Clinical Patient Care
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During this four week rotation, students will be involved in both inpatient and outpatient Clinical Neurology. The hospital experience consists of 2 weeks of Neurology Ward Service, followed by 2 weeks of Neurology Consult Service, or vice versa. At Foster-McGaw Hospital, the Ward Service may also include inpatients in the Stroke Unit and Neuroscience ICU. Students on Ward Service at Foster-McGaw or Hines are expected to “split up” and make weekend rounds with the team on ONE Saturday or Sunday morning for the month, after which they may go home. There is no student overnight call, and thus no early “post-call” dismissal for students. The outpatient clinic experience consists of participating in 1 half-day clinic session each week, with an assigned Neurology Attending. Details about hospital and clinic assignments will be given at orientation.
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Students will present the patients they have interviewed and examined to their service team or clinic attending, along with a differential diagnosis, proposed diagnostic workup and treatment options, all recorded or documented as necessary. Students on hospital services are expected to “follow” assigned patients daily, determine any changes in patient status or condition, be aware of diagnostic test results, record appropriate notes and acquire related, current neurological knowledge for optimal patient care. Such daily patient information is presented by the student to the service team on hospital rounds.
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A major goal of this clerkship is for students to demonstrate their ability to perform key parts of the bedside neurological physical examination. A videotaped demonstration of the neurological examination by Dr. Merchut may be viewed on the Neurology Clerkship webpage on LUMEN (see www.meddean.luc.edu/lumen/, select “Undergraduate Medical Education,” then under “Clinical Sciences” select “Neurology,” “CAI Modules,” “Neurological Exam” and then “Movie.”) Each clinic attending will directly observe how their assigned student performs key parts of this exam (cranial nerves, motor exam, reflexes and sensory exam), give them feedback and suggestions for improvement, and verify this competency on the student’s outpatient clinic evaluation form.
- Students are expected to see a variety of patients in hospital and clinic, and are required to record or “log” these diagnoses on their yellow pocket cards, preferably at the end of each day. At least weekly, these patient cases should be entered on-line as the Student Neuro Log (SNL). For an adequate learning experience, every student should see at least one patient with each of the following seven generic conditions or syndromes:
- focal weakness/numbness
- visual changes
- dementia, delirium or language/memory/cognitive loss
- dizziness/abnormal gait/balance
- headache/regional pain
- impaired consciousness or sleep disorder
- seizures/abnormal movements
These are generic syndromes, because the exact diagnosis or disease may not be readily apparent on the first patient encounter in hospital or clinic. Two other clinical patient situations, which may be encountered by students, should also be recorded, but are not mandatory:
- cultural/religious/ethnic diversity
- end of life care
Each patient may have more than one generic syndrome. If a syndrome is not encountered with a patient in hospital or clinic, look up that syndrome (or disease) in Study Guide 1 or 2 for the Practical Neurology DVD Review, found in this Handbook, and review that videotaped case. List that syndrome as a “Simulation” on the yellow card and SNL. Hospital or clinic patients are recorded or logged as “Assigned,” if the student either performs the initial H&P or consultation, or follows them daily with progress notes on service, or both. All ward or consult service patients seen by the team (attending, residents, students) on rounds are a learning experience. Patients seen on team rounds by other students should be recorded or logged as “Not Assigned,” whenever those students have not performed the initial H&P, consultation or daily progress notes. Any patient, whether “Assigned” or “Not Assigned,” having more than one clinical condition or syndrome, should have all of their clinical syndromes recorded or logged. Please keep a separate tally or number of “Assigned Patients” for the yellow card and on-line log as well, since the number of clinical conditions or syndromes will be greater than the number of “Assigned Patients.” Failure to enter the SNL data on-line will cause subtraction of 5 points from the final grade, and a “does not meet expectations” rating for the Professionalism competency.
If the student performs or observes any of the procedures listed on their yellow card, this should also be recorded and logged on-line. It is unlikely that every student will have the opportunity to perform a lumbar puncture on this clerkship. Therefore, lecture and simulation teaching on this procedure will be provided in this clerkship, and every student should at least record a “Simulation” for lumbar puncture.
Keeping the SNL helps verify clinical competencies, as done in most residency training programs, and also helps the student study Clinical Neurology. Every patient encounter should prompt further study of that syndrome or diagnosis, preferably on the same day of the encounter. Certain clinical conditions/syndromes or diagnoses can be studied further by viewing the relevant videotaped patients in Practical Neurology DVD Review, a compilation by Dr. José Biller of over 100 patients, available through the Neurology Clerkship website on LUMEN.
The Practical Neurology DVD Review patient cases have been organized into two Study Guides in this booklet. Study Guide 1 lists videotaped cases to study by initial symptoms or syndrome, as above (e.g., focal weakness or numbness, visual changes, etc). Study Guide 2 lists videotaped cases to study by final diagnosis (e.g., cerebrovascular, dementia, etc).
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