UWO Neurology Resident Handbook

The UNIVERSITY of WESTERN ONTARIO

Department of Clinical Neurological Sciences

Division of Neurology

Neurology Resident Handbook

prepared by Miguel Bussière

Last update: September 2004

Table of Contents Introduction ...................................................................................................................................................3 Contacts ........................................................................................................................................................4

Key Contacts .............................................................................................................................................4 Current Trainees........................................................................................................................................4 Subspecialties ...........................................................................................................................................4 Clinical Nurses...........................................................................................................................................4 Pharmacists...............................................................................................................................................4

RCPSC requirements for training in Neurology ............................................................................................5 Outline of the UWO training program in Neurology ......................................................................................6 Rotation Selection .........................................................................................................................................7

Rotation schedule......................................................................................................................................7 Rotation options.........................................................................................................................................7 Location of medical services .....................................................................................................................7 Change of Rotation Requests ...................................................................................................................7

Research.......................................................................................................................................................8 Longitudinal Clinic .........................................................................................................................................8 Educational Rounds ......................................................................................................................................9 UWO Clinical Neurological Sciences Research Day ..................................................................................10 Grand rounds ..............................................................................................................................................10 Evidence Based Neurology.........................................................................................................................10 Off-Site Neurology Courses ........................................................................................................................11 Educational Resources ...............................................................................................................................11 Evaluations..................................................................................................................................................11 Chief Resident.............................................................................................................................................12 Senior Resident...........................................................................................................................................12 Salary and Tuition / Fees ............................................................................................................................13 On-Call and Meal Allowance.......................................................................................................................13 CMPA..........................................................................................................................................................13 Ordering CT scans On-Call.........................................................................................................................13 Committees .................................................................................................................................................14 Holidays / Education Leave.........................................................................................................................14 Annual Neurology Association Meetings ....................................................................................................14 Funding / Bursaries .....................................................................................................................................14 Mailboxes ....................................................................................................................................................14 Codes..........................................................................................................................................................15 Computer Resources ..................................................................................................................................15 Email ...........................................................................................................................................................15 Pagers .........................................................................................................................................................15 Dictations.....................................................................................................................................................16 Recommended Reference Texts ................................................................................................................16 Useful Web sites .........................................................................................................................................18 Weekly Calendar of Events.........................................................................................................................19 Monthly Calendar of Events ........................................................................................................................20

UWO Neurology Resident Handbook – September 2004 2

Introduction The goal of this document is to provide an up-to-date concise source of information about residency training in Neurology at the University of Western Ontario in London, Ontario. This information is intended for new and current Neurology trainees, as well as medical students who are considering applying for training in Neurology at the University of Western Ontario. Some of this information is available in much greater detail in the Trainee Handbook provided to each resident at the beginning of their Neurology training and in the Guidelines for the Neurology Clinical Teaching Unit manual available in the resident’s room. Other sources to be consulted are the Western Housestaff Handbook and PAIRO Member's Manual. This document is available in its entirety on the UWO Neurology Resident web site (http://www.uwo.ca/cns/resident).

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Contacts Key Contacts Dr. Michael Strong Chair, Division of Neurology 33874 [email protected] Dr. Chris Watling Program Director, Division of Neurology 58586 [email protected] Nicole Farrell Education Coordinator 33696 [email protected] Ann Hern Medical Education/ 82019 [email protected] Single Paymaster Office Gerry Niles Faculty of Medicine - Postgraduate Office 76587 [email protected] Switchboards London Health Sciences Centre (LHSC) 685-8500 St. Joseph's Health Centre 646-6000 Current Trainees

Pgy-5 Pgy-4 Pgy-3 Pgy-2 Pgy-1 2005 2006 2007 2008 2009

Christen Shoesmith Raj Dhar

Miguel Bussiere Ahmed Al-Amri

Lawrence Korngut Sarah Morrow

Abdullah Al-Ajmi

Alex Fraser Carmela Tartaglia

Amal Al-Khotani Jamie Steckley Hakim Raghig

Subspecialties Cognitive / Behavioral Dr. A. Kertesz Dr. S. Pasternak

* Movement Disorders Dr. M. Jog Dr. M. Jenkins Dr. C. Hyson (2005)

Neuro-ophthalmology Dr. D. Nicolle (ophthalmology)

Critical Care Dr. B. Young

* Multiple Sclerosis Dr. G. Rice Dr. M. Kremenchutzky

Pain Dr. D. Moulin Dr. C. Watling

* Epilepsy Dr. W. Blume Dr. R. McClachlan Dr. S. Mirsatarri Dr. B. Young Dr. D. Diosy (clinical assoc.) Dr. G. Ganapathy (clinical assoc.) Dr. J. Burneo (2004)

Neuroendocrinology Dr. P. Cooper * Neuromuscular Dr. J. Brown Dr. A. Hahn Dr. M. Nicolle Dr. M. Strong Dr. S. Venance Dr. T. Doherty (PM&R)

Pediatric Neurology Dr. C. Campbell Dr. S. Levin Dr. N. Prasad * Stroke / TIA Dr. V. Hachinski Dr. D. Spence Dr. R. Chan

Headache Dr. P. Cooper

Oncology Dr. D. MacDonald Dr. D. Moulin Dr. C. Watling

*subspecialties offering fellowships Clinical Nurses Breeda O’Farrell General Neurology Wilma Koopman Neuromuscular Lynn McEwan MS Linda Hall Movement Disorder Margo Devries-Rizzo Pediatric Neurology Lisa Pearlman Pediatric Neurology

Cheryl Mayer TIA Clinic Connie Frank Stroke Trials Sandi Taylor Stroke Deb Bisnaire Neurosurgery Pat Doyle-Pettypiece Neurosurgery

Pharmacists Anjali Banerjee Neurology Aaron Sehn Neurosurgery

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RCPSC requirements for training in Neurology These are the requirements listed on the RCPSC web site for training in Adult Neurology: Five years of approved residency training. This period must include:

1. One year of basic clinical training. 2. a. a minimum of one year of approved residency training in internal medicine (two years are

preferable).

NOTE: Training under Sections 1 and 2(a) combined may include up to six months of neurology.

b. a minimum of three years of approved residency training in neurology, to include

- a minimum of 24 months of training in clinical neurology, with at least 18 months adult neurology and 3 months pediatric neurology,

- one further year of clinical or basic science research, basic science study, clinical

training, or other training directly pertinent to neurology, at a hospital or university centre, acceptable to the residency program committee and the Royal College.

More details are available on the RCPSC web site (http://rcpsc.medical.org/)

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Outline of the UWO training program in Neurology There is a fair amount of flexibility in the program given the above RCSPC requirements. The following is an outline of the mandatory (RCPSC and UWO) and recommended rotations in Pgy-1 to 5 years. Pgy-1 and 2 Mandatory rotations: 2 mo. of In-patient Neurology in Pgy-1

4 mo. of In-patient Neurology in Pgy-2 2 mo. of In-patient Internal Medicine

Recommended rotations: 1 month on the Stroke Service in Pgy-2 1-2 month rotations in each of the following:

o Medicine subspecialties: Cardiology, Endocrinology, Rheumatology, Infectious Disease, Hematology, Out-patient Medicine

o ER o ICU o Neurosurgery (1 month HIGHLY recommended) o Neuroradiology (2 months HIGHLY recommended, see Ordering CT Scans below) o Psychiatry

NOTE: There is a minimum requirement of 12 months of Internal Medicine over the Pgy-1 and 2 years (includes in-patient and out-patient Internal Medicine rotations, as well as medicine subspecialty services, ER and ICU)

Pgy-3 Mandatory rotations:

4 mo. In-patient Neurology 4 mo. Urgent Neurology Research (one half-day per week)

Recommended rotations: 4 mo. Out-patient Neurology Clinics Pgy-4 Mandatory rotations: 3 mo. Pediatric Neurology 3 mo. Neuropathology Research (one half-day per week)

Longitudinal clinic (one half day per month)

Recommended rotations: 3 mo. Epilepsy / EEG 3 mo. Neuromuscular / EMG Pgy-5

Mandatory rotations: 4 mo. In-patient Neurology 4 mo. Urgent Neurology 4 mo. Outpatient Neurology Clinics

Longitudinal clinic (one half day per month)

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Rotation Selection Rotation schedule - At the beginning of each academic year, residents must submit a list of their desired rotation schedule, including the specific rotations, location of their rotations and order of their rotations. This list must be submitted to the CNS Education Coordinator by May or early June. In the Pgy-1 and 2 years, rotation requests must be coordinated with other departments, such as the internal medicine department, therefore rotation requests should be submitted as early as possible. - NOTE: Final rotation schedules for Pgy-1 and 2 years have traditionally only been available at the very end of June. - An overview of the rotations previous or senior residents have selected throughout their Pgy-1 to 5 years is available from the CNS Education Coordinator. Rotation options - Elective time away from London can be arranged. Approval from the Department / Program Director must be obtained well in advance. - Rotations on services not listed in the outline above, such as stroke, MS, oncology, family medicine, anesthesia, pediatrics, rehabilitation medicine, neuro-ophthalmology etc. can be arranged with approval from the department. - also see Research section below Location of medical services Medical services in London are currently divided amongst 4 hospitals: University Hospital (UH), St. Joseph’s (SJ), South Street (SS) and Westminster Campus (WC). The location(s) of select in-patient and out-patient services are listed below:

• Neurology, including In-patient, Out-patient, Epilepsy, Neuromuscular, Stroke, MS, Movement Disorders - UH

• Urgent Neurology Clinic, Headache - SS • Pediatric Neurology, Neuro-Oncology - WC • Neurosurgery, Neuroradiology, Neuropathology, Neuro-ophthalmology - UH • In-patient and Out-patient Medicine, Cardiology, Infectious diseases, ICU - UH or SS • Hematology - WC • Endocrinology, Rheumatology - SJ • ER - SJ or LHSC (which will include shifts at SS or UH) • Psychiatry In-patients - SS • Pediatrics – WC

Change of Rotation Requests Official change of rotation forms are available in the Resident’s room or from the CNS Education Coordinator and must be completed if a resident decides to change a previously approved rotation. All necessary signatures must be obtained. Requests must be approved well in advance of their start date.

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Research - One half-day per week is protected in the Pgy-3 and Pgy-4 years for research. - Early in the third year, residents should approach a mentor to discuss a potential research project. - Opportunities exist to undertake either clinical and/or basic research projects. - Additional or alternative elective time for research (e.g. 3 month block) could be arranged with approval from the program - This is a new intiative in the program as of the 2002-2003 academic year and is subject to modification Longitudinal Clinic - This is a new intiative in the program as of the 2002-2003 academic year and is subject to modification -Proposed Guidelines are listed below: Goal: - Starting in the Pgy-4 year, and continuing throughout the Pgy-5 year, residents will have their own longitudinal patient follow-up clinic. The goal of the clinic is for residents to gain experience managing patients with neurological disorders. Residents will have primary responsibility for their patients under the mentorship of a consultant. Patients will be enrolled and followed over time thereby providing continuity of care. Years of residency: - Pgy-4 and 5 Frequency: - One half-day clinic per month - Resident’s are to be excused from their duties on other services in order to attend their monthly clinic Mentorship: - At the end of third year, each resident will choose / be assigned one consultant as mentor for their longitudinal clinic - To encourage enrollment of patients with a variety of neurological disorders, it is recommended that consultants with general neurology clinics should be selected as mentors i.e. Dr. P. Cooper, Dr. M. Strong, Dr. C. Watling, Dr. A. Hahn, Dr. M. Nicolle - This will facilitate the organization and booking of patients for the clinic which is to be coordinated with the mentoring consultant's secretary Patient recruitment: - New patients can be referred directly to residents by consultants or drawn from the pool of patients seen either at the urgent neurology clinic or the inpatient service (at the attending consultant’s discretion) - Mentors may refer patients to a resident’s longitudinal clinic - Residents are encouraged to enroll patients with a variety of neurological disorders. Expected patient load: - Residents will be expected to follow 5-10 patients over the course of 2 years - At the end of the 2 years, the mentoring consultant will assume care of patient’s enrolled in the resident’s clinic

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Educational Rounds Academic Half Day When: Tuesday 0800-1300 What takes place: Grand Rounds (see below)

Neurology and Neurosurgery Case presentations +/- Guest speaker +/- Neuropathology rounds +/- Physical Diagnosis rounds +/- Evidence Based Neurology (EBN) rounds (alternate weeks; see below) +/- Teaching on a variety of topics (organized by the Senior Resident) Weekly Rounds

Neuroradiology weekly Wednesday 0800 Neuromuscular monthly Wednesday (1st) 1200 Stroke weekly Wednesday (2nd-4th) 1200 Movement Disorders bi-monthly Thursday (2nd/4th) 0800 Professor Rounds monthly Thursday (3rd) 1200 Epilepsy weekly Friday 0800

* A schedule of the confirmed weekly rounds and topics is distributed via email by the CNS Education Coordinator Neuroanatomy course: - Offered on alternate years along with neurosurgery / ophthalmology residents. One day per week for 3 weeks. Neuropathology : - One hour neuropathology slide review sessions occur once per month during academic half-days (usually the third Tuesday of every month), along with the neurosurgery and neuropathology residents - During the academic year, residents also traditionally meet once per week (usually Thursdays) to review pathology slides. These session are usually organized by the Pgy-4/5s. - A collection of slides is available for review from the CNS education coordinator. Basic Neurosciences: - The current format is a new initiative as of the 2004-2005 academic year and is thus subject to change - Each resident chooses one topic per year to prepare and present to the neurology residents. - One power point presentation occurs per month. - 22 different topics are to be reviewed over a 2 year cycle. - Presentations are to be maximum of 1 hour in duration and should include a maximum of 30 minute of didactic teaching followed by interactive sample questions taken from e.g. Neurology secrets, Neuroscience secrets, Neurology Pearls etc. - The Power Point Presentation is to be provided to the group at the end of the talk - The topic list includes:

Neurotransmitter Systems Vascular Anatomy Thalamus Anatomy Spinal sensory systems Cranial nerve sensory systems Visual System Auditory System Taste and Smell Descending Motor Pathways and Motor Function of Spinal Cord Cranial nerve motor nuclei Vestibular System Oculomotor system

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Cerebellum Basal Ganglia Hypothalamus and neuroendocrine Limbic system (circuits for emotions, learning and memory) Reflex anatomy Autonomic Nervous system Nerve physiology (AP creation and transmission and neuromuscular junction) Neuroembryology CSF physiology Pain physiology

UWO Clinical Neurological Sciences Research Day All Residents, Fellows, and Graduate Students in the Department of Clinical Neurological Sciences, including Neuropathology and Neuroradiology, are invited to submit abstracts for the Annual CNS Research Day, which usually occurs in January or February. The format is 10 minute presentations, each followed by a 5 minute discussion. The presentations are judged according to the quality of presentations (organization, clarity, timing, and slides), content, relevance to neurosciences, and originality. Awards are made for the best presentations. Grand rounds CNS Grand Rounds occur every Tuesday morning as part of the Neurology and Neurosurgery resident academic half-day. One case is presented and then discussed by each of the Neurology and Neurosurgery services. Following the case presentations, there are often invited guest speaker presentations. Case Presentations: - Neurology residents on the in-patient service are primarily responsible for the case presentations at Grand Rounds. - Weekly case selection and assignment is the responsibility of the Chief Resident. - Pgy-1 residents will present a case a minimum of 1 time while on the in-patient service - Pgy-2 to 5 residents share the responsibility of weekly case presentations when on the in-patient service - Pgy-3 to 5 residents are required to present once every 2 months at Grand Rounds while on their Urgent Neurology or Pediatric Neurology rotations (first tuesday of each month) - Off service residents are not currently required to present a case at Grand Rounds Case Discussion - Pgy-1 residents are “generally” not called upon to discuss cases at Grand Rounds. - Pgy-2 to 5 residents should be prepared to discuss the cases presented at rounds

Evidence Based Neurology - The evidence based medicine rounds for the UWO Neurology program. For the 2004-2005 academic year, this course is organized by Dr. M. Jenkins and Dr. J. Burneo. - Prior to the start of each academic year, topics of interest are selected by the residents for the entire year. Attempts are made to select topics from all aspects of neurology.

- Each resident in the program is generally responsible for 2 topics per year. - Topics should be researched well ahead of time and selected articles MUST be reviewed with Dr. Jenkins and/or Dr. J Burneo prior to distribution to the group.

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- Rating scales and worksheets for critical appraisal of articles are available in the 10th floor EBN room and on the EBN web site. - At the start of their residency, residents are provided with the following evidence based medicine resources:

- EBM and Critical Appraisal Resource Guide Binder - Demaerschalk, Wiebe - Evidence Based Medicine. How to practice and teach EBM - Sackett, Strauss, Richardson, Rosenberg, Haynes

- Additional resources are available in the 10th floor EBN room - More information, including the topic schedule, a CAT outline, rating scales and worksheets, various evidence-based medicine tools, links to useful websites and a database of all our CATs (Critically Appraised Topics) are available on the EBN web site (http://www.uwo.ca/cns/ebn/).

Off-Site Neurology Courses Every year, residents in neurology programs across the country attend 2-3 day courses on a variety of subspecialties in neurology. Courses are fully sponsored, including airfare/travel, accommodation and meals. The current list of courses offered and in what year of training residents qualify to attend are listed below. Subspecialty Date Residents Epilepsy February Pgy 4-5 Headache October Pgy 3-5 Movement Disorders January Pgy 4 Stroke April Pgy 2-5 Educational Resources - The 7th floor Neuroscience library contains many useful neurology, neurosurgery and neuroscience references, as well as a collection of journals. - A collection of evidence based medicine references is available in the 10th floor EBN room - There are hospital libraries at UH (near auditorium A), SS (in the Nurse’s residence) and SJ (2nd floor). - The health sciences library for the UWO is the Ann and Betty Taylor library - Additional educational resources are available for sign out from the CNS Education coordinator including:

- a growing collection of the Continuum series from the AAN - the annual AAN CDs - neuropathology review slides

Evaluations Trial oral exams For the purpose of this examination, each resident is assigned to a consultant. At a mutually agreed upon date/time, residents perform a supervised history and physical examination and case discussion. The case discussion includes a summary of pertinent signs and symptoms, localization of the lesion / deficit, a differential diagnosis, further investigations and management. Expectations will increase as a resident progresses from Pgy-1 to 5. The frequency of oral examinations are listed below: Pgy-1 and 2 1x / year Pgy-3 and 4 3x / year Pgy-5 4x / year

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Mock Royal College short answer exam Yearly in the fall residents write a mock Royal College short answer exam. The same examination is given to all levels of trainees. The exam is not graded. Rather, it is meant to be an educational tool and to prepare resident’s for the kind of questions they will face in the final certification exam. Dr. Jog is currently responsible for the preparation of this examination. Mock OSCE ? yearly ? April Dr. Watling is currently responsible for the preparation of this examination. AAN Residency In-Service Training Examination February/March Pgy-3 to 5 Evidence Based Neurology pop quizzes Random quizzes on various aspects of evidence based medicine occur throughout the year during the EBN course. Rotation evaluations It is the responsibility of the resident to obtain a Rotation Evaluation after each completed rotation. Forms are available in the Resident's room, from the CNS Education Coordinator. LMCC Part II October Pgy-2 RCPSC Examination for certification in Neurology end of May / early June Pgy-5

Chief Resident - Shared by Pgy-5 residents or most senior resident on the neurology service at UH or SS - Responsibilities: 1. University Campus

- Supervision of the in-patient CTU, ER referrals, and consult service - Call schedules for UH - Weekly case selection and assignment of presentations for Grand Rounds, Physical Diagnosis Rounds and Professor’s Rounds - Housestaff teaching and evaluations

2. Urgent Neurology Clinic / South Street Campus (SSC) - Supervision of Urgent Neurology Clinic, Neurology consults and ER referrals at SSC - Call schedules for SSC - Monthly rounds presentation for Medicine residents (Noon rounds on first Wednesday of the month) - Grand Rounds once per 2 month rotation on first Tuesday of the month - Attend Neurology Consultant Medicine Rounds at 8 a.m. on first and second Thursday of each month - Housestaff teaching and evaluations

Senior Resident - Shared by Pgy-4 residents - Responsibilities: - Organize academic ½ day / talks

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Salary and Tuition / Fees - The current scale of renumeration, as listed in the PAIRO Member's Manual:

Current Pgy-1 44,230 Pgy-2 51,628 Pgy-3 54,765 Pgy-4 58,475 Pgy-5 62,358

- Chief resident bonus = $3650 - Senior resident bonus = $1825 - Current annual UWO tuition / fees: $325.00/year deducted from your September pay cheque

On-Call and Meal Allowance - up to 1:4 in house, up to 1:3 home-call, as per PAIRO agreement - call on the Neurology in-patient service is home-call and rarely, if ever, exceeds 1:4 - On the Urgent Neurology rotation, residents will cover the SS hospital on-call. Call does not exceed 1:3 and is home-call. - Residents are generally protected from in-patient/team call in their Pgy-4 year and during the last 4 months of the Pgy-5 year. Call while rotating through certain services may be expected as a Pgy-4 resident, for example on the epilepsy or stroke services. - Meal allowance: $8.25/meal Home call = 1 meal / 4-12h In house (Monday-Friday) = 2 meals / 12-24h In house (Saturday or Sunday) = 3 meals / 24h - call schedules for internal medicine, medicine subspecialties and ICU rotations are forwarded directly to Ann Hern in the Education Office located on the 2nd floor of the Nursing Residence across from SSC *** on other rotations, including neurology, you must inform Ann Hern of your call schedule or else you will not get a meal allowance for your on-call time - you may email her your call schedule at [email protected] - cheques are available every 3 months (July-Sep, Oct-Dec, Jan-Mar, Apr-Jun) in the Education Office from Ann Hern or if you wait long enough, it will be mailed to you

CMPA - current monthly resident fees = $164.00 - applications for reimbursement are sent to residents in February from the Ministry of Health and Long-Term Care - reimbursements have traditionally been on the order of 80% of total yearly fees and are sent to residents in May/June. Ordering CT scans On-Call All radiology imaging requests (MRI / CT) must be approved by the radiology staff or resident on-call, with the following exception: Neurology residents who have successfully completed a 2 month rotation in Neuroradiology are able to order CT head / brain scans when on-call for neurology at University hospital without contacting the radiology resident on-call. Residents ordering CT scans on-call become responsible for interpreting the scan. This exception DOES NOT apply during normal working hours or at other institutions in London (SJ, SS, WC) and DOES NOT apply to MRI scans.

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Committees Residency Program Committee

- Goals: Continuing education issues, recruitment / interviews of new residents, curriculum changes, resident problems / issues

- Current Members: Residents: Christen Shoesmith, Miguel Bussiere, Abdullah Al-Ajmi, Alex Fraser Staff: Dr. Cooper, Dr. Jog, Dr. Venance, Dr. Watling, Nicole Farrell

- Minutes from committee meetings will be made available to residents after each meeting.

Holidays / Education Leave - 4 weeks of holidays / year - 1 week (7 days) education leave / year - Christmas / New Years: 5 days either over Christmas or New Year's - Deadlines for holiday / education leave requests:

15th of every month for the following month Feb. 15th

- Official forms are available in the Resident’s room, from the CNS Education Coordinator or on the UWO Neurology Resident web site (http://www.uwo.ca/cns/resident) and must be completed prior to the above deadlines. All necessary signatures, including that of the Chief resident and Attending staff of the service from which leave is requested, must be obtained.

Annual Neurology Association Meetings Canadian Congress of Neurological Sciences (CCNS) June American Academy of Neurology (AAN) April or May American Neurological Association (ANA) September or October

Funding / Bursaries Travel

Clinical Neurological Sciences department Not presenting a poster/talk $450/yr. Presenting a poster/talk $800/yr. Subspecialty meeting Flight / Accomodation / Registration may be subsidized

or funded with demonstrated interest in subspecialty (e.g. research and/or presenting poster/talk)

NOTE: Currently unused portions DO NOT carry over to next year Research RCPSC* Awards

AAN* PAIRO*

PGE* Canadian Neurological Society* *see web sites listed below for details

Mailboxes Rm 224, Resident mail room at the Nursing Residence, South street - Monthly pay stubs will be placed in this mail slot. Residents room 7th floor UH

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Codes Codes are required for access to the following locations:

- Mail Room at Nursing Residence 2nd floor, South street - 7th floor Neurology Resident Call Room

- 7th floor CNS library at UH - Other Call rooms @ UH

These codes are provided to residents at the beginning of their residency training in London by the Education office, the Western Housestaff Committee or the Neurology program. Computer Resources 7th floor Neurology Resident Call Room 2nd floor University Hospital library UWO Ann and Betty Taylor Library

Email - All residents are given a UWO Personal Computing Account for their own use - This provides residents with an email address, web space to create a personal web page and dial-in access to the Email Express Service with up to 40 hours per month. - It is important to check this email address frequently since all information dealing with residency training at UWO is sent to this email address - If you prefer to use a different email address, simply forward the UWO email to this account. - More information and instructions are available from the ITS web site (http://www.uwo.ca/its/) Pagers - As of June 2004, all residents in the Neurology program will be assigned (and be responsible for) a pager for the duration of their residency. - Switchboards:

LHSC 685-8500 St. Joseph's 646-6000

- To page someone directly - if you are located at one of the LHSC sites and using one of the house phones, simply dial the pager number then enter a call back number and hang-up - if you are off site, call one of the switchboards, enter the pager number and hold the line

- Forwarding a pager (a) to another pager (b) Call switchboard, enter pager number (a), press ** 16, then 3, then 6, then enter the pager # (b)

- Unforwarding a pager Call switchboard, enter pager number to be unforwarded, press ** 16, then 3 - Answering an external call when the caller is waiting on the line

- If you get paged to your own pager number, this indicates that someone is waiting on the line to speak with you - call the switchboard, enter your pager number and then press **3 to be connected

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Dictations - Detailed instructions are available on the ward or in the Western Housestaff Handbook or from Medical Records - Brief Instructions (LHSC):

- Dial LHSC central dictation #58570 - Enter your ID then Password (assigned when you start residency) - Enter patient site code: University 1, Victoria 2 - Enter patient identification number (PIN) - Enter work type followed by a # key 1 Discharge summary, 2 Death summary, 3 OR note, 4 Clinic Note, 5 H&P, 6 Consultation note, 7 Procedure room note - Dictate Note by pressing 2 to record - Press 2 again to pause dictation, 3 to rewind - Enter 8 to end note and continue, 5 to end note and sign off the system

- General format of discharge summary: • Date of admission • Date of discharge • CC (Hospital chart, family doctor, attending staff) • Patient profile and reason for admission • Discharge diagnosis • Problem list: Active and Inactive subheadings • Current problem • Investigations while in hospital • Course in hospital • Discharge medications • Discharge follow-up

Recommended Reference Texts General Neurology • Neurology in Clinical Practice – Bradley, Daroff, Fenichel, Marsden ($$$) or • Merritt’s textbook of Neurology – Rowland ($$) • Neurology and General Medicine – Aminoff ($$) On-Call • On-Call Neurology - Marshall, Mayer ($) EBN • EBM and Critical Appraisal Resource Guide Binder - Demaerschalk, Wiebe • Evidence Based Medicine. How to practice and teach EBM - Sackett, Strauss, Richardson,

Rosenberg, Haynes - Both of these texts are provided to residents at the start of their residency (Dr. Wiebe) Movement Disorder • Movement Disorder Manual - Jog, Jenkins, Hyson - Provided to residents at the start of their residency (Dr. Jog) Epilepsy / EEG • EEG Primer – Fisch ($$) • Handbook of Epilepsy – Browne and Holmes ($) For reference or if interested in subspecialty: • The Treatment of Epilepsy: Principles and Practice - Elaine Wyllie ($$$) • Epilepsy: A Comprehensive Textbook - J Engel, T.A. Pedley ($$$)

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Neuromuscular / EMG • Aids to the examination of the peripheral nervous system ($) For reference or if interested in subspecialty: • EMG and Neuromuscular disorders: Clinical-Electrophysiologic correlations – Preston and

Shapiro ($$) Neuro-ophthalmology • Neuro-ophthalmology review manual - Kline and Bajandas ($) • Neuro-ophthalmology: A problem-oriented approach - Beck and Smith Neuropathology • Manual of Basic Neuropathology – Gray, De Girolami and Poirier ($$) Neuroradiology • Neuroradiology: The Requisites - Grossman and Yousem ($$) Neurosurgery • Handbook of Neurosurgery – Greenberg ($) Basic Neurosciences • Neuroscience Secrets – Wong-Riley ($) • Principles of Neural Science - Kandel, Schwartz, Jassell Neuroanatomy • Nervous system and sensory organs. Color atlas of human anatomy, Vol 3 – Kahle and

Frotscher ($) Medicine • Washington Manual of Medical Therapeutics - Ahya, Flood, Paranjothi ($) • UpToDate (currently available via the internet using the UWO library system) Medications • Tarascon Pocket Pharmacopoeia ($) Bugs and Drugs • Sanford Guide to Antimicrobial Therapy ($) Neurology Review Manuals • Neurology Pearls of Wisdom – Labanowski et al. ($$) • Neurology Recall – Miller and Fountain ($) • Neurology Secrets – Rolak ($)

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Useful Web sites Local Sites John P. Robarts Research Institute http://www.robarts.ca/ London Health Sciences Centre http://www.lhsc.on.ca/ London Regional Cancer Centre http://www.lrcc.on.ca/ New Resident Orientation http://www.sjhc.london.on.ca/sjh/profess/

medical_affairs/orient/index.htm St. Joseph's Health Care of London http://www.sjhc.london.on.ca/ University of Western Ontario (UWO) http://www.uwo.ca/ UWO Clinical Neurological Sciences http://www.uwo.ca/cns/ UWO Neurology Residents http://www.uwo.ca/cns/resident/ UWO Evidence Based Neurology http:///www.uwo.ca/cns/ebn/ UWO Information Technology Services http://www.uwo.ca/its/ UWO Library http://www.lib.uwo.ca/ UWO Post Graduate Education Office http://www.fmd.uwo.ca/postgrad-medicine/ Western Housestaff http://www.westernhousestaff.com/ Clinics Cognitive Neurology Clinic http://kerteszpickftd.neurohub.net/ Epilepsy Unit http://www.lhsc.on.ca/eeg/ Movement Disorders Clinic http://mdc.lhsc.on.ca/ MS Clinic http://www.lhsc.on.ca/programs/msclinic/msclinic.htm Pediatric Neurology http://www.chwo.org/programs/n_missio.htm Organizations American Academy of Neurology http://www.aan.com/ American Neurological Association http://www.aneuroa.org/ Canadian Congress of Neurological Sciences http://www.ccns.org/ Canadian Medical Association http://www.cma.ca/ Canadian Medical Protective Association http://www.cmpa.org/ CPSO http://www.cpso.on.ca/ Medical Council of Canada http://www.mcc.ca/ Ontario Medical Association http://www.oma.org/ PAIRO http://www.pairo.org/ RCPSC http://rcpsc.medical.org/

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Weekly Calendar of Events Monday 1200 Cerebrovascular research rounds (every 2nd week) - MRI Conference Room Tuesday Neurology academic half-day 0800-1300 0800 CNS Grand Rounds 1030 Neurology teaching sessions Wednesday 0800 Neuroradiology rounds 1200 Neuromuscular (1st Wednesday of every month) 1200 Stroke Rounds (2nd-4th Wednesdays of every month) SSC – 1st Wednesday of the month – Noon Rounds presented by Urgent Neurology resident Thursday 0800 Movement Disorders rounds (2nd and 4th Thursdays of every month) 1200 Professor Rounds (3rd Thursday of every month) SSC – 1st and 2nd Thursday of the month – 8 a.m. Neurology Rounds presented by Urgent Neurology

Consultant Friday 0800 Epilepsy Rounds * A schedule of the confirmed weekly rounds and topics is distributed by email by the CNS Education Coordinator

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UWO Neurology Resident Handbook – September 2004 20

Monthly Calendar of Events January Interviews for new applicants CNS Research Day Annual Movement Disorders course (Pgy 4) February Last day to request holiday / education leave Feb. 15 Annual Epilepsy course (Pgy 4-5) Annual UWO Neuromuscular Course March AAN Resident In-Service Training Examination (Pgy 3-5) April AAN Meeting Annual Stroke course (Pgy 2-5) May RCPSC Examination in Neurology (Pgy 5), end of May / early June June CCNS Meeting July Start of academic year Annual CNS baseball game August September Annual UWO CNS Update (course for Family Physicians) October ANA Meeting LMCC Part II Exam (Pgy-2) Annual Headache course (Pgy 3-5) November December