Specific Standards of Accreditation for Residency Programs in Adult and Pediatric Neurology

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1 Specific Standards of Accreditation for Residency Programs in Adult and Pediatric Neurology INTRODUCTION 2011 A university wishing to have an accredited program in adult Neurology must also sponsor an accredited program in Internal Medicine. Similarly, a university wishing to have an accredited program in pediatric Neurology must also sponsor an accredited program in Pediatrics. The purpose of this document is to provide program directors and surveyors with an interpretation of the general standards of accreditation as they relate to the accreditation of programs in adult and pediatric Neurology. This document should be read in conjunction with the General Standards of Accreditation and the Objectives of Training and Specialty Training Requirements in Neurology. STANDARD B1: ADMINISTRATIVE STRUCTURE There must be an appropriate administrative structure for each residency program. Please refer to Standard B1 in the General Standards of Accreditation for the interpretation of this standard. A university offering full training in pediatric Neurology and in adult Neurology must have a formal arrangement for joint sponsorship by both the Department of Pediatrics and the Department of Medicine or neurosciences. STANDARD B2: GOALS AND OBJECTIVES There must be a clearly worded statement outlining the goals of the residency program and the educational objectives of the residents. The general goals and objectives for adult and pediatric Neurology are outlined in the Objectives of Training and the Specialty Training Requirements in Neurology. Based upon these general objectives each program must develop rotation specific objectives suitable for that particular program, as noted in Standard B2 of the General Standards of Accreditation. STANDARD B3: STRUCTURE AND ORGANIZATION OF THE PROGRAM There must be an organized program of rotations and other educational experiences, both mandatory and elective, designed to provide each resident with the opportunity to fulfil the educational requirements and achieve competence in the specialty. This document may be reproduced for educational purposes only provided that the following phrase is included in all related materials: Copyright 2011 The Royal College of Physicians and Surgeons of Canada. Referenced and produced with permission. Please forward a copy of the final product to the Office of Education, attn: Associate Director. Written permission from the Royal College is required for all other uses. For further information regarding intellectual property, please contact: documents@royalcollege.ca. For questions regarding the use of this document, please contact: accred@royalcollege.ca. Page 1 of 5

2 The structure and organization of each accredited program in adult or pediatric Neurology must be consistent with the specialty training requirements as outlined in the Objectives of Training and the Specialty Training Requirements in Neurology. Residents must be provided with increasing individual professional responsibility, under appropriate supervision, according to the level of competence in the management of neurological patients. STANDARD B4: RESOURCES There must be sufficient resources including teaching faculty, the number and variety of patients, physical and technical resources, as well as the supporting facilities and services necessary to provide the opportunity for all residents in the program to achieve the educational objectives and receive full training as defined by the Royal College specialty training requirements. In those cases where a university has sufficient resources to provide most of the training in adult or pediatric Neurology but lacks one or more essential elements, the program may still be accredited provided that formal arrangements have been made to send residents to another accredited residency program for periods of appropriate prescribed training. Learning environments must include experiences that facilitate the acquisition of knowledge, skills, and attitudes relating to aspects of age, gender, culture, and ethnicity appropriate to Neurology. 1. Teaching Faculty There must be a sufficient number of qualified teaching staff to supervise the residents and provide teaching in the basic and clinical sciences related to Neurology. 2. Number and Variety of Patients The number and variety of patients available to the program on a consistent basis must be sufficient to meet the educational needs of the residents. The program must provide an adequate volume of patients to give experience in the diagnosis, prevention and management of conditions seen in neurological practice, as outlined in the Objectives of Training. 3. Clinical Services Specific to Neurology Clinical training must be based on adequate resources to ensure full training in all areas of adult and pediatric Neurology and related fields of medicine, as outlined in Objectives of Training and the Specialty Training Requirements in Neurology. a) In-Patient i) Direct Care Residents must be given adequate opportunity to be the responsible physician, under appropriate supervision, for patients admitted for neurological problems, including acute stroke. As residents progress, they must also have the opportunity to assume graded responsibility. There must be one or more general Neurology clinical teaching units (CTUs), which must be supervised by Neurology faculty. Geographic unity of a Page 2 of 5

3 CTU is preferred. If this is not possible, geographic dispersion must not interfere with the educational process. Active neurosurgical and psychiatric services must also be available. ii) Consultation Residents must be given adequate training in in-patient neurology consultation. There must be an active neurology consultation service, dealing with neurological conditions and complications associated with diseases in Internal Medicine, surgery, Obstetrics and Gynecology, oncology, Pediatrics, and Psychiatry. b) Ambulatory Organized clinics must be available to provide residents with adequate training in all areas of outpatient Neurology. To allow continuity of patient observation, resident longitudinal clinics and the integration of outpatient teaching services with in-patient services are desirable. c) Emergency Residents must be given adequate experience in assessing and managing referred patients with urgent neurological problems in the emergency department and other hospital departments. There must be systematic supervision of residents to ensure expertise in the management of neurological emergencies. d) Intensive Care Each resident must gain experience in the care of critically ill patients presenting with neurological problems. Residents in a pediatric Neurology program must have experience in a Level 3 neonatal unit. e) Community Learning Experiences Community experiences should be available which provide a learning environment with appropriate supervision and evaluation based on rotation-specific objectives. This assumes administrative support and linkages with the program. 4. Supporting Services - Clinical, Diagnostic, Technical The program must include specialized staff and facilities for electroencephalography, electromyography, nerve conduction studies and evoked potentials and must have access to specialized staff and facilities for computerized tomography (CT), magnetic resonance imaging (MRI), CT and MR angiography, ultrasonography, interventional neuroradiology and radioisotopic diagnostic testing for neurological diseases. A neuropathology laboratory organized for teaching neurology residents under the supervision of a neuropathologist must be available. Neuro-ophthalmology and neuro-otology training should be available. There must be appropriate liaison with teaching services in internal medicine, pediatrics, critical care medicine, diagnostic imaging, psychiatry, neurosurgery and physical medicine and rehabilitation. Page 3 of 5

4 STANDARD B5: CLINICAL, ACADEMIC AND SCHOLARLY CONTENT OF THE PROGRAM The clinical, academic and scholarly content of the program must be appropriate for university postgraduate education and adequately prepare residents to fulfill all of the CanMEDS Roles of the specialist. The quality of scholarship in the program will, in part, be demonstrated by a spirit of enquiry during clinical discussions, at the bedside, in clinics or in the community, and in seminars, rounds, and conferences. Scholarship implies an in-depth understanding of basic mechanisms of normal and abnormal states and the application of current knowledge to practice. Please refer to Standard B5 in the General Standards of Accreditation, the Objectives of Training, the Subspecialty Training Requirements in Neurology and the CanMEDS Framework for the interpretation of this standard. Each program is expected to develop a curriculum for each of the CanMEDS Roles, which reflects the uniqueness of the program and its particular environment. Specific additional requirements are listed below. 1. Medical Expert This must include organized teaching of the clinical knowledge, skills and attitudes required for effective neurological practice, including performing a neurological assessment. There also must be organized teaching of the related neurosciences, including the relevant aspects of anatomy, biochemistry, pharmacology, physiology, psychology, pathology and diagnostic imaging. 2. Communicator This must include teaching of the knowledge, skills and attitudes required for effective communication in neurological practice, including taking a neurological history, explaining neurological diagnoses and treatment plans to patients and families, especially with regard to progressive or terminal conditions, dealing with anger and difficult patient-clinician relationships and writing neurological consultation letters and discharge summaries. Role modeling and feedback in the clinical setting are important teaching strategies but more formalized teaching methods also must be employed. 3. Collaborator This must include teaching of the knowledge, skills and attitudes required for effective participation as a Neurologist in interprofessional teams that manage neurological conditions. Residents must be given adequate opportunity to participate as members of such teams. 4. Manager This must include teaching of the knowledge, skills and attitudes required to manage a neurological practice and career, to contribute to the effectiveness of systems that provide neurological care, and to appropriately allocate and utilize resources commonly required in neurological practice. Residents must be given adequate opportunity to participate in systemic quality process evaluation and improvement and serve in administrative and leadership roles. Page 4 of 5

5 5. Health Advocate This must include teaching of the knowledge, skills and attitudes required to advocate for the prevention of neurological diseases and their complications and for the provision of adequate resources for their investigation and treatment. Residents must be given adequate opportunity to participate in the prevention of stroke, the counselling of patients with epilepsy and other neurological disabilities and the identification of deficiencies in resources required for neurological care. 6. Scholar This must include teaching of the knowledge, skills and attitudes required to educate colleagues, students and patients, critically appraise medical information, conduct scholarly inquiry, present oral and written clinical and scientific reports and maintain neurological competency in practice. Formalized teaching methods must be employed in addition to role modeling. Residents must be encouraged to participate in teaching and research and to attend conferences outside their own universities. 7. Professional This must include teaching of the knowledge, skills and attitudes required to practice Neurology ethically and professionally, fulfill regulatory, legal and other ethical obligations, and promote personal health and a sustainable neurological practice. Formalized teaching methods must be employed in addition to role modeling. STANDARD B6: EVALUATION OF RESIDENT PERFORMANCE There must be mechanisms in place to ensure the systematic collection and interpretation of evaluation data on each resident enrolled in the program. Evaluation must include the use of the Structured Assessment of Clinical Encounter Report (STACER) or equivalent. The program must assess the resident as many times as necessary to attest that the clinical skills outlined in the STACER have been acquired by the end of training. Please refer to Standard B6 in the General Standards of Accreditation for the interpretation of this standard. Adopted by Council STACER January 2011 Revised June 2011 Page 5 of 5