Faculty supervisors:
- Dr. Alyssa Bautista and rotating faculty
Description:
The Adult Neurology Consultation Service at Columbia University Medical Center is a busy teaching service that accommodates trainees at many levels, including medical students, interns (psychiatry and neurology) and neurology residents of all levels [PGY-2, 3 and -4]. The service provides over 2000 neurological consultations annually to every service in the medical center, including the Emergency Department, the intensive care units, and the inpatient ward services.
PGY-2 and 3 Rotation
The education goals of the rotation for PGY-2 and 3 residents are to master history-taking and neurological examination skills, to develop neurological reasoning and problem-solving strategies, to make independent clinical formulations, to learn how to present clinical information and to develop a clinical approach to the diagnosis and management of neurological emergencies. The service makes twice daily attending rounds, 5 days a week and once daily attending rounds on the weekends and holidays.
PGY 2 and 3 residents on the consult service are expected to see their follow ups independently. Follow up visits should be documented. The PGY2 and 3 resident is responsible for communicating the plan of care with the primary team. The duration and frequency of follow up needed for each patient will be determined through discussion with the attending and senior resident on service.
Evaluation:
Performance written evaluations are provided by the Consult Attending, who receive the resident’s presentations on morning rounds using the electronic Medhub system. Verbal feedback is provided at the end of the rotation by supervising faculty..
Specific Objectives:
Patient Care
To develop further competence in obtaining the neurological history and performing the neurological examination.
To perform a focused neurological examination on the comatose patient.
To perform in-hospital consultations on patients with neurological complaints in a variety of settings, including the emergency room, intensive care units, and the in-patient services.
To develop and implement a comprehensive plan of diagnostic testing, therapeutic management and disposition for patients presenting with acute neurological conditions.
To develop and refine an approach to the evaluation and treatment of neurological emergencies, including stroke, seizure, and alterations in consciousness.
Medical Knowledge
To recognize the symptoms and signs common neurological conditions, including emergencies.
To become familiar with clinical neuroanatomy, and to use this knowledge as a basis for clinical reasoning.
To become more skilled at making a well-informed synthesis of the neurological history and exam as part of clinical problem-solving
To acquire knowledge of the pathophysiology and epidemiology of common neurological problems including stroke, epilepsy, headache, vertigo, encephalopathy and coma, acute spinal cord conditions, acute neuromuscular weakness, and the neurological complications of alcohol and drug addiction, among other conditions.
To learn the indications for appropriate neuro-diagnostic tests and the fundamentals of their interpretation.
To develop knowledge of the indications for diagnostic testing and medical procedures, including the administration of thrombolytic for acute stroke.
Interpersonal Skills and Communication
To interact and communicate effectively and compassionately with patients and family members in a professional, ethical and culturally sensitive manner.
To master skills in communicating with patients who have neurological impairment.
To develop and improve the interpersonal and communication skills, both written and oral, necessary to
- transmit an accurate neurological history and exam to other physicians,
- present cases on rounds and in conferences, and
- to provide competent counseling to patients and families.
To write a comprehensive, problem-oriented consultation note on patients admitted to the ward services overnight.
Professionalism
To demonstrate the professional habits of punctuality, responsibility, honesty, integrity, compassion, and cultural sensitivity in responding to requests for neurological consultation.
To show appropriate respect for and cultural sensitivity to patients and their families
To demonstrate an appreciation for end-of-life care and issues regarding provision or withholding of care
To serve as an effective neurological consultant, competent to admit and manage the care of patients with neurological disease while demonstrating the professional attributes of integrity, empathy, and compassion.
To be compliant with ethical and legal standards, work hour’s guidelines and the requirements of patient confidentiality.
Systems-Based Practice
To demonstrate the ability to interact with many other entities and services within the medical center, including the Departments of Emergency Medicine and Radiology, in the urgent evaluation, treatment, and admission of patients with acute neurological conditions.
To demonstrate the ability to reference and utilize electronic information systems to access medical, scientific and patient information.
To develop awareness of hospital protocols, triage guidelines and standards of practice that have an impact on the evaluation and management of patients with acute neurological problems.
To become adept at making triage decisions and urgent diagnostic and management recommendations for patients with acute neurological problems.
To develop effective time management and triage skills in responding to demands for neurological consultation.
Practice-Based Learning and Improvement
To use the medical literature, including electronic databases, in the diagnosis, management, and recommendations of patients with neurological diseases.
To become familiar with hospital information systems in the evaluation and treatment of neurological patients.
To be able to appropriately document consultations and to understand components of proper documentation.
PGY-4 Rotation
For the senior PGY-4 neurology resident, the rotation is an important step in the formation of an independent neurological consultant. The senior resident role comes with an increase in clinical responsibility, autonomy in decision-making, and leadership expectations. Although the attending neurologist assumes ultimate responsibility for patient care and management decisions, it is the senior resident who serves as team leader, responsible for the important organizational tasks of the service, including the triage of consultation requests and the timing of rounds. PGY-4 residents are expected to function as increasingly skilled and informed neurological consultants as they advance through their training.
The consultation service rotation, with its steady caseload of challenging neurological problems, is the educational experience that most closely resembles the work of a practicing consultant neurologist in the acute hospital setting. As noted, the consultation service responds to over 2000 request for consultation each year, and makes daily rounds, 7 days a week. In the evening, the senior neurology resident on service hands off the consultation pager to the senior consultation night float resident, a PGY-4 resident, [see rotation description to follow] for overnight consultations.
The PGY4 resident is also expected to assume the role of teaching medical students rotating on the service. With some exceptions, they should supervise medical student consults and provide students with feedback on their performance.
Specific Objectives:
Patient Care
To obtain a complete neurological history and to perform a comprehensive neurological examination on patients presenting to the Department of Emergency Medicine with acute neurological symptoms.
To obtain a complete neurological history and to perform a comprehensive neurological examination on patients hospitalized on other medical services and intensive care units throughout the medical center who develop acute neurological symptoms.
To develop and implement a comprehensive plan of diagnostic testing, therapeutic management and disposition for patients presenting with acute neurological conditions.
To develop and refine an approach to the evaluation and treatment of neurological emergencies, including stroke, seizure, and alterations in consciousness.
To create a complete, rational and independently-formulated synthesis of each case for presentation at morning rounds to the consult service.
Medical Knowledge
To expand knowledge of a full range of neurological conditions, including neurological emergencies in adults.
To demonstrate an expanded knowledge of the pathophysiology and epidemiology of acute neurological problems, including stroke, seizure and status epilepticus, alterations of mental status and coma.
To refine the skill of making a well-informed synthesis of neurological history, examination and laboratory data, and a sophisticated differential diagnosis, diagnostic and therapeutic plan.
To identify and describe abnormalities seen in important and acute neurologic disorders on neuroimaging and neurophysiological studies.
Interpersonal Skills and Communication
To present a complete summary and synthesis of new consultation service patients at morning rounds for review by the consultation service attending.
To write a comprehensive, problem-oriented consultation note on patients admitted to the ward services overnight.
To interact and communicate effectively and compassionately with patients and family members in a professional, ethical and culturally sensitive manner.
To improve skill in communicating with patients who have neurological impairment.
To improve and refine the interpersonal and communication skills, both written and oral, necessary to
- communicate with other physicians,
- present cases on rounds and in conferences, and
- to provide competent counseling to patients and families.
Professionalism
To serve as an effective neurological consultant and team leader, competent to admit and manage the care of patients with neurological disease, triage multiple patients requiring medical attention, while demonstrating the professional attributes of integrity, empathy, and compassion.
To supervise students, interns, off-service rotators, and PGY-3s in performance and documentation of consultations.
To serve as a knowledgeable and supportive in-hospital consultant for the daytime adult consult service.
To show appropriate respect for and cultural sensitivity to patients and their families.
To demonstrate an appreciation for end-of-life care and issues regarding consent, competence, advance directives, do not resuscitate orders, and the provision or withholding of care.
To be compliant with ethical and legal standards, work hour guidelines and the requirements of patient confidentiality.
To demonstrate appropriate respect for the opinions of other physicians in the evaluation and management of patients with neurological illness.
Systems-Based Practice
To interact with many other entities and services within the medical center, including the Departments of Emergency Medicine and Radiology, in the urgent evaluation, treatment, and admission of patients with acute neurological conditions.
To demonstrate the ability to reference and utilize electronic information systems to access medical, scientific and patient information.
To master hospital protocols, triage guidelines and standards of practice that have an impact on the evaluation and management of patients with acute neurological problems.
To master making triage decisions and urgent diagnostic and management recommendations for patients with acute neurological problems.
To develop effective time management and triage skills in responding to demands for neurological consultation, including mastering when consultations are appropriate for outpatient evaluation.
Practice-Based Learning and Improvement
To refine the use of the medical literature, including electronic databases, in the application to patient care and neurological education.
To become adept with hospital information systems in the evaluation and treatment of neurological patients.
To develop an appreciation for clinical trials and evidence-based medicine that informs the management of neurological problems.
To evaluate patient care practices and outcomes by participating in Morbidity & Mortality rounds, during which the outcomes and complications of admitted patients are reviewed.
Updated 6/19/24