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Child Neurology, 6 months
The resident is responsible for examining/reviewing every patient on the Child Neurology service which includes neurosurgery patients, PICU, EMU, Virginia Treatment Center for Children, consult service and NICU. The residents are expected to review and report all testing and are required to advise and teach pediatric interns and residents. The residents are responsible for seeing patients in the ER. All patients seen by Child Neurology residents are discussed at all times with the attending on call/on service. Many of the patients are followed after discharge in the resident’s outpatient continuity clinic.
Neurology Ward Blocks, 3 months
MCVH and/or VAMC
Child neurology residents evaluate patients on request in the emergency departments or they receive admissions from the neurology clinics. Patients with an extensive variety of neurological disorders are managed both on a neurology ward and in the neuroscience intensive care unit. Daily teaching rounds occur.
Neurology Consult Blocks, 2 months
MCVH and/or VAMC
Child neurology residents are expected to demonstrate competence at obtaining the neurologic history using a variety of sources: the patient, the patient’s caregiver(s), the hospital chart, and other practioners involved in the patient’s care. The resident performs consults requested by other medical and surgical services. All patients are presented to and examined by an attending.
Core Neuroscience Elective (Neurophysiology), 1 month
EEG
MCVH
Participate in the weekly Adult seizure and Pediatric epilepsy clinics. During clinic, reviews the history, examines the patient, and presents to the attending. Reviews both adult and pediatric EEGs and EPs and with guidance of faculty member interprets these studies.
Pediatric Epilepsy Clinic, 6 months (while on Child rotation)
MCVH
The Child neurology resident will review the history, examine the patient, and present the case to an attending on 2-3 new and 1-2 follow-up patients a week. This weekly clinic is dedicated to the evaluation of possible new onset seizure disorders and for the multi-disciplinary management of established epilepsy patients including medication management, antiepileptic drug research trials, evaluation for epilepsy surgery and/or vagus nerve stimulation.
Child Neurology continuity clinic, 12 months
MCVH
Child neurology resident exams 2-3 new and 1-2 follow-up patients a week. Presents all patients to attending.
Child Neurology, 3 months
MCVH
Neurology Consult Blocks, 4 months
MCVH and/or VAMC
Core Neuroscience Elective (Neurophysiology), 1 or more months
EMG
MCVH and VAMC
Participate in the weekly adult MDA clinic at MCVH and the twice monthly pediatric MDA clinic at Children’s Hospital of Richmond. Perform and interpret EMGs under guidance of attending. Resident expected to learn peripheral nerve and nerve root innervations of the muscles commonly studied, and understand the principles of nerve conduction and synaptic transmission. The residents are also expected to learn the basics of needle EMG examination. The residents are responsible for participating in neuromuscular clinic, becoming familiar with the clinic presentations, diagnostic evaluation, treatment options, and social issues associated with neuromuscular disease.
EMU
MCVH
The resident obtains complete histories containing all relevant details regarding a patient’s seizure disorder and presents all patients to an attending. They review with the EMU attending long-term video monitoring studies of adults and children who are admitted for evaluation of refractory epilepsy and possible epilepsy surgery. Seizure semiology is learned. Acute and chronic anticonvulsant management is extensive as are clinical correlations of neuroimaging studies including CT, MRI, SPECT, and PET.
EEG
MCVH
Electives, 3 months
Neuropathology
MCVH
Resident removes brain, arranges photographs or gross specimen, blocks brain sections for histology, reviews slides. Prepares a clinical case summary, writes a description of gross and histological findings, and reviews diagnosis and report with attending neuropathologist. Works up at least 2 pediatric or adult brains a week and reviews 20-30 biopsy sections of brain, muscle, and peripheral nerve. An excellent in-house prepared
neuropathology CD-ROM provides an additional structured learning opportunity including numerous pictures of gross specimens and photomicrographs.
Neuroradiology
MCVH
Gain additional experience interpreting imaging studies with a neuroradiologist and observing neuroradiologic procedures. Radiological procedures reviewed in this rotation include: computerized tomography of the head and spine, CT angiography, and spiral CT; magnetic resonance imaging and magnetic resonance angiography; conventional cerebral angiography; endovascular interventional procedures; myelography.
Sleep
VAMC
Participate in polysomnogram reading sessions reviewing and interpreting with attending physicians. Participate in sleep disorders clinics.
Research
MCV or VAMC
A basic science or clinical research elective can be arranged with permission of the program director and a faculty sponsor.
EEG
MCVH
EMG
MCVH and VAMC
EMU
MCVH
Pediatric Epilepsy Clinic, 3 months (while on Child rotation)
MCVH
Child Neurology continuity clinic, 12 months
MCVH
Child Neurology resident exams 2 new and 3 follow-up patients a week. Presents all patients to attending.
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Pediatric Psychiatry, 1 month
MCVH
Consult patients at Virginia Treatment Center for Children (VTCC) as an active member of the treatment team. Discuss patients with the psychiatry attending. Participate in evaluation of children with the neurophysiologist.
Child Neurology, 3 months
MCVH
Neurology Consult Blocks, 1 month
MCVH and/or VAMC
Ambulatory Care Clinic, 1 month
MCVH
The purpose of this rotation is for the resident to gain experience in the dynamics of a busy outpatient practice, in terms of scheduling, message management, and documentation. Resident expected to participate in specialty clinics, including: headache, seizure, movement disorders, memory disorders, and neuromuscular.
Neuro-ophthalmology, 1 month
MCVH, VAMC, Stony Point
Clinical experience is focused on outpatient care supplemented by in-hospital consultations. Residents see patients under the direct supervision of neuro-ophthalmology faculty in the outpatient clinic at Ambulatory Care Center, MCV Physicians Stony Point offices, and at VAMC. Residents perform 15-20 new outpatient consultations each week, obtain history and perform examinations, then discuss with the attending on a one-on-one basis the symptoms, signs, pathophysiology, evaluation and treatment of the patient.
Electives, 4 months
Genetics
MCVH
Participate in comprehensive pediatric genetics clinics and evaluations. During this rotation the resident will learn to recognize major syndromes and how to access genetics databases. The resident will also be expected to cooperate with genetic and metabolism dedicated dietitians.
Neuropathology
MCVH
EMG
MCVH
Neuroradiology
MCVH
Sleep
VAMC
EMU
MCVH
Research
MCVH or VAMC
Child Neurology continuity clinic, 12 months
MCVH
Child neurology resident exams 1 new and 5 follow-up patients a week. Presents all patients to attending. Residents may overbook their own clinics as their efficiency and proficiency improves.
Pediatric Epilepsy Clinic, 3 months (while on Child rotation)
MCVH
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Journal Club
There is a monthly general neurology journal club moderated by the Chief Residents and supervised by Dr. Towne. There is also a monthly stroke journal club moderated by Dr. Felton. During this time stroke guidelines, current literature, etc., is discussed.
Teaching Rounds
Child Neurology service:
MCVH
Teaching rounds occur daily with an attending. Many of the clinical cases discussed at the weekly Child Neurology conferences are captured from the inpatient service.
Adult Services:
MCVH
Ward teaching rounds are held every morning, including weekends and holidays, overseen by the attending neurologist on service. Resident work up new admissions and present them on morning rounds. Patient care and management are discussed with the on-service attending physician. There is a Senior Neurology resident each month who provides leadership to the junior residents and directs special teaching sessions.
There is a separate neurology consultation service and the attending rounds Monday through Friday with the team. The resident presents all consults with the attending who sees each new consult, and discusses the case with the team. On weekends, the ward attending also rounds on consult patients.
VAMC
Teaching rounds are held every morning, including weekends and holidays, overseen by the attending neurologist on service. The same team sees ward patients and consultations.
Conferences
Weekly Child Neurology conferences where both interesting and recent cases are reviewed and comprehensive topics covered. There are also monthly combined Pediatrics and Child Neurology noon conferences.
Daily noon conferences covering the following: neurophysiology, neuro-ophthalmology, neuropathology, and neuroradiology. Neurology basics course held each July through August. Basic science, board reviews, morbidity and mortality conferences held on Fridays.
Residents are expected to attend weekly brain cutting conferences, neuro-oncology conferences, and epilepsy care conferences when on specific rotations as well.
Grand Rounds
Held every Thursday from September through June. Visiting and local neurologists give updates on latest developments in the field of neuroscience.
Chairs Rounds
Dr. Pellock conducts a child neurology oral board-style meeting monthly. This meeting consists of a live patient evaluation and observed examination followed by oral board-style questioning.
Dr. Towne meets with the residents monthly to attain feedback from residents regarding the program. Also covers various topics such as costs of healthcare, insurance and billing, practice management, quality assurance, and medical ethics.
GME Core Lecture Series
VCU GME sponsored lectures which cover the following topics: medical ethics, quality assurance, healthcare organization, practice management, financing of healthcare, and management information systems.
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