Milestone 1:  History — Patient Care
Level 1		Level 2		Level 3		Level 4		Level 5
• Obtains a neurologic history		• Obtains a complete and relevant neurologic history		• Obtains a complete, relevant, and organized neurologic history		• Efficiently obtains a complete, relevant, and organized neurologic history		• Efficiently obtains a complete, relevant, and organized neurologic history incorporating subtle verbal and non- verbal cues
1	1.5	2	2.5	3	3.5	4	4.5	5
Milestone 2:  Neurological Exam — Patient Care
Level 1		Level 2		Level 3		Level 4		Level 5
• Performs complete neurological exam		• Performs complete neurological exam accurately		• Performs a relevant neurological exam incorporating some additional appropriate maneuvers • Visualizes papilledema • Accurately performs a neurological exam on the comatose patient		• Efficiently performs a relevant neurological exam accurately incorporating all additional appropriate maneuvers • Accurately performs a brain death examination		• Consistently demonstrates mastery in performing a complete, relevant, and organized neurological exam
1	1.5	2	2.5	3	3.5	4	4.5	5
Milestone 3:  Management/Treatment — Patient Care
Level 1		Level 2		Level 3		Level 4		Level 5
• Demonstrates basic knowledge of management of patients with neurologic disease		• Discusses general approach to initial treatment of common neurologic disorders, including risks and benefits of treatment • Identifies neurologic emergencies		• Individualizes treatment for specific patients • Initiates management for neurologic emergencies and triages patient to appropriate level of care • Appropriately requests consultations from non- neurologic care providers for additional evaluation and management		• Adapts treatment based on patient response • Identifies and manages complications of therapy • Independently directs management of patients with neurologic emergencies • Appropriately requests consultations from a neurologic subspecialist for additional evaluation or management		• Demonstrates sophisticated knowledge of treatment subtleties and controversies
1	1.5	2	2.5	3	3.5	4	4.5	5
Milestone 4:  Movement Disorders — Patient Care
Level 1		Level 2		Level 3		Level 4		Level 5
• Recognizes when a patient may have a movement disorder		• Identifies movement disorder phenomenology and categories (hypokinetic and hyperkinetic)		• Diagnoses and manages common movement disorders • Identifies movement disorder emergencies		• Diagnoses uncommon movement disorders • Appropriately refers a movement disorder patient for a surgical evaluation or other interventional therapies • Manages movement disorders emergencies		• Manages uncommon movement disorders • Engages in scholarly activity in movement disorders (e.g., teaching, research)
1	1.5	2	2.5	3	3.5	4	4.5	5
Milestone 5:  Neuromuscular Disorders — Patient Care
Level 1		Level 2		Level 3		Level 4		Level 5
• Recognizes when a patient may have a neuromuscular disorder		• Identifies patterns of neuromuscular disease (e.g., anterior horn cell disease, nerve root, plexus, peripheral nerve, neuromuscular junction, muscle) • Identifies neuromuscular disorder emergencies • Orders NCS (nerve conductive study)/EMG (electromyography) testing appropriately		• Diagnoses and manages common neuromuscular disorders • Manages neuromuscular disorder emergencies • Interprets results of NCS/EMG testing in context of clinical presentation		• Diagnoses uncommon neuromuscular disorders • Recognizes when tissue biopsy is warranted		• Manages uncommon neuromuscular disorders • Engages in scholarly activity in neuromuscular disorders (e.g., teaching, research)
1	1.5	2	2.5	3	3.5	4	4.5	5
Milestone 6:  Cerebrovascular Disorders — Patient Care
Level 1		Level 2		Level 3		Level 4		Level 5
• Recognizes when a patient may have a cerebrovascular disorder		• Describes stroke syndromes and etiologic subtypes • Identifies cerebrovascular emergencies • Lists indications and contraindications for intravenous thrombolytic therapy		• Identifies specific mechanism of patient’s cerebrovascular disorder • Appropriately refers for interventional or surgical evaluation • Manages common cerebrovascular disorders including appropriate use of thrombolytics		• Diagnoses uncommon cerebrovascular disorders		• Manages uncommon cerebrovascular disorders • Engages in scholarly activity in cerebrovascular disorders (e.g., teaching, research)
1	1.5	2	2.5	3	3.5	4	4.5	5
Milestone 7:  Cognitive/Behavioral Disorders — Patient Care
• Recognizes when a patient may have a cognitive/behavioral disorder		• Identifies common cognitive/behavioral disorders		• Diagnoses and manages common cognitive/behavioral disorders, including cognitive effects of traumatic brain injury • Manages behavioral complications of cognitive/behavioral disorders • Appropriately refers for neuropsychological testing in evaluating patients with cognitive/behavioral disorders		• Diagnoses and manages uncommon cognitive/behavioral disorders		• Engages in scholarly activity in cognitive/behavioral disorders (e.g., teaching, research) • Demonstrates sophisticated knowledge of advanced diagnostic testing and controversies
1	1.5	2	2.5	3	3.5	4	4.5	5
Milestone 8:  Demyelinating Disorders — Patient Care
Level 1		Level 2		Level 3		Level 4		Level 5
• Recognizes when a patient may have a demyelinating disorder		• Diagnoses and manages common demyelinating disorders		• Recognizes uncommon demyelinating disorders • Manages acute presentations of demyelinating disorders		• Diagnoses uncommon demyelinating disorders		• Manages uncommon demyelinating disorders • Engages in scholarly activity in demyelinating disorders (e.g., teaching, research)
1	1.5	2	2.5	3	3.5	4	4.5	5
Milestone 9:  Epilepsy — Patient Care
Level 1		Level 2		Level 3		Level 4		Level 5
• Recognizes when a patient may have had a seizure		• Identifies epilepsy phenomenology, and classification of seizures and epilepsies • Diagnoses convulsive status epilepticus		• Diagnoses and manages common seizure disorders and provides antiepileptic drug treatment • Diagnoses non- convulsive status epilepticus • Manages convulsive and non-convulsive status epilepticus		• Diagnoses uncommon seizure disorders • Appropriately refers an epilepsy patient for surgical evaluation or other interventional therapies		• Manages uncommon seizure disorders • Engages in scholarly activity in epilepsy (e.g., teaching, research)
1	1.5	2	2.5	3	3.5	4	4.5	5
Milestone 10:  Headache Syndromes — Patient Care
Level 1		Level 2		Level 3		Level 4		Level 5
• Recognizes common headache syndromes		• Diagnoses and manages common headache syndromes • Identifies headache emergencies		• Recognizes uncommon headache syndromes • Diagnoses and manages headache emergencies		• Diagnoses and manages uncommon headache syndromes		• Engages in scholarly activity in headache syndromes (e.g., teaching, research)
1	1.5	2	2.5	3	3.5	4	4.5	5
Milestone 11:  Neurologic Manifestations of Systemic Disease — Patient Care
Level 1		Level 2		Level 3		Level 4		Level 5
• Recognizes when a patient’s neurologic symptoms may be due to systemic illness • Identifies neurologic emergencies due to systemic disease		• Diagnoses and manages common neurologic manifestations of systemic diseases • Diagnoses and manages neurologic emergencies due to systemic disease		• Recognizes uncommon neurologic manifestations of systemic disease		• Diagnoses and manages uncommon neurologic manifestations of systemic disease		• Engages in scholarly activity in neurologic manifestations of systemic disease (e.g., teaching, research)
1	1.5	2	2.5	3	3.5	4	4.5	5
Milestone 12:  Child Neurology for the Adult Neurologist — Patient Care
Level 1		Level 2		Level 3		Level 4		Level 5
• Obtains basic neurologic history of infants and children		• Lists the elements of a neurological examination of infants and children • Recognizes broad patterns of neurologic disease in infants and children • Lists normal developmental milestones		• Obtains a complete and age-appropriate neurologic history of infants and children • Performs a complete and age-appropriate neurological examination of infants and children • Diagnoses common child neurologic disorders		• Initiates management of common childhood neurologic disorders • Initiates management of common neurologic emergencies in infants and children		• Diagnoses uncommon childhood neurologic disorders
1	1.5	2	2.5	3	3.5	4	4.5	5
Milestone 13:  Neuro-Oncology — Patient Care
Level 1		Level 2		Level 3		Level 4		Level 5
• Recognizes common clinical presentations of a brain or spine mass		• Identifies neuro- oncological emergencies and initiates management		• Provides differential diagnosis of brain or spine mass • Identifies neurologic complications due to cancer or the treatment of cancer		• Appropriately refers for advanced testing, including biopsy • Manages neurologic complications due to cancer or the treatment of cancer		• Engages in scholarly activity in neuro- oncology (e.g., teaching, research)
1	1.5	2	2.5	3	3.5	4	4.5	5
Milestone 14:  Psychiatry for the Adult Neurologist — Patient Care
Level 1		Level 2		Level 3		Level 4		Level 5
• Recognizes when a patient may have a psychiatric disorder • Obtains an appropriate psychiatric history		• Identifies common psychiatric disorders • Identifies psychiatric co- morbidities in patients with a neurologic disease		• Recognizes when a patient’s neurological symptoms are of psychiatric origin • Recognizes when a patient’s psychiatric symptoms are of neurologic origin • Identifies major side effects of psychiatric medications		• Diagnoses common psychiatric disorders • Initiates management of psychiatric co- morbidities in patients with a neurologic disease		• Engages in scholarly activity in psychiatric disorders (e.g., teaching, research)
1	1.5	2	2.5	3	3.5	4	4.5	5
Milestone 15:  Neuroimaging — Patient Care
Level 1		Level 2		Level 3		Level 4		Level 5
• Identifies basic neuroanatomy on brain MR (magnetic resonance ) and CT (computerized tomography)		• Recognizes emergent imaging findings on brain MR and CT • Identifies major vascular anatomy on angiography • Identifies basic neuroanatomy on spine MR and CT		• Describes abnormalities of the brain and spine on MR and CT • Identifies major abnormalities on angiography		• Interprets MR and CT neuroimaging of brain and spine		• Identifies subtle abnormalities on angiography • Interprets carotid and transcranial ultrasound
1	1.5	2	2.5	3	3.5	4	4.5	5
Milestone 16:  Electroencephalogram (EEG) — Patient Care
Level 1		Level 2		Level 3		Level 4		Level 5
• Explains an EEG procedure in non- technical terms		• Uses appropriate terminology related to EEG (e.g., montage, amplitude, frequency)		• Describes normal EEG features of wake and sleep states • Recognizes EEG patterns of status epilepticus • Recognizes common EEG artifacts		• Interprets common EEG abnormalities and creates a report • Recognizes normal EEG variants		• Interprets uncommon EEG abnormalities • Describes normal and some abnormal EEG features of wake and sleep states in children
1	1.5	2	2.5	3	3.5	4	4.5	5
Milestone 17:  Nerve Conduction Studies (NCS)/Electromyography (EMG) — Patient Care
Level 1		Level 2		Level 3		Level 4		Level 5
• Explains an NCS/EMG procedure in nontechnical terms		• Uses appropriate terminology related to NCS/EMG		• Describes NCS/EMG data • Lists NCS/EMG findings in common disorders		• Interprets NCS/EMG data in common disorders • Describes common pitfalls of NCS/EMG • Formulates basic NCS/EMG plan for specific, common clinical presentations		• Performs, interprets, and creates a report for NCS/EMG
1	1.5	2	2.5	3	3.5	4	4.5	5
Milestone 18:  Lumbar Puncture — Patient Care
Level 1		Level 2		Level 3		Level 4		Level 5
• Lists the indications and contraindications for lumbar puncture		• Lists the complications of lumbar puncture and their management		• Performs lumbar puncture under direct supervision		• Performs lumbar puncture without direct supervision		• Performs lumbar puncture on patients with challenging anatomy
1	1.5	2	2.5	3	3.5	4	4.5	5
Milestone 19:  Localization — Medical Knowledge
Level 1		Level 2		Level 3		Level 4		Level 5
• Attempts to localize lesions within the nervous system • Describes basic neuroanatomy		• Localizes lesions to general regions of the nervous system		• Accurately localizes lesions to specific regions of the nervous system		• Efficiently and accurately localizes lesions to specific regions of the nervous system • Describes advanced neuroanatomy		• Consistently demonstrates sophisticated and detailed knowledge of neuroanatomy in localizing lesions
1	1.5	2	2.5	3	3.5	4	4.5	5
Milestone 20:  Formulation — Medical Knowledge
Level 1		Level 2		Level 3		Level 4		Level 5
• Summarizes history and exam findings		• Summarizes key elements of history and exam findings • Identifies relevant pathophysiologic categories to generate a broad differential diagnosis		• Synthesizes information to focus and prioritize diagnostic possibilities • Correlates the clinical presentation with basic anatomy of the disorder		• Efficiently synthesizes information to focus and prioritize diagnostic possibilities • Accurately correlates the clinical presentation with detailed anatomy of the disorder • Continuously reconsiders diagnostic differential in response to changes in clinical circumstances • Diagnoses brain death		• Consistently demonstrates sophisticated and detailed knowledge of pathophysiology in diagnosis • Effectively educates others about diagnostic reasoning
1	1.5	2	2.5	3	3.5	4	4.5	5
Milestone 21:  Diagnostic Investigation — Medical Knowledge
Level 1		Level 2		Level 3		Level 4		Level 5
• Demonstrates general knowledge of diagnostic tests in neurology		• Discusses general diagnostic approach appropriate to clinical presentation • Lists risks and benefits of tests to patient		• Individualizes diagnostic approach to the specific patient • Accurately interprets results of common diagnostic tests		• Explains diagnostic yield and cost-effectiveness of testing • Accurately interprets results of less common diagnostic testing • Recognizes indications and implications of genetic testing • Recognizes indications of advanced imaging and other diagnostic studies		• Demonstrates sophisticated knowledge of diagnostic testing and controversies
1	1.5	2	2.5	3	3.5	4	4.5	5
Milestone 22:  Compassion, integrity, accountability, and respect for self and others — Professionalism
Level 1		Level 2		Level 3		Level 4		Level 5
• Demonstrates compassion, sensitivity, and responsiveness to patients and families • Demonstrates non- discriminatory behavior in all interactions, including diverse and vulnerable populations • Describes effects of sleep deprivation and substance abuse on performance		• Demonstrates appropriate steps to address impairment in self •  Consistently demonstrates professional behavior, including dress and timeliness		• Demonstrates compassionate practice of medicine, even in context of disagreement with patient beliefs • Incorporates patients’ socio-cultural needs and beliefs into patient care • Demonstrates appropriate steps to address impairment in colleagues		• Mentors others in the compassionate practice of medicine, even in context of disagreement with patient beliefs • Mentors others in sensitivity and responsiveness to diverse and vulnerable populations • Advocates for quality patient care		• Engages in scholarly activity regarding professionalism
1	1.5	2	2.5	3	3.5	4	4.5	5
Milestone 23:  Knowledge about, respect for, and adherence to the ethical principles relevant to the practice of medicine, remembering in particular that
responsiveness to patients that supersedes self-interest is an essential aspect of medical practice — Professionalism
Level 1		Level 2		Level 3		Level 4		Level 5
• Describes basic ethical principles		• Determines presence of ethical issues in practice		• Analyzes and manages ethical issues in straightforward clinical situations		• Analyzes and manages ethical issues in complex clinical situations		• Demonstrates leadership and mentorship on applying ethical principles
1	1.5	2	2.5	3	3.5	4	4.5	5
Milestone 24:  Relationship development, teamwork, and managing conflict — Interpersonal and Communication Skills
Level 1		Level 2		Level 3		Level 4		Level 5
• Develops a positive relationship with patients in uncomplicated situations • Actively participates in team-based care		• Manages simple patient/family-related conflicts • Engages patients in shared decision-making		• Manages conflict in complex situations • Uses easy-to-understand language in all phases of communication		• Manages conflict across specialties and systems of care • Leads team-based patient care activities		• Engages in scholarly activity regarding teamwork and conflict management
1	1.5	2	2.5	3	3.5	4	4.5	5
Milestone 25:  Information sharing, gathering, and technology — Interpersonal and Communication Skills
Level 1		Level 2		Level 3		Level 4		Level 5
• Effectively communicates during patient hand-overs using a structured communication tool • Completes documentation in a timely fashion • Accurately documents transitions of care		• Effectively communicates during team meetings, discharge planning, and other transitions of care • Educates patients about their disease and management, including risks and benefits of treatment options • Completes all documentation accurately, including use of EHR, to promote patient safety		• Effectively communicates the results of a neurologic consultation in a timely manner • Effectively gathers information from collateral sources when necessary • Demonstrates synthesis, formulation, and thought process in documentation		• Effectively leads family meetings • Effectively and ethically uses all forms of communication • Mentors colleagues in timely, accurate, and efficient documentation		• Develops patient education materials • Engages in scholarly activity regarding interpersonal communication
1	1.5	2	2.5	3	3.5	4	4.5	5
Milestone 26:  Self-directed learning — Practice-based Learning and Improvement
• Identify strengths, deficiencies, and limits in one’s knowledge and expertise
• Set learning and improvement goals
• Identify and perform appropriate learning activities
• Use information technology to optimize learning
Level 1		Level 2		Level 3		Level 4		Level 5
• Acknowledges gaps in knowledge and expertise		• Incorporates feedback		• Develops an appropriate learning plan based upon clinical experience		• Completes an appropriate learning plan based upon clinical experience		• Engages in scholarly activity regarding practice-based learning and improvement
1	1.5	2	2.5	3	3.5	4	4.5	5
Milestone 27:  Locate, appraise, and assimilate evidence from scientific studies related to the patient’s health problems – Practice-based Learning and Improvement
Level 1		Level 2		Level 3		Level 4		Level 5
• Uses information technology to search and access relevant medical information		• Uses scholarly articles and guidelines to answer patient care issues		• Critically evaluates scientific literature		• Incorporates appropriate evidence- based information into patient care • Understands the limits of evidence-based medicine in patient care		• Engages in scholarly activity regarding evidence-based medicine
1	1.5	2	2.5	3	3.5	4	4.5	5
Milestone 28:  Systems thinking, including cost and risk effective practice — Systems-based Practice
Level 1		Level 2		Level 3		Level 4		Level 5
• Describes basic cost and risk implications of care		• Describes cost and risk benefit ratios in patient care		• Makes clinical decisions that balance cost and risk benefit ratios		• Incorporates available quality measures in patient care		• Engages in scholarly activity regarding cost- and risk-effective practice
1	1.5	2	2.5	3	3.5	4	4.5	5
Milestone 29:  Work in inter-professional teams to enhance patient safety — Systems-based Practice
Level 1		Level 2		Level 3		Level 4		Level 5
• Describes team members’ roles in maintaining patient safety		• Identifies and reports errors and near-misses		• Describes potential sources of system failure in clinical care such as minor, major, and sentinel events		• Participates in a team- based approach to medical error analysis		• Engages in scholarly activity regarding error analysis and patient safety
1	1.5	2	2.5	3	3.5	4	4.5	5