Neurology

Neurology (4 weeks)

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. 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 are assigned on the basis of a lottery, but can communicate site preferences to be accommodated when possible. Students at both sites will be provided a joint orientation session on the first day of the clerkship, and receive parallel didactic training. Students from both sites will re-convene at UCMC for testing on the last day of the clerkship.

The UCMC Clerkship Site

During the 4 week clerkship, students participate in several venues, including the adult neurology inpatient ward, the Neurointensive care unit, and the adult and pediatric outpatient neurology subspecialty clinics. Two weeks will be spent on the Adult Inpatient ward, where students will make rounds with residents, attend morning conferences, and participate in daily rounds, Monday through Saturday. Students will help admit new patients and follow established patients, monitoring their examinations and assisting in care. Students will take call through midnight with their assigned resident. The goal of this rotation is experience in hands-on evaluation and management of acute neurological problems.

In the NeuroICU, students will participate in providing care to critically ill neurological patients, working with the NeuroICU team. Students will participate in the care of critically ill neurological and neurosurgical patients (acute ischemic stroke, intracranial hemorrhages, traumatic brain injury, hydrocephalus, intracranial hypertension, paralytic syndromes, status epilepticus) admitted to the NeuroICU or in consultation in the E.R. or other ICUs. Students will also participate in first response to acute stroke calls. The NeuroICU team will round on the patients on a daily basis. An intense experience of the care of critically ill neurological patients can be expected.

In the Outpatient Clinics, students will work one-on-one with attending physicians in general adult and 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, 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. Octavia Kincaid.   The third year neurology clerkship at NorthShore University is an intensive 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, pediatric neurology and neuro-oncology.  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).  Opportunities will also be provided to observe and/or assist with lumbar punctures, electroencephalography and EMGs.

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.

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
    • Students will learn about localization during an orientation session with the clerkship director.
    • They will also learn the importance of localization in diagnosis.
  • Obtain exposure to a variety of neurological disorders
    • On the inpatient floor and in the neuro-intensive care unit students will have exposure to acute presentations of stroke, seizures, multiple sclerosis, and neuromuscular disorders.
    • 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.

Neurology Grade

  • Clinical Performance - 50%
  • Written Exam - 25%
  • OSCE - 25%

Recommended Reading

Overviews of Neurology, suggested as background reading during clerkship (choose one):

  • Lange’s Clinical Neurology; Ed. Aminoff MJ, Greenberg DA, Simon RP. 6th ed.
  • Blueprints in Neurology (Blueprints Series), by Frank Drislane et al.

Comprehensive textbooks of Neurology, useful for reference purposes:

  • Harrison’s Neurology in Clinical Medicine; Ed. Hauser S.
  • Merritt's Textbook of Neurology. Rowland, L.P. 11th ed.
  • Adams and Victor’s Principles of Neurology. Ropper AH, Brown R. Eighth Ed.
  • Neurology in Clinical Practice. Bradley, Daroff, Fenichel, Jankovic. 5th Ed.