clinical neurology clerkship

Stephen Deputy, MD - Director, Clinical Neurology Clerkship

[email protected] 913-4964James Breazeale - Academic [email protected] 568-4090 Neurology Chief Resident : Dr. Cornel Rogers:

[email protected]

Baton Rouge: Dr. Charles

Barkemeyer – [email protected]

Rotation SitesBaton Rouge-OLOL Hospital

Dr Barkemeyer is in charge of all attending rounds, student evaluations, and didactic lectures

BR students are not required to attend the Thursday afternoon didactics at LSU

If you need housing, contact Brenda Fields: 225-768-5820 or [email protected]

Rotation SitesSt Charles LSU Faculty Clinics

Participate in clinics run by LSU Faculty at the St Charles Hospital site Monday-Thursday

On Fridays, participate in Dr Gutierrez’s clinic at Ochsner Kenner

Try to identify one attending from each week to evaluate your clinical performance

Rotation SitesLSU Interim Hospital

Round on Inpatients at the Interim Hospital on all days

Clinics at Lord and Taylor› Monday AM: Neurology resident Continuity

Clinic› Monday PM: Either MS Clinic or Epilepsy Clinic› Tuesday: Stroke Clinic

Do not forget to be prepared to present a patient for Professor’s Rounds on the first Thursday

Rotation SitesTouro Hospital

Manage inpatient consults at the Touro Hospital Campus

Students need to fill out paperwork (which will be emailed to you) and present it to the medical staff office on the first day to receive a temporary ID and parking

Rotation SitesChildren’s Hospital

Round on inpatients with child neurology attending, child neurology fellow, and adult neurology residents

Fill out paperwork (that will be emailed to you) to be able to log on to the Sorian computer system

Questions on where you are going to be or who you will need to

contact?

Duties of Students

EquipmentEach student should own or have access to the following equipment in

order to adequately exam patients with neurological disorders:

• Ophthalmoscope (Welsch Allyn or Pan-Optic head)• Snellen Eye Chart• Reflex Hammer (preferably Queen Square type and not Tomahawk

type)• Flashlight (or penlight)• Tuning Fork (C-128 for vibration sense detection +/- C-256 or 512

for hearing)• Your Brain!!!!

Duties of StudentsDidactic Lectures

Neurology Resident-Led Clinical Case Studies Applicable Neuroradiology Faculty-led Student Professor’s Rounds Neurology Review

Lectures are held on Thursday afternoons (see calendar) in room 111 of the 1542 Tulane Ave Building. They are mandatory for all students with the exception of those rotating in Baton Rouge


Neurology Resident-Led Clinical Case Studies 2 Cases; one is a Stroke case and the other is an

Epilepsy case Read the cases (contained within your Passport)

and be ready to answer the discussion points prior to attending the lecture

Audience participation is expected


Applicable Neuroradiology Lecture Reviews various types of Neuroimaging Modalities Reviews Neuroanatomy from a Neuroradiology

perspective Reviews the Neuroradiographic findings of some

common pathologic processes

Faculty-Led Student professor’s Rounds Students assigned to University Hospital are responsible for

bringing a case to the conference Only one student needs to present the case Be sure to include pertinent details from the Chief Complaint,

HPI, PMHx, PSHx, Social Hx, Medications and their Dosages Present the Physical Examination and a DETAILED Neurological

Examination Be prepared to discuss a pertinent Differential Diagnosis based

on Localization of the disease process Discuss the results of Diagnostic Studies Discuss Treatment and Outcome of the patient

Neurology Review Lecture Briefly touches on important clinical aspects of

multiple Neurological Disorders to help as a study guide for the SHELF Exam

Topics include: CNS Infections, Auto-immune disorders, Epilepsy and Sleep disorders, Vascular disorders, Headache and Pain syndromes, Trauma, Degenerative disorders, Altered Mental Status, Movement disorders, Structural abnormalities, Toxic and Metabolic disorders, Psychiatric conditions, Neuromuscular disorders, Anatomy and Localization.

Progress Notes

Progress notes should be written as frequently as the patient’s condition warrants. These can be written on hospital Progress Notes sheets but should be identified as L3 with signature and should be cosigned by staff or resident. Students working at the Interim LSU Hospital will document notes on the EPIC system

Each medical student is expected to be an active participant of the team to which he/she is assigned. Responsibilities include, but are not limited to, participating in all work rounds (except when didactic lectures are occurring), reviewing all pertinent laboratory studies obtained on his/her assigned patient (including blood work, CSF results, neuroimaging results, and electrodiagnostic studies), and writing daily progress notes on the patients that they are assigned to follow.

The official Student Leave Policy During the Neurology Clerkship essentially states that students should try and minimize absences during required clerkships. During this short 2 week rotation, you will be allowed no more than 1 day for an excused personal absence. It is expected that you inform your resident as well as other students on the team of any planned absence so that your patient care duties can be covered. You must also inform the clerkship administrative assistant (JB) as well as the Clerkship Director in writing (by email) of your planned absences at or before the beginning of the 2 week block and receive permission to take said absence, otherwise it will be considered unexcused. Unexcused absences may be grounds for failing or repeating the clerkship. In the event a student needs to take more than 1 day off for personal matters, this student will generally need to make up extra time within the clerkship at the clerkship director’s discretion. The LSUHSC policy regarding absences from Junior Clerkships are listed in the Duties for Students document.

Work Hours In recognizing the time commitment required of medical students during

clinical rotations and taking into account the effects of fatigue and sleep deprivation on learning, clinical responsibilities, and student health and safety, the following duty hour limitations have been adopted by the LSU Clerkship Directors as of 5/22/08 and are to be followed without exception:

1. Duty hours must be limited to 80 hours per week averaged over a four- week period, inclusive of all clinical and didactic learning activities.

2. Students who are assigned to overnight call in the hospital should not have patient care responsibilities after 1:00 PM on the following day.

3. Students will be expected to attend mandatory didactic activities even after overnight call.

Any breech of the outlined work hour limits described above should be reported directly to the Director of the Clinical Sciences Curriculum, the Associate Dean for Student Affairs, the Assistant Dean for Student Affairs, or the Assistant Dean for Undergraduate Medical Education.

On CallIn-house call is not required during your

Neurology Clerkship

(However, if you have a particularly good resident and wish to take call electively to gain further clinical experience, please feel free to do so)

Junior Neurology Clerkship Passport

Neurology PassportThe Junior Neurology Clerkship Passport is your link to

documenting your directly observed neurological examination and pertinent neurological history taking skills, patient log, and student presentations. It has been designed to allow faculty to be better able to assess the performance of each student during the Junior Neurology Clerkship. The Passport is to accompany each student during each day during the rotation and must turned in at the end of the rotation in order for the student to be able to sit for the final written examination. Do not leave your Neurology Clerkship Evaluation Form with any attending physician or resident to be filled out “later”. Lost or misplaced Passports may be reconciled on a case-by-case basis by the Clerkship Director. Each Passport will have the following components:

Clinical Neurosciences PassportI. Neurological Examination Competency Form

II. Neurological History Taking Competency Form

III. Student Presentations Form

IV. Patient Log

Basic Competencies:Neurological Examination Skills

One of your learning goals during the clerkship is to improve your competency in performing a neurological examination.

During your Neurology Clerkship you will be asked to formally demonstrate your neurological examination skills on at least one of the patients that you are taking care of (though the more you do, the better you will get with these skills).

Have an attending physician or neurology resident sign off on the Basic Competencies form that corresponds to your specific rotation (Adult or Child Neurology).

Basic CompetenciesAdult Neurology: Neurological Examination Skills. Minimum

CriteriaThe Neurological Examination demonstrates completeness by: Containing components from each of the six sub-sets of the neuro exam

(mental status, cranial nerves, motor, sensory, coordination and gait)Application of the Neurological Examination by: Correctly interpreting normal and abnormal findings to aid in localization

of the disease process. Use of the neurological examination to quantify the severity of any

neurological deficits identified.Professionalism: The approach to the patient during the examination shows respect for the

patient’s privacy and dignity.

Basic CompetenciesChild Neurology: Neurological Examination Skills.

Minimum CriteriaThe Neurological Examination demonstrates completeness by: Containing components from each of the six sub-sets of the neuro exam

(mental status, cranial nerves, motor, sensory, coordination and gait), even if just by observation.

Pertinent “non-neurological” aspects of the examination are demonstrated (head circumference, dysmorphic features, cutaneous findings, etc).

Application of the Neurological Examination by: Correctly interpreting normal and abnormal findings in an age-specific

fashion Use of the neurological examination to aid in localization of the disease

processProfessionalism: The approach to the patient shows courtesy and respect for the child’s

modesty and parental concerns

Basic CompetenciesOverall Student Competence (circle one):

Strong Acceptable Unacceptable (needs to be repeated)

I observed this student perform this skill and attest that he/she met the specified criteria

Signed:________________________________________________

Printed Name/Title:_______________________________________

Basic Competencies:Taking a Pertinent Neurological History

Your neurological history should include information concerning the onset and evolution of any neurological complaints as well as their chronicity.

The history should also allow for some degree of localization of the disease process.

Be sure to include how the deficits functionally impair the patient

Present your history to an attending physician or resident and get your basic competency card signed

Basic Competencies Adult Neurology: Pertinent History Taking

Skills. Minimum Criteria The history contains enough information to begin the

process of localization The history contains enough information to gain an

understanding of the chronology and severity of the disease process

Information is obtained concerning psychosocial functioning of the patient as it pertains to his/her illness

Medication dosages and allergies are accurately listed

Basic CompetenciesChild Neurology: Pertinent History Taking Skills.

Minimum Criteria The history contains enough information to begin the

process of localization The history contains enough information to gain an

understanding of the chronology and severity of the disease process

A thorough developmental history/school performance history is identified

Medication dosages and allergies are accurately listed

Basic CompetenciesOverall Student Competence (circle one):

Strong Acceptable Unacceptable (needs to be repeated)

I observed this student perform this skill and attest that he/she met the specified criteria

Signed:________________________________________________

Printed Name/Title:_______________________________________

Student Presentations Students are encouraged to prepare and present brief

presentations concerning some aspect of the disease (diagnosis, treatment, prognosis, etc.) that their patient has. This demonstrates independent learning which is strongly encouraged during the clerkship

Each time that you give a presentation to your team, please document the date and topic of your talk. Have the resident or attending sign your passport and provide comments about the quality of the presentation

Patient LogThe Liaison Committee on medical Education requires that each

clerkship specify the number and kinds of patients that students must evaluate in order to achieve the objectives of the clerkship. The Neurology Clerkship Grading Committee has determined that each student must be involved in the care of at least two patients with the following conditions:

Paroxysmal Disorders Vascular Disorders Neuromuscular Disorders Progressive Degenerative Disorders

It is recommended that students care for at least One patient from each of these categories through the 2 weeks of the clerkship.

Examples of common disorders within each category specific to each rotation are listed in the Duties for Students document

Patient LogParoxysmal Disorders

Adult Neurology examples include: Headaches, Seizures, Epilepsy, Channelopathies, etc.

Child Neurology examples include: Headaches, Seizures, Epilepsy, Myotonia or other Channelopathies, etc.

Vascular Disorders Adult Neurology examples include: Stroke, Intracranial Hemorrhage, Hypertensive Encephalopathy, Hypoxic-Ischemic Encephalopathy. Child Neurology examples include: Childhood Stroke, Neonatal Intraventricular Hemorrhage or Periventricular Leukomalacia, Hypoxic-Ischemic Encephalopathy.

Patient LogNeuromuscular Disorders Adult Neurology examples include: Myopathies, Guillan-Barre Syndrome,

CIDP, Charcot-Marie-Tooth, Diabetic Neuropathy, Amyotrophic Lateral Sclerosis, Traumatic or Focal Neuropathies, etcChild Neurology examples include: Congenital Myopathies, Muscular

Dystrophy, Guillan-Barre Syndrome, Spinal Muscular Atrophy, Charcot-Marie-Tooth

Disease Myasthenia Gravis, Erb’s Palsy, etc.

Progressive Degenerative DisordersAdult Neurology examples include: Alzheimer’s Disease and other

Dementia’s, Huntington’s Disease, Parkinson’s Disease, Vascular Dementia, etc.Child Neurology examples include: Leukodystrophies, Neurodegenerative Disorders, Metabolic Disorders, Brain Tumors, etc.

Neurology Clerkship EvaluationClerkship Competencies (6 Domains) Medical Knowledge Patient Care Interpersonal Relationships and Communication Practice-Based Learning and Improvement Systems based Practice Professional Behavior

Neurology Clerkship Evaluation Always Exceeds Expectations for level of training* Sometimes Exceeds Expectations for level of

training* Meets Expectations for level of training* Does Not Meet Expectations for training*

(*Guidelines for the various expectations for each item graded are available on the Student Web Page in a document entitled “The Neurology Clerkship Clinical Evaluation”)

Neurology Clerkship Evaluation Form Does Not Meet Expectations for level of trainingA grade of “Does Not Meet Expectations” for

Competency Domains 1-5 should prompt a meeting of the student with the Clerkship Director to develop a plan for remediation and may be grounds for failure of the clerkship. The evaluating faculty member should contact the clerkship director for clarification.

Medical Knowledge1. Demonstrates adequate understanding of the pathology, pathophysiology, and anatomic features of neurological diseases.

2. Participates regularly in activities that advance knowledge and competence

Patient Care1. Takes a pertinent and thorough Neurological History containing information which provides some degree of neurological localization and allows for an understanding of the chronology and severity of the disease process.

2. The history contains accurate medication dosages, formulations and drug allergies

Patient Care3. Is able to demonstrate a thorough Neurological Examination that contains pertinent aspects from each of the 6 realms of the neurological exam and contains enough detail to localize the disease process.

4. Generates a pertinent Differential Diagnosis that takes into account disease localization and prioritizes the most likely diagnosis

Patient Care5. Develops an appropriate Diagnostic Plan specific to the unique aspects and needs of their patients

6. Develops an appropriate Treatment Plan specific to their patient’s illness

7. Provides effective care with respect to the patient’s psychosocial level of functioning and their cultural beliefs

Interpersonal Relationships and Communication

1. Clearly and accurately presents patients findings to team members

2. Maintains clear, complete, accurate, timely and legible medical records 3. Shows empathy and respect to patients and their families

Practice Based Learning and Improvement

1. Uses evidence from practice guidelines and scientific studies to develop appropriate diagnostic and treatment plans

2. Shows an eagerness to learn, identifying their own questions and reviewing the literature concerning their patients’ illness

Professional Behavior Maintains honesty and integrity in written

documentation Establishes professional relationships with patients

and families Reliably fulfills patient care responsibilities without

frequent reminders Functions as a respectful and helpful team member Arrives on time and leaves only when work is done or

for didactic sessions Seeks feedback and/or responds well to constructive

criticism in order to improve performance

Professional BehaviorA grade of “Does Not Meet Expectations” for

Professional Behavior items shall prompt a Physician Evaluation Form, which will be completed by the Clerkship Director and discussed with the student. The evaluating faculty member must contact the Clerkship Director for clarification. Unprofessional behavior may also be grounds for failure of the clerkship.

Each student’s Clinical Grade will then be based on the following format (the mean is determined for each evaluating attending physician based on his/her prior evaluation scores):

Honors: Score is greater than +0.75 SD’s above the meanHigh Pass: Score is between -1 SD’s below the mean and +0.75

SD above the meanPass: Score is between -2 SD’s below the mean and -1 SD’s

below the meanFail: Score is below -2 SD’s below the mean* *Students may also be in jeopardy of failing the course for behavior

deemed to be unprofessional.

The Written Examination› Beginning with the 2009 Academic Year, the Clinical

Neurosciences Clerkship started to use the USMLE SHELF examination as it’s instrument to assess student’s clinical knowledge. This test has been extended to the Junior Neurology Clerkship as well. The test is highly geared towards adult neurology. In order to prepare for this examination, it is strongly encouraged that each student review the supplied curriculum of reading materials contained within the LSU Neurology department website www.medschool.lsuhsc.edu/neurology

Click on the L3 Students tab

Other Sources to Aid in Preparation for the SHELF Examination

Neurology Case Files (Lange Case Files) Blueprints Neurology (Blueprints Series) USMLE World Step 2 CK (Neurology Questions) Neurology Pre Test Self-Assessment and Review The Neurology Chapter contained within your

Internal medicine Textbook

The Written Examination Students are required to obtain a score of at least 59 on the

SHELF examination in order to pass the clerkship. Those students who score less than 59 will need to either

repeat the SHELF examination at the end of their Junior year and score a passing grade in order to receive a Pass final grade for the clerkship.

SHELF scores will be weighted compared to other students taking the examination in your block. Each student who passes the SHELF will thus be given an Honors, High Pass or Pass based on their weighted score.

The Written Examination GradePassing SHELF scores will be translated into a Written Examination

Grade for the course based on the following paradigm generated for each group of students taking the SHELF at any one time:

Honors: Score is greater than +0.5 SD’s above the mean High Pass: Score is between -0.5 SD below the mean and +0.5

SD’s above the mean Pass: Score is between 59 and -0.5 SD below the mean Fail: Score is less than 59

Final Clerkship Grade Schemata Each student will receive a Final Assigned Grade for their Neurology

Clerkship based on a combination of their Clinical Grade and their Written Examination Grade as follows:

Honors: Need to have Honors for both the Clinical and Written grades.

High Pass: The lowest of the Clinical and Written Grades must be a High Pass or a combination of Pass and of Honors with the Clinical and Written grades

Pass: The lowest of the Clinical and Written Grades is a PassFail: The Clinical Grade is a Fail or The student is unable to score a

passing grade on the SHELF examination despite repeated attempts (LSU School of Medicine Policy), or possible if the student engages in unprofessional behavior that cannot be rectified per the Clerkship Director’s discretion.

Student Feedback about the Junior Neurology Clerkship Useful Aspects of the Clerkship: Counterproductive/Needs Improvement Aspects of the Clerkship: Changes that you would suggest for the Clerkship: How did your clerkship experience help you to prepare for the

Neurology SHELF examination? What could have been done differently to help you better prepare

for the Neurology SHELF exam?

Student Feedback about the Junior Neurology Clerkship

Note: Your feedback is extremely important and will allow us to continually update and adjust different aspects of the Clinical Neurosciences Clerkship. Following the completion of the SHELF examination, each student will receive notification from New Innovations and asked to complete the Neurology Clerkship Student Feedback. Answers are stored and returned to the clerkship coordinator anonymously. Negative feedback will in no way influence your final grade. Please feel free to directly email the Clerkship Director (Dr Deputy) at [email protected] if you have any further suggestions or comments about your experiences during the rotation.

Questions???

Now go out there with an open mind and discover the amazing complexities of the science and art of Clinical Neurology

clinical neurology clerkship

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