Faculty supervisor:
- Dr. Randolph Marshall and rotating faculty
Description:
The Adult Vascular Neurology Consultation Service at Columbia University Medical Center is a busy teaching service that provides neurological consultation in the management of acute and chronic stroke, in the adult and pediatric Emergency Departments, the intensive care units, and the inpatient ward services.
Evaluation:
Performance written evaluations are provided by the Stroke Consult Service Attending, who receive the resident’s presentations. Verbal feedback is provided at the end of the rotation by supervising faculty.
PGY-3 Rotation
The education goals of the rotation for PGY-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 vascular neurological emergencies. The PGY-3 resident is carefully supervised by the attending faculty, as well as by a vascular neurology fellow (PGY-5 or PGY-6). The PGY-3 resident is primary responder to acute stroke alert activations in a busy Certified Comprehensive Stroke center with the capability of delivery of thrombolysis, thrombectomy, and vascular remodeling.
PGY-2 Rotation
The education goals of the rotation for PGY-2 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 vascular neurological emergencies. The PGY-2 resident is responsible for seeing non-urgent vascular consults.
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 such as acute stroke and acute intracranial hemorrhage.
To acquire knowledge of the pathophysiology and epidemiology of common neurological vascular problems including stroke, intracranial hemorrhage, vasculopathy/vasculitis, and endocarditis.
To develop knowledge of the indications for diagnostic testing and medical procedures, including the administration of thrombolytic for acute stroke.
To become familiar with the indications, risks, and benefits of throbectomy for acute stroke.
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 learn the indications for appropriate neuro-diagnostic tests and the fundamentals of their interpretation.
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 hours 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.
Updated 7/21/25