Lectures

Dr. Branch Lecture
"Overview of Stroke"

Applicable Neuroradiology

Neurology Review

The Neurological Examination(pdf)

The Neurological Examination(ppt)

Neurological Emergencies 

 

Orientation to the 
Junior Neurology Clerkship

Goals & Objectives

Passport

Student Leave Policy

L3 Orientation

Duties of Students

2011-2012 Resident/Faculty Contact Info

LSU Junior Neurology Clerkship

Duties of Students

Equipment

Each student should own or have access to the following equipment in order to adequately exam patients with neurological or neurosurgical disorders:        

• Ophthalmoscope (with traditional Welch Allen or Pan-Optic head)
• Reflex Hammer (preferably Queen Square type and not Tomahawk type)·        
• Flashlight (or penlight)·        
• Snellen Visual Acuity Chart·        
• Tuning Fork (C-128 for vibration sense detection +/- C-256 or 512 for hearing)        
• Your Brain!

Didactic Lectures
Each student on Neurology is expected to attend the weekly Thursday afternoon didactic lectures as per their schedule. Attendance may be taken and students who are absent without permission from the Clerkship Director will be assigned an “Incomplete” at the end of the course and additional work will be required from the student to achieve a final grade for the course. All students must attend the Thursday afternoon didactics with the exception being those students who are rotating through neurology in Baton Rouge under the guidance of Dr Barkemeyer.

Required lectures will include:·        

• Neurology-Resident-led Clinical Case Studies- There will be two cases: A Stroke Case on the first week and an Epilepsy case on the second week of the Neurology Clerkship block. Students are expected to read and review the cases prior to the didactic session as well as be ready to answer each of the discussion points provided with the cases.
   
• Applicable Neuroradiology Lecture- This didactic lecture (also on the first Thursday of each 2 week Neurology Clerkship block) covers the various modalities of neuroimaging and their applications. Students will be questioned on CNS anatomical structures seen on the various imaging studies. Examples of normal and pathological imaging studies will also be presented and discussed. 
   
• Faculty-led Student Professor’s Rounds- This conference is taught with the Socratic Method by one of the Neurology Department faculty members. One student who is assigned to University Hospital will be required to prepare a case for presentation to the faculty member. The case presentation should include a Chief Complaint, a thorough, yet pertinent History of Present Illness, Past Medical History, Past Surgical History, Medications, Family History, a pertinent Review of Systems and a relevant Social History. Physical Examination should include Vital Signs, a General Medical Examination, and a detailed Neurological Examination that covers each of the sub-components of the neurological exam (Mental Status, Cranial nerves, Motor, Sensory, Coordination and Gait). Localization of the disease process should be considered on the basis of the History and Physical Examination. Following Localization, a reasonable Differential Diagnosis should be developed and appropriate diagnostic studies obtained to confirm a working diagnosis. Finally treatment, expected outcome and counseling should be discussed. One student will be asked to present the case (though each student assigned to University Hospital should help in preparation). Be prepared to bring all relevant diagnostic results to the conference. While one student is asked to present the case, all students will be asked to contribute to the discussion of the case.
   
• Neurology Review- This lecture briefly touches on important clinical and diagnostic aspects of many neurological disorders from the following disease categories: CNS Infections, Auto-immune Disorders, Epilepsy and Sleep, Vascular Disorders, Headache and Pain Syndromes, Trauma, Degenerative Disorders, Altered Mental Status, Movement Disorders, Structural Disorders, Toxic and Metabolic Disorders, Psychiatric Conditions, Neuromuscular Disorders, as well as Anatomy and Localization.              

Junior Neurology Passport
The Passport is your link to documenting basic competencies in performing a neurological examination and in taking a pertinent neurological history. It also contains a Patient Log, a Neurology Clerkship Evaluation Form, and a Student Feedback Form. The Passport should accompany each student each day during their Neurology rotation and must be turned in at the end of the block in order for the student to be able to sit for the final written SHELF exam. Lost or misplaced Passports may be reconciled on a case-by-case basis by the Clerkship Director. Each Passport will have the following components:

• Direct Observation of Your Neurological Examination After demonstrating a thorough Neurological Examination, have your attending physician or resident physician sign off on your Basic Competencies:Neurological Examination Skills Form. There is a specific form for Adult Neurology and for Child neurology (though each student is only required to document exam skills on either adult or child neurology patients depending on their assigned rotation). A minimum of one documented Neurological Exam is necessary to pass the course, but students are encouraged to practice their neurological examination skills under supervision as many times as possible during their Neurology Clerkship.
         
• Evaluation of Taking a Pertinent Neurological History After demonstrating a thorough, yet pertinent Neurological History, have you attending physician or resident physician sign off on your Basic Competencies:Pertinent History Taking Skills Form. As with the Neurological Examination Basic Competency Forms, there is a specific Neurological History Competency Form for Adult and for Child neurology. You are likewise expected to have at least one documented pertinent neurological history to pass the course. Even after this requirement has been met, seek feedback from your history taking skills from neurology residents or child neurology fellows or attending physicians to hone your skills. Remember that most of the useful information you will obtain on your neurology patients comes from the neurological history (and not necessarily from the exam, imaging, or other diagnostic studies).
          
• Student Presentations Students are encouraged to give short presentations covering topics that directly pertain to the diagnosis, treatment, pathogenesis, and/or prognosis of disorders that their patients are suffering from. Taking the initiative to educate yourself and others on your team is an important aspect of self-directed learning as will be evaluated on your Neurology Evaluation Form.
          
• Patient Log The Liaison Committee on Medical Education requires that each clerkship specify the number and kinds of patients that students must evaluate in order to achieve the objectives of the clerkship. The Neurology Clerkship Grading Committee has determined that each student must be involved in the care of at least one patient with the following conditions: 
           
  • Paroxysmal Disorders
    • Adult Neurology example include:     Headaches, Seizures, Epilepsy, Channelopathies, etc
    • Child Neurology examples include: Headaches, Seizures, Epilepsy, Myotonia or other Channelopathies, etc
              
  • Vascular Disorders
    • Adult Neurology examples include: Stroke, Intracranial Hemorrhage, Hypertensive Encephalopathy, Hypoxic-Ischemic Encephalopathy
    • Child Neurology examples include: Childhood Stroke, Neonatal Intraventricular Hemorrhage or Periventricular Leukomalacia, Hypoxic-Ischemic Encephalopathy
              
  • Neuromuscular Disorders
    • Adult Neurology examples include: Myopathies, Guillan-Barre Syndrome, CIDP, Charcot-Marie-Tooth, Diabetic Neuropathy, Amyotrophic Lateral Sclerosis, Traumatic or Focal Neuropathies, etc
    • Child Neurology examples include: Congenital Myopathies, Muscular Dystrophy, Guillan-Barre Syndrome, Spinal Muscular Atrophy, Charcot-Marie-Tooth Disease, Myasthenia Gravis, Erb’s Palsy, etc
       
  • Progressive Degenerative Disorders
    • Adult Neurology examples include: Alzheimer’s Disease and other Dementia’s, Huntington’s Disease, Parkinson’s Disease, Vascular Dementia, etc
    • Child Neurology examples include: Leukodystrophies, Neurodegenerative Disorders, Metabolic Disorders, Brain Tumors, etcIt would be ideal to have experience caring for patients from each of the four categories within your two week rotation; however, this is not always possible given the short duration of this clerkship so students will not be penalized if patients from each of these categories are unavailable to be seen and cared for by the student. 
            
• Formal Faculty and Resident Feedback Students will be assigned a clinical grade for their performance on the Neurology Clerkship towards the end of their two week rotation based on the results on their Neurology Clerkship Evaluation Form. This evaluation covers areas in Patient Care, Medical Knowledge, Interpersonal Relationships and Communication Skills, Practice-Based Learning and Improvement, Systems Based Practice and Professional Behavior.This form should ideally be filled out by your supervising attending physician. If an attending physician does not fill out the form, he/she still needs to countersign the evaluation written in by a senior neurology resident or fellow. Each student should receive direct verbal feedback about their performance from the person evaluating them. Students should sign their own forms indicating whether or not they received narrative feedback concerning their performance.Each Evaluation Form has space for Formative Feedback to help define each student’s strengths and weaknesses. It also has a section for Summative Evaluation comments that will be forwarded to the Office of Student Affairs and may be included in your Dean’s Letter when applying for residency programs.

A numerical score will be added up by the Clerkship Administrator once the Passports are turned in at the end of the Medicine Clerkship. Passports are collected on the day of the Neurology SHELF examination. 

A Clinical Grade for the Neurology Clerkship will then be assigned to each student based on their numerical score. All Neurology Evaluation scores for any given Medicine Block will be collected and a mean score determined. Each student’s Clinical Grade will then be based on the following format:        

• Honors: Score is greater than +0.75 SD’s above the mean·        
• High Pass: Score is between -1 SD’s below the mean and +0.75 SD above the mean·        
• Pass: Score is between -2 SD’s below the mean and -1 SD’s below the mean·        
• Fail: Score is below -2SD’s below the meanStudents may also be in jeopardy of failing the course for behavior deemed to be unprofessional. Any student engaging in unprofessional behavior will have a Physicianship Evaluation Form filled out by the course Director and plans for remediation will be instituted.

Clerkship Student Feedback Please fill out the student feedback section of your Passport prior to the end of the rotation. The Junior Neurology Clerkship is frequently updated and changed based largely on your anonymous feedback. You can detach the form from your passport and mail it to Dr Deputy if you are concerned about confidentiality. His mailing address is 200 Henry Clay Ave, New Orleans, LA 70118

Progress Notes Progress notes should be written as frequently as the patient’s condition warrants. These can be written on hospital Progress Notes sheets but should be identified as L-III with signature and should be cosigned by staff or resident.

Call Schedule Staying overnight for call is not required during any of the Neurology or Child Neurology portion of this Clerkship. If however, you are working with a particularly engaging resident and wish to take call with that person, feel free to do so. There is a lot that one can learn from working one-on-one with a resident.     

Duty Hours In recognizing the time commitment required of medical students during clinical rotations and taking into account the effects of fatigue and sleep deprivation on learning, clinical responsibilities, and student health and safety, the following duty hour limitations have been adopted by the LSU Clerkship Directors as of 5/22/08 and are to be followed without exception:

“Duty hours must be limited to 80 hours per week averaged over a four-week period, inclusive of all clinical and didactic learning activities. Students who are assigned to overnight call in the hospital should not have patient care responsibilities after 1:00 PM on the following day. Students will be expected to attend mandatory didactic activities even after overnight call.”

Any breeches of this policy should be immediately reported to any of the following:Director of Clinical Sciences Curriculum, the Associate Dean for Student Affairs, the Assistant Dean for Student Affairs, or the Assistant Dean for Undergraduate Medical Education”

SHELF Examination The LSU School of Medicine Neurology Clerkship has used the Neurology Subject Examination developed by the USMLE as an external measure to track student performance in the clerkship since the 2009-2010 academic year. This standardized written examination allows for comparisons between groups of students going through their Neurology Clerkship in a given academic year, between academic years and among other various medical school programs in the United States. It also provides for a fairly objective measurement of each student’s medical knowledge to counterbalance the more subjective Neurology Clerkship Evaluation Form-generated Clinical Grade. Students are expected to score at least a 59 in order to pass the SHELF as well as the Neurology Clerkship. Students who score below a 59 will be assigned an initial grade of “Incomplete” for the course. They will then have the opportunity to retake the SHELF examination at the end of the Junior year but can only receive a grade of Pass for the course regardless of their Clinical Grade (assuming that they pass the SHELF on their second attempt). It is recognized that students will need to study for both the Medicine and Neurology SHELF examinations concurrently during their 12 week medicine Clerkship block and that they will take both examinations on the final two days of the clerkship. Because of this it is recommended, that each student spend at least some time reviewing for their Neurology SHELF even on weeks that they are not assigned to neurology.Passing SHELF scores will be translated into a Written Examination Grade for the course based on the following paradigm generated for each group of students taking the SHELF at any one time:·        

• Honors: Score is greater than +1.5 SD’s above the mean·        
• High Pass: Score is between -1 SD below the mean and +1.5 SD’s above the mean·        
• Pass: Score is between (and includes) 59 and -1 SD below the mean·        
• Fail: Score is less than 59

Final Grade Assignment for the Neurology Clerkship Each student will receive a Final Assigned Grade for their Neurology Clerkship based on a combination of their Clinical Grade and their Written Examination Grade as follows:·        

• Honors: Need to have Honors for both the Clinical and Written grades.·        
• High Pass: The lowest of the Clinical and Written Grades must be a High Pass·        
• Pass: The lowest of the Clinical and WrittenGrades is a Pass·        
• Fail: The Clinical Grade is a Fail or the student is unable to score a passing grade on the SHELF examination despite repeated attempts (LSU School of Medicine Policy), or possible if the student engages in unprofessional behavior that cannot be rectified per the Clerkship Director’s discretion.