EEG/Clinical Neurophysiology

EEG/Clinical Neurophysiology EP & PSG

RESIDENT EDUCATION CURRICULUM

Description of Rotation The Clinical Neurophysiology/EEG Section of the Department of Neurology has redefined its educational programs for Neurology residents. The following rotations are offered: 1. One-month “basic rotation” mandatory for all Adult Neurology residents and for Pediatric Neurology residents. 2. Additional “level 2” one month rotation including EEG, evoked potentials (EPs) and polysomnography (psg). 3. Advanced EEG-EP-psg elective rotation of up to three consecutive months in the EEG Laboratory for residents interested in learning more about EEG and clinical neurophysiology and those who have a potential interest in fellowship training in EEG/clinical neurophysiology. Participation in this elective requires prior successful completion of the introductory 2 month EEG rotation and requires permission from the EEG section head, based on specific request by the interested resident. The principles of intraoperative monitoring (EEG, EP) will be introduced here 4. Elective in clinical neurophysiology/epilepsy/sleep disorders. This elective month requires permission from the Clinical Neurophysiology/EEG head, based on specific request by the interested resident.

Educational Purpose 1. To provide an experience that will allow the resident to increase their knowledge of anatomy of the central nervous system and the clinical presentation and pathophysiology of epilepsy, sleep disorders, and other diagnosable entities. 2. To provide an experience that will allow the resident to achieve understanding of electrodiagnostic studies correlating it with the basic science of neurophysiology and clinical presentation. 3. To learn the indications for ordering, diagnostic evaluation and interpretation of EEGs, evoked potentials (visual evoked potentials, brainstem auditory potentials, somatosensory evoked potentials), and sleep studies (polysomnograms, multiple sleep latency tests, multiple wakefulness test, etc). 4. To provide training and supervision that allows development of skills necessary to provide accurate diagnosis in clinical neurophysiology studies.

Assessment Summary The resident will work one-on-one with staff, and get immediate feedback about his/her performance after every patient encounter/work-up. It is expected that the resident will improve their performance based on the feedback they receive and as the rotation progresses.

Resident performance will be assessed in the six core competencies: 1. Patient Care (PC) 2. Medical Knowledge (MK) 3. Interpersonal and Communication Skills (ICS) 4. Practice Based Learning and Improvement (PBLI) 5. Professionalism (P) 6. Systems Based Practice (SBP)

By the end of the rotation, the resident should receive and/or complete the following assessments: 1. Verbal feedback from preceptors 2. Global written assessments (METS) 3. Procedure Logs 4. Written examination 5. Testing of residents performance through direct observation and record review

Expectations This rotation must be approved by the EEG Section head, and requires successful completion of the basic/mandatory 2 months of rotation. The one-to-three-month rotation requires a commitment to work in the EEG, evoked potential (EP) and polysomnography (psg) laboratories and active participation in the ongoing research projects.

Orientation This occurs on the first day of the rotation by the staff attending assigned to the clinic/lab. Orientation to the EEG machine will evolve over the first month of the clinical rotation.

Supervision Residents will actively participate in the clinics/lab supervised both by EEG staff physicians as well as EEG fellows when available.

Mix of Diseases  Epilepsy including status epilepticus in adults and children  Encephalopathies (including ICU monitoring of head trauma)  Coma; persistent vegetative state; electrocerebral inactivity  Sleep disorders  Conditions diagnosable by evoked potentials such as hearing screening, multiple sclerosis, surgical monitoring, etc Patient Characteristics Patients will be referred to the EEG laboratory from either physicians in the outpatient department or from the inpatient hospital services for further diagnosis of a wide variety of epilepsy and other disorders. Children and adult, of various ethnic backgrounds and socioeconomic backgrounds with acute and chronic neurological disorders will be encountered during the EEG rotation. Adults over the age of 18 will be encountered in the EEG clinic.

Procedural Skill Acquisition 1. Normal and abnormal findings in EEG and video/EEG monitoring 2. Interpretation of EEG and EEG monitoring findings 3. Interpretation of visual, brainstem auditory and somatosensory evoked potentials (EPs) 4. Analysis of polysomnography (psg) techniques with staff supervision 5. Writing and dictating electrodiagnostic interpretations with clinical correlations

Conferences The residents should continue to attend the mandatory Neurology conferences including Neurology Grand Rounds. In addition, the residents are required to attend the weekly EEG/Epilepsy conferences (schedule to be determined)

References: Resources recommended for learning skills:

Fisch & Spehlmann’s EEG primer Current Practice of Clinical Encephalography (Ebersole & Pedley), Lippincott Williams & Wilkins Comprehensive Clinical Neurophysiology by Kerry Levin, Hans O. Luders, Saunders; 2000. AAN Practice Guidelines: http://www.aan.com/professionals/practice/index.cfm

You schedule will be as follows: Mon: Continuity Clinic Tues: Dr. McGuire at Children’s Hospital Wed: University EEG readings for adult residents or Children’s Hospital Clinic for pediatric fellows Thursday AM: Baptist Clinic w/ Dr. Olejniczak PM: Resident Lectures Friday: University EEG readings with Dr. Olejniczak (and or sleep disorders and evoked potentials) PATIENT CARE Objectives Teaching Methods Assessment Strategy EP& PSG Perform competently on 15 interpretations of previously Direct Patient Care Checklist evaluation of live performance recorded EEG and EEG monitoring, 3 EP and 3 psg EEG case conference Record review studies Didactic Lectures Case Logs Become familiar with principles of intraoperative Staff instruction and supervision monitoring utilizing both EEG and EP technology Observed performance on EEG interpretation with staff supervision Daily performance of at least one EEG or EP or psg Direct Patient Care Checklist evaluation of live performance interpretation per day EEG case conference Record review Didactic Lectures Case Logs Staff instruction and supervision

MEDICAL KNOWLEDGE Objectives Teaching Methods Assessment Strategy EP& PSG Synthesize an impression of the findings of the EEG, EPs, Didactic Lecture Global ratings psgs independent of Staff’s input Case Conference In-training examination Clinical Teaching End of course quiz Localize and characterize observed abnormality Didactic Lecture Global ratings Case Conference In-training examination Clinical Teaching End of course quiz Describe the findings and clinical correlations of EP and psg Didactic Lecture Global ratings studies Case Conference In-training examination Clinical Teaching End of course quiz INTERPERSONAL AND COMMUNICATION Clinical neurophysiology/ EEG Rotation Interpersonal and Communication Objectives Teaching Methods Assessment Strategy EP& PSG Establish excellent rapport and communication with their Clinical practice Global ratings patients and their families Modeling 360 degree evaluation Work as an integrated member of the Epilepsy Center and Clinical practice Global ratings EEG/clinical neurophysiology Lab Modeling 360 degree evaluation Present case presentations in an organized and detailed Clinical practice Global ratings manner Modeling 360 degree evaluation Educate their patients and their families as appropriate to the Direct patient care Global rating clinical situation in a manner that is geared to the patients educational level Modeling Demonstrate the ability to provide consultants with a report that Clinical rounds Global ratings can be easily interpreted. Modeling PRACTICE BASED LEARNING AND IMPROVEMENT Clinical Neurophysiology/ EEG Rotation Practice Based Learning and Improvement Objectives EP& PSG Teaching Methods Assessment Strategy Research clinical questions regarding their patient’s health Electronic medical record Self assessment problems using information technology to access on-line medical Medline/OVID searches- patient Global ratings information to support their own education and to improve patient centered care and education Case presentations Evaluate the clinical literature applying knowledge of Teaching conferences Global ratings of Journal club epidemiology, biostatistics, and research study design Journal Clubs performance Integrate the feedback they receive from Staff physicians such that Modeling Global ratings (METS) their performance will improve as the rotation progresses.

PROFESSIONALISM Clinical Neurophysiology/ EEG Rotation Professionalism Objectives Teaching Methods Assessment Strategy EP& PSG Demonstrate respect, compassion, integrity, and honesty Direct patient care Global ratings Modeling Interact responsibly with patients and families taking into Modeling Global ratings consideration age, disability, culture and gender issues Demonstrate exemplary interaction with their colleagues Modeling Global ratings Demonstrate appropriate use of the EMR in regards to patient Direct patient care Global ratings respect and confidentiality Modeling Self-assess their performance and the means for Modeling Global ratings improvement Recognize mistakes that occur and take measures to learn Direct patient care Global rating from them so that the do not recur Modeling Self assessment SYSTEM BASED PRACTICE Clinical Neurophysiology/ EEG Rotation System Based Practice Objective Teaching Methods Assessment Strategy EP& PSG Utilize appropriate resources to better care for their patients. Direct patient care Global ratings Review of evidence based medicine Focused Record Review and guidelines of the AAN Departmental conferences Identify obstacles to good patient care, engaging other Direct patient care Global ratings members of the health care team such as child-life and social 360 degree evaluation work, appropriately consulting other subspecialists or generalists. Communicate with the specialized services or laboratories in Direct patient care Global ratings order to obtain timely information on their patients Modeling 360 degree evaluation Consider ethical, legal, and cost-effective standards of Role modeling Self assessment practice Clinical teaching Focused record review Focused record review