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Clinical Neurology Clerkship

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Title: Clinical Neurology Clerkship


1
Clinical Neurology Clerkship
  • Stephen Deputy, MD - Director, Clinical
    Neurology Clerkship
  • sdeput_at_lsuhsc.edu 250-8139
  • James Breazeale - Academic Coordinator
  • jbre11_at_lsuhsc.edu 568-4090
  • Neurology
  •  
  • Chief Resident Dr. Lourdes Lago
    llago_at_lsuhsc.edu
  •  
  • Baton Rouge            Dr. Charles
    Barkemeyer  (225)-358-1179 office

2
Clinical Neurology Clerkship
  • Duties of Students
  •  
  • Equipment
  • Each 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!!!!
  •  

3
Clinical Neurology Clerkship
  • Duties of Students
  • Didactic Lectures
  • Neurology Resident-Led Clinical Case Studies
  • Applicable Neuroradiology
  • Faculty-led Student Professors Rounds
  • Neurology Review
  • Lectures are held on Thursday afternoons (see
    calendar) and are mandatory for all students with
    the exception of those rotating in Baton Rouge
  •  
  •  

4
Clinical Neurology Clerkship
  • Duties of Students
  • Didactic Lectures
  • Neurology Resident-Led Clinical Case Studies
  • 2 Cases one is a Stroke case and the other is an
    Epilepsy case
  • Read the cases and be ready to answer the
    discussion points prior to attending the lecture
  • Audience participation is expected
  •  
  •  

5
Clinical Neurology Clerkship
  • Duties of Students
  • Didactic Lectures
  • Applicable Neuroradiology Lecture
  • Reviews various types of Neuroimaging Modalities
  • Reviews Neuroanatomy from a Neuroradiology
    perspective
  • Reviews the Neuroradiographic findings of some
    common pathologies
  •  
  •  

6
Clinical Neurology Clerkship
  • Faculty-Led Student professors Rounds
  • Students assigned to University Hospital are
    responsible for bringing a case to the conference
  • Only one student presents
  • 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 
  •  

7
Clinical Neurology Clerkship
  • 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.

8
Clinical Neurology Clerkship
  • Progress Notes
  • Progress notes should be written as frequently as
    the patients 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.
  • 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.

9
Absences During the Clerkship
  • 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
    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 directors
    discretion. The LSUHSC policy regarding absences
    from Junior Clerkships are listed in the Duties
    for Students document.

10
Clinical Neurology Clerkship
  • 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 100 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.
  •  

11
Clinical Neurology Clerkship
  • On Call
  • In-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)

12
Clinical Neurology Clerkship
  • Junior Neurology Clerkship Passport

13
Clinical Neurology Clerkship
  • Neurology Passport
  • The 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

14
Clinical Neurology Clerkship
  • Clinical Neurosciences Passport
  • I. Neurological Examination Competency Form
  • II. Neurological History Taking Competency Form
  • III. Student Presentations Form
  • IV. Patient Log

15
Clinical Neurology Clerkship
  • 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).

16
Clinical Neurology Clerkship
  • Basic Competencies
  • Adult Neurology Neurological Examination
    Skills. Minimum Criteria
  • The 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 patients
    privacy and dignity.
  •  
  •  
  •  
  •  
  •  
  •  
  •  

17
Clinical Neurology Clerkship
  • Basic Competencies
  • Child Neurology Neurological Examination Skills.
    Minimum Criteria
  • The 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 process
  • Professionalism
  • The approach to the patient shows courtesy and
    respect for the childs modesty and parental
    concerns
  •  
  •  
  •  
  •  
  •  
  •  
  •  

18
Clinical Neurology Clerkship
  • Basic Competencies
  • Overall 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_______________________________
    ________
  •  
  •  
  •  
  •  
  •  
  •  
  •  

19
Clinical Neurology Clerkship
  • 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

20
Clinical Neurology Clerkship
  • 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

21
Clinical Neurology Clerkship
  • Basic Competencies
  • Child 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

22
Clinical Neurology Clerkship
  • Basic Competencies
  • Overall 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_______________________________
    ________
  •  
  •  
  •  
  •  
  •  
  •  
  •  

23
Clinical Neurology Clerkship
  • 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

24
Clinical Neurology Clerkship
  • Patient Log
  • The 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

25
Clinical Neurology Clerkship
  • Patient Log
  • Paroxysmal 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.

26
Clinical Neurology Clerkship
  • Patient Log
  • Neuromuscular Disorders
  • Adult Neurology examples include Myopathies,
    Guillan-Barre Syndrome, CIDP,
  • Charcot-Marie-Tooth, Diabetic Neuropathy,
    Amyotrophic Lateral Sclerosis,
  • Traumatic or Focal Neuropathies, etc
  • Child Neurology examples include Congenital
    Myopathies, Muscular Dystrophy,
  • Guillan-Barre Syndrome, Spinal Muscular Atrophy,
    Charcot-Marie-Tooth Disease
  • Myasthenia Gravis, Erbs Palsy, etc.
  •  Progressive Degenerative Disorders
  • Adult Neurology examples include Alzheimers
    Disease and other Dementias,
  • Huntingtons Disease, Parkinsons Disease,
    Vascular Dementia, etc.
  • Child Neurology examples include
    Leukodystrophies, Neurodegenerative
  • Disorders, Metabolic Disorders, Brain Tumors, etc.

27
Clinical Neurology Clerkship
  • Neurology Clerkship Evaluation
  • Clerkship Competencies (6 Domains)
  • Medical Knowledge
  • Patient Care
  • Interpersonal Relationships and Communication
  •  Practice-Based Learning and Improvement
  • Systems based Practice
  • Professional Behavior

28
Clinical Neurology Clerkship
  • 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 contained within
    the LSU Department of Neurology Home Web Page)

29
Clinical Neurology Clerkship
  • Neurology Clerkship Evaluation Form
  •  Does Not Meet Expectations for level of training
  • A 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.

30
Clinical Neurology Clerkship Clinical Evaluation
Form
  • Medical Knowledge
  • 1. Demonstrates adequate understanding of the
    pathology, pathophysiology, and anatomic features
    of neurological diseases.
  • 2. Participates regularly in activities that
    advance knowledge and competence

31
Clinical Neurology Clerkship Clinical Evaluation
Form
  • Patient Care
  • 1. 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

32
Clinical Neurology Clerkship Clinical Evaluation
Form
  • Patient Care
  • 3. 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

33
Clinical Neurology Clerkship Clinical Evaluation
Form
  • Patient Care
  • 5. Develops an appropriate Diagnostic Plan
    specific to the unique aspects and needs of their
    patients
  • 6. Develops an appropriate Treatment Plan
    specific to their patients illness
  • 7. Provides effective care with respect to the
    patients psychosocial level of functioning and
    their cultural beliefs

34
Clinical Neurology Clerkship Clinical Evaluation
Form
  • 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

35
Clinical Neurology Clerkship Clinical Evaluation
Form
  • 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

36
Clinical Neurology Clerkship Clinical Evaluation
Form
  •   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

37
Clinical Neurology Clerkship Clinical Evaluation
Form
  •   Professional Behavior
  • A 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.

38
Clinical Neurology Clerkship
  • Each students Clinical Grade will then be based
    on the following format (averaged per individual
    Blocks)
  • Honors Score is greater than 0.75 SDs above
    the mean
  • High Pass Score is between -1 SDs below the
    mean and 0.75 SD above the mean
  • Pass Score is between -2 SDs below the mean
    and -1 SDs below the mean
  • Fail Score is below -2 SDs below the mean
  •  
  • Students may also be in jeopardy of failing the
    course for behavior deemed to be unprofessional.

39
Clinical Neurology Clerkship
  • The Written Examination
  • Beginning with the 2009 Academic Year, the
    Clinical Neurosciences Clerkship started to use
    the USMLE SHELF examination as its instrument to
    assess students 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

40
Clinical Neurology Clerkship
41
Clinical Neurology Clerkship
42
Clinical Neurology Clerkship
43
Clinical Neurology Clerkship
44
Clinical Neurology Clerkship
45
Clinical Neurology Clerkship
46
Clinical Neurology Clerkship
47
Clinical Neurology Clerkship
48
Clinical Neurology Clerkship
49
Clinical Neurology Clerkship
  • 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

50
Clinical Neurology Clerkship
  • 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.

51
Clinical Neurology Clerkship
  • The Written Examination Grade
  • Passing 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 SDs above
    the mean
  • High Pass Score is between -0.5 SD below the
    mean and 0.5 SDs above the mean
  • Pass Score is between 59 and -0.5 SD below the
    mean
  • Fail Score is less than 59

52
Clinical Neurology Clerkship
  • 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 Pass
  • Fail 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 Directors
    discretion.

53
Clinical Neurology Clerkship
  • 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?

54
Clinical Neurology Clerkship
  • 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
    sdeput_at_lsuhsc.edu if you have any further
    suggestions or comments about your experiences
    during the rotation.

55
Clinical Neurology Clerkship
  • Where Can I Get More Information?
  • Check out the student website on the Department
    of Neurology Web Page
  • http//www.medschool.lsuhsc.edu/neurology
  • Click on the Students tab

56
Clinical Neurology Clerkship
  • Questions???
  • Now go out there with an open mind and discover
    the amazing complexities of the art of Clinical
    Neurology
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