Fellowship In Neuro Critical Care

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Fellowship In Neuro Critical Care (F.N.C.C) Brief Information

Type of Fellowship: 1-year Neuro Critical Care

Number of fellowship positions: 05

Course Fee: – Rs. 97,000/- Per year, Library Charges etc. Extra.

Name of hospital involved in training: Uppal Neuro Hospital, 4, Rani Ka Bagh, Amritsar, Punjab – 143001.

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Eligibility requirements:

  • MD/DNB- Medicine/Paediatrics/ Anesthesiology
  • MD/DNB/Diploma- Paediatrics/ Anesthesiology

Description of Fellowship: Introduction

Many critically ill patients suffer primary or secondary neurologic dysfunction. Through residency training, Neuro Critical Care fellowships and continuing medical education, trainees will need to master a body of knowledge concerning the special care of the critically ill patients with neurological disorders and incorporate this information into clinical practice, education and research. To this end, the Uppal Neuro Hospital in association with members of Indian Medical Association Academy of Medical Specialty have developed a core curriculum for critical care and emergency neurology. This curriculum is intended to serve principally as a tool for programs developing fellowships in Neuro Critical Care and Emergency Neurology. It also can serve as a guideline for the integration of the Neuro Critical Care knowledge base and related skills in to the education of medical students, residents, fellows, and other medical and allied health care providers desiring education in this area.

Definition

Neuro Critical Care is a special area of neurology that focuses on the neurological disorders that affect critically ill patients. These can be primary neurologic disorders, or secondary to other systemic diseases that can affect the central nervous system, the peripheral nervous system or both. It includes understanding the effects of critical illness on the nervous system and the special vulnerabilities of the nervous system of patients in intensive care units and other emergency settings. It requires knowledge of the disorders that frequently occur in these settings as well as the methods of diagnosis, assessment, treatment, management and prevention of further injury. Neuro Critical Care also involves bridges into many medical and allied health specialties, including critical care medicine, emergency medicine, neurosurgery, nursing and social work.

Development of the specialty of Neuro Critical Care recognizes the special health needs of the population of critically ill patients with neurologic dysfunction, the characteristics of the nervous system in critically ill patients and the need for interdisciplinary collaboration in this field.

Goals and Objectives

The primary goal of the core curriculum in Neuro Critical Care is to provide a training program that will prepare neurologists, anesthetists, neurosurgeons, emergency medicine physicians and medical intensivists to competently care for critically ill patients with neurologic disorders. This training must be based on supervised clinical work with increasing responsibility for inpatients. It should include not only the specific diseases of the nervous system of different age groups but also the neurological complications of medical and surgical conditions. Neuro Critical Care is particularly a procedure-oriented specialty and basic training in procedures used in neurocritical care must be included.

In the 1-year program, there is an additional, equally important goal, and it is here that the two programs differ most. In this program the resident is expected to spend 50% of his or her time in research. There will be instruction in basic and/or clinical neuroscience research and the applicant is expected to complete at least one project leading to presentation and, hopefully, publication.

The overall objective for specialty training in Neuro Critical Care is to provide the skills and knowledge necessary to:

  • Provide high quality clinical care and assessments of critically ill patients with neurological disorders, including diagnostic evaluation, treatment, management, counseling and social intervention;
  • Develop the capacity to pursue an academic/research career focusing on neurological dysfunction in critically ill patients.
  • evelop the capacity to teach others in the methods and concepts used in the care of critically ill patients with neurological disorders.
  • Continue elaborating and completing research projects in Neuro Critical Care.

Topics in Critical Care and Emergency Neurology

The topics listed below provide an outline of a core curriculum, in Critical Care and Emergency Neurology, for fellowship training. Many of the topics included can be used for educational programs in Neuro Critical Care for internists, anesthesiologist, neurology residents, academic neurologists and neurologists in practice. All educational components of a fellowship program should relate to the program goals listed above.

  • Status Epilepticus
  • Guillain-Barre’ Syndrome
  • Myasthenia Gravis
  • Coma
  • Encephalopathies and Delirium
  • Herniation Syndromes
  • Hydrocephalus
  • Intracranial hemorrhages
  • Cerebral Venous Thrombosis
  • Occlusive Strokes
  • Cerebral Blood Flow and Hypo perfusion
  • Cerebral Metabolism and Oxygen Demand Cerebral Edema
  • Syncope Brain Abscess
  • Encephalitis: Bacterial and Viral / Autoimmune
  • Meningitis: Bacterial and Viral
  • Traumatic Brain Injury
  • Traumatic Spinal Cord Injury
  • Equipment and technologies: Knowledge of the basic physiology and underlying technical principles.
  • Cardiovascular and Pulmonary Monitoring Devices
  • Intracranial Pressures Monitors: Fibreoptic, Intraventricular and Epidural non-invasive
  • Transcranial Doppler
  • Blood Pressure Management in the context of severe neurologic disease.
  • General Principles of Management of critically ill Neurologic Patients.
  • Management of Nutrition
  • Management of Intravascular Volume Status and Blood Pressure
  • Management of Anticoagulation and Thrombolytic therapy
  • Management of Neurologic Complications in Critically ill Patients
  • Management of Post – operative Neuro surgical Patients
  • Management of Pulmonary Complications
  • Management of Cardiac Complications
  • Management of Acid – based disorders and Hypertonic and Hypotonic States
  • Management of Gastrointestinal Complications
  • Management of Nosocomial Infections
  • Intensive Care Unit Organizations and Management Psychosocial Issues in the intensive Care Unit
  • End of Life Decision making
  • Brain Death
  • Transplant and Organ Donation
  • Management of Airway and Mechanical Ventilation.
  • Management of Agitation delirium and Pain.
  • General Principles in the assessment of sedation, agitation, delirium and pain using objective criteria.
  • General Prespectives of Care in Critically ill Neurologic Patients.
  • General Principles of Management of critically ill Neurologic Patients.

Mission statement for fellowship is to promote:

Quality Patient Care by identifying and implementing best medical practices for acute neurological disorders that are consistent with current scientific knowledge, and that promote compassionate care and respect for patient-centered values.

Professional Collaboration by providing a forum for communication, collaboration, and exchange of ideas between physicians and allied health- care professionals within different specialties who care for critically-ill neurological patients.

Research by fostering clinical, experimental and outcomes research focused on developing innovative and cost-effective medical and surgical interventions for acute neurological disorders.

Training and Education by developing standards for advanced fellowship training, program accreditation, and physician certification in the subspecialty of neurological intensive care.

Advocacy by making the case to patients, the public, policy makers and other healthcare professionals that complex, life-threatening neurological diseases are best cared for by a multidisciplinary team with special expertise in neuro critical car

Academic Facilities

The fellow will be using the facilities of the Neurological Intensive Care for his clinical and academic pursuits. The unit has a conference room and access to internet as well as Up-to-date on its computers.

  • Library access is available inside the Hospital.
  • Multimedia learning materials available on CD and internet. There is also access to, DELNET-(E-LIBRARY), up to date E-LIBRARY.

Fellow Duties and Responsibilities

  • Call responsibilities to cover service: the fellow is on home-call 9 days per 28- day period. This includes a maximum of 2 weekends per month: the weekend call starts on Saturday morning and ends on Monday morning. Each call entails physically staying in the ICU until 7PM and then taking home call until the next morning. The fellow is on first call with full support from the ICU attending. He or she does not replace the neurology or neurosurgery resident whose job it is to assess and admit the patient. The resident goes over admissions with the fellow. The attending is on as second call to supervise the fellow.
  • The fellow is expected to supervise residents rotating through the ICU with the help and instruction of the attending.
  • Outpatient clinic responsibilities: there are no outpatient clinic responsibilities.
  • Teaching responsibilities towards residents: the fellow is expected to present one subject a week at 2PM teaching rounds. He also responsible for presenting 1 pertinent article at journal club on the 4th Thursday of every month at
  • Outline participation in academic activities involving the residents: the residentwillparticipateinservicerounds.Thefellowwilleitherpresentor assist the 2PM teaching rounds.
  • The resident in training will actively involve himself / herself in the monitoring of all admitted patients. The resident should be present in the ICU from 8AM to 5PM. Chart notes on a daily basis are required.
  • Bedside rounds occur each morning and the resident is expected to attend, along with the nurse responsible for the patient and the ICU attending.
  • The resident will actively participate in teaching rounds within and outside the ICU context.

ONE PROJECT:

One Paper Publication in a National/International Journal to be eligible for sitting in Final Exam.

  • Intended percentages of the varieties of cases: there is a large variety of cases. All the pathologies listed in the section called topics are more than likely to be encountered.
  • Outline the weekly / monthly conference schedule
  • Afternoon course from 2 to 3 PM 3 days per week, 3 out of 4weeks
  • Neurology service rounds: once per week
  • Grand Rounds in Neurology: once per week
  • Grand rounds in Neurosurgery: once per week
  • Stroke rounds: once per month
  • Epilepsy rounds
  • Neuro critical care rounds

CLINICAL FACULTY:

S.NONAMEQUALIFICATION
1.DR. ASHOK UPPALMBBS,MD (MEDICINE) DM (NEUROLOGY)
2.DR. SALIL UPPALMBBS,MD (MEDICINE) DM (NEUROLOGY)
3.DR. SHIKHIL UPPALMBBS, MS( GENERAL SURGERY), M.Ch ( NEUROSURGERY)
4.DR. LATIKA SAHANI UPPALMBBS,DM ( PAEDIATRICS)
5.DR. ROMIT JAINMBBS,DCH,DNB,PDF IAT
6.DR. ASHARAB KUTUB TADAVIMBBS, MD (ANAESTHESIA)
7.DR. ATIBHI GOELMBBS, DNB ANEASTHESIA FELLOW- NEURO ANAESTHESIA
8.DR. MANISHA SHARMAMBBS,MD( PATHOLOGY)
9.DR. SHIVAM SAHNIMBBS, MD( RADIO-DIAGNOSIS)
10.DR. ANSHUL MODIMBBS, MD(MEDICINE)
11.DR. RAJEEV TIWARIMBBS, MD, MPH(MICROBIOLOGY)
12.DR. VARINDER SINGHMBBS,DM(NEPHROLOGY)
13.DR. BALBIR MALHOTRAMBBS, MD(CHEST & TB)
14.DR. HARPREET SINGHMBBS, MS(ORTHO)
15.DR. SARTAJ SINGH SANDHUMBBS, MS(GENERAL SURGERY)
16.DR. BARINDER BAJWAMBBS, M.Ch(ONCO-SURGERY)
17.DR PADAMPREET SINGH BATRAMBBS, MS(ENT)
18.DR. HARSIMRAN KAURBPT,MPT(NEUROLOGY)
19.DR. INDERBIR SINGHMD PSYCHIATRY
20.SIMRANPREET KAURPSYCHOLOGIST
21.DR. MADHU DIWANMDS, MAXILLOFACIAL SURGEON
22.DR VIKRAM GUPTAMCH PLASTIC SURGEON
23.DR. RAJNEESHM.D. NON – INVASIVE CARDIOLOGIST
24.DR. AMARJEET SHARMASONOLOGIST

INFRASTRUCTURE

TOTAL BEDS:- 125

  • ICU(03):- 23 BEDS
  • OPERATION THEATRE:-02
  • LIBRARY:-01
  • RADIOLOGY DEPARTMENT:
  1. MRI 105 TESLA SEIMENS
  2. CT SEIMENS -32 SLIDES
  • CLINICAL LABORATORY
  • IN HOUSE PHARMACY
  • SEMINAR ROOM
  • DEMO ROOM

IMPORTANT NOTE

  • For good academic pursuit, more guidelines may be added from time to time.
  • The fellow will be evaluated every month. Practical as well as Theoretical Exam will be conducted.
  • These courses are to improve skill & Knowledge and to render better service to the people.
  • These Courses are not recognized by MCI.