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Neurology Clerkship MNEU7000
SYLLABUS
2018-2019 ACADEMIC YEAR
Education Director: Terrence Li, MD [email protected]
Clinical Education Specialist: Kathleen Fisher DNP APRN CHSE CCNS [email protected]
Undergraduate Medical Education Specialist: Maria Ramirez [email protected] Office Phone: 847-578-8703 RWCLC 1.088
CLERKSHIP DESCRIPTION
Clinical Neurology is a 4-week required clerkship that prepares students to recognize and begin the management of patients with neurologic conditions, to demonstrate the ability to perform a complete and reliable neurologic history and physical examination, and to continue their progress toward achieving the School’s educational competencies. The students are provided with practical experience at the bedside, clinics, and teaching rounds, as well as varied learning environments.
Students in this clerkship receive their clinical instruction at Advocate Christ Medical Center, Advocate Illinois Masonic Medical Center, Advocate Lutheran General Hospital, Capt. James A. Lovell Federal Health Care Center, and John H. Stroger, Jr. Hospital of Cook County. Students interact with patients with a wide variety of neurological conditions on both outpatient and inpatient services under the preceptorship of neurology attendings and residents.
Student participation in group discussions, didactic presentations, workshops, and conferences is required, and facilitated, and supervised by preceptors at specific training sites. These activities ensure continued learning and application of the principles and practice of neuroscience and clinical neurology and ensure that the student’s learning experience in neurology is an integral contribution to progress in becoming competent physicians. There is a required 1 day summative simulation day in the 2nd or 3rd week of the neurology rotation at Huntley that will emphasize the ability to complete a neurologic history and physical examination, be able to generate a differential diagnosis with a leading diagnosis, and test overall neurological fund of knowledge.
CLERKSHIP OBJECTIVES
Upon completion of the clerkship, students will be able to:
1. Order, perform, interpret appropriate diagnostic technical procedures and develop appropriate differential diagnostic and therapeutic strategies for neurologic patients with common acute and chronic conditions. (1.1, 1.4, 1.5, 6.2) 2. Document an organized and comprehensive medical records including history and physical and progress notes. (1.2, 4.5) 3. Identify risk factors and preventive strategies for neurologic patients. (1.9) 4. Demonstrate an investigatory approach to clinical situation using bio-physical and clinical scientific principles to distinguish the causes and underlying mechanisms of disease as it relates to neurological cases/management. (2.1, 2.2, 2.3) 5. Identify risk factors, treatment strategies, psychosocial and cultural influences and preventive strategies for neurologic patients using epidemiological and social-behavioral sciences. (2.4, 2.5) 6. Identify one’s own limitations, knowledge gaps, biases, and vulnerabilities that may impact patient care through reflection and feedback to and from others. (3.1, 3,2, 3.3, 3.5, 5.5) 6/07/18 2 7. Search for, evaluate, and apply evidence found in scientific studies in the care of neurologic patients using technology. (3.6, 3.7, 3.9, 3.10) 8. Demonstrate effective professional relationships and communication skills (verbal and non-verbal) by demonstrating respect, patient autonomy, dignity, integrity, honesty, trust, and compassion when engaging with patients, their families, peers, the public, the university community and other healthcare providers in neurology rotation. (3.8, 4.1, 4.2, 4.3, 5.1, 5.3, 7.1, 7.3) 9. Identify systematic Interprofessional practices that improve patient safety, minimize error, and contribute to continuous quality improvement. (6.5) 10. Identify one’s own role as a physician on the neurologic healthcare team, how it relates to other members and recognize when and how to initiate their assistance. (6.6, 7.1, 7.2, 7.3, 7.4) 11. Describe health care settings in neurology practice and interprofessional team members of these practices and how they are used to meet community needs. (6.2, 7.4)
Reference D2L for COMPETENCY MAP
CLERKSHIP-SPECIFIC PERFORMANCES, PROJECTS, REQUIREMENTS
1. Neurology Simulation Day at Huntley • Students will complete a full day formative simulation activity at Huntley in the 2nd or 3rd week of the neurology rotation. • The simulation will consist of standardized patients, mannequin presentations and a written component. A lumbar puncture experience will be offered during the neuroimaging and medical errors portion of the simulation day. • The simulation day will strictly be graded pass or unsatisfactory and will NOT impact your clinical grade. There is a minimum passing grade established to ensure minimum clinical competency and students will be remediated based if their performance is below the minimum passing grade. • Students MUST pass the simulation day to complete the neurology rotation. • Unsatisfactory performances will be individually remediated by the neurology education director.
2. Mid-clerkship evaluation • Students must print the mid-clerkship evaluation form out (available on D2L) and bring it to one of your preceptors during the 2nd or 3rd week of the clerkship. • Your preceptor will give you feedback, thus helping you to work on any weaknesses or problems they may perceive. This form won’t be used to determine your final grade, but only to identify deficiencies in any of these three areas that must be
6/07/18 3 overcome before the end of the clerkship: medical knowledge, communication and professionalism. This form MUST be signed by your preceptor. • All mid-clerkship evaluations must be submitted into D2L by Wednesday 11:59 PM on the last week of the neurology rotation. Failure to comply will result in a grade of Needs Remediation.
3. Patient logs • Students must enter the number of patients you have had contact with and their diagnoses (not names) on One45.com to help you keep track of your patients. • All patient logs MUST be submitted by Wednesday 11:59 PM on the last week of the neurology rotation. Failure to comply will result in a grade of Needs Remediation. • Important: If you find that you have not been exposed to the required patient diagnoses that are listed in the neurology clerkship required encounters, you need to inform your attending or the site coordinator who will assist you in resolving this deficit.
4. Neurologic Exam • Students MUST complete a neurologic exam direct observation log on day one of clerkship under direct observation of Dr. Wiesz or Dr. Li.
5. NBME Exam • Students must complete the NBME exam on the last day of the rotation.
REQUIRED PATIENT ENCOUNTERS
Student will: Differentiate among common etiologies based on presenting symptom(s) Recognize “don’t miss” conditions that may present with symptoms Elicit a focused history and perform a focused exam Describe the initial management of common and dangerous diagnoses that present with symptom(s) Discuss the importance of cost effective approach to the diagnostic work-up * Partial Participation (PP) = Participate in at least 2 of the components above * Full Participation (FP) = Practice in at least 4 of the components above
6/07/18 4 It is expected that most patient encounters counting toward the minimal encounter requirement will be at Full Participation. If the student is unable to complete the required diagnoses minimal numbers, then alternative experiences are available via D2L.
Type of Patient/ Level of Student Clinical Setting Benchmark/Explanation Alternative Clinical Condition Responsibility Cerebrovascular Disease (CVD) Inpatient & FP Student will participate in the evaluation If a student is unable to complete the CVD 2 Patients Outpatient of the patient. Student will obtain history, encounter by the end of the clerkship, the perform physical, and participate in student will contact the Clerkship Director who developing clinical assessment and will arrange an encounter opportunity. The diagnostic and therapeutic plan, along Clerkship Director will provide feedback and with or under the guidance of an record the completion of the student’s attending physician. alternative experience. Headache Inpatient & FP Student will participate in the evaluation If a student is unable to complete the Headache 1 Patient Outpatient of the patient. Student will obtain history, encounter by the end of the clerkship, the perform physical, and participate in student will contact the Clerkship Director who developing clinical assessment and will arrange an encounter opportunity. The diagnostic and therapeutic plan, along Clerkship Director will provide feedback and with or under the guidance of an record the completion of the student’s attending physician. alternative experience. Neurodegenerative Disease Inpatient & FP Student will participate in the evaluation If a student is unable to complete the 2 Patients Outpatient of the patient. Student will obtain history, Neurodegenerative Disease encounter by the perform physical, and participate in end of the clerkship, the student will contact developing clinical assessment and the Clerkship Director who will arrange an diagnostic and therapeutic plan, along encounter opportunity. The Clerkship Director with or under the guidance of an will provide feedback and record the attending physician. completion of the student’s alternative experience. Peripheral Nerve / Muscle Inpatient & FP Student will participate in the evaluation If a student is unable to complete the Conditions Outpatient of the patient. Student will obtain history, Peripheral Nerve / Muscle Conditions 2 Patients perform physical, and participate in encounter by the end of the clerkship, the developing clinical assessment and student will contact the Clerkship Director who diagnostic and therapeutic plan, along will arrange an encounter opportunity. The with or under the guidance of an Clerkship Director will provide feedback and attending physician. record the completion of the student’s alternative experience.
6/07/18 5 Type of Patient/ Level of Student Clinical Setting Benchmark/Explanation Alternative Clinical Condition Responsibility Seizures Inpatient & FP Student will participate in the evaluation If a student is unable to complete the Seizures 1 Patient Outpatient of the patient. Student will obtain history, encounter by the end of perform physical, and participate in the clerkship, the student will contact the developing clinical assessment and Clerkship Director who will arrange an diagnostic and therapeutic plan, along encounter opportunity. The Clerkship Director with or under the guidance of an will provide feedback and record the attending physician. completion of the student’s alternative experience.
REQUIRED AND RECOMMENDED CLERKSHIP MATERIALS
It is expected that all students make use of the following resources & materials within the Boxer Library.
Reading and Learning Materials
There is no particular required text designated for the Neurology Clerkship. However, it is expected that all students rotating through the service should obtain a textbook for reference and to study for the NBME Clinical Neurology subject examination. The Neurology clerkship will allow you to borrow Pretest Neurology 9th edition and the Blue Prints Neurology (4th edition) (a total of 9 copies each). These will be available on the first day of the neurology clerkship. They need to be signed out during the required lectures. The books are to be returned at the end of the clerkship prior to the NBME examination and handed to the UGMES with a signature. The final grade will be withheld until all borrowed reading and learning materials are returned. It is encouraged to obtain an additional text book for reference and to maximize your score for the NBME neurology examination.
Please reference D2L for required reading materials (3rd Year Medical Student Guide to Neurology). Students are required to read and review these learning materials and attend lectures. Participation will be monitored via D2L analytics. Non-compliance may result in a failing clerkship grade or necessitate remediation.
Recommendations:
Aminoff, M., Greenberg, D., Simon, R. (2015). Clinical Neurology, 9th ed. A very good Lange Series introduction to Clinical Neurology. It teaches Neurology based on presenting signs and symptoms. A very good bridge between basic and clinical sciences; however, it does not go into great depth. Although this text could work well as a start and as a baseline reference in looking up individual patient problems, it is
6/07/18 6 likely one would need to supplement their reading with other texts if a high score on the NBME clinical subject exam is desired. Nice section on the neurological exam.
Weiner, W., Goetz, C., eds. (2010). Neurology for the Non-Neurologist, 6th ed. A good introduction to Neurology. Chapters are organized very logically with questions at the end to check knowledge. Much like the Aminoff book, this would afford the reader with a solid foundation in Neurology but it does not go into great depth, although the references are well chosen. One would likely need to consider supplementing this text as well for the NBME clinical subject exam.
The student should be sure to read about some of the material not covered in detail in any of the introductory texts such as diagnosis and treatment of the meningitides and encephalitis as well as the common congenital and developmental pediatric conditions. The following may be helpful to you:
Textbooks:
Principles in Neurology Ropper, Adams, Victor, Brown. 10th Ed, 2014; McGraw Hill Note: Accessible online at http://www.rosalindfranklin.edu/lrc/ - click on STATRef
Harrison’s Principles of Internal Medicine (Part 15: Neurologic Disorders) Kasper, Braunwald, Fauci, Hauser, Longo. 19th Ed, 2015; McGraw Hill Note: Accessible online at http://www.rosalindfranklin.edu/lrc/ - click on STATRef
Localization in Clinical Neurology Brazis, Masdeu, Biller. 7th Ed, 2016; Libble Brown, Boston
Diagnosis of Stupor and Coma Plum. 4th Ed, 2007; FA Davis, Philadelphia
Clinical Pediatric Neurology Fenichel. 6th ed, 2009; Saunders
Medlink via Library. This has reviews of all conditions in Neurology free through the library. Often have videos as well. Accessible on line at: http://www.rosalindfranklin.edu/lrc/ Click on Medlink.
6/07/18 7 Primers:
High Yield Neuroanatomy James Fix. 4th Ed, 2008; Lippincott Williams and Wilkins
Case Files Neurology Toy, Simpson, Tinter. 2nd ed, 2012; McGraw-Hill
Aids to Examination of the Peripheral Nervous System O’Brien. 5th ed, 2010; Saunders
Neurology for the House Officer (House Officer Series) Rae-Grant. 8th Ed, 2008; Lippincott Williams and Wilkens
Lecture Notes: Neurology Ginsberg. 9th Ed, 2010; Blackwell Publishing
Additional Resources:
American Board of Psychiatry and Neurology (ABPN) https://www.abpn.com/ American Psychiatric Association https://www.psychiatry.org/
EVALUATION, EXAMINATION, AND REMEDIATION POLICIES
Refer to D2L for: • CMS Excused Absence Policy document for examination and other clinical experience remediation guidelines. • CMS Clerkship Grading Policy • Clinical Evaluation Standards • Required Minimum Patient Encounters are included in the syllabus and indicate specific patient type/clinical condition remediation guidelines. • CMS Exam Conduct Policy • RFUMS Exam Loaner Laptop Policy
6/07/18 8 • CMS Clerkship Retake/Rescheduled Exam Policy • RFU Remediation Policy
NBME Online Shelf Exam:
The NBME Online Shelf Exam is typically held at the RFUMS Campus on the last Friday of the rotation from 9:00 a.m. to 12:00 p.m. However, please refer to D2L for the most recent updates.
The NBME is responsible for grading exams. No challenges are accepted for NBME exams. Scores will be available approximately 1-2 weeks after the exam has been completed, but will not be published until clinical evaluations have been received.
In general, Clerkship Directors will determine how the student will make up patient encounters, clinical activities or other clerkship requirements. Clerkship Directors will determine if and when the student will be required to repeat the clerkship. Clerkship Directors will use case-by- case evaluation and coordinate with the Office of Student Affairs & Education.
CMS Remediation Procedures:
Eligibility Criteria for Remediation: At the end of the rotation, students who have a failing grade in any of the applicable course components (final exam, clinical evaluation, and/or performances) will be offered remediation for the component(s) they have failed.
Process for Remediation: Students are required to take exams, if applicable, as scheduled and in the proscribed manner outlined in the CMS Clerkship Retake/Rescheduled Exam Policy. Clinical evaluations and/or rotation-specific performances requiring remediation will be addressed by the Education Director based upon the deficits.
Remediation Grading Outcomes: If the student passes the remediation, they receive a grade of “Pass” for the rotation. If the student fails the remediation, they receive a grade of “Fail” for the rotation. A failure will result in the student repeating all or part of the rotation at the discretion of the Education Director, in consultation with the Assistant Dean of Clinical Education.
Maximum number of attempts to remediate: Students will have one retake opportunity to pass a remediation.
Please reference the following additional Polices and Guidelines posted to D2L: • SEPAC Handbook • SEPAC Policy
6/07/18 9 • Clinical Grade Appeal Policy • Clerkship/Sub-Internship Grade Appeal Form • Student Policies Handbook • Testing Accommodations Guidelines • CMS Learner Mistreatment Policy and Procedures • Medical Student Work Hours Policy • Off-Site Secure Storage Policy • Teacher-Learner Expectations • CMS Professionalism Policy and Procedures • CMS Dress Code Policy • Ebola Virus Policy • Exposure Incidents Policy • Alcohol and Drug Use Policy
Holiday Schedule: You must follow the holiday schedule for your site, not Chicago Medical School's schedule.
Weather Emergencies: If the University is closed due to extreme weather, check with your clinical site regarding its status. Unless otherwise directed by your Site Director, you should go to your clinical site.
ACADEMIC ACCOMMODATION
Rosalind Franklin University of Medicine and Science is committed to providing equal access to learning opportunities for students with documented disabilities. To ensure access to this class and your program, please contact the ADA Coordinator at 847.578.8354 or [email protected] to engage in a confidential conversation about the process for requesting accommodations in the classroom and clinical settings.
Accommodations are not provided retroactively. Students are encouraged to register with the ADA Coordinator as soon as they begin their program. Rosalind Franklin University of Medicine and Science encourages students to access all resources available. More information can be found on the Academic Support InSite page or by contacting the ADA Coordinator.
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OTHER CLERKSHIP INFORMATION
Didactic Day:
Speaker Topic Lecture Objectives Dr. Li Neurological Localization Identify clinical neurological findings to basic neurological localization of lesions. Dr. Li Headache (HA) Differentiate between a primary and secondary cause of headache. Identify clinical characteristics of selected neurodegenerative diseases: dementia, Dr. Li Neurodegenerative Disease multiple sclerosis and Parkinson’s disease. Dr. Weisz & Recognize the definition of epilepsy, status epilepticus, and the typical presentation of a Epilepsy Dr. Li generalized tonic-clonic seizure. Dr. Li Cerebrovascular Disease (CVD) Recognize the clinical presentation of acute cerebrovascular disease. Dr. Li Vertigo Differentiate between central and peripheral vertigo. Dr. Weisz Higher Cortical Function Explain the definition of aphasia, agnosia and apraxia.
Note: Topics, location, or speakers are subject to change. Students will be notified if changes occur via D2L.
SITE DIRECTORS, FACULTY AND STAFF
Site Faculty Phone E-mail (Advocate Christ Medical Center) Robert Egel, M.D. (708) 684-5289 [email protected] Department of Neurology 4440 West 95th St., Suite 7311P Administrative Phone E-mail Oak Lawn, IL 60453 Rachelle Anderson (708) 684-5289 [email protected] Site Faculty Phone E-mail (Advocate Illinois Masonic Hospital) Tim Mikesell, M.D. (847) 318-2500 [email protected] 836 West Wellington Ave Administrative Phone E-mail
6/07/18 11 Chicago, Il 60657 Maria Garcia 773-296-5945 [email protected] Site Faculty Phone E-mail (Weiss Memorial Hospital) Anthony Stephens,M.D. (773) 296-7079 [email protected] 4646 N. Marine Drive Chicago, IL 66405 Administrative Phone E-mail Karen Verga (773) 296-7079 [email protected] Site Faculty Phone E-mail (Captain James A. Lovell Federal) Mark Trelka, M.D. (847) 688-1900 [email protected] Health Care Center 3001 Green Bay Road Administrative Phone E-mail North Chicago,IL . 60064 Beve Bartley 224-610-3094 [email protected] Site Faculty Phone E-mail (John H. Stroger, Jr. Hospital James Dorman, M.D (312) 864-7287 [email protected] of Cook County) 1900 West Polk Street, Room 920 Administrative Phone E-mail Chicago, IL 60612 Ebonie J. Moore (312) 864-7280 [email protected] Site Faculty Phone E-mail (Advocate Lutheran General Hospital) Terrence Li, M.D. 847-318-2500 [email protected] 1775 Dempster Street, 6 South Park Ridge, IL 60068 Administrative Phone E-mail Tara Murphy 847-723-6479 [email protected]
CLERKSHIP SCHEDULE FOR 2018-2019
Orientation at CMS End-of-Clerkship Exam Rotation # First Day at Site Final Day Site SIM Day 9:00 a.m. – 3:30 p.m. 9:00 a.m. – 11:45 a.m.
6/07/18 12 Monday, Monday, Friday, Tuesday, Thursday, July 16, 2018 1 July 02, 2018 July 27, 2018 July 03, 2018 July 26, 2018 10400 Haligus Rd, Room Location TBD Room Location TBD Huntley, IL 60142 Monday, Monday, Friday, Tuesday, Thursday, August, 13, 2018 2 July 30, 2018 August 24, 2018 July 31, 2018 August 23, 2018 10400 Haligus Rd, Room Location TBD Room Location TBD Huntley, IL 60142 Tuesday, Monday, Friday, Tuesday, Thursday, September 11, 2018 3 August 27, 2018 September 21, 2018 August 28, 2018 September 20, 2018 10400 Haligus Rd, Room Location TBD Room Location TBD Huntley, IL 60142 Tuesday, Monday, Friday, Tuesday, Thursday, October 09, 2018 4 September 24, 2018 October 19, 2018 September 25, 2018 October 18, 2018 10400 Haligus Rd, Room Location TBD Room Location TBD Huntley, IL 60142 Monday, Monday, Friday, Tuesday, Thursday, November 12, 2018 5 October 22, 2018 November 16, 2018 October 23, 2018 October 15, 2018 10400 Haligus Rd, Room Location TBD Room Location TBD Huntley, IL 60142 Monday, Monday, Friday, Tuesday, Thursday, December 3, 2018 6 November 19, 2018 December 14, 2018 November 20, 2018 December 13, 2018 10400 Haligus Rd, Room Location TBD Room Location TBD Huntley, IL 60142 Monday, Monday, Friday, Tuesday, Thursday, January 14, 2019 7 January 07, 2019 February 1, 2018 January 08, 2019 January 31, 2019 10400 Haligus Rd, Room Location TBD Room Location TBD Huntley, IL 60142 Monday, Monday, Friday, Tuesday, Thursday, February 11, 2019 8 February 04, 2019 March 1, 2019 February 05, 2019 February 28, 2019 10400 Haligus Rd, Room Location TBD Room Location TBD Huntley, IL 60142
6/07/18 13 Monday, Monday, Friday, Tuesday, Thursday, March 11, 2019 9 March 4, 2019 March 29, 2019 March 5, 2019 March 28, 2019 10400 Haligus Rd, Room Location TBD Room Location TBD Huntley, IL 60142 Monday, Monday, Friday, Tuesday, Thursday, April 08, 2019 10 April 1, 2019 April 26, 2019 April 02, 2019 April 25, 2019 10400 Haligus Rd, Room Location TBD Room Location TBD Huntley, IL 60142 Monday, Monday, Friday, Tuesday, Thursday, May 06, 2019 11 April 29, 2019 May 24, 2019 April 30, 2019 May 23, 2019 10400 Haligus Rd, Room Location TBD Room Location TBD Huntley, IL 60142 Monday, Monday, Friday, Tuesday, Thursday, June 03, 2019 12 May 27, 2019 June 21, 2019 May 25, 2019 June 20, 2019 10400 Haligus Rd, Room Location TBD Room Location TBD Huntley, IL 60142
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