Clinical Patient Care
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During this four week rotation, students will work with Neurology
residents and attendings in the hospital and clinic. The
hospital experience consists of 2 weeks of Neurology Ward
Service, followed by 2 weeks of Neurology Consult Service, or vice
versa. When on ward Service at Foster-McGaw or Hines, students
are expected to "split up" and make morning rounds with the team on
ONE Saturday or Sunday morning for the month, after which they may
go home. There is no student overnight call, and thus no early
"post-call" dismissal for student . The outpatient clinic
experience consists of participating in 1 half-day clinic session
each week, with an assigned Neurology attending. Details about
hospital and clinic assignment will be given at orientation.
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Students will present the patients they have interviewed and examined to their service team or clinic attending, along with a differential diagnosis, proposed diagnostic workup and treatment options, all recorded or documented as necessary. Students on hospital services are expected to “follow” assigned patients daily, determine any changes in patient status or condition, be aware of diagnostic test results, record appropriate notes and acquire related, current neurological knowledge for optimal patient care. Such daily patient information is presented by the student to the service team on hospital rounds.
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A major goal of this clerkship is for students to demonstrate their ability to perform key parts of the bedside neurological physical examination. A videotaped demonstration of the neurological examination by Dr. Merchut
may be viewed on the Neurology Clerkship webpage on LUMEN under "CAI
Modules". Each clinic attending will directly observe how
their assigned student performs key parts of this exam (cranial
nerves, motor exam, reflexes and sensory exam), give them feedback
and suggestions for improvement, and verify this competency on the
student's outpatient clinic evaluation form.
- Students are expected to see a variety of patients in hospital and clinic, and are required to record or “log” these diagnoses on their yellow pocket cards, preferably at the end of each day. At least weekly, these patient cases should be entered on-line as the
Student Neuro
Log (SNL). For an adequate learning experience, every student should see at least one patient with each of the following seven generic conditions or syndromes:
- focal weakness/numbness
- visual changes
- dementia, delirium or language/memory/cognitive loss
- dizziness/abnormal gait/balance
- headache/regional pain
- impaired consciousness or sleep disorder
- seizures/abnormal movements
These are generic syndromes, because the exact diagnosis or disease may not be readily apparent on the first patient encounter in hospital or clinic. Two other clinical patient situations, which may be encountered by students, should also be recorded, but are not mandatory:
- cultural/religious/ethnic diversity
- end of life care
Each patient may have more than one generic syndrome. Therefore,
please keep a separate tally or number of "Assigned Patients" at the
top of the yellow card and later in the on-line log as well, since
the number of clinical conditions or syndromes will likely be
greater than the number of "Assigned Patients." Hospital or clinic
patients are recorded or logged as "Assigned," if the student either
performs the initial H&P or consultation, or enters daily patient
progress notes, or both, at the direction of the resident or
attending on the team. "Not Assigned" patient conditions should
also be recorded or logged when the service team sees, examines, and
discusses patients on rounds, even though they are not officially
"assigned" to that student. (If another student's assigned patient
has interesting findings on neurological exam, politely ask that
patient if you could examine him or her at another time after
rounds. Seeing real patients far exceeds reading about cases in a
book.)
If the student performs or observes any of the procedures listed on their yellow card, this should also be recorded and logged on-line. It is unlikely that every student will have the opportunity to perform a lumbar puncture on this clerkship. Therefore, lecture and simulation teaching on this procedure will be provided in this clerkship, and every student should at least record a “Simulation” for lumbar puncture.
Failure to enter the SNL data on-line will cause
subtraction of 5 points from the final grade, and a "does not meet
expectations" rating for the Professionalism competency.
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