Neurology (2 weeks elective)
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Description
Students in the Neurology clerkship will be assigned to either the University of Chicago Medical Center site, or the NorthShore Medical University site in Evanston (only by request). Clinical training at the two sites is similar in breadth and depth of patient exposure and educational content, with some differences in the structure and specific focus of the clinical rotations. Students at both sites will receive parallel didactic training. Students from both sites will re-convene at UCMC for OSCE testing on the last day of the clerkship.
The UCMC Clerkship Site
During the 2 week clerkship, students participate in several venues, including the adult neurology inpatient ward, the consult service, the stroke service, and the adult/pediatric outpatient neurology subspecialty clinics. One week will be spent on an inpatient service, where students will round with residents, attend conferences, and participate in daily rounds, Monday through Friday plus one weekend day. Students will help admit new patients and follow established patients, monitoring their examinations and assisting in care. Students will take call once per week through 8 PM with a resident. The goal of this rotation is experience in hands-on evaluation and management of acute neurological problems.
One week will be spent in the Outpatient Clinics, where students will work one-on-one with attending physicians in the general adult/pediatric neurology subspecialty clinics. The goal of this week is to become familiar with common and unusual neurological problems by observing numerous patients in specialty clinics in areas including multiple sclerosis, neuro-oncology, sleep disorders, epilepsy, stroke, sleep, movement disorders, and diseases of the peripheral nervous system. This week will also afford opportunities to observe and assist in performing a lumbar puncture, to observe electroencephalography, and to observe an EMG.
The Northshore University HealthSystem Clerkship Site
At the NorthShore University HealthSystem site, the clerkship is directed by Dr. Megan Shanks. The third year neurology clerkship at NorthShore University is a broad clinical exposure to neurological patients. At NorthShore, students rotate through the inpatient general Neurology consult service, the stroke consult service, and the Neurology outpatient clinics, experiencing a wide variety of neurologic disorders and treatment options.
During the Neurology Consult service rotation students will perform histories and physicals on assigned patients and develop treatment plans including a differential diagnosis, diagnostic work-up and treatment recommendations. They will follow patients throughout their hospital stay and adjust the treatment plan as needed whether in the ICU, medical or surgical units.
Rotation on the Stroke service will involve working with the stroke team to evaluate patients with stroke from the time they enter the emergency room through diagnosis and treatment. Students will gain insight into acute stroke treatment management as well as secondary stroke prevention.
Rotation in the Outpatient Neurology Clinic will provide students with an opportunity to work with subspecialty attendings in the areas of epilepsy, movement disorders, multiple sclerosis, behavioral neurology, neuromuscular disorders, sleep medicine, and more. Throughout the rotation students will participate in didactic and case review lectures and will attend departmental conferences, both at NorthShore and at University of Chicago (via videoconferences).
Clinical Evaluation
Students are expected to be present daily during the clerkship. They will be evaluated by attending physicians on their ability to perform a complete neurological examination and interpret the abnormal findings, make a diagnosis and understand the agents used in therapy. In addition, oral and written communication and professional behavior will be assessed. Students are expected to participate in weekly Case Discussion sessions with the teaching attending, to attend clinical conferences, and to submit a complete write-up of a case. There will also be an OSCE at the end of the rotation, focusing on the neurologic examination.
Objectives
- Learn to obtain a neurological history and perform a competent neurological examination
- Students will be provided a framework for neurological history taking and examination that they will utilize when examining patients on the floor.
- They will also observe attendings and residents perform the neurological examination on the floor and in the clinics.
- Learn the basics of localization in neurology and the importance in diagnosis
- Obtain exposure to a variety of neurological disorders
- On the inpatient rotations, students will have exposure to acute presentations of stroke, seizures, multiple sclerosis, neuromuscular disorders and more
- During the outpatient week students have the opportunity to work with attendings in specialty clinics.
- Understand the role of diagnostic tests in neurology
- Students will have the opportunity to see patients undergoing EMG and EEG tests.
- They will also have the opportunity to understand the role of multiple diagnostic modalities including CT, MRI and ultrasound imaging as well as lumbar puncture and other lab investigations relevant to patients seen on the floors and in the clinics.
- Understand the role of medical and surgical treatment and rehabilitation of neurological disorders
- Students will have exposure to various acute and chronic modalities of medical and surgical treatment as applied to patients seen on the floor and in the clinic.
- Obtain feedback on neurological history taking and examination
- Students will obtain ad-hoc feedback on history /examination skills on the floors and in the clinic
- Students on the inpatient service will present their history and physical examination to the attending, and they will be given feedback on their history taking and localization skills during presentations.