Goals and Objectives:
- To demonstrate the ability to perform a complete neurological exam on conscious and unresponsive patients.
- To demonstrate the ability to perform a complete neurological history
- To demonstrate the ability to recognize core neurological symptoms and illnesses, as well as neurological emergencies.
- To demonstrate the ability to diagnose and treat the major neurologic disorders.
- To demonstrate the ability to recognize indications for ordering appropriate neuro-diagnostic studies and testing.
- To demonstrate the ability to understand the basic anatomy, physiology, pathology, therapeutic pharmacology and procedures of the major neurologic disorders.
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.
Because the Clerkship is only 4 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 coordinator. This may be accomplished by filling out an on-line Chit Form through Student Affairs. If you have an authorized absence, Please inform your attending, resident, team and the clerkship office. All authorized absences from the Office of Student Affairs are accepted without question. No one else is authorized to grant leave. 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.
If a student is required to make up time, an incomplete (I) grade may 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.
- Always observe Universal Precautions when interacting with patients.
- 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.
- 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.
- 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.
- 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
- Check Tulane Police and Student Affairs websites for additional personal safety tips.
The official textbook for the Neurology Clerkship is On Call Neurology by Drs. Randolph S. Marshall, MD, MS & 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 and Victor and Textbook of Neurology by Merritt and the Neurology Chapters in Harrison Textbook of Medicine.
If you are on the Pediatric Neurology rotation, ask your attending to direct you to some appropriate resources.
In order to pass this course, you must fulfill all of the following requirements:
- Fully participate in your assigned service team. This includes presentation of the patients on rounds.
- Take the shelf exam and score 60 or above.
- Complete a patient log documenting patients seen on in-patient and consult services, as well as, clinic and all other experiences.
- Complete the standardized patient examination.
- You are to be observed by Faculty/Resident performing the neurologic exam at least one time.
- You must obtain a mid-course evaluation signed by student, resident and/or attending.
- Attend Neurology Grand Rounds, Lectures, and Case Conferences each week.
- Give a presentation to your service team on a topic of your interest.
Locations Available for Rotation:
- Tulane Hospital and Clinic: Drs. Sheryl Martin-Schild and David Moore will be the preceptor-attendings for the Stroke Service. Dr. Patricia Colón will be the preceptor-attending for the Consult Service. Three to four (3-4) students will be assigned and the students will follow the Resident/s on each service. Students will work two weeks on each service, switching at the midpoint. Students will also attend afternoon clinics with the resident/s.
- Ochsner Medical Center: Two (2) students will be assigned to work with Drs. Gaines & Oser for adult neurology. They will assign students to work with Faculty for stroke or general neurology. Students will be assigned one afternoon per week to attend the Tulane downtown clinics.
- Pediatric Neurology: Two (2) will be assigned to this site and it is mainly for students interested in Pediatric Neurology and/or going into a related field. This is only available at the discretion of the preceptors.
- One (1) student will work with Dr. Africk at Ochsner Medical Center
- One (1) student will work with Dr. Willis at Ochsner Medical Center.
- West Jefferson Hospital/Culicchia Neurological Group: Four (4) students will work with Faculty and will be supervised by Dr. John Freiberg (former Tulane Neurology Course Director). Students may also take the opportunity to be exposed to Neurosurgery with Drs. Culicchia and Steck. This is located at West Jefferson Medical Center. Each student will also have the opportunity to work with Dr. Freiberg for one week at Touro Hospital.
- Advanced Neurodiagnostic Center (ANC): One (1) student will rotate with Dr. Shamsnia at his private clinic in Metairie and travel with him to Bogalusa and sometimes to the Tulane Clinic and/or University Hospital. At times you will also work with his associates Drs. Beaucoudray, Blaya, and Traylor. Students will have the opportunity to be exposed to sleep studies, EEGs, and the business aspects of neurology.
- University Hospital: Four (4) students will be assigned to the consult-clinic service working with Drs. Blaya, Traylor, Shamsnia, Redmann and resident/s assigned to University. Students will also attend afternoon clinics with the resident/s.
- 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.
- 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.
- The breakdown for the Neurology Clerkship is as follows: 60% of your grade will come from your clinical evaluation; 20% percent from your Shelf exam; 10% from your Standardized Patient Exam; and 10% from your Mid-Block Evaluation, Patient Log and other required assignments. You must achieve a score of 60 or above on the Shelf exam in order to pass the clerkship.
- 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 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.
- Students need to know their residents and attending (preceptor). They 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.
- Your clinical evaluation grade will be given by your primary resident/s and attending/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.
- 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 a report at the end of the clerkship. This information should be completed by your last day of clinical responsibilities. Your final grade cannot be calculated without this information.
- You final grades will be calculated as follows: Honors (100-92); High Pass (91-85); Pass (84-70); Condition (69-60); Fail (60 or below).
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:
- Doing a complete history and physical for your own purposes and reviewing all prior records.
- 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.
- Checking up on your patient frequently to assess progress and detect complications.
- Talking to nurses, therapists, dietitians, and consultants to get information about your patient.
- Writing progress notes on your patients.
- Following up on all test results and interpreting these results.
- Reading in depth about your patients' medical problems.
- Participating in morning report.
- In an effort to standardize the clinical experience, the faculty/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:
- Episodic loss of consciousness
- Evaluation of the "confused" patient
- Assessment of "comatose" patient
- Evaluation of new onset headache
- Management of acute stroke
- Evaluation of "dizzy patient"
- Approach to neck and back pain
- Meaning of "brain death"
Lectures, Grand Rounds, & Case Conferences
You are to come prepared for the Lectures, Grand Rounds, & Case Conferences by reading the appropriate sections of your assigned textbook. Also, read any handouts that were distributed with your orientation packet and read up on the various subjects that are found on our Web Site. This includes the clinical problems, which are setup for you to print.
Your orientation packet will contain a Lecture Schedule for the entire four weeks of the clerkship. Lectures and Grand Rounds are scheduled every Monday afternoon, excluding Holidays. Lectures are held from 1:00–3:00 p.m.; Grand Rounds are held from 3:00-4:00 p.m. Neurology Grand Rounds focuses on clinically relevant issues and is geared towards the student and resident level. Case Conferences are held every Friday from 12:00-1:00 p.m. The Program Coordinator will inform you by email of any changes or cancellations. Attending Lectures, Grand Rounds, and Case Conferences are mandatory for the Neurology Clerkship. Three separate sign-in sheets will be made available to you. Please be sure to sign these; otherwise, you may risk being marked as absent.
If the speaker is late, contact the program coordinator who will attempt to obtain a substitute. The Faculty/Residents have been encouraged to use case presentation and not lecture format.
Neurology Information Goals
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:
- Headache and face pain
- Dizziness-vertigo and episodic loss of consciousness
- Weakness and gait impairment
- Stupor and coma
- Cerebrovascular disease
- Seizures and epilepsy
- Traumatic injury - brain and spine
- Neurobehavioral disorders, including dementia, amnesia and aphasia
- Central nervous system infection
- Abnormal involuntary movements, including Parkinsonism
- Demyelinating disorders (multiple sclerosis and its mimics)
- Neurological complication of medical illness
- Delirium & Dementia
- Acute Spinal Cord Disorders
- It is expected that students will read each topic in the text book.
You should give a presentation to your service team on a topic related to clinical neurology in which you find a particular interest and should be one of "topics" listed on page 6, #9 a-h. 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.