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General
Information
- Neurology
Clerkship Bulletin Board:
Your bulletin board is located adjacent to Tidewater Building Room
1045 and contains up-to-date service assignments, call schedules,
outpatient experience assignments, and lecture schedules. Also posted
is the Neurology weekly schedule. You are welcome at any event on
this schedule including Wednesday noon resident seminars and dinner
meetings of New Orleans Neuro Society.
- What to do
if you have Questions, Problems, or Complaints:
Call
or go see Marsha Graves, the clerkship coordinator, and she will help
you to resolve the issue. If a personal or medical issue interferes
with your performance on the rotation, contact Dr. Weisberg 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.
- Absenses:
A leave of absence for any reason must be authorized in writing
by the Office of Student Affairs and forwarded to Marsha Graves, or
may be obtained by simply talking with Dr. Weisberg and your resident.
- Safety
- 1. Always
observe Universal Precautions when interacting with patients.
- 2. Do not
use 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.
- 3. Do not
use a hollow or beveled needle (Eg. Gelco) to test for pinprick
because these needle types are too sharp. Use safety pins and
dispose of them after one use in a sharps box.
- 4. Always
guard yourself from crime, patient violence, and all types of
danger. Lock your call room doors. Use the shuttle to travel between
East and West Charity campus. Be street-smart.
- 5. Escort
service for on-call:
- TMC 588-5531
- Charity
568-5531
- VA 568-0811
ext. 5105
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It is expected that
the student will accomplish these 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 Seminars and conferences. The student is expected to
know the clinical history, examination fmdings and appropriate decision
analysis for patients with the following disorders:
- 1 Techniques
of history taking and examination of the patient with symptoms of
central and peripheral nervous system dysfunctions. This examination
includes mental state, gait and balance, motor system, coordination,
reflexes, sensation, cranial nerve.
- 2. Appropriate
utilization of neuro-imaging studies. Emphasis on when to order specific
techniques and information provided by these tests. Ability to interpret
normal and abnormal CT and MRI is stressed. Student performance of
lumbar puncture is expected during the clerkship. (Don't worry, your
resident won't let you actually hurt the patient.)
- 3. Problem solving
of neurological conditions to stress neurological localization. We
utilize brain and spinal cord mass lesions as examples and discuss
the pathophysiology of these lesions.
- 4. Approach
to management of patient with cerebrovascular disease. Stress the
preventive aspects. Careful review of treatment aspects including
neurorehabilitation techniques.
- 5. Management
of the patient with acute and chronic headaches.
- 6. Management
of patient with "spells". Recognition and management of epilepsy differentiation
of epilepsy from "syncope" and "pseudo-seizures".
- 7. Approach
to patient with "thinking" or "memory" impairment. Ability to diagnose
"dementia" and to carry out appropriate neuro-imaging studies and
utilize medications which have been shown to be effective in controlling
cognitive and behavioral symptoms.
- 8. Systematic
assessment of the "dizzy" patient. Evaluate syncope and dizziness"
in cost-effective manner.
- 9. Discussion
of "trauma" to include "concussion," "whiplash", "lumbago". Outline
appropriate utilization of neuro-iraaging studies in-patients with
neck and back pain. Discuss post-concussive syndrome.
- 10. Discussion
of multiple sclerosis and its "mimickers". This includes discussion
of fatigue syndrome and fibromyalgia.
- 11. Evaluation
and management of sleep disorders. This includes "excessive daytime
sleepiness" and "insomnia". Discuss role of the sleep lab (polysomnogram).
- 12. Approach
to patient who reports "weakness" or "numbness" as prominent symptom.
This includes discussion of neuropathy and myopathy.
- 13. Overview
of neurological manifestations of medical conditions and latrogenic
illness. We include discussion of neurological manifestations of HIV-AIDS.
- 14. Approach
to the comatose patient discussion of "brain death" and "vegetative
state".
- 15. Evaluation
of "gait" disorders, which leads into discussion of Parkinsonism and
tremor. Approach to medical and surgical management of these conditions.
- 16. Neurological
manifestations of alcohol and substance abuse with discussion of "delirium"
and "confusional states".
- 17. Overview
of issues unique to child neurology.
- 18. Management
of neurological emergencies including:
- a. status
epilepticus
- b. acute
ischemic stroke
- c. intracerebral
hemorrhage
- d. intracranial
hypertension
- e. herniation
- f. subarachnoid
hemorrhage
- g. memingitis
- h. rapidly
progressing weakness
- 19. Evaluation
of pain syndromes.
- 20. Evaluation
of "impaired vision patient" with emphasis on fundoscopic exam, pupil
exam. Visual field exam and eye movement examination.
In assessing each condition
the faculty stresses the importance of history taking and examination
to help guide decision analysis about need for subsequent neuro-diagnostic
studies. We discuss the natural history of neurological conditions and
treatment options. We discuss the impact of these neurological conditions
on the patient's quality of life. These topics are covered in seminars,
but are also reviewed when student sees patients with these disorders.
The focus of the
clerkship is to learn neurology as likely to be relevant to the primary
care physician. It is therefore more relevant for the student to understand
how to prevent and treat stoke than to know about myasthenia gravis.
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You are required to
give a presentation to your service team on a topic related to clinical
neurology and medical or professional ethics. Your presentation should
be five to ten minutes in length but no longer. You are free to choose
any circumscribed topic that you wish. You can analyze a case that you
encounter while on the clerkship or give a lecture on a specific topic.
The following references are on reserve in the library to assist you:
- 1. Ethical Issues
in Neurology by James Bemat
- 2. Neurology
Clinics: Ethics
- 3. Seminars
in Neurology: Ethical Issues in the Practice of Neurology edited by
Robert Joynt
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. Enclosed
is a list of suggested topics, but choose any topic that you wish.
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Questions on the final
exam will relate to material found in the assigned textbook, handouts,
seminars, and Grand Rounds. The test might include all of the following
formats: short answer, essay, matching, and multiple choice. The questions
predominantly come from the lecture material and from the textbook by
Dr. Weisberg, Neurology for Psychiatry Specialty Board Exam. Multiple
copies of this book are on reserve in the library.
You are expected to
read heavily. The course's official textbook is Essentials of Clinical
Neurology by Weisberg, Strub, and Garcia (one copy on reserve in library;
available in the bookstore). 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, both, which
are on reserve in the library. If you are on the Pediatric Neurology rotation,
ask your attending to direct you to some resources.
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In order to pass
this course, you must fulfill all of the following requirements:
- 1. Fully participate
in your assigned service team. (Remember, "80% of life is showing
up.")
- 2. Participate
in On-call twice. (Yes, you have to stay all night at Charity.)
- 3. Participate
in Outpatient Experience once.
- 4. Attend Charity
Neurology Clinic once each week.
- 5. Attend VA
Neurology Clinic once each week.
- 6. Attend all
Neurology seminars, whether you are on Psychiatry or Neurology.
- 7. Attend Neurology
Grand Rounds each week, whether you are on Psychiatry or Neurology.
- 8. Give a presentation
to your service team on medical and professional ethics.
- 9. Take the
final exam.
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- Evaluations
are given to the students by the residents and staff who worked with
them. Usually the resident or staff will need to work with the student
for at least a week to have a major impact on the evaluation, but
everyone who believes they can comment does so.
- To score "honors"
minimal criteria is '2' or 'outstanding' in all categories.
- The clinical
evaluations are reviewed by Dr. Weisberg and a numerical grade is
assigned.
- The clinical
and exam grades are factored to give a final grade.
- The final grades
are reviewed again by Dr. Weisberg to see if there are "borderline"
student grades which can be adjusted upwards. Also the 'portfolio'
(which is optional) is used to help make an upward adjustment.
- The student
personal evaluation is compared with the resident and faculty evaluation.
If there is a major discrepancy Dr. Weisberg will arbitrate based
upon the evaluation and grades only the students he has worked with.
Exceedingly optimistic personal evaluations are fair game for a conference
at Joe's after the grading session.
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- a. Your responsibilities
here include participating in rounds and taking care of your patients.
Taking care of your patients includes:
- 1. Doing
a complete history and physical for your own purposes and reviewing
all prior records.
- 2.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.
- 3.Checking
up on your patient frequently to assess progress and detect complications.
- 4.Talking
to nurses, therapists, dietitians, and consultants to get information
about your patient.
- 5.Writing
progress notes on your patients.
- 6.Following
up on all test results and interpreting these results.
- 7.Reading
in depth about your patient's medical problems.
- b. Some services
require morning weekend rounds. However, no medical student is allowed
to work more than an average of one weekend day per week while on
neurology, including on-call assignments.
- c. You are expected
to work a full day with your team on the day prior to the final exam.
Services
Students are assigned
to the following services:
- 1 .CH in-patient
- 2. CH consult
- 3. VAH in-patient
- 4. VAH consult
- 5. TMC in-patient
- 6. Child neurology
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- a. You are required
to be on-call [just] twice while on neurology. This involves staying
overnight and working with the on-call neurology resident. On-call
runs from 5pm to 7am the next morning. Afterwards you will attend
Morning Report, where your resident presents the cases from the night
before. This usually occurs the next morning at 7:30am at TMC in room
7812. If your call night falls on a Friday, Saturday, or Sunday, Morning
Report will not occur until the next week. Ask your on-call resident
when to show up for morning report.
- b. See the enclosed
schedule to determine when you will be on-call. Check the bulletin
board on your call day to note any last-minute changes in your on-call
resident. Page your on-call resident before 5pm to get instructions.
- c. You are required
to stay the entire night while on-call.
- d. Your call
room is at MCLNO, room 1429. Obtain the key from your resident. The
rumors about a large bat-like creature have been blown entirely out
of proportion.
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The purpose of the
outpatient experience is to give you a glimpse of a neurologist in a private
practice setting. You are required to participate in the Neurology Outpatient
Experience once during the clerkship. Attached is a schedule of clinic
dates/times to which each of you has been assigned. Call your preceptor
1-2 days prior to your scheduled visit.
No active participation
is expected. The preceptor may decide to spend time with you to explain
certain aspects of the clinic or a case, but he/she is not required
to do so.
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You are required to
attend both of these clinics once each week during your stay on neurology.
Go with your team's resident on the days of your choice. Of course you
are welcome to go to as many of these clinics as you wish.
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- a. You are expected
to prepare for the seminars beforehand. Prepare by reading the appropriate
sections of your assigned textbook. Also, read any handouts that are
included in these pages. This includes the clinical problems, which
you should be prepared to discuss at time of lecture. The handouts
are labeled as to which lecture they pertain.
- b. You should
attend all neurology seminars, whether you are on Psychiatry or Neurology.
Seminars take precedence over service duties; no team resident or
attending should cause you to miss seminars for rounds or patient
care. If this happens, bring it to Marsha Graves' attention immediately.
- c. All seminars
scheduled will be given. If the lecturer is late, contact Marsha Graves
and a substitute lecturer will be obtained.
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You are required to
attend Neurology Grand Rounds each week while you are on Psychiatry and
Neurology. Neurology Grand Rounds occur every Tuesday from Noon to 1 pm
at Tidewater Building Room 1027. As with the seminars, no one should ask
you to miss Grand Rounds for rounds or patient care.
On
This Page
General Info | Goals |
Ethics Presentation | Final Exam |
Reading | Requirements |
Grading | Service Duties |
On-Call | Out-Patient Experience |
VA/Charity Clinics | Seminars |
Grand Rounds
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