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[Curriculum]
[Childrens]
[Laboratory]
[Neurocritical Care]
[Parkland Chief]
[Parkland Junior]
[Neurology]
[Spine]
[Tumor]
[VA]
[Vascular Chief]
[Vascular Junior]
Neurology Curriculum
 
BASIC TOPICS SECTION
 
A. NEUROPHYSIOLOGY
UNIT OBJECTIVES
Demonstrate knowledge of physiology that is pertinent to the understanding of neurological disease.
 
COMPETENCY-BASED KNOWLEDGE OBJECTIVES:
Review the basic biology of the nerves including:
synthesis and movement of proteins in the nerve
membrane potential and membrane properties
ion channels
generation and conduction of an action potential
Discuss synaptic transmission including:
types of synaptic transmission
transmitter release
nerve-muscle transmission
chemical messengers
direct gated receptors
second messenger linked receptors
Describe the physiology of the sensory systems including:
sensory receptor physiology
anatomy of somatic sensory system
coding of modality specific sensory information
pain and analgesia
cortical integration of sensory perception
visual system
processing of information in the retina
processing of vision in the central visual pathways
columnar units of visual cortex
processing in the geniculate nucleus
visual perception of motion and form.
auditory system. Within this description review the processing of hearing in the cochlea and the central auditory pathways.
olfaction and taste
Discuss the physiology of the motor system including:
mechanisms of muscle contraction
muscle receptors, spinal reflexes
spinal reflexes concerned with position
brain stem reflexes controlling motion
vestibular nuclei control of movement and posture
red nucleus control of movement
cortical control of movement
cerebellar control of movement
regional and cellular organization of the cerebellum
functional divisions of the cerebellum
the role of the cerebellum in planning movement
basal ganglia
the anatomy of basal ganglia pathways
neural transmitters in the circuits within the basal ganglia
thalamus
Describe the attributes of the autonomic nervous system including both the sympathetic and parasympathetic systems.
Review the physiological basis of arousal and emotion. Include within this review the:
noradrenergic systems
limbic system. Include within this review the physiologic basis for emotion and memory
sleeping and sleep states
reticular activating system
Describe the higher cortical functions including:
anatomy of language
function of association cortex
Describe the physiological basis for cerebrospinal fluid production and reabsorption.
Review the physiological control of the cerebral vasculature.
Discuss, in detail, the physiology of the hypothalamus and pituitary, particularly as related to
 
 
 
B.  NEUROLOGY
UNIT OBJECTIVES
Demonstrate an understanding of the neurologic examination, diagnostic neurologic testing, neurologic diseases and their treatment.
 
COMPETENCY-BASED KNOWLEDGE OBJECTIVES:
    Discuss electroencephalography. Recognize normal and abnormal EEG patterns. Identify specific epileptic conditions by EEG findings.
    Describe the principles of sensory evoked potential testing (SEPs). Discuss how SEPs may be useful diagnostically.
    List the indications for using intraoperative SEP monitoring and describe in detail how the procedure may be performed.
    Describe the principles of visual evoked potential testing (VEPs). Discuss how VEPs may be useful diagnostically.
    Describe the principles of motor evoked potential testing (MEPs). Discuss how MEPs may be useful diagnostically.
    List the indications for using intraoperative MEP monitoring and describe in detail how the procedure may be performed.
    Discuss electromyographic (EMG) testing in detail. Describe how the testing is performed and review the diagnostic capabilities of EMG testing. Describe the EMG changes associated with neuromuscular pathology.
    List the indications for using intraoperative EMG testing and describe in detail how the procedure may be performed.
    Discuss nerve conduction velocity (NCV) testing in detail. Describe how the testing is performed and review its diagnostic capabilities.  List the transmission velocities of the major nerves. Describe NCV changes observed in neuropathy.
    Define delirium and dementia. List the differential diagnoses for each.
    Define and discuss coma and altered states of conciousness.
    Describe the evaluation of a patient with syncope.
    Describe the etiology and pathogenesis of cerebrovascular disease.
    Review the clinical presentation and discuss the radiographic evaluation, clinical evaluation, and management of the following:
      transient ischemic attacks
      cerebral infarction
      cerebral and cerebellar hemorrhage
      subarachnoid hemorrhage
      venous infarction
    Identify the primary causes of stroke in the pediatric population.
    Comprehensively discuss the etiology, clinical presentation, diagnostic evaluation, and management of cerebral vasculitis.
    Differentiate between basal occlusive disease with and without telangiectasia. Review the prognosis and treatment options for each.
    Describe the acute and chronic effects of ionizing radiation on the central nervous system.
    Review the diagnosis and management of pseudotumor cerebri.
    Discuss the diagnosis and management of normal pressure hydrocephalus.
    Discuss the management of hyperosmolar hyperglycemic nonketotic diabetic coma.
    Review the neurological manifestations of altitude sickness.
    List the neurological manifestations of decompression sickness.
    Describe autism.
    Revivew the general topic of chromosomal abnormalities as they may relate to the central nervous system including etiology, inheritance patterns, penetrance, and laboratory diagnosis.
    List the major syndromes characterized by obesity and hypogonadism, including Prader-Willi syndrome.
    Discuss agenesis of the corpus callosum.
    Discuss anencephaly, microencephaly, and megalencephaly.
    List the major disorders of amino acid and purine metabolism. Discuss the neurological manifestations of each.
    Review each of the major storage diseases including:
      GM1-Gangliosidoses
      GM2-Gangliosidoses
      Fabry disease
      Gaucher disease
      Niemann-Pick disease
      Farber disease
      Wolman disease
      Refsum disease
      Cerebrotendinous Xanthomatosis
      Neuronal ceroid lipofuscinoses
    Review each of the major leukodystrophies including:
      Krabbe leukodystrophy
      metachromatic leukodystrophy
      X-linked leukodystrophies with and without adrenal involvement.
    Review each of the major mucopolysaccharidoses including:
      Hurler syndrome (MPS IH)
      Hunter syndrome (MPS II)
      Sanfilippo syndrome (MPS III)
      Morquio syndrome (MPS IV)
      Maroteaux-Lamy syndrome (MPS VI)
    Review the disorders of carbohydrate metabolism including:
      glycogen storage diseases
      Lafora disease and other polyglucosan storage diseases
    Discuss hyperammonemia as it relates to neurological dysfunction.
    Discuss adrenoleukodystrophy as it relates to neurological dysfunction including Reye's syndrome.
    Review the major syndromes of dysfunctional copper metabolism including:
      hepatolenticular degeneration (Wilson disease)
      trichopoliodystrophy (Menkes' syndrome)
    Review the pathogensis, clinical presentation, diagnosis, and treatment of acute intermittent porphyria. List drugs to avoid in patients with porphyria (i.e., sulfa drugs, etc.).
    Review the pathogensis, clinical presentation, diagnosis, and treatment of abetalipoproteinemia.
    orders associated with xeroderma pigmentosum.
    List the major cerebral degenerative disorders of childhood including:
      progressive sclerosing poliodystrophy
      spongy degeneration
      infantile neuraxonal dystrophy
      Hallervorden-Spatz disease
      Pelizaeus-Merzbacher disease
      Alexander disease
      Cockayne syndrome
      peroxisomal diseases
      Leigh disease
    Review in detail the major neurocutaneous disorders including:
      neurofibromatosis, Type 1 and Type 2
      encephalotrigeminal angiomatosis
      incontinentia pigmenti
      tuberous sclerosis
    Discuss Leber Herditary Optic Atrophy.
    Review the salient features of progressive external ophthalmoplegia.
    Define peripheral neuropathy, polyneuropathy, mononeuropathy, mononeuropathy multiplex, and neuritis.
    Review the major inherited neuropathies including:
      peroneal muscle atrophy
      Dejerine-Sottas disease
      Refsum disease
      hereditary sensory neuropathy
      porphyric neuropathy
    Discuss the etiology, clinical presentation, diagnosis, treatment, and prognosis of Guillain-Barre syndrome.
    List the major acquired neuropathies other than Guillain-Barre syndrome including:
      chronic demyelinating polyneuritis
      acute and chronic idiopathic sensory neuropathy
      acute pandysautonomia
      tick paralysis
      brachial neuropathy (neuralgic amyotrophy)
      radiation neuropathy
      cold neuropathy
      cryoglobin neuropathy
      diabetic neuropathy
      hypothyroid neuropathy
      acromegalic neuropathy
      vasculitic neuropathy
      uremic neuropathy
      hepatic neuropathy
      infectious neuropathies
        leprosy
        acquired immunodeficiency virus
        Lyme
        herpes zoster
      sarcoid neuropathy
      paraneoplastic neuropathy
      amyloid neuropathy
      polyneuropathy associated with plasma cell dyscrasia
      polyneuropathy associated with dietary deficiencies
      neuropathy induced by metals
        arsenic
        lead
        mercury
        thallium
      drug-induced neuropathy
      neuropathy produced by aliphatic chemicals
    Discuss the major hereditary ataxias including:
      Friedreich ataxia
      Levy-Roussy syndrome
      hereditary cerebellar ataxia
    Review the major noninherited forms of cerebellar ataxia including:
      acute cerebellar ataxia in children
      ataxia telangiectasia
      Marinesco-Sjögren syndrome
      Ramsay-Hunt syndrome
      Joseph disease
    Discuss the pathophysiology, clinical presentation, treatment, and prognosis of Alzheimer's disease, Pick disease, and diffuse Lewy body disease.
    Define hemichorea and hemiballismus.
    Review the pathophysiology, clinical presentation, treatment, and prognosis of Syndenham chorea, Huntington's disease, and senile chorea.
    Define myoclonus.
    Review Tourette's syndrome.
    Review the major general and focal dystonic conditions.
    Define benign essential tremor.
    Discuss the pahtophysiology, clinical presentation, diagnosis, treatments and prognosis of Parkinsonism in detail.
    Define progressive supranuclear palsy.
    Review the pathophysiology, clinical presentation, diagnosis, and treatment of tardive dyskinesia.
    Discuss hereditary spastic paraplegia.
    List the major generalized and focal forms of spinal muscular atrophy including:
      Wernig-Hoffmann disease
      Kugelberg-Welander syndrome
      benign focal amyotrophy
    Describe the pathophysiology and neurological manifestations of poliomyelitis.
    Review the pathophysiology, clinical presentation, diagnosis, treatment, and prognosis of amyotrophic lateral sclerosis.
    Review the pathophysiology, clinical presentation, diagnosis, treatment, and prognosis of subacute combined degeneration of the spinal cord.
    Review the pathophysiology, clinical presentation, diagnosis, treatment, and prognosis of juvenile and adult myasthenia gravis.
    Review the pathophysiology, clinical presentation, diagnosis, treatment, and prognosis of botulism.
    Review the common muscular dystrophies including:
      Duchenne muscular dystrophy
      fascioscapulohumeral muscular dystrophy
      myotonic muscular dystrophy
      myotonia congenita
      congenital muscular dystrophy
    Review the major periodic paralysis syndromes including:
      familial periodic paralysis
      hypokalemic periodic paralysis
      hyperkalemic periodic paralysis
      paramyotonia congenita
    Discuss polymyositis.
    Review the epidemiology, pathophysiology, clinical presentation, diagnosis, treatment, and prognosis of multiple sclerosis.
    Define Marchiafava-Bignami disease.
    Review central pontine myelinolysis in detail.
    Discuss multiple system atrophy.
    Review the pathophysiology, clinical presentation, diagnosis, treatment, and prognosis of migraine headaches.
    Discuss the diagnosis and management of non-migrainous headache syndromes.
    Review the pathophysiology, clinical presentation, diagnosis, treatment, and prognosis of the common epileptic disorders in detail.
    Define status epilepticus and discuss the medical treatment of same.
    Describe the neurological implications of the common collagen-vascular diseases.
    Describe the neurological implications of alcoholism.
    Discuss the neurological aspects of pregnancy.
    Review malignant hyperthermia.
 
 
C. PRACTICE MANAGEMENT, LEGAL AND SOCIOECONOMIC ISSUES
UNIT OBJECTIVES
Demonstrate an understanding of the principles of practice management and the business aspects associated with the delivery of health care.
 
COMPETENCY-BASED SKILL OBJECTIVES:
    Discuss the ethical and moral factors associated with the practice of neurosurgery.
    Review the role of the neurosurgical leadership in the community and hospital setting.
    Explain the neurosurgeon's responsibilities in terms of health care cost containment.
    Review the features and relationships of the healthcare system including:
      treatment facilities
      third party payment systems
        Medicare
        Medicaid
        employer-provided insurance
        private insurance
      physician practice organizations
      medical equipment manufacturers
      pharmaceutical companies
    Recite the rules and regulations of the training hospital(s) as they pertain to the practice of neurosurgery in which the residency is performed.
    Name the institutional and social service agencies in your community and review their role in the overall management of neurosurgical patients.
    Demonstrate a knowledge of the rules and regulations of your State Medical Board.
    Discuss the concept of informed consent.
    Discuss mandatory reporting laws.
    Discuss issues pertinent to the topic of the impaired physician.
    Name and describe the local, regional, and national neurosurgical organizations including their purposes, roles, activities, and interactions.
    Discuss the importance of tracking morbidity, mortality, and patient outcomes.
    Review the career options available at the completion of neurosurgical residency in detail including:
      private practice
      academic practice
      subspecialty fellowship
      research
      administration
      military
    Discuss post-residency fellowship training program availability, application process, and career usefulness.
    Describe the types and characteristics of surgical practice organizations including:
      solo practice
      group practice
        partnership
        professional association
        corporation
      academic practice
      Health Maintenance Organizations (HMO)
        Preferred Provider Organizations (PPO)
        Individual Practice Associations(IPA)
        staff model (Kaiser-Permanente type)
      Federal
        Department of Veterans Affairs
        Military
        Public Health Service
    Discuss hospital payment systems (e.g., DRGs, per diem rates) and describe their incentives and how they affect hospital profitability.
    Discuss the role and influence of national quality oversight and review organizations for hospitals and health plans (JCAHO, NCQA).
    Discuss the history, changes, eligibility, funding, and problems associated with the Medicare program.
    Describe the Medicare program features, such as eligibility, funding, administration, federal-state relationship, benefits, and payment methods.
    Discuss federal funding of graduate medical education and how current federal budget allocations and proposals for changes in funding affect or will affect neurosurgical training programs.
    Discuss the significance of the following issues as they relate to the practice of neurosurgery:
      legislative/regulatory requirements
        Americans with Disabilities Act
        Clinical Laboratory Improvement Amendments (CLIA)
      Federal/professional regulatory institutions
        Health Care Financing Administration (HFCA)
        Joint Commission on Accreditation of Healthcare Organizations (JCAHO)
        Occupational Safety and Health Administration (OSHA)
      miscellaneous
        affirmative action
        equal opportunity
        sexual harassment
    Discuss the common causes of malpractice actions and effective measures to reduce the risk of malpractice complaints.
    Describe the ways, means, and reasons physicians influence the political process at the national, state, and local level.
    Discuss the demographics of neurosurgeon distribution, numbers, workload studies, and workforce needs.
    Outline the requirements for certification by the American Board of Neurological Surgery.
    Formulate a strategy to evaluate personal and professional considerations in making a career choice.
    Appraise the importance of family involvement in making career choices, including geographic location.
COMPETENCY-BASED SKILL OBJECTIVES:
Demonstrate an ability to interact effectively, professionally, and respectfully with:
patients and their families
fellow residents
allied health care personnel
hospital staff
medical students
faculty physicians
referring physicians
Demonstrate the ability to maintain accurate and current medical records.
Discuss neurosurgical career options with:
faculty
peers
family
non-faculty neurosurgeons and other mentors
Accumulate information about post-residency career options.
Create and keep current a resume/curriculum vitae.
Record CPT codes for office visits and procedures performed on service.
Accurately document H&P and consultations according to the AMA-CPT E&M documentation guidelines.

Last Updated Feb 2013