Schedule

The Child Neurology Residency Program at the University of Iowa is three years in duration. The residency will typically begin after the trainee has completed two years of general pediatric training. Throughout the three years of neurology training, the resident will have alternating experiences in pediatric and adult neurology, thus allowing continuous growth of knowledge and experience in both areas.

The first year of the program is designed to provide the trainee with a broad experience in adult and pediatric neurology. This will allow the trainee to become familiar with concepts of neurologic localization and to acquire competence in diagnosing and managing the most common and basic clinical problems in adult and pediatric patients with neurologic disease. During this year, the resident will also gain an exposure to child psychiatry and receive an introduction to electrophysiology.

The second year of the program is designed to provide the trainee with greater responsibility in the care of adult and pediatric patients with neurologic disease. During this year, the resident will gain leadership skills by serving as senior resident on the inpatient adult stroke service and epilepsy monitoring unit. The resident will also gain substantial geriatric neurology experience through a rotation at the VA Hospital. The resident will acquire a broadened and deepened knowledge of child neurology in the child neurology clinic and inpatient services. The resident will also gain experience in neuroradiology and neuro-rehabilitation and will expand his or her knowledge of clinical electrophysiology.

The third year of the program is designed to solidify the trainee's expertise in clinical pediatric neurology and provide the trainee with substantial teaching experience. During the third year, the resident will serve as team leader on pediatric neurology morning rounds and will manage the inpatient child neurology service. The senior resident will also schedule and coordinate the weekly Child Neurology Clinical Conference, which is the principal didactic and clinical conference for the division. In addition, the resident will gain further leadership and clinical skills by serving as senior resident on the adult neurology stroke service and consultation service. The resident will receive in-depth training in neuropathology. In addition, the resident will conduct a research project and will present the results to an audience of neurologists.

Throughout all three years of the program, the child neurology resident will have a weekly continuity of care clinic in child neurology. This will allow the resident to follow the course of child neurology diseases over a prolonged period of time and will provide the resident the opportunity to manage and care for child neurology patients over a long term.

FIRST YEAR OF THE RESIDENCY (PGY-3)
Goals:
1.  To learn to diagnose and manage hospitalized patients with common neurologic disorders.
2.  To learn to diagnose and care for patients with acute and critical neurological illnesses.
3.  To learn to diagnose and manage adult and pediatric patients with a broad range of neurologic diseases in an outpatient setting.
4.  To learn to diagnose and treat neurologic conditions secondary to systemic conditions.
5.  To learn to triage and manage neurologic patients in the Emergency 
Department.
6.  To learn to diagnose and care for children and adolescents with psychiatric disorders.
7.  To learn electrophysiologic techniques and how to apply and interpret these techniques in patients with neurological diseases.
8.  To choose elective work that will facilitate the attainment of career goals.

Objectives:
Pediatric Neurology I
During the first year of the program, the child neurology resident will complete five four-week rotations in clinical child neurology. The resident will learn how to perform a neurological examination on children of all ages and how to document these findings in the medical record. To understand the clinical features and management of neurological conditions of infancy, childhood, and adolescence, the child neurology resident will examine and care for children of all ages with acute and chronic neurological diseases in both inpatient and outpatient settings. The resident will learn to recognize historical and clinical patterns that suggest specific neurologic disorders. The resident will understand normal neurologic development of infants, children, and adolescents and recognize deviations from normal. The resident will begin to understand the concepts and utility of neurodiagnostic procedures in the evaluation and treatment of children with neurologic disorders. The resident will begin to understand the pharmacologic treatment of common neurologic disorders of children.

Adult Neurology Inpatient/Consultation Service: Junior Resident
To learn to diagnose and care for hospitalized adult neurologic patients, the child neurology resident will serve as a junior resident on the Adult Neurology Inpatient/Consultation Service (2 Boyd Tower). The resident will develop the ability to formulate the diagnosis of both acute and chronic neurologic problems and institute therapy for these conditions. Diseases commonly encountered on this service include multiple sclerosis, intractable migraine, and complicated Parkinson’s disease.

This is also the neurological consultation service for inpatients throughout the hospital. Thus, on this service, the resident will learn to diagnose and treat neurologic conditions secondary to or in association with systemic conditions, such as cancer, heart disease, pregnancy, surgical procedures, immunosuppression, metabolic and endocrine disturbances, and drug overdose.

This service will also provide the resident the opportunity to learn to triage and manage neurologic patients in the Emergency Department. In addition, in the ETC, the neurology resident will participate in the administration of tissue plasminogen activator to patients with acute ischemic stroke.

Adult Neurology Critical Illness Service: Junior Resident
To learn to diagnose and care for adult patients with acute and critical neurological illnesses, the child neurology resident will serve as a junior neurology resident on the High Acuity Inpatient Neurology Ward (6 Colloton Pavilion). The resident will learn to diagnose and care for patients with acute and critical neurological illnesses, such as acute stroke, subarachnoid hemorrhage, Guillain Barre Syndrome, acute infections of the central nervous system, and coma. The resident will learn the principles of intensive care management by having co-responsibility for adult neurology patients in the Medical Intensive Care Unit.

Neurology Outpatient Clinic (University Hospital)
To learn to diagnose and manage adult patients with a broad range of neurologic diseases in an outpatient setting, the child neurology resident will evaluate and treat patients in the Neurology Outpatient Clinic. In this clinic, the resident will rotate among a wide variety of subspecialty neurology clinics, including clinics in stroke, movement disorders, headache and pain, sleep, neuromuscular disorders, memory disorders, general neurology, and epilepsy. In these different clinics, the resident will learn to formulate the diagnosis and plan the treatment of neurologic illnesses, including the principles of their long-term care.

Clinical Electrophysiology (EMG/EEG)
To learn the techniques and interpretation of clinical electrophysiology, the resident will perform and interpret neurophysiologic studies, including electromyography, nerve conduction velocity studies, evoked potentials, electroencephalography, and sleep studies. In the course of learning electromyography, nerve conduction studies, and electroencephalography, emphasis will be placed on learning the anatomy of the peripheral nervous system and the neurophysiology of the central and peripheral nervous systems.

Child and Adolescent Psychiatry
To learn to diagnose and care for children and adolescents with psychiatric disorders, the resident will serve on in the Child and Adolescent Outpatient Psychiatry Clinic. The resident will become familiar with the diagnosis, classification, pharmacotherapy, and behavioral therapy of child psychiatry disorders, including bipolar affective disorder, schizophrenia, depression, anxiety and panic disorders, eating disorders, attention deficit disorders, and autism.

Elective Rotation
During the first year of the residency, the resident will have the opportunity to choose one month of elective work that will be conducive to reaching his or her specific career goals. This may include an additional rotation concentrating on clinical neurology, diagnostic neurology, subspecialty neurology, clinical research, or basic research.

SECOND YEAR OF THE RESIDENCY (PGY-4)
Goals:
1.  To learn to diagnose and care for adult patients with acute and critical neurological illnesses.
2.  To learn the leadership skills necessary to organize a busy inpatient unit and to direct the care delivered on that unit.
3.  To learn electrophysiologic techniques and how to apply and interpret these techniques in patients with neurological diseases.
4.  To learn techniques of, indications for, and interpretation of neuroradiological studies in patients with neurological diseases.
5.  To care for geriatric patients with neurologic disease.
6.  To understand the clinical features and management of neurological conditions of infancy, childhood, and adolescence in inpatient and outpatient settings.
7.  To choose elective work that will facilitate the attainment of career goals.

Objectives:
Pediatric Neurology II
In the second year of the program, the advancing child neurology resident will complete four four-week rotations in clinical child neurology. These rotations will include experiences in the child neurology outpatient clinic, as well as the child neurology inpatient service. During these rotations, the resident will further enhance his or her skills and efficiency in acquiring clinical histories and performing physical examinations on pediatric neurology patients. The resident will become familiar with diagnoses and approaches, not only to common disorders, but also to disorders that are complex and rare. The resident will acquire an awareness of the academic foundations of pediatric neurology, including basic neuroscience and other relevant scientific disciplines.

Adult Neurology Critical Illness Service: Senior Resident
To learn to diagnose and care for adult patients with acute and critical neurological illnesses, the child neurology resident will serve on the 6 Colloton Service, where adult patients with acute neurological illnesses, such as acute stroke, subarachnoid hemorrhage, Guillain Barre syndrome, acute infections of the central nervous system, and coma are admitted. To learn to care for critically ill patients with neurological disease, the child neurology resident will have co-responsibility for patients on the Intensive Care Unit.

To learn the leadership skills necessary to organize a busy inpatient unit and to direct the care delivered on that unit, the child neurology resident will serve as Senior Resident on the 6 Colloton Service. The child neurology resident will supervise junior residents, as well as senior and junior medical students and will learn to take a leadership role while helping to direct the care delivered by these team members.

Adult Epilepsy Monitoring Unit During the second year of the residency, the child neurology resident will serve for one rotation on the Adult Epilepsy Monitoring Unit. This experience will allow the resident to focus on adult patients with unstable epilepsy, including those patients requiring inpatient video EEG monitoring for spell identification and presurgical workup.

VA Hospital Consultation Service and Clinics:
To learn to care for geriatric patients with neurologic disease, the resident will serve on the VA Consultation Service. On the VA rotation, the resident will learn to recognize, diagnose and treat neurologic conditions seen in a largely geriatric population, in an inpatient consultation and outpatient clinic setting.

Neuroradiology
To learn techniques of, indications for, and interpretation of neuroradiological studies in children and adults with neurological diseases, the resident will develop skill in interpreting head ultrasounds, CT scans, and MRI scans of the cranium, spine, brain and spinal cord, and learn to interpret cerebral arteriography, and magnetic resonance angiography. The resident will learn the anatomic basis of these procedures and the proper clinical indications for each.

Pediatric Neurorehabilitation
While assigned to this service, the resident will participate weekly in rehabilitation rounds and become familiar with rehabilitation strategies and techniques, especially as they apply to diseases and trauma of the spine, spinal cord, and brain.

Clinical Electrophysiology
The child neurology resident will build on his or her previous experience in clinical electrophysiology to acquire a thorough knowledge of the techniques, application and interpretation of electroencephalography, electromyography, nerve conduction studies, evoked potentials, and sleep studies. The resident will learn to apply his or her knowledge of physiology and anatomy of the central and peripheral nervous systems to the conduct and interpretation of electrophysiologic tests.

Elective Rotations
During the second year of the residency, the resident will have the opportunity to choose two rotations of elective work that will be conducive to reaching his or her specific career goals. This may include an additional rotation concentrating on clinical neurology, diagnostic neurology, subspecialty neurology, clinical research, or basic research.

THIRD YEAR OF THE RESIDENCY (PGY-5)
Goals:
1.  To acquire a detailed understanding of concepts of clinical pediatric neurology and to become fully competent in the diagnosis and management of children with neurological diseases.
2.  To demonstrate a broad and deep knowledge of child neurology by effectively teaching concepts and information of child neurology. 3. To acquire a thorough understanding of neuropathology.
4.  To build a thorough knowledge regarding electrophysiologic techniques and the application and interpretation of these techniques in patients with neurological diseases.
5.  To learn techniques of neurological research and to apply these techniques toward completion of a meaningful research project.
6.  To choose elective work that will facilitate the attainment of career goals.

Objectives:
Child Neurology III
The resident will acquire a detailed understanding of concepts of clinical pediatric neurology and to will become fully competent in the diagnosis and management of children with neurological diseases by caring for children in the pediatric neurology clinic and by serving as team leader for the child neurology inpatient service. The resident will master skills in history taking and physical examination. The resident will learn to integrate them together into a comprehensive neurological assessment. The resident will learn to delineate an appropriate differential diagnosis for common and rare problems in pediatric neurology. The resident will develop sound clinical judgment and the ability to use patient information and scientific and clinical knowledge appropriately to optimize care of children with neurologic disease.

The senior child neurology resident will acquire a broad and deep knowledge of clinical child neurology. The resident will demonstrate and transmit this knowledge, in part, by effectively teaching medical students, junior residents and faculty. The senior child neurology resident’s administrative and teaching skills will be further enhanced by organizing the weekly Child Neurology Clinical Conference.

Adult Neurology Critical Illness Service: Senior Resident
During the third year of the program, the child neurology resident will serve for one rotation as the senior resident on the Critical Illness (Stroke) service. During this rotation, the child neurology resident will solidify his or her knowledge of diagnostic approaches and management of acutely and critically ill adults with neurologic diseases. Leadership skills will be further developed by directing and overseeing the actions of junior residents and medical students assigned to the service.

Adult Neurology Inpatient/Consultation Service: Senior Resident
During the third year of the program, the child neurology resident will serve for one rotation as the senior resident on the adult neurology inpatient and consultation service. On this rotation, the child neurology resident will solidify his or her competence in the diagnosis and treatment of adult patients with acute and chronic neurological diseases, including those neurologic conditions secondary to other systemic diseases. The resident will also become more experienced in the triage and management of patients in the Emergency 
Department, including acute ischemic stroke patients requiring administration of tissue plasminogen activator. As senior resident on this service, the child neurology resident will gain leadership skills by assigning and overseeing the duties of junior residents and medical students.

Neurology Outpatient Clinic (University Hospital)
The third-year child neurology resident will build upon his or her prior experience in the adult neurology outpatient clinics to become fully competent in the diagnosis and treatment of adults with neurological diseases. The resident will solidify his or her knowledge of the pharmacologic and non-pharmacologic treatments of adult patients with a wide variety of neurologic conditions, including headaches, epilepsy, movement disorders, cognitive disorders, neuromuscular disorders, and pain.

Neuropathology
The resident will learn to recognize the gross and microscopic features of neoplastic, degenerative, infectious, ischemic, toxic, developmental, and traumatic disorders of the central and peripheral nervous systems. The resident will also learn the basic pathology of muscle and nerve. This learning will be facilitated by the study of microscopic slides, as well as gross pathology viewed at brain cutting, and evaluation of fresh surgical specimens.

Research
To gain an experience in research, the resident will work with a faculty member on a research project with relevance to child neurology. The resident will gain an in-depth knowledge of a particular clinical or basic science issue and will understand the gap in modern knowledge that the research project can partially fill. To gain skills in public speaking and scientific presentations, the resident will make a formal presentation of the research project to the Department of Neurology.

Elective Rotations
During the third year of the residency, the resident will have two elective rotations, providing the opportunity to build specific skills and knowledge conducive to reaching his or her specific career goals. This may include an additional rotation concentrating on clinical neurology, diagnostic neurology, subspecialty neurology, clinical research or basic research.

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