COURSE DESCRIPTION:

The course is divided into 3 principal components: Inpatient Service, Outpatient Clinics and Teaching Sessions. It is designed to give the student a broad overview of clinical neurology.

1)         Inpatient Service (2 weeks): Each student is assigned to an inpatient ward experience either on the VA or OHSU neurology service.  The location of your assignment may be found in the beginning of the assignment.  The student will evaluate patients admitted to the ward or seen on the consultation service, and will present the case to the attending physician during rounds.  The student will be expected to write an admitting history and physical examination along with case analysis for each patient they are assigned.  The student will make rounds with the house staff and actively participate in the care of patients he or she is assigned.  An awareness of the status of their patients during hospitalization as well as pertinent results of laboratory and radiological testing is expected from the student.  Students are especially encouraged to undertake independent in-depth reading and literature search on neurologic disorders that pertain to their patients.  Participation may also include performance of simple diagnostic tests such as lumbar puncture. 

During the weeks a student clerk is assigned to the inpatient service, each student is expected to be present for daily rounds Monday through Friday.  Students not “on call” will be expected to be available to accept a new patient until 5 pm.  Students will be "on call" until 10:00 pm three nights during their rotation.  Students will be asked to be present on occasional weekend days in accordance with their on-call schedule.  In order to allow greater continuity in patient care it is generally expected that you will perform your weekend call time while you are assigned to the inpatient wards.

To optimize the learning experience, students are not expected to admit more than one patient a day, and their patient load should be limited to 4 or less at any one time.  Students should read extensively and be familiar with the disease processes, complications, and potential therapies of the patients they have seen.

2)         Outpatient Clinics (2 weeks):  Each student will be assigned to General and Subspecialty Neurology Clinics for one week.  During this assigned week, students are required to attend clinics according to the accompanying schedule.  The level of involvement of the student will vary from clinic to clinic.  Ideally the student will be allowed to see patients individually and discuss the case with a staff.  Unfortunately due to busy clinic schedules, this level of involvement in the patient care is not always available.

3)         Teaching Sessions: In the course of his/her ward assignment; it is unlikely that each student will be exposed to all the important aspects of neurological diseases.  A Medical Student Attending will conduct one-hour teaching sessions at least 3 times per week.  These are intended to introduce students to the approach of common neurological problems, through didactic sessions, case vignettes and student presentations.  The students will also learn the fundamentals of the neurological examination.  This is an important portion of the clerkship, and all students are expected to attend.  These teaching sessions take priority in case of scheduling conflicts.

            Students will also be assigned to participate in a learning experience at a long term Alzheimer’s care unit.  This is a required trip, and if the student is unable to attend on the day they are assigned, they must make arrangements to reschedule or make up the experience with the course director.

5)         Clinical Conferences: Each student is encouraged to attend as many of the regularly scheduled neurological conferences as possible.  Attendance by all students is expected at the Neurology Grand Rounds, Neuroradiology Conferences, the Thursday Noon Conference and the Neuroscience Conferences.

REQUIRED ASSIGNMENTS:

1)         Patient write-up:  Each student will turn in a formal write up of a patient they have encountered during the course of the clerkship due on the third Friday of the clerkship.  The write up should include a complete history (CC, HPI, ROS, PMHx/PSHx, MEDS, FHx, SHx), and physical examination (with complete neurological examination).  It should have a brief assessment (1 sentence at the most), and thorough discussion of differential diagnosis with assessment of how each diagnostic possibility fits or does not fit this case.  There should also be a discussion of what laboratory, radiological tests, or other testing should be performed with commentary made to which diagnostic possibility is being addressed by this test.  The student may also include a discussion of how well this test is at ruling in or ruling out a diagnosis (ie specificity/sensitivity).   Each write-up will have at a minimum 3 references (from neurological textbooks/web resources).  An honors level paper will have references from the primary literature from neurology journals (ie Neurology, Annals of Neurology, Lancet Neurology, various subspecialty journals, etc.).

2)         Neurological examination passport:  Each student will have the entire neurological examination observed by a faculty member.  As we realize that faculty members do not always have the time to watch a complete physical examination, we have established a passport system.  With this system, the student has the opportunity to have a faculty member observe a single component of the examination.  If the student is felt to have competently demonstrated that portion of the examination, the faculty member will sign off on the passport form.  Later a student may then have another faculty member observe a different portion of the examination. Through the course of the clerkship, the student is responsible for having all of the portions of the neurological examination observed and signed off.  For example, student Luke has attending Dr. Vader observe the cranial nerve examination.  Luke then asks Dr. Vader to sign the cranial nerve part of the passport.  Luke the next day has Dr. Yoda observe him doing the strength testing, and Dr. Yoda signs on the strength testing line.  By the end of the rotation, Luke has a signature on each part of the neurological examination, and he feels super to have mastered this part of his training.  (Then Luke finds out Dr. Vader is his father, and throws himself into a wind tunnel, and he then drops out of medical school and goes to some naturopathic school).

            The passport will also have a section for students to obtain signatures from either a physician or nurse when attending the subspecialty clinics.

3)         Alzheimer’s Disease day center visit:  Attendance to your assigned visit to an Alzheimer’s disease center is required to pass this course.  Attendance at the lecture/orientation is mandatory.

STUDENT EVALUATION:

1)     Ward/Clinic evaluations:  Evaluation of the student clerk's performance, knowledge base and clinical skills will be provided by the residents and attending staff on each service.  The Medical Student Attending will be responsible to gather together these evaluations and provide feedback to each student. Although there are individual differences in emphasis, most attending and resident staff looks for motivation, competence and responsibility in a student.  The student will have ample opportunity to demonstrate mastery of the history and neurological examination skills with a Neurology staff.  The neurological examination passport must be completed for a student to pass this course. 

3)     Patient write- up:  Students are expected to complete a patient write-up by the end of the third week.  Description is found above.

4)     Final examination:  Students are expected to take an exam on the final day of the clerkship.  The score from the exam will be incorporated into the students’ final grade.

WEEKLY SCHEDULE:

Inpatient Service: Work rounds and attending rounds - exact time varies.

Clinics:  Most clinics start at 8:30AM and 1:00PM. Check your clinic assignments during the assigned week.  We are often not informed of last minute changes in the clinic schedule.  Don’t be shy about joining other ongoing clinical activities if you have an unexpected lull in your schedule. Also bring along a book or be prepared to use the library just in case.

Teaching Sessions: You will meet with your teaching attending at least 3 times per week.  Each session is about an hour long. These generally occur on Mondays, Wednesdays, and Thursdays from 4 to 5 pm, but the time is subject to change based on availability of the teaching physician.   Attendance at the teaching sessions is required.

Conferences:  Conferences of relevance are listed below.

**Neurology Grand Rounds are canceled during the summer.