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NEUROLOGY RESIDENT HANDBOOK Emory University_____________________________________________________________________________________

EMORY UNIVERSITY DEPARTMENT OF NEUROLOGYRESIDENCY PROGRAM HANDBOOK

TABLE OF CONTENTS

PAGE 2 Core Values

PAGE 3 Resident Job Responsibilities

PAGE 5 Rotation Objectives

PAGE 53 Evaluations

PAGE 63 Teaching Responsibilities

PAGE 65 Neurology Clinical Clerkship

PAGE 65 Visiting Professors

PAGE 66 Discretionary Funds and Support

PAGE 67 Transcription Tips

PAGE 68 Morning Report Presentations

PAGE 69 Department & Medical School Policies

PAGE 71 Faculty/Staff Assistance & Wellness Program (FSAP)

PAGE 73 Patient Telephone Call Guidelines

PAGE 74 Lecture & Conference Schedules

PAGE 76 ACGME Program Requirements for Neurology

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EMORY UNIVERSITY DEPARTMENT OF NEUROLOGY

Core Values of the Emory Neurology Residency Training Program

We recognize that learning is inherently communal in nature. We strive to promote an environment which nurtures the professional interaction necessary to strengthen our neurologic community.

We believe that students learn best by interacting with a subject and are committed to drawing medical students and junior colleagues into the process of active learning.

We welcome diversity, encourage critical inquiry, and embrace paradox in the constant act of reconciling established concepts with new evidence in the process of life-long learning.

We treat people with respect and believe that individuals who are given respect and responsibility respond by giving their best.

We strive for excellence and require honesty and integrity in all we do.

We recognize that intellectual rigor is required to amass neurological knowledge; likewise, an ethos of trust, compassion, and respect is essential to creating a future neurologist.

We recognize our limits as well as our capabilities and act accordingly at all times.

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RESIDENT JOB RESPONSIBILITIES

POSITION DESCRIPTION FOR RESIDENT PHYSICIANSDepartment of Neurology

Emory University School of MedicineAtlanta, Georgia

Introduction

The RRC-approved residency-training program at Emory University School of Medicine is under the direction of Dr. Allan Levey, Chairman, Dr. Jonathan Glass, Program Director, and Dr. Jane Gilmore, Associate Program Director. The residency-training program currently utilizes the following hospitals:

Emory University Hospital and Emory ClinicGrady Memorial HospitalVeterans Affairs Medical CenterEgleston Children’s HospitalWesley Woods Health Center

General Principles of the Training Program for Residents in Neurology at Emory University

1. The house staff physician meets the qualifications for resident eligibility outlined in the Essentials of Accredited Residencies in Graduate Medical Education in the AMA Graduate Medical Education Directory.2. As the position of house staff physician involves a combination of supervised, progressively more

complex and independent patient evaluation and management functions and formal educational activities, the competence of the house staff physician is evaluated on a regular basis. The program maintains a confidential record of the evaluations.3. The position of house staff physician entails provision of care commensurate with the house staff physician’s level of advancement and competence, under the general supervision of appropriately privileged attending teaching staff. This includes:

participation in safe, effective, and compassionate patient care; developing an understanding of ethical, socioeconomic, and medical/legal issues that

affect graduate medical education, and of how to apply cost containment measures in the provision of patient care;

participation in the educational activities of the training program and, as appropriate, assumption of responsibility for teaching and supervising other residents and students, and participation in institutional orientation and education programs and other activities involving the clinical staff;

participation in institutional committees and councils to which the house staff physician is appointed or invited; and

performance of these duties in accordance with the established practices, procedures, and policies of the institution, and those of its programs, clinical departments and other institutions to which the house staff physician is assigned, including among others, state licensure requirements for physicians in training where these exist.

each resident will maintain a one half day per week outpatient continuity clinic at Grady Hospital.

Position Description for Resident Physicians Specific to PGY Level

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1. PGY-2

A. The PGY-2 neurology resident rotates through the inpatient neurology services at Emory and Grady Hospitals, including rotations in Neuro-ICU at Emory Hospital. They will typically spend one month on an elective service, such as rotating through different neurology subspeciality clinics, or on the Wesley Woods Neurology Consultation service.

B. Fundamental duties include the performance and documentation of the history and physical examination; writing of orders and otherwise carrying out the care plan for their patients as directed by the attending and senior resident. They also perform minimally invasive techniques such as lumbar puncture.

C. Direct supervision of the PGY-2 neurology resident occurs on a regular basis. Each patient seen by the resident is also personally evaluated by the attending and/or the senior resident. The exception is at night at Emory Hospital where any patient seen is discussed with the attending by phone. Those admitted to the hospital will then be seen by the attending the following day.

2. PGY-3

A. The PGY-3 neurology resident rotates through subspeciality rotations and electives such as Neuromuscular, Epilepsy, Child Neurology, Neuro-ophthalmology, and Neuropathology. They will also begin to rotate on the Inpatient and Consult services at Emory and Grady Hospitals where they will have a more supervisory and teaching role.

B. Fundamental duties are the same as the PGY-2 neurology resident, except they will be expected to be able to formulate a diagnostic and therapeutic care plan for the patients they see.

C. Direct supervision of the PGY-3 neurology resident continues as the attending will see and evaluate the vast majority of the patients seen by the resident.

3. PGY-4

A. The PGY-4 neurology resident rotates through Inpatient and Consult services at Emory and Grady Hospitals, as well as the Veterans Affairs Medical Center. They will complete any remaining required subspeciality rotations such as Child Neurology. The remaining months will be spent in elective rotations in subspecialty services in the Department of Neurology.

B. Fundamental duties are the same as those of PGY-2 and PGY-3 neurology residents C. Direct supervision of the PGY-4 neurology resident by an attending neurologist

continues, although it is expected that it should be more to confirm the impression and care plan for patients evaluated by the resident, rather than have it dictated by the attending as would be the case for more junior residents.

D. Two or three of the PGY-4 neurology residents will be selected as Chief Residents. They have the additional duties of developing the resident rotation schedules, setting up Grand Rounds and other administrative, as well as teaching activities.

Approved, Neurology Education Committee, September, 2005

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ROTATION OBJECTIVESEmory University Hospital Neurology Inpatient Service

Emory University School of Medicine

I. IntroductionThis document provides guidelines for neurology resident training while on the inpatient service at

Emory University Hospital. The patient population consists of patients with both emergent and non-emergent problems. Patients with primary neurologic problems are evaluated and managed in the Emergency Department, the inpatient neurology service, and in the intensive care units. A broad range of problems are cared for in this setting including, but not limited to coma, encephalopathy, dementia, seizures, and weakness. The resident must learn to assign specific diagnoses and management strategies, represented by such entities as stroke, epilepsy, neuromuscular diseases, movement disorders, and degenerative diseases.

II. DescriptionDuring the first year of neurology training, 3 first-year neurology and 1 senior neurology resident are

assigned to the inpatient service each month. The senior resident (second or third year of training) functions as the team leader for 3 junior residents and 1 or 2 medical students.

In addition to the 3 neurology residents assigned to the in-patient service, an additional resident may be assigned to the Neurology/Neurosurgery ICU for one month rotations. At least one month of ICU experience is required of each resident during the three years of training.

III. Rotation Directors and FacultyJane Gilmore, M.D., Associate Program Director, coordinates the resident’s experience on the

inpatient service.Department of Neurology faculty are assigned to attending roles on the inpatient service on a monthly

basis. These individuals have been selected for their excellence in both patient care and teaching. There is also a dedicated neurology/neurosurgery ICU attending who has completed neurology training, a stroke fellowship, and a neurology/neurosurgery intensive care fellowship.

IV. Rotation EnvironmentEmory University Hospital provides care to the surrounding community and referral care to the

metro-Atlanta area as well as the state of Georgia and surrounding region. There is an active Emergency Department with full-time emergency physician faculty coverage, a 14-bed neurology/neurosurgery ICU, and 24 beds on the dedicated neurology/neurosurgery floor. A full-spectrum of highly sophisticated support facilities are available as well as physician consultative services.

V. Educational Objectives/Expectations Obtain an orderly and detailed history from the patient, reliably eliciting appropriate information Conduct a thorough general and neurological examination, reliably detecting abnormal findings Correctly integrate the findings from the history and physical examination to localize the neurological

problem and generate etiologic hypotheses Formulate a diagnostic plan incorporating appropriate laboratory, imaging, and physiologic tools to

further refine the diagnostic impression Define a logical and comprehensive management plan for the patient’s problem

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NEUROLOGY RESIDENT HANDBOOK Emory University_____________________________________________________________________________________ Critically analyze and interpret biomedical data Participate in the ongoing management of the patient, including discharge planning Participate in the evaluation and decision-making for patients requiring surgical management Participate in the evaluation and decision-making for patients with neurologic presentations of

psychiatric disease Understand the importance of personal, social, and cultural factors in disease processes and their clinical

expression Participate in the evaluation and management of the patient in the Emergency Department or ICU Learn the indications for and basic principles of rehabilitation for neurologic disorders Appreciate the parameters for appropriate and cost-effective patient evaluation Understand the management of end-of-life palliative care, pain relief, and counseling of patients and

families, including issues related to brain death and the vegetative state Communicate and interact effectively and appropriately with patients, medical staff, and colleagues,

including acting as a role model for the health care team

VI. EvaluationThe residents will be evaluated by the attending physicians as well as by each other. The attending

physician will give the resident formal feedback at such times as the faculty member thinks is appropriate, but certainly at the end of the rotation. A written evaluation will be filed with the residency program director’s office.

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ROTATION OBJECTIVESEmory University Hospital Neurology Consultation Service


I. IntroductionThis document provides guidelines for neurology resident training while on the neurology

consultation service at Emory University Hospital. The patient population consists of patients with comorbid or secondary neurologic problems occurring in the setting of primary medical or surgical illnesses. Patients are evaluated and managed in the Emergency Department; intensive care units; and on various medical, surgical, psychiatry, and rehabilitation services. A broad range of problems are cared for in this setting, including but not limited to coma, encephalopathy, dementia, stroke, seizures, movement disorders, and weakness. The resident must learn to assign specific diagnoses and management strategies, represented by such entities as stroke, epilepsy, neuromuscular diseases, movement disorders, and degenerative diseases.

II. DescriptionDuring the second and/or third year of neurology training, the resident is assigned to the neurology

consultation service where he/she functions as the team leader for medical and (occasionally) junior neurology residents and 1 or 2 medical students.

III. Rotation Directors and FacultyJane Gilmore, M.D., Associate Program Director, coordinates the resident’s experience on the

consultation service.Department of Neurology faculty are assigned to attending roles on the neurology consultation

service for two-week blocks. These individuals have been selected for their excellence in both patient care and teaching.

IV. Rotation EnvironmentEmory University Hospital provides care to the surrounding community and referral care to the

metro-Atlanta area as well as the state of Georgia and surrounding region. There is an active Emergency Department with full-time emergency physician faculty coverage and a full range of specialty and subspecialty services and ICUs. A full-spectrum of highly sophisticated support facilities are available as well as physician consultative services.

V. Educational Objectives and Expectations Obtain an orderly and detailed history from the patient, reliably eliciting appropriate information Conduct a thorough general and neurological examination, reliably detecting abnormal findings Correctly integrate the findings from the history and physical examination to localize the neurological

problem and generate etiologic hypotheses Formulate a diagnostic plan incorporating appropriate laboratory, imaging, and physiologic tools to

further refine the diagnostic impression Define a logical and comprehensive management plan for the patient’s problem Critically analyze and interpret biomedical data Communicate clearly with the patient’s primary service and other consulting services,

and participate in the ongoing management of the patient, as appropriate to the situation

Participate in the evaluation and decision-making for patients requiring surgical management Participate in the evaluation and decision-making for patients with neurologic presentations of

psychiatric disease

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NEUROLOGY RESIDENT HANDBOOK Emory University_____________________________________________________________________________________ Understand the importance of personal, social, and cultural factors in disease processes and their clinical

expression Participate in the evaluation and management of the patient in the Emergency Department or ICU Learn the indications for and basic principles of rehabilitation for neurologic disorders Appreciate the parameters for appropriate and cost-effective patient evaluation Understand the management of end-of-life palliative care, pain relief, and counseling of patients and

families, including issues related to brain death and the vegetative state Communicate clearly and interact effectively with patients, medical staff, and

colleagues

VI. EvaluationThe residents will be evaluated by the attending physicians as well as by each other. The attending

physician will give the resident formal feedback at such times as the faculty member thinks is appropriate, but certainly at the end of the rotation. A written evaluation will be filed with the residency program director’s office.

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ROTATION OBJECTIVESGrady Memorial Hospital Neurology Inpatient Service


I. IntroductionThis document provides guidelines for neurology resident training while on the inpatient service at

Grady Memorial Hospital. The patient population is made up of both emergent and elective admissions. A broad array of neurologic problems are evaluated and cared for at Grady.

II. DescriptionThe Grady in-patient neurology service is a demanding rotation characterized by a great deal of

resident autonomy and responsibility for patient care. Organization and efficiency are of key importance on this service. The team consists of the attending, 1 senior and 2 junior neurology residents, 1 medical intern, 1 psychiatry intern, and medical students.

III. Rotation Director and FacultyDr. Mike Frankel, Chief of Neurology at Grady, Dr. Jaffar Khan, and Dr. Archana Koganti, in

conjunction with faculty from Emory and other sites, provide attending coverage at Grady. Residents are encouraged to contact Dr. Frankel or any member of the faculty (whether assigned to Grady or not) at any time if assistance in patient management is needed.

IV. Rotation EnvironmentNeurology patients are located primarily on the 12A Ward of Grady Memorial Hospital with

overflow patients in other areas of the hospital. Neurology ICU patients are located in the 7K ICU with overflow patients located in other ICUs.

V. Educational Objectives/ExpectationsAt the conclusion of the Grady neurology inpatient rotation, the first year resident should be able to

meet the following objectives: Elicit a thorough and pertinent history; conduct a thorough general and neurological examination; record

data in an organized written record Define the neurological localization and formulate a logical differential diagnosis of the neurologic

problem Present an outline of a logical approach for appropriate diagnostic evaluation Describe an appropriate plan of treatment and begin implementation under the direction of the senior

neurology resident and attending Present the above information concisely and clearly to the attending physician and other members of the

inpatient team Develop a basic understanding of relevant serologic tests, cerebrospinal fluid analysis, neuroimaging

interpretation, and the use of other neurodiagnostic tests such as electroencephalography and electromyography

Understand the basic aspects of managing critically ill patients who have unstable neurological problems in the emergency room and in the intensive care unit

Actively participate in the educational discussion during teaching rounds and show a thorough understanding of the relevant anatomy, pathology, and therapeutic options related to patient care

Relate successfully to patients, families, and professionals; display professional attitudes toward learning by showing interest and responsibility in patient care; sensitivity to patients’ needs; good interpersonal relationships and tact; good work habits and consistency; curiosity as well as evidence of a desire to learn

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and improve (by reading, study, discussions); and ability to improve (response to suggestions/ corrections)

At the conclusion of the Grady neurology inpatient rotation, the second- or third-year neurology resident should be able to meet the following objectives:

Manage responsibly a group of inpatients with acute neurological problems with guidance from the attending

Display a thorough understanding of the process of neurological localization and of formulating a logical differential diagnosis of a neurologic problem

Display a thorough understanding of the relevant anatomy, pathology, and therapeutic options for each patient on the inpatient service

Describe the appropriate use of neurodiagnostic tests and their relevance in clinical decision-making for each patient on the inpatient service

Provide teaching to other members of the team including neurology residents, interns, and students by presenting and presiding over didactic sessions regarding anatomy, pathology, clinical diagnosis, and therapy based on relevant literature

Display an ability to present effectively each patient’s history, physical, assessment, and plan in a concise and straightforward format

Develop an advanced understanding of relevant serologic tests, cerebrospinal fluid analysis, neuroimaging interpretation, and the use of other neurodiagnostic tests such as electroencephalography and electromyography

Develop an advanced understanding of all the relevant aspects of managing critically ill patients who have unstable neurological problems in the emergency room and in the intensive care unit

Relate successfully to patients, families, and professionals; display professional attitudes toward learning by showing interest and responsibility in patient care; sensitivity to patients’ needs; good interpersonal relationships and tact; good work habits and consistency; curiosity as well as evidence of a desire to learn and improve (by reading, study, discussions); and ability to improve (response to suggestions/ corrections)

Display an ability to communicate effectively with patients and their families regarding compassionate end-of-life decisions

VI. EvaluationWritten evaluations will be filed monthly with the Program Director’s office. In addition, the attending will review the resident’s performance with him/her at the end of the rotation and at such times as may be necessary.

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ROTATION OBJECTIVESGrady Memorial Hospital Neurology Consultation Service


I. IntroductionThis document provides guidelines for neurology resident training while on the Neurology

Consultation Service at Grady Memorial Hospital. The patient population includes patients with both emergent and non-emergent problems. A wide range of neurologic problems are encountered on this service, including coma, delirium, dementia, seizures, stroke, gait disturbances of various etiologies, and others.

II. DescriptionThe consult team consists of the attending, 1 senior and 1 junior neurology resident, rotating residents

from other services (Medicine, Neurosurgery) and medical students.

III. Rotation Director and FacultyDr. Mike Frankel, Chief of Neurology at Grady, Dr. Jaffar Khan, and Dr. Archana Koganti, in

conjunction with faculty from Emory and other sites, provide attending coverage. Residents are encouraged to contact Dr. Frankel or any member of the faculty (whether assigned to Grady or not) at any time if assistance in patient management is needed.

IV. Rotation EnvironmentThe Neurology Consultation Service provides service to an active Emergency Department as well as

to a full range of specialty and ICU services at Grady.

V. Educational Objectives/Expectations Elicit a thorough and pertinent history; conduct a thorough general and neurological examination; record

data in an organized written record Define the neurological localization and formulate a logical differential diagnosis of the neurologic

problem Present an outline of a logical approach for appropriate diagnostic evaluation Display a thorough understanding of the process of neurological localization and of formulating a logical

differential diagnosis of a neurologic problem Display a thorough understanding of the relevant anatomy, pathology, and therapeutic options for each

patient on the inpatient service Describe the appropriate use of neurodiagnostic tests and their relevance in clinical decision-making for

each patient Provide an assessment and recommendations for care in a format that is both legible and understandable

to non-neurologists Provide teaching to other members of the team including neurology residents, interns, and students by

presenting and presiding over didactic sessions regarding anatomy, pathology, clinical diagnosis, and therapy based on relevant literature

Display an ability to present effectively each patient’s history, physical, assessment, and plan in a concise and straightforward format

Develop an advanced understanding of relevant serologic tests, cerebrospinal fluid analysis, the interpretation of neuroimaging, and the use of other neurodiagnostic tests such as electroencephalography and electromyography

Develop an advanced understanding of all the relevant aspects of managing critically ill patients who have unstable neurological problems in the emergency room and in the intensive care unit

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NEUROLOGY RESIDENT HANDBOOK Emory University_____________________________________________________________________________________ Develop an advanced understanding of the pathophysiology, diagnosis and treatment of neurologic

problems associated with medical diseases Relate successfully to patients, families, and professionals; display professional attitudes toward learning

by showing interest and responsibility in patient care; sensitivity to patients’ needs; good interpersonal relationships and tact; good work habits and consistency; curiosity and evidence of a desire to learn and improve (by reading, study, discussions); and ability to improve (response to suggestions/corrections)

Display an ability to communicate effectively with patients and their families regarding compassionate end-of-life decisions

VI. EvaluationWritten evaluations will be filed monthly with the program director’s office. In addition, the

attending will review the resident’s performance with him/her at the end of the rotation and at such times as may be necessary.

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ROTATION OBJECTIVESNeuroscience Critical Care Unit (NCCU) Rotation


I. IntroductionThis document provides guidelines for neurology residency training in neurocritical care medicine.

The scope of neurocritical care encompasses the three separate disciplines of neurology, neurosurgery, and critical care medicine. As such, much of the time spent by a neurology resident in neurocritical care will be focused on the critical care aspects of managing acutely ill neurologic patients.

II. DurationEach Neurology resident will spend one or more fully dedicated months on this rotation.

III. Rotation FacultyOwen B. Samuels, M.D., Assistant Professor of Neurology and NeurosurgeryWendy Wright, M.D., Assistant Professor of Neurology and Neurosurgery

IV. Rotation EnvironmentThe rotation will take place primarily in the Neuroscience Critical Care Units (2G/3G ICUs) at

Emory University Hospital. These clinical units are state-of-the-art intensive care units with all the standard facilities to manage critically ill patients. A continuous flow of neurocritical care patients is seen under direct faculty supervision.

V. Educational Objectives and ExpectationsThe resident will be expected to

Evaluate and manage, under direct faculty supervision, all neurology patients admitted to the NCCU

Assist in the evaluation and management of neurosurgery patients admitted to the Neuroscience critical care unit

Obtain an orderly and detailed history from the patient and/or family members,reliably eliciting appropriate information

Correctly integrate the findings from the history and the neurological and medical examinations to localize the neurologic and critical care problems

Formulate a diagnostic plan incorporating appropriate laboratory, physiological data, and imaging

Define a comprehensive management plan for the patient’s neurocritical problem(s) Appreciate the considerations of appropriate and cost-effective patient evaluation Understand the management of end-of-life issues, palliative care, and counseling of

patients and families, including issues related to brain death and the vegetative states

Become familiar with the brain death exam and ancillary assessments of brain death Manage various aspects of hemorrhagic stroke such as SAH, ICH, SDH, and EDH

hemorrhages Become familiar with cerebral hemodynamics as they relate to management of

various disease entities such as SAH, ICH, and acute ischemic stroke Learn about the principles of intracranial pressure monitoring (e.g., ventricular

catheters, Camino monitors) and the medical management of increased intracranial pressure and cerebral edema

Manage patients with status epilepticus and become familiar with various

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pharmacologic management strategies Manage routine critical care and medical aspects of patient care Become familiar with the diagnosis and management of fluid and electrolyte

abnormalities associated with neurologic and neurosurgical diseases such as SIADH and diabetes insipidus

Communicate and interact effectively with the floor neurology team, as well as with patients, medical staff, and colleagues

VI. EvaluationSince the resident is under frequent supervision of the rotation director, there should be ample

opportunity for immediate feedback on issues of patient history, examination, and ICU management. In addition, a formal evaluation, which goes into the resident’s master file, will be filled out at the completion of the rotation. Feedback from the resident to the rotation director during the rotation will be encouraged, and formal evaluation of the rotation by the resident will occur at the completion of the rotation.

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ROTATION OBJECTIVESNeuromuscular Disorders / Electromyography (EMG)


I. IntroductionThis rotation will provide basic knowledge and clinical experience in neuromuscular

pathophysiology, diagnosis and therapy. In addition the resident will become proficient with the technical aspects of nerve conduction studies (NCS) and electromyography (EMG), as well as, the interpretation and clinical application of the findings. Exposure to the clinical aspects of neuromuscular disorders in children and adults will be derived from the outpatient clinic and inpatient consultation services. A fundamental knowledge of the histopathology of neuromuscular disease will be obtained through the review of muscle and nerve biopsies in the neurology neuromuscular laboratory.

II. DurationEach neurology resident will spend one or more months on the rotation. In addition, each resident

will attend the introductory lecture series for new Neuro-physiology fellows, in the year in which the resident is scheduled to participate in this rotation.

III. Rotation FacultyThe neurology resident works with several different board certified neurologists. Each faculty

member has additional board certification in electrophysiology and/or electromyography. The resident is also taught by electrophysiology fellows and a technician.

Faculty Members: Jonathan Glass, M.D., Linton Hopkins, M.D., Jaffar Khan, M.D., John Sladky, M.D., Michael Benatar M.D, PhD, Taylor Harrison MD

IV. Rotation EnvironmentThe rotation takes place at The Emory Clinic, Emory University Hospital, and Grady Memorial

Hospital. The vast majority of patients are seen in an outpatient laboratory setting, but inpatients are also evaluated. All of the EMG machines are digital. There are many educational resources available to the residents at the site of the laboratory: video tapes, audio tapes, textbooks, interesting case files.

V. ObjectivesUpon successful completion of this rotation, the Neurology Resident will be able to:1) Obtain a comprehensive history of neuromuscular-specific signs and symptoms, from patients and

other lay historians, in addition to obtaining comprehensive general historical history and examination.

2) Develop an appropriate differential diagnosis of neuromuscular disease based upon the clinical data.3) Appropriately order and apply the results of laboratory, genetic and electrophysiologic testing as

indicated by the history and physical examination findings. 4) Distinguish the electrophysiological characteristics of myopathy from neuropathy.5) Distinguish the electrophysiological characteristics of demyelinating neuropathy from axonal

neuropathy.6) Appropriately choose patients that would benefit form a muscle and or nerve biopsy.7) Distinguish the histopathological findings of a neuropathy from a myopathy. 8) Become familiar with the information obtained from the common stains used for the

histopathological analysis of muscle and nerve biopsies. 9) Choose appropriate pharmacologic, physical therapy, and counseling modalities for the

neuromuscular diseases.

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10) Become familiar with the use, adverse effects and monitoring of the immunomodulatory medications commonly used to treat various neuromuscular diseases.

11) Be able to perform the common motor and sensory nerve conduction studies of the upper and lower extremities.

12) Be able to perform the needle examination.13) Identify and apply the clinical significance of the waveforms analyzed during the needle examination.14) Become aware of the common technical fallacies and pitfalls of nerve conduction studies.

Upon successful completion of this rotation, the neurology resident will have:1) Completed multiple EMG/NC studies and interpreted the results2) Been exposed to the clinical and basic science research of the Neuromuscular Faculty3) Prepared, presented and defended a EMG/NCS at the EMG conference on Tuesday Morning

VI. Daily Schedule

MondayAMClinic (Benatar)

PM

EMG (Harrison)

TuesdayAMEMG ConfClinic (Glass)

PM

EMG (Khan)

Glass Rounds

WednesdayAM

MDA Clinic or ALS Clinic orDaltonPM

EMG (Sladky)

ThursdayAM

EMG (Benatar)

PM

Muscle and Nerve Histopath

FridayAMGrand RoundsResident LecIndependent ReadingPM

Peds NM Clinic at Dunwoody(Sladky)

Note: On the first Wednesday of every month the Resident will attend the MDA clinic in Dalton, GA for the entire day (with Dr. Linton Hopkins – call 404.778.3452 for more info). Grady continuity clinic should be scheduled (or swapped) so that residents do not miss key sessions.

VII. EvaluationThe resident is evaluated by the faculty at the end of the rotation based on his or her ability to achieve

the above described expectations. Feedback is given on a daily basis by the supervising faculty. A written evaluation is submitted to the Program Director at the conclusion of the rotation.

VIII. Reading List

Required Reading:1) Griggs RC. Evaluation and Treatment of Myopathies.2) Mendell JR, Kissel JT, and Cornblath DR. Diagnosis and Management of Peripheral Nerve

Disorders3) Stewart JD. Focal Peripheral Neuropathies.4) Preston DC, Shapiro BE. Electromyography and Neuromuscular Disorders.5) Perotto. Anatomic Guide for the Electromyographer.

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Recommended Reading:1) Dyck, P. Peripheral Neuropathy2) Engel AG. Myology: Basic and Clinical3) Katirji, B. Neuromuscular Disorders in Clinical Practice

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ROTATION OBJECTIVESEpilepsy and Electroencephalography (EEG)


I. IntroductionThis six week, full-time rotation will provide essential knowledge and clinical experience in epilepsy

pathophysiology, diagnosis, and therapy, and in interpretation and application of electroencephalography (EEG). The resident’s exposure to epilepsy and EEG will be primarily via participation in three areas: (1) outpatient epilepsy clinic (2) inpatient and outpatient EEG reading (3) epilepsy monitoring unit.

II. DurationEach Neurology resident will spend six weeks on this rotation. In addition, each resident will attend

the introductory lecture series for new Neuro-physiology fellows, in the year in which the resident is scheduled to participate in this rotation.

III. Rotation Director and FacultyRotation Director:

Suzette LaRoche, M.D., Assistant Professor of NeurologyAdditional Faculty:

Page B. Pennell, M.D., Associate Professor of NeurologyCharles M. Epstein, M.D., Professor of NeurologySandra Helmers, M.D., Associate Professor of NeurologyThomas R. Henry, M.D., Professor of NeurologyPhilip J. Holt, M.D., Assistant Professor of Neurology and PediatricsArchana Koganti, M.D., Assistant Professor of NeurologyLarry D. Olson, M.D., Assistant Professor of Neurology and Pediatrics

These faculty members are board certified by the American Board of Psychiatry & Neurology in adult or pediatric neurology, and are board certified or eligible in clinical neurophysiology. Fellows enrolled in the department’s ACGME-accredited Clinical Neurophysiology Training Program also participate in this rotation.

IV. Rotation EnvironmentThe primary sites of the rotation are the Emory University Hospital, the Emory Clinic, and Grady

Memorial Hospital. These procedures are interpreted in reading rooms of the Clinic and Hospital, which are equipped with high-resolution digital display. The Clinical Neurophysiology Fellows’ Room is available to the Residents for on-site access to reference texts and other education materials including an EEG teaching syllabus and EEG teaching files. The residents have access to the extensive collection of texts and journals of the Emory University School of Medicine Biomedical Library, located in a nearby building.

V. Educational Objectives and Expectations

A. Outpatient Epilepsy clinic

Expectations: Participation in 2 half day clinics at Emory Epilepsy Center working with various epilepsy attendings and 1 half day clinic at the Grady Seizure Clinic.

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NEUROLOGY RESIDENT HANDBOOK Emory University_____________________________________________________________________________________Objectives:1) Obtain comprehensive history of ictal semiology and other epilepsy-specific signs and symptoms in

addition to obtaining comprehensive general neurological history and examination. 2) Describe commonly occurring abnormalities detected with EEG, MRI and other laboratory studies used

in initial seizure evaluation, and appropriately order and apply results of these studies in patient care. 3) Classify seizures and epilepsies based on clinical and laboratory data. 4) Choose appropriate anti-epileptic drug (AED) therapy and other therapies for initial treatment of

seizures, and describe pharmacokinetics, pharmacodynamics, dosing and important adverse effects of commonly used AEDs.

5) Identify AED-refractory seizure disorders, describe applications of diagnostic video-EEG monitoring in evaluation of uncontrolled seizures, and utilize reports of video-EEG in clinical care of patients with epileptic and non-epileptic seizures.

6) Describe epilepsy surgery, vagus nerve stimulation, the ketogenic diet, and other therapies used in AED-refractory epilepsies.

B. Outpatient/Inpatient EEG:Expectations: Personally interpreted and prepared reports for 30 routine inpatient or outpatient

EEG studies and personally run one routine EEG, including electrode application. Participation in daily EEG attending rounds.

Objectives:7) Describe the physiological basis of scalp EEG generation. 8) Describe all steps in acquisition of routine EEG (based, in part, on personally undergoing a routine EEG). 9) Define generators of evoked potentials and interpret normal and abnormal studies (including intra-

operative monitoring).10) Describe and recognize normal features of waking and sleeping EEG activity in infants, children, adults

and elderly.11) Describe and recognize pathological EEG features including focal and generalized interictal epileptiform

activity, focal and diffuse background slowing and periodic patterns.12) Recognize common EEG artifacts and benign variants.13) Recognize common patterns seen in comatose and severely encephalopathic patients and describe their

clinical significance.14) Recognize electrographic presentations of status epilepticus.

C. Epilepsy Monitoring Unit:Expectations: Obtain history and physical examination of epilepsy monitoring patients upon admission and daily follow-up thereafter. Follow at least one patient at a time in detail including daily review of video and EEG findings. Participation in daily EMU attending rounds.

Objectives:15) Differentiate non-epileptic and epileptic seizures based on semiology and electrographic presentation.16) Recognize and describe ictal EEG discharges both focal and generalized. 17) Recognize various seizure semiologies and classify by seizure type and epilepsy syndrome.18) Become familiar with epilepsy surgery evaluation including intracranial EEG monitoring and cortical

mapping. In addition, on successful completion of this rotation, the Neurology Resident will have: 1) Prepared and presented a one-hour presentation on an important topic of epilepsy or EEG at the

Thursday Teaching Conference.

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NEUROLOGY RESIDENT HANDBOOK Emory University_____________________________________________________________________________________VI. Evaluation

The Clinical Neurophysiology faculty member(s) who supervise the resident during the rotation will provide a written evaluation of the resident. The final written evaluation is submitted to the Director of the Neurology Residency Training Program. In addition, each resident will be required to take a test at the end of the rotation that will cover the educational objectives outlined above. Each resident will also be given the opportunity to take the annual clinical neurophysiology in-service examination in the spring of their PGY-4 year to assess their central neurophysiology knowledge.

VII. Reading ListRequired Reading *:1) Fisch B. Spehlmann’s Primer of EEG.2) Leppik IE. Contemporary Diagnosis and Management of the Patient with Epilepsy, 5rd Ed. 2002. * To be completed by the end of the one-month rotation.Recommended Reading:Daley DD, Pedley TA (eds.). Current Practice of Clinical Electroencephalography, 2nd Ed. New York:

Raven Press. 1990.Wyllie E (ed.). The Treatment of Epilepsy: Principles and Practice, 2nd Ed. Philadelphia: Lippincott

Williams & Wilkins. 2001.Other Recommended Sources:Engel J Jr, Pedley TA (eds.). Epilepsy: A Comprehensive Textbook Philadelphia: Lippincott-Raven

Publishers. 1998.Lüders HO (ed.) Epilepsy Surgery Philadelphia: Lippincott Williams & Wilkins. 1992.Niedermeyer E, Lopes da Silva F (eds.). Electroencephalography: Basic Principles, Clinical Applications,

and Related Fields, 3rd Ed. Baltimore: Williams & Wilkins. 1993.Nuwer MR. Evoked Potential Monitoring in the Operating Room. Raven Press: New York. 1987.

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ROTATION OBJECTIVESNeurology Services at Wesley Woods Center


I. IntroductionThe Wesley Woods Neurology rotation offers a rich environment for Medical Students, Psychiatry Residents, Neurology Residents, and Attendings to learn together in the unique setting of the Wesley Woods Center. The focus at Wesley Woods is on aging in its broadest sense. The Emory University Center for Health in Aging is housed on the Wesley Woods campus and brings together expertise and medical leadership from the Schools of Medicine, Nursing, Public Health, and Theology to the study and practice of Gerontology and Neuroscience. The Departments of Neurology, Psychiatry, Rehabilitation, Pathology, and Medicine provide medical services and conduct most of the research activities at Wesley Woods.

II. DurationThe Neurology resident spends two months on the Neurology rotation at Wesley Woods during the first and second years of training.

III. Rotation Faculty

Allan Levey, M.D., Ph.D. Chairman of NeurologyDirector, Alzheimer’s Disease Center

James Lah, M.D., Ph.D. Chief of Neurology at Wesley WoodsDirector, Wesley Woods Neurobehavior Program

Jorge Juncos, M.D. Associate Chief of Neurology at Wesley WoodsDirector, Inpatient Services

These individuals and other faculty from the Movement Disorders and Cognitive Neurology programs, provide attending coverage on the inpatient Neurology Consultation Service as well as the outpatient Neurology Subspecialty Clinics based in the Wesley Woods Health Center.

IV. Rotation EnvironmentThe Neurology Service provides consultation liaison services to the Psychiatry, Medicine, and Rehabilitation Services at Wesley Woods Hospital. Additional services are provided at Budd Terrace and A.G. Rhodes Nursing Home. The inpatient setting provides opportunities to develop skill in diagnosing and managing neurologic illnesses in a diverse group of hospitalized geriatric patients. The Wesley Woods campus is also home to several outpatient clinics focusing on Parkinson’s, Alzheimer’s, Huntington’s, and other neurodegenerative diseases. Since these diseases typically have a chronic, progressive clinical course, the outpatient clinic is the best setting in which to gain first-hand experience with these diseases. Out-patient programs include the Alzheimer’s Disease Center, Memory Disorders Clinic, Huntington’s Disease Center and Clinic, the Movement Disorders Program and associated clinics (Parkinson’s Disease, Dystonia, Tourette’s, and Botulinum Toxin and Spasticity Clinics), and the Sleep Disorders Laboratory. Residents participate in both the in-patient and out-patient activities during their rotation.

V. Educational Objectives and Expectations

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NEUROLOGY RESIDENT HANDBOOK Emory University_____________________________________________________________________________________General Educational Goals Appreciate the parameters of normal aging and learn to diagnose and treat age-related neurologic

problems Develop familiarity with the evaluation and management of Parkinson’s, Alzheimer’s, and other

common neurologic diseases affecting elderly patients Gain an understanding of the pathogenesis of neurodegenerative disorders Learn to recognize neurologic presentations of psychiatric disease and to appreciate the psychiatric

manifestations of neurologic disorders Learn to appreciate and weigh social and cultural factors in the clinical expression and management of

chronic, age-related neurologic disease Achieve an appreciation for special decision-making considerations involving elderly patients based on

their individual life circumstances as well as medical circumstances Learn to appreciate the special rehabilitation issues of the elderly and/or cognitively impaired Learn to communicate and relate successfully with patients, families, medical staff and ancillary

personnel who participate in the care of patients with chronic, age-related neurologic disorders Appreciate bioethical issues inherent in providing comprehensive neurologic care to the elderly and to

those with chronic, degenerative neurologic disease

Expectations for Neurology Attending Teach appropriate neurologic evaluation and management skills through individual case discussions and

critical review of the clinical decision making process. Plan and prepare formal didactic sessions. Relevant topics may be selected based on appropriate cases

from the inpatient or outpatient services. Alternatively, topics may be selected from the rotation syllabus. Coordinate outpatient clinical participation by Medical Students and Psychiatry Residents. Participate in development and refinement of a core syllabus for the Wesley Woods Neurology rotation. Provide feedback and written evaluations for all Medical Students and Residents.

Expectations for Neurology Resident The Neurology Resident will direct and supervise members of the Neurology Consultation service. Participate in teaching activities for junior team members. Attend outpatient clinics in Memory Disorders (Monday AM) and Movement Disorders (Tuesday AM)

Clinics each week. In addition, the Neurology Resident will participate in Huntington’s Disease clinic every other week (2nd and 4th Thursday AM).

Develop expertise in the evaluation and management of Parkinson’s and related movement disorders, Alzheimer’s disease and other dementias, gait disorders, altered mental status, agitation in demented patients, and other common neurologic problems encountered in geriatric populations.

Achieve a thorough understanding of the pathophysiology and principles of management for important causes of basal ganglia disorders and dementing illnesses.

VI. EvaluationThe residents will be evaluated by the attending physicians as well as by each other. The attending physician will give the resident formal feedback at such times as the faculty member thinks is appropriate, but certainly at the end of the rotation. A written evaluation will be filed with the residency program director’s office.

Updated 8/04

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Wesley Woods Neurology RotationINTRODUCTIONThe Wesley Woods Neurology rotation offers rich opportunities for Medical Students, Psychiatry Residents, Neurology Residents, and Attendings to learn together in the unique setting of the Wesley Woods Geriatric Center. The Neurology Consultation Service provides inpatient Neurology Consultations in the Wesley Woods Geriatric Hospital. The inpatient setting provides opportunities to develop skill in diagnosing and managing neurologic illnesses in a diverse group of hospitalized geriatric patients. The Wesley Woods campus is also home to several outpatient clinics focusing on Parkinson’s, Alzheimer’s, Huntington’s, and other neurodegenerative diseases. Since these diseases typically have a chronic, progressive clinical course, the outpatient clinic is the best setting in which to gain first-hand experience with these diseases.EDUCATIONAL GOALSThe general educational goals of the Wesley Woods Neurology Rotation are to: Develop familiarity and expertise in the evaluation and management of Geriatric inpatients with Parkinson’s disease,

Alzheimer’s disease, gait disorders, and other common neurologic conditions affecting elderly patients. Achieve an appreciation for special decision-making considerations involving elderly patients based on their individual life

circumstances as well as medical circumstances. Learn the clinical features and principles of management for neurodegenerative conditions through regular participation in

outpatient Movement Disorders, Cognitive Neurology, and Huntington’s Disease clinics. Expand the base of knowledge on the clinical features and pathophysiology of a variety of neurodegenerative diseases through

independent reading, directed reading, and didactic sessions.EXPECTATIONS FOR NEUROLOGY ATTENDING Teach appropriate neurologic evaluation and management skills through individual case discussions and critical review of the

clinical decision making process. Plan formal didactic sessions at least once weekly. Relevant topics may be selected based on appropriate cases from the

inpatient or outpatient services. Alternatively, topics may be selected from the rotation syllabus. Coordinate outpatient clinical participation by Medical Students and Psychiatry Residents. Participate in development and refinement of a core syllabus for the Wesley Woods Neurology rotation. Provide feedback and written evaluations for all Medical Students and Residents.EXPECTATIONS FOR NEUROLOGY PGY-3 RESIDENT The Neurology Resident will direct and supervise members of the Neurology Consultation service. Participate in teaching activities for junior team members. Attend one half-day outpatient clinic in Movement Disorders (Tuesday AM – Dr. Alan Freeman) and Cognitive Neurology

(Monday AM – Dr. Allan Levey) each week. In addition, the Neurology Resident will participate in Huntington’s Disease clinic every other week (2nd and 4th Thursday AM – Drs. Greenamyre and Testa).

Develop expertise in the evaluation and management of Parkinson’s disease and related movement disorders, Alzheimer’s disease and other dementias, gait disorders, altered mental status, agitation in demented patients, and other common neurologic problems encountered in geriatric inpatient populations.

Achieve a thorough understanding of the pathophysiology and principles of management for important causes of basal ganglia disorders and dementing illnesses.

EXPECTATIONS FOR PSYCHIATRY PGY-1 RESIDENT Develop familiarity with the evaluation and management of neurological conditions commonly encountered among

hospitalized geriatric patients. Participate in teaching Medical Students the basics of history-taking and physical examination, and refine his or her own skills

in Neurologic History and Examination. Develop familiarity with outpatient evaluation of common movement disorders and dementing illnesses. The Psychiatry

Resident will participate in one half-day outpatient clinic per week with the Neurology Attending. In addition, the Attending will coordinate additional outpatient exposure in other specialty areas (e.g. Movement clinic if Attending’s specialty is Cognitive Neurology).

Achieve a basic understanding of the pathophysiology and principles of management for the most important causes of dementia and movement disorders.

PROCEDURES FOR NEUROLOGY ADMISSIONS TO WESLEY WOODS GERIATRIC HOSPITAL

Selection of appropriate admitting service Neurology patients with acute medical illnesses may be appropriate for admission to the Medicine service at WWGH. Typical

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indications for admission might include evaluation and treatment of acute infections, metabolic disturbances, and mild encephalopathy.

Patients with baseline dementia and significant behavioral disturbances or those patients with primarily psychiatric or neuropsychiatric indications for admission are appropriate for admission to the Psychiatry or Neuropsychiatry units.

If the patient is a new patient who requires an extensive diagnostic assessment for a neurological condition, consider admitting the patient to the EUH Neurology service.

Any Neurology Attending with admitting privileges at WWGH has the option of admitting patients independently. These patients will not be covered by the Wesley Woods Neurology Consultation Service, and the Neurology Attending assumes primary responsibility for all aspects of the patient’s admission and care.

Admission proceduresAs a courtesy to our Medicine and Psychiatry colleagues, direct contact should be made by the Neurology Attending with the Medicine or Psychiatry Attending.

Medicine admissions: Monday-Friday, 8am-5pm Page the Medicine Inpatient Attending with patient information (name, date of birth, diagnosis with HPI, and availability

of Wesley Woods outpatient or hospital records) to confirm that the patient meets admission criteria, discuss approach to the case, and ascertain bed availability.

Ask Neurology admissions coordinator to contact Intake Office (404-728-6222) with patient information, insurance information, and diagnosis.

Ask Neurology admissions coordinator to page Neurology Resident on Wesley Woods Neurology Consultation Service regarding admission and fax clinic notes if available.

Psychiatry or Neuropsychiatry Unit admissions: Monday-Friday, 8am-5pm Ask Neurology admissions coordinator to contact the Intake Office (404-728-6222) with patient information to confirm

that patient fulfills criteria for admission and that a bed is available. Intake office will determine whether the patient will be admitted to Dr. Larry Tune or Dr. Frank Brown. The Neurology Attending will page Dr. Tune or Brown to discuss the patient. Ask Neurology admissions coordinator to page Neurology Resident on Wesley Woods Neurology Consultation Service

regarding admission and fax clinic notes if available.

Medicine/Psychiatry/Neuropsychiatry Unit admissions: Weekdays after 5pm, Saturday, Sunday In general, admissions after regular weekday hours will occur after the patient has been evaluated by the EUH or CLH

Emergency Department, and the ED staff will coordinate these admissions. In rare instances, if direct admission is felt to be appropriate, this should be coordinated with the service appropriate On-

Call Attending (WWGH schedule available through WW operator at 404-728-6200).

Neurology consultations The patient will frequently require evaluation and management of chronic neurologic conditions, and it is anticipated that the

Neurology Consultation team will assist the primary service during the hospitalization. The admitting service will routinely order a Neurology consultation. The Neurology Consultation team will be expected to follow the patient throughout the hospitalization.

Follow up care Follow-up in Medicine or Psychiatry clinics may be arranged as deemed appropriate by the primary service. The Neurology Consultation team will assist in arranging appropriate Neurology follow-up and communicate with the

patient’s outpatient Neurologist.

Problem resolutionPlease report any difficulties with these procedures to Jim Lah (PIC #15358 or [email protected]).

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mailto:[email protected]


ROTATION OBJECTIVESNeuro-Ophthalmology


I. IntroductionThis document provides guidelines for neurology residency training in the clinical subspecialty of

neuro-ophthalmology. The scope of neuro-ophthalmology encompasses two parent disciplines, neurology and ophthalmology. As such, much of the time spent by a neurology resident in neuro-ophthalmology should be focused on learning the anatomy, physiology, pathophysiology, examination techniques, and language of the discipline of ophthalmology.

II. DurationEach neurology resident will spend one or more months assigned to the Neuro-

Ophthalmology Unit for full-time outpatient clinical training.

III. Rotation Director and FacultyThe neurology resident will have full-time one-on-one contact with a fellowship- trained neuro-

ophthalmologist, board certified in either ophthamlmology or neurology, with a clinical practice primarily dedicated to neuro-ophthalmology. Ophthalmologists or neurologists currently in neuro-ophthalmology training will also provide supervision and teaching.

Rotation Director: Nancy J. Newman, M.D.Professor of Ophthalmology and NeurologyInstructor in Neurosurgery

Faculty: Valerie Biousse, M.D.Assistant Professor of Neurology

IV. Rotation EnvironmentThe rotation will take place primarily in the Neuro-Ophthalmology Unit at Emory University. This is

a state-of-the-art facility with all the standard equipment needed to perform a complete neuro-ophthalmology examination, including acce4ss to slit lamp biomicroscopy, indirect ophthalmoscopy, formal visual field testing and ocular photography. There is an on-site neuro-ophthalmlogy library with access to all the standard resource texts of neuro-ophthalmology, neurology, ophthalmology, and neurosurgery. There is a continuous flow of neuro-ophthalmology patients seen under faculty supervision. The resident will regularly perform initial patient work-ups including history and examinations utilizing the techniques of neurology and ophthalmology. The resident will receive instruction and experience in ordering and evaluating tests of visual function, such as perimetry, and in interpreting neuro-imaging and electrophysiologic testing, including visual field evoked potentials and electroretinography. Frequent neuroimaging consultation and conferences are an integral activity of the Unit

V. Educational Objectives and Expectations The neurology resident will be exposed to a wide variety of conditions falling within the scope of neuro-ophthalmology. This experience will include disorders of the anterior and posterior afferent visual pathways, the ocular motor system, orbital disease, disorders of the cranial nerves and disorders of the eyelids. The resident should be able to assess the patient with visual loss, diplopia, nystagmus, papillary abnormalities, or ptosis. The major categories of disease affecting the eye, orbit, and brain, including infections, neoplasm, occlusive and non-occlusive vascular disease, inflammatory disorders, degenerative conditions, hereditary disease and nonorganic psychogenic disorders, will be experienced. The neurology

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NEUROLOGY RESIDENT HANDBOOK Emory University_____________________________________________________________________________________resident will also be exposed to other eye conditions that are generally considered within the scope of other ophthalmic specialties.

By the end of the neuro-ophthalmology rotation, the neurology resident should gain the following skills: Be conversant with the anatomy of the cerebral visual pathways and brainstem motility pathways. Be able to perform a reliable neuroophthalmic history and examination and communicate this

information efficiently. Feel comfortable with the basic evaluation of patients with optic neuropathy (especially optic

neuritis, anterior ischemic optic neuropathy, compressive optic neuropathy, chronic papilledema), disc edema, unexplained visual loss, diplopia (3rd, 4th, 5th, 6th nerve palsies, supranuclear and internuclear disorders, myasthenia gravis, thyroid ophthalmopathy), ptosis and nystagmus.

Be able to order appropriately and interpret Goldmann and Humphrey visual fields.

VI. EvaluationSince the resident is under almost constant supervision of the rotation director, there should be ample

opportunity for immediate feedback on issues of patient history, examination and management. In addition, a formal evaluation that goes into the resident’s master file will be filled out at the completion of the rotation. Feedback from the resident to the rotation director during the rotation will be encouraged and formal evaluation of the rotation by the resident will occur at the completion of the rotation.

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ROTATION OBJECTIVESChild Neurology


I. IntroductionIn order to fulfill their Neurology Residency training requirements every Neurology Resident will

complete training in Child Neurology. The rotation will include experience in both inpatient and outpatient settings and, in addition to general child neurology, will include exposure to more specialized areas of the discipline such as neonatal neurology, neurorehabilitation, pediatric epilepsy and epilepsy monitoring, neuromuscular disease, and movement disorders in childhood. Residents will learn diagnostic and management principles for common and rare neurological conditions in children. Emphasis will be placed on fundamental issues of developmental neurobiology as they apply uniquely to normal/abnormal neurodevelopment in children.

II. DurationThe neurology resident will spend a minimum of three months on the Pediatric Neurology rotation

during the second and/or third year of training.

III. Rotation Director and FacultyOverall responsibility for coordinating the various components of the rotation will reside with the

Division Director, John T. Sladky, M.D. Four other faculty members will also participate on a rotating basis as the primary inpatient attending who will supervise the inpatient component of the rotation and who will be responsible for daily teaching rounds with the resident and medical students.

IV. Rotation EnvironmentThe Division of Pediatric Neurology at the Emory University School of Medicine has inpatient

consultative responsibilities at four sites: Egleston Children’s Hospital, Hughes-Spaulding Children’s Hospital, and the Grady Memorial and Crawford Long Hospitals’ neonatal nurseries. The primary inpatient neurology service is at Egleston Children’s Hospital. The core education during the rotation is structured around this experience with daily didactic teaching rounds followed by teaching rounds at the bedside. Residents will be supervised in inpatient consultations at each of the other facilities. In addition, there are busy Emergency Departments at both Egleston and Hughes-Spaulding for which acute neurological consultative services are provided.

While on the Child Neurology rotation, residents will participate in a minimum of three half-day general child neurology outpatient clinics each week. Two of the clinics are on the Emory campus, with the third at Hughes-Spaulding. Each of the resident clinics is staffed by two attending pediatric neurologists to provide resident supervision but, more importantly, to utilize this fertile environment for the one-on-one mentoring of the residents in the practice of clinical child neurology. In addition to the assigned clinics, elective participation in specialized clinics is encouraged. These sub-specialty experiences include epilepsy, ketogenic diet, neuromuscular, neurogenetics, brain tumor, neurorehabilitation and spasticity clinics.

V. Educational Objectives/ExpectationsNeurology residents will perform their Pediatric Neurology rotation in the second and third years of

their neurology residency. It is anticipated that, at this stage of their training, they will have mastered the basics of adult general neurology and will be able to take a fluent history and be familiar with the neurological examination. During the course of their rotation residents will be exposed to patients and their families in both inpatient and outpatient settings and will refine their understanding of the following topics:

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NEUROLOGY RESIDENT HANDBOOK Emory University_____________________________________________________________________________________ The normal pattern and tempo of acquisition of developmental skills in children and patterns of

deviation from normal in pathological conditions Nuances of the neurological examination unique to preterm and term neonates, infants, and toddlers Developmental influences on neurodiagnostic investigations Importance of genetic factors in the evaluation of children with abnormal neurological development Pathogenesis of neurogenetic/metabolic degenerative disorders unique to this age group Management of children with chronic neurological diseases and the impact of those diseases on families Recognition and management of pediatric neurological emergencies in the Emergency room and

intensive care unit Refine communication skills with patients, families, and other health care providers in coordinating the

care of complex neurological disorders Understand social and cultural factors as they influence disease presentation and management strategies Incorporate bioethical issues into the overall plan for comprehensive care of the patient and their family

VI. EvaluationThe responsibility for the formal written evaluation of the resident will be assumed by the attending Neurologist who was the primary inpatient attending during the resident’s rotation. These will be completed only after consultation with other faculty members who interacted with the resident in outpatient clinic settings before submission to the Residency Director. Because residents and faculty work closely together on a daily basis, there is ample opportunity for informal feedback and constructive criticism during the course of the rotation. For similar reasons, the Attending Neurologist comes to know the strengths and weaknesses of each of the residents quite thoroughly in the course of their three months on Pediatric Neurology. These insights are incorporated into a final evaluation prepared by the Division Director after completion of the three-month rotation. The residents also complete a formal but anonymous evaluation of their attending at the end of each month.

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ROTATION OBJECTIVESOutpatient Clinics


I. IntroductionThis rotation allows the resident to attend a variety of neurology subspeciality clinics with neurology faculty.

II. DurationDuration: ½ month to 1 month

III. Rotation FacultyRotation Director: Dr. Jane Gilmore, the Associate Residency Program Director. All Neurology faculty members may participate in the rotation. Resident must designate at least one faculty member to compile faculty feedback in order to write a Resident Evaluation at the end of the rotation.

IV. Educational Objectives and Expectations:o The resident is scheduled to attend nine half-days of clinic. One half day will be in their own continuity

clinic at Grady, and the remainder will be in different subspeciality clinics per half day, including Ataxia, Epilepsy, Movement Disorders (including Huntington’s Disease, Tourettes, Botulinum Toxin, Surgical, as well as general Movement Disorders), Vestibular, Neuro-ophthalomology, Stroke, Neuromuscular (including ALS, MDA, Dalton, as well as general Neuromuscular), Sleep, Child Neurology, and Neurobehavior Clinic.

o The resident is expected to be at all clinics on time and actively see and evaluate patients with the attending.

o Additional reading or study is at the discretion of the faculty. o If the resident wishes to do a clinic other than what is assigned in the schedule outlined below, they

MUST submit a revised rotation schedule to the program coordinator one month in advance of the start date of the rotation. All faculty members will be informed of your anticipated participation in their clinic in advance of your rotation start date.

VI. Daily Schedule

MondayAM Levey - Neurobehavior

PMContinuity ClinicORRye - Sleep

TuesdayAMDeLong – Movement Disorders

PMChimowitz - Stroke

WednesdayAMContinuity ClinicORHenry - Epilepsy

PMContinuity ClinicOR Tusa – Vestibular

OR 1st WedALL DAY- Daltonwith Hopkins & Sladky - MDA

ThursdayAMGreenamyre – Huntington’s (WW)OREvatt – Mvmt. Dis

PMContinuity ClinicORHopkins - Neuromuscular

FridayAMGrand Rounds &Resident Lecture

PMFreeman – BoTox

Each ½ day is assigned as above, except Friday morning for Grand Rounds and other conferences. of 76


IV. Rotation EnvironmentThe clinics will take place at The Emory Clinic, Wesley Woods, and The Center for Rehabilitation Medicine, and Grady Hospital.

VIII. Reading ListRequired and Suggested Reading assigned at the discretion of the individual faculty.

VII. EvaluationEach resident will select one or two faculty to write Resident Evaluations at the end of the rotation. Any additional faculty may fill out evaluations as they see fit. The resident is expected to submit an Attending Evaluation to the Program Coordinator on their faculty evaluator(s).

Faculty evaluator(s) must be designated by the resident:

Evaluator(s): ________________________________ _________________________________

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ROTATION OBJECTIVESAtlanta VA Hospital Rotation


I. IntroductionThis document provides guidelines for neurology residency training at the Atlanta VA Hospital. The scope of activities for the resident at the VAH includes neurological consultation services for in-patients and out-patients, including consultations in the Emergency Department.

II. DurationThe neurology resident will typically spend one month or four weeks on this rotation.

III. Rotation DirectorGeorge Wilmot, M.D., Ph.D., Assistant Professor of Neurology

IV. Rotation EnvironmentThe rotation will take place at the Atlanta VAH, located on Clairmont Road. This location is approximately three miles from the Emory medical center complex. The VAH is a busy facility treating veterans from the Atlanta metropolitan area as well as throughout Georgia. Patients are referred to the Atlanta VAH for sub-specialty care, including neurological care, from other VA facilities. CT and MR imaging is available at the Atlanta VAH.

V. Educational Objectives and ExpectationsThe resident will be expected to:

Provide expert neurology consultation services to in-patients and out-patients at the Atlanta VAH. There should be appropriate follow-up of these patients.

Provide responsive consultation advice to physicians at the Atlanta VAH, as well as other VAH physicians contacting the neurology service.

Present the patients evaluated to an attending neurologist in a manner dictated by the urgency of the neurological problem. Consult urgently with an attending neurologist if there are critical issues regarding optimal patient care.

Be available for clinic sessions in a timely fashion and provide consultation to the in-patient service and Emergency Department in a responsive manner, appropriate to generally accepted standards of care.

Be familiar with the level of scientific evidence guiding patient management decisions. Be familiar with the scientific basis of neurobiology that is appropriate for providing expert

neurological care. Be a teaching resource for health professionals at the Atlanta VAH.

VI. EvaluationThe neurology attending physicians will provide feedback to the neurology resident on an on-going basis. In addition, a formal evaluation, which goes into the resident’s master file, will be filled out at the completion of the rotation by those attendings spending time with the resident. Feedback from the resident to the Rotation Director will be encouraged, and formal evaluation by the resident of the Atlanta VAH rotation will occur at the completion of the rotation.

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ROTATION OBJECTIVESNeuropathology


I. IntroductionThe goal of the neuropathology rotation is to provide residents with basic factual information and

experience in neuropathology necessary to begin a successful career in academic or community neurology, with particular attention to covering the broad spectrum of disorders encountered on Neurology Board Examinations.

II. DurationEach neurology resident will spend two months on the rotation during their second or third year of

neurology training.

III. Rotation Director and FacultyThe neurology resident works with several different board certified neuropathologists, research

scientists, and fellows, including the following:

Stephen Hunter, M.D., Assistant Professor and Director of NeuropathologyBruce Wainer, M.D., Ph.D., Professor of Pathology and NeurologyDaniel Brat, M.D., Assistant Professor of PathologyJonathan D. Glass, M.D., Professor of Neurology and Pathology (Nerve and Muscle)John T. Sladky, M.D., Professor of Pediatrics and Neurology (Nerve and Muscle)

IV. Rotation EnvironmentThe rotation takes place at Emory University Hospital, where the resident will also have access to

relevant specimens from other hospitals in the Emory system. Nerve and muscle pathology is done in the Neuromuscular Laboratory, WMB 6th floor.

V. Educational Objectives Become familiar with the basic principles and diagnostic criteria involved in the interpretation and

reporting or pathology specimens from the brain and spinal cord. These specimens will include surgical frozen sections, permanent sections and cytology preparations.

Become familiar with the technique of brain cutting and the salient features of brain and spinal cord diseases encountered at autopsy. The resident will understand basic pathophysiologic mechanisms involved in degenerative, vascular, infectious, demyelinating, neoplastic, and metabolic diseases of the nervous system.

Become familiar with the basic principles involved in the interpretation of nerve and muscle biopsy specimens.

Initiate the acquisition of an updated knowledge base in the emerging field of molecular pathobiology. In addition to the learning experiences provided through brain cutting, surgical and autopsy sections, the

resident will also have access to teaching slides and self-study questions for review during the rotation.

VI. ExpectationsThe resident is expected to participate in sign-out rounds as well as the review of frozen sections

when scheduled. The resident is also expected to attend Neuroradiology/Neuropathology Conference, where correlative radiographic and pathologic cases are presented in the context of the patient’s clinical

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NEUROLOGY RESIDENT HANDBOOK Emory University_____________________________________________________________________________________presentation and findings. Weekly sign-outs of Nerve and Muscle specimens with the Neuromuscular Pathology faculty.

VII. EvaluationA written evaluation will be submitted to the Program Director’s office at the conclusion of the

rotation. Because of the close day-to-day contact between the residents and the neuropathologists, informal feedback is given throughout the rotation.

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ROTATION OBJECTIVESSleep/Epilepsy Neurophysiology Elective


I. IntroductionThis is an elective rotation that provides residents with practical knowledge and experience using neurophysiologic tests to assess consciousness, and diagnose sleep and epilepsy-related disorders. Residents will become familiar with the technical aspects of polysomnography (PSG), multiple sleep latency tests (MSLT), actigraphy, intra-operative monitoring (IOM) and electroencephalography (EEG), as well as the interpretation and clinical application of the findings. Residents will have an opportunity to interview, examine and manage patients with various sleep disorders including narcolepsy, restless legs syndrome, sleep disordered breathing, REM behavior disorder (RBD) and pediatric sleep disorders. Residents will review a variety of EEG studies including routine inpatient and outpatient recordings, ambulatory EEG, continuous ICU EEG monitoring and ictal recordings obtained in the epilepsy monitoring unit. A fundamental knowledge of the neuroanatomical and neurophysiological systems involved in consciousness, epileptigenesis, sleep homeostasis, sleep disorders and circadian rhythm generation will be obtained through weekly research and clinical conferences, as well as attending and fellow supervision during diagnostic testing.

II. Duration4 weeks

III. Rotation FacultyRotation Directors:

Suzette LaRoche, M.D., Assistant Professor of Neurology (Epilepsy)*Jeffrey S. Durmer, M.D., Ph.D., Assistant Professor of Neurology (Sleep)*

Epilepsy Faculty:Page B. Pennell, M.D., Associate Professor of Neurology*Charles M. Epstein, M.D., Professor of Neurology*Sandra Helmers, M.D., Associate Professor of Neurology*Thomas R. Henry, M.D., Professor of Neurology*Philip J. Holt, M.D., Assistant Professor of Neurology and Pediatrics*Archana Koganti, M.D., Assistant Professor of Neurology*Larry D. Olson, M.D., Assistant Professor of Neurology and Pediatrics

Sleep Faculty:David B. Rye, M.D., Ph.D., Associate Professor of Neurology*Donald L. Bliwise, Ph.D., Professor of NeurologyKathy P. Parker, Ph.D., R.N., Professor of NursingGary Freed, DO, Professor of PediatricsMichael Decker, R.N., PhD, Assistant Professor of NeurologyGlenda Keating, Ph.D., Instructor of Neurology

*These faculty members are board certified by the American Board of Psychiatry & Neurology in adult or pediatric neurology, and are board certified or eligible in Clinical Neurophysiology, or are Diplomates of the American Board of Sleep Medicine.

IV. Educational Expectations: The resident is scheduled to attend three half-days of sleep clinic. Two half days will be in the adult

sleep clinic, and the remainder will be in pediatric and adolescent sleep clinic. of 76


The resident is expected to be at all clinics on time and actively see and evaluate sleep medicine patients with fellows and attendings.

The resident is responsible for interpretation and preparation of reports for at least 25 routine inpatient and/or outpatient EEG studies, and run one routine EEG, including electrode application.

The resident is responsible for interpretation and preparation of reports for at least 20 outpatient PSG studies and MSLT studies, and run one routine PSG and/or MSLT, including set-up.

The resident is responsible for interpretation of 5 actigraphy studies. The resident is responsible for attending and interpreting 4 IOM studies.

V. Educational Objectives: Be able to obtain a comprehensive history of sleep and wake symptoms in children and adults, and

develop an appropriate differential diagnosis and rudimentary treatment plan for intrinsic and extrinsic disorders of sleep and wake.

Describe the physiological basis of scalp EEG generation, and all steps in the acquisition of routine EEG.

Describe the physiological basis of EEG, surface electromyography (EMG), electro-oculography (EOG), breathing patterns, sleep stage generation and all steps in the acquisition of routine PSG.

Describe and recognize normal and abnormal findings on routine IOM. Describe and recognize normal features of waking and sleeping PSG/EEG activity in infants, children,

adults and elderly. Describe and recognize pathological PSG/MSLT/EEG features including sleep related breathing

disorders, periodic limb movements, narcolepsy, RBD, focal and generalized interictal epileptiform activity, focal and diffuse background slowing and periodic EEG patterns.

Recognize common PSG/EEG artifacts and benign variants. Recognize common EEG/PSG patterns seen in depressed, comatose and severely encephalopathic

patients and describe their clinical significance. Recognize electrographic presentations of status epilepticus. Understand the application of actigraphy to circadian rhythm disorders and nocturnal movement

disorders. Understand the basis and application of behavioral sleep medicine techniques.

VI. Daily Schedule:

MondayAMAdult Sleep Clinic (Durmer)

PMAdult Sleep Clinic (Rye, Parker, Bliwise)

TuesdayAMPeds.&Adol. Sleep Clinic (Durmer)

PMPSG/EEG interpretation

Wednesday9-11 AMPSG/MSLT Teaching, Research & Case Present.

PMPSG/EEG interpretation

ThursdayAMIOM (Epstein)

12:30EEG Teaching, Research & Case Present.PMEEG/PSG interpretation

Friday9-10:30 AMEpilepsy Surg. Conference10:30Grand Rounds

PMEEG/PSG interpretation

IV. Rotation Environment

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The primary sites of the rotation are the Emory University Hospital, the Emory Clinic and the Egleston Children’s Hospital of Children’s Healthcare of Atlanta. PSG and MSLT recordings in adults are performed in the Emory University Sleep Laboratory using stationary digital equipment as well as ambulatory equipment for hospital-based consultations. Similar studies with pediatric patients are performed in the Egleston Sleep Laboratory using stationary and portable digital systems. EEG recordings in adults are performed in the Emory University EEG Laboratory using stationary systems and portable digital systems for IOM. These procedures are interpreted in reading rooms associated with each laboratory, and may be accessed remotely. Actigraphy-based studies are performed in patient homes’ using ambulatory units which are returned to the Emory Sleep Laboratory for interpretation. Residents have available a wide range of basic and clinical literature and textbook collections for reference within the epilepsy and sleep medicine administrative and faculty offices. In addition, residents have access to the extensive collection of texts and journals of the Emory University School of Medicine Biomedical Library.

VIII. Reading Lists

Primary EEG Reading:Fisch B. Spehlmann’s Primer of EEG.Leppik IE. Contemporary Diagnosis and Management of the Patient with Epilepsy, 3rd Ed. Newtown, PA:

Handbooks in healthcare. 1997.

More EEG Reading:Daley DD & Pedley TA (Eds.). Current Practice of Clinical Electroencephalography, 2nd Ed. New York:

Raven Press, 1990.Wyllie E (Ed.). The Treatment of Epilepsy: Principles and Practice, 2nd Ed. Philadelphia: Lippincott

Williams & Wilkins, 2001.

More EEG/Evoked Potentials Resources:Engel J Jr, Pedley TA (Eds.), Epilepsy: A Comprehensive Textbook Philadelphia: Lippincott-Raven

Publishers, 1998.Lüders HO (Ed.) Epilepsy Surgery Philadelphia: Lippincott Williams & Wilkins, 1992.Niedermeyer E, Lopes da Silva F (Eds.). Electroencephalography: Basic Principles, Clinical Applications,

and Related Fields, 3rd Ed., Baltimore: Williams & Wilkins, 1993.Nuwer MR, Evoked Potential Monitoring in the Operating Room. Raven Press: NY, 1987.Sleep/PSG Reading (selected sections of texts and atlases available):Aldrich MS, Sleep Medicine. Oxford University Press, 1999.Kryger M, Roth T, Dement W (Eds.), Principles and Practice of Sleep Medicine, 4th Ed.,

Elsevier/Saunders, 2005.Rechtschaffen A & Kales A, A Manual of Standardized Terminology, Techniques and Scoring

System for Sleep Stages of Human Subjects.Pressman MR, Primer of Polysomnogram Interpretation. Philadelphia: Butterworth-Heinemann

Publishing, 2002.Sheldon S, Riter S, Detrojan M (Eds.), Atlas of Sleep Medicine in Infants and Children. Futura

Publishing, 1999.More Sleep/PSG Reading:Avidon AY and Roos KL (Eds.), Seminars in Neurology: Introduction to Sleep and Its

Disorders; 24(3): September, 2004.Avidon AY and Roos KL (Eds.), Seminars in Neurology: Sleep in Neurological Practice; 25(1):

March, 2005.

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NEUROLOGY RESIDENT HANDBOOK Emory University_____________________________________________________________________________________Chokoverty S (Ed.), SleepDisorders Medicine: Basic Science, Technical Considerations and

Clinical Aspects, 2nd Ed., Philadelphia: Butterworth-Heinemann Publishers, 1999.Chokroverty S, Hening WA, Walters AS (Eds.), Sleep and Movement Disorders. Philadelphia:

Butterworth-Heinemann Publishing, 2002.Espana RA & Scammell TE, Sleep Neurobiology for the Clinician, SLEEP, 2004; 27(4):811-

820.Hauri P & Linde S, No More Sleepless Nights, 2nd Ed. Philadelphia: Wiley Press, 1996.Mindell JA, Sleeping Through the Night, Philadelphia: Harper Collins Publishers, 1997.

VII. EvaluationResidents will be required to keep a log book of EEG, PSG, MSLT, actigraphy and IOM cases observed and interpreted during the month. The log book should include all pertinent clinical data and neurophysiologic findings for each case. The log book will be collected at the end of the rotation and used along with sleep and epilepsy faculty assessment to determine the resident’s level of sophistication with these neurophysiologic tests. Weekly sleep clinics and PSG & EEG conferences (Wed. and Thurs.) will be used primarily as educational sessions, but will also serve as a venue for residents to demonstrate their fund of clinical and neuro-scientific knowledge on specific topics. Residents are required to present cases or technical topics that demonstrate interesting clinical or research issues at the sleep and epilepsy conferences.

_________________________ ________________________ Signature of Resident Signature of Faculty

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ROTATION OBJECTIVESGeneral Neurophysiology

Emory University Hospital Neurology Elective Emory University School of Medicine

I. Description:This is an elective rotation that provides residents with practical knowledge and experience using neurophysiologic tests to assess epilepsy-related disorders and neuromuscular disease. This elective is meant to build on the resident’s basic experience gained during the neuromuscular and epilepsy rotations. The resident will acquire experience with the technical aspects of performing nerve conduction studies, electromyography, and electroencephalography as well as the interpretation of the data, report generation and clinical application of the findings. The resident will acquire this knowledge through time spent in the neurophysiology laboratory, attendance at conferences, and the performance and review of these studies with the neurophysiology attending.

II. Rotation Advisor and Faculty:Rotation Advisor: Jaffar Khan, M.D.Residents may also work with the following faculty members: Michael Frankel, M.D., Archana Koganti, M.D., Jonathan Glass, M.D. Michael Benatar, M.D. Ph.D.

III. Rotation Environment:The primary site of the rotation is Grady Memorial Hospital, with ancillary lab experience and conferences at Emory University Hospital and Clinics.

IV. Educational Objectives: Describe the physiological basis of scalp EEG generation and all steps in the acquisition of routine EEG. Describe and recognize normal features of waking and sleeping EEG activity in adults and elderly. Recognize common EEG artifacts and benign variants. Recognize common EEG patterns seen in depressed, comatose and severely encephalopathic patients and

describe their clinical significance. Recognize electrographic presentations of status epilepticus. Describe applications of and interpret basic diagnostic video-EEG monitoring in evaluation of refractory

seizures. Develop an appropriate differential diagnosis of neuromuscular disease based upon the clinical and

electrophysiological data. Distinguish the electrophysiological characteristics of myopathy from neuropathy. Distinguish the electrophysiological characteristics of demyelinating neuropathy from axonal

neuropathy. Be able to perform the common motor and sensory nerve conductions studies of the upper and lower

extremities. Identify and apply the clinical significance of the waveforms analyzed during the needle examination. Become aware of the common technical fallacies and pitfalls of nerve conduction studies.

Educational Expectations

The resident will be expected to independently perform EMG/NCS with supervison during the rotation.

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The resident will be expected to independently interpret and generate reports on EEGs during the rotation. All reports will be reviewed by the attending and discussed with the resident.

The resident will be expected to independently interpret and create reports on EMG/NCS during the rotation. All reports will be reviewed by the attending and discussed with the resident.

The resident will be expected to attend the Grady and Emory Neurophysiology conferences and Emory Neuromuscular conference.

The resident will be expected to give one 30 minute conference for the Grady Neurophysiology conference.

VI. Daily Schedule

MondayAM-Perform/review EEG/EMG studies

Seizure Clinic (per schedule)

PM12:15-1 PM-Grady neurophysiology conference

-Perform/review EEG/EMG

TuesdayAM8 AM – Emory neurophysiology conference

-Perform/review EEG/EMG studies

PM-Perform/review EEG/EMG studies

4 PM – ???Neuromuscular Rounds

WednesdayAM-Perform/review EEG/EMG studies


5:30-6:30 PM –Combined NR/Neuro/NS/NP conference

ThursdayAM-Perform/review EEG/EMG studies

PM

Perform/review EEG/EMG studies

FridayAMGrand RoundsResident LecturesIndependent Reading


VII. Reading List

Required Reading:1) Preston DC, Shapiro BE. Electromyography and Neuromuscular Disorders.2) Perotto. Anatomic Guide for the Electromyographer. 3) Fisch B. Spehlmann’s Primer of EEG . 4) Leppik IE. Contemporary Diagnosis and Management of the Patient with Epilepsy, 3 rd Edition. 5) Daley DD and Pedley TA. Current Practice of Clinical Electroencephalography.6) Wyllie E. The Treatment of Epilepsy: Principles and Practice, 2 nd Edition .

Recommended Reading: (both located in the Health Sciences Library)6) Griggs RC. Evaluation and Treatment of Myopathies.7) Mendell JR, Kissel JT, and Cornblath DR. Diagnosis and Management of Peripheral Nerve Disorder.8) Stewart JD. Focal Peripheral Neuropathies.9) Dyck P. Peripheral Neuropathy.

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10) Engel AG. Myology: Basic and Clinical11) Katirji, B. Neuromuscular Disorders in Clinical Practice.12) Engel J, Pedley TA. Epilepsy: A Comprehensive Textbook.13) Niedermeyer E, Lopes da Silva F. Electroencephalography: Basic Principles, Clinical Applications,

and Related Fields.

VIII. EvaluationThe resident will be evaluated by Dr. Jaffar Khan and/or Dr. Archana Koganti.

Signatures:

____________________________________ _____________________________________Resident date Rotation Advisor date

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ROTATION OBJECTIVESDizziness and Balance Clinic


I. IntroductionPatients with complaints of dizziness and/or disequilibrium are seen at the Dizziness and Balance clinic. Residents will become familiar with aspects of history taking, physical examination, diagnostic evaluation, and treatment of benign paroxysmal positional vertigo, migraine-associated dizziness, vestibular neuritis, Meniere’s disease, psychogenic dizziness, and non-vestibular gait imbalance.

II. Duration2 weeks (daily)4 weeks (could add 2nd elective)

III. Rotation FacultyDr. Ronald Tusa, Professor, and Dr. Sharon Hartman, Assistant Professor, Dizziness and Balance Center, Department of Neurology.

IV. Educational Objectives and Expectations:o The resident is scheduled to attend six half-days of clinic. One half day will be in their own

continuity clinic at Grady, and the remainder will be in clinic.o The resident is expected to be at all clinics on time and actively see and evaluate patients with the

attending.

VI. Daily Schedule

Monday

AM Hartman - Clinic

PMTusa – Clinic

Tuesday

AMVestibular Testing, PT observation, review PowerPoint

PMHartman - Clinic

Wednesday

AMHartman - clinic

PMTusa – Clinic

Thursday

AMVestibular Testing, PT observation, review PowerPoint

PMTusa – Clinic

Friday

AM8:30-9:30 Vestibular case conference; Grand Rounds & Resident Lecture

PMVestibular Testing, PT observation, review PowerPoint

IV. Rotation EnvironmentThe clinics will take place at The Center for Rehabilitation Medicine, 2nd floor.

VIII. Reading ListRequired reading “Practical Management of the Dizzy Patient” by Joel A. Goebel

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VII. EvaluationThere will be both a video and a written test on the last day of the rotation. Dr. Tusa or Hartman will go over the test with the resident for addition learning experience. The resident is expected to submit an Attending Evaluation to the Program Coordinator and a D&B evaluation form to Dr. Tusa or Hartman.

_________________________ ________________________ Signature of Resident Signature of Faculty

__________________ Dates of rotation

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ROTATION OBJECTIVESGeneral Neurology


I. DescriptionThis is an elective rotation that provides residents with experience in evaluating and managing general neurology patients. The resident will be exposed to patients with a variety of neurologic disorders, including, but not limited to, demyelinating disease, CNS neoplasms, headache, neuromuscular disorders, epilepsy-related disorders, and progressive degenerative neurologic disease including movement disorders and dementias. The resident will gain this experience through clinics, electromyography (EMG)/electroencephalography (EEG) lab, and conferences.

II. Rotation Advisor and FacultyRotation Advisor: Gregory Esper, M.D.Residents may also work with the following faculty members: Patricia Behlmer, M.D.

III. Rotation EnvironmentThe primary site of the rotation is The Emory Clinic, with ancillary experiences taking place at Emory University Hospital and Grady Memorial Hospital.

IV. Educational Objectives- Evaluate, diagnose and manage patients with demyelinating disease.- Evaluate, diagnose and manage patients with CNS neoplasms.- Evaluate, diagnose and manage patients with headaches.- Evaluate, diagnose and manage patients with neuromuscular disorders.- Evaluate, diagnose and manage patients with neurologic pain syndromes.- Evaluate, diagnose and manage patients with epilepsy-related disorders.- Evaluate, diagnose and manage patients with progressive degenerative neurologic disease, including

movement disorders and dementias.

Educational Expectations- The resident is expected to attend all clinics with the aforementioned attendings.- The resident is expected to independently interpret EEGs and EMG/ nerve conduction studies (NCS)

and create reports. All reports will be reviewed by the attending and discussed with the resident.- The resident is expected to independently perform lumbar puncture procedures, injections for

headaches, and injections for carpal tunnel syndrome. The attending will be available for all procedures performed.

- The resident will be expected to attend the Emory Neurophysiology, Combined, and Epilepsy conferences.

- The resident may be expected to attend Grady seizure clinic during the rotation.

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NEUROLOGY RESIDENT HANDBOOK Emory University_____________________________________________________________________________________VI. Daily Schedule

MondayAMClinic – Behlmer/Esper

Seizure Clinic (Grady) – per schedule

PMClinic- Behlmer/Esper

EEGs-Esper

TuesdayAM8 AM – Emory neurophysiology conference

EMG/NCS-Esper

PMClinic-Behlmer/Esper

EEGs-Esper

WednesdayAMIndependent Reading

LP clinic(per schedule)

PMClinic-EsperEEGs-Esper5:30-6:30 PM –Combined NR/Neuro/NS/NP conference

ThursdayAMClinic-Esper

PM12:30-1 PM-Emory Epilepsy ConferenceClinic-EsperEEGs-Esper



PMIndependent Reading


VII. Reading List1) Olanow, CW, Watts, RL, Koller, WC. “An algorithm (decision tree) for

management of Parkinson’s disease (2001): Treatment Guidelines.” Neurology 56(11), Supplement 5. 12 June 2001, pp. S1-S88.

2) To be determined.

VIII. EvaluationThe resident will be evaluated by Drs. Gregory Esper and Patricia Behlmer..

Signatures:

___________________________ ____________________________________Resident date Rotation Advisor date

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ROTATION DESCRIPTIONMovement Disorder


I. IntroductionThis rotation will provide basic knowledge and clinical experience in movement disorders to Neurology residents. Similar to the treatment of patients with movement disorders, the schedule is centered on outpatient exposure. The resident will also have the opportunity to observe intra-operative monitoring of patients undergoing neurosurgical procedures for the treatment of movement disorders, and may also observe (and participate in) clinical research. The various clinical settings provide a rich variety of experiences with patients with movement disorders.

II. DurationThis is an elective rotation. Neurology resident are expected to spend at least one month on this rotation.

III. Clinical FacultyStewart Factor, D.O. (director), Garrett Alexander, M.D., Ph.D., Mahlon DeLong, M.D., Marian Evatt, M.D., Alan Freeman, M.D., James Greene, M.D., Ph.D., Robert Gross, M.D., Ph.D. (primary appointment in Neurosurgery), Jorge Juncos, M.D., Claudia Testa, M.D., Ph.D., Thomas Wichmann, M.D., George Wilmot, M.D., Ph.D.

IV. Clinical FellowChristine Doss, M.D.

V. EnvironmentPatients are seen at the Wesley Woods Health Center. Although excellent text books are available for study, the residents will gain most of their experience with movement disorders by seeing patients with these diseases. In addition to the exposure to clinical problems that arise in the care of movement disorder patients, the resident is encouraged to get also acquainted with a number of specific procedures/interventions during this rotation:

1. Functional neurosurgery sessions, done to alleviate the symptoms of movement disorders. Electrophysiologic recording, done routinely to help surgical targeting offers a unique opportunity to directly experience some of the neuronal abnormalities that underlie these disorders.

2. Data collection/patient evaluation procedures in clinical trials3. Toxin (Botox, Myobloc, Dynaport) injections in the treatment of dystonia4. Genetic counseling as part of the care for patients with Huntington’s disease

VI. ObjectivesUpon successful completion of this rotation, the resident will be able to:. Obtain a comprehensive history in patients with movement disorders, as well as their family members. In most cases this also requires to obtain a comprehensive general history to evaluate the patient for conditions associated with their movement disorder.. To perform a competent examination that focuses on specific aspects of movement disorders.. Develop the ability to differentiate movement disorders from other clinical entities, and develop an appropriate differential diagnosis within the field of movement disorders.. Quantify the symptoms of the more common movement disorders by applying rating scales such as the United Parkinson Disease Rating Scale (UPDRS), or the Burke-Marsden-Fahn dystonia rating scale.. Develop an appropriate plan for diagnostic workup, including general and specific laboratory results, genetic testing (as needed), and medication trials as indicated by the history and physical examination findings. . Choose appropriate pharmacologic or physical therapy for the initial treatment of the disorder in question, and counsel the patient on prognostic issues, the need for follow-up, and issues related to their specific social situation.. Develop long-term pharmacologic strategies in the treatment of patients with movement disorders, aimed at reducing drug side effects, while maintaining adequate mobility.. Recognize and treat medication side effects as they arise.

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VII. Current clinic schedule

AM PM

Monday Evatt (Botox)FreemanAtaxia clinic (Wilmot, clinic A)Functional Neurosurgery

FactorFreeman

Tuesday DeLongFactor Freeman

DeLong Freeman

Wednesday AlexanderFreeman (1st and 3rd Wednesday)JuncosFunctional Neurosurgery

AlexanderFreeman (2nd and 4th Wednesday)Juncos

Thursday Factor (Botox)Testa (1st and 3rd Thursday)Huntington’s disease clinic (Testa & Greene, 2nd and 4th Thursday)

Freeman (1st and 3rd Thursday)Wichmann

Friday [Grand rounds/Resident lecture] Botox clinic (Evatt every Friday, Greene 1st, 3rd, and 5th Friday, Freeman 2nd and 4th Wednesday)Juncos (Tourette/pediatric)

Notes: 1. The clinic schedule may change – resident needs to verify with attendings current clinic time.2. Prior to starting the rotation, the month=s schedule needs to be confirmed with the respective clinic

attendings. The interaction between residents and attendings should occur several months in advance to the actual rotation so that clinic patients can be booked appropriately.

3. In general, the resident should attend her/his regular Grady continuity clinic. However, the resident should not miss the opportunity to attend at least one surgical session, one session of the Huntington=s disease clinic, and one Botox clinic. This may necessitate rescheduling or swapping the resident=s Grady clinic.

4. The resident is expected to attend the section’s monthly video discussion sessions. The resident should contact the movement disorder fellow for date, time and location of this meeting.

5. Surgeries generally start around 9:30 AM. The resident is responsible to check for exact dates of surgeries (call Jim Stanton at 404-712-8485).

VIII. EvaluationThe resident is evaluated by each faculty member at the end of the rotation based on his or her ability to achieve the above described expectations. To help in this process, the resident is expected to keep a log of the cases seen in the clinic. Feedback is given frequently by the supervising faculty. A written evaluation is submitted to the residency program director at the conclusion of the rotation.

IX. Suggested ReadingWatts, RL and Koller WC, eds. Movement Disorders, 2nd edition. New York, McGraw-Hill 2004.

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ROTATION OBJECTIVESNeuro-oncology


I. Description: This rotation is designed to give the neurology resident an introductory review of common CNS malignancies. The resident should expect to gain knowledge of epidemiology, clinical presentation, diagnosis/pathology, treatment (including adverse effects), and prognosis of common malignancies.

II. Rotation Advisor and Faculty:Rotation Advisor: _____Dr. Anna Janss, Dr. Phuphanich______Resident may also work with the following faculty members: Dr Jeffrey Olson, Dr Nelson Oyesiku, Dr Ian Crocker, Dr Hui-kuo Shu, Dr Daniel Brat, Dr Steve Hunter, Dr Charlie Hao, Dr Chad Holder and Dr Erwin VanMeir III. Rotation Environment:The rotation will take place within the Neuro-Oncology Clinics at Winship Cancer Institute, as well as the Aflac Cancer and Blood Disorders Clinic of Children’s Healthcare of Atlanta at Egleston. While most time will be dedicated to outpatient clinics, inpatient consults can also be incorperated into the resident’s experience.

IV. Educational Objectives/Expectations: The residents will be able to recognize histological and neuroimaging features of common adult/pediatric

neoplasms Residents should become involved in workup of newly diagnosed CNS malignancies, understand the

initial evaluation and therapy of tumors as well as be familiar with ongoing workup/management of established patients.

Residents are expected to achieve basic understanding of treatment options/modalities for common adult/pediatric neoplasms

Residents should learn classification schemes and prognostic indicators for common malignancies Residents should learn systemic complication of cancer and treatment ie. Spinal cord complication,

meningeal carcinomatosis , peripheral neuropathy, leukoencephalopathy and paraneoplastic syndrome

V. Daily ScheduleNote: Residents that have continuity clinic on Thursdays are expected to arrange a change of clinic to Mon or Wed during their neuro-onc rotation. This is to allow the resident to attend the Pediatric Brain Tumor Survivor Clinic at AFLAC-Egleston.

MondayAM8am-2pm On treatment clinic Egleston (janss)

TuesdayAM/PM8:30-5:00Established pt clinic 2nd floor Winship Cancer InstituteHall-E

WednesdayAM

Time for reading or review of path slides and work with neuro-pathologist

ThursdayAM8am-12:30pm On treatment clinic (2nd/4th th)(Janss) 8:30-5 Brain Tumor clinic at Winship


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PM

Reading of recommended articles/ review of slide setsor review pathology slides withneuropathologist in preparation for Tumor Board

Emory Brain Tumor Conf –12:30-2:00 PMWCI C-3018

Optional: Survivor Clinic at Scottish Rite Children’s Hosp.

Egleston Neuro onc Tumor Board B-52 12:30 (2nd Wed)

PM ProcedureLumbar Puncture and Intrathecal chemotherapy

(Phuphanich)Egleston Brain Tumor Conf 12:30-1:30 (1st, 3rd, 5th in 6th floor conf, B-52 2nd, 4th)PM2-6pm Comp.Brain Tumor Clinic (1st, 3rd, 5th Th)1-4pm Janss 2nd/4th

PM

Article/slide set review

VI. Reading List

Required Reading: (see attached pdf file or Neuro-Onc folder on Yahoo website)14) __________________________________________________________________15) __________________________________________________________________16) __________________________________________________________________

Recommended Reading:17) Neurologic complications of CancerBy Jerome Posner Contemporary Neurology Series #45 (F.A. DAVIS)18) Pathology & Genetics Tumor of the nervous System by Paul Kleihues $& Webster Cavenee (WHO)19) Cancer Neurology in Clinical practice by David Schiff & Patrick Wen (HUMANA PRESS)

VII. EvaluationThe resident will be evaluated by ______________________________________

Signatures:____________________________________ _____________________________________Resident date Rotation Advisor date

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ROTATION OBJECTIVESOutpatient Clinics


I. IntroductionThis rotation allows the resident to attend a variety of neurology subspeciality clinics with neurology faculty.

II. DurationDuration: ½ month to 1 month

III. Rotation FacultyRotation Director: Dr. Jane Gilmore, the Associate Residency Program Director. All Neurology faculty members may participate in the rotation. Resident must designate at least one faculty member to compile faculty feedback in order to write a Resident Evaluation at the end of the rotation.

IV. Educational Objectives and Expectations:o The resident is scheduled to attend nine half-days of clinic. One half day will be in their own continuity

clinic at Grady, and the remainder will be in different subspeciality clinics per half day, including Ataxia, Epilepsy, Movement Disorders (including Huntington’s Disease, Tourettes, Botulinum Toxin, Surgical, as well as general Movement Disorders), Vestibular, Neuro-ophthalomology, Stroke, Neuromuscular (including ALS, MDA, Dalton, as well as general Neuromuscular), Sleep, Child Neurology, and Neurobehavior Clinic.

o The resident is expected to be at all clinics on time and actively see and evaluate patients with the attending.

o Additional reading or study is at the discretion of the faculty. o If the resident wishes to do a clinic other than what is assigned in the schedule outlined below, they

MUST submit a revised rotation schedule to the program coordinator one month in advance of the start date of the rotation. All faculty members will be informed of your anticipated participation in their clinic in advance of your rotation start date.

VI. Daily Schedule

MondayAM Levey - Neurobehavior

PMContinuity ClinicORRye - Sleep

TuesdayAMDeLong – Movement Disorders

PMChimowitz - Stroke

WednesdayAMContinuity ClinicORHenry - Epilepsy

PMContinuity ClinicOR Tusa – Vestibular

OR 1st WedALL DAY- Daltonwith Hopkins & Sladky - MDA

ThursdayAMGreenamyre – Huntington’s (WW)OREvatt – Mvmt. Dis

PMContinuity ClinicORHopkins - Neuromuscular

FridayAMGrand Rounds &Resident Lecture

PMFreeman – BoTox

Each ½ day is assigned as above, except Friday morning for Grand Rounds and other conferences.

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NEUROLOGY RESIDENT HANDBOOK Emory University_____________________________________________________________________________________IV. Rotation EnvironmentThe clinics will take place at The Emory Clinic, Wesley Woods, and The Center for Rehabilitation Medicine, and Grady Hospital.

VIII. Reading ListRequired and Suggested Reading assigned at the discretion of the individual faculty.

VII. EvaluationEach resident will select one or two faculty to write Resident Evaluations at the end of the rotation. Any additional faculty may fill out evaluations as they see fit. The resident is expected to submit an Attending Evaluation to the Program Coordinator on their faculty evaluator(s).

Faculty evaluator(s) must be designated by the resident:Evaluator(s): ________________________________ _________________________________

September, 2003

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OTHER ELECTIVES

Residents may design electives to address specific interests. The Rotation Objectives are to be defined with the supervising faculty and approved by the program director. This following form is to be submitted to the Education Program Office no less than one month prior to the start of an elective rotation.

Residents must:

1.) Decide how they would like to spend their elective time

2.) Designate a faculty member to be their primary elective advisor

3.) Meet with the designated elective advisor to discuss elective objectives, environment, daily schedule, and reading list, etc.

4.) Submit completed and signed form to Program Coordinator no less than one month prior to the start date of the elective.

5.) Program Coordinator will contact faculty members to alert them as to the resident’s plan to attend their clinics, etc. so that the faculty members may plan their patient load accordingly

6.) The Resident’s designated elective advisor will collect feedback from those the resident worked with during the elective and will submit a summative evaluation on the resident’s performance.

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ROTATION OBJECTIVESEmory University Hospital Neurology Elective


Dates of elective: start: _____________ end: ______________

I. Description:_____________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________

II. Rotation Advisor and Faculty:Rotation Advisor: _______________________________________________________________Resident will work with the following faculty members: ______________________________________________________________________________________________________________________________________________________________________________

III. Rotation Environment:______________________________________________________________________________________________________________________________________________________________________________

IV. Educational Objectives/Expectations: ____________________________________________________________________________________

____________________________________________________________________________________ ____________________________________________________________________________________

____________________________________________________________________________________

V. Daily Schedule

VI. Reading ListRequired Reading:

______________________________________________________________________________________________________________________________________________________________________________________________________

Recommended Reading: __________________________________________________________________

VII. EvaluationThe resident will be evaluated by ______________________________________

Signatures:

____________________________________ _____________________________________Resident date Rotation Advisor date

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NEUROLOGY RESIDENT HANDBOOK Emory University_____________________________________________________________________________________EVALUATIONS

Multiple types of evaluation, including both subjective and objective methods, are used to assess knowledge, skills, and attitudes. Written evaluations of resident performance (form attached) are submitted to the Program Director’s office at the conclusion of each rotation. In the event that a resident was supervised by more than one attending during a rotation, a written evaluation is completed by each attending who supervised the resident for a period of two weeks or longer. Each resident meets twice annually with a faculty advisor for a six-month review, and is provided with copies of performance evaluations at time. First-year resident have their first six-month review with the Program Directors in order to give each new resident an opportunity to become acquainted with the faculty before selecting an advisor. In the event of an Unsatisfactory evaluation, the resident is notified immediately by the Program Directors.

Structured oral examinations simulating the American Board of Psychiatry and Neurology Examination Part II are conducted twice annually, in two different formats. The first Mock Oral Board exam consists of three clinical vignettes: one pediatric and two adult neurology cases, which are discussed with three different faculty members. The second Mock Oral Board exam involves a resident performing a live-patient, timed history and examination under the observation of two faculty members. The evaluation forms used in these examinations can be found on the following pages for review.

All Neurology residents participate annually in the Residency In-Service Training Exam (RITE) sponsored by the American Academy of Neurology. The exam typically takes place at the beginning of March. The examination is a day-long written examination consisting of two sessions, each lasting 3 ½ hours. All time away and vacations are to be scheduled such that all residents are available to participate in the examination.

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RESIDENT/FELLOW EVALUATIONDEPARTMENT OF NEUROLOGY

EMORY UNIVERSITY SCHOOL OF MEDICINE

PGY-

RESIDENT/FELLOW NAME MONTH / YEAR LEVEL OF TRAINING

SERVICE :(circle)

EMORY - Ward EMORY - Consult EMORY - Clinic

GRADY - Ward GRADY - Consult WWHC

PEDS VAMC Other: _________________________

GENERAL COMPETENCIES

Faile

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Not

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Impr

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ent

Dem

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d C

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Exc

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d C

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PATIENT CAREResidents must be able to provide patient care that is compassionate,

appropriate, and effective for the treatment of health problems and the promotion of health.

MEDICAL KNOWLEDGEResidents must demonstrate knowledge about established and evolving

biomedical, clinical, and cognate (e.g. epidemiological and social-behavioral) sciences and the application of this knowledge to patient care.

PRACTICE-BASED LEARNING/IMPROVEMENTResidents must be able to investigate and evaluate their patient care practices,

appraise and assimilate scientific evidence, and improve their patient care practices.

INTERPERSONAL & COMMUNICATION SKILLSResidents must be able to demonstrate interpersonal and communication

skills that result in effective information exchange and teaming with patients, their patients’ families, and professional associates.

PROFESSIONALISMResidents must demonstrate a commitment to carrying out professional

responsibilities, adherence to ethical principles, and sensitivity to a diverse patient population.

SYSTEMS-BASED PRACTICEResidents must demonstrate an awareness of and responsiveness to the larger context and system of healthcare and the ability to effectively call on system

resources to provide care that is of optimal value.

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NARRATIVE COMMENTS(Note: This section may be used verbatim in letters of recommendation. Please include strengths and areas of improvement.)

______________________________________________________________________________________________________

______________________________________________________________________________________________________

______________________________________________________________________________________________________

______________________________________________________________________________________________________

______________________________________________________________________________________________________

______________________________________________________________________________________________________

______________________________________________________________________________________________________

Is this individual where he/she should be at this point in training? □ Yes □ No

EVALUATOR’S NAME : (please print legibly)

PLEASE CIRCLE ONE : FACULTY RESIDENT FELLOW STUDENT STAFF

DEPARTMENT :

EVALUATOR’S SIGNATURE : ___________________________________________ DATE: ____________________

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RESIDENT EVALUATION – PROFICIENCY IN EEG CHECKLISTDEPARTMENT OF NEUROLOGY

EMORY UNIVERSITY SCHOOL OF MEDICINE

PGY-

RESIDENT/FELLOW NAME MONTH / YEAR LEVEL OF TRAINING

The resident has demonstrated understanding and proficiency in the following areas:(mark N/A if specific pattern was not seen on any records during the rotation)

______Electrode placement using 10-20 system and acquisition of routine EEG

______Recognize normal waking background in adults

______Recognize normal waking background in children

______Recognize normal sleep activities in adults and children

______Recognize benign EEG changes seen in the elderly

______Distinguish physiological and non-physiological artifacts from cerebral activity (eye blinks, muscle, EKG, 60

cycle, ventilator)

______Identify generalized interictal epileptiform activity

______Identify focal interictal epileptiform activity

______Identify benign variants (rhythmic midtemporal discharges, mu rhythm)

______Identify focal and generalized background slowing and understand clinical significance

Identify the following specific patterns and understand their clinical significance:

______Periodic lateralizing epileptiform discharges (PLEDs)

______Generalized periodic epileptiform discharges (GPEDs)

______Triphasic waves

______Frontally predominant intermittent rhythmic delta activity (FIRDA)

______Burst-suppression

______Recognize focal ictal EEG patterns

______Recognize generalized ictal EEG patterns

______Recognize electrographic status epilepticus

______Differentiate epileptic and non-epileptic seizures by electrographic and clinical presentation

______Prepares concise written reports with clear communication of EEG interpretationand clinical correlation

Signed: ________________________________________Date:__________________

Attending Evaluator: (please print name) _____________________________________

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ATTENDING PHYSICIAN EVALUATIONEMORY UNIVERSITY SCHOOL OF MEDICINE

DEPARTMENT OF NEUROLOGYAttending Physician: ______________________________________________________________________

Please rate (√) the attending physician oneach of the skills described below:

MAR

GIN

AL

SATI

SFAC

TORY

Very

Goo

d

Exce

llent

AVAI

LABI

LITY

Was usually promptAdhered to rounds and conference schedulesKept interruptions to a minimumDevoted enough time to rounds and patient careCOMMENTS:

TEAC

HING

Kept discussions focused on case or topicAsked questions in an appropriate mannerUsed bedside teaching to demonstrate history-taking and examination skillsEmphasized problem-solving (thought processes leading to decisions)Integrated social/ethical aspects of medicine: cost containment, pain control, etc. as appropriateEncouraged team members to read, research, and review pertinent topicsAccommodated teaching to actively incorporate all members of teamCOMMENTS:

Prof

essio

nalis

man

d Pa

tient

Car

e

Always acted in the best interest of the patientDisplayed a respectful attitude toward patientsEstablished rapport with team membersShowed appropriate regard for other specialties and health care professionalsServed as a role modelWas enthusiastic and stimulatingRecognized own limitations; was appropriately self criticalCOMMENTS:

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Please rate (√) the attending physician oneach of the skills Described below: M

ARG

INAL

SATI

SFAC

TORY

Very

Goo

d

Exce

llent

Fund

of

Know

ledg

e &

Cont

inui

ng

Scho

lars

hip

Demonstrated broad knowledge of neurologyWas up-to-dateIdentified important elements in case analysisUsed relevant medical/scientific literature to support decision makingCOMMENTS:

Orga

niza

tion Provided clear expectations at the beginning of rotation

Provided useful feedback including constructive criticism to team membersBalanced service responsibilities and teaching functionsCOMMENTS:

RECOMMENDATIONS:

Please rank order on a scale of1 (most effective) to 9 (least effective)

the services where you believe thisfaculty member would be

most effective:

EMORY INPATIENT

EMORY CONSULTS

GRADY INPATIENT

GRADY CONSULTS

WESLEY WOODS

OUT-PATIENT CLINIC

VASUBSPECIALTY ROTATION

(e.g. EEG/epilepsy; EMG/neuromuscular)

OTHER:

THIS EVALUATION WILL BE HELD IN THE STRICTEST CONFIDENCE. The evaluation form will NOT be given to the attending. Composite information from all evaluations will be abstracted and provided to attendings, in

summary form, annually. Information from this evaluation will be used in determining attending assignments.

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Emory UniversityDepartment of Neurology

M O C K O R A L B O A R D S E X A M I N A T I O NVignette Evaluation

DATE RESIDENT EXAMINER CASE #

COMPONENTS ADEQUATELY PERFORMED?

Localization YES NODifferential Diagnosis YES NO

Diagnostic Plans YES NOManagement / Therapeutic Plans YES NO

DOCUMENTING STATEMENTS & COMMENTS

GRADE: PASS FAIL CONDITIONAL PASS

SIGNATURE OF EXAMINER

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GUIDELINES FOR LIVE PATIENT ORAL BOARDS

The purpose of this exercise is to assess the residents’ skill in obtaining a history and performing a neurological examination. The format is similar to the live patient portion of Part II of the American Board of Psychiatry and Neurology examination.

Two randomly selected faculty members will evaluate each resident. The resident is responsible for contacting the attendings and setting up the date and time for the examination. One of the attendings is responsible for determining where the examination will take place and finding a suitable patient to be examined who has agreed to participate. The attendings on the inpatient or consultation services at any hospital will assist in finding patients. The attending examiner may also arrange an outpatient for the exam.

The time allotted for the resident to take the history and do the examination is 30 minutes. The resident should be informed of the time when 15 and 5 minutes remain. It is suggested the examiners take notes about the resident’s performance throughout the examination on the back of the attached evaluation sheet. The team will then leave the patient’s room to discuss the case for approximately 15 minutes, followed by 10 additional minutes where the attendings may ask questions on any topic. It is suggested the questions be aimed at the resident’s level of training. Finally, the attendings should spend a few minutes giving feedback to the resident about his/her performance.

Please contact me with any questions or problems about the process.

Jane GilmoreJane Gilmore, M.D.

EVALUATION TEAM:

ATTENDINGS: _______________________ RESIDENT: _______________________

RESPONSIBILITIES: RESPONSIBILITIES:* coordinate exam date, place & time w/ resident * contact attendings* find and invite a suitable patient * coordinate exam date, place & time* inform resident when 15 & 5 min remain * arrive promptly on scheduled date* provide verbal & written feedback * initial and verify that evaluation has been* sign and return evaluation sheet returned

30 minutes – History & Patient Exam15 minutes – Discussion of Case

10 minutes – Attendings ask Questions5 minutes – Feedback

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Emory University - Department of NeurologyM O C K O R A L B O A R D S E X A M I N A T I O N

Live Patient EvaluationDATE RESIDENT EXAMINERS

COMPONENTS ADEQUATELY PERFORMED?History PASS CONDITIONAL

PASS FAIL

Comments:

Examination PASS CONDITIONAL PASS FAIL

Comments:

Localization PASS CONDITIONAL PASS FAIL

Comments:

Differential Diagnosis PASS CONDITIONAL PASS FAIL

Comments:

Diagnostic Plans PASS CONDITIONAL PASS FAIL

Comments:

Professionalism PASS CONDITIONAL PASS FAIL

Comments:

Humanistic Qualities PASS CONDITIONAL PASS FAIL

Comments:

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SUMMARY STATEMENTS & COMMENTS

OVERALL GRADE: PASS CONDITIONAL PASS FAIL

EXAMINERS’ SIGNATURES:

RESIDENT’SINITIALS:

Please return completed/signed forms to Pam Julien fax: 404.727.3157 / WMRB 6009

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TEACHING RESPONSIBILITIES

(Adapted from Lecture Handout prepared by Dr. Kate Heilpern and Dr. Alan Otsuki)

All residents teach, and there is no doubt that the instruction received by medical students from residents is a significant part of their education. In addition, residents also teach patients as well as their colleagues, both junior and senior. The word doctor comes from the Latin docer, which does not mean healer, but rather teacher. In addition, it is also true that teaching enhances your own learning. Remember that “ to teach is to learn twice.”

In an effort to enhance your effectiveness in teaching the medical students assigned to Neurology, the Learning Objectives for the Neurology Clerkship, as well as the articles “What should a graduating medical students know about neurology?” is attached for your review. In addition, the following resources are available in the Neurology Library at Grady.

Residents as Teachers:A Guide to Educational Practice, 2nd Ed., Schwenk and Whitman, 1993.

Preceptors as Teachers: A Guide to Clinical Teaching, 2nd Ed., Whitman and Schwenk, 1995.

Creative Medical Teaching , Whitman, 1990.Essential Hyperteaching: Supervising Medical Students and Resident, Whitman,

1997.The Courage to Teach, Parker, PJ, Josey-Bass, Inc., 1998.

Please keep in mind the following points with regard to resident teaching:

Goals and Objectives

Recognize the resident’s responsibility for patient care and teaching: patients, families, colleagues, medical student, and self

Identify opportunities for teaching on the run at the bedside, on rounds during procedures morning report and conferences special “teaching moments”

Recognize the special reasons why residents can be good teachers availability near peer novice learner role model do not ever use e-mail to deliver negative commentary do not shift blame to the student (“the student told me he

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Teaching Responsibilities (continued):

Teaching Recognition Awards:

The medical students at Emory have acknowledged their appreciation of resident teachers by establishing an Outstanding Resident Teacher Award bestowed annually. The winner of the award, as well as the select pool of nominees from which the winner is chosen, is honored at the Senior Graduation Banquet. The Department of Neurology is fortunate to have had several residents honored by the medical students in this manner in the past. In addition to the annual teaching award supported and funded by the medical school, the individual medical school classes have chosen to recognize additional resident teachers by establishing separate Teaching Recognition Awards. The Department of Neurology has been fortunate to have its residents honored in this manner in the past. We are proud of the dedication to teaching that our resident have shown.

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NEUROLOGY CLINICAL CLERKSHIP

Residents will supervise and teach medical students when they rotate onto the neurology service each month. At the end of each rotation, residents will be asked to write an evaluation on the students they supervised.

Dr. Linton Hopkins is the Clerkship Director. He can be contacted at the Emory Clinic at 404.778-3452 (assisted by Shanna Miller).

GOALS AND OBJECTIVES:

Learn the 12 major symptoms of neurologic disease. Learn how to localize symptoms and signs to specific places in the brain, spinal cord, peripheral nerves, and muscle.

Perform a competent neurological exam that solves the problems brought out in

your history, i.e. is focused toward the complaint of your patient. Become familiar with the diagnosis and management of ten chronic neurological

disorders that are common and treatable (such as carpal tunnel syndrome and migraine), and ten neurologic emergencies (such as TIA, subarachnoid hemorrage and spinal epidural abscess).

Produce a vignette and image every week about the patient and subject you think will be of most interest to your peers. You will be writing to enhance your own learning as well as that of your peers.

Consider researching a neurologic topic of interest to you. Submit a ten-page original paper with at least 5 references to the course director for credit.

Learn the skill of asking about your own performance in a way that invites constructive criticism, and seek to understand the reasons for the subjective part of your grade. Everyone can improve in some way. One of your jobs is to find out what we think of you.

VISTING PROFESSORS

Each year the Department of Neurology sponsors a visiting professor noted for both academic excellence and teaching skill to come and spend time with the residents. Typically, the visiting professor will spend two days in patient-centered educational activities at Grady and Emory in addition to delivering Grand Rounds and having dinner with the residents.

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DISCRETIONARY FUNDS AND SUPPORT

The Department of Neurology provides discretionary funds for each resident to cover travel expenses to an academic meeting or to purchase textbooks or other approved educational materials.

The amount of discretionary funds available to residents is determined annually and can not be accumulated from one year to the next. Funds are available at the beginning of the department’s fiscal year, September 1, and MUST be spent by June 30 of each academic year.

The discretionary fund is $750.00/resident. Residents may purchase medical books, medical equipment, a PDA, and other pre-approved educational items. Purchase of computers and computer equipment with book funds is NOT permitted. You may opt to have the Program Coordinator order books through Majors online on your behalf at a discounted price. For Majors book orders, send an email to [email protected] which includes the title, author, and ISBN number of the book(s) you’d like to order. Pam will call you when your order arrives.

INSTRUCTIONS FOR REIMBURSEMENT: The accounting department has very strict guidelines regarding documentation required for reimbursement. To receive a book fund reimbursement, submit the following to the Program Coordinator:

1. ORIGINAL RECEIPT(S) taped to a 8 1/2”x 11” sheet of paper 2. copy of PROOF OF PAYMENT, bank or credit card statement, to the Program

Coordinator. Obviously, no proof of payment is necessary for cash purchases.

Funds will be direct deposited into your bank account within four weeks.

Attendance at approved meetings must be anticipated well in advance and coordinated through the Chief Residents so that adequate call coverage can be provided. Keep in mind that one week of resident vacation is set aside for attendance at meetings, so meeting attendance should coincide with scheduled vacation time. Jeopardy may NOT be used to attend meetings.

AAN Membership:The department also arranges for membership in the American Academy of Neurology for each resident. This membership is renewed in January of each training year.

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TRANSCRIPTION TIPSPlease complete all transcriptions on the day of discharge if at all possible. Discharge summaries should be succinct, no more than 1-2 typewritten pages. For the Emory in-patient service, please list the Ward Attending as the attending for all patients, including the Epilepsy Monitoring Unit patients. The Epilepsy Monitoring Unit Attending is a consulting neurologist. The Ward Attending is the patient’s attending of record, and the discharge summary should reflect that fact.

Please use complete words and sentences. Avoid jargon. Never use abbreviations and avoid contractions. Speak clearly. Please spell any words that you think a transcriptionist may not understand.

The transcriptionists are general medical transcripitionists who are not necessarily familiar with all neurologic terms.

Please spell the names of all people, including your own. Please include, at the conclusion of the transcription, the name (and addresses,

if readily available) of all physicians to whom a copy of the transcription is to be sent. This should include, at a minimum, the referring physician and any physicians who are to see the patient in follow-up.

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TEMPLATE FOR MORNING REPORT PRESENTATIONS

The following template contains the required elements of a complete presentation:

Introductory Statement to orient the listenerMr. Jones is an 86 year old patient followed by Dr. Evatt for Parkinson’s Disease admitted form

the ER last night with difficulty swallowing and a recent fall.

History Relevant Physical Examination Neurological Examination

Mental Status (includes LOC, speech, language, cognition at a minimum)

Cranial Nerve and Fundus Examination Sensory Examination Motor Examination Gait Coordination Reflexes

Anatomical Localization Differential Diagnosis Assessment & Plan (includes diagnostic and therapeutic plan)

Imaging studies are ordered to test a specific hypothesis; thus, they are part of the diagnostic plan and follow rather than precede the derivation of the anatomical localization and differential diagnosis.

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DEPARTMENT AND MEDICAL SCHOOL POLICIES

Policies regarding vacation, moonlighting, all forms of leave (e.g., family, medical, disability, etc.), as well as all information pertaining to benefits, may be found in the Housestaff Training Manual published by the Office of Graduate Medical Education (available on the web at www.emory.edu/WHSC/MED/GME/index.html). Please be aware that the professional services of the Emory Employee Assistance Program (EEAP), are available to all residents 24 hours per day. An overview of the program, listing its services and the appropriate telephone numbers, are found on the following pages.

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FACULTY / STAFF ASSISTANCE AND WELLNESS PROGRAM (FSAP)

OVERVIEW & ELIGIBILITYThe Faculty Staff Assistance Program (FSAP) provides professional counseling and consultative services designed to enhance the health, performance and well-being of individuals and organizational units, while also fostering a greater sense of community.

In this capacity, it functions as a resource for faculty, staff, physicians, administrators, and their family members. It also serves as a management support system for leadership.

Services provided by the FSAP are confidential and are rendered in private office locations to ensure the comfort of the clients that are served.

The program is available to the faculty, staff, and family members of those employed by the Emory University and Emory Healthcare. House staff members in the Residency Training Program, School of Medicine are also served by the FSAP.

COMPONENTSThe FSAP staff assists clients with identifying options, strategies and resources for addressing issues and concerns impacting their ability to live or work in a healthy manner.

Services include professional consultations and interventions for a wide range of individual and organizational behaviors, issues, and needs provided in three core areas, which include:

behavioral mental health,

organizational dynamics, and

health promotion and wellness

BEHAVIORAL MENTAL HEALTHThe FSAP offers confidential and professional consulting, counseling, education, and referral services, which cover areas such as family and spousal/ partner relationships, parenting, and eldercare concerns; alcohol and substance abuse, as well as other addictive behaviors; financial pressures; legal issues; psychological issues (i.e., depression, anxiety), stress, conflict; career counseling and work-related matters.

Clients are encouraged to call the FSAP before a concern becomes a crisis. Any change, however subtle, in productivity, competency, attendance or behavior is often the first indicators that help may be needed.

Licensed professional mental health providers committed to client respect and privacy offer behavioral mental health services in a confidential location.

ORGANIZATIONAL DYNAMICSThe FSAP provides organizational development, assessment and intervention services to enhance the overall effectiveness of departments, units and/or divisions.

Leadership consultations are conducted via preliminary needs analyses to determine the focus of the organizational challenge, which may relate to change management, communication difficulties, conflict issues, and/or strategy planning and development.

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NEUROLOGY RESIDENT HANDBOOK Emory University_____________________________________________________________________________________These process consultation services are custom designed following a comprehensive needs assessment, involving both leadership and staff members.

HEALTH PROMOTION & WELLNESSThe FSAP also provides services to enhance individual and organizational health and wellness. A comprehensive program designed to deliver health education and wellness services to Emory departments and locations complements the many services available through the Emory HealthCare. Further information about wellness is available by calling 727-WELL.

ACCESSING THE FSAPFSAP services may be accessed directly by individuals or through supervisory recommendations or referrals.

Individuals seeking services for themselves or a family member are encouraged to call the FSAP directly for information or to schedule an appointment or consultation.

The FSAP seeks to support emotional health and well-being by working with individuals to address concerns before they negatively impact the person or their workplace performance. Thus, early consultations and interventions are strongly encouraged.

While the FSAP does offer crisis intervention and debriefing services for individuals and groups, it encourages utilization of its services early and often, before a crisis develops or before a change in productivity, attendance or behavior becomes a debilitating pattern.

LEADERSHIP & THE FSAPThe FSAP is a resource whenever an individual indicates to leadership that a personal concern or problem exists, even though there may be no immediate or discernible impact on work performance. Leadership is encouraged to recommend that an individual visit or consult with the FSAP at the first indication of a behavior change (however subtle or slight) in productivity, competency, attendance or performance.

The FSAP provides consultative services regarding the behavior and group dynamics of Emory’s departmental units, and the impact on individual and organizational effectiveness. As such, it serves as a resource of education and information for administrators, managers, supervisors and others in sorting through organizational, behavioral or performance issues. In addition, the FSAP will assist leadership with identification of interventions strategies, as well as providing consultation about when and how to recommend/refer someone to the FSAP.

SUPERVISORY REFERRALIn certain instances, leadership may determine in consultation with the FSAP that referring an individual to the FSAP is advisable and necessary. Such referral is generally based upon a demonstrated pattern of declining productivity, erratic attendance or atypical behavior. To make a referral, a supervisor must first consult directly with the FSAP. This confidential consultation is designed to review facts, perceptions, observations and circumstances in order to determine the most appropriate way of proceeding.

All FSAP services are confidential. Clients generally control what they want to share about their situation and with whom they want to share information. (Faculty Staff Assistance Programs do have a “duty to protect and warn” under certain prescribed circumstances.)

When an individual comes to the office as a supervisory referral, the clinician will verify to the referring supervisor that the employee is working with the FSAP. While the FSAP may provide ongoing consultation

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NEUROLOGY RESIDENT HANDBOOK Emory University_____________________________________________________________________________________with the supervisor, details or information about the type or nature of services will not be provided except as authorized by the client.

GENERAL INFORMATIONThe FSAP does not provide a shelter or protection from adverse consequences of such acts as erratic attendance, unsatisfactory productivity or unacceptable behavior. In addition, utilization of FSAP services may not be held or used against an individual. The program offers an opportunity and a method for identifying and dealing with the underlying cause(s) of performance-impairing issues.

Individuals who utilize FSAP services may do so at no loss in pay and without using any accrued leave time. Where a clinical assessment indicates that time away from work is warranted, it may be necessary for an individual to request and use appropriate leave.

The FSAP is a pivotal and important resource for assessing whether it is appropriate for an individual to be at work. The FSAP is available to certify, based on clinical review, an individual’s need to be absent from work or the need for a medical leave of absence. The FSAP also is available to facilitate communications regarding an individual’s return to work from medical and/or disability leave.

Assessments and short-term sessions with the FSAP’s licensed clinicians are provided at no cost to employees or family members. The FSAP maintains program and referral linkages with EmoryCare and EmoryChoice providers, as well as with other community resources to facilitate the appropriate referrals, when additional services are indicated based upon a client’s clinical needs and/or financial circumstances.

LOCATIONThe FSAP is based in the Emory Well House, located on Emory’s main campus at 1735 Lowergate Drive, directly across from the patients’ and visitors’ entrance to Lowergate Parking Deck. The FSAP also maintains an office at Crawford Long Hospital in the Byron Building, 549 Peachtree Street, Suite 3518.

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PATIENT TELEPHONE CALL GUIDELINES (EMORY)

1. Make clear to the patient, in a polite way that you are the resident on call and are available for urgent or emergent issues only.

2. If a patient needs an essential prescription refill (i.e., a neurological medication that they take on a regular basis), they should be given a four day supply. This should be enough to bridge until their clinic physician can give them a more complete refill. Under certain circumstances (holiday weekends or Christmas), they may need an extra day or two. They should be instructed to call their clinic physician on the next business day.

3. No Narcotics, Refills or Otherwise. Ever! If you have questions about requests for other drugs with abuse potential (e.g., benzos), discuss it with the attending on call.

4. If they are only calling to leave a message for their clinic physician, they should be instructed to call back during business hours.

5. Do not promise (or suggest) an expedited clinic visit (e.g., “Dr. DeLong will see you tomorrow.”).

6. Do not make any major changes in patient management (e.g., changes from dilantin to tegretol) without explicitly discussing it with the attending n call.

7. Calls from outside physicians should be directed to the attending on call.8. For non-neurologic issues, the patient should call their primary care physician.9. Document each phone call on the provided log sheet. Give the log sheet to

Shirley Franks on the next business day.10. Always inform the patient that it is his/her responsibility to call their clinic

physician the next day to follow-up an evening call.11. Always call the attending on call with any question.12. In general, you are an emergency bridge to allow the patient to make it

through to the next business day, when they can call their clinic physician.13. If it’s a true emergency, they need to go to the emergency room.

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Neurology Resident Summer Lecture SeriesJuly-August, 2005

7/5/05 8-9am The Neurological Exam Dr. Hopkins Clinic A, 4th Floor Conference Room(Tues) 9-10am Intracerebral Hemorrhage Dr. Samuels

7/8/05 8-9am Acute Stroke Dr. Frankel Clinic A, Brown Auditorium (Fri) 9-10am Coma “

7/12/05 8-9am Intro to Neuro-Ophth Dr. Newman Clinic A, 4th Floor Conference Room(Tues) 9-10am “ “

7/15/05 8-9am Neuro-Ophth in the ER Dr. Biousse Clinic A, Brown Auditorium(Fri) 9-10am “ “

7/19/05 8-9am Intro to Movement Disorders Dr. Greene Clinic A, 4th Floor Conference Room(Tues) 9-10am Brain Death Dr. Samuels

7/22/05 8-9am Neuromuscular Emergencies Dr. Benatar Clinic A, Brown Auditorium(Fri) 9-10am Multiple Sclerosis Dr. Gilmore

7/26/05 8-9am Vestibulopathy/Dizziness Dr. Tusa Clinic A, 4th Floor Conference Room(Tues) 9-10am “ “

7/29/05 8-9am Eye Movements Dr. Tusa Clinic A, Brown Auditorium(Fri) 9-10am “ “

8/2/05 8-9am Introduction to EEG Dr. LaRoche Clinic A, 4th Floor Conference Room(Tues) 9-10am “ “

8/5/05 8-9am Adult Epilepsy Dr. Henry Clinic A, Brown Auditorium(Fri) 9-10am The Pediatric Neuro Exam Dr. Krawiecki

8/9/05 8-9am Status Epilepticus/ICU EEG Dr. LaRoche Clinic A, 4th Floor Conference Room(Tues) 9-10am Intro to Pharmacokinetics Dr. Olson

8/12/05 8-9am Introduction to Statistics Dr. Benatar Clinic A, Brown Auditorium(Fri) 9-10am CSF Analysis Dr. Khan

8/16/05 8-9am Brainstem Neuroanatomy Dr. Rye Clinic A, 4th Floor Conference Room(Tues) 9-10am “ “

8/19/05 8-9am Approach to Neuropathy Dr. Glass Clinic A, Brown Auditorium(Fri) 9-10am Approach to Myopathy “

8/23/05 8-9am Dementia Dr. Ringholz Clinic A, 4th Floor Conference Room(Tues) 9-10am Intro to Sleep Medicine Dr. Durmer

8/26/05 8-9am Intro to Neuroradiology Dr. Hudgins Clinic A, Brown Auditorium(Fri) 9-10am Intro to Brain Tumors Dr. Brat

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Emory University Clinical Neurophysiology Fellows2005-06 Review of Clinical Electrophysiology

8:00 am - 9:00 am, 3rd floor conference room, Emory Clinic Building A

Date Topic Faculty

July 12 Nerve Conduction Studies T. HarrisionJuly 14 Normal and Non-Epileptiform Abnormal EEG of

AdulthoodA. Koganti

July 19 Interictal Epileptiform EEG Abnormalities P. PennellJuly 21 Diagnostic Ictal Video EEG Recording; Seizure &

Epilepsy ClassificationT. Henry

July 26 Presurgical Ictal Video EEG Recording & Electrocorticography

T. Henry

July 28 Electrophysiology in the Operating Room C. EpsteinAug 2 The Needle Examination: Part I J. KhanAug 4 The EEG of Childhood Epilepsy Syndromes L. OlsonAug 9 The Needle Examination: Part II J. KhanAug 11 No lectureAug 16 Evoked Potentials C. EpsteinAug 18 Normal and Non-Epileptiform Abnormal EEG of

ChildhoodP. Holt

Aug 23 Electrophysiology of Peripheral Neuropathy and Motor Neuron Disease

J. Glass

Aug 25 Carpal Tunnel Syndrome M. BenatarAug 30 Disorders of Neuromuscular Transmission M. BenatarSept 1 ICU Monitoring S. LaRocheSept 6 Normal Pediatric & Adult Sleep Architecture;

Instrumentation for Recording Sleep: Polysomnography & Actigraphy

D. Bliwise

Sept 8 Electrophysiologic Correlates of Respiration in Sleep: Sleep Disordered Breathing

D. Bliwise

Sept 13 Assessment of Daytime Sleepiness: Multiple Sleep Latency Testing (MSLT) and Maintenance of Wakefullness (MWT)

D. Rye

Sept 15 Electrophysiologic Assessment of Parasomnias: Nocturnal Movement Disorders and Epilepsy

D. Rye

Sept 20 Technical Aspects of EEG & EEG Artifacts C. EpsteinSept 22 Autonomic Testing* L. FreedmanSept 27 Radiculopathy J. KhanSept 29 Myopathy T. HarrisionOct 4 Treatment of Epilepsy with VNS S. Helmers

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NEUROLOGY RESIDENT HANDBOOK Emory University_____________________________________________________________________________________NEUROLOGY GRAND ROUNDS SCHEDULE: SEE WWW.NEUROLOGY.EMORY.EDU

ACGME PROGRAM REQUIREMENTS FOR RESIDENCY EDUCATION IN NEUROLOGY

www.acgme.orgSee “Program Requirements” for Neurology

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