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Third Year Clerkships

Neurology
4 weeks

Description

Students in the Neurology clerkship will be assigned to either the University of Chicago Medical Center site, or the NorthShore University HealthSystem (NorthShore) site in Evanston. Students are assigned on the basis of a lottery, but can communicate preferences for the assigned site to be accommodated when possible. Students at both sites will be provided a joint orientation session on the first day of the clerkship, and receive parallel didactic training. Students from both sites will convene at UCMC for testing on the last day of the clerkship.

The UCMC Clerkship Site

During the 4 week clerkship, students participate in several venues, including the adult neurology inpatient ward, the Neurointensive care unit, and the adult and pediatric outpatient neurology subspecialty clinics. Two weeks will be spent on the Adult Inpatient ward, where students will make rounds with residents, attend morning conferences, and participate in daily rounds, Monday through Saturday. Students will help admit new patients and follow established patients, monitoring their examinations and assisting in care. Students will take call through midnight with their assigned resident. The goal of this rotation is experience in hands-on evaluation and management of acute neurological problems.

In the NeuroICU, students will participate in providing care to critically ill neurological patients, working with the NeuroICU team. Students will participate in the care of critically ill neurological and neurosurgical patients (acute ischemic stroke, subarachnoid hemorrhage, intracerebral hemorrhage, traumatic brain injury, intracranial hypertension, meningoencephalitis, Guillain-Barre syndrome, myasthenic crisis, hydrocephalus, status epilepticus) admitted to the NeuroICU or in consultation in the E.R. or other ICUs. Students will also participate in first response to acute stroke calls. The NeuroICU team will round on the patients on a daily basis. An intense experience of the care of critically ill neurological patients can be expected.

In the Outpatient Clinics, students will work one-on-one with attending physicians in general adult and pediatric neurology subspecialty clinics. The goal of this week is to become familiar with common neurological problems and to evaluate several patients with similar problems in specialty clinics such as multiple sclerosis, neuro-oncology, sleep disorders, epilepsy, stroke, movement disorders, ALS and diseases of the peripheral nervous system. This week will also afford opportunities to observe and assist in performing a lumbar puncture, to observe electroencephalography, and to observe an EMG.

The Northshore University HealthSystem Clerkship Site

At the NorthShore site, the clerkship is directed by Dr. Susan Rubin, The third year neurology clerkship at NorthShore is an intensive clinical exposure to neurological patients, equivalent to the experience at the University of Chicago Medical Center. At NorthShore, students rotate through the Neurology consult service, the stroke unit, and the Neurology clinics experiencing a wide variety of neurologic disorders and treatment options.  During the Neurology Consult service experience students will perform a history and physical on assigned patients and develop a treatment plan including a differential diagnosis, diagnostic work-up and treatment recommendations. They will follow patients throughout their hospital stay and adjust the treatment plan as needed whether in the ICU, medical or surgical units.  Rotation in the stroke unit will involving working with the stroke unit attending physician to evaluate patients with stroke from the time they enter the emergency room through diagnosis and treatment.  Students will gain experience with multiple treatment options including intravenous and intra-arterial tPA, Merci clot retraction and possibly experimental protocols when appropriate.  Rotation in the Outpatient Neurology Clinic will provide students with an opportunity to work with subspecialty attendings in the areas of epilepsy, movement disorders, multiple sclerosis, behavioral neurology, neuromuscular disorders, sleep medicine, pediatric neurology and neuro-oncology.  Students will have an opportunity to become familiar with common neurologic conditions by evaluating several patients with similar problems in each of the subspeciality clinic.  Throughout the rotation student will partipate in diadactic and case review lectures and will attend conferences including the monthly sleep, neurodegenerative, multiple sclerosis, epilepsy, neuromuscular and neuro-oncology conferences.  Opportunities will also be provided to observe and/or assist with lumbar punctures, electroencophalography and EMGs.

Clinical Evaluation

Students are expected to be present at all times during the clerkship. They will be evaluated by attending physicians on their ability to perform a complete neurological examination and interpret the abnormal findings, make a diagnosis and understand the agents used in therapy.  In addition, oral and written communication and professional behavior will be assessed. Students are expected to participate in weekly Case Discussion sessions with the teaching attending, to attend clinical conferences, and to submit a complete write-up of a case with a section on the differential diagnosis.

Objectives

  • Learn to obtain a neurological history and perform a competent neurological examination
    • Students will be provided a framework for neurological history taking and examination that they will utilize when examining patients on the floor.
    • They will also observe attendings and residents perform the neurological examination on the floor and in the clinics.
  • Learn the basics of localization in neurology
    • Students will learn about localization during an orientation session with the clerkship director.
    • They will also learn the importance of localization in diagnosis.
  • Obtain exposure to a variety of neurological disorders
    • On the inpatient floor and in the neuro-intensive care unit students will have exposure to acute presentations of stroke, seizures, multiple sclerosis, and neuromuscular disorders.
    • During the outpatient week students have the opportunity to work with attendings in specialty clinics.
  • Understand the role of diagnostic tests in neurology
  • Students will have the opportunity to see patients undergoing EMG and EEG tests.
    • They will also have the opportunity to understand the role of multiple diagnostic modalities including CT, MRI and ultrasound imaging as well as lumbar puncture and other lab investigations relevant to patients seen on the floors and in the clinics.
  • Understand the role of medical and surgical treatment and rehabilitation of neurological disorders
    • Students will have exposure to various acute and chronic modalities of medical and surgical treatment as applied to patients seen on the floor and in the clinic.
  • Obtain feedback on neurological history taking and examination
    • Students will obtain ad-hoc feedback on history /examination skills on the floors and in the clinic
    • Students on the inpatient service will present a history and physical examination to the clerkship director at the end of the week. They will be given feedback on their history taking and localization skills during these presentations.

Clinical Evaluation

  • 50% Clinical Performance
  • 25% NBME Shelf exam performance
  • 25% Objective evaluation of neurological patient history-taking, neurological examination, and assessment skills, using stardardized patients (OSCE)

Recommended Reading

Overviews of Neurology, suggested as background reading during clerkship (choose one):

  • Lange’s Clinical Neurology; Ed. Aminoff MJ, Greenberg DA, Simon RP. 6th ed.
  • Blueprints in Neurology (Blueprints Series), by Frank Drislane et al.

- Brief review of neurology as part of USME review series.

Comprehensive textbooks of Neurology, useful for reference purposes:

  • Harrison’s Neurology in Clinical Medicine; Ed. Hauser S..
  • Merritt's Textbook of Neurology. Rowland, L.P. 11th ed.
  • Adams and Victor’s Principles of Neurology. Ropper AH, Brown R. Eighth Ed.
  • Neurology in Clinical Practice. Bradley, Daroff, Fenichel, Jankovic. 5th Ed.