Focus of this EPA is the application of clinical skills acquired in medical school in the new setting of neurology residency. Includes eliciting the history and obtaining corroborating information from charts and/or caregivers, as well as performing a general physical examination and a neurological examination, including mental status, as relevant. Does not require Developing management plans for patient's care.
Focuses on recognizing that a patient is, or is likely to become, critically ill and seeking assistance. Includes prioritizing actions, initiating stabilizing activities, calling for help (as required) and documenting the encounter appropriately. Does not include diagnosing the cause of illness or providing ongoing management. Includes patients with a variety of medical and neurological presentations.
Focuses on synthesizing assessment findings to provide comprehensive concise, accurate, and well-organized case summaries to a supervisor
Focus is on documenting clinical assessments, including key history and physical examination findings, in an organized, accurate, and legible manner
Focuses on communicating acute and ongoing information between colleagues at transitional periods in care. Includes verbal handover when going off duty, at the end of a rotation, and/or at the end of call shifts
Focuses on the recognition, timely assessment, and initial management of a variety of neurological emergencies. Includes administering relevant scales and selecting, ordering and interpreting appropriate neuro-imaging and other investigations. Important aspect is the timely and appropriate recognition of the need for assistance and/or definitive management. Does not include performing procedures such as intubation, central line placement, or other invasive procedures. Does not include making final decisions or arranging for definitive management.
Focuses on performing and documenting a history and physical exam, and localizing a neurological problem. Examples of common presentations may include weakness, sensory changes or abnormal movements
Focuses on localizing a neurological problem, providing a differential diagnosis, and developing a management plan. May include using ancillary courses to synthesis information. Includes ordering a first line of treatment and consulting other health professionals, as appropriate
Focuses on the initial management of outpatient and inpatient presenting with a variety of common medical and/or psychiatric issues and complications. Includes providing initial assessment and treatment, and seeking consultation for definitive management as needed.
Focuses on the safe performance of lumbar puncture, including measurement opening pressure when indicated. Includes obtaining informed consent, documenting the procedure, as well as planning post-procedural care. Must be achieved in simple and complex contexts
Focuses on the application of communication skills to identify and document the patient's goals of care, including resuscitation status, limits of care, and advanced directives. Includes discussions with a patient and/or substitute decision maker. May be observed in the clinical setting on in simulation
Focuses on diagnosis and comprehensive management of patients in an acute care setting, such as the emergency department, intensive care unit or inpatient ward. Includes performing the clinical assessment, localizing the lesion, developing and prioritizing a differential diagnosis, ordering and interpreting investigations, and treating patients.
Focuses on the full breadth of care for patients with chronic neurological conditions. Includes managing disease related symptoms, assessing response to treatment and clinical status, addressing goals of care, providing follow-up and end of life care, and accessing community resources
Builds on the skills of foundations to add the skills of interpreting investigations, making decisions regarding intervention and selecting appropriate interventions. Includes communicating with families regarding diagnosis, prognosis and plan, and obtaining informed consent, as appropriate. Includes consultation with other services and prioritization/ triage of patient management. Patient presentation relevant to this EPA include acute stroke, neuromuscular respiratory failure, status epliepticus, spinal cord compression, meningitis/encephalitis, herniation syndromes, and/or reduced level of consciousness.
Focuses on the performance of focused neurological examinations and specialized techniques. May be observed in simulation
Focuses on the application of written communication skills in a variety of formats: discharge summaries; consultations; progress notes. Includes a synthesis of the pertinent clinical findings, investigations and management plan, as well as clear articulation of the role of the neurologist and the referring physician in further care. Documents submitted for review must be the sole work of the resident. May be observed in any care setting and any patient presentation
Focuses on clinical management of inpatients; could include either consulting or inpatient neurology services. Includes leadership and management of a team of junior residents and medical students, and collaboration with the inter-professional team. Does not include planning and implementing transitions of care. Observation based on regular interaction over at least one week, includes feedback from team members.
Focuses on ensuring safe transition of patient care between different clinical settings. Includes working with the patient and family to assess and address their needs, making medical decisions, applying knowledge of available resources and facilitating access to those resources and services. Includes summarizing the patient's medical issues, anticipating the evolution of the patient's clinical status and providing direction and anticipatory guidance to other health care professionals.
Focuses on the application of advanced communication and conflict resolution skills to address difficult situations that may involve patients, families, and/or members of the healthcare team. May be observed in any scenario that is emotionally charged. These communications can include, but are not limited to, managing conflict, disclosing unexpected complications and/or medical errors, addressing non-adherence with treatment plan, breaking bad news, and establishing goals of care.
Focuses on the scholarly research project completed in residency
Focuses on the independent management of an inpatient service in the role of the physician most responsible for patient's neurological care. Building on the competencies of the Core stage. Involves 4 components: overall care of acute and chronic patients; working effectively with the inter-professional team; administrative responsibilities; and coaching, assessment and feedback from junior learners. Based on at least one week of observation. Based on two parts: A) Patient care B) Inter-professional interaction/supervision
Focuses on the management of clinical and related administrative responsibilities for individual patients in the outpatient setting. Includes: completing medical documentation in a timely manner; completing administrative responsibilities which may include billing, triaging, insurance forms, phone calls, and clinic scheduling in a timely manner; and working effectively with the staff and/or other learners in the clinic. May be observed in any clinic experience where supervisors have the opportunity for longitudinal observation of the resident. Must be based on a period of at least 3 months.
Focuses on being accessible to health care professionals and patients in an outside center to provide advice about diagnosis, management and/or patient disposition. Includes gathering information to make a clinical assessment, assessing resources and options available in that setting, providing guidance for management and making decisions regarding triaging patients to outpatient clinics, inpatient wards or the ICU. Includes recognizing conditions that can be managed remotely revus those that require in-person assessment.