Introduction To Junior Neurology Clerkship
Welcome to the Junior Neurology Clerkship!
DIRECTOR, STUDENT EDUCATION
Kristina M. Lafaye, M.D.
131 S. Robertson St.
Suite 1340, Room 1365
Office: (504) 988-3888
Fax: (504) 988-9197
131 S. Robertson St.
Suite 1340, Room 1345
Office: (504) 988-3888
Fax: (504) 988-9197
1. To demonstrate the ability to obtain an accurate and complete neurological history.
2. To demonstrate the ability to perform a complete neurological exam on conscious and unresponsive patients.
3. To demonstrate the ability to recognize core neurological symptoms and illnesses, as well as neurological emergencies.
4. To demonstrate the ability to diagnose and treat the major neurologic disorders.
5. To demonstrate the ability to recognize indications for ordering appropriate neurodiagnostic studies and testing to include: EEG, EMG, nerve conduction studies, evoked potentials, lumbar puncture, CT & MR imaging of the brain and spinal cord.
6. To demonstrate the ability to understand the basic anatomy, physiology, pathology, therapeutic pharmacology and procedures of the major neurologic disorders.
7. To demonstrate the many personal attributes necessary in becoming an effective physician to include honesty, empathy, reliability, and effective communication skills.
It is expected that the student will accomplish the following educational informational goals during the clerkship. This can be achieved by evaluating patients on the in-patient, consult, and clinic services as well as participating in clinical problem solving during the lectures and conferences. The student is expected to know the clinical history, examination findings and appropriate decision analysis for patients with the following disorders:
1. Headache and face pain
2. Dizziness-vertigo and episodic loss of consciousness
3. Weakness and gait impairment
4. Stupor and coma
5. Cerebrovascular disease
6. Seizures and epilepsy
7. Traumatic injury – brain and spine
8. Neurobehavioral disorders, including dementia, amnesia and aphasia
9. Central nervous system infection
10. Abnormal involuntary movements, including Parkinsonism
11. Demyelinating disorders (multiple sclerosis and its mimics)
12. Neurological complication of medical illness
14. Delirium & Dementia
15. Neuromuscular Disorders
16. Acute Spinal Cord Disorders
It is expected that students will read each topic in the text book.
Please bring the appropriate equipment for this rotation to include:
″ Ophthalmoscope (if you have one)
″ Reflex hammer
″ Visual acuity chart
″ Tuning fork
″ Pen light
″ Items for assessing sensation
These items are necessary for performing a neurologic examination.
In order to pass this course, you must fulfill all of the following requirements:
1. Fully participate in your assigned service team. This includes presentation of the patients on rounds.
2. Take the shelf exam and score 61 or above. To be eligible for Honors, you must score a 75 or above.
3. Complete a patient log documenting patients seen on in-patient and consult services, as well as, clinic and all other experiences.
4. Complete a Clinic Log signed and dated by attending or resident; one clinic per week is required.
5. Complete the standardized patient examination.
6. You are to be observed by Faculty and/or Resident performing the neurologic exam at least one time.
7. Obtain a mid-course evaluation signed by student, resident and/or attending.
8. Attend Neurology Grand Rounds and Clerkship Didactics each week.
9. Give a presentation to your service team on a topic of your interest.
You should give a presentation to your service team on a topic related to clinical neurology in which you find a particular interest. Your presentation should be five to ten minutes in length but no longer. You are free to choose any topic that you wish. You can analyze a case that you encounter while on the clerkship or give a presentation on a specific topic. There are books on reserve in the library relating to neurological disorders. You are not required to look any further than these references to make your report. These references will provide enough information to complete your assignment, but feel free to expand your research. Your subject matter should be focused.
Your responsibilities here include participating in rounds and taking care of your patients. Be aware you are students who are here to learn and need guidance and supervision. You are not the hand-maiden of the physicians, and are not expected to do tedious or unnecessary work. It is expected that you are treated with dignity and respect.
Taking care of your patients includes:
1. Doing a complete history and physical for your own purposes and reviewing all prior records.
2. Forming a care plan for your patients: Take every opportunity to write the orders for your patients, but remember these must be immediately signed by your resident or attending.
3. Checking up on your patients frequently to assess progress and detect complications.
4. Talking to nurses, therapists, dietitians, and consultants to get information about your patients.
5. Writing progress notes on your patients.
6. Following up on all test results and interpreting these results.
7. Reading indepth about your patients' medical problems.
8. Participating in patient rounds.
9. In an effort to standardize the clinical experience, the faculty and resident/s are required to review a series of clinical problems in neurology with you. It is expected that the preceptor/attending will meet with students twice weekly to discuss topics in neurology (examples are listed here). The time is to be mutually agreeable. Your residents have been "schooled" in these topics and you should review with resident/s and preceptor.
The topics include:
a. Episodic loss of consciousness
b. Evaluation of the "confused" patient
c. Assessment of "comatose" patient
d. Evaluation of new onset headache
e. Management of acute stroke
f. Evaluation of "dizzy patient"
g. Approach to neck and back pain
h. Meaning of "brain death"
1. The breakdown for the Neurology Clerkship is as follows: 55% of your grade will come from your clinical evaluation; 30% percent from your Shelf exam; 10% from your Standardized Patient Exam; and 5% from your Mid-Block Evaluation, Patient Logs, Clinic Log, and other required assignments. You must achieve a score of 61 or above on the Shelf exam in order to pass the clerkship and a 75 or above to be eligible for Honors.
2. At orientation, you will be given a mid-block evaluation that is to be returned to the program coordinator at the end of week two. At the end of the clerkship, a clinical evaluation will be generated through the E-value system and completed by your preceptor/s and resident/s. The clinical evaluation includes assessment of your clinical work, punctuality, reliability, effort, enthusiasm, interactions with others, completeness of history and exam, written notes and medical knowledge.
3. Your Attending(s) and/or Resident(s) are expected to give you a verbal assessment of your performance at the midpoint and end of the clerkship so that you will know your strengths and weaknesses. If you do not get this assessment, be sure to ask for it.
4. Your clinical evaluation grade will be given by your primary attending/s and resident/s. It is the student's responsibility to review their assessment and if there are any concerns, discuss with the attending and resident. If you have any further concerns please contact the program director. Although, the Director is not at liberty to modify these evaluations or grades, she is available to review and discuss them with the student.
5. Students are to maintain their Patient Log by entering the information into the PXDX module of the E-value system. You are to use this system to log your daily activities. You will generate two reports at the end of the clerkship; a Procedure Log and a Diagnosis Log. This information should be completed by your last day of clinical responsibilities. Your final grade cannot be calculated without this information and you will lose points off your final grade if these reports are not turned in.
6. You final grades will be calculated as follows: Honors (100-92); High Pass (91-85); Pass (84-70); Condition (69-60); Fail (59 or below).
Because the Clerkship is only four weeks, we strongly discourage students from taking time off. However, if you must take time off, please follow the instructions below:
A leave of absence for any reason must be authorized in writing by the Office of Student Affairs and forwarded to the program director and coordinator. This may be accomplished by filling out an on-line Chit Form through Student Affairs. All authorized absences from the Office of Student Affairs are accepted without question. No one else is authorized to grant leave. If you have an authorized absence, please inform your attending, resident, team, and the clerkship office. You must show or email a copy of your approval to your attending and/or resident. If you are ill, please obtain medical leave from Student Affairs.
Any student missing more than three days during the Clerkship will be required to make up the lost time. For every one day missed, you will have to work one entire weekend call with the resident/s on schedule at TMC or University, who will sign a document of confirmation when completed. The program coordinator will make the arrangements. Credit will not be given until the document of confirmation has been returned to the program coordinator.
Not obtaining an excused absence from Student Affairs for any reason is unacceptable and the absence will be considered unexcused. All unexcused absences will require make up time as stated above. In addition to the weekend call, you will also need to write a paper on a topic chosen by the Director. You may also risk losing points off your final grade.
If a student is required to make up time, an incomplete (I) grade will be entered onto the transcript until the deficiency is remediated.
Repeated tardiness will affect the final grade.
We strongly discourage students from missing the Shelf and Standardized Patient exams at the end of the clerkship. However, if you receive an approved absence from Student Affairs, you may take both exams at a later date at the end of another rotation. Special arrangements for this must be made in advance with the program coordinator and you must complete this within six months of concluding the clerkship. If you do not complete the exam within the six months you will receive a "Fail" and will need to repeat the clerkship.
You are to come prepared for didactics by reading the appropriate sections of your assigned textbook. Also, read any handouts and/or articles that were included in your orientation packet, on your flash drive or emailed to you.
Your orientation packet will contain a Didactic Schedule for the entire four weeks of the clerkship. Didactics are scheduled every Monday afternoon, excluding Holidays. Didactics are from 12:00–3:00 p.m. and Grand Rounds are from 3:00-4:00 p.m. Neurology Grand Rounds focuses on clinically relevant issues and is geared towards the student and resident level.
The Program Coordinator will inform you by email of any changes or cancellations. Attending Didactics & Grand Rounds is mandatory for the Neurology Clerkship.
Two separate sign-in sheets will be made available to you. Please be sure to sign these; otherwise, you may risk being marked as absent and the unexcused absence policy would apply.
WHAT TO DO IF YOU HAVE QUESTIONS, PROBLEMS, OR COMPLAINTS
Call or go to the office of the clerkship coordinator and she will help you to resolve the issue. If a personal problem or medical issue interferes with your performance on the rotation, contact the Director or the Coordinator so that we are aware of this issue at the time of the occurrence not at the end of course. The definition of a "problem" is: any event or action, which makes the student feel uncomfortable or may interfere with student performance. Please feel free to email the Director at any time.
The official textbook for the Neurology Clerkship is On Call Neurology by Drs. Randolph S. Marshall, M.D., M.S. & Stephan A. Mayer, M.D., FCCM.
Our former textbook, Essentials of Clinical Neurology by Drs. Weisberg, Strub, and Garcia (updated Oct 2004) can still be found on the neurology website; two hard copies are also on reserve in the Matas Library.
You should read in more depth about your own patients' medical problems.
Recommended for this purpose are:
Principles of Neurology by Adams, Victor
Merritt's Textbook of Neurology by Rowland, Pedley
Harrison's Neurology in Clinical Medicineby Hauser, Josephson, Josephson
Clinical Neurology by Greenberg, Aminoff, Simon
Neurological Examination Made Easy by Geraint Fuller
The Mental Status Examination in Neurology by Strub, Black
Neuroanatomy Through Clinical Cases by Hal Blumenfeld, M.D., Ph.D
If you are interested in Pediatric Neurology, we recommend:
Clinical Pediatric Neurology by Gerald M. Fenichel, M.D.
Neonatal Neurology by Gerald M. Fenichel, M.D.
Pediatric Neurology: A Case-Based Review by Tena Rosser, M.D.
You can also ask your attending to direct you to other appropriate resources.
Recommended reading for Shelf Exam:
Case Files Neurology, (LANGE Case Files) by Toy, Simpson, Tinter
Blueprints Neurology by Drislane, Benatar, Chang, Acosta, Tarulli, Caplan
Neurology PreTest Self-Assessment & Review by Anschel
LOCATIONS AVAILABLE FOR ROTATION:
1. Tulane Medical Center (TMC): This is located on the Downtown Campus. You will follow assigned Neurology Faculty and Residents for the Stroke Service and the Consult Service. Students will work two weeks on each service, switching at the midpoint and will also attend afternoon clinics. For this rotation, we have six (6) openings.
2. University Medical Center (UMC): This is located on the Downtown Campus. You will follow assigned Neurology Faculty and Residents on the ER/stroke consult service. It is a busy service and you will have an opportunity to see a variety of patients there. Students will also attend afternoon clinics. For this rotation, we have four (4) openings.
3. Ochsner Medical Center (OCH): Ochsner is located in Jefferson and has a full patient load with numerous excellent learning opportunities. This is an Adult Neurology rotation, with your primary contacts being Drs. Daniel Larriviere & David Houghton. They will assign students to work with their faculty for stroke and/or general neurology. Students will also attend Ochsner clinics. For this rotation, we have four (4) openings.
4. Tulane-Lakeside Pediatric Neurology (LPN): For this option you will be following Dr. Stephen Nelson, exclusively, at Lakeside Hospital for an overall in-patient/out-patient experience. You will have exposure to inpatient and ICU consults, as well as Dr. Nelson's clinics. You will concentrate on Pediatric Neurology making this rotation beneficial for anyone going into Pediatrics. For this rotation, we have two (2) opening.
5. Tulane-Lakeside Rehab/LakeView (LS/LV): For this option you will be following Dr. Ramy El Khoury, exclusively, for an overall in-patient, out-patient experience between Lakeside Hospital, Tulane Medical Center, and Dr. El Khoury's clinics. You will have exposure to consults, neuro-imaging, Neuro-rehab, stroke activations, and some exposure to stroke research. For this rotation, we have one (1) opening.
6. Spectrum Neurology Center (SNC): For this option you will be working with Dr. Troy Beaucoudray at his Metairie clinic, specializing in the diagnosis and treatment of painful neurological disorders but also treating all neurological conditions. All diagnostic and treatment procedures are performed at the center, which is a brand new, state-of-the-art facility that offers a multidisciplinary approach to treating, diagnosing and evaluating neurological disorders. For this rotation, we have one (1) opening.
7. Rural Rotations: Dr. Shelly Savant practices in New Iberia, Louisiana and specializes in the treatment of adult neurological problems including multiple sclerosis, movement disorders, headaches, stroke and epilepsy. Her practice includes Psych-Neuro. This is only available at the discretion of the doctor and only at the request of the student; housing will need to be arranged on your own.
8. Individual Faculty: By request, a student may be assigned to a specific Resident, Fellow, or Faculty member, who does not have specific service requirements during that time period and agrees to the assignment.
1. Always observe Universal Precautions when interacting with patients.
2. Avoid using your reflex hammer or key to check for Babinski signs. Your tool could become a vector of serious disease. Instead, use a clean wooden swab or tongue blade and throw it away after one use.
3. Do not use a hollow or beveled needle (E.g. Gelco) to test for pinprick because these needle types are too sharp; use safety pins or toothpicks and dispose of them after one use in a sharps box.
4. Always guard yourself from crime, patient violence, and all types of danger. Lock your call room doors. Be street-smart. Wear your I.D. badge at all times.
5. Use the Escort Service & Safe Rides; See emergency numbers below.
Tulane Police Emergency: 504-865-5911
Tulane University Police Non-Emergency: 504-865-5381
New Orleans Police Department Emergency: 911
New Orleans Police Department Non-Emergency: 504-821-2222
Safe Rides: 504-865-5381
6. Check Tulane Police and Student Affairs websites for additional personal safety tips.
NEUROLOGY CLERKSHIP WEB LINKS
You can access Neurology Web Site via the URL below:
or through My Tulane (Blackboard).
Neurology Department Facebook Page: https://www.facebook.com/tulaneneurology
Baton Rouge Campus: http://www.brneuro.com/
Tulane University, New Orleans, LA 70118 504-865-5000 email@example.com