Welcome to your 4th year Neurology Clerkship. During the next four weeks, you will be exposed to the depth and breadth of the nervous system. We are eager to provide a stimulating educational environment where you can acquire the knowledge, skills, and attitudes important in the care of neurologic disorders. The Department of Neurology places the highest priority on your education. We expect you will display an eagerness to learn, ability to teach yourself and others, and appreciate the special nature of patients with neurologic conditions. We want you to be the best!
We have set the following as goals for you to accomplish during this experience:
- Provide an educational program that helps prepare our students for any residency they may choose as part of the general professional education.
- Prepare students to be exemplary house officers (AKA residents).
- Acquisition of the clinical application of basic knowledge of the nervous system.
- Development of communication skills that will facilitate the clinical interaction with patients with neurologic disorders and their families and thus ensure that complete, accurate data are obtained.
- Development of competency in the single system neurological examination.
- Acquisition of the knowledge necessary for the diagnosis and initial management of common acute and chronic neurological conditions.
- Development of clinical problem-solving skills.
- An understanding of the influence of family, community, and society in the care of people with neurological conditions.
- Development of strategies for health promotion and prevention of neurological damage.
- Development of the attitudes and professional behaviors appropriate for clinical practice.
- An understanding of the approach of neurologists to the health care of people with neurologic conditions.
- Begin to understand an educational plan for continuous learning throughout your medical career.
The Department’s expectations of your performance are in line with the College of Medicine’s competency based curriculum. There are several objectives, both general and specific. You will experience, be taught, and evaluated specifically in the following competencies:
- Professionalism (P)
- Practice-Based Learning (PBL)
- Patient Care (PC)
- Interpersonal Communication (IC)
- Medical Knowledge (MK)
- System Based Practice (SBP)
- Demonstrate the professional conduct necessary for a successful clinical interaction with patients and families (P).
- Demonstrate respect of patient and family differences in attitudes, behaviors, and lifestyles, paying particular attention to cultural, ethnic, and socioeconomic influences (P).
- Demonstrate intellectual curiosity, initiative, responsibility, honesty, and reliability (P).
- Demonstrate solicitation, acceptance, and action on feedback (P).
- Demonstrate collegiality and respect for all members of the health care team (P).
- Evaluate patients in a variety of clinical settings, establishing rapport with the patient and family in order to obtain a complete history and physical examination (PC)(IC).
- Summarize history and exam findings, especially the key elements. (MK)(IC).
- Prepare a complete written summary of the history and physical and orally present the case in a chief complaint focused and chronological manner (PC)(IC).
- Identify clinical problems and outline an initial diagnostic and therapeutic plan (PC).
- Recognize when hospitalization and diagnostic tests are indicated (PC).
- Identify the most useful diagnostic tests and be aware of their costs and limitations (PC)(SBP).
- Effectively communicate information about the diagnosis and treatment to patients and families (IC).
- Obtain updated information relevant to the diagnosis and treatment of the patient, performing a literature search and critical review of the literature (PBL).
Neurologic Assessment (PC)(MK)
- Obtain a complete and relevant neurologic history (PC).
- Perform a complete neurological exam accurately (PC).
- Perform a coma and brain death examination accurately (PC).
- Describe basic neuroanatomy (MK).
- Localize lesions to general regions of the nervous system (PC)(MK).
- Identify relevant pathophysiologic categories and combine with history, localization, and time course to generate a broad differential diagnosis (PC)(MK).
- Identify and approach the main neurological emergencies (e.g. GBS, Myasthenia Gravis, Status epilepticus) (PC)(MK).
Disturbances of Senses (visual, hearing, and balance)
- Recognize when a patient may have a disorder of senses (PC)(MK).
- Diagnose and manage common sense disorders (PC)(MK)
Movement Disorders (PC)(MK)
- Identify movement disorder phenomenology and categories: hypokinetic and hyperkinetic (PC)(MK).
- Identify movement disorder emergencies (PC)(MK).
Neuromuscular Disorders (PC)(MK)(IC)
- Identify patterns of neuromuscular disease – e.g. anterior horn cell disease, nerve root, plexus, peripheral nerve, neuromuscular junction, muscle (PC)(MK).
- Explain a nerve conduction study/electromyography procedure in nontechnical terms (PC)(MK)(IC).
Cerebrovascular Disorders (PC)(MK)
- Describe stroke syndromes and etiologic subtypes (PC)(MK).
- Identify cerebrovascular emergencies (PC)(MK).
- List indications and contraindications for intravenous thrombolytic therapy (PC)(MK).
Cognitive/Behavioral Disorders (PC)(MK)
- Recognize when a patient may have a cognitive/behavioral disorder (PC)
- Identify common cognitive/behavioral disorders (PC)(MK).
Demyelinating Disorders (PC)(MK)
- Recognize when a patient may have a demyelinating disorder (PC)(MK).
- Diagnose and manage common demyelinating disorders (PC)(MK)
- Identify epilepsy phenomenology, and classification of seizures and epilepsies (PC)(MK).
- Diagnose convulsive status epilepticus (PC).
- Explain an electroencephalogram procedure in non-technical terms (PC)(MK)(IC).
- Use appropriate terminology related to electroencephalogram – e.g. montage, amplitude, frequency (PC)(MK)
- Diagnose common headache syndromes (PC)(MK).
- Discuss when neuroimaging is required in headache disorders (PC)(MK).
- Manage common headache syndromes (PC)(MK).
- Recognize common clinical presentations of a brain or spine mass (PC)(MK).
- Identify neuro-oncological emergencies (PC)(MK).
- Demonstrate basic knowledge of management of patients with neurologic disease (PC)(MK).
- Discuss general approach to initial treatment of common neurologic disorders, including risks and benefits of treatment (PC)(MK)(IC).
- Demonstrate general knowledge of diagnostic tests in neurology (MK).
- Discuss general diagnostic approach appropriate to clinical presentation (PC)(MK).
- List risks and benefits of tests to patient (PC)(MK)(IC).
- Identify situations in which it is appropriate to request neurologic consultation (SBP).
- Identify basic neuroanatomy on brain MRI and CT (PC)(MK).
- Recognize emergent imaging findings on brain MRI and CT (PC)(MK).
- Identify basic neuroanatomy on spine MRI and CT (PC)(MK).
Lumbar Puncture (PC)(MK)(IC)
- List the indications and contraindications for lumbar puncture (PC)(MK).
- List the complications of lumbar puncture and their management (PC)(MK).
- Demonstrate the ability to perform a lumbar puncture (PC).