Neurology Program
The Medical Education department under the leadership of the Director works to ensure that our system of postgraduate medical education is established according to the internationally acceptable criteria and meet all the requirements of the College of Physicians and Surgeons Pakistan (CPSP).
Program Director Message
Welcome to Shifa Neurology Residency Program. Selecting a residency program is a difficult task. Not only is the training you receive going to determine how well you are prepared to be a neurologist, it will also impact your decisions regarding the next steps in your career. The foremost goal of the Shifa Neurology Residency is to train physicians to become the very best clinicians – people who can apply the most up to date knowledge in the field and principles of patient-centered care to effectively and compassionately diagnose and treat neurological disease. Our program offers state-of-the-art technological resources, evidence-based medicine, and abundant opportunities for research. Most of our faculty members are actively engaged in clinical management of patients, teaching medical students and residents, and clinical research. We believe these scholarly activities are all critical, rewarding, and synergistic.
Our neurology residency program sets a standard in neurological education, scholarly accomplishment and career opportunities. I invite you to learn all about our residency program, the Department of Neurology, our educational curriculum and conferences, and our residents and faculty. We have a tremendously diverse patient population, providing ample opportunities for learning the skilled management of the entire spectrum of neurological disorders. Residents receive personal supervision and are provided with one-on-one teaching by neurology faculty. When residents complete their training they are fully capable of independent practice as competent neurologists. In addition, there are many chances to learn about research methods and to participate in research projects.
Each resident is expected to achieve the following competencies as specified by CPSP.
Knowledge:
Each postgraduate resident is able to
- Perform a complete neurological history and examination
- Localize symptoms and signs to the appropriate anatomic parts of the nervous system
- Formulate differential diagnosis, evaluation, and management strategies based on relevant history, examination and laboratory features.
- Interpret the results of electroencephalography (EEG), electromyography (EMG), nerve conduction studies(NCS), evoked potentials, sleep studies
- Relate the underlying pathophysiological mechanisms of common neurological disorders to their clinical manifestations and treatment.
- Evaluate the application and relevance of investigative procedures and their interpretation in the diagnosis of neurologic disease including electroencephalogram, motor and sensory nerve conduction studies, electromyography, evoked potentials, polysomnography, audiometry, perimetry, psychometry, CSF analysis and radiographic studies
Skills
Each postgraduate resident is able to
- Perform lumbar puncture
- Perform/be familiar with neurophysiologic testing (EEG, EMG, NCS, evoked potentials)
- Perform tensilon test and caloric testing
- Identify and describe abnormalities seen in common neurological disorders on radiographic testing including CT scan, MRI, plain X-rays and angiography
- Identify and describe gross and microscopic specimens taken from the normal nervous system and from patients with major neurological disorders
Attitude
Each postgraduate resident is able to
- Communicate effectively with patients using verbal, nonverbal and written skills as appropriate
- Communicate with allied health care practitioners to facilitate excellent patient care.
- Demonstrate personal and professional attitudes of integrity, honesty and compassion in the delivery of principles or consultative patient care
- Demonstrate a commitment to excellence in clinical practice through the establishment of life-long learning habits and continuing medical education
- Demonstrate respect for patient’s cultural, ethnic, religious and socioeconomic background in providing patient care
- Demonstrate appreciation of end-of –life care and issues regarding provision or withholding of care
- Demonstrate the ability to act as an advocate for patients within their social and financial constraints
- Program Director
- Associate Program Director
- Chief Resident
- Program Coordinator
Total duration of the training is 3 years, which includes rotations in allied specialties.
Core rotations: The three year of neurology training will include rotations in neurology in-patient services, outpatient clinic, neurology consultation services and other sub – specialty rotations as per required by CPSP.
Neurology Clinical: The post-graduate trainee will spend most of the 3 years of training in neurology in-patient/consult/out-patient services learning neurology through didactic lectures, conferences, direct and in-direct patient care, and other means of learning including self-reading.
Out – patient: The out-patient services of neurology division are mostly comprised of consultant based OPD clinics. There are resident based OPD clinics for continuation of care and teaching/learning. The first year neurology trainee has one half-day clinic per week and in year 2 and 3, the trainee has two half day clinics per week, in which the trainee sees the patients for continuation of care from in-patient discharges, and new out-patient referrals. All efforts are made for exposure to variety of out-patient neurological problems and longitudinal care.
Consult service: Neurology department provides consult/opinion service to patients admitted to all the units of Shifa International Hospital. The post-graduate trainee in will be expected to do the initial evaluation of these patients and discuss the assessment and plan with the assigned faculty and provide the consult services to the requesting ward. He/she will also be expected to follow the patient until needed and update the faculty on the progress of the patient.
In-patient Service: The division of neurology admits a vast variety and excellent mix of patients. The postgraduate trainee is expected to do the initial assessment including history and physical examination of the patient, make a rationale differential diagnosis, order pertinent investigations and make a management plan and discuss it with the senior resident, faculty on call. He is expected to write admission orders, daily progress notes, discharge plans/orders and will dictate discharge summaries.
Call schedule: The call schedule will be according to policies of Shifa International Hospital. The post-graduate trainee will do on average one-in-four/five in house night calls per month. The call schedule is made by chief resident/designated person from the program director.
Duty hours: The hours of duty will be according to the policies of Shifa International Hospital. An attendance register is maintained.
Conferences/ Academic Activities: The department of neurology organizes conferences, workshops and CMEs regularly and expect postgraduate trainee to actively participate in these conferences.
Log Book: The trainee is required to maintain the log book according to CPSP regulations and guidelines.
The following evaluation instruments will be used to evaluate the post-graduate trainee mastery of the core competencies
- Clinical skills
- examination
- Written test
- Chart Review
- Resident Global assessment
- 360º evaluation
- Resident case log
Monthly test: The post-graduate trainees will be given a monthly written examination. The written examination will be shorter in length and the results will be kept in trainee’s file.
Mini Clinical Evaluation Exercise (CEX): The post graduate trainees will have clinical evaluation exercise (CEX) every three months. They will be given feedback on their performance and record will be kept.
Chart Review: Chart review provides evidence about clinical decision making, follow up in patient management and appropriate use of clinical facilities and resources. The attending faculty will review charts and give verbal feed back to the trainee concerning the written note.
The following items from each note will be specifically reviewed by the attending:
- Chief complaint or reason for consultation
- History of the present illness
- Past medical history
- Neurological examination
- Assessment and differential diagnosis
- Diagnostic and treatment plan
Annual mock boards: The post-graduate trainee will be given a chance to practice for the post-graduate examination every year. The mock board examination will be designed in the pattern of FCPS-II examination and will be conducted by the faculty of the department or visiting faculty from other institutions.
Global rating forms are summary assessments about performance observed over days or weeks.
Scoring rating forms entails combining numeric ratings with comments to obtain a useful judgment about performance based upon more than one rater. A Global Rating Form has been constructed for neurology residents, and must be completed by the Attending after each rotation. The Program Director reviews the Global Rating Forms with each resident during their semi-annual evaluation meeting.
Half-yearly evaluation by the head of department: The head of department will meet with the trainee in the middle of each year of training to discuss his evaluations, performance in the in-training examinations, and overall performance in the ward and rotations. The head of department will draft a letter of evaluation which will be kept in the file of the trainee.
Anonymous evaluation of the faculty: The post-graduate trainees will be provided with the evaluation forms twice a year to assess the faculty anonymously. The completed forms will be submitted to the head of department and will be kept in the faculty’s file.
360º Evaluation consist of measurement tools completed by multiple people in a person’s sphere of influence. Evaluators completing rating forms in a 360º evaluation usually are superiors, peers, subordinates, and patients and their families. Most 360º evaluations use rating scales to assess how frequently a behavior is performed. The ratings are summarized for all evaluators by topic and overall to provide feedback. A 360º evaluation can be used to assess interpersonal and communication skills, professional behaviors, and some aspects of patient care.
Annual assessment of eligibility for promotion to the next year of training in the eleventh month of each year of training, the head of department in consultation with the program director and senior faculty will meet with the trainee to discuss his assessment of the year and will decide whether the trainee can be promoted to the next year of training. Residents must receive satisfactory ratings to be promoted at the end of the academic to the next year of training.
Resident Case Log: Each resident will be responsible for keeping a log of patients seen. Patient encounters that may be included in this case log are:
- ER consultations
- Adult consultations – In-house
- Pediatric consultations – In-house
- Inpatients
- Outpatients
- The Program Director will review the Case Logs with each resident during their semi-annual evaluation meeting.
The post-graduate trainee will be expected to choose the topic of his dissertation/original paper in the first 6 months of neurology training and will start working on it. He/she will be expected to have completed the dissertation/original paper and submitted it for review to supervisor by the end of 2nd year of neurology training. The dissertation/original paper should be submitted to the College of Physicians and Surgeons of Pakistan or a Medline indexed journal at the beginning of the third year of neurology training.
Research and publications: The trainee will be expected to participate actively in the on-going research in the department. He/she will also be expected to design own research studies with the help of faculty and conduct those through the years of training. Every trainee will be expected to have at least 2 publications in peer reviewed journals by the end of five years of training.
Mentorship: Every trainee is encouraged to select one member of the faculty as his/her mentor and seek guidance from him/her during the years of training.
Every trainee is expected to be ready for part II examination in neurology given by the College of Physicians and Surgeons of Pakistan as soon as he/she finishes the five year of post-graduate training. Every trainee is encouraged to take the part II examination in the shortest possible time.
Salary: The salary of post-graduate trainee will be according to the policy of Shifa International Hospital.
Vacations: The post-graduate trainee will be given vacations according to the policy of Shifa International Hospital.
Reading List:
- Adams & Victor’s Principles of Neurology – Victor & Ropper
- Merritt’s Neurology – Rowland, Lewis
- Neurological Differential Diagnosis – Patten, John
- Neurology in Clinical Practice – Bradley WG, Daroff RB, Fenichel GM, Marsden CD
- Pediatric Neurology. Principles and Practice - Swaiman KF, Wright
- Neurology in General Medicine – Aminoff
- Diagnostic Neurology – Osborn AM.
- Sadock BJ, Sadock VA. Kaplan and Sadock’s Synopsis of Psychiatry (9th ed.). Philadelphia, PA: Lippincott Williams & Wilkins
- Electromyography and Neuromuscular Disorders – Preston DC, Shapiro BE
- Current Practice of Clinical Electroencephalography – Ebersole JS, Pedley TA
- Current Neurology. Diagnosis &Treatment
Journals:
- Neurology
- Annals of Neurology
- Archives of Neurology
- Brain
- Journal of Neurology, Neurosurgery and Psychiatry
- Stroke
- New England Journal of Medicine
- Lancet Neurology
- Continuum
Neurology Training Program – 3-year schedule
| Year 1 | Year 2 | Year 3 | |
|---|---|---|---|
| Month 1 | Neurology | Neurology | Neurology |
| Month 2 | Neurology | Radiology | Psychiatry |
| Month 3 | Neurology | Radiology | Psychiatry |
| Month 4 | Neurology | Radiology | Psychiatry |
| Month 5 | Neurology | Neurosurgery | Neurology |
| Month 6 | Neurology | Neurosurgery | Elective |
| Month 7 | Neurology | Neuro-opthalmology | Neuro-rehabilitation |
| Month 8 | Neurology | Neurophysiology | Neurology |
| Month 9 | Neurology | Neurophysiology | Neurology |
| Month 10 | Neurology | Neurophysiology | Neurology |
| Month 11 | Neurology | Elective | Emergency medicine |
| Month 12 | Neurology | Pediatric neurology | Neurology |
Teaching and Academic Activities
Weekly Conferences (currently existing – can be modified according to needs)
Monday – 8:30 – 9:00am – Morning Report including discussion of cases
Tuesday – 8:30 – 9:00am – Topic discussion
Wednesday – 9:00 – 10:00 am – Department of Medicine meeting (weekly schedule of clinicopathological conference, mortality & morbidity conference, journal club, and grand round – the meeting rotates between various divisions/ sections of department of medicine and neurology division gets the chance once or twice a year to present)
Thursday – 8:30 – 9:00am – Localization in Neurology
Friday – 9:00 – 10:00am – Neuroscience conference (attended by neurologist, neurosurgeons, radiologists, psychiatrist - difficult/interesting clinical/radiological cases of the week are discussed)
Saturday – 8:30 9:00am – Neurophysiology
Monthly Meetings:
Monthly Neurology Journal Club – held on 4th Tuesday of every month between 2:00pm – 3:00pm – so far 62 Journal Clubs have been held
Monthly Grand Rounds of Shifa International Hospital – hosted by various medical/surgical specialties – held on 3rd Saturday of every month between 9:00am to 10:00am
Annual Meetings:
Annual Neurology Research Day for Medical Students and Residents – occurs in summer every year at Shifa International Hospital – so far 6 Research Days held
Annual Meeting of Pakistan Society of Neurology (PSN) – residents are encouraged to participate and present papers
Each resident does an average of one night in four on-calls within the Hospital premises, although occasionally one night in three or two may be necessary.
Residents are evaluated by faculty every month, based on their rotation. Feedback is provided by the Programme Director and Coordinator, every 3 months.
Annual TOACS and Year end PGME exams are conducted. In addition, formative assessments based on assorted topics may be arranged every 2-3 months.
Candidates are required to fill on-line application form. Please follow the steps mentioned below:
1. Register yourself by defining user name and password.
2. After your account is created, you will need to login to fill the Application Form. Programs offered will be displayed after registration.
3. A candidate can apply for only one program at a time.
4. Candidate may partially fill the form and save it on-line for resuming filling out the form later using login credentials.
5. Once the on-line application form is filled and submitted, candidate would be able to take a printout.
6. The hard copy of the on-line application form along with the required documents mentioned in the Application Form must be submitted to the PGME Office, Medical Staff Affairs either personally, through friends/relatives or through reliable courier service.
7. Check your junk emails (in case of email not received).
If there is still confusion, then follow these Steps
Step 1. Register yourself
Step 2. Check your email address and click on the received link
Step 3. Login
Step 4. Fill the Profile necessary information
Step 5. Submit
Step 6. Ok
Step 7. Online Application Form
Step 8. Select Program or Medical Officer
Step 9. Select specialty
Step 10. Submit
Step 11. Print application form.
All residents are encouraged to get involved in audits and research projects, however research project as per CPSP requirements is mandatory for all.
- MBBS or equivalent.
- One-year House Job
- Two years training in Internal Medicine
- Eligible to appear in Medicine Intermediate Module examination (IMM)
