Division of Neurology

McMaster Objectives: Specific Objectives

Adult Neurology Residency Training Program

Dear Neurology Residents,

On behalf of the Department of Neurology and the Neurology Residency Training Committee, I would like to take this opportunity to welcome you to The Adult Neurology Training Program of McMaster University. We wish you the best of success in your future studies and will guide you to become the best neurologist.

In this package, please find enclosed our training program specific objectives of training and training requirements. These objectives and training requirements are to be considered as supplements to those provided by the Royal College of Physician and Surgeons of Canada Education Committee. The latter objectives and training requirements are also included in this package.

You will note that our program specific objectives and requirements are provided in the CanMEDS format. A brief description of the CanMEDS roles, as they relate to our training program, is provided. Furthermore, program specific objectives and requirements for each of the core rotations as well as elective rotations within our program will be provided as and when available.

Your evaluation will be based on these objectives. Since we are a new programme we will be updating these objectives and I am sure you will help to formulate these. Please contact me if any of these are unclear.

Dr. Demetrios Sahlas
Adult Neurology Training Program Director

Adult Neurology Residency Training Program
McMaster University

Preamble

Neurology is the subspecialty of Internal medicine dealing with the investigation, diagnosis and therapy of diseases specific to the peripheral and central nervous system as well as complications of systemic disorders affecting nervous function. Significant overlap occurs with psychiatric disorders. Thus trainees in neurology should acquire a firm grounding in Internal medicine and some understanding of psychiatric disorders.

The aim of the program is to produce a physician-specialist with the competence to effectively diagnose and manage the care of patients with neurological diseases.

The objectives of our residency training program outlined below are provided in the CanMEDS format. The CanMEDS roles for physicians (and trainees) define wide range knowledge, attitudes and skills required in order to be an effective, competent, knowledgeable and professional physician. The CanMEDS roles also provide the framework by which you will be evaluated during your residency training.

The following paragraphs outline the components of the CanMEDS roles, methods by which the objectives of such roles can be met and methods that will be used for evaluation. Detailed objectives are provided thereafter and you are asked to familiarize yourself with them as well.

Additional objectives forth by the Royal College and by a sub-committee of the Canadian Neurological Society Education and Manpower Committee will also be provided. These objectives are given to trainees entering the program and the trainee is referred to these documents for further information on expected competencies when presenting for certification examinations.

 

  1. Medical Expert/Clinical Decision-Maker
  2. Communicator
  3. Scholar
  4. Collaborator
  5. Manager
  6. Health Advocate
  7. Professional

1. Medical Expert

The Resident is expected:

  • To progress appropriately through training and develop the requisite knowledge, skills and experience in general Neurology and its subspecialties.
  • To be competent in the care of complex Neurological patients with multi-system disease in a variety of settings, including the emergency room, ward critical care units and ambulatory care clinics.
  • Upon completion of the program to show evidence of competence and meet the objectives and requirements of training in Neurology as mandated by the Royal College of Physicians and Surgeons
  • To be competent in procedures commonly used in the care of neurology patients and as mandated by the Royal College of Physician and Surgeons

Objectives of Training in Neurology

Teaching the Medical Expert Role: It is important for each resident to set personal learning goals and continuously improve knowledge base. This involves consistent reading throughout all five years and full participation in all academic activities.

Clinical Rotations:

  • Faculty, Fellow and Senior Resident teaching around individual patient encounters
  • Specific procedures
  • Rotation-specific didactic teaching rounds
    • Stroke Rounds
    • Noon-time Neurology Rounds
    • Neuromuscular Rounds
    • Neuroscience Rounds
  • Clinical Skills sessions:
  • Bedside Clinical skills

Self-Directed Learning:

  • Consistent organized reading schedules
    • Journals: Neurology, NEJM,Lancet,Annals of Neurology and archives of Neurology
    • American Academy of Neurology Programs and Continuum Journal
    • UptoDate
    • Textbooks as in the Neurology Handbook
  • Formal presentations
  • Research activity
  • Conferences and seminars

Program Academic Curriculum:

  • Academic Half-Day Wednesday PM
  • Small-group Clinical Skills with Faculty
  • Neuroanatomic Session with Faculty
  • Journal Club Monthly
  • Organized CME events:
    • Stroke Day
    • Neuromuscular day
    • Thrombosis seminar
    • Movement disorder

Hospital-based:

  • Grand Medical rounds- weekly at each hospital
  • Subspecialty rounds
  • Neuroscience Rounds

National Seminars:

  • Residents are expected to attend from PGY3 annual seminars on STROKE,EPILEPSY,MOVEMENT DISORDER and NEUROMUSCULAR DISEASES


Evaluation of the Medical Expert Role:

Formal promotion to senior years and need for remediation is based only on the results of the ITER reports. All other examinations and evaluative components in the Program are designed to be formative only.

  • In-Training Evaluation Report (ITER)
    These must be accompanied by formal face to face verbal feedback. Residents should take equal responsibility in ensuring feedback. Feedback occurs with the director at the end of every quarter.
  • American Academy of Neurology in-Training Examination annually
  • Quarterly Short answer examination from PGY3 onwards
  • National LAUNCH examination for exam going resident
  • Biannual Objective Structured Clinical Examination (OSCE)
    This is based on the Royal College format
  • Witnessed History/Physical Examination exercise in PGY4 and PGY5 year

Residents are also advised to maintain an accurate and up to date record of their procedural skills through paper or electronic log book.

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2. Communicator

The resident is expected to:

  • Develop rapport, trust and ethical therapeutic relationships with patients and families.
  • Accurately elicit and synthesize relevant information and perspectives of patients and families, colleagues and other professionals;
  • Accurately convey relevant information and explanations to patients and families, colleagues and other professionals;
  • Develop a common understanding on issues, problems and plans with patients and families, colleagues and other professionals to develop a shared plan of care,
  • Convey effective oral and written information about a medical encounter.

Teaching the Communicator Role

Many of the skills of the communicator role are developed through direct patient encounters and role-modeling by colleagues, senior residents and staff people. It is important to recognize both poor and good communication skills. Residents at any opportunity should obtain feedback on all components of communication.

I. Communication skills with patients and families:
Assessment of the patient in different settings: ward, emergency room, outpatient clinics: these assessments are primarily based on gathering medical information accurately and efficiently. The assessments should vary according to the level of training. As a resident reaches senior levels, he/she should be able to synthesize the information gathered and presented by junior learners and become more efficient and focused in history-gathering. With an aging population, residents should be able to obtain accurate histories from any source possible: families, nursing homes, pharmacies.

These skills should be developed by:

  • All inpatient clinical rotations
  • On-call activities
  • Clinics in senior years and subspecialty rotations
  • Difficult Communication Scenarios:
    • Breaking bad news
    • Consent /Substitute Decision Maker
    • End of Life Discussions
    • Withdrawal of driving license
    • Obtaining Code Status
    • Placement discussions
    • Capacity assessments

II Communication with Colleagues around a patient encounter:

  • Verbal presentation skills to senior residents and/or staff
  • Verbal communication with allied health professions
  • Verbal communication to admitting or consulting services
  • Verbal communication to Family practitioners and other health care providers
  • Written communication skills:
    • Progress notes on admitted patients
    • Discharge summaries
    • Consultation notes

Evaluation of Communication Skills

  • In-training Evaluation: Communication skills are assessed by the supervisor after consultation with others, including patients, and allied health professionals.
  • Communication Scenarios on OSCE
  • Senior year witnessed history/physical examination
  • Evaluation of written documentation- discharge and consultation notes
    (4 per year)
  • Clinical skills (informal- no documentation)
  • Clinical Skills of students (small group sessions)

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3. Scholar

The resident is expected to:

  • Develop life-long learning skills that will maintain and enhance professional activities.
  • Effectively and efficiently evaluate the medical literature and apply to the care of patients
  • Develop the skills necessary to effectively teach students, peers, other health professionals, the public and others
  • Develop an understanding of research practice and contribute to the dissemination, application and translation of new medical knowledge and practices.

Teaching the Scholar Role

I Teaching Activities

Clinical Rotations:
All senior rotations and in special services are associated with an expectation that residents will seek out and take advantage of opportunities to teach junior learners on rotations and while on-call.

  • Clinical Skills for clinical clerks
  • MF5 Teaching
  • Senior resident supervising the Juniors and students in a rotation

II Research Activities

Resident research activity is supervised by the Residency Program Research Coordinator, Dr. Michael Mazurek. Research mentors are listed with their areas of interest in the Faculty page on the Program WEB-site. Residents are able to take a research selective anytime during core training. This can include one month of a block research selective or two-months combined with clinics (3-4 clinics weekly).
Residents may request a further one to two months which will be granted after discussion of the proposal at the Education Committee. It is mandatory to do research during the course of five years. They need to present at least one poster or paper.

III Evidence-Based Medicine Activities:

Clinical Rotations:

It is expected that all residents utilize the principles of EBM during core patient care activities.

  • Stroke rotations
  • Journal Clubs
  • Subspecialty rotations- EBM should be a part of all SS rotations

Program-Specific Activities

I. Teaching

  • Teaching Clinical Skills
  • Formal Presentations:
    • Journal Club/ Ethics- Once during three core years
    • Medical Grand Rounds /Neuroscience Rounds
    • Rotation-specific Rounds
  • Undergraduate Education:
    • Professional Skills Tutor for the Undergraduate Program
    • Lectures for the Internal Medicine Residents
    • Lectures at BCT Group

II. Research

  • Annual meetings with the Research Director
  • Annual Resident Research Day combined with Neurosurgery

III. Evidence-Based Medicine

  • Journal Clubs
  • Conferences and seminars

Evaluation of the Scholar Role

I. Teaching Activities

  • Domain on all ITERs
  • Clerkship Tutorial Evaluation
  • Evaluation by medical students for Professional Skills Preceptor role
  • Evaluation of presentations
    • Medical/Neuroscience Grand Rounds
    • Journal Club
    • Stroke Rounds

II. Research Activities:

  • Evaluation of Research Presentation

III. Evidence-Based Medicine

  • Evaluation of Journal Club presentation
  • Evaluation component of Neuroscience Rounds

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4. Collaborator

The resident is expected to:

  • Participate effectively and appropriately in an interprofessional healthcare team
  • Effectively work with other health professionals to prevent, negotiate and resolve inter-professional conflict

Teaching the Collaborator Role

  • Clinical Rotations:
  • Major component of all inpatient-based rotations
  • Multi-disciplinary Rounds on Stroke rotations
  • Outpatient collaboration- clinic rotations

Program-Specific Activities

  • Involvement of other disciplines in Academic events
  • Evaluation of Collaborator Role:
  • Domain on ITER
  • Collaborator Evaluation Form
  • Neurology rotations
  • Stroke Team Rounds

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5. Manager

The resident is expected to:

  • Manage day to day clinical activities with efficiency and organization
  • Able to effectively balance personal and professional activities
    o learn how to independently set up a practice
  • Develop an approach to resource management both in the clinical setting and on a provincial/national perspective
  • Serve in Administrative and leadership roles

Teaching the Manager Role

Clinical Rotations:

Residents must learn to manage the day to day clinical activities on rotations. This includes triaging and prioritization during call activities. As the resident progresses through senior levels, the resident must learn to manage the clinical delegation, supervision and education of junior learners on rotations and on call. The Chief Resident Rotation evaluation allows each resident to develop administrative, managerial and leadership roles.

Program-Specific Activities

  • HealthCare Organization in Stroke retreat
  • Membership on Program Committees
    • Education Committee
    • Subspecialty sub-committees
    • Postgraduate Committees
    • Provincial Committee
  • PAIRO

Evaluation of the Manager Role

  • Domain on ITER form
  • Short evaluation forms
  • Academic Evaluation form

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6. Health Advocate

The resident is expected to:

  • Respond to individual patient health care needs and issues as part of patient care
  • Respond to the health needs of the community
  • Identify the determinants of health of the populations
  • Promote the health of individual patients, communities and populations


Teaching the Health Advocate Role

Clinical rotations:

Residents are expected to act as health advocates in the clinical care of patients.
This would include advocating for resources such as home care, PT, OT. As well, residents should be aware of patient costs to care such as drugs, travel, parking etc and adjust care accordingly. The resident should be aware of provincial guidelines for drug funding and how it affects the patient access to medications.

Program-Specific Activities

  • Health Advocacy on Stroke and Smoking
  • Academic Half-Day- Health Advocacy issues are identified with case.

Evaluation of the Health Advocate Role

  • Domain on the ITER form

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7. Professional

The resident is expected to:

  • Display professionalism in the context of clinical care which includes
    • Ethical behavior
    • Professional behavior with patients, families and colleagues
    • Completion of all duties in a timely manner
  • Display professionalism in the context of a trainee
    • Appropriate and timely responses
    • Fulfillment of all program expectations
    • Participation in program activities
    • Responsiveness to the mandate of the Education committee
    • Active participation in evaluation
    • Active self-assessment
    • Demonstrate a commitment of physician health and stress management
  • Be aware of the Profession of Medicine
    • Medical- legal aspects of medicine
    • Principles and practice of Medical Bioethics
    • Awareness of provincial and national medical organizations
    • Awareness of the responsibilities of a self-regulated profession

Teaching the Professional Role

Clinical Rotations:

Ethical and professional behavior is expected on all clinical rotations. Program professionalism is outlined at orientation with reminders throughout the core years.

Program-Specific Activities

  • CMPA presentation

Evaluation of the Professional Role

  • Domain on the ITER form