Figure e-1. Observation Guide for Students MEDICAL STUDENT OBSERVATION GUIDE BEDSIDE SKILLS MODELING FOR THIRD YEAR MEDICAL STUDENTS DEPARTMENT OF NEUROLOGY UNIVERSITY OF ROCHESTER Modeling: A group of faculty neurologists have been selected to provide you with a formal modeling experience. During the first week of the clerkship, you will be assigned to a specific faculty neurologist preceptor, and will be given the date, time, and location of the patient encounter. All modeling encounters will take place during the physician’s regularly scheduled clinic. As you are meant to see a full history and neurological exam modeled by an attending physician, it will be a new patient encounter that should be carried out directly by the attending and not a resident or fellow. Please plan on arriving at the encounter 5 minutes early. After the case, you will have 5 minutes to ask questions about the encounter, and the physician preceptor should highlight important points. You will fill out the below observation questionnaire during the experience. The guide will list all of the aspects of the history and neurologic exam that you may be observing. Please note that all of these items may not be directly tested in each encounter as many neurologists will do focused examinations based on the chief complaint. Please list general observations and/or questions you have that may arise during the encounter. Also, think about what was done during the visit that was surprising to you or different from what you expected. When participating in the observation experience, you should focus on the technique utilized by your preceptor in obtaining various aspects of the history and performing various aspects of the exam. After each experience, you should be able to: Understand the important elements of how to take a neurologic history. Identify all major sections of the exam (i.e. mental status, cranial nerves, etc). Understand how to effectively perform the different parts of each exam section. Thank you for your participation! If you have any questions please feel free to contact me. Sincerely, Robert Thompson Stone, MD Senior Instructor of Neurology and Pediatrics University of Rochester School of Medicine and Dentistry History General Observations/Questions; Items Different From What was Expected History of Present Illness Past History: Medical/Surgical Medications Allergies Family Social Review of Systems Neurologic Examination General Observations/Questions; Items Different From What was Expected Mental Status Exam: Level of Consciousness Attention Language (reading, writing, naming, repetition, comprehension, fluency) Memory (registration and recall) Orientation Executive Function Cranial Nerve Exam: Cranial Nerve II – Visual Acuity, Visual Fields, Pupils, Fundoscopy. Cranial Nerves III, IV, VI - Pupils, extra-ocular muscles. Cranial Nerve V - Facial sensation and muscles of mastication. Cranial Nerve VII - Facial strength/symmetry. Cranial Nerve VIII – Gross Hearing. Cranial Nerves IX/X – Palate elevation. Cranial Nerve XI – Sternocleidomastoid and trapezius strength. Cranial Nerve XII – Tongue movements. Motor Exam: Muscle bulk (observational) Muscle tone in limbs Pronator Drift Strength (“push-pull” testing, and functional testing) Observe for abnormal movements (tremor, chorea) Sensory Exam: Light Touch +/- pin-prick Temperature Vibration Proprioception Deep-tendon Reflexes Coordination: Limb dysmetria (upper and lower extremities) Dysdiadochokinesia ( rapid alternating movements) Truncal coordination (gait testing) Gait: Normal walking Heel/toe walking Tandem gait .