Aims & Objectives

Nomenclature

Aims: Your global level of competency and comfort at the end of the rotation. The objectives should help you reach the Aims.

Objectives: Specific, teachable, and testable components which, in sum, will lead to the Aims.

Expectations: What we require you to do,a priori, to have an optimal and successful experience. Expectations may overlap with objectives. However, expectations may include behaviors not explicitly taught by this clerkship, but common to the role of the medical student within the health care setting.

Knowledge: Factual information, as might be conveyed by a lecture, your reading, or a written exam (e.g. the differential for vertigo).

Skills: How knowledge is communicated and applied in life (e.g. obtaining the history, performing a neurological exam, presenting the patient on rounds, and synthesizing the case to arrive at a differential).

Attitude: Behaviors and professionalism in terms of your commitment to the patient, your team, and your education. Attitude is conveyed through verbal and non-verbal cues, and is how someone else perceives you.

The Neurology Clerkship provides an immersive experience as an integral team member treating patients with diverse diseases of the nervous system. The clerkship will provide broad exposure across a range of disease acuities and severity, location of health care access, age, and subspecialties.

Aims

At the conclusion of this rotation, the student will become competent at:/p>

  • Compiling a Detailed Neurologic History and Performing a Comprehensive and Accurate Neurologic Exam.
  • Localizing the Lesion, Creating a Prioritized Differential, and Communicating the Neurological Problem to Physicians.
  • Understanding Common Neurologic Disorders and Recognizing Neurologic Emergencies to Initiate Treatment.
  • Appreciating when to Obtain Neurological Consultation.

Clerkship objectives

Neurology clerkship CBLOs

Knowledge of structure, function, & disease

  • Neuroscience background & development (MK1)
  • Neurology knowledge & development (MK2, MK4)
  • Patient-specific disease knowledge (MK2)

Knowledge application and case synthesis

  • Participation during rounds and conferences (PROF4)
  • Ability to synthesize information for diagnosis and management (PC4, PC5, MK4)
  • Ability to build upon prior lessons and experiences (PBLI2)
  • Use of literature & educating the team (PBLI3, PBLI4)

History and data ascertainment

  • Complete, reliable, differential-oriented history (PC1, MK2)
  • Psychosocial background (PC1, MK4)
  • Gathered ancillary data (PC1)
  • Aware of active issues (PC1, ICS3, PROF4)

Physical examination

  • Technique (PC2)
  • Reliability (PC2)
  • Flexibility (PC2, PC4)

Oral presentations

  • Composure (ICS3)
  • Organization and logic (ICS3)
  • Assessment (PC4, 5, 6)

Documentation

  • Structure, legibility, timeliness (ICS4)
  • Comprehensiveness & accuracy (ICS4, PC4, PC5)

Patients and families

  • Rapport (ICS1)
  • Education and updating (PC7, ICS2, MK4, SBP2)
  • Respect and advocacy (PROF1, PROF2, PROF3, PROF6, SBP4)

Teamwork and communication

  • Teamwork and work ethic (PROF4)
  • Reliability & resourcefulness (PC4, PC5)
  • Communication (ICS3)

Professionalism, personal development and judgement

  • Feedback (PBL2)
  • Dedication & initiative (PBL2, PROF4)
  • Appearance (PROF1)

Below are the clerkship objectives and how the neurology clerkship supports achieving these competencies through experiences and didactics.

Integral team member on a busy neurology service

  • Carry new and follow-up patients
  • Provide continuity on your patients
  • Assist with patient care duties for others on your team

Proficiency in neurology history and exam

  • Exam Demonstration After Orientation
  • Structured Neurological Exam Handout and Neurologic Exam Skills Workshop during the 2nd week
  • Observing Attendings, Chiefs, and Junior Residents talk to patients and examine them on rounds
  • Witnessed Exam with Feedback from Resident
  • Standardized patient encounter (OSCE)

Synthesize information for patient care

  • Discuss Patient with Resident after Initial Work-up
  • Discuss Differential Diagnosis and Management on Rounds with Attendings and Chiefs
  • Weekly Student Bedside Teaching which emphasizes the Problem-Based Approach and Pro-Active Data Gathering

Present patients concisely

  • Oral Presentation Skills Workshop
  • Learn Key Components of the Case History during Bedside Teaching Rounds
  • Informal Presentation to Resident after each Initial Work-up
  • Presenting Patients on Daily Rounds with Team
  • Listening to Resident and Other Student Present on Rounds

Knowledge of neurological disease

  • Core Clerkship Lectures
  • Localization and Imaging Workshops
  • Neurosurgery Lectures
  • Assigned Reading Topics
  • Clinical Exposure across Inpatient and Outpatient Settings
Specific learning objectives

Below are detailed objectives on the knowledge, skills, and attitudes you should demonstrate to your teachers, on the OSCE, and on the written shelf. You will likewise be evaluated upon each of these.

Symptom and approach based knowledge

Proficiency in obtaining a complete history, exam, with a comprehensive diagnostic approach for:

  • Disorders of consciousness
  • Mental status and/or behavioral changes
  • Memory complaints
  • Pain in the head, neck, and back
  • Numbness, paresthesias, and neuropathic pain
  • Weakness and clumsiness
  • Dizziness and vertigo
  • Disorders of language
  • Vision loss and diplopia
  • Dysarthria and dysphagia
  • Abnormal movements
  • Sleep-related complaints

Disease specific knowledge

Understanding pathophysiology, work-up, and treatments for:

Ischemic stroke

  • Presentations
  • Risk factors
  • Subtypes and Etiologies
  • Imaging (i.e. Head CT, Diffusion MRI)
  • Administration of tPA
  • Acute and chronic BP management
  • Pharmacotherapy (i.e. antiplatelets, anticoagulants, statins, BP meds)
  • Testing (i.e. EKG, echocardiogram, carotid Doppler, telemetry)

Intracranial hemorrhage

  • Presentations
  • Risk factors
  • Subtypes and etiologies (i.e. intraparenchymal, subarachnoid, subdural, epidural)
  • Diagnosis
  • Acute management

Structural coma

  • Presentations
  • Imaging
  • Raised intracranial pressure
  • Hydrocephalus
  • Herniation
  • Acute management

Metabolic encephalopathies

  • Presentations
  • Etiologies (i.e. Na, Ca, Glucose, CO2, Cardiac, Hepatic, Thyroid, Infection, Medication/Toxin, Hypoxic-Ischemic)
  • Treatment for hyponatremia and hepatic

Neuro-toxicology and vitamin deficiencies

  • Presentations
  • Etiologies (B12, copper, thiamine, lead)

Meningitis and encephalitis

  • Presentations
  • Etiologies (i.e. bacterial, Cryptococcus, Tuberculosis, syphilis, Herpes)
  • Treatment (antibiotics, glucocorticoids)
  • Complications

Dementia and memory disorders

  • Presentations
  • Etiologies & Pathogenesis (i.e. Alzheimer’s, Lewy Body, Frontotemporal, Head Trauma)
  • Work-up
  • Treatment

Seizures and epilepsy

  • Presentations
  • Risk factors
  • Subtypes (i.e. Simple Partial, Complex Partial, Generalized Tonic Clonic, Absence, Non-Convulsive Status)
  • Status Epilepticus
  • Seizure precautions
  • Chronic treatment

Syncope

  • Presentations
  • Etiologies & Pathogenesis (arrhythmia, aortic stenosis, orthostasis, intracranial stenoses)
  • Work-up

Vertigo

  • Presentations
  • Etiologies (i.e. central, neuronitis, benign positional vertigo, Meniere’s disease)

Headache disorders

  • Presentations
  • Etiologies & Pathogenesis (i.e. migraine, cluster, tension, analgesia-overuse, neuralgias, idiopathic intracranial hypertension, temporal arteritis)
  • Treatments (Acute, Prophylaxis)

Myelopathies

  • Presentations
  • Etiologies & Pathogenesis (i.e. compressive, inflammatory, nutritional, infectious)

Radiculopathies and plexopathies

  • Presentations (i.e. single cervical or lumbar/sacral root, polyradiculopathy, cauda equina syndrome, conus medularis syndrome)
  • Etiologies & Pathogenesis (i.e. compressive, tumor or carcinomatous meningitis, HIV, syphilis, Lyme)

Neuropathies (Carpal Tunnel, Diabetic, B12, Monoclonal, Guillain Barre, CIDP, Alcohol, Vasculitis and Connective Tissue)

  • Presentations

Immunologic diseases

  • Presentations
  • Etiologies & Pathogenesis (Multiple Sclerosis, Neurosarcoid, SLE, Paraneoplastic)

Movement disorders

  • Presentations
  • Pathophysiology
  • Etiologies & Pathogenesis (i.e. Parkinson’s disease, essential tremor, Huntington’s disease, tics, medication-induced dyskinesias)

Neuromuscular disorders

  • Presentations
  • Etiologies & Pathogenesis (i.e. myasthenia gravis, Lambert-Eaton, botulism, myositis/myopathy, ALS)

Brain tumors

  • Presentations
  • Etiologies (common primary CNS tumors, nervous system mets and carcinomatous meningitis)

Neurologic history

  • Obtain Complete History with Open, Non-leading Questions
  • Understand how Disease Affects a Person’s Life
  • Obtaining full Psychosocial Background

Neurologic exam

  • Perform a Complete and Smooth Screening Neurologic Exam within 15 Minutes
  • Correctly Interpret the Exam Findings
  • Perform a Coma Exam

Oral presentations

  • Concisely Present a Full Medical History and Exam.
  • Organize your Presentation to have a Logical Structure
  • Preview Localization and Differential with Pertinent Positive and Negatives
  • Include a Comprehensive Assessment with Prioritized Differential and Plan

Case synthesis

  • Determine Key Pieces of the History, Exam, Labs, and Studies to Localize and Rationalize a Prioritized Differential
  • Employ a Mnemonic to Review Categories of Disease (i.e. DVICTIM).

Documentation

  • Write a Clear, Concise, and Comprehensive Initial Work-Up that has Value for Others when they Review the Chart
  • In The Assessment and Plan, Include a Brief Summary Statement Distilling the Quintessential Components and Illustrating your Thought Process and Logic
  • Write Clear SOAP Notes which Effectively Documents Progress and the Thought Process

Establish an effective relationship with patient and families

  • Listen with Patience and Understanding
  • Professional and Empathetic First Encounter
  • Involve Families in Medical Care
  • Keep Your Patients Informed about Past and Upcoming Tests and Plans
  • Advocate for Your Patient and Ensure a Good Healthcare Experience

Valued and productive team member

  • Reliable Member who Helps Provide Excellent Care and Identifies How to be Helpful
  • Contribute towards Discussion and Learning
  • Communicate Effectively about Patient Care, Your Learning, and Your Whereabouts

Professionalism

  • Professional Appearance and Demeanor
  • Approach the Clerkship with Dedication, Initiative, and a Pro-Active Approach to Patient Care and Learning
  • Seek, Accept, Incorporate Provided Feedback