PEDIATRIC NEUROLOGY HOSPITAL ROTATION



LSUHSC PEDIATRIC NEUROLOGY ROTATION

Description of Rotation:

This is a one month rotation for a total of three months. These rotations will take place

during the PGY 2 –PGY 4 year. Beeper Call will occur during this rotation. The rotation

will consist of hospital inpatient setting, and outpatient clinics.

Consultation services will include the emergency room, pediatric critical care unit and the

in- patient care unit. Residents are responsible for consultations in rotational bases

with other residents from Pediatrics, Tulane Adult Neurology and Pediatric Neurology

Fellow.

Residents will not attend longitudinal clinic during these months.

Educational Purpose/Goals:

1. To gain experience in the recognition, diagnosis, treatment, and management of acute neurological disorders in newborns, infants, children, and adolescents.

2. To assume progressive responsibility in the care of neurological patients.

3. To provide bedside education instruction to the pediatric residents, as well medical students on the rotation.

4. To provide consultation services to other health care services.

Assessment Summary:

The objectives (below) will be evaluated through a number of measures (tools) which are reviewed in the preceding section (General Competencies) above.

By the end of the rotation, the resident should receive and/or complete the following assessments:

1. Verbal feedback from preceptors/attending staff

2. Global written assessments

3. One(1) NEX evaluation per pediatric staff in rotations block # 2 or 3

Orientation:

Orientation occurs on day 1 of the rotation. Expectations, duties, goals and objectives of the rotation are discussed.

Supervision:

Residents are supervised by the precepting attending child neurologist and pediatric neurology fellows. All cases, including management plans, must be reviewed with the preceptor.

Literature:

• Clinical Pediatric Neurology, Fenichel

• A collection of essential articles will be provided at the beginning of the rotation

Objectives for Pediatric Neurology Rotation #1

Patient Care:

Residents will be able to provide patient care that is compassionate, appropriate and effective for the treatment of neurological health problems and the promotion of health in newborns, infant, children and adolescents.

Competency: Gathering Information - Gather essential and accurate information about the patient.

Knowledge/Skills:

• Perform a comprehensive history, including a chief complaint, history of the present illness, past medical and surgical history, family and social history and a complete review of systems.

• Obtain detailed information regarding birth and developmental history as age appropriate.

• Demonstrate knowledge of how to access adjunctive sources of information to the history obtained from the family (e.g. chart)

• Perform a fundamental pediatric neurological examination.

• Convey an appreciation for the opportunity to be involved in the care of the patient.

Tools used for assessment

Global evaluation

Medical Knowledge:

Residents must demonstrate knowledge about established and evolving biomedical, clinical, and cognate (e.g. epidemiological and social-behavioral) sciences and how to apply this knowledge to patient care.

Competency: Acquisition – learn about the pathophysiology, biochemistry, genetics, and clinical presentation of the patient’s neurological disorder

Knowledge/Skills:

• Recognize and interpret abnormal neurological findings

• Utilize medical references, journal articles, and information technology to learn about the pathophysiology, biochemistry, genetics and clinical features of the patient’s neurological condition and generate a differential diagnosis.

• Use evidence-based medicine and accepted medical guidelines to help inform medical decision making

Tools used for assessment

In-service examination

Practice-Based Learning and Improvement

Residents must be able to investigate and evaluate their patient care practices, appraise and assimilate scientific evidence, and improve their patient care practices.

Competency: Life-long learning

Knowledge/Skills:

• Utilize outside resources, including the internet, medical textbooks, and journals, to increase knowledge base in dealing directly with patient care encounters

• Independently draw upon clinical resources in order to formulate differential diagnoses and management plans

• Incorporate feedback from staff and consultant physicians during the rotation to improve work performance

Competency: Evidence based medicine

Knowledge/Skills:

• Wherever possible evidence based medicine should be used in basing medical treatment decisions

• Utilize accepted standards of practice or recognized guidelines in informing practice management

Tools used for assessment

Global assessment

Case conference

Interpersonal and Communication Skills:

Residents must be able to demonstrate interpersonal and communication skills that result in effective information exchange and teaming with patients, their patients families, and professional associates.

Competency: Communication with patients and families

Knowledge/Skills:

• Establish effective rapport and communication with patients and their families

• Learn to interpret and address non-verbal communication presented by patients and/or their families

• Accurately describe and explain procedures and management plan to patients and/or caregivers in a language that is appropriate to their education

• Understand and respect religious and ethnical differences in your patient/families in your communications with them

• Understand privacy issues in communications when dealing with a minor

Competency: Communication with team members

Knowledge/Skills:

• Impart knowledge and educate medical students

• Formulation and clear communication of consultation questions to consultative service

• Discuss consultation findings with members of the team and family

• Integrate information from various team members and consultants into an effective care plan

Tools used for assessment

Global evaluation

Professionalism:

Residents must demonstrate a commitment to carrying out professional responsibilities, adherence to ethical principles, and sensitivity to a diverse patient population.

Competency: Professional behavior

Knowledge/Skills:

• Demonstrate respect, compassion, and integrity in their interaction with patients and their families

• Be responsive and respectful to the needs of the patients

• Consistently use compassion and empathy in one's role as a physician

• Practice evidence based medicine whenever possible and be familiar with best practice parameters and guidelines from professional societies such as the AAN, CNS, AAP, AES, etc.

• Recognize and respond to personal stress and fatigue that might interfere with professional duties

Competency: Ethical behavior

Knowledge/Skills:

• Demonstrate a commitment to ethical principles pertaining to the provision or withholding of clinical care, confidentiality of patient information, and informed consent

• Maintain professional boundaries in one's dealings with patients, family, staff, and

professional colleagues

• Demonstrate respect for patient confidentiality and privacy regulations and be aware of HIPAA guidelines

Tools used for assessment

Global evaluation

System-based Practice:

Residents must demonstrate and awareness of and responsiveness to the larger context of and system of health care and the ability to effectively call on system resources to provide care that is of optimal value.

Competency: Health care delivery system

Knowledge/Skills:

• Work with health care and case managers on the ward to assess, coordinate, and improve patient care, consistently advocating for high quality

• Be familiar with special care programs available such as palliative care, home care, early intervention programs etc.

Competency: Cost effective practice

Knowledge/Skills:

• Practice cost-effective health care and resource allocation that does not compromise quality of care

• Be familiar with generic alternatives with respect to cost and efficacy

Goals for Pediatric Neurology Rotation #2

Patient Care:

Competency: Synthesis - Make informed diagnostic and therapeutic decisions based on patient information, current scientific evidence, clinical judgment, and patient preference.

Knowledge/Skills:

• Formulate and prioritize a differential diagnosis based on patient information and/or current scientific evidence and/or sound clinical judgment.

• Determine and implement appropriate tests and/or procedures in evaluation of the neurological problem

• Recognize limitations of the level of training and seek help appropriately.

• Identify and utilize subspecialty support appropriately

Tools used for assessment:

Global evaluations

Patient survey

Medical Knowledge:

Competency: Analysis – critically review the relevance, application and appropriateness of medical information acquired

Knowledge/Skills:

• Formulate a diagnosis differential and treatment plan that meets expected standards of care for patient’s condition

Tools used for assessment:

In-service training exam

Review of treatment Plan

Practice Based Learning

Competency: Evidence based medicine

Knowledge/Skills:

• Wherever possible evidence based medicine should be used in basing medical treatment decisions

• Utilize accepted standards of practice or recognized guidelines in informing practice management

Tools used for assessment:

Case Conference

In-service examination

Interpersonal and Communication Skills:

Residents must be able to demonstrate interpersonal and communication skills that result in effective information exchange and teaming with patients, their patients families, and professional associates.

Competency: Communication with patients and families

Knowledge/Skills:

• Accurately describe and explain procedures and management plan to patients and/or caregivers in a language that is appropriate to their education

• Understand and respect religious and ethnical differences in your patient/families in your communications with them

Competency: Communication with team members

Knowledge/Skills:

• Integrate information from various team members and consultants into an effective care plan

Tools used for assessment:

Global evaluation

360 evaluations

Professionalism:

Residents must demonstrate a commitment to carrying out professional responsibilities, adherence to ethical principles, and sensitivity to a diverse patient population.

Competency: Professional behavior

• Practice evidence based medicine whenever possible and be familiar with best practice parameters and guidelines from professional societies such as the AAN, CNS, AAP, AES, etc.

• Recognize and respond to personal stress and fatigue that might interfere with professional duties

Competency: Ethical behavior

• Maintain professional boundaries in one's dealings with patients, family, staff, and

professional colleagues

Tools used to for assessment

Global evaluations

Peer evaluations

System-based Practice:

Residents must demonstrate and awareness of and responsiveness to the larger context of and system of health care and the ability to effectively call on system resources to provide care that is of optimal value

Competency: Cost effective practice

Knowledge/Skills:

• Practice cost-effective health care and resource allocation that does not compromise quality of care

• Be familiar with generic alternatives with respect to cost and efficacy

Tools used for evaluation:

Global evaluations

Case conference

Objectives for Pediatric Rotation # 3

Patient Care:

Residents will be able to provide patient care that is compassionate, appropriate and effective for the treatment of neurological health problems and the promotion of health in newborns, infant, children and adolescents.

Competency: Partnering with patients/families – Establish and carry out patient management plans; counsel patients and families.

Knowledge/Skills:

• Accurately describe and explain procedures to patients and/or caregivers in a language that is appropriate to their education

• Communicate information to other providers when necessary and appropriate.

• Communicates, answers questions and calls and provides emotional support as appropriate

Tools used for assessment

NEX evaluation

Global evaluation

Medical Knowledge:

Residents must demonstrate knowledge about established and evolving biomedical, clinical, and cognate (e.g. epidemiological and social-behavioral) sciences and how to apply this knowledge to patient care.

Competency: Application – apply acquired medical knowledge appropriately to clinical care

Knowledge/Skills:

• Generate a differential diagnosis based on acquired medical knowledge

• Use newly acquired knowledge to educate patient care team

Tools used for assessment

In-service examination

Case Conference

Pediatric Grand Rounds Presentation

Global evaluation

Practice-Based Learning and Improvement

Residents must be able to investigate and evaluate their patient care practices, appraise and assimilate scientific evidence, and improve their patient care practices.

Competency: Quality improvement

Knowledge/Skills:

• Incorporate learned knowledge and feedback into changing and improving practice management

Competency: Teaching Skills

Knowledge/Skills:

• Review educational resources and methods of access to medical information as applicable to child neurology to other members of the team

Tools used for assessment

Case conference

Global evaluation

Interpersonal and Communication Skills:

Residents must be able to demonstrate interpersonal and communication skills that result in effective information exchange and teaming with patients, their patients families, and professional associates.

Competency: Scholarly Communication

Knowledge/Skills:

• Regular presentations at pediatric neurology grand rounds

• Attendance at monthly journal club

• Participation in weekly case vignette sessions

Tools used for assessment

Case Conference

Pediatric Grand Rounds Presentation

Professionalism:

Residents must demonstrate a commitment to carrying out professional responsibilities, adherence to ethical principles, and sensitivity to a diverse patient population.

Competency: Cultural competence

Knowledge/Skills:

• Demonstrate a sensitivity and responsiveness to patients age, gender, and disabilities

System-based Practice:

Residents must demonstrate and awareness of and responsiveness to the larger context of and system of health care and the ability to effectively call on system resources to provide care that is of optimal value.

Competency: Patient safety and advocacy/Systems causes of error

Knowledge/Skills:

• Advocate for the promotion of health and the prevention of disease and injury in

populations

• Be familiar with Clinic safety policy and reporting of adverse events as documented in the policy section on the intranet home page

Tools used for assessment

Global evaluations

Case conference

Revised 6/07

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