Description:
The Stroke Service cares for patients in three levels of acuity: a dedicated Neurological Intensive Care Unit (NSICU), a stroke step-down unit, and stoke patients on the regular medical-surgical unit. The Stroke Team consists of a Stroke Attending, one of six stroke-dedicated faculty members with fellowship training in Vascular Neurology, one Stroke Fellow in their first or second year of Vascular Neurology fellowship (PGY5 or 6), a PGY-4 neurology resident (during the first six months of each academic year), and two PGY-2 neurology residents. There is also a full complement of medical students, including two to three Mount Sinai medical students in their third year of medical school and a variable number (zero to three) of medical students visiting from both US and foreign medical schools.
Teaching rounds on the Stroke Service are held seven days a week. Teaching rounds are led by the Stroke Fellow in conjunction with the Stroke Attending. The PGY-2 neurology resident is responsible for providing accurate and up-to-date patient presentations, interim histories, exam findings, laboratory results and radiographic information. Medical students help to collect this information on the patients they are following before teaching rounds begin. The PGY-4 neurology resident is called upon to synthesize this information and help to determine a treatment plan under the guidance of the Stroke Fellow and Stroke Attending. Teaching is done by both the Stroke Attending and Stroke Fellow both during bedside rounds and, more formally, after bedside rounds are finished. Monday through Friday, stroke rounds concludes by a review of each day's new neuroimaging studies in the Neuroradiology Reading Room with a Neuroradiologist.
Goals
To build the resident's clinical knowledge and skills in the care of stroke inpatients.
To teach residents to develop the knowledge and skills related to the assessment and management of stroke patients in the acute and subacute setting.
To provide exposure to comprehensive/interdisciplinary care for patients with stroke (including nursing, social work, rehabilitation medicine, etc).
Objectives
The resident will
Recognize the common presentations of TIA and acute stroke symptoms (Patient Care)
Provide compassionate and empathetic care to stroke patients and their families (Patient Care)
Demonstrate their ability to obtain a comprehensive history and neurological exam on stroke patients, to be assessed by the senior neurology resident, stroke fellow or stroke attending on the service (Medical Knowledge)
Demonstrate their ability to quickly and effectively evaluate acute stroke patients for possible tPA therapy (Medical Knowledge)
Demonstrate knowledge of the epidemiology, pathophysiology and treatments of ischemic, embolic and hemorrhagic stroke (Medical Knowledge)
Develop the ability to locate and assess scientific evidence related to the treatment of stroke patients and incorporate their findings into clinical practice (Practice-Based Learning and Improvement)
Integrate formative feedback from attendings, colleagues and students into daily practices (Practice-Based Learning and Improvement)
Effectively communicate and collaborate with nurses, nurse managers, case managers, social workers, physical therapists and consultants from other medical specialties as part of the interdisciplinary patient care team (Professionalism, Interpersonal and Communication Skills, Systems-Based Practice)
Be able to effectively present patient cases (new patients and interval histories) on both teaching and work rounds (Interpersonal and Communication Skills)
Be able to write comprehensive and effective patient notes (admission and progress notes), to be evaluated by the senior neurology resident, stroke fellow or stroke attending on service (Interpersonal and Communication Skills)
Demonstrate effective communication skills and provide effective education in formal and informal discussions with stroke patients and their families (Interpersonal and Communication Skills)
Develop strategies for teaching medical students and interns on the stroke service (Interpersonal and Communication Skills)
Provide clear and directed performance feedback to medical students on the stroke service based on the goals and objectives for their rotation (Interpersonal and Communication Skills)
Understand the legal, ethical and cultural complexities of decision-making in post-stroke patients (Professionalism, Interpersonal and Communication Skills)
Demonstrate a commitment to performing their professional responsibilities to the best of their ability (eg writing comprehensive notes, following up test results, presenting on rounds, etc) (Professionalism)
Recognize the complex social, family and community issues surrounding acute, critical illness such as stroke (Professionalism, Systems-Based Practice)
Learn to advocate for patients and navigate through government and commercial insurance providers in order to ensure optimal inpatient care and post-hospital placement for stroke patients (Systems-Based Practice)