Miami Valley Hospital Vascular Neurology Service

The educational objectives are to:

1. Acquire the knowledge, skills and attitudes to perform a thorough neurological exam, and
2. To diagnose and manage acute vascular neurology illness.

The vascular neurology service at Miami Valley Hospital includes faculty-supervised care to a diverse population of stroke patient's with a full range of acute and chronic cerebrovascular 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. Faculty supervised teaching rounds are held seven days per week. During these rounds, residents present cases and their diagnostic and therapeutic plans. The vascular neurology service is responsible solely for managing patients with acute vascular neurological disorders. The program includes a telemedicine system with multiple spokes and a hub at Miami Valley Hospital, an acute stroke intervention service, an inpatient vascular neurology service, a rehabilitation consultation and in-patient rehabilitation service all within a Comprehensive Stroke Center. The in-patient vascular neurology service involves primary care for all stroke patients admitted to Miami Valley Hospital. The staffing of this service includes PGY1 psychiatry residents and PGY2 internal medicine residents, PGY2 through PGY4 neurology residents, a nurse specialist, multidisciplinary stroke team (physical therapy, occupational therapy, speech therapy, nursing, rehabilitation, nutrition) and an attending vascular neurologist. One vascular neurology attending provides the neurovascular staffing for the service which is comanaged with a primary care hospitalist.

The specific educational goals of the Miami Valley Hospital Vascular Neurology Service include:

1. Develop skills in obtaining an orderly and detailed history from the patient, conducting a thorough general neurological examination, a focused vascular examination and organizing and recording the data in patients with multiple types of ischemic and hemorrhagic stroke. Competencies addressed: patient care, medical knowledge, practice-based learning and improvement, interpersonal and communication skills and professionalism
2. Understanding of the indications for and the limitations of clinical neurodiagnostic tests and their interpretation, including computerized tomography, magnetic resonance imaging, ultrasound imaging, echocardiography, lipid analysis and coagulation studies. Competencies addressed: patient care, medical knowledge, practice-based learning and improvement.
3. Develop the ability to correlate information derived from neurodiagnostic studies with the clinical history and examination in formulating a differential diagnosis and management plan for the vascular neurology patient. Competencies addressed: patient care, medical knowledge, practice-based learning and improvement, interpersonal and communication skills and professionalism.
4. Learn to work with the health care team in the evaluation of and the decision-making for patients with vascular disorders of the nervous system requiring neurointerventional and surgical management. Competencies addressed: patient care, medical knowledge, practice-based learning and improvement, interpersonal and communication skills and professionalism
5. Understand the management of patients with vascular disease who have psychiatric, socioeconomic and neuropsychiatric comorbidities. Competencies addressed: patient care, medical knowledge, practice-based learning and improvement, interpersonal and communication skills and professionalism
6. Understand the role of vascular neurology in the management of patients with acute vascular neurological disorders in the neurointensive care unit, including blood pressure management, intracranial pressure monitoring and respiratory failure. Competencies addressed: patient care, medical knowledge, practice-based learning and improvement, interpersonal and communication skills and professionalism.
7. Understand the principles of bioethics in the provision of cost-effective evaluation and treatment of patients with vascular neurological disorders. Core Competencies addressed: patient care, interpersonal and communication skills and professionalism.
8. Participation in end-of-life palliative care including adequate pain relief and psychosocial support and counseling for family members about these issues. Core Competencies addressed: patient care, interpersonal and communication skills and professionalism.

Service Schedule on Vascular Neurology Service

1. Admissions and on-going patient care: PGY2 neurology residents and rotating PGY2 internal medicine rotating residents and PGY1 psychiatry residents.
2. Consultations: PGY2 neurology residents and rotating PGY2 internal medicine rotating residents and PGY1 psychiatry residents.
3. Resident rounds: Supervising: PGY3 neurology residents; Required participation: PGY2 neurology residents, PGY2 internal medicine rotating residents, PGY1 psychiatry residents and medical students.
4. Continuity clinic one half day per week.