Interpretation of neurophysiologic studies is a commonly required and increasingly complex component of patient care in the neurocritical care unit. The skillset needed to utilize neurophysiologic studies in the context of management of patients with acute brain is highly specialized and in demand.
Training for neurophysiology occurs in the inpatient critical care electroencephalography and neurophysiology services at NewYork-Presbyterian Hospital-Columbia University Medical Center over two weeks during both the first and second year of fellowship. Upon completion, fellows are proficient in the basic interpretation and implementation of critical care electroencephalography (EEG) and somatosensory evoked potentials (SSEPs) as they relate to the management of patients with severe acute brain injury. The following set of core educational objectives is designed to clearly communicate the expectations of neurocritical care fellows in terms of knowledge, skills and attitudes during their rotation in neurophysiology.
These educational goals are met through a series of clinical experiences in neurophysiology (supervised clinical practice in the Columbia critical care EEG and neurophysiology services), regularly scheduled seminars and conferences in critical care neurophysiology, multidisciplinary conferences (neurophysiology, critical care grand rounds) and individual projects.
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INDEX OF COMPETENCIES: PC=Patient Care; MK=Medical Knowledge; PBLI=Practice-Based Learning & Improvement; ICS=Interpersonal & Communication Skills; Prof=Professionalism; SBP=Systems-Based Practice |
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This rotation is a one-week rotation during both the first and second year of fellowship. At the end of the rotation, the fellows are expected to demonstrate the following:
Objective 1 (PC, ICS, PBLI, MK): Demonstrate proficiency in all medical and diagnostic procedures considered to be essential for the area of neurophysiology for neurocritical care by:
- Demonstrating competence in the following interpretation and applications of advanced technology in neurophysiology for monitoring the physiologic status of patients with critical neurologic illness:
- Neurologic: Interpretation of critical care EEG and quantitative EEG as measures of intracranial physiologic monitoring in critical neurologic illness. Interpretation of somatosensory evoked potentials in critical neurologic illness.
- Recognizing common cases in neurophysiology such and developing a comprehensive differential diagnosis regarding etiology. Examples include (but are not limited to):
- Status epilepticus (including myoclonic status epilepticus and refractory status epilepticus)
- Inter-ictal continuum
- Hypoxic-ischemic encephalopathy
- Increased intracranial pressure and herniation syndromes
- Brain death
- Developing and executing a therapeutic management plan for patients with common diagnoses in neurophysiology including:
- Status epilepticus (including myoclonic status epilepticus and refractory status epilepticus)
- Inter-ictal continuum
- Hypoxic-ischemic encephalopathy
- Increased intracranial pressure and herniation syndromes
- Brain death
- Participating in a multi-specialty team of physicians, medical students and allied health professionals in patient management.
Objective 2 (MK): Demonstrate knowledge of established and evolving biomedical, clinical, epidemiological, and social behavioral sciences, as well as the application of this knowledge to patient care in neurophysiology by:
- Recognizing common cases of neurophysiology including:
- Status epilepticus (including myoclonic status epilepticus and refractory status epilepticus)
- Inter-ictal continuum
- Hypoxic-ischemic encephalopathy
- Increased intracranial pressure and herniation syndromes
- Brain death
- Demonstrate the ability to independently manage common cases of neurophysiology
Objective 3 (ICS, MK, PBLI): Acquire and demonstrate the ability to synthesize and apply knowledge and understanding gained from basic science, clinical research, and information technology to provide accessible information to patients and support one’s own education by:
- Leveraging information technology to gather the most up-to-date scientific evidence to make informed decisions regarding diagnostic and therapeutic interventions.
- Proficiently using information technology to manage information, access on-line medical information, support their own education, and apply this information in the interpretation of patient neurophysiologic studies.
- Finding, assessing, and assimilating the best evidence for clinical decision-making and continuously evaluating and improving patient care practices.
Objective 4 (SBP, PROF, ICS): Leverage knowledge of medical systems and regulatory requirements of medical training and practice by:
- Participating in analysis of safety event(s)
- Disclosing patient safety events to patients and their families (simulated/actual) with guidance from mentor as needed
- Delivering patient-centered care with focus on individual needs of patient and family
- Leading interdisciplinary patient-centered care
- Advocating for safe and effective transitions of care
- Adjusting individual practice to address needs of specific patient populations
- Modifying individual practice to optimize care within a broader health care system
Objective 5 (SBP, ICS, PROF): Demonstrate professionalism and expertise in using the system of care in a way that is beneficial and essential for patients, by:
- Effectively communicating with other members of the health care team (i.e., other physicians, nurses, social workers, etc.) to coordinate and optimize patient care.
- Advocating for quality patient care and assisting patients in dealing with system complexities.
- Functioning as a team member to facilitate and optimize patient care.
- Demonstrating effective listening skills and providing patients the opportunity to explain their problem and concerns.
- Actively participating in the education of patients, families, medical students, residents and other health care professionals.
- Demonstrating superior interpersonal and communications skills with professional associates and other health care providers.
Objective 6 (ICS, PROF, PC): Demonstrate the ability to interact and communicate with patients in a manner that is culturally sensitive and patient-centered, by:
- Demonstrating respect, compassion, integrity, and responsiveness to the needs of patients, their families and society that supersede self-interest.
- Providing care that is sensitive to each person’s age; gender; and cultural, economic, and social circumstances.
- Demonstrating clear, understandable, and effective interpersonal and communication skills to counsel and educate patients and their families.
- Demonstrating a commitment to ethical practices pertaining to patient privacy and autonomy, the provision or withholding of clinical care, confidentiality of patient information, informed consent, and conflict of interest and business practices.
- Creating and sustaining a therapeutic and ethically sound patient-physician relationship.
- Creating and sustaining an environment where patients and their families feel comfortable asking questions about the patients’ diseases and treatments.
- Promoting an environment that supports shared decision making by including patients and families in decisions and choices about treatment.
- Effectively and empathetically delivering bad news to patients and their families.
Objective 7 (ICS, PROF, SBP): Demonstrate the ability to interact, communicate and work effectively with clinical and ancillary staff in inpatient neurology and critical care unit arenas, by:
- Obtaining and providing appropriate consultation.
- Carrying out respectful and effective communication with: colleagues, nurses, and ancillary staff in a way that encourages cooperation and patient-based care.
- Demonstrating ability to communicate complex ideas and concepts effectively to clinical and ancillary staff.
Objective 8 (PROF): Demonstrate the ability to conduct oneself in a professional manner by:
- Consistently exhibiting a professional appearance; neat, well-groomed, conservative attire in compliance with the hospital dress code.
- Consistently demonstrating professional attitudes consistent with being a physician, with an emphasis on responsibility, compassion, sensitivity to diverse patient populations and cultures.
- Continuously adhering to ethical principles, confidentiality, informed consent and a commitment to excellence and on-going professional development.
- Exhibiting dependability, responsibility and self-respect.
- Arriving for clinical duties and completing work in a timely manner and with appropriate attention to detail.
- Consistently demonstrating personal integrity and altruism.
Objective 9 (PROF, ICS): Demonstrate teaching skills by:
- Providing instruction to residents and medical students in inpatient fields (inpatient neurology, critical care units) for patients requiring neurophysiologic studies.
- Demonstrating ability to impart learned skills to medical students and junior residents
- Exhibiting leadership in advising, teaching and supervising residents and medical students.