Neurology Residency Program

Bradley Jacobs, M.D., M.S., Director

VA Medical Center General Neurology Service

Inpatient & Outpatient Rotation

The educational objectives during the adult general neurology rotation at the VA Medical Center are to:

  1.  Acquire the knowledge, skills and attitudes to perform a thorough neurological history and exam, and
  2. To learn the role of the neurologist to diagnose and manage acute and chronic neurological illness.

The adult general neurology service at VA Medical Center includes faculty-supervised care to a diverse population of patient's with a full range of acute and chronic neurological illnesses. The resident assumes an ascending level of responsibility based upon maturation of knowledge, skills and attitudes applicable to the educational goals of this experience. The PGY2 and PGY4 neurology residents assigned to this service will provide neurological care for patients admitted with neurological problems. In addition, they will obtain an outpatient experience with particular emphasis on neuromuscular disease and sleep disorders and procedural experience in EMG/NCV performance and interpretation, polysomnogram interpretation and EEG interpretation.

Faculty supervised teaching rounds are held five days per week. During these rounds, residents present cases and their diagnostic and therapeutic plans. The service is responsible for managing patients with neurological disorders with the pathology spectrum including multiple sclerosis exacerbations, intractable epilepsy, central nervous system infections, encephalopathy, peripheral nervous system disorders, central nervous system malignancies and stroke. There is one attending for the service, with subspecialty attendings overseeing neuromuscular disease and sleep disorders experiences.

The specific educational goals of the VA Medical Center General Neurology experience includes:

  1. Obtain a practical experience in obtaining an orderly and detailed history from the patient, conducting a thorough general and neurological examination and organizing and recording data. Competencies addressed: patient care, medical knowledge, practice-based learning and improvement, interpersonal and communication skills and professionalism.
  2. Understanding of the indications for and the limitations of clinical neurodiagnostic tests and their interpretation. Competencies addressed: patient care, medical knowledge, practice-based learning and improvement.
  3. Learn the ability to correlate information derived from neurodiagnostic studies with the clinical history and examination in formulating a differential diagnosis and management plan. Competencies addressed: patient care, medical knowledge, practice-based learning and improvement.
  4. Understand the evaluation of and the decision-making for patients with disorders of the nervous system requiring surgical management. Competencies addressed: patient care, medical knowledge, practice-based learning and improvement.
  5. Learn the neurological consultants role in the management of patient's with psychiatric and neuropsychiatric disorders and comorbidities including substance abuse. Competencies addressed: patient care, medical knowledge, practice-based learning and improvement, interpersonal and communication skills and professionalism.
  6. Understand the role of the neurological consultant in the management of patients with acute neurological disorders in the medical and surgical intensive care units. Competencies addressed: patient care, medical knowledge, practice-based learning and improvement.
  7. To better understand the principles of bioethics in the provision of acute and cost-effective evaluation and treatment of patients with neurological disorders, including the medically underserved. Competencies addressed: patient care, medical knowledge, practice-based learning and improvement, interpersonal and communication skills and professionalism.
  8. Understand the participation of the neurologist in end-of-life palliative care including adequate pain relief and psychosocial support and counseling for family members about these issues. Competencies addressed: patient care, medical knowledge, practice-based learning and improvement, interpersonal and communication skills and professionalism.
  9. Learn the role of family and social issues by participation in neurological care including psycho-social support and counseling for family members. Competencies addressed: patient care, medical knowledge, practice-based learning and improvement, interpersonal and communication skills and professionalism.
  10. Develop expertise in the coordination of care with the primary care team for which neurology is comanaging patients or providing a consultation, including appropriate written and verbal communication with the primary care team and with the patient and their family. Competencies addressed: patient care, medical knowledge, practice-based learning and improvement, interpersonal and communication skills and professionalism.
  11. A comprehensive review of the basic clinical neurophysiology that provides the foundation for the acquisition and interpretation of EMG and nerve conduction studies. Competencies addressed: medical knowledge.
  12. A practical experience in performance of EMG and nerve conduction studies including technological aspects of instrumentation and patient safety. Competencies addressed: patient care, medical knowledge, practice-based learning and improvement.
  13. A practical experience in interpreting EMG and nerve conduction studies. Competencies addressed: patient care, medical knowledge, practice-based learning and improvement.
  14. A practical experiencing utilizing the information obtained from EMG and nerve conduction studies, formulation of the differential diagnosis based on the results and the correlation of the information derived with the clinical history and examination in the formation of a differential diagnosis and management plan. Competencies addressed: patient care, medical knowledge, practice-based learning and improvement.
  15. A practical experience in the diagnosis and management of sleep disorders. Competencies addressed: patient care, medical knowledge, practice-based learning and improvement.
  16. A comprehensive review of the basic clinical neurophysiology that provides the foundation for the acquisition and interpretation of polysomnograms. Competencies addressed: medical knowledge.
  17. A practical experience in performing a sleep study, including the technological aspects of polysomnography. Competencies addressed: patient care, medical knowledge.
  18. The interpretation of polysomnograms, formulation of the differential diagnosis based on the results of polysomnograms and the correlation of the information derived with the clinical history and examination in formulating a management plan. Competencies addressed: patient care, medical knowledge, practice-based learning and improvement.
  19. A comprehensive review of the basic clinical neurophysiology that provides the foundation for the acquisition and interpretation of EEGs. Competencies addressed: medical knowledge.
  20. The interpretation of EEGs, formulation of the differential diagnosis based on the results of an EEG and the correlation of the information derived with the clinical history and examination in formulating a management plan. Competencies addressed: patient care, medical knowledge, practice-based learning and improvement.