Clerkship Organization and Orientation

During this four week rotation, students will be involved in both inpatient and outpatient Clinical Neurology. The hospital experience consists of the Neurology Ward Service (2 weeks) and the Neurology Consult Service (2 weeks), staffed by Neurology Resident and Attending teams. At Foster-McGaw Hospital , the Ward Service consists of General Neurology inpatients as well as those in the Stroke Unit and Neuroscience ICU, while the Consult Service sees patients in both the ER and Hospital. Students on Ward Service at Foster-McGaw or Hines are expected to “split up” and make weekend rounds with the team on ONE Saturday or Sunday morning for the month. Students do not take overnight call, but are expected to stay until 7:00 PM on two weekdays (Monday through Friday) chosen on a sign-up sheet, to help the on-call Neurology Resident with consults or admissions, if any occur during that time. There is no early “post-call” dismissal for students. The clinic experience consists of partaking in 1 half-day clinic session each week, with an assigned Neurology Attending.
Prior to seeing patients, review on-line the Neuro Exam videotape by Dr. Merchut available in LUMEN (www.meddean.luc.edu/lumen/ ). Select “Undergraduate Medical Education,” then under “Clinical Sciences” select “Neurology,” “CAI Modules,” “Neurological Exam” and then “Movie.” Also under CAI Modules is the Practical Neurology DVD Review by Dr. Biller, which contains the patient videotapes listed in Study Guides 1 and 2. A selection of these patients will constitute the Patient Case Vignette Video Exam, taken at the end of the clerkship. The “Radiology Curriculum” under CAI Modules contains self-study CT and MRI images of normal neuroanatomy as well as neurological disorders.
This Neurology Clerkship website in LUMEN also contains Powerpoint slides for the lectures on Neurodiagnostic Testing (Student Neuroradiology, Lumbar Puncture, which includes a movie) and Neurological Emergencies. “Literature Article Refs” include basic articles on stroke, end-of-life and nutritional issues pertaining to Neurology. Most of this Handbook is also available under the “Information” section.
The Castro textbook from the second-year Neuroscience Course is a good review for neuroanatomy, neurophysiology and neuropathology:

Castro AJ, Merchut MP, Neafsey EJ, Wurster RD. Neuroscience: An Outline Approach . Mosby: St. Louis , MO , 2002.

A recommended textbook for the Neurology Clerkship is (your choice) either:

Drislane FW, Benatar M, Chang BS, et al. Blueprints Neurology . 2 nd ed. Lippincott Williams & Wilkins: Philadelphia , 2006.

Aminoff MJ, Simon RP, Greenberg DA. Clinical Neurology . 6 th ed. Lange Medical Books: 2005.

Students will present the patients they have interviewed and examined to their service team or clinic attending, along with a differential diagnosis and proposed evaluation and treatment plan, 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 related to patient care. Such daily patient information is presented by the student to the service team on hospital rounds.
Each student will see a variety of patients, either performing the initial H&P or consultation (in clinic or hospital), or creating a hospital progress note or clinic visit note (= assigned patients) ; OR observing the hospital or clinic patient during team rounds; OR studying videotaped or DVD patients (= simulation patients). Students are asked to keep a Student Neuro Log (SNL) , by recording the total number of “assigned patients” encountered, as well as their initial symptoms or syndromes listed on the yellow pocket cards provided. A recorded patient may have one or more initial symptoms or syndromes, so the number of clinical problems will exceed the number of assigned patients. It is expected that at least one patient is seen for each of the neurological syndromes listed below (and on the yellow cards):

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

Please also enter on the yellow pocket card any patient encounters regarding these medical conditions:

cultural/religious/ethnic diversity
end of life care

Any procedures performed should be recorded on the reverse side of the yellow pocket card. It is unlikely that every medical student will have the opportunity to perform a lumbar puncture on this clerkship. However, lecture and simulation teaching on this procedure will be provided.

The Student Neuro Log (SNL), consisting of all the patient information tallied on one or more yellow pocket cards, should be entered on-line periodically, and completely by the end of the Neurology Clerkship. Failure to enter the SNL data on-line will cause subtraction of 5 points from the final grade.

Keeping the SNL helps verify clinical competencies, as done in most residency training programs, and also helps the student study Clinical Neurology. Every patient encounter should prompt further study of that syndrome or diagnosis, preferably on the same day of the encounter. If certain syndromes or diagnoses are not seen, the relevant videotaped patients in Practical Neurology DVD Review should be reviewed by the student, and a “simulation” encounter listed on the yellow pocket card.

The Practical Neurology DVD Review patient cases have been organized into two Study Guides in this booklet. Study Guide 1 lists videotaped cases to study by initial symptoms or syndrome, as above (e.g., focal weakness or numbness, visual changes, etc). Study Guide 2 lists videotaped cases to study by final diagnosis (e.g., cerebrovascular, dementia, etc).

Clinical competencies (Communication Skills, Professionalism, Patient Care and Practice Based and Lifelong Learning) for each student will be evaluated on at least 3 Student Summative Evaluation (SSE) forms, one each from the Neurology Attendings on Ward Service, Consult Service and in Clinic. The Ward and Consult Attendings (with input from service residents) will complete an SSE, discuss it with the student and both will sign it, at the end of the second and fourth weeks of the rotation; the Clinic Attending will complete an SSE after the last clinic for the rotation. The SSE forms are included in this booklet, and must be given to the appropriate Attending by the student . The mid-rotation (end of week 2) evaluation counts toward the final grade, and is not informal feedback, but it does give the student guidance as to modifying, improving or encouraging continuation of their performance to the end of the clerkship.
The assigned Clinic Attending during the rotation will also verify by direct observation that the student can competently perform four components of the Neurological Examination: cranial nerve exam, motor exam, reflex exam and sensory exam. Each component should be demonstrated on selected outpatients, repeated if necessary, and “signed off” by the Attending on the Directly Observed Neuro Exam (DONE) section of the SSE form, given to the appropriate Clinic Attending by the student .
On the last day of the clerkship, students will take: (1) an on-line, 100 multiple-choice question test, and (2) a patient case vignette videotape examination. Before beginning the final examination, students must turn all forms in to the proctor (3 or more SSEs) with their name clearly written on each. All forms can be reinserted in this handbook and returned, or returned as a separate packet. The 100 question examination consists of written patient cases or scenarios, in Boards format, with a few CT or MRI images, patient graphics or EEG recordings. The topic(s) on questions missed by the student will be provided as feedback after the test. The patient case vignette videotape exam consists of 25 on-line, multiple choice questions pertaining to 12 videotaped patients from the Practical Neurology DVD Review , accessible on-line (Neurology LUMEN website).
Student feedback of this clerkship is also important to us. Please provide it on-line to receive your final grade from the Loyola-Stritch registrar.
Students (from medical schools other than Loyola-Stritch) taking this Neurology Clerkship as an extramural rotation must also complete the forms described above and take the final examinations.
Student abuse, whether physical, psychological or sexual, is never to be accepted or tolerated. Students are asked to confidentially discuss any issues of abuse, as early as possible, with the clerkship director.
Paula Griffin-Arnold (708-216-6755, Bldg. 105, Rm 2705, LUMC) ; Anette Bullion (708-216-5332, Bldg 105, Rm 2709, LUMC) and Carol Kala ((708) 202-2843, Bldg 1, Rm F201, Hines) are available to help you with administrative issues on your rotation.

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