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Curriculum

Objectives of Neurology Resident Education

Patient care that is compassionate, appropriate, and effective for the treatment of health problems and the promotion of health.

Medical 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 and improvement that involves investigation and evaluation of their own patient care, appraisal and assimilation of scientific evidence, and improvements in patient care.

Interpersonal and communication skills that result in effective information exchange and teaming with patients, their families, and other health professionals.

Professionalism, as manifested through a commitment to carrying out professional responsibilities, adherence to ethical principles, and sensitivity to a diverse patient population.

Systems-based practice, as manifested by actions that demonstrate an awareness of and responsiveness to the larger context and system of health care and the ability to effectively call on system resources to provide care that is of optimal value.

Specific Objectives for the PG 2, 3, and 4 years of training (Program levels 1, 2 and 3)

PGY-2 Year

Patient care: The resident will develop clinical skills centering on the evaluation and treatment of patients with neurological diseases. Special attention will be placed on neurological examination skills, the management of neurology inpatients, and the management of neurological emergencies. The practice of Evidence-Based Medicine and practice-based learning will be emphasized on a daily basis. Skills will be assessed weekly by the supervising attending and senior residents as well as by Oral Board prep conference leader (Program Director) regularly.

Medical Knowledge: The resident will develop a fundamental knowledge base covering clinical neurology and basic neuroscience. Residents will attend clinical and basic science lectures and neurology conferences as well as study independently. Reference material for each rotation will be provided. Knowledge base will be assessed by faculty and senior residents who supervise clinical work as well as by conference lecturers who monitor progress.

Attitudes: The development of interpersonal skills and professionalism will be emphasized on all clinical rotations. The resident will develop skills in priority setting, stress management, and time management. Skills will be assessed at the end of each rotation by the appropriate attending.

PGY-3 Year

Patient Care: The resident will expand their skills in the evaluation and treatment of patients with neurological diseases. Special attention will be placed on patients receiving outpatient neurological evaluations and inpatient neurological consultation. In addition, subspecialty skills will be emphasized including developing pediatric neurological examination techniques and fundamental interpretation of EEG and EMG. Skills will be assessed weekly by the supervising attending and chief residents as well as by Oral Board prep conference leader (Program Director) regularly.

Medical Knowledge: The resident will build on the fundamental knowledge base created during the first year. Areas for improvement will be identified via the previous years evaluations and reviewed with the resident during their biannual meeting with the Program Director. The resident will continue to attend the clinical and basic science lectures, conferences, and study independently. Second Year rotations on subspecialty services including Pediatric Neurology, EEG/Epilepsy, and EMG/Neuromuscular, Neuroradiology, Neuro-oncology/Neuropathology will expand the resident’s knowledge base in these areas.  Clinical research skills will be developed.

Attitudes: Continued polishing of interpersonal skills and professionalism will be emphasized on all clinical rotations. Skills will be assessed at the end of each rotation by the appropriate attending. Professional development will be reviewed with their faculty advisor each quarter in order to develop future plans following residency, including applying for fellowship positions.

PGY-4 Year

Patient Care: The resident will continue to refine their skills in the diagnosis and management of patients with neurological diseases. A key element of their education and professional development is the supervision of junior residents. The PG4 residents should progress toward independency in terms of their clinical skills and at the end of the year be fully prepared to evaluate and manage neurological patients without supervision. Skills will be assessed at the end of each rotation by the appropriate attending and by the program director during the mock oral examination format of the weekly review course.

Medical Knowledge: The resident will again build their clinical and basic neuroscience knowledge base especially centering on areas for improvement identified during the previous year. The resident will continue to attend clinical and basic science lectures, conferences, and study independently. Special attention will be placed on subspecialty training on the resident's electives including research based electives.

Attitudes: The PG4 resident is expected to have mastered stress and time management skills in all clinical neurological settings. Interpersonal skills and professionalism will continue to be stressed and monitored closely with the expectation that on completion of the residency program, he or she will display these qualities in an exemplary fashion. Professional development will again be reviewed with their advisors on a quarterly basis.

Residents are taught to master the following major areas in Neurological Science:

Signs and Symptoms in Clinical Neurology The Neurological Exam Localization in Neurology Neurodiagnositic studies Lumbar puncture Neuroradiology (CT, MRI, Interventional Radiology, Ultrasonography) Neurophysiological studies (EMG, NCV; EEG; Evoked potentials) Neurological Diseases Headache disorders Neuroophthalmology and neurootology Cerebrovascular disease Infections of the nervous system Neurological Trauma MS and related disorders Systemic and Metabolic Disease Movement disorders Neurooncology Epilepsy Sleep Disorders Nerve and Muscle Disease Ataxias Neurological Pain syndromes Dementias and disorders of behavior Critical Care Neurology Neuro-Rehabilitation Child Neurology Basic Neuroscience Neuroanatomy Neuropathology Neuroimmunology Neurogenetics Neuropharmacology Neurophysiology

Clinical Teaching

As in all residency training, learning clinical skills tends to revolve around patients seen in our clinics and admitted to our hospitals. Neurology service and Consultation service patients are seen daily. Mentoring occurs at several levels with primary educators including Ward service attending neurologist, Consultation attending neurologist, Elective supervising neurologist, and Chief resident. Below is a summary of the clinical experience in the Dartmouth Neurology Program.

Training Year	Inpatient DHMC	Inpatient VA	Required rotations/Elective
PG2	4-6 blocks DHMC Adult Inpatient Neurology Longitudinal DHMC General Neurology Clinic one half-day/week) 1-2 blocks Urgent service	4 blocks VA Hospital Adult Inpatient Neurology Consultation service Longitudinal VA General Neurology Clinic 3 half-days/week	Longitudinal DHMC General Neurology Clinic one half-day/week) Longitudinal VA General Neurology Clinic 1 half-day/week
PG3	4 blocks DHMC Neurology Consult 2 Blocks Urgent service EEG technology and interpretation Longitudinal DHMC General Neurology Clinic two half-days/week	Longitudinal VA General   Neurology Clinic one half-day/week when on elective rotations	6 blocks elective or required rotation Longitudinal DHMC General Neurology Clinic one half-day/week
PG4	4 blocks DHMC Adult Inpatient Neurology Chief Resident	Longitudinal VA General Neurology Clinic one half-day/week	8 blocks elective or required rotation Longitudinal DHMC General Neurology Clinic one half-day/week

Formal Didactics

At Dartmouth, we are committed to teaching in both Neuroscience and Clinical Neurology. There is a full program of didactic teaching, in addition to case-based teaching, as listed below. See Teaching and Conferences.

Teaching by Residents

Residents in the Dartmouth Neurology Program are involved in teaching at every level. PG2 residents will mentor and teach Dartmouth Medical students and interns rotating through the neurology ward service.  PG3 residents teach interns and students on the Neurology Consultation service.  PG4 residents are considered junior faculty, hold the appointment of Instructor at Dartmouth Medical School and are responsible for instructing medical students and residents at all levels of training on the Neurology Services.

Advisor Program

Each resident in the Dartmouth Neurology Residency Training Program is asked to choose from the full-time attending staff an advisor, who will serve as mentor and senior colleague regarding curriculum and research projects. It is expected that residents will choose their faculty advisor by the second half of their first year. The assignment of advisors may change if the need arises. It is expected that residents will meet with their advisors quarterly. See Research Opportunities.