Professional Documents
Culture Documents
I. INTRODUCTION:
WELCOME TO THE NEUROLOGY CLERKSHIP!
We look forward to helping you build a foundation of knowledge and acumen in this
important field of medicine. You will function as an integral part of the medical team and
we hope that you will take full advantage of this opportunity to make an important
contribution to your patients' care and foster their well-being.
This clerkship is a required four-week rotation, offered during the junior/senior
continuum. Completion of the Medicine Part I clerkship is a prerequisite. Please read this
package carefully. It contains important information that should help you get the most
from the clerkship.
OBJECTIVES: NEUROLOGY CLERKSHIP
The clerkship objectives are aligned with the *Keck School of Medicine objectives.
During the Neurology Clerkship, the students will be able to:
*Medical Knowledge: Demonstrate knowledge of established and evolving biomedical,
clinical, epidemiological, and social-behavioral sciences, and apply this knowledge to
patient care.
Neurology Clerkship
Demonstrate basic knowledge, based on patient care as well as study, of selected SPP or
must see neurologic conditions. For neurology those are:
Dementia
Demyelinating disease: MS or GBS
Disorders of Sleep
Headache
Movement Disorders: PD or other
Seizure
Stroke
ALS (DVD)
Myasthenia Gravis (DVD)
*Patient Care: Provide patient care that is compassionate, appropriate, and effective for
the treatment of health problems and the promotion of health including demonstrating
basic clinical skills of history taking and physical examination; appropriate usage and
interpretation of clinical procedures and diagnostic tests; and clinical problem solving,
patient care activities, patient education, and the ability to respond to dynamic clinical
situations.
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Neurology Clerkship
Demonstrate basic clinical skills of history taking and physical examination in the
setting of neurologic disease;
Demonstrate skill in performing the neurologic examination;
Demonstrate appropriate usage and interpretation of imaging and other diagnostic
tests;
Demonstrate clinical problem solving and the ability to generate an appropriate
differential diagnosis;
Demonstrate skill in patient care activities in both the inpatient and outpatient
setting;
Demonstrate the ability to deliver timely and appropriate guidance to the patient
with a neurodegenerative disorder
*Ethical Judgment: Recognize the ethical dimensions of medical practice and health
policy. Demonstrate understanding of ethical principles required for provision of the
highest caliber clinical practice as well as those that must accompany research involving
human participants. Demonstrate adherence to ethical principles. Identify alternatives in
difficult ethical choices, analyze conflicting considerations, and execute a course of
action that takes into account the ethical complexities.
Neurology Clerkship
Describe the practical applications of the major ethical principles (i.e. justice,
beneficence, non-malfeasance and respect for autonomy)
Identify alternatives in difficult ethical choices and analyze conflicting
considerations, particularly in the setting of coma and brain death
Respect patients rights and wishes. Act in a respectful manner toward patients, faculty,
colleagues and staff. Model good leadership in interactions with others, and foster the
development of others.
Neurology Clerkship
Describe and demonstrate behaviors that respect the patient's modesty, privacy,
and confidentiality;
Demonstrate a commitment to the highest standards of patient advocacy and care;
Demonstrate professional interaction with a patient in the setting of the OSCE
examination;
Demonstrate collegiality and respect for all members of the health care team as
well as to the broader community
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The clerkship has videotapes of our faculty and/or PowerPoint presentations for all
required and some additional topics. These are on the MedWeb site under Education
Resources for Neurology. Please see your schedule handout for a complete list of topics.
Not required but highly recommended is "Neuroanatomy through Clinical Cases" by Hal
Blumenfeld, MD, PhD. This book is unsurpassed in clarity. It is an excellent reference for
anatomy, localization and the neurologic exam and is on reserve at Norris library.
Also on reserve: Practical Neurology DVD Review, Jose Biller: video clips of actual
patients with various diagnoses.
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You are encouraged to use various other resources available on line (see list of sites
below) and at Norris Library.
Web Sites:
The AAN has issued practice parameters for a number of common neurologic entities.
These can be found at www.aan.com or at www.guidelines.gov. Additional web sites
with a great deal of helpful information are listed below:
http://www.neurophys.wisc.edu/brain/
One of the world's largest collections of well-preserved, sectioned and stained brains of
mammals - over 100 different species (including humans) representing 17 mammalian
orders. Links to many other web sites
http://www9.biostr.washington.edu/da.html
Interactive atlases of the human brain, including gross views, histological sections,
computer-aided reconstructions, and movies that show complex structural relationships
http://www.med.Harvard.edu/AANLIB/cases/caseM/case.html
MRI atlas of the human brain, with your choice labeled or unlabelled. Includes MRIs of
normal human brains and of patients with a variety of different types of pathology,
correlated with single photon emission computed tomography (SPECT) images
http://www.neuropat.dote.hu/
The website of neuroscience/neuropathology websites
http://www.meddean.luc.edu/lumen/MedEd/Neuro/Neuro.html
A particularly well done atlas of brainstem, thalamus, basal ganglia and immediately
adjacent structures pairing unadorned histological sections with color labeled sections
demonstration the location and extent of various structures and pathways. Also contains a
tutorial on vasculature
http://www.medinfo.ufl.edu/year1/neurosci/
Pictorial tours of selected topics (most anatomical; some functional systems), some
correlated with figures from this text; movies of selected anatomic structures, particularly
helpful in gaining 3D conceptualizations; name the lesion labs; a limited MRI based atlas
http://www.urmc.rochester.edu/neuroslides
The University of Rochester's Neuropathology and Neuroimaging Laboratory, which is a
web-based collection of 202 images for the Mind, Brain and Behavior Course at the
University of Rochester School of Medicine. This laboratory exercise includes 12 gross
and microscopic neuropathological specimens that are correlated with 74 CT or MR
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images. Each of these images is accompanied by a description, and the neuroimages also
include a clinical vignette
http://www.neuroexam.com/
A collection of video clips demonstrating how to do each componet of the neurologic
examination
http://cnsnewsonline.com
Clinical reviews and updates in Neurology and Psychiatry
VIII. ADDITIONAL REQUIREMENTS:
A. Faculty Mentor Sessions - Faculty serve as the preceptors and mentors for the
medical students. The preceptor/mentor reviews clinical cases, special topics in
Neurology, and the students history taking, physical examination, presentation and
charting skills. It is the medical students responsibility to solicit an evaluation of
his/her patient write-up (see C below) during the rotation.
B. Observed Neuro Exam - The faculty attending will observe each student
performing neurologic examinations during the clinical experience
.
C. Patient Write Up - During the clerkship, each student will submit a patient writeup for review by the faculty attending. The write-up is due on the third Friday of
the rotation. An excerpt should be entered into the Clinical Experience Portfolio
(see D., below), and the full write-up should be emailed to the Medical Student
Educator. Please also submit a copy directly to your attending. Each write up
should include the following elements: 1) history of present illness organized
chronologically, without repetition, omission, or extraneous information; 2) other
relevant historical information (i.e. Meds, SH, FH, ROS) without repetition,
omission, or extraneous information; 3) a comprehensive physical examination
with detail pertinent to the patients problem; 4) a listing of relevant laboratory
information and diagnostic studies; (5) a discussion of the likely location of the
lesion causing the patients complaint, differential diagnosis, assessment and
management. Discussion of the diagnosis and management should reflect your use
of Ovid or other resources and reflect a systematic review of current literature. Be
sure to list references.
Specifically with regard to the typed write-ups, Third year students should focus
their efforts on demonstrating their ability to acquire and organize data. The
historical, physical, and laboratory information should be detailed and
comprehensive. The problem list should also be detailed and comprehensive and
include concise assessments and plans for each problem identified. Fourth year
students should focus their efforts on providing a detailed and sophisticated
assessment and plan. Your analysis of the data and justification for your
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conclusions and plans should be clearly evident. You can focus your search on any
aspect of the case that is of interest to you. Examples may be: review articles,
current trends, basic science-related issues (e.g., physiology), diagnostic evaluation,
etc. Note: In addition, please limit the identifiable patient information to initials and
the last four digits of the PF number.
D. Medical Student Documentation of Patient Encounters using the Clinical
Experience Portfolio on MyMedWeb.usc.edu: "MyMedWeb" is a highly
specialized information system used throughout the medical school curriculum. In
addition to course materials, class schedules, web-based educational programs and
interactive links, patient encounters and clerkship evaluations are accessed through
the system.
Patient Encounters are brief summaries of the student's interaction with assigned
patients. The rationale for the timely completion of patient encounters is twofold. In
addition to providing the student with a readily accessible patient profile, it enables
the faculty to review the number, complexity and breadth of clinical experiences the
student is afforded during the clerkship. The patient encounter format is concise and
allows the student to describe relevant patient findings reflected through the history,
physical examination, assessment and plan.
The data that are collected and aggregated through the Clinical Experience
Portfolio provide a representation of the patient population and clinical sites, and
allows the faculty to evaluate and revise the clinical experience as it relates to the
core curriculum objectives and competencies. In addition, the Clinical Experience
Portfolio allows students and faculty to track learners experiences with the cases of
the Student Practice Profile, and to assure that patient encounters are equivalent
across sites.
During the clerkship, you will be required to enter an encounter for at least one each
of the Student Practice Profile (SPP) cases, also known as MUST SEE cases. The
MUST SEE cases for the Neurology Clerkship are:
1. Dementia
2. Headache
3. Demyelinating disease: MS or GBS
4. Movement Disorders: PD or other
5. Seizure
6. Stroke
7. Disorders of Sleep
8. Myasthenia gravis (DVD case)
9. ALS (DVD case)
We hope that you will have an actual patient experience for each of the MUST SEE
cases. If you do not encounter an actual patient with a particular diagnosis or
symptom, the clerkship will provide an alternative experience. It may be that you
are provided with an actual patient encounter at another site, or you may be asked to
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complete a simulated or alternative experience, e.g., a virtual (paper or webbased) case, a lecture or case discussion, a problem-based learning case, etc. You
will then document this alternative encounter in the Clinical Experience Portfolio
according to the instructions given to you by the MSE or Clerkship Director.
For complete instructions on entering patient encounters in the Clinical Experience
Portfolio, please refer to the document entitled Clinical Experience Portfolio User
Instructions on myMedWeb, listed under Clerkship Learning Resources. You may
also wish to view the Introduction to Clinical Experience Portfolio Instructional
Video located at the same site. Please use the following formula to enter the
patients alias:
Patients last name is Johnson
Patients pf# is 1234567
Patientss alias is son567
Note: Students must have all of their patient encounters completed on myMedWeb no
later than 5pm the 3rd Friday of the rotation. The Clerkship Director or Medical Student
Educator will review the patient encounters and determine if the submissions are
adequate. All clerkship evaluations (program, attendings, residents) must be entered into
myMedWeb no later than 5pm the final Thursday of the rotation. To verify completion of
your evaluations, print the myMedWeb page stating, no uncompleted evaluations.
F. Practice Neuro Exam:
On two occasions each student will be evaluated performing a neurologic exam. The first
evaluation will take place by the second week of the rotation. Feedback will be recorded
on the Mid-rotation Feedback Form, which must be submitted to the Medical Student
Educator no later than the third Tuesday of the rotation.
G. OSCE
An OSCE session is scheduled for each student during the third week of the rotation. It
includes a standardized patient experience as well as a cognitive component. The OSCE
follows Kecks established protocol for an OSCE session.
VII. FINAL EXAMINATIONS:
A. Subject Exam. 25% of the grade The written final examination is the nationally
standardized Subject Exam covering neurology and developed by the National Board
of Medical Examiners (NBME). This will be given on the last Friday of the rotation.
Missing this exam means that you must explain your absence not only to the clerkship,
but also to the Associate Dean of Student Affairs or the Assistant Dean of Curriculum
and Student Affairs, Clinical Sciences.
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X. EVALUATION AND GRADING: Please see the KSOM Grading Policy that is
posted on MyMedWeb
Mid-rotation evaluations and feedback:
A. Each student will perform a practice neurologic examination for his/her resident or
attending; feedback is reflected in the mid-rotation feedback.
B. The mid-rotation evaluation, which is in use across the clerkships, will be filled out by
the students attending and discussed with the student no later than day 11 of the
clerkship.
Final evaluations:
In addition to the final exams (see above) there are 6 components to each individuals
grade:
A. Student-Patient Interaction: This is an all or none grade (i.e. students with marginal
performance may pass or fail the clerkship depending on their interaction with patients,
paramedical staff, colleagues and their supervisors). See general objectives.
B. Overall clinical skills and attitudes as reflected in performance on the clinical
evaluation, 50%
1. Medical Knowledge
2. Interpersonal and Communication Skills
3. Using Basic Science in the Practice of Medicine
4. Patient Care
5. Diagnosis, Management, and Prevention
6. Problem Solving
7. Professionalism
8. Initiative and Interest
Skill at performing a neurologic exam
C. Clinical Experience Portfolio and Patient Write-up: 10%
Each student is expected to enter an encounter for each must see diagnosis. These
entries will be reviewed for completeness. The write-up is a much more detailed
encounter that is also entered into the CEP and should include history, physical exam
with emphasis on neurological examination, localization of the lesion, differential
diagnosis, assessment, and management. Discussion of the diagnosis and management
should reflect your use of resources, so be sure to include a list references. The CEP
write-up is due by Friday afternoon of the third week of your clerkship and should be
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50%
25%
10%
10%
5%
required
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The medical student plays an important role in patient care. Your diligence will make an
important contribution to your patient's well being. Please take this opportunity not only
to provide a work-up and treatment, but to explore and provide for the psychological and
social needs of your patients. Your patients will have diverse ethnic and socioeconomic
backgrounds. Please remember that all patients are equally deserving of your respect and
empathy. The patients in teaching hospitals provide us with remarkable learning
opportunities. It is essential that we reward their trust by doing our utmost to provide the
best care.
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Appendix
For read-ahead, and for reference throughout the rotation, please visit the clerkship's
Video Library where you'll find all of the lectures. PowerPoint slides are also available
online under clerkship resources.
1. Log on to myMedWeb in the usual manner.
2. At the Clerkship General Learning Resources screen, click on Neurology
3. Select Educational Resources from the drop-down menu
Then Lecture Webcasts
4. That brings you to the mediasite login page
log in:
a. neurology
b. medicine
5. Then you can select from the library.
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