Learning Objectives

The Stritch School of Medicine has a required clerkship in the Department of Neurology, typically taken in the fourth year. This initial experience in Neurology may also be taken as an early elective in the third year. At the completion of this four week program, medical students will have acquired knowledge or improved skills in the following competency areas:

Medical Knowledge

1. Describe the currently accepted pathophysiology, usual clinical manifestations, and appropriate treatment of the disorders commonly encountered in Neurology, including:
   
   
   1. cerebrovascular disease (transient ischemic attacks, infarction and hemorrhage)
   2. epilepsy (partial and generalized seizures, status epilepticus)
   3. infections affecting the central nervous system (meningitis, encephalitis)
   4. central nervous system tumors (primary, metastatic)
   5. multiple sclerosis
   6. headaches (migraine, tension headache, secondary headache)
   7. dementia (especially Alzheimer's disease, vascular dementia)
   8. neuromuscular disorders (neuropathies, myopathies, neuromuscular junction disorders, motor neuron diseases, radiculopathies)
   9. movement disorders (especially Parkinson's disease, essential tremor)
   10. sleep disorders (especially sleep apnea)
       
       
2. Review the clinically relevant anatomy of different levels or functional units of the nervous system, as well as clinically significant interconnecting anatomical pathways and blood supply, being able to relate anatomical lesions with typical clinical symptoms and signs. These areas or levels include:
   
   
   1. cerebral cortex
   2. subcortical centers (basal ganglia, thalamus)
   3. cerebellum
   4. brain stem
   5. spinal cord and nerve roots
   6. nerve
   7. neuromuscular junction
   8. muscle
      
      
3. Describe the basic science, including significant molecular, biochemical, cellular, and genetic mechanisms, relevant to Neurology. This includes:
   
   
   1. the role of neurotransmitters in the central nervous system (dopamine in Parkinson's disease, acetylcholine in Alzheimer's dementia, serotonin in migraine, GABA in seizures)
   2. the function of the blood-brain-barrier (as in meningoencephalitis, metatstatic cancer, mannitol therapy)
   3. synaptic transmission at the neuromuscular junction (myasthenia gravis, botulism)
   4. normal and abnormal nerve conduction (axonal vs demyelinating neuropathies) and muscle contraction (myopathies)
   5. effects of focal ischemia (TIA, infarction) or global anoxia (hypoxic encephalopathy) on the nervous system
   6. effects of inflammation and edema on the nervous system (as in MS, brain tumors, trauma, hemorrhage, myelitis, Guillain-Barre syndrome)
   7. systemic biochemical or nutritional abnormalities responsible for certain neurological syndromes (B vitamin deficiencies, diabetes, alcoholism)
   8. the hereditary aspects of certain neurological diseases (MS, migraine, cerebrovascular disease; trinucleotide repeats in Huntington's disease)
   9. current hypothetical mechanisms for autoimmune neurological diseases (MS, Guillain-Barre syndrome)
      
      
4. Describe the practical pharmacology (proper dosing, indications, risks, benefits and common side-effects) of medicines commonly used in Neurology, including:
   
   
   1. anticonvulsants
   2. levodopa and dopamine agonists
   3. cholinesterase inhibitors, central and peripheral
   4. corticosteroids
   5. immunomodulatory agents, such as beta-interferon, gamma globulin
   6. anticoagulant and platelet inhibitory drugs
   7. triptans, beta-blockers, tricyclic antidepressants (migraine therapy)
   8. anticholinergics, beta-blockers, dopamine antagonists (treatment of hyperkinetic movement disorders)
      
      
5. Discuss the neurological criteria for brain death and poor prognostic clinical signs for patients in a persistent vegetative state.

Communication Skills

1. Elicit, legibly record, and present appropriately focused history and physical examinations for common problems encountered in Neurology.
   
   
2. Explain findings from clinical investigations, plans for follow up, and possible courses of therapy with indications, risks, benefits, and alternatives to patients and caregivers.
   
   
3. Discuss the impact of a neurological illness and its treatment (or lack thereof) on the patient and family members.

Professionalism

1. Display appropriate dress, grooming, punctuality, honesty, courtesy, respect for patient confidentiality, and other norms of behavior in professional relationships with patients.
   
   
2. Converse and behave appropriately in interactions with peers, faculty, residents, and healthcare staff, working collaboratively in providing care and treatment of inpatients and outpatients.

Patient Care

1. Effectively observe, communicate, and interact with patients, families, and other healthcare workers to obtain neurological histories, deal with difficult situations, and insure proper record keeping.
   
   
2. Perform, record, present, and interpret a neurological physical exam.
   
   
3. Integrate data from the neurological history and physical to localize the neurological lesion(s), and refine the differential diagnosis by means of rational diagnostic testing.
   
   
4. Describe the indications, utility, complications and contraindications of neurological diagnostic procedures, including:
   
   
1. neuroimaging (CT, MRI, angiography, myelography)
2. nerve, muscle or brain biopsy
3. electroencephalography (EEG)
4. electromyography (EMG)
5. lumbar puncture
   
   
5. Describe a rational diagnostic and therapeutic approach to neurological patients with the following disorders:
   
   
   1. cerebrovascular disease (transient ischemic attacks, infarction and hemorrhage)
   2. epilepsy (partial and generalized seizures, status epilepticus)
   3. infections affecting the central nervous system (meningitis, encephalitis)
   4. central nervous system tumors (primary, metastatic)
   5. multiple sclerosis
   6. headaches (migraine, tension headache, secondary headache)
   7. dementia (especially Alzheimer's disease, vascular dementia)
   8. neuromuscular disorders (neuropathies, myopathies, neuromuscular junction disorders, motor neuron diseases, radiculopathies)
   9. movement disorders (especially Parkinson's disease, essential tremor)
   10. sleep disorders (especially sleep apnea)
       
       
6. Create a differential diagnosis, method of evaluating and eventually treating common neurological generic syndromes, both acute and chronic, including:
   
   
   1. focal weakness or numbness
   2. visual impairment
   3. language, memory or cognitive loss
   4. dizziness, abnormal balance or gait
   5. headache or regional pain
   6. impaired consciousness or sleep disorder
   7. seizures or involuntary movements
      
      
7. Discuss various options for caring of patients with chronic or incurable neurological disorders, including:
   
   
   1. rehabilitative services
   2. adaptive devices or aids
   3. hospice care
   4. decisions to forego life-sustaining devices or procedures
      
      
8. Describe the optimal diagnostic and therapeutic management of neurological emergencies, including:
   
   
   1. acute stroke syndrome
   2. status epilepticus
   3. coma
   4. increased intracranial pressure
   5. meningitis or encephalitis
   6. spinal cord compression
   7. myasthenic crisis
   8. Guillain-Barré syndrome
      
      
9. Discuss the therapeutic options for relieving pain in patients with neurological disorders, such as:
   
   
   1. migraine and other headache syndromes
   2. neuropathic pain conditions
   3. radicular pain (zoster, “sciatica”)

Practice-Based and Lifelong Learning

1. Use information technology to access and manage clinical information and perform on-line searches to support ongoing self-directed learning.
   
   
2. Search, evaluate and critically review medical literature appropriate to the care of individual patients or as an approach to a clinical problem, and present this information, as appropriate, to the health care team.

Previous

  © Loyola University Chicago Stritch School of Medicine. All rights reserved.
Please send questions or comments to: Michael Merchut , M.D.
Updated: 07/10/06 ..Created: 08/15/00