Internship Training Programs
Introduction
The Department of Neurology in the Neurological Institute is responsible for four weeks of training of clerkship for fifth grade medical student of National Yang Ming University, and offers internship program for domestic 6th and 7th grade medical student and international trainees. An attending physician, a neurological resident or a postgraduate year (PGY) resident, and an intern constitute a complete teaching and training team. Under the supervision of the attending physician and the resident, interns take the opportunity to primary care, and improve the clinical skills in managing patients with neurological diseases, such as neurological examination and lumbar puncture. Interns also gain knowledge by the instruction of attending physicians and residents. Through the course of our training program, progressively greater independence comes with greater experience.
Objective
- To learn and practice how to construct an integrated patient history, perform neurological examinations, and further conduct accurate neurological localizations and differential diagnoses.
- To learn comprehensively the indications and essential interpretations of specialized neurological tests.
- To practice evidence-based medicine.
For movement disorders…
- To analyze the phenomenology of involuntary movements, further classified and make differential diagnosis of the possible diseases.
- To learn treatable or easily neglected movement disorders, as well as the diseases most commonly encountered.
For dementia and cognitive disorders…
- To know the definition, pathophysiology, and management of dementia, delirium, and depression. To distinguish and make differential diagnosis of these three diseases.
- To utilize various tools for cognitive assessment
- Medical and non-pharmacological treatment for behavior disorders of the dementia patients.
- Ethical and legal issues of the dementia individuals.
For migraine and other types of headache…
- To approach a headache patient and make differential diagnosis.
- To know the acute and preventive treatment of migraine.
- To learn the clinical manifestation and treatment of medication overuse headache (MOH).
- To comprehend the clinical manifestation, characteristic of neuroimaging, and treatment of cluster headache, thunderclap headache, and low pressure headache.
- To understand the indication of lumbar puncture and the interpretation of cerebrospinal fluid analysis.
For cerebrovascular diseases…
- To apply the neuroanatomy and seminology to conduct accurate neurological localizations.
- To familiar with the diagnosis, classification, and treatment guidelines of stroke.
- To learn the diagnosis and treatment alternatives of carotid stenosis.
- To distinguish between central and peripheral vertigo.
- To correctly interpret the specialized neurological examinations, such as cerebrovascular ultrasonography, tilting table and cerebral hemodynamic test, vestibular function test, and Ankle-brachial index (ABI).
For epilepsy…
- To discriminate between epileptic seizure and syncope.
- To know the diagnosis, classification, workup, and treatment of epilepsy.
- To obtain the patient’s detailed clinical history and to describe the manifestation accurately.
- To know the indication of electroencephalogram.
- To learn how to manage seizure attack and status epilepticus.
For peripheral nervous system disorders…
- To learn the symptoms and signs of peripheral nervous system disorders
- To localize the peripheral nervous system disorders to root, nerve, neuromuscular junction, or muscle, and further perform the ancillary tests and treatment.
- To know the differentiation between nociceptive pain and neuropathic pain, and know how to treat.
- The indication of nerve conduction study, electromyogram, nerve biopsy and muscle biopsy.
Program Overview
Workload
1. Document the history, including admission note, progress note and weekly summary.
2. Trainees should perform primary care for 3-5 patients under the supervision of the resident and attending, report the condition of the patient to the supervisor, and complete the progress notes everyday.
3. Interns are the first-line doctor on-call to evaluate patients. One can report the condition to the second-line residents.
4. Participate in inpatient care with residents and attend service round with the leading of attending physicians. On Saturday and Sunday, the interns on duty should attend the teaching round as well.
5. Attend basic core lectures, teaching round, and conferences.
6. Present one case with a brief clinical history and neuroimaging in the Case presentation on Friday.
7. Interns can visit the “neurological clinics with teaching” to learn how to manage outpatient. The “outpatient teaching clinics” allow trainees to approach new patients.
Schedule
|
Mon. |
Tue. |
Wed. |
Thu. |
Fri. |
Sat. |
Sun. |
08:00-08:30 |
Clinical Challenges |
Clinical Challenges |
Discussion of ethical, legal and social issue in medical care |
Didactic lectures |
Case presentation by interns & clerks |
|
|
9:00-12:00 |
Impatient care |
Impatient care |
10-11am |
10-11am |
Impatient care |
Teaching round* |
Teaching round* |
13:30-16:00 |
Service round |
Service round 2-3pm |
Service round |
Service round |
Service round |
|
|
16:00-17:00 |
Journal reading & Grand round |
Case demonstration |
|
Mortality & morbidity conference |
Epilepsy Surgery Case Conference |
|
|
* The attending physician on duty held the teaching rounds on Saturday and Sunday and only the interns on duty should attend.
Basic Core Lectures
Topic |
Frequency |
Speaker |
Neurological examination |
2/month |
Dr. Yen-Feng Wang |
Conscious disturbance and brain death |
2/month |
Prof. Pei-Ning Wang |
Movement disorders |
1/month |
Prof. Din-E Shan |
Headache and dizziness |
2/month |
Dr. Wei-Ta Chen |
Overview of epilepsy |
2/month |
Dr. Hsiang-Yu Yu |
General concept of stroke |
2/month |
Dr. Li-Chi Hsu |
Indication of neuroimaging |
2/month |
Dr. Yi-Chu Liao |
Indication of specialized neurologic tests |
2/month |
Dr. Kuan Lin Lai |
Visit neurological laboratories (optional)
|
Frequency |
Supervisor |
NCS/EMG, EP, TMS |
1/month |
Dr. Yi-Chu Liao |
Cerebrovascular ultrasonography |
1/month |
Dr. Chun-Jen Lin |
Botox injection |
1/month |
Dr. Yen-Feng Wang |
* Trainees can also other visit neurological laboratories (hemodynamic test, neuromuscular pathology and neurogenetic/ neuroimmunological tests) with the supervision of the attending (optional).
Teaching round
The attending physician holds teaching round at bedside, with comprehensive review from taking medical history, neurological examination, differential diagnosis, and treatment. Trainees should attend the teaching round once a week.
On call
The working hours should not exceed 80 hours per week in average. The on-call time should not exceed 12 hours per day, and should take rest for at least 10 hours in between. The continuity working hours should be within 32 hours.
Avaliable Supervisors
Deputy Head of Neurology institute
Shuu-Jiun Wang
Division of Cerebrovascular diseases
Chief: Dr. Yung-Yang Lin
Attending physician: Dr. Li-Chi Hsu, Dr. I-Hui Lee, Dr. Chih-Ping Chung, Dr. Chun-Jen Lin
Division of Peripheral Nervous System Disorders
Chief: Dr. Bing-Wen Soong
Attending physician: Dr. Kon-Ping Lin, Dr. Kwong-kum Liao, Yi-Chung Lee, Dr. Yi-Chu Liao
Division of General Neurology
Chief: Dr. Din-E Shan
Attending physician: Dr. Jong-Ling Fuh, Dr. Pei-Ning Wang, Dr. Wei-Ta Chen, Dr. Shih-Pin Chen, Dr. Yen-Feng Wang
Division of Epilepsy
Chief: Dr. Der-Jen Yen
Attending physician: Dr. Shang-Yeong Kwan, Dr. Hsiang-Yu Yu, Dr. Chien Chen, Dr. Yo-Tsen Liu, Dr. Chien-Chen Chou
Assessment
- The supervisor will assess the document of medical history by the trainee every two weeks.
- Student’s performance was assessed mainly by so-called “TPS two-way feedback system”, which is a workplace-based evaluation by other team members and the supervisors.
- To evaluate the clinical skills and provide real time feedback to the trainees, the supervisors will perform the mini clinical evaluation exercise, or mini-CEX by the end of the training program.
- Symposium for interns will take place every month, allowing interactive feedback with the chairman of program director. Trainees can provide practical recommendations to improve the training program.
Program Directors
Deputy Head of Neurology Institute and
Chairman of National Yang-Ming University School of Medicine
Prof. Shuu-Jiun Wang
TEL:02-28757578
Email: sjwang@vghtpe.gov.tw
Chairman of the program director
Prof. Bing-Wen Soong
TEL:02-28757578
Email: bwsoong@vghtpe.gov.tw
Program Director
Prof. Jong-Ling Fuh
TEL:02-28757578
Email: jlfuh@vghtpe.gov.tw
Program Designer
Dr. Chun-Jen Lin
TEL:02-28757578
Email: cjlin9@vghtpe.gov.tw
Secretory of Education Programs
Ms. Yang
TEL: 02-28757578
Email: tlyang@vghtpe.gov.tw
Ms. Feng
TEL: 02-28757578
Email: ccfeng@vghtpe.gov.tw
References
Books
- Neurology and Neurosurgery Illustrated. Renneth W. Lindsay. 5thedition, 2010
- Merritt’s Neurology. Lewis P Rowland. 13th edition, 2015
- Adams and Victors Principles of Neurology. Allan H. Ropper, Martin A. Samuels, Joshua P. Klein. 10th edition, 2014
- Technique of the Neurologic Examination. William E. Demyer, M.D. 5th edition, 2004.
- Topical Diagnosis in Neurology. Peter Duus. 5th completely revised edition, 2011
Links
VGHTPE Library
E-learning
Neurology
Lancet Neurology
UpToDate
Last Modified: