Neurological Intensive Care Unit

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Faculty supervisors:

Dr. Jan Claassen and rotating attendings

PGY-2 Rotation

Description:

The PGY-2 resident rotates on the Neurological Intensive Care Unit at Columbia University Medical Center in one- or two week blocks during the junior year. The NICU is an 18-bed state-of-the-art combined neurology/neurological surgery intensive care unit that treats patients with severe and acute neurological emergencies who require advanced monitoring, mechanical ventilation, cardiovascular support, invasive procedures and neurosurgical interventions. The junior resident participates as member of the NICU team, and has the role of: evaluating and admitting patients; gathering clinical information from patients, families, and other medical sources; presenting a synthesis of the case to the clinical fellow on service, formulating treatment plans and ultimately presenting the case to the attending neurointensivist. They also contribute to daily management decisions; perform procedures (including but not limited to lumbar puncture, arterial and central line placement); providing follow-up assessments and evaluation; maintaining ongoing electronic updates of each patient’s clinical course; and preparing summaries for patients discharged from the NICU. The rotation is divided into a day team rotation and a night float. At the end of the rotation the PGY-2 resident will become familiar with managing neurological emergencies, as well as medical complications arising from neurological disease. This will serve as the foundation of knowledge for the management of patients with neurological emergencies and critical illness seen on the neurology consult service in the PGY-3 and PGY-4 year.

Evaluation:

Performance written evaluations are completed by faculty supervisors at the end of the clinical rotations. Verbal feedback will be provided at the mid-point and end of rotation by the supervising attending and fellow.

Specific Objectives:

Patient Care

To obtain medical and neurological histories from patients, or families on admission to the NICU with acute neurological disorders.
To learn the neurological examination of the comatose patient.
To become familiar with the process of determining brain death. Residents should be able to perform a brain death exam and recognize when that exam is consistent with brain death. They should become familiar with the apnea test and other ancillary tests which may be also be used in the determination of brain death.
To become familiar with the assessment and management of severe, acute neurological disease, including coma and encephalopathy, status epilepticus, severe acute ischemic or hemorrhagic stroke, subarachnoid hemorrhage, acute neuromuscular weakness, head trauma, spinal cord compression, brain tumors, and increased intracranial pressure, under direct supervision of neurocritical care fellows and attending’s.
To become familiar with the principles of monitoring and management of the critically ill neurological patient with but not limited to acute ischemic stroke following thrombolytics, malignant edema after stroke, vasospasm after subarachnoid hemorrhage, elevated intracranial pressure, blood pressure control, ventilation, anticonvulsant and anesthetic treatment of status epilepticus, hypothermia and other treatments of fever in the neurocritical care unit, management of metabolic, infectious, and other medical complications of acute neurological illness.
To learn the indications and complications of neurosurgical and invasive neuroradiological interventions in patients with acute neurological emergencies and critical neurological illness.
To develop skill in recognizing the radiographic appearance of acute ischemic stroke, hemorrhagic stroke, and the cerebral herniation syndromes.
To learn the indications and potential limitations of neuro-physiological and multi-modality recording in patients in the NICU.
To contribute to the diagnostic and management plan of the patients in the NICU, incorporating clinical, physiologic and image-based data.

Medical Knowledge

To learn about the pathophysiology and manifestations of severe, acute neurological disease and neurological emergencies
To become familiar with the physiology of cerebral hemodynamic monitoring and its application to the patients with coma and severe stroke.
To become familiar with the pathophysiology of increased intracranial pressure and cerebral edema.
To become familiar with the pathophysiology and management of medical illness in patients with concomitant life-threatening neurological diseases.

Interpersonal Skills and Communication

To interact and communicate effectively and compassionately with family members of patients with critical illness in a professional, ethical and culturally-sensitive manner.
To develop and improve the interpersonal and communication skills, both written and oral, necessary to
1. transmit an accurate neurological history and exam to other members of the neuro-critical care unit
2. present cases on rounds,
3. to provide competent counseling to patients and families, and (iv) to communicate through written discharge summaries the diagnostic and management plan for patients transferred out of the NICU.
To maintain up-to-date electronic documentation of history, neurological examination, physiological monitoring and laboratory data, and NICU course of patients with neuro-critical illness.

Professionalism

To demonstrate the professional habits of punctuality, responsibility, honesty, integrity, compassion, and cultural sensitivity in caring for neuro-critical care patients and their families.

To demonstrate an approach to the ethical concepts of neuro-critical care, including informed consent, advanced directives, medical futility, palliative care, and end-of-life care, including issues relating to brain death and the persistent vegetative state.

To be compliant with ethical and legal standards, work hour guidelines and the requirements of patient confidentiality.

Systems-Based Practice

To demonstrate the ability to function as a member of the multidisciplinary NICU team, including collaborations with physician extenders.
To develop awareness of NICU monitoring and management protocols, practice guidelines and other resources that contribute to the care of neuro-critical care patients.
To become familiar with transfer planning for patients who are discharged from the NICU to the Merritt Ward Service, Stroke Service, step-down/monitoring units, and the hospitalist [“Graduate”] service, including recommendations for in-patient medical management and neurological rehabilitation.

Practice-Based Learning and Improvement

To begin to use the medical literature, including electronic databases and practice guidelines, in the diagnosis and management of patients with neuro-critical care illness.
To become familiar with hospital information systems in the evaluation and treatment of patients in the neuro-critical care unit.
To become familiar with the management protocols in the NICU, and their outcomes.
To become familiar with the clinical trials, protocols and other medical evidence that has shaped the current standard of monitoring and management for patients with critical neurological illness.

PGY-3 Rotation

Description:

The PGY-3 resident rotates on the Neurological Intensive Care Unit at Columbia University Medical Center in one 2-week block. The senior junior resident role builds upon the neuro-critical care knowledge base and skill set developed during the PGY-2 to contribute at a more advanced level to the evaluation and management of patients admitted to the NICU. While working under the supervision of the faculty neuro-intensivists and neuro-critical fellows, the PGY-3 neurology resident brings a larger clinical experience, more independence in decision-making, and a greater appreciation of evidence-based medicine and medical ethics to the care of neuro-critical patients, while serving as a proximate role model and educator of the PGY-2 residents and medical students on the NICU service.

Evaluation:

Specific Objectives:

Patient Care

To become more familiar with the assessment and management of severe, acute neurological disease and neurological emergencies under direct supervision of faculty and neuro-critical care fellows.
To develop more skill and confidence in the determination of brain death using clinical and laboratory-based techniques.
To become more familiar with the principles of monitoring and management of the critically ill neurological patient, including medical and neurological complications.
To refine skills in recognizing the radiographic appearance of acute ischemic stroke, hemorrhagic stroke, and the cerebral herniation syndromes.
To interpret the result of neuro-physiological and multi-modality recording in patients in the NICU
To contribute at an advanced resident level to the diagnostic and management plan of the patients in the NICU, incorporating clinical, physiologic and image-based data.

Medical Knowledge

To increase knowledge regarding the pathophysiology of severe, acute neurological disease and neurological emergencies, as well as associated medical and neurological complications
To become more familiar with the physiology of cerebral hemodynamic monitoring and its application to the patients with coma and severe stroke.

Interpersonal Skills and Communication

To improve communication skills and counseling for patients with neuro-critical disease and their family members, interacting in a professional, ethical and culturally-sensitive manner.

Professionalism

To demonstrate the professional habits of punctuality, responsibility, honesty, integrity, compassion, and cultural sensitivity in caring for neuro-critical care patients and their families.
To develop a sophisticated approach to the ethical concepts of neuro-critical care, including informed consent, advanced directives, medical futility, palliative care, and end-of-life care, including issues relating to brain death and the persistent vegetative state.
To be compliant with ethical and legal standards, work hours guidelines and the requirements of patient confidentiality.

Systems-Based Practice

To contribute at a managerial level to the multidisciplinary NICU team, demonstrating awareness of the principles of triage and hospital resource management.
To become adept with NICU monitoring and management protocols, practice guidelines and other resources that contribute to the care of neuro-critical care patients.
To orchestrate transfer planning for patients who are discharged from the NICU to the Merritt Ward Service, Stroke Service, step-down/monitoring units, and the hospitalist [“Graduate”] service, including recommendations for in-patient medical management and neurological rehabilitation.

Practice-Based Learning and Improvement

To become more familiar with the neuro-critical care management protocols and their outcomes
To become more familiar with the clinical trials, protocols and other medical evidence that has shaped the current standard of monitoring and management for patients with critical neurological illness.

Updated 7/21/25