule 8:45 am . neck and spine. Residents will gain familiarity with indications and contraindications for ordering CT and MR of the head. 3. Rajiv Mangla.D. Neurology Resident Responsibilities • • • • • Attend morning and afternoon read-out sessions. Ali Hussain. M. D. Residents will understand the limitations of each neuroimaging study. neck and spine as well as myelography. M. 2.D. Ph. Residents will gain exposure to neuroimaging research and future neuroimaging techniques.NEURORADIOLOGY ELECTIVE Neuroradiology Faculty • • • • • • Jeevak Almast.D. M. Sven E. Learning Objectives 1.D. 4.D. Residents will gain familiarity with indications and contraindications for ordering angiography of the head. M. Review one paper for presentation at neuroradiology journal club.D. Ph.12:00 noon 1:00 .D. P-L Westesson. M. Attend weekly and monthly neuroradiology conferences Observe invasive procedures including myelography.D. Ph. Residents will gain appreciation for the risks and consequences of invasive studies..D. 5.S. Ekholm... Belinda De Libero (x5-1839). and diagnostic and interventional angiography. The administrator for the neurology elective in neuroradiology is the neuroradiology division secretary.D. M. 6.5:00 pm Morning read-out/observe procedures Afternoon read-out session 119 .. Prepare two cases for the neuroradiology web-based teaching file. Henry Z. Residents will develop an ability to preliminarily interpret an imaging study on an emergency basis. Wang.

Weekly Conferences Conferences in Diagnostic and Interventional Neuroradiology Monday Tuesday 12:00-1:00 PM Pediatric Neuro-oncology Conference Wednesday 7:30 – 8:00 AM Neuroradiology Interesting Case Conference Thursday 7:30-8:00 AM Clinical Neuroscience Conference Van Wagenen Conference Room 2-8130 Neuroradiology Conference Room 1-4719 Imaging Sciences Conference Room G-3302 Friday 9:00-10:30 Neurology Grand Rounds Room K-307 8:00-9:00 AM Multidisciplinary Neurooncology Conference 12:00-1:00 Neurovascular Conference Van Wagenen Conference Room 2-8130 Van Wagenen Conference Room 2-8130 4:30-6:00 PM Multidisciplinary Head & Neck Tumor Board Wilmot Cancer Center Room 2-0727 Evaluation of Residents A written evaluation form from each attending will be completed for each neurology resident at the end of each neuroradiology http://www. Bibliography 120 .

and exacerbating chronic pain from the perspective of providers with varied backgrounds. NP 242-1300 Description The Pain Management elective is conducted in the Pain Treatment Center practice. NP Julie Simmons. Learning Objectives 1. MD Janet Vaughan. MD Annie Philip. Recognize the varied psychosocial factors that play a role in initiating. 4. MD Joel Kent. radiofrequency ablation.PAIN MANAGEMENT ELECTIVE For 2nd and 3rd year Neurology Residents Faculty: Director: Joel Kent. The Pain Treatment Center is located at 180 Sawgrass Drive. 3. physiatrists and psychologist. interventional therapies and behavioral therapy as is indicated based on the patient’s presentation. Identify indications for interventional and surgical therapies for chronic pain conditions. This is a multidisciplinary practice that currently consists of anesthesiologists. spinal cord stimulation. The educational experience will focus on the clinical assessment of these patients and developing treatment plans tailored to address each patient’s individual needs. Understand diagnostic and treatment strategies for managing common chronic pain conditions. MD Rajbala Thakur. Treatments provided to these patients include medication management. 121 . 2. and intrathecal drug delivery for the treatment of pain. maintaining. Develop familiarity with common fluoroscopy-based procedures including epidural interventions. Residents will gain exposure to a broad range of nociceptive and neuropathic pain conditions.

Mao J. Butler. Edwards JE. mechanisms. Thieme. New England Journal of Medicine. Evaluation Your evaluation will be completed on the standard form provided by the Department of Neurology. Dreyfuss P. Halbrook B. Saunders. selected review of a clinical text. 60(11):1524-34. Stephen H. 2. 4. McQuay HJ. Fenton DS. Ballantyne JC. Efficacy and validity of radiofrequency neurotomy for chronic lumbar zygapophysial joint pain. Image Guided Spine Intervention. Opioids in chronic non-cancer pain: systematic review of efficacy and safety. The resident will be exposed to basic pain management procedures. The resident will assist in the performance of basic injection and ablation techniques. and treatment recommendations.Responsibilities of the Resident The resident will initially participate as an observer in the outpatient clinic. Benzon HT (ed. Richard Chapman. Once familiar with the assessment approach. and should include time with each of the faculty in order to ensure a sufficiently broad clinical exposure. Essentials of Pain Medicine and Regional Anesthesia 3rd. 2002. Bogduk N. 2004 122 . Burchiel K. and will be heavily weighted upon your level of interest and involvement. 2000 May 15. the resident will perform independent outpatient assessment of chronic pain patients and formulation of treatment plans with close faculty supervision. Pauza K. 112(3):372-80. 2003 Nov. 2007. Turk (eds. Spine. Surgical Management of Pain. Opioid therapy for chronic pain.) Bonica’s Management of Pain. Pain. General Guidelines The rotation is intended to be four weeks in duration. 349(20):1943-53. Kalso E. Lippincott Williams & Wilkins. Joshi A. C. 2011. Loeser. McLarty J. References 1. Moore RA. and Dennis C. and participation in the conferences offered at the center. 2003 Selected Journal Articles for Review 1. John D. 3. Your reading should include a review of the pain center’s manual and summary journal articles provided at the start of the rotation. Archives of Neurology.). Dworkin RH. Advances in neuropathic pain: diagnosis. 25(10):12707. 4. 2003 Nov 13 2. Churchill Livingstone. 3.

6. Kidd DH. Davies PS. Twilling L. Zahurak M. 7. Mohr D. Pain: moving from symptom control toward mechanism-specific pharmacologic management. 2004 Mar 16 123 . American Physiological Society. 140(6):441-51. 2003 Mar 27. 32(3):384-94. 348(13):1223-32. Taylor K. discussion 3945. Annals of Internal Medicine. intractable pain: experience over two decades. American College of Physicians.5. 1993 Mar. Reisner L. Woolf CJ. Long DM. Spinal cord stimulation for chronic. Rowbotham MC. James CS. Oral opioid therapy for chronic peripheral and central neuropathic pain. Neurosurgery. North RB. New England Journal of Medicine.

124 .

MD Robert McCann.4315 Phone: (585) 275-1018 Fax: (585) 244-2529 Center for Ethics. Humanities and Palliative Care Contact: Sherri Seeger Office: Rm. MD Ronald Epstein. MD Robert Holloway. URMC (near Miner Library) Phone: (585) 273-1154 Fax: (585) 275-7403 Description The Palliative Care elective is integrated within the busy inpatient Palliative Care Program at Strong Memorial Hospital. Palliative care works with patient. MD Bernard Sussman. Palliative care is often delivered alongside very aggressive disease-directed treatment. MD Aaron Olden. ALS. MD Tom Campbell. Most palliative care patients seen in consultation have multiple physical symptoms and considerable limitations in functional status consistent with their having advanced disease and diminished capacity for decision-making. MD Location: Department of Neurology Contact: Office: Rm. and failure to thrive from multiple sources. MD Timothy Quill. stroke. although in some circumstances it becomes the predominant treatment approach. MD Robert Gramling. as well as to assist and support patients and families while making difficult medical decisions. 1-6305. Inpatient referrals to the PCCS come from all inpatient units and intensive care units in the hospital. with the addition of the inpatient Palliative Care Consultation Service (PCCS). MD David Korones. as well as from rehabilitation floors and the emergency department. MD 273-1154 Faculty: Jeffrey Allen. MD Michelle Carpenter.PALLIATIVE CARE ELECTIVE For 2 and 3rd year Neurology Residents nd Director: Robert Holloway. About half of patients seen in consultation have cancer and the other half have a wide range of acute and chronic diseases including congestive heart failure. The Palliative Care Program began in 2000 with the initiation of a comprehensive 4-year medical student education program and was further expanded in October 2001. dementia. MD 275-1018 Palliative Care Program Director: Tim Quill. The PCCS team now conducts approximately 800 inpatient consultations per year and approximately 150 in an outpatient setting and/or in the home. 125 . COPD. 5. family and the medical team to address pain and other uncomfortable symptoms.

Learning Objectives
1. Understand the role of palliative care in the evaluation and management of patients and
families with serious illness, including neurological illness, and to appreciate and
demonstrate an ability to effectively work within the palliative care multidisciplinary team.
2. Develop basic knowledge and skill about pain management, including equianalgesic dose
3. Develop basic knowledge and skill in the management of other physical symptoms that
afflict seriously ill patients, including constipation, dyspnea, depression, and delirium.
4. To identify common neurological conditions often appropriate for palliative care and
demonstrate an ability to estimate and communicate prognosis of life expectancy and
outcomes important to patients.
5. Learn how to talk with and listen to severely ill patients and their families about non-physical
suffering, including issues of loss, hope, meaning, spirituality, and religion.
6. To develop a framework for initiating and conducting end-of-life discussions in patients with
serious illness, including neurological illness.
7. To understand the role and use of hospice and other support services in the evaluation and
management of patients with serious illness, including neurological illness.
8. Develop self-awareness about one’s own personal responses to severely ill and dying

Responsibilities of the Resident
1. Responsible for performing 3-5 palliative care consultations per week as part of the palliative
care consultation team

Discuss with referring attending and staff
Interview patient and family, examine patient, and review chart as guided by consultation
assessment form
Develop recommendations with palliative care attending
Round daily on assigned patients; join team for rounds when possible
First call for palliative care problems on assigned patients
At end of rotation, discuss patient transfer/follow-up with next resident coming on

2. No on-call responsibility for palliative care service on weekends
3. Attend the weekly Wednesday morning multidisciplinary team meeting (7:30-9 am in the
Social Work Conference Rm. 1-1450) and the Wednesday noon conference series on
Clinical Ethics, Palliative Care, and Schwartz Rounds.
4. Read the required readings and Unipacs, complete pain cases and calculations, and
discuss answers with Dr. Holloway or attending on service


Orientation Schedule
In advance, Sherri Seeger from the Palliative Care Office will send you a schedule. Please
review the schedule for any conflicts (i.e. clinic schedule, urgent care clinic, post-call conflicts,
etc.) Please pick up syllabus from the Palliative Care office, Rm. 1-6305 near the Miner Library.
Then, on first day of service meet with Marcia Buckley or Laura Hogan, Palliative Care Nurse
Practitioners and/or Palliative Care Physician Consultant to review the following:

Rounding schedule / patient assignment / time of weekly session to review readings
Consult availability and documentation requirements

Core Activities
1. Palliative Care Team Rounds – daily Monday to Friday, at times agreed upon by the team at
the beginning of each week
2. Palliative Care Interdisciplinary Team Meeting – Wednesdays, 7:30-9 am in the Social Work
Conference Room 1-1450 (across from the main Lab near the main lobby)
3. Wednesday Noon Conference Series:
1st Wednesday
Medical Humanities Conference, K-207, URMC
2nd Wednesday
Interdisciplinary Clinical Ethics Conference, K-207, URMC
3 Wednesday
Schwartz Rounds Conference, Whipple Auditorium, 2-6424,
4th Wednesday
Palliative Care Conference, K-207, URMC
5th Wednesday
Spiritual Care Conference, K-207, URMC
[1st Tuesday
Ethics Committee Mtg., Anderson Room, G-8543, URMC]

Your evaluation will be completed on the standard form provided by the Department of
Neurology, and will be heavily weighted upon your level of interest and involvement. Your
performance on the self-assessment exam will not be included in the final evaluation.

Required General Palliative Care Reading
1. Quill TE, Holloway RG, Shah MS, Caprio TV, Storey CP. Primer of Palliative Care. 4th
Edition. American Academy of Hospice and Palliative Medicine, Glenview IL, 2007.
2. UNIPAC One: The Hospice/Palliative Medicine Approach to End of Life Care, 3rd ed. 2005.
3. UNIPAC Three: Assessment and Treatment of Pain in the Terminally Ill, 2nd ed. 2005. 2539.
4. UNIPAC Four: Management of Selected Non-pain Symptoms in the Terminally Ill, 2nd ed.
2005. 22-25, 29-35, 36-43, 47-51.


Additional Palliative Care Reading
General Palliative Care
1. Quill, TE. Chapter 7: Discussing Palliative Care with Patients. Caring for Patients at the End
of Life: Facing an Uncertain Future Together. Oxford University Press, 2001.
2. Quill TE. Arnold RM. Platt F. "I wish things were different": expressing wishes in response to
loss, futility, and unrealistic hopes. Annals of Internal Medicine. 2001;135:551-5.
3. Meier DE. Back AL. Morrison RS. The inner life of physicians and care of the seriously ill.
JAMA. 2001;286:3007-14.
4. Quill, TE. Chapter 12: Palliative options of last resort: a comparison of practices,
justifications, and safeguards. Caring for Patients at the End of Life: Facing an Uncertain
Future Together. Oxford University Press, 2001.
5. Casarett D. Kutner JS. Abrahm J. End-of-Life Care Consensus Panel. Life after death: a
practical approach to grief and bereavement. Annals of Internal Medicine. 134(3):208-15,
2001 Feb 6.

Neurology Palliative Care
1. Voltz R, Bernat JL, Borasio GD, Maddocks I, Oliver D, and Portenoy RK. Palliative Care in
Neurology. New York, NY: Oxford University Press, 2004.
2. Maddocks I, Brew B, Heather W, and Williams I. Palliative Neurology. New York, NY:
Cambridge University Press, 2006.
3. Holloway RG, Benesch C, Burgin WS, Zentner J. Prognosis and decision-making in severe
stroke. JAMA, 2005;294:725-733.
4. Wijdicks, EFM. Brain Death. Philadelphia, PA: Lippincott Williams & Wilkins, 2001.
5. Bauby, J. The Diving Bell and the Butterfly. New York, NY: Random House, Inc., 1997.


NY 14625 585-586-7550 Description The residency program in Neurology at Strong Memorial Hospital emphasizes academic and research neurology. The residents will be able to encounter the private sector and see if that has an appeal and which type of private arena best suits him/her. 4. 129 . 3. The resident will participate in the Friday morning teaching conferences of the Department of Neurology at Strong Memorial Hospital as well as his/her weekly afternoon Firm. MD Ryan Evans. MD Ann Moss. 300 Rochester. Get exposure to private practice 2. Meet with experienced and expert people who deal with insurance and billing in the office. Experience the diversity of patient encounters.PRIVATE NEUROLOGY PRACTICE ELECTIVE For 2nd and 3rd year Neurology Residents Faculty: Ashanthi Gajaweera. Ancillary activities include observing EMG and nerve conduction studies. Learning Objectives 1. Have an understanding of CPT and ICD-9 codes and how they affect reimbursement. Ste. Experience in private practice Neurology is limited. MD Location: Linden Oaks Medical Practice 20 Hagen Street. MD Andrew Stern. This rotation will provide neurology residents with the opportunity to explore private practice Neurology in an office-based setting. The resident will evaluate private patients with a variety of neurological disorders in an officebased practice.

Responsibilities of the Resident 1. Plan to be at the office at 9:00 AM Monday through Friday Evaluation The resident evaluation will be completed on the standard form used by the department. 130 . 2. Visit the Linden Oaks practice for a period of up to 2 weeks.

Dr. 2. Modrak. MD Joseph E.SLEEP MEDICINE ELECTIVE For 2 and 3rd year Neurology Residents nd Director: Mike Yurcheshen. MD Jonathan Marcus. Become familiar with the diagnostic nomenclature of the International Classification of Sleep Disorders-2 (ICSD-2). in the Westfall Park Medical Center Complex. The pediatric patients are evaluated at a separate facility as listed above. 131 . faculty members from the Departments of Internal Medicine. NY 14618 Description The Sleep Medicine rotation is conducted in a multidisciplinary outpatient sleep clinic. MD Michael Yurcheshen. Understand the clinical features of sleep disorders and the modalities used for their diagnosis and treatment. NY 14618 Pediatric Sleep Medicine Services 2180 Clinton Avenue South Rochester. Learning Objectives 1. MD Heidi Connolly. Understand the physiological substrates involved in normal and pathological sleep. Greenblatt. In these centers. MD Donald W. 3. Develop sufficient familiarity with the Polysomnogram (PSG) and Multiple Sleep Latency Test (MSLT) to allow basic recognition of sleep stages and fundamental sleep disorders. The Strong Sleep Disorders Center is an outpatient clinic and a 14-bed diagnostic laboratory located at 2337 South Clinton Avenue. Donald Greenblatt is the director of the Strong Sleep Disorders Center. MD Faculty: 341-7575 Lynn Liu. MD Laura Tomaselli 273-3524 341-7575 341-7575 341-7575 341-7444 341-7575 341-7444 Location: Strong Sleep Disorders Center 2337 Clinton Avenue South Rochester. Neurology and Pediatrics assess pediatric and adult patients with potential sleep disorders.

Technical Considerations.Responsibilities of the Resident 1. Saunders Co. Butterworth-Heinemann. IL 2007. PA. Ancoli-Israel. Westchester. WC (eds. in order to ensure a sufficiently broad clinical exposure. Dement. 1999. MH. AL. Sheldon SH: Evaluating Sleep in Infants and Children. PA. 4. Initial participation as an observer in the outpatient clinic. References 1. 132 . Kryger. Chesson. 1996. 2. and Clinical Aspects. Roth T. 2nd Edition: Diagnostic Coding Manuel. Philadelphia. and should include time with each of the faculty. W. C.): Principles and Practice of Sleep Medicine. B. and will be heavily weighted upon your level of interest and involvement. This may progress to independent outpatient assessment as deemed appropriate by the clinical faculty. Additional references for the rotation are listed below. The International Classification of Sleep Disorders. et al. The AASM Manual for the Scoring of Sleep and Associated Events. the resident should take the opportunity to review the journals Sleep and Journal of Clinical Sleep Medicine. progressing to sleep scoring and interpretation as deemed appropriate by the clinic faculty. American Academy of Sleep Medicine. Philadelphia. Your reading should include a review of summary journal articles provided at the start of the rotation. Iber. and review of the International Classification of Sleep Disorders-2. Chokroverty. 3.. Directed review of polysomnographic studies. Lippincott-Raven. Westchester. S. American Academy of Sleep Medicine. S (ed. MA. Boston.): Sleep Disorders Medicine: Basic Science. Evaluation Your evaluation will be completed on the standard form provided by the Department of Neurology. 2011. General Guidelines The rotation is intended to be two weeks in duration. 2. selected review of a clinical text. 5. IL 2005. Your performance on the self-assessment exam will not be included in the final evaluation. During the rotation.

et al. 5. 2008. Kushida CA. Picchietti DL. 7. J Clin Sleep Med.30:1705-11. 9. Mahowald MW. Hening WA. Dorsey C. 4. Hirshkowitz M. An update on the dopaminergic treatment of restless legs syndrome and periodic limb movement disorder. Practice parameters for the use of continuous and bilevel positive airway pressure devices to treat adult patients with sleep-related breathing disorders. Littner MR. Practice parameters for the Treatment of Narcolepsy and other Hypersomnias of Central Origin. Buysse D. Restless Legs Syndrome Task Force of the Standards of Practice Committee of the American Academy of Sleep Medicine. Anderson WM. et al. J Clin Sleep Med 2010. et al. 2. Morgenthaler TI. Kushida CA. Allen RP. developmental. 10.27:560-83. Morganthaler TI. Practice parameters for the dopaminergic treatment of restless legs syndrome and periodic limb movement disorder.27:557-9. Best Practice Guide for the Treatment of Nightmare Disorder in Adults. Kushida CA. Kapur VK. Sleep 2002. Auerbach SH et al. Littner M. Kushida C. Sleep 2004. Practice parameters for the treatment of snoring and Obstructive Sleep Apnea with oral appliances: an update for 2005. Littner MR. 133 .26:337-41. Schenck CH. 6: 389-401. Earley CJ. Azk RS.29:375-80. Schutte-Rodin S. et al.29:240-3. 8.Selected Journal Articles for Review 1.see comment. Anderson WM. Practice parameters for the role of actigraphy in the study of sleep and circadian rhythms: an update for 2002. Littner MR. Sleep 2006. 15: 487-504. Clinical Guideline for the Evaluation and Management of Chronic Insomnia in Adults. Sleep 2006. 6.29:1031-5. Morgenthaler TI. Lee-Chiong T. Broch L. Kapen S. Sleep 2007. Sleep 2003. Practice parameters for the medical therapy of obstructive sleep apnea.25:120-38. Aurora RN. Sleep 2006. Brown T et al. REM sleep behavior disorder: clinical. et al. Sleep 2004. 3. and neuroscience perspectives 16 years after its formal identification in SLEEP. Sateia M. Silber MH.

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as evidenced by their official transcript Performance in the basic and clinical science years. International Medical Graduates applying for a Neurology residency at the University of Rochester are selected on the basis of the same criteria as above. consisting of the Residency Program Director. based on an interview with the Program Director and several other faculty and residents in the Department of Neurology at the University of Rochester. they must have the following: • • ECFMG certification at the time of application to the residency program Only J-1 visas are accepted for training The Neurology Residency Selection Committee. as evidenced by the Medical Student Performance Evaluation (MSPE) Performance on the USMLE Step 1 and Step 2 examinations A letter of reference from the Chairman of Neurology at their medical school Two additional letters of reference from faculty at their medical school Personal and professional traits.Department of Neurology Policy on Selection of Residents Graduates of LCME-accredited US or Canadian medical schools applying for a Neurology residency at the University of Rochester are selected on the basis of the following: • • • • • • Performance in medical school. the Associate Residency Program Director. subject to approval by the Department Chair. reviews all information on candidates and constructs the match list. a neurology Chief Resident and two ad-hoc faculty members. In addition. 135 .

either in the institution. These attendings are readily available to the residents via pager on evenings. These activities are appropriately covered by the "General" designation. and is immediately available to provide Direct Supervision. • With direct supervision available – the supervising physician is not physically present within the hospital or other site of patient care. Supervision may be exercised through a variety of methods. Residents and faculty members should inform patients of their respective roles in each patient’s care. has been credentialed) to do the procedure. resident patient care activities are supervised by a senior resident or attending physician. Oversight – The supervising physician is available to provide review of procedures / encounters with feedback provided after care is delivered. which is defined as follows: The supervising physician needs to be physically present when a procedure is performed except when the resident: • Has documented adequate training (i. • Indirect Supervision: • • With direct supervision immediately available – the supervising physician is physically within the hospital or other site of patient care.e. nights and weekends. the supervising physician may be a more advanced resident or fellow. but is immediately available by means of telephonic and/or electronic modalities. Some activities require the physical presence of the supervising faculty member. In the clinical learning environment. appropriately-credentialed and privileged attending physician who is ultimately responsible for that patient’s care. or by means of telephonic and/or electronic modalities. our residency program uses the following classification of supervision: • Direct Supervision – the supervising physician is physically present with the resident and patient.. 136 . Other portions of care provided by the resident can be adequately supervised by the immediate availability of the supervising faculty member or resident physician. and • Has permission of the supervising physician to perform the procedure. For many aspects of patient care. and is available to provide Direct Supervision. In compliance with accreditation standards of the New York State Health Code. In some circumstances. each patient has an identifiable. who round daily with the residents on their patients.Department of Neurology Policy on Resident Supervision All patients admitted to the neurology inpatient unit and seen on the consultation services are directly supervised by full-time neurology faculty. Levels of Supervision To ensure oversight of resident supervision and graded authority and responsibility. supervision may include post-hoc review of resident delivered care with feedback as to the appropriateness of that care.

Critical Care. • Faculty members functioning as supervising physicians delegate portions of care to residents. conditional independence. End-of life decisions: Residents must communicate with appropriate supervising faculty members when TPA is to be administered to a patient presenting with an acute stroke. Credentialing to perform lumbar punctures without direct supervision requires the performance of five successful lumbar punctures supervised by a physician credentialed to perform this procedure. based on the needs of each patient and the skills of the individual resident or fellow. and the circumstances under which he/she is permitted to act with conditional independence. and when end-of-life decisions are being contemplated. Evaluation is guided by specific national standards-based criteria. and a supervisory role in patient care delegated to each resident is assigned by the program director and faculty members. 137 . Neurology-specific procedures: TPA. based on the needs of the patient and the skills of the residents. when a patient is to be transferred to an intensive care unit. Each resident must know the limits of his/her scope of authority. Lumbar punctures: Residents can only perform lumbar punctures without direct supervision if they have been credentialed to do so.The privilege of progressive authority and responsibility. as follows: • The program director evaluates each resident’s abilities based on specific criteria. • Senior residents or fellows serve in a supervisory role of junior residents in recognition of their progress toward independence.

where they have more autonomy. overseeing the inpatient teams and the more junior residents. • PGY-3 residents primarily work on the consultation services.Department of Neurology Policy on Progressive Responsibility for Patient Management Neurology residents assume progressive responsibility for patient care as they progress through the residency program due to the structure of the program: • PGY-2 residents primarily work in a supervised inpatient setting. Decision making is shared by the residents and attending physicians. and also coordinate medical student teaching. with residents becoming more autonomous in their decision making as they proceed through the residency program. 138 . • PGY-4 residents serve as chief residents.

Anticipatory guidance: A bulleted list of anticipated events that the cross-cover resident may be notified about. the NF should inform the upper level floor residents about any patients admitted to their teams overnight. Synopsis: A brief summary of the patient. including any antibiotics that the patient is receiving.g. New Admissions: Any patient admitted by the EF or NF should be entered into the "Admitted List" in the EMR and should also be listed on the dry erase board in the resident office. including the reason for admission. 4. lab results. the upper level resident and the intern on each inpatient team will "run the list" to finalize a plan for all patients on their team and to ensure that any outstanding issues (test results. 3. The following morning.g. Neurology Inpatient and Consult Team Follow-ups: The inpatient and consult team residents should indicate in writing on the dry erase board in the residents’ office anything that needs to be followed-up for their patients (e. Any sign-outs completed by medical students should be reviewed and addended by the intern or resident. pain issues. acute neurologic change in a stroke patient suggestive of hemorrhagic transformation. In addition. 5. 2. Evening Float/Night Float Residents: 1. including guidance about how to manage the problem (e. and any active patient care issues. including significant symptoms. Baseline assessment: A brief assessment of the patient. Any patients admitted during the day who are to be signed out to medicine cross cover resident should also have an updated sign-out in the EMR. Sign-outs must be entered into the defined area for this in each patient’s EMR and must be updated daily for all patients on each team. Code status Sign-out Rounds: At the end of each day. Any items that need to be followed-up by the medicine cross cover resident should also be noted. delirium. New Consults: Any patient seen by the EF or NF and placed on the Stroke or General Consult list should be entered into the appropriate shared list for the Stroke or General Consult team in the EMR. this information should be personally communicated to the NF and EF residents by the inpatient and consult team residents before they leave the hospital. patient or family questions. the NF should inform the consult residents and attendings about any patients placed on their consult lists overnight. important details of the PMH. 2. attending requests) have been addressed.Department of Neurology Policy on Hand-offs Inpatient Teams: All sign-outs in the EMR for neurology inpatients should include the following components: 1. The acting chief resident should facilitate these discussions. level of alertness. disposition). 3. 139 . hypertension). Medications: An updated medication list. and should also be listed on the dry erase board in the resident office. and current neurological exam including any neurological deficits. The following morning.

Step-down Unit Patients: Patients on the step-down unit covered by the NF should be listed on the dry erase board in the resident office. anticipatory guidance. the NF must be personally made aware of these patients. Evening Float and Weekend Day Float Residents: All patients seen by the EF and Weekend Day Float residents should be briefly discussed with the NF prior to their leaving the hospital. including any pending studies. Covering Provider: The “covering provider” in the EMR should be switched to the crosscovering resident for all new admissions so that the nurses know whom to contact regarding orders and questions. These residents should also send an email with a summary for each new patient seen to the respective consult service residents and the acting chief resident. 5. disposition issues. 6.4. 140 . etc.

Department of Neurology Policy on Resident Work Hours The Department of Neurology is fully committed to maintaining high standards of patient care and resident education. • No resident may work more than 24 consecutive hours involved in direct patient care. 141 . The Department also expects to be in full compliance with the New York State 405 Work Hours Regulations. No new patient responsibilities can be assumed during this 3-hour grace period. The following policy on Resident Work Hours has therefore been established: • A resident may not work more than 80 hours in a single week. • A 3-hour grace period is allowed post-call for residents to sign-out patients seen overnight. all educational conferences and rounds. and all time on-call during which the resident is involved in the care of patients. Activities included in these 80 hours are all time spent in the hospital in the care of both inpatients and outpatients. • Each resident will have a 24-hour period off each week. • Each resident must have 10 hours off between shifts. and realizes that monitoring and regulating work hours are key aspects of this standard of care. Resident work hours are monitored twice yearly with a survey by the Graduate Medical Education Committee.

• The following evaluation instruments will be used to evaluate mastery of these six competencies: RITE. The program director reviews each resident’s performance on this examination at the June evaluation and feedback meeting. resident case log. and achievement of the six core competencies and the specific goals for each rotation. consisting of the department chair. skills and attitudes. All neurology residents are expected to achieve mastery of these competencies at the time of completion of the training program. Each resident is assessed as to his knowledge. • A residency promotions committee. 360° assessment. • A clinical skills examination is administered yearly to all of the residents. program director and associate program director. A written summary of this meeting is provided to each resident for his review and signature. • All neurology residents take the Residency In-service Training Examination (RITE) each year. professionalism. attending global assessment. meets in June of each year to review each resident’s progress in the program and determines if the resident is qualified to advance to the next year of training. clinical skills examination. • Written faculty global assessments are obtained on each resident following each rotation or elective. practice-based learning and improvement. as well as the specific objectives for each individual rotation or elective. • Neurology residents receive regular formal and informal feedback that is both quantitative and qualitative. and systems-based practice. interpersonal and communication skills. • Specific Neurology Core Competencies have been developed by the ABPN and are included in this syllabus. chart review. • The Program Director meets semi-annually with each resident to review progress and to discuss career planning. These evaluation instruments are described elsewhere in this syllabus. The program director reviews each resident’s performance on this examination at the June evaluation and feedback meeting. and resident portfolio. and is filed in the resident’s evaluation folder. 142 . Written documentation of each individual feedback meeting is filed in each resident’s performance folder. Written evaluations are also obtained on each resident in the outpatient firm and the faculty practice clinic experience (for PGY-4's). The faculty member meets with each resident following each rotation to discuss the evaluation with the resident. The completed evaluation is then sent to the program director for review. medical knowledge.Department of Neurology Policy on Evaluation and Promotion of Residents The following is the Department of Neurology policy on Evaluation and Promotion of Residents: • The evaluation system for neurology residents is designed to assess educational outcomes in all six of the ACGME core competencies: patient care. Advancement is contingent upon meeting the specific objectives for each year of training.

• The Department Chair meets with each resident at least annually to review progress and to provide career planning. will be given a program of remediation. based upon not meeting the specific objectives noted above.• A resident who is deemed unqualified to advance to the next year of training. 143 . If remediation is unsuccessful in the allotted period of time. the resident may be asked to repeat the year.

• A Department of Neurology Education Retreat is held biennially to discuss specific aspects of the residency program. The program director and chair then review these written evaluations. The chair meets at least yearly with each faculty member to discuss this feedback. • The residency steering committee. The neurology residents select the resident members on this committee. meets monthly to discuss the residency program. All clinical faculty members and residents attend this retreat. and the report is distributed to all clinical faculty and residents and discussed at a meeting of the neurology residency steering committee as well as at a general faculty meeting. electives. • The program director meets monthly with all residents to discuss program structure. These questionnaires are structured to provide feedback regarding clinical rotations. The results are collated and summarized in a written report. and the program director. 144 . Faculty members receiving poor feedback as to their teaching methods are given specific suggestions for improvement. Minutes from these meetings are distributed to all residents and faculty members. Formal minutes are taken and distributed to all clinical faculty members and residents. • Residents and faculty complete two separate on-line questionnaires regarding the residency program at the end of each academic year. four residents. consisting of four clinical faculty.Department of Neurology Policy on Evaluation of Faculty and the Residency Program • Faculty members are regularly evaluated in writing by all residents following each rotation. This committee reviews the structure of the residency program on a regular basis and suggests changes in program structure. based on feedback from the residents and faculty. teaching conferences and suggestions for change.

• No resident may work more than 24 consecutive hours involved in direct patient care. • Combined night-call duty may not occur more frequently than an average of every third night. • Each resident must have at least 10 hours off between shifts. Please keep the following points in mind when considering moonlighting: • Moonlighting is not allowed for first year neurology residents. 145 . • Resident working hours are monitored by the GME Office. • When residency responsibility and moonlighting activities are combined. Neurology residents who wish to engage in outside activities (moonlighting): • Are required to have written approval from the Neurology Department Chair and Program Director • Should seek written assurance of malpractice and workers’ compensation coverage from any outside employer • Must have a valid New York State medical license and Federal DEA number. the following conditions must be met: • Residents must spend at least 1 full day out of 7 away from clinical work. • Total working hours per week may not exceed an average of 80 hours. The number of hours devoted to moonlighting activities must be added to the training program work hours and must be reported on the GME office work hours survey. • Residents should be aware that University of Rochester malpractice insurance does not cover moonlighting activities.Department of Neurology Policy on Moonlighting Professional activities outside the neurology training program are prohibited to the extent that they may interfere with training program responsibilities. Prior to seeking such employment.

etc. etc. (Use it or lose it!) • If the resident is presenting a paper at a scientific meeting. 146 . tuning fork. stethoscope.Department of Neurology Policy on Support for Resident Travel to Scientific Meetings • The Department of Neurology will provide up to $500 annually for each Neurology Resident to cover travel expenses to an approved scientific meeting or to purchase medical textbooks. • Neurology educational meetings: registration fees and travel. iPads. Written documentation of such coverage must be approved by the Program Director. non-medical supplies. the appropriate departmental unit will provide support for any travel expenses exceeding the $500 provided by the Department of Neurology. • Medical equipment: reflex hammer. • This stipend expires at the end of each academic year and cannot be carried over into the next academic year. • It is the resident's responsibility to arrange for resident coverage for any clinical responsibilities while he/she is away from the Medical Center. • Examples of unallowable expenses include: iPhones. e-books. up to a maximum of $1000. journals. Nooks. Allowable expenses include: • Neurology related textbooks.

• The Committee meets monthly. • Four (4) clinical neurology faculty. • The Committee is chaired by the program director.Department of Neurology Residency Steering Committee • The Department of Neurology Residency Steering Committee is an advisory committee of the Department that reviews the structure of the residency program on a regular basis and suggests changes in program structure. The neurology residents select the resident members on this committee. • The residency program coordinator provides administrative support to the committee and takes minutes. usually on the third Thursday of each month. • Minutes from committee meetings are distributed to all residents and clinical faculty members. at 4:00 pm in the Garvey Room. • Committee membership: • Four (4) neurology residents. at least one from each year of training. selected by the faculty. based on feedback from the residents and faculty. 147 . • The Chair and Vice Chair of Neurology are ex officio members of the Committee.

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. Butterworth Heinemann. 1996 151 .) Oxford University Press. Williams & Wilkins. Miller NR. 2009. 4th ed. Fishman RA. WB Matthews ed. USA.). 2003 Neurology of AIDS 41. Martin Dunitz. Escourolle and Poirier Manual of Basic Neuropathology (4th ed. Oxford University Press. Leibel SA. 2003 32.. and Rao S. Wijdicks EFM. Neuropsychiatry. De Girolami U. Intracranial Tumors.).). Gutin PH. 2008. Schiffer R. Diagnosis and Treatment. Oxford University Press. The Neurology of Eye Movements. 2nd ed. 2nd ed. Neurologic Complications of Cancer (2nd ed. Kerrison JB. Harrison M and McArthur J.. 1995. 2006. 1991 Neuro-Critical Care 31. Lippincott Williams & Wilkins. Neuropathology 38. Biousse V. Churchill Livingstone. Wijdicks EFM. Catastrophic Neurologic Disorders in the Emergency Department (2nd ed.30. Gray F.). 1995 Neuropsychiatry 42. The Clinical Practice of Critical Care Neurology (2nd ed. Williams & Wilkins. Newman NJ. McAlpine. Baltimore. Mosby. Baltimore. 37. and Poirier J. 2004 39. Walsh and Hoyt’s Clinical NeuroOphthalmology : The Essentials. Brooke M. WB Saunders. Posner JB. 35.. DeAngelis LM. Neuroradiology: The Requisites (2nd ed. Churchill Livingstone.). New York. 1986 Neuro-Oncology 34. Cerebrospinal Fluid in Diseases of the Nervous System (2nd ed. A Clinicians View of Neuromuscular Diseases. 2004 Neuromuscular Disorders 33. Yousem DM. AIDS and Neurology. New York . Leigh J and Zee D. Fogel B. Grossman RI. Oxford University Press. Multiple Sclerosis. Posner JB. New York. Neuro-Ophthalmology 36. DeAngelis LM. 1980 Neuroradiology 40.

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MD Epilepsy Unit: Michel Berg. PhD Gary Paige. MD Frederick Marshall. MD. MD Gretchen Birbeck. PhD Robert G. Józefowicz. MPH Michelle Burack. PhD Jennifer Kwon. MD. MD Robert Gross. MD Gary Myers. Holloway. MD David Wang. MD Sleep Disorders Center Lynn Liu. MD David Herrmann. MD. MD Nimish Mohile. MD Vladan Radovic. MD Neuro-oncology Unit: Adilia Hormigo. PhD Inna Hughes. MD Eric Logigian. MD Robert C. PhD Kevin Biglan. MD Rochester General Hospital: Refat Assad. Józefowicz. MD Michael Stanton. MD General Neurology Unit: Daniel Britton. MD Harris Gelbard. MD Todd Holmquist. MD Jonathan Mink. MD Neuro-ophthalmology Unit: Charles Duffy. PhD 153 . MD Davender Khera. PhD Mark Mapstone. MD. MD. MD Stroke Unit: Curtis Benesch. MD. MD Richard Moxley. PhD John Langfitt. MD. MD Olga Selioutski. MD. PhD Pediatric Neurology Unit: Erika Augustine. PhD Giuseppe Erba. MD. PhD Curtis Benesch. MD St. MD Adam Kelly. MD Michael Chilungu. Mary's Brain Injury Unit: Mary Dombovy. PhD Lynn Liu. MD. MD Michael Yurcheshen. MD Jonathan Marcus. MD Emma Ciafaloni. MD Lawrence Samkoff. MD. MD Neuromuscular Disease Unit: Amy Chen. MD Ralph F. MD Jeffrey Burdett. MD Bogachan Sahin. MD. MD Robert Gross.DEPARTMENT OF NEUROLOGY CLINICAL FACULTY Administration: Robert G. MD Jonathan Mink. MD Anthony Maroldo. MD Michael Chilungu. PhD Fred Marshall. MD Interim Chair Vice-Chair Associate Chair for Educational Programs Associate Chair for Academic Affairs Associate Chair for Clinical Affairs Associate Chair for Basic Research Associate Chair for Clinical Research Cognitive and Behavioral Neurology Unit: Charles Duffy. MD James Fessler. MD James Burchfiel. PhD Jennifer Mulbury. MD. MD Neuroimmunology Unit: Matthew Bellizzi. MD Rabi Tawil. MD HIV Unit: Giovanni Schifitto. MPH Jeffrey Burdett. MD. PhD Irene Richard. PhD Su Kanchana. MD Marc Halterman. PhD Kevin Biglan. Holloway. MD Charles Thornton. MPH Gerald Honch. MD Marc Schieber. MD. MD. MD. MD. MD. DO Robert Stone. PhD Ralph F. DO Thomas Wychowski. MPH Jonathan Mink. MD Marc Halterman. MD. Griggs. MD Chad Heatwole. PhD Andrew Goodman. MD Megan Hyland. MD Alex Paciorkowski. MD Raissa Villanueva. MD Movement Disorders Unit: Richard Barbano. MD. PhD Laurie Seltzer.

Jaclyn Martindale Amy Catalfamo SEC-IP AMB SMH SMH 154 RGH HH SMH RGH SMH AMB URG AMB NF SMH SMH AMB SMH AMB 1/6-1/19 1/20-2/2 2/3-2/16 NF MVT NNICU NNICU NF SMH URG SMH NF VAC HH NNICU VAC AMB 5/12-5/26 URG NNICU EEG NNICU 4/28-5/11 EEG VAC AMB 6/23-6/30 6/9-6/22 5/27-6/8 4/14-4/27 3/31-4/13 NF NNICU 3/17-3/30 URG 3/3-3/16 HA RGH SECOP NF URG SMH URG SMH SECOP NF SMH VAC SEC URG 12/23-1/5 URG VAC SMH NF URG SMH VAC HH AMB 12/9-12/22 AMB NF SMH NF 11/25-12/8 VAC URG 2/17-3/2 11/11-11/24 NF RGH NMD NF VAC VAC HH NNICU NF NF VAC SMH URG URG URG SMH URG 10/28-11/10 10/14-10/27 9/30-10/13 9/16-9/29 9/3-9/15 8/19-9/2 8/5-8/18 7/22-8/4 7/1-7/21 URG SEC NMD NNICU HH URG SMH AMB SEC NNICU HH NF SMH SMH NF URG VAC AMB EEG SMH VAC NNICU NF URG NNICU VAC NF AMB AMB SEC-IP VAC RGH NF NMD SEC URG SMH NF RGH RGH URG SMH NMD SMH MVT MVT SEC HH VAC SMH SMH SMH NF Peter Morrison SEC URG RGH AMB Lauren Loss HH NNICU Justin Chandler EMG SMH NMD Johanna Hamel AMB Christopher Tarolli AMB NMD Resident Name VAC Peter Creigh RES 1st YEAR NEUROLOGY RESIDENT SCHEDULE 2013 – 2014 .

AMB = Ambulatory Subspecialty Clinics at SMH EEG = Basic EEG HA = Headache Elective HH = Highland Hospital MVT = Movement Disorders Elective NF = Night Float Rotation NMD = Neuromuscular Disease NNICU = Neuroscience ICU RES = Research RGH = Rochester General Hospital SEC = Strong Epilepsy Center SMH = Strong Memorial Hospital Neurology Inpatient Service URG = Urgent Care/Evening Float VAC = Vacation 155 .

2014 GEN NMD .Trenton Tollefson PEDS-OP PSYCH GEN 156 VAC GEN GEN PSYCH STROKE PEDS STROKE PEDS-OP VAC NPATH VAC PEDS PEDS GEN STROKE SLEEP 12/9-12/22 12/23-1/5 1/6-1/19 BEH PEDS PEDS-OP VAC PEDS PEDS VAC STROKE GEN PEDS PEDS-OP VAC STROKE 6/23-6/30 6/9-6/22 4/28-5/11 5/27-6/8 4/14-4/27 3/31-4/13 3/17-3/30 5/12-5/26 STROKE PEDS 3/3-3/16 VAC STROKE NRAD EEG PEDS-OP 2/17-3/2 PEDS-OP 2/3-2/16 1/20-2/2 10/28-11/10 PEDS GEN EEG GEN PEDS PSYCH PALL 11/25-12/8 NI NONC PEDS-OP GEN NNICU PEDS VAC STROKE PEDS-OP PEDS N-OPHTH 11/11-11/24 PSYCH 10/14-10/27 GEN STROKE PEDS VAC STROKE PEDS PEDS PEDS-OP 9/16-9/29 VAC 9/30-10/13 9/3-9/15 8/19-9/2 8/5-8/18 7/22-8/4 7/1-7/21 URG NF STROKE PSYCH GEN NRAD PEDS-OP PEDS PEDS STROKE NF PEDS GEN NF URG GEN URG Anthony Noto NF Anjali BoseKolanu URG NF STROKE EEG NONC URG Resident Name STROKE Fulvio Roberto Gil STROKE GEN MVT Andrew Smith III NF 2nd YEAR NEUROLOGY RESIDENT SCHEDULE 2013 .

BEH = Behavioral Neurology EEG = Basic EEG GEN = General Neurology Consult MVT = Movement NF = Night Float Rotation NNICU = Neuroscience ICU NONC = Neuro-oncology PALL = Palliative Care PEDS = Pediatric Neurology Service PSYCH = Psych NPATH = Neuropathology NRAD = Neuroradiology RES = Research SLEEP = Sleep STROKE = Stroke Consultation Service URG = Urgent Care/Evening Float VAC = Vacation NI = Neuroimmunology 157 .


* Chief Resident Schedule during MBB course: 8/26-9/2 9/3-9/15 9/16-9/22 9/23-10/6 10/7-10/13 10/14-10/27 AMB = Ambulatory Subspecialty Clinics at SMH CHF = Chief Resident EEG = Advanced Neurophysiology EMG = EMG/Neuromuscular Rotation HA = Headache Elective MBB = Mind. Brain and Behavior Medical Student Course MVT = Movement disorders NI = Neuroimmunology NNICU = Neuroscience ICU N-OPHTH = Neuro-ophthalmology Schneider Kulik Hilmarsson Huffer Meyers Muhlhofer NPATH = Neuropathology NRAD = Neuroradiology N-REHAB = Neurorehabilitation PAIN = Pain management PALL = Palliative Care POLAND = Teaching elective. Kraków. Poland PR PRAC = Private Practice RES = Research SLEEP = Sleep Disorders ** Maternity leave: 9/23/13 – 11/3/13 159 .

Poland PR PRAC = Private Practice PSYCH = Child Psychiatry RES = Research VAC = Vacation 160 VAC MBB Marina Rubin 4 N-OPHTH NPATH 4 VAC OUTPT 4 OUTPT INPT 4 NRAD MBB 6/9-6/30 NMD INPT Erika Wexler 5/12-6/8 GENT 4 4/14-5/11 HA 4 3/17-4/13 OUTPT 4 2/17-3/16 HA 9 1/20-2/16 VAC 4 8/26-10/27 10/28-11/24 11/25-12/22 12/23-1/19 NPATH 4 VAC (# of weeks) OUTPT 7/29-8/25 BOSTON 7/1-7/28 OUTPT VAC Resident Name NMD GENT .3rd YEAR CHILD NEUROLOGY RESIDENT SCHEDULE (PGY-5) 2013 – 2014 OUTPT EEG = EEG/Advanced Neurophysiology GENT = Genetics HA = Headache Elective INPT = Inpatient Child Neurology OUTPT = Outpatient Child Neurology MBB = Mind. Kraków. Brain and Behavior Medical Student Course NMD = Neuromuscular Disease N-OPHTH = Neuro-Ophthalmology VAC EEG PR PRAC NYC INPT 4 3 PSYCH PSYCH RES POLAND POLAND NPATH = Neuropathology NRAD = Neuroradiology POLAND = Teaching elective.

NEUROLOGY RESIDENT VACATION SCHEDULE 2013-2014 1st Year Residents Name Amy Catalfamo Vacation dates 11/25/13 – 12/18/13 4/28/14 – 5/11/14 # of Weeks 2 2 Justin Chandler 7/22/13 – 8/4/13 2/3/14 – 2/16/14 2 2 Peter Creigh 10/14/13 – 10/27/13 2/17/14 – 3/2/14 2 2 Johanna Hamel 12/23/13 – 1/5/14 4/14/14 – 4/27/14 2 2 Lauren Loss 11/11/13 – 11/24/13 5/27/14 – 6/8/14 2 2 Jaclyn Martindale 12/9/13 – 12/22/13 3/31/14 – 4/13/14 2 2 Peter Morrison 9/30/13 – 10/13/13 3/3/14 – 3/16/14 2 2 Christopher Tarolli 11/25/13 – 12/8/13 6/9/14 – 6/22/14 2 2 2nd Year Residents Name Anjali Bose-Kolanu Vacation dates 1/20/14 – 2/2/14 5/12/14 – 5/26/14 # of Weeks 2 2 Fulvio Roberto Gil 12/23/13 – 1/5/14 4/28/14 – 5/11/14 2 2 Anthony Noto 11/11/13 – 11/24/13 6/9/14 – 6/22/14 2 2 Andrew Smith III 9/16/13 – 9/29/13 3/3/14 – 3/16/14 2 2 Trenton Tollefson 12/9/13 – 12/22/13 5/27/14 – 6/8/14 2 2 161 .

NEUROLOGY RESIDENT VACATION SCHEDULE 2013-2014 3rd Year Residents Name Agust Hilmarsson Vacation dates 1/20/14 – 1/26/14 3/10/14 – 3/16/14 6/2/14 – 6/15/14 # of Weeks 1 1 2 Andrew Huffer 7/15/13 – 7/21/13 8/19/13 – 8/25/13 12/23/13 – 12/29/13 3/24/14 – 3/30/14 1 1 1 1 Tobias Kulik 8/5/13 – 8/11/13 2/10/14 – 2/16/14 3/3/14 – 3/9/14 6/2/14 – 6/8/14 1 1 1 1 Clifford Meyers 7/22/13 – 7/28/13 2/10/14 – 2/16/14 4/28/14 – 5/4/14 6/2/14 – 6/8/14 1 1 1 1 Wolfgang Muhlhofer 9/2/13 – 9/8/13 12/23/16 – 1/5/14 4/28/14 – 5/4/14 1 2 1 Ruth Schneider 11/4/13 – 11/17/13 1/20/14 – 1/26/14 6/16/14 – 6/22/14 2 1 1 Child Neurology Residents Name Marina Rubin Vacation dates 8/12/13 – 8/25/13 1/13/14 – 1/19/14 4/28/14 – 5/4/14 Erika Wexler 7/8/13 – 7/14/13 1/20/14 – 1/26/14 6/2/14 – 6/15/14 162 # of Weeks 2 1 1 1 1 2 .

DEPARTMENT OF NEUROLOGY UNIVERSITY OF ROCHESTER FIRM ASSIGNMENTS FOR 2013-2014 FIRM Monday ATTENDINGS Irene Richard Davender Khera RESIDENTS Agust Hilmarsson Anjali Bose-Kolanu Justin Chandler Katherine Amodeo YEAR PGY 4 PGY 3 PGY 2 PGY 1 Tuesday Gerald Honch Larry Samkoff Andrew Huffer Andrew Smith Peter Creigh Jennifer Choudri PGY 4 PGY 3 PGY 2 PGY 1 Wednesday Anthony Maroldo Robert Holloway Tobias Kulik Fulvio Roberto Gil Johanna Hamel Jenie George PGY 4 PGY 3 PGY 2 PGY 1 Thursday Andrew Goodman Megan Hyland Wolfgang Muhlhofer Anthony Noto Lauren Loss Elliot Johnson PGY 4 PGY 3 PGY 2 PGY 1 Friday A Ralph Józefowicz Richard Beresford Ruth Schneider Trenton Tollefson Peter Morrison Jorge Risco PGY 4 PGY 3 PGY 2 PGY 1 Friday B Giovanni Schifitto Karen Odrzywolski Clifford Meyers Christopher Tarolli Neal Weisbrod PGY 4 PGY 2 PGY 1 163 .

The Firm takes precedence over a subspecialty clinic.DEPARTMENT OF NEUROLOGY UNIVERSITY OF ROCHESTER AMBULATORY BLOCK ROTATION FOR FIRST YEAR RESIDENTS 2013-2014 AM MONDAY Epilepsy Clinic* TUESDAY MS Clinic WEDNESDAY Neuromuscular Clinic THURSDAY Movement Clinic * PM Epilepsy Clinic* Stroke Clinic Neuromuscular Clinic Movement Clinic * FRIDAY Grand Rounds * 919 Westfall Road • First year residents also have a weekly afternoon Firm. NEUROLOGY FIRST YEAR RESIDENT FIRMS MONDAY Justin Chandler TUESDAY Peter Creigh WEDNESDAY Johanna Hamel 164 THURSDAY Lauren Loss FRIDAY Peter Morrison Christopher Tarolli . The Firm assignments are listed below.

Third year residents have a weekly afternoon Firm and a weekly afternoon Faculty Practice or subspecialty clinic. The acting chief resident has no Faculty Practice or Subspecialty Clinics. 2655 Ridgeway Avenue All clinics occur in the afternoon and are located in the SMH neurology OPD unless indicated otherwise. Brain and Behavior Course (8/26/13 – 10/25/13). The Resident Firm takes precedence over all Faculty Practice or Subspecialty Clinics. These clinics are listed below.DEPARTMENT OF NEUROLOGY UNIVERSITY OF ROCHESTER AMBULATORY BLOCK ROTATION FOR THIRD YEAR RESIDENTS 2013-2014 AM PM MONDAY Epilepsy Clinic* TUESDAY Stroke Clinic WEDNESDAY Neuromuscular Clinic THURSDAY Movement Clinic * FRIDAY Grand Rounds Headache Clinic** Dementia Clinic Khera* MS Clinic Neuro-oncology Clinic Villanueva* Józefowicz* Movement Clinic * MS Clinic Barbano* Maroldo* PM FPC FPC=Faculty Practice Clinic • • • * 919 Westfall Road **Unity Neurology. 2655 Ridgeway Avenue 165 Mo Mo We Mo Muhlhofer Khera Dementia NMD Epilepsy Th Tu Mo We Schneider Movement Villanueva Dementia Neuro-Onc . including during the Mind. NEUROLOGY THIRD YEAR RESIDENT FIRMS MONDAY Agust Hilmarsson TUESDAY Andrew Huffer WEDNESDAY Tobias Kulik THURSDAY Wolfgang Muhlhofer FRIDAY Ruth Schneider Clifford Meyers NEUROLOGY THIRD YEAR RESIDENT FACULTY PRACTICE/SUBSPECIALTY CLINIC SCHEDULE JUL-SEP OCT-DEC JAN-MAR APR-JUN We We We Th Hilmarsson Huffer Kulik Meyers Józefowicz Mo Epilepsy Tu Stroke We NMD NMD Th Barbano Mo Epilepsy Th Movement Neuro-Onc Th Movement Mo Khera Mo Epilepsy Movement Mo Headache Mo MS Mo Khera *919 Westfall Road ** Unity Neurology.

the block is split into two equal weeks.Department of Neurology 2013–2014 SMH. with each week beginning on a Monday. July 8 – July 21 Holloway Halterman Gross 166 RGH Blue Chen Selioutski Barbano Chen Chilungu Selioutski Chilungu TBD Chilungu TBD Chilungu TBD Chilungu TBD Chilungu TBD Chilungu Halterman Chilungu Samkoff Chilungu TBD Chilungu Chilungu TBD Chilungu TBD Chilungu TBD Chilungu TBD Chilungu TBD TBD Chilungu TBD Chilungu Burdett Chilungu TBD Chilungu TBD Chilungu TBD TBD Burdett . Highland and RGH Attending Schedules Dates* SMH General Consults SMH Inpatient Red SMH Inpatient Blue Citywide Stroke SMH Child Highland RGH Red Holmquist Richard Stone Burdett Sahin Kelly Benesch Maroldo July 22 – Aug 4 Heatwole Samkoff Chilungu Kwon Assad Kelly Burack Schifitto Augustine Stanton Aug 5 – Aug 18 Józefowicz Liu Bellizzi Burdett Holloway Wang Burack Holmquist Augustine Khera Assad Aug 19 – Sept 2 Logigian Hormigo Statland Sahin Wang Robb Burdett Kelly Maroldo Assad Sept 3 – Sept 15 Tawil Barbano Biglan Mulbury Benesch Burack Burdett Holmquist Schifitto Assad Sept 16 – Sept 29 Liu Mohile TBD Myers Benesch Kelly Burdett Holmquist Hormigo Sept 30 – Oct 13 Berg Stanton Heatwole Gelbard Assad Sahin Khera Kelly Mohile Burack Oct 14 – Oct 27 Richard Statland Burdett Augustine Sahin Selioutski Samkoff Benesch Marcus Burack Oct 28 – Nov 10 Hyland Holmquist Chen Tomaselli Kelly Khera Burdett Sahin Maroldo Holloway Nov 11 – Nov 24 Gross Benesch Assad Paciorkowski Holmquist Richard Chen Sahin Robb Nov 25 – Dec 8 Thornton Marshall TBD Mulbury Burdett Holmquist Kelly Sahin Stanton Assad Dec 9 – Dec 22 Griggs Herrmann Fessler Stone Benesch Kelly TBD Holmquist Juersivich Dec 23 – Jan 5 Bellizzi Tawil Samkoff Hughes Assad Benesch Józefowicz Kelly Hyland Jan 6 – Jan 19 Marshall Yurcheshen Wychowski Wang Burdett Sahin Juersivich Benesch Józefowicz Assad Jan 20 – Feb 2 Fessler Ciafaloni Mohile Mink Holmquist Holloway Burdett Sahin Hyland Assad Feb 3 – Feb 16 Goodman Berg Maroldo Kwon Schifitto Khera Burdett Holmquist Wychowski Assad Feb 17 – Mar 2 Barbano Józefowicz Marcus Paciorkowski Sahin Khera Burdett Benesch Kelly Burdett Mar 3 – Mar 16 Mohile Chen Hormigo Augustine Sahin Richard Assad Kelly Maroldo Assad Mar 17 – Mar 30 Gross Hyland Juersivich Mulbury Sahin Hormigo Burdett Holmquist Stanton Assad Mar 31 – Apr 13 Heatwole Richard Robb Mink Holloway Kelly Benesch Sahin Maroldo Barbano Apr 14 – Apr 27 Duffy Burdett Assad Seltzer Kelly Wychowski Chen Holmquist Burack Benesch Apr 28 – May 11 Hormigo Logigian Villanueva Myers Sahin Stanton Assad Benesch Marcus Assad May 12 – May 26 Biglan Duffy Khera Kwon Kelly Mohile Burdett Benesch Khera Assad May 27 – June 8 Ciafaloni Thornton Stanton Stone Sahin Maroldo Burdett Benesch Schifitto Assad June 9 – June 22 Herrmann Goodman Tawil Wang Holmquist Holloway Burdett Benesch Selioutski June 23 – July 6 Logigian Griggs Chilungu Mink Assad Sahin Richard *When two names are listed in a block.

Child Neurology Weekend Coverage 2013-2014 Date Attending Resident Date Attending Resident July January 7/6-7/7 Mink Rubin 1/4-1/5 Hughes 7/13-7/14 Stone Wexler 1/11-1/12 Wang Gil 7/20-7/21 Stone Rubin 1/18-1/19 Wang 7/27-7/28 Kwon 1/25-1/26 Mink Tollefson August February 8/3-8/4 Kwon Wexler 2/1-2/2 Mink 8/10-8/11 Augustine Rubin 2/8-2/9 Kwon Bose-Kolanu 8/17-8/18 Wang Wexler 2/15-2/16 Kwon Wexler 8/24-8/25 Augustine Bose-Kolanu 2/22-2/23 Paciorkowski Noto March 8/31-9/1 Wang September 3/1-3/2 Paciorkowski 9/7-9/8 Mulbury Gil 3/8-3/9 Augustine Noto 9/14-9/15 Mulbury 3/15-3/16 Augustine 9/21-9/22 Myers Gil 3/22-3/23 Mulbury Tollefson 9/28-9/29 Myers Rubin 3/29-3/30 Mulbury October April 10/5-10/6 Gelbard Noto 4/5-4/6 Mink Tollefson 10/12-10/13 Gelbard Rubin 4/12-4/13 Mink 10/19-10/20 Augustine Bose-Kolanu 4/19-4/20 Seltzer Smith 10/26-10/27 Augustine Wexler 4/26-4/27 Seltzer November May 11/2-11/3 Tomaselli 5/34-5/4 Myers Smith 11/9-11/10 Tomaselli Wexler 5/10-5/11 Myers 11/16-11/17 Paciorkowski Rubin 5/178-5/18 Kwon Noto 11/23-11/24 Paciorkowski Wexler 5/24-5/25 Kwon 11/30-12/1 Mulbury Tollefson 5/31-6/1 Stone Smith December June 12/7-12/8 Mulbury 6/7-6/8 Stone 12/14-12/15 Stone Wexler 6/14-6/15 Wang Gil 12/21-12/22 Stone Bose-Kolanu 6/21-6/22 Wang 12/28-12/29 Hughes Smith 6/28-6/29 Mink * denotes being on inpatient call on weekends when you are otherwise on outpatient 167 .

Department of Neurology Residency Program Important Dates for 2013-2014 Department Retreat Department Winter Ball RITE Clinical Skills Examination Friday. 2014 Saturday. March 22. June 21. 2014 2013-2014 Neurology Chief Resident Responsibilities Grand Rounds Journal Club Noon Conferences and lunches Block schedules On-call schedules Clinic liaison SIGN liaison Social Chair Tobias Kulik Ruth Schneider Agust Hilmarsson Andrew Huffer Clifford Meyers Andrew Huffer Wolfgang Muhlhofer Wolfgang Muhlhofer 2013-2014 Neurology Resident Committee Assignments Residency Selection Committee Clerkship Grading Committee GMEC representative Ruth Schneider Wolfgang Muhlhofer Agust Hilmarsson 168 . 2014 Saturday. June 20. November 22. January 25. March 1. March 29. 2014 Resident & Fellow Poster Session Friday. 2014 Saturday. 2014 Resident Graduation Saturday. 2013 Saturday.