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Third Year Clerkships

Neurology
4 weeks

Description

The third year neurology clerkship is a four-week rotation at the University of Chicago Medical Center, comprising both inpatient and outpatient experiences. One week is spent on the Neurology inpatient (floor) service, one week on the NeuroICU service, one week on the Pediatric Neurology service, and one week in the Neurology outpatient clinic.

During the inpatient (floor) week, students will make rounds with residents, attend morning report and participate in daily Attending rounds, Monday through Saturday. The chief neurology resident will assign students newly admitted patients to work up and present at Attending Rounds, as well as ongoing patients to follow. The student will assist in scheduling and garnering results of diagnostic studies, and in patient communication. Diagnostic studies, particularly imaging and neurophysiology studies, will be reviewed with residents and at rounds. The goal of this week is to train students to perform a complete neurological evaluation, to consider a differential diagnosis, to plan diagnostic tests, and to become familiar with acute neurological problems. Students will take call, write admission notes and attend all conferences, as well as inpatient rounds.

In the NeuroICU week, students will participate in the NeuroICU team consisting of the ICU Attending, a fellow, a resident, and the assigned students. The team will provide primary care for the NeuroICU patients and will be involved with this team in first response to acute stroke calls in the E.R. or other hospital floors as well. The students will participate in the care of critically ill neurological and neurosurgical patients admitted to the Neuro ICU or in consultation in the E.R. or other ICUs. The NeuroICU team, composed of the attending, the fellow, the neurology resident and the medical students, will round on the patients on a daily basis. Clinical information will be obtained early in the morning, all the patients will be examined and the images reviewed prior to making treatment decisions and prognostic observations. The medical student will be able to observe and actively participate in all aspects of care of the neuroICU patients.

In the Pediatric Neurology week, students will participate in the care of pediatric inpatients with neurological problems, and also participate in outpatient pediatric neurology clinics. Students will round daily on patients on the pediatric neurology service with the attending, pediatric neurology fellow, and neurology resident, participating in diagnosis and clinical decision-making.

During the outpatient clinic week, students will work with Attending physicians in general neurology and 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 a s MS, sleep disorders, epilepsy, stroke, movement disorders, ALS and diseases of the peripheral nervous system. This week will also afford an opportunity to observe and assist in performing a lumbar puncture, and to observe an EMG.

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 submit a complete write-up of a case with a section on the differential diagnosis; the write-up should be signed by a resident or attending

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 the basics of localization during an orientation session with the clerkship director.
  • They will also learn the importance of localization in making a differential diagnosis and guiding imaging studies.

Obtain exposure to a variety of neurological disorders

  • On the inpatient floor and in the neuron-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 in multiple sclerosis, neuromuscular disease, Parkinson’s disease, neurooncology as well as general neurology.

Understand the role of diagnostic tests in neurology

  • Students will have the opportunity to see patients undergoing EMG and EEG tests as part of their outpatient rotation
  • 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 treatment as applied to patients seen on the floor and in the clinic.
  • They will also be exposed to the role of surgical treatments in epilepsy and Parkinson’s disease.

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.
  • Key elements of the neurological examination will also bee reviewed at these feedback sessions.

Evaluation of Clinical Clerks

  • 60% Clinical Performance
  • 20% Shelf exam performance
  • 20% Patient write-up and neurological examination skills

Recommended Reading

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

  • Neurology section of Harrison’s Textbook of Medicine.
  • Clinical Neurology. 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:

  • Merritt's Textbook of Neurology. Rowland, L.P. 11th ed.
  • Adams and Victor’s Principles of Neurology. Ropper AH, Brown R. Eighth Ed.