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) |
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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) |
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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 patients
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) |
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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 |
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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) |
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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) |
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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 patients 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 patients neurological symptoms
are of psychiatric origin Recognizes when a patients 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 |
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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 |
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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 |
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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 |
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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 ones 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 patients 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 |