Miami Valley Hospital Neurocritical Care Service

The educational objectives during the adult neurocritical care unit rotation at Miami Valley Hospital are to:

1. Acquire the knowledge, skills and attitudes to perform a thorough neurological exam, assess for life threatening conditions in the acute neurologically ill patient and evaluate acute comorbidities, and
2. To diagnose and manage acute neurological illness requiring intensive care management.

The Neurocritical Care service at Miami Valley Hospital includes faculty-supervised care to a diverse population of critically ill neurological patients with a full range of acute neurological illnesses. The resident assumes an ascending level of responsibility based upon maturation of knowledge, skills and attitudes applicable to the educational goals of this experience. The neurocritical care division of the neurology department is responsible solely for managing critically ill patients with neurological disorders, including ischemic stroke, hemorrhagic stroke, subarachnoid hemorrhage, brain trauma, neuromuscular disorders, intractable epilepsy, central nervous system infections, encephalopathy and central nervous system malignancies. The program includes an 9-bed dedicated neurocritical care unit with overflow beds if needed. The in-patient Neurocritical Care service involves primary care for all critically ill neurological patients admitted to Miami Valley Hospital. The staffing includes PGY2, PGY3 and PGY4 neurology residents, PGY2 internal medicine residents, medical students, advanced practice nurses and an attending neurointensivist. Faculty supervised teaching rounds are held seven days per week. During these rounds, residents present cases and their diagnostic and therapeutic plans.  

The specific educational goals of the Neurocritical Care rotation are:

1. A practical experience in obtaining an orderly and detailed history from the patient, conducting a thorough general and neurological examination, a focused evaluation of the critically ill patient and organizing and recording data. Competencies addressed: patient care, medical knowledge, practice-based learning and improvement, interpersonal and communication skills, professionalism, systems-based practice.
2. An understanding of the indications for and the limitations of clinical neurodiagnostic studies and brain monitoring devices including continuous EEG monitoring and their interpretation. Competencies addressed: patient care, medical knowledge, practice-based learning and improvement, interpersonal and communication skills, professionalism, systems-based practice.
3. The ability to correlate information derived from neurodiagnostic studies with the clinical history and examination in formulating a differential diagnosis and management plan. Competencies addressed: patient care, medical knowledge, practice-based learning and improvement
4. Understand the evaluation of and the decision-making for critically ill patients with neurological disorders of the nervous system requiring surgical and interventional management, including subarachnoid hemorrhage, central nervous system tumors and head trauma. Competencies addressed: patient care, medical knowledge, practice-based learning and improvement, interpersonal and communication skills, professionalism, systems-based practice.
5. Understand the management of medical comorbidities including blood pressure; develop procedural competencies based on faculty evaluation in endotracheal intubation, ventilator management, central line insertion and neurological monitoring devices in patients with acute neurological disorders in the neurointensive care unit. Competencies addressed: patient care, medical knowledge, practice-based learning and improvement, interpersonal and communication skills, professionalism, systems-based practice.
6. Understand the principles of bioethics in the provision of acute and cost-effective evaluation and treatment of patients with critical neurological disorders and participation in end-of-life palliative care including adequate pain relief and psychosocial support and counseling for family members about these issues. Competencies addressed: patient care, interpersonal and communication skills, professionalism, systems-based practice.