Neurology Residency Program

Program Instructor: Yoshiyuki Matsumoto

1. Basic philosophy

Most neurological diseases can be localized and diagnosed through accurate medical history taking and neurological examination. The importance of these basic diagnostic skills, established over the long history of clinical neurology, has not diminished in the slightest even today, despite advances in imaging diagnosis, including MRI, and clinical testing.
The clinical training at Kitano Hospital's Department of Neurology aims to provide students with experience and mastery of the following skills necessary for diagnosing neurological diseases and formulating treatment plans: 1) taking a medical history, 2) neurological examination methods, 3) diagnostic imaging, and 4) electrophysiological testing methods.

2. Program Objectives

• 1) Understand the physiology and pathology of the central and peripheral nervous systems through neurological practice.
• 2) Under the supervision of a supervising physician, students will become the attending physician for inpatients in the neurology department, be responsible for diagnosis, examination, and treatment, and understand how to proceed with the basic medical treatment process.
• 3) Acquire problem-solving skills.
• 4) Learn about safety concepts in the medical field, actively work to prevent medical accidents and hospital-acquired infections, and acquire a safety management mindset.

3. Goals of neurology training

General goal

• (1) Medical history taking: Localization and pathological diagnosis of many cranial nerve diseases can be made by taking an accurate medical history of the patient. In the early stages of training, the goal is to acquire medical history taking methods that will lead to a correct diagnosis.
• (2) Neurological examination: Acquire basic neurological examination skills to confirm the localized diagnosis based on the medical history.
• (3) Reading of imaging tests: Develop diagnostic skills for cerebrospinal imaging through weekly imaging conferences, not just for the patients you are responsible for.
• (4) Analysis of electrophysiological tests: Understand the significance of electroencephalography, peripheral nerve conduction velocity tests, and skeletal muscle needle electromyography tests and learn to interpret them.

Behavioral goals

• (1) Under one-on-one supervision from a supervising physician, students will be responsible for 5-10 patients and learn basic knowledge and skills in neurology. Among the goals set by the Ministry of Health, Labor and Welfare, students will receive training in areas such as general goals, basic examination methods, basic testing methods, basic treatment methods, terminal care, patient-family relationships, medical team members, documentation, treatment plans and evaluations, and terminal care. The focus will be on the diagnosis and treatment of cerebrovascular disorders, neurodegenerative diseases, and neurological symptoms associated with internal diseases.
• (2) Under the supervision of a supervising physician, you will work in the ward and outpatient department. In the ward, you will be responsible for approximately 10 patients, and will decide on examinations and treatment plans under the supervision of a supervising physician. You will also be in charge of outpatient neurology care once or twice a week. You will mainly be responsible for treating patients who were in your care in the ward after they were discharged and for treating new patients.
• (3) In addition to specialized training in neurology, students may also supervise internal medicine residents or first-term neurology residents. They gain experience performing nerve and muscle biopsies and making neuropathological diagnoses. Furthermore, they engage in clinical research under the supervision of their supervising physicians, write papers, and give presentations at academic conferences.

Experience Goals

• (1) Common symptoms
  Headache, dizziness, unsteadiness, visual impairment, double vision, dysarthria, weakness, paralysis, muscle weakness, numbness, tremor, gait disturbance, convulsions, loss of consciousness
• (2) Symptoms and conditions requiring emergency treatment
  Loss of consciousness, acute headache, muscle weakness
• (3) Diseases and pathologies that require experience
  Cerebrovascular disorders, differential diagnosis of headaches, differential diagnosis of dizziness, Parkinson's disease

4. Training and guidance system

As a general rule, one or two trainees will be supervised and instructed daily by a Japanese Society of Neurology certified physician.
Each inpatient is assigned one preceptor and one resident.
Supervisor: Yoshiyuki Matsumoto, Director of the Department of Neurology at Kitano Hospital
4 instructors

5. Weekly Schedule

• ●Working hours: In principle, from 8:00 AM to 6:00 PM. In practice, you often work after 6:00 PM. There are hospital on-call shifts or neurology home shifts once or twice a week.
• ●Educational events
• *Orientation: During the first few days of training, you will receive instruction on hospital regulations, an overview of the facilities, the health insurance system, medical laws and regulations, etc.
• *Lectures on emergency conditions: During the first few months of training, participants will receive lectures and practical training on various emergency conditions.
• *Director's rounds: Held once a week, the director reviews each patient's problems at the bedside.
• *Case study meetings: A study meeting for interesting cases, mainly handled by trainees, is held once a week with the attendance of all neurologists.
• *Discharge conference: held once a month.
• *Electrophysiological testing (EEG, electromyogram, various evoked potential tests): Trainees undergo practical training several times a week under the guidance of a supervising physician.
• *Neuroradiological examination (cerebral angiography, spinal cord imaging): Same as above.
• *Special lectures: Once every month or every other month, external lecturers give lectures related to neurology and neuroscience. All neurologists participate.
• *Domestic study abroad: Participants will receive 1-2 weeks of training at the Shizuoka National Sanatorium for learning about epilepsy cases.

6. Assessment of neurology training achievements

The trainee is evaluated by the head of the neurology department, the ward chief, and the supervising physician. The trainee also performs a self-evaluation.
Residents evaluate our training program

7. Characteristics of training in the clinical department

This clinical training program aims to train clinical neurologists by providing a wide range of clinical experience across the entire field of neurology. Upon completion of the training, students are expected to attain the ability to take the Japanese Society of Neurology Specialist Examination.