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					         Department of Psychiatry and Human Behavior
         Butler Hospital - Rhode Island Hospital – the Miriam Hospital

                                                      Overview of Rotation
                                                          revised date9/26/07

Neurology rotations in the Brown Psychiatry Residency constitute a core training experience during which residents learn to
perform competent neurological evaluations and treatment of neurological illnesses. The rotation requires a high degree of
organization and efficiency, as well as a strong commitment to professionalism. This latter quality is a core value, which
should guide residents in decision-making about which steps to take on behalf of their patients, as well as their own
Description of Rotation

This rotation consists of a one or two month assignment at Rhode Island Hospital, Butler Hospital, or a neurological outpatient
practice under the auspices of the Miriam Hospital.. Each resident’s assignments are scheduled in order to provide broad clinical
experience in all areas of neurology. Resident’s usually elect to do rotations in outpatient practices for three days out of the week and
combine that with 2 day of electives in Sleep Disorders, Electroecephalograms, and/or Neuroradiology.

Butler Hospital: The Neurology Service at Butler Hospital consists of consultations on inpatient units and Day Hospital patients, care
of inpatients with neurological disorders on the Behavioral Neurology and Senior Specialty Services and care of outpatients in the
neurology offices of Dr. Salloway and Dr. Rickler.

Rhode Island Hospital: The neurology consultation service at RIH provides a varied, intensive exposure to a wide variety of acute
neurologic conditions. Psychiatric residents are closely supervised by chief residents and service attendings. The intensive experience
gives the resident a strong basis of neurologic experience. At RIH residents also have access to neuroradiology, a sleep disorders
clinic and an electroencephalogram clinic. Outpatient neurology through this facility may be done through the outpatient offices of
Dr. Easton and Dr. LaFrance.

Miriam Hospital: This outpatient neurology rotation gives residents a broad exposure to the assessment and treatment of common
neurologic problems such as headache management, and the management of many neurological illnesses such as stroke, epilepsy and

Name of Rotation                                         Neurology
Chiefs of Service                                        Donald Easton, MD (Rhode Island Hospital), Norman Gordon, MD (the
                                                         Miriam Hospital); Kenneth Rickler MD (Butler Hospital)
Contact Information                                      Donald Easton, MD (Rhode Island Hospital):
                                                         Norman Gordon, MD (the Miriam Hospital):
                                                         Kenneth Rickler, MD (Butler Hospital):
                                                         Curt LaFrance, MD (Rhode Island Hospital):
Residency Coordinator                                    Rita Misek: 455 6375
Drs. Easton, Salloway, Blum, Feldmann, Gilchrist, Rizvi, Sachs, Gordon, Rickler, LaFrance

Topics to be covered are based upon:
 The patient population cared for by the team over the course of the rotation and
 The weekly afternoon seminars
 Cases selected for presentation
Principal teaching methods:
      Attending Rounds
      Weekly afternoon seminars
Educational materials provided/referred to residents:
 Reading: Each attending and resident is expected to utilize current medical literature in the planning of therapeutic and

     diagnostic interventions.
    Computer-assisted educational materials: All housestaff have access to full-text literature search and retrieval capacity through
     the hospitals’ computer networks. Terminals are located on all floors and in the residents’ offices.
    Other: Residents are given articles as part of their weekly afternoon seminar series and by faculty on service .

Residents are expected to regularly review relevant:
 Neuroimaging studies
 Laboratory testing results
 neuropsychological testing results
 Electroencephalograms
 Sleep studies
On this rotation, residents may act as consultants to other clinical services such as surgery or psychiatry. Among the attendings'
responsibilities is the application of cost-effective care measures and principles to the actual care of the patients on the service.
Residents are expected to communicate as needed with discharge planning specialists.

    Evaluation of the resident's successful completion of the goals listed below will be carried out by the attending.
    Evaluation of the attending's successful completion of the goals listed below will be carried out by the resident.
    Evaluation of the rotation will be completed as part of the annual resident retreat report.

 The attending is ultimately responsible for all outpatients in their clinic.
 The attending will be available to during office hours Monday morning through Friday afternoon and obtain appropriate coverage
    on weekends.
 The attending will write visit notes on all outpatients seen and review all cases seen by the resident.
 The attending is responsible for the clinical education of all house staff and students rotating on the service. This is generally
    accomplished by informal as well as formal bedside teaching related to conditions of patients seen.
 The attending will review all neurological imaging and diagnostic studies with the residents.
 The attending is responsible for monitoring the progress of the resident on rotation throughout the month and communicating his
    impressions of the resident's performance to the resident throughout the month.
 The attending will at some time observe each resident in interactions with patients and families, in the performance of aspects of
    history taking and physical examination, and will review residents’ admission and progress notes in order to be able to evaluate
    the residents’ clinical and communication skills.
 The attending will complete an electronic evaluation for each resident at the end of the month.


Rhode Island Hospital:
 The residents will see outpatients with Dr. Easton or Dr. LaFrance in their offices
 The resident will perform the initial H&P on new patients and present cases to their attending, with an evaluation and treatment
 The resident will perform appropriate interim neurologic exams on patients during follow up visits, present cases to their
    attending or see cases with their attending
 The resident will write a complete note on all new patients evaluated and will write follow-up notes on patients during outpatient
    visits. Residents will follow up on the patient’s neurologic progress and the results of recommended neurodiagnostic tests.
 The resident will communicate directly with the primary physician and/or primary housestaff when urgent diagnostic testing or
    intervention is required and otherwise as appropriate.
 In cases requiring immediate attention, the resident will consult with the attending physician regarding urgent interventions.
 The residents will work out with the attending the days/times they will be working with them in their outpatient clinics.
 Residents are responsible for setting up their elective days/times in Neuroradiology, Sleep Disorders and/or EEG Clinic.
 Resident will attend Neurology Grand Rounds on Wednesday mornings from 8 am to 9.30am, noon conference on Monday,
    Thursday and Friday and Neuroradiology rounds on Wednesday at noon.
Butler Hospital:
 Resident is responsible for evaluating outpatients in the Memory Disorders Clinic and presenting them to Dr. Salloway.
 Residents will see outpatients with Dr. Salloway or Dr. Rickler in their offices
 The resident will perform the initial H&P on new patients and present cases to their attending, with an evaluation and treatment

   The resident will perform appropriate interim neurologic exams on patients during follow up visits, present cases to their
    attending or see cases with their attending
 The resident will write a complete note on all new patients evaluated and will write follow-up notes on patients during outpatient
    visits. Residents will follow up on the patient’s neurologic progress and the results of recommended neurodiagnostic tests.
 The resident will communicate directly with the primary physician and/or primary housestaff when urgent diagnostic testing or
    intervention is required and otherwise as appropriate.
 In cases requiring immediate attention, the resident will consult with the attending physician regarding urgent interventions.
 Residents will attend Neurology Grand Rounds on Wednesday mornings at RIH and Neurology Case Conference at noon on
 Residents may also set up outpatient rotations with Dr. Friedman at the Movement Disorders Clinic.
 The residents will work out with the attending the days/times they will be working with them in their outpatient clinics at
Miriam Hospital:
 Resident will attend regular outpatient hours in Dr. Gordon’s office at 450 Veterans Memorial Parkway in East Providence
 Resident will perform initial H&P on new patients and present cases to Dr Gordon, with an evaluation and treatment plan
 Resident will accompany Dr Gordon to the Miriam hospital to consult on inpatients as needed
 Resident will attend Neurology Grand Rounds at RIH on Wednesday mornings from 8 am to 9.30am.

Morning Rounds                  Monday, Tuesday, Thursday, Friday at 8:00 Neurology Library #322 (RIH)
Noon Resident Conference        Monday, Thursday, Friday Neurology Library #322 (RIH)
Grand Rounds                   Wednesday 8am George Auditorium (RIH)
Neuroradiology                 Wednesday 12 noon Neuroradiology conference room (RIH)
Objectives -      By the end of this rotation, the resident will be able to:
Rhode Island Hospital, Miriam Hospital, Butler Hospital:
 Obtain an orderly and detailed neurologic history, conducting a thorough general and neurological examination, and organizing
    and recording data
 Obtain an understanding of the pathophysiology of cerebrovascular disease, its acute management, and diagnostic evaluation
 Develop the skill set needed to evaluate and manage patients with acute neuromuscular disorders and other inpatient neurologic
    disorders including but not limited to seizures, cerebral neoplasms, elevated intracranial pressure, multiple sclerosis and CNS
 Be familiar with the indications for and limitations of clinical neurodiagnostic tests and their interpretation as well as to correlate
    the information derived from these neurodiagnostic studies with the clinical history and examination in formulating a differential
    diagnosis and management plan
 Prepare and present case presentations
 Develop an appreciation for cost-efficient care, proper utilization of resources, the importance of after-hospital care planning, and
    patient autonomy
 Work in a coordinated fashion with a multi-disciplinary team
 Learn to interpret brain CTs and MRIs, EEGs and Sleep Studies
Additional educational objectives for Butler Hospital:
 Develop careful history taking skills and skills of neuropsychiatric assessment and differential diagnosis
 Better understand brain systems relevant to neurology and psychiatry.
 Be knowledgeable about neurological syndromes affecting psychiatric patients

1. Patient Care                                      Goals and Objectives                                                       Evaluation Method
 Resident must be able Residents                                                                                        - Residents are evaluated by
                             -    Learn to gather essential and accurate information about their patients
    to provide care that is                                                                                              their attending
                             -    Prepare and present case presentations
    compassionate,           -    Assess severity of illness and demonstrate prioritization skills necessary to          - Performance during patient
    appropriate, and              make interventions in a timely manner                                                  encounters through direct
    effective for the        -    Make informed decisions about diagnostic and therapeutic interventions                 supervision by the attending
                                  based on patient information and preferences, up-to-date scientific evidence,
    treatment of health
                                  and clinical judgment
    problems and the         -    Counsel family and patients
    promotion of health.     -    Develop the ability to communicate effectively and demonstrate caring and
                                          respectful behaviors when interacting with patients and their families.
                                     -    Work with health care professionals, including those from other disciplines,
                                          to provide patient-focused care

2. Medical Knowledge                                         Goals and Objectives                                                 Evaluation Method
 Residents must               Residents                                                                                      - Feedback of both oral and
                                    -    Will learn to generate a differential diagnosis and unique treatment plan for
    demonstrate                                                                                                               written presentations will be
                                         each patient encounter, learn to judiciously use diagnostic tests, laboratory
    knowledge about                      studies to narrow the diagnosis                                                      provided
    established and                 -    Will demonstrate an investigatory and analytic thinking approach to clinical         - Presentation skills,
    evolving biomedical,                 situations                                                                           management decisions and
                                    -    Learn to effectively communicate their investigatory and analytic thinking
    clinical, and cognate                                                                                                     knowledge are evaluated at
                                         approach via written notes and at clinical conferences and didactic teaching
    (e.g. epidemiological                sessions                                                                             rounds, case conference and
    and social-                     -    Will keep abreast of new scientific knowledge, which is obtained via                 through direct supervision by
    behavioral) sciences                 didactic sessions, Grand Rounds, critical review of scientific literature,           the attending
                                         computer and web-based resources
    and the application of
                                    -    Will actively participate in conferences
    this knowledge to               -    Understand and apply basic principles of physiology and pathophysiology to
    patient care.                        common diseases; understand the diagnosis and prognosis and management
                                         options for these illnesses
                                    -    Will know and apply the basic and clinically supportive sciences which are
                                         appropriate to their discipline

3. Interpersonal and                                         Goals and Objectives                                                 Evaluation Method
Communication Skills
 Residents must be                 -     Residents will approach patients/families with a friendly, interested, and        - Attendings rate their residents
                                          respectful demeanor.
    able to demonstrate                                                                                                     on rounds, bedside teaching
                                    -     Residents will scrupulously maintain patient confidentiality, and specifically
    interpersonal and                     reassure patients/families of the confidentiality of their personal and medical   interactions
    communication skills                  information                                                                       - Observation by chiefs, other
    that result in effective        -     Residents will make every effort to safeguard patient/family dignity.             residents and attendings on a
                                    -     Residents will know and be able to describe the proper boundaries of the
    information exchange                                                                                                    day to day basis
                                          physician/patient relationship, and will consistently and conscientiously
    and teaming with                      avoid any breach of these boundaries.                                             - Feedback from nursing staff,
    patients, their                                                                                                         other disciplines
    patients’ families,             -     Residents will make explanations in clear, common-parlance language,
    and professional                      avoiding use of medical jargon, and using graphic aids (including informal
    associates.                           sketches) where helpful to get points across.
                                    -     Residents will ask patient’s/family’s concerns and questions and address
                                          these specifically and directly to ensure that patient/family have received
                                          information in the desired degree of detail.

                                    -     Residents will clearly identify differences in patient/family and medical
                                          perspectives, bringing such differences into open discussion, and explaining
                                          the rationales for medical actions that differ from patient/family preferences
                                          and values.

                                    -     Residents will negotiate priorities for problems to be addressed in the
                                          particular visit, once all issues have been identified.
                                    -     Residents will write clearly and legibly when hand-writing instructions or
                                          other information for patients/families

                                    -     Residents will help to ensure that written or printed information for
                                          patients/families is language-congruent and literacy appropriate using
                                          straightforward language and comprehensible and culturally appropriate
                                    -     Written communications in patient charts will effectively permit subsequent
                                          caregivers to understand the nature of the patient interaction and the goals
                                          and plans for the encounter as well as future encounters when applicable
4. Professionalism                                           Goals and Objectives                                                 Evaluation Method
 Residents must                    -     Residents will ask patients/family members how they wish to be addressed          - Residents evaluate each other
                                    -     Residents will openly support and assist patients/families in dealing with
    demonstrate a                                                                                                           each month and rate their
                                          health challenges and their administrative complications.
    commitment to                   -     Residents will know and avoid breach of the boundaries of the                     interpersonal skills with each
    carrying out                          physician/patient relationship, including but not limited to strict avoidance     member of the team as well as
    professional                          of sexual or romantic suggestiveness or involvement with patients/family          with patients/families
    responsibilities,                                                                                                       - Attendings rate their team on
                                    -     Residents will make reasonable efforts to act as advocates for their patients.
    adherence to ethical            -     Residents will place patient safety as their first priority without               rounds, bedside teaching
    principles, and                       compromising their own safety or the safety of others that they are               interactions
    sensitivity to a                      supervising.                                                                      - Observation by chiefs, other
                                    -     Residents will recognize and support patient’s rights to receive full

    diverse patient               information regarding the risks, benefits, and when appropriate, costs of          residents on a day to day basis
                                  appropriate treatment options, and to be advised of potential conflicts of
    population                                                                                                       - Feedback from nursing staff,
                                  interest on the part of their physicians.
                              -   Residents will truthfully report medical errors of their own to their              other disciplines
                                  attending, or Risk Management and to follow hospital protocols in the face         - Patient satisfaction surveys
                                  of errors. Residents will encourage and facilitate reporting of medical error
                                  on the part of professional colleagues.
                              -   Residents will seek professional help for personal impairments that may
                                  compromise patient care; will assist impaired colleagues to obtain
                                  professional help; and will take responsibility for interceding to protect
                                  patient safety when impaired colleagues do not respond appropriately to
                                  their own duties in this regard.
                              -   Residents shall not withhold needed medical care from patients/families
                                  wishing to receive it, irrespective of ability to pay for such care.
                              -   Residents will participate with an attitude to support the appropriate
                                  decisions of patients or recognized family decision makers to withhold or
                                  withdraw life-sustaining treatment from patients in terminal conditions.
                              -   Residents will fully and clearly inform patients and families of the benefits
                                  and risks of all proposed diagnostic and therapeutic interventions, with the
                                  purpose of facilitating the ability to make an informed decision, even if the
                                  eventual decision is not the one the physician prefers for the patient.
                              -   Residents will avoid any form of coercion of patient/family decision
                              -   Residents will make every effort to elicit and to accommodate, to the fullest
                                  extent of their ability, differing religious and cultural needs and values in
                                  delivering medical care– but are under no obligation to accommodate
                                  requests based upon any form of identity-group prejudice.
                              -   Residents will clearly and openly identify and repudiate statements of
                                  prejudice made by professional colleagues, and will not permit their actions
                                  as physicians to be influenced by such prejudice.
                              -   Residents will cultivate the ability to identify and articulate their own
                                  cultural values and preferences, comforts and discomforts; and to be self
                                  aware in attempting to deliver fair and optimal medical care to all patients –
                                  including recognizing their obligation to transfer care to another physician
                                  should the occasion arise in which personal values or biases interfere with
                                  such care delivery to any patient or family.
                              -   Demonstrate understanding of and sensitivity to end of life care and issues
                                  regarding provision of care.

5. Practice-Based                                    Goals and Objectives                                                 Evaluation Method
Learning and
 Residents must be           -   At the end of this rotation, the resident should be able to identify gaps in       - Day to day knowledge base
                                  knowledge based upon experience, introspective awareness, and feedback
    able to investigate                                                                                              evaluated by feedback on
                                  for the month. The resident is expected to regularly review both textbook
    and evaluate their            and primary source literature to maintain up to date understanding of              differential diagnoses,
    patient care practices,       specific topics that have arisen in practice.                                      management plans
    appraise and              -   The resident should actively seek feedback and advice on practice from             -morning rounds
                                  peers, mentors, staff, and patients alike to gain greater objective insight into
    assimilate scientific                                                                                            -conferences
                                  their strengths and weaknesses.
    evidence, and             -   The resident should be able to obtain scientific literature, appraise quality,     and through direct supervision
    improve their patient         and assimilate data through the use of up to date resources to improve their       by the attending
    care practices.               practice and care of patients’ health problems.
                              -   The resident will gain basic skills in literature search methodologies using
                                  standard web-based medical literature search engines such as Ovid, MD
                                  Consult, Pubmed.
                              -   The resident will have familiarity with a variety of computer and hand-held
                                  computer based resources for looking up medications, dosing, and other
                                  topics of use to the general internist
                              -   The resident will actively participate in lectures and discussions with peers
                                  and experts on the topics related to the care of their patients.
                              -   The resident is expected to take a proactive and interactive approach to
                                  enhancing their knowledge. The resident is expected to “think out loud”,
                                  ask for clarification and guidance, and actively seek input on their practice
                                  and knowledge base from their mentors.

6. Systems-Based                                     Goals and Objectives                                                 Evaluation Method
 Resident must               -   The resident will learn how to work within a multidisciplinary team to             - Evaluations from attending
                                  develop a care plan for their patients.
    demonstrate an                                                                                                    - Feedback from team
    awareness of and             -    The resident will become familiar with hospital and community based             members
                                      health care professionals and their roles in groups such as social work,
    responsiveness to a                                                                                               - Observation by chiefs and
                                      mental health professionals, PT, OT, dietitians, and VNA etc.
    larger context and                                                                                                other faculty
    system of health care        -    The resident will evaluate how interacting with the above groups and health
                                      professionals affects their own practice..
    and the ability to
    effectively call on          -    The resident will practice cost-effective health care and resource allocation
    system resources to               that does not compromise quality of care.
    provide care that is of      -    The resident will learn about a variety of insurances and how they affect
    optimal value. By                 patient referrals and prescriptions. They will learn the legal rights of the
                                      uninsured and will work with the appropriate services to assist patients who
    the end of their                  are under- or un-insured.
    training, residents are
    expected to have             -    The resident will learn how to interact and advocate effectively with other
                                      physicians, ancillary caregivers, community agencies, landlords, and
    attained competence               insurance companies etc. via spoken and written communications when it
    in the following                  effects the health of their patients.
                                 -    The resident will learn about the various community resources available for
                                      patients and will work with case managers and social workers to enable
                                      patients to access these resources. The resident will learn to work with
                                      translator services for optimal and appropriate patient care

Residents should be mindful of the unique opportunity with which they are presented during this rotation. In caring for sick,
hospitalized patients in a supervised environment, you are being given the chance to study in a protected environment while caring for
patients with the illnesses you are studying. We urge you not to waste this time but rather to embrace your responsibilities and to
study and teach based upon the needs of your patients.