Junior Neurology Clerkship

Duties of Students

Equipment

Each student should own or have access to the following equipment in order to adequately examine 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)
  • A Receptive 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.  Required lectures will include:

  • Neurology-Resident-led Clinical Case Studies - There are 3 sets of 5 cases that will be worked through (one set per week) under the guidance of a Neurology Resident.  The cases are symptom based.  Following a brief history, students will be asked to summarize the case.  Next a physical and neurological examination will be given.  The students will then need to localize the site of the neurological deficit.  Following this, a broad differential diagnosis will be created, then a more narrowed differential diagnosis.  Diagnostic evaluation will be determined and eventually the diagnosis of the case presented will be solved.  A “pearls and pitfalls” section about the disease will be presented.  Cases focus on localization and differential diagnosis more than on management of the disease process.  These lectures are not available on the student web site or the New Innovation web site, so that students will be able to hone their ability to “think like a neurologist” and work their way through the cases to come up with a final diagnosis.

  • Neurological Examination Lecture - This lecture reviews the fundamentals of how to perform a neurological examination.   Discussion includes breaking down the neuro exam into its 6 major sub-components:  Mental Status; Cranial Nerves; Motor; Sensory; Coordination; Gait. Also discussed are the strategies of how to apply the examination to localize deficits as well as how to quantify those deficits.  In addition, the concept of a “screening” neurological examination is discussed.  In the small group setting of Thursday afternoon didactics, students will be able to practice performing key parts of the examination with each other.

  • Applicable Neuroradiology Lecture - This didactic lecture (presented on the second  Thursday of each 3 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 (so prepare yourself by reviewing some neuroanatomy beforehand!)  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 Department of Neurology 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 contains important information to help guide you through your neurology clerkship. Included are the following items:

  • The Neurology Resident Rotation Schedule (to help you know who to contact for your first day of the Neurology Clerkship Rotation).
  • Contact information for Neurology Residents and Faculty.
  • The Neurological Examination document to help remind you of the fundamental components of the neurological examination.
  • A “Disease Category” approach to the differential diagnosis.
  • A chart of sensory dermatomes.
  • A list of Important Muscles to Test when evaluating the peripheral nervous system.
  • A list of major Developmental Milestones (for those rotating at Children’s Hospital).
  • NIH Stroke Scale.
  • An outline of the components for the Basic Competency:  Neurological Examination for Adults and for Children.
  • An outline for the components for the Basic Competency:  Neurological History for Adults and for Children.
  • A list of disease types that would fit into your Patient Log categories (Paroxysmal, Vascular, Neuromuscular, and Progressive/Degenerative Disorders) for both Adults and for Children.
  • Instructions on how to document your written note evaluations by your attending physician.

Direct Observation of Your Neurological Examination

After demonstrating a thorough Neurological Examination, sign in to your New Innovations page and click on the “Evaluations” tag.  From there you can send a request to the resident or attending physician who watched you perform your Neurological Examination to receive credit for completing this Basic Competency.

Evaluation of Taking a Pertinent Neurological History

After demonstrating a thorough, yet pertinent Neurological History, sign in to your New Innovations page and click on the “Evaluations” tag.  From there you can send a request to the resident or attending physician who heard your Neurological History to receive credit for completing this Basic Competency.

Student Presentations

Students are required to give at least one short presentation 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.  Documentation of your presentation will be made through your New Innovations page under the tag of “Logger”.  From there, you may send a request to the attending physician or resident who heard your presentation to receive credit for completing this clerkship requirement.                                     

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 two patients 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, and 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, Guillain-Barre Syndrome, CIDP, Charcot-Marie-Tooth, Diabetic Neuropathy, Amyotrophic Lateral Sclerosis, Traumatic or Focal Neuropathies, etc

Child Neurology examples include: Congenital Myopathies, Muscular Dystrophy, Guillain-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, etc

It would be ideal to have experience caring for patients from each of the four categories within your 3 week rotation; however, this is not always possible given the relatively short duration of this clerkship and the different clinical settings in which each of you will encounter patients.  As such, students will not be penalized if patients from each of these categories are unavailable to be seen and cared for by the student.

Documentation of your patient log is also contained within your New Innovations page under “Logger”.  Be sure to put the age and diagnosis of your patient as well as the clinical setting in which they were seen within the appropriate disease category box (Paroxysmal, Vascular, Neuromuscular, or Progressive/Degenerative disorders).

Clerkship Expectation:  Written Notes

It has come to the attention of the clerkship directors that some students may not be receiving enough attending-level feedback about their written clinical notes.  As such, each clerkship is requiring students to have at least one of their written clinical notes critically evaluated by their attending physician.  The attending physician should then provide constructive feedback directly to the student about how to improve the format and contents of their clinical note writing skills.  Dr. Deputy feels that this is a very useful exercise and is, therefore, asking that students have at least two separate clinical notes evaluated by one or more of their attending physicians during their 3 week neurology clerkship rotation.  Once an evaluation is completed and feedback given, the student should send an invitation through New Innovations to have the attending physician document that this clerkship expectation has been successfully completed.

Neurology Clerkship Evaluation

Students will be assigned a Clinical Grade for their performance on the Neurology Clerkship shortly following the end of their three week rotation based on the results on their Neurology Clerkship Evaluation. Students will be asked to send a Clinical Evaluation request to at least one attending physician that they worked with for each week of their rotation.  Thus most students will be evaluated by more than one attending physician.  Based on a blinded numerical scoring system, a final clinical grade Standard Deviation Score (SDS) will be generated for each student based on the averaged SDS’s from each of the evaluators.  Residents working with students will also fill out an evaluation of each student to provide the attending physician more feedback about each student’s clinical performance during their Neurology Clerkship rotation. Each Neurology Clerkship Evaluation covers areas in Patient Care, Medical Knowledge, Interpersonal Relationships and Communication Skills, Practice-Based Learning and Improvement, Systems Based Practice and Professional Behavior.  For each question of assessment, the rating attending physican will choose one of the following assessments:

  • Does not meet Basic Expectations for level of training
  • Meets Basic Expectations for level of training
  • Sometimes exceeds Basic Expectations for level of training
  • Frequently exceeds Basic Expectations for level of training

The following list represents the skill areas evaluated on the Clinical Evaluation as well as guidelines as to what does not meet, what meets and what exceeds Basic Expectations for level of training for each item evaluated.

Medical Knowledge

  1. Demonstrates adequate understanding of the pathophysiology and anatomic features of neurological diseases.
    1. A student who does not meet Basic Expectations for training:
      1. Cannot describe factual knowledge regarding common or simple disease processes
      2. Is unable to recall factual knowledge regarding diseases pertinent to his own patients
    2. To meet Basic Expectations for level of training, students should be able to:
      1. Describe the main clinical features expected for their patients’ diseases
      2. Broadly localize what part of the nervous system is affected by the disease (ie, cortex, spinal cord, peripheral nervous system)
    3. To exceed Basic Expectations for level of training, students should be able to:
      1. Translate the specific features of their patient’s clinical presentation and neurological deficits into known features of their disease process
      2. More specifically localize what part of the nervous system is affected by the disease process (ie cortex, subcortical structures, cerebellum, cord, plexus, nerve root, NMJ, muscle)
      3. Describe how the pathophysiology of the disease causes neurological dysfunction
         
  2. Participates regularly in activities that advance knowledge and competence
    1. A student who does not meet Basic Expectations for training:
      1. Misses conferences and other required didactic activities
      2. Attends but does not engage in required didactic activities (e.g. is otherwise occupied)
    2. To meet Basic Expectations for level of training, students should:
      1. Attend and be active participants in all required conferences and didactic lectures
    3. To exceed Basic Expectations for level of training, students should:
      1. Engage in independent reading and literature evaluation for the disease processes of their patients
      2. Bring scholarly articles to rounds and discussions about their patients
      3. Take an active role in teaching his/her teammates
      4. Give one or more topic presentations to their rounding teams

Patient Care

  1. Takes a pertinent and thorough Neurological History containing information which provides some degree of neurological localization and allows for an understanding of the chronology and severity of the disease process.
    1. A student who does not meet Basic Expectations for training:
      1. Fails to ask basic components of the history, such as the chief complaint, time course of symptoms, past medical/surgical history, medications, and allergies
      2. Is unable to organize basic data from the History of Present Illness in a coherent fashion
    2. To meet Basic Expectations for level of training, the student’s history should:
      1. Contain the patient’s chief complaint and as well as a basic history of present illness
      2. Include the clinical features of the patient’s neurological deficits
      3. Include the onset and time course of the neurological deficits
      4. Allow for a rough general localization of the disease process within the nervous system (ie. brain, spinal cord, peripheral nervous system)
    3. To exceed Basic Expectations for level of training, the student’s history should:
      1. Contain a history of present illness that is expansive for the details of the patient’s neurological symptoms
      2. Include a neurological review of systems that includes both positive and pertinent negative features
      3. Contain some information concerning the patient’s functional disability caused by their  neurological deficits
      4. Allow for a more precise localization of the disease process within the nervous system (ie cortex, subcortical structures, cerebellum, cord, plexus, nerve root, NMJ, muscle)
  1. The history contains accurate medication dosages, formulations and drug allergies
    1. A student who does not meet Basic Expectations for training:
      1. Fails to list medications or does not know the dosages of the patient’s medications
    2. To meet Basic Expectations for level of training, the student’s history should:
      1. Include all medications the patient is taking
      2. Include a list of all medications causing prior allergic reactions
    3. To exceed Basic Expectations for level of training, the student’s history should:
      1. Include a list of all medications and their respective dosages that the patient is taking including OTC medications
      2. Elucidate any side effects from the current medications that the patient is taking
      3. Include a list of all medications causing prior allergic reactions or adverse tolerance reactions
  1. Is able to demonstrate a thorough Neurological Examination that contains pertinent aspects from each of the 6 realms of the neurological exam and contains enough detail to localize the disease process.
    1. A student who does not meet Basic Expectations for training:
      1. Consistently fails to include pertinent components of the neurological examination necessary to provide localization and quantification of their patient’s deficits
      2. Is unable to adequately perform basic components of the neurological examination (such as examining pupillary function,  eliciting DTR’s, evaluating gait, etc)
    2. To meet Basic Expectations for level of training, the student’s Neurological Exam should:
      1. Mention enough details to include at least a screening evaluation for mental status, cranial nerves, motor , sensory, coordination, and gait (or whatever is appropriate for their patient)
      2. Be able to properly demonstrate neurological deficits in their patients
      3. Allow the student to generally localize neurological deficits (ie. brain, spinal cord, peripheral nervous system)
    3. To exceed Basic Expectations for level of training, the student’s Neurological Exam should:
      1. Include a basic screening neurological examination covering mental status, cranial nerves, motor, coordination, sensory and gait (or whatever is appropriate for their patient)
      2. Allow the student to more accurately localize neurological deficits (ie cortex, subcortical structures, cerebellum, cord, plexus, nerve root, NMJ, muscle)
      3. Include as well a more expanded neurological exam that quantifies the severity of the deficits
  1. Generates a pertinent Differential Diagnosis that takes into account disease localization and prioritizes the most likely diagnosis
    1. A student who does not meet Basic Expectations for training:
      1. Is unable to formulate a potential list of plausible diagnoses for simple complaints
      2. Is unable to use discriminating features of the disease process (e.g. acute vs. chronic) to determine likely disease processes
    2. To meet Basic Expectations for level of training, the student’s Differential Diagnosis should:
      1. List neurological disorders that occur within the broad localized region of the nervous system where their patient’s neurological deficits exist
      2. Include the most likely disease processes based on the history and physical examination findings
    3. To exceed Basic Expectations for level of training, the student’s Differential Diagnosis should:
      1. Apply localization based on both the neurological examination and on historical features of the disease process to the differential diagnosis
      2. Take into account the onset and time course and severity of the disease process
      3. Take into account the patient’s past medical, surgical and medication use histories
      4. Prioritize common disorders which are most likely to cause the patient’s disease process as well as those disorders considered to be neurological emergencies
  1. Develops an appropriate Diagnostic Plan specific to the unique aspects and needs of their patients
    1. A student who does not meet Basic Expectations for training:
      1. Is unable to explain the rationale for tests that are ordered
      2. Orders a long list of tests that are not pertinent to the differential diagnosis or management of the patient’s illness
    2. To meet Basic Expectations for level of training, the Diagnostic Plan should include investigations that:
      1. Pertain to those diagnoses entertained within their Differential Diagnosis
      2. Are justifiable with results that will alter the diagnosis or management of the disease process and not be obtained “just to get a baseline”
    3. To exceed Basic Expectations for level of training, the Diagnostic Plan should include investigations that:
      1. Pertain to the most likely diagnoses within their Differential Diagnosis
      2. Are justified by the patient’s clinical presentation and do not include superfluous investigations that are likely to be normal or not directly affect patient care
      3. The results of which can be interpreted correctly by the student as they pertain to their patient’s disease process
  1. Develops an appropriate Treatment Plan specific to their patient’s illness
    1. A student who does not meet Basic Expectations for training:
      1. Fails to develop a basic plan for treatment based on the patient’s condition
      2. Does not understand the rationale for their patients’ treatment plans
    2. To meet Basic Expectations for level of training, the Treatment Plan should:
      1. Positively affect the outcome of the patient’s disease process
      2. Be understood by the student as to the expected benefits and risks associated with the treatment
    3. To exceed Basic Expectations for level of training, the Treatment Plan should:
      1. Be understood by the student and justified by available literature or standard of care arguments
      2. Include alternative options for treatment that can be weighed against one another with regards to cost, benefits and risks
      3. Include appropriate monitoring and follow up for the patient to assess risks and benefits
         
  2. Provides effective care with respect to the patient’s psychosociallevel of functioning and their cultural beliefs
    1. A student who does not meet Basic Expectations for training:
      1. Is insensitive to or does not accept the cultures or backgrounds of patients
      2. Fails to consider a patient’s cultural beliefs when providing care
    2. To meet Basic Expectations for level of training, Care Plans should:
      1. Include treatment options that individuals will most likely be able to comply with based on cultural or religious beliefs
      2. Be sensitive to the patient’s culture, sexual orientation and religious belief system
    3. To exceed Basic Expectations for level of training, Care Plans should:
      1. Include treatment options that are considerate for the patient’s  medical compliance (eg. frequency of treatments, need for follow up, ability to pay for prescribed medications, etc)
      2. Be explained to the patient in a way that is commensurate with the patient’s level of medical sophistication and understanding
      3. Allow patients to question the treatment plan and provide answers to those questions

Interpersonal Relationships and Communication

  1. Clearly and accurately presents patients' findings to team members
    1. A student who does not meet Basic Expectations for training:
      1. Is frequently unaware of pertinent aspects of their patients’ diagnostic workup
      2. Is frequently unaware of their patient’s current clinical status
    2. To meet Basic Expectations for level of training, students should:
      1. Have a thorough understanding of their patients’ current clinical status
      2. Be able to provide the results of all diagnostic testing obtained on their patients to the treating team
      3. Be able to provide details of their patients’ neurological examinations
    3. To exceed Basic Expectations for level of training, students should:
      1. Be organized in presenting patient findings, pointing out pertinent abnormal and normal results from diagnostic evaluations
      2. Present their patients’ neurological examination and deficits in a systemic and quantitative fashion
         
  2. Maintains clear, complete, accurate, timely and legible medical records
    1. A student who does not meet Basic Expectations for training:
      1. Does not complete daily notes within the time frame set forth by expectations
      2. Does not address the patient’s primary problem on the medical record
      3. Does not follow the expected order of providing information on the medical record (e.g. SOAP note, etc)
      4. Provides inaccurate details of their patient’s clinical findings or diagnostic workup.
      5. Provides inaccurate information concerning their patient’s care (diagnostic studies, vitals, examination findings, medications and dosages) on the medical record
    2. To meet Basic Expectations for level of training, student progress notes should:
      1. Contain a daily general and neurological examination on each patient being followed
      2. Contain the results of diagnostic evaluations and current medications
      3. Consist of legible writing
    3. To exceed Basic Expectations for level of training, student progress notes should:
      1. Accurately define and quantify neurological deficits found in their patients
      2. List the results of diagnostic evaluations for their patients
      3. Suggest treatment plans for their patients
         
  3. Shows empathy and respect to patients and their families
    1. A student who does not meet Basic Expectations for training:
      1. Demonstrates insensitivity or rudeness when speaking to a patient or a family
      2. Openly shows bias or prejudice against a patient or family
      3. Ignores or minimizes a patient’s or family’s concerns
    2. To meet Basic Expectations for level of training, students should:
      1. Acknowledge their patients’ concerns regarding their treatment
      2. Demonstrates sensitivity and courtesy when speaking to a patient or family
    3. To exceed Basic Expectations for level of training, students should:
      1. Directly communicate treatment plans to patients and their families
      2. Be available to directly answer their patients’ questions in an empathetic way
      3. Demonstrate an understanding for the burden that their patients’ disease process plays in their personal lives and seeks to alleviate that burden

Practice Based Learning and Improvement

  1. Uses evidence from practice guidelines and scientific studies to develop appropriate diagnostic and treatment plans
    1. A student who does not meet Basic Expectations for training:
      1. Is unable to identify potential sources of information regarding patient care
      2. Is unable to identify gaps in one’s own knowledge in order to guide further inquiry
    2. To meet basic expectations for level of training, students should:
      1. Can identify and search potential sources of reliable information (such as “Up to Date”, “E-Medicine”, “MD Consult” etc.) regarding their patients’ conditions and treatment plans when directed to do so
      2. Identifies gaps in one’s own knowledge in order to guide further inquiry
    3. To exceed basic expectations for level of training, students should:
      1. Can identify and search for more specific articles directed towards their patient’s disease process (such as practice parameters or pivotal studies) independently on their own volition
      2. Is able to identify characteristics of studies and guidelines that suggest reliability or a lack of applicability to their patients
         
  2. Shows an eagerness to learn, identifying their own questions and reviewing the literature concerning their patients’ illness
    1. A student who does not meet Basic Expectations for training:
      1. Does not read about their own patient’s conditions
      2. Is not concerned with their own lack of knowledge concerning their patients’ conditions
    2. Tomeet basic expectations for level of training, students should:
      1. Read background information (e.g. textbooks or review articles contained within “MD Consult”, “E-Medicine”, “Up-to –Date”) about their patient’s conditions
      2. Identifies questions that need to be answered before determining a plan of care
    3. To exceed basic expectations for level of training, students should:
      1. Use their own initiatives including background (e.g. textbook and review articles) and foreground (e.g. evidence-based literature, pivotal trial articles, and guidelines) to review the relevant literature concerning their patients’ disease processes
      2. Develop their own independent questions about the care of their patients to guide reading and literature searches
      3. Spontaneously share what they have discovered during rounds or clinic patient presentations

Once the Clinical Evaluation is completed, a numerical score is generated based on the score for each item evaluated. This score is compared with the evaluator’s ongoing mean and standard deviation of scores to develop a Standard Deviation Score (SDS).  If there are more than one attending physician evaluating an individual student, then the SDS scores will be averaged to provide a final SDS score. A Clinical Grade for the Neurology Clerkship will then be assigned to each student based on the SDS score as follows:

 
Honors: SDS score is greater than +0.50 SD’s above the mean 
High Pass:  SDS score is between (and includes) -0.50 SD’s below the mean and +0.50 SD above the mean       
Pass:  SDS score is between (and includes) -2 SD’s below the mean and less than -0.5 SD’s below the mean      
Fail (requiring remediation):  Score is below -2SD’s below the mean

Students 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.

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 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). The SHELF examination will be given on the last Friday of each 3-week Neurology Clerkship rotation.

Passing SHELF scores will be translated into a Written Examination Grade for the course based on the the mean SHELF score and Standard Deviation derived from all US medical schools with a 3 week neurology clerkship from the previous academic year. For example, during the 2012-2013 year, the national mean was 76.3 with a standard deviation of 8.2.  As such, each student will be assigned a SDS score based on the SHELF score.  The Written Examination Grade will be scored as follows:

Honors:  SDS score is greater than +0.5 SD’s above the mean  
High Pass: SDS score is between (and includes) -0.5 SD below the mean and +0.5 SD’s above the mean           
Pass:  Total SHELF score is above (and includes) 59 and the SDS score is less than -0.5 below the mean           
Fail:  Total SHELF Score is less than 59

Final Clerkship Grade

Each student will receive a Final Assigned Grade for their Neurology Clerkship based on a the average of their Clinical and their Written Examination SDS scores. 

Honors:  Averaged SDS scores > +0.5
High Pass:  Averaged SDS scores between (and including)  -0.5 and +0.5
Pass:  Averaged SDS scores between – 2 and – 0.5
Fail:  Averaged SDS scores <  -2 or a Clinical SDS of  < -2.  A failing SHELF score of < 59 along with a passing or better Clinical grade will prompt a repeat attempt to pass the SHELF at the end of the junior year.  If the student is unable to score a passing grade on the SHELF examination despite repeated attempts (LSU School of Medicine Policy), he/she will fail the course.  Finally, a fail grade is possible if the student engages in unprofessional behavior that cannot be rectified per the Clerkship Director’s discretion.

Clerkship Student Feedback

Students will be asked to evaluate their residents and attending physicians at the end of the rotation through New Innovations. Other feedback for the Neurology Clerkship will be sought, including how useful the didactic lectures were, suggested changes to the Neurology Clerkship and how well various aspects of the clerkship prepared the student for the Shelf Exam. This feedback is extremely valuable and provides the rationale for future change to the course. Feedback is anonymous and has no effect on a student’s final grade.

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. Students using EMR systems must be trained in their use and document notes per hospital protocol.

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: Robin English, MD, Director of Clinical Sciences Curriculum, Joseph Delcarpio, PhD, Associate Dean for Student Affairs, Fred Lopez, MD, Assistant Dean for Student Affairs, or Richard DiCarlo, MD, Assistant Dean for Undergraduate Medical Education”

Student Leave Policy during the Junior Neurology Clerkship

The official Student Leave Policy during the Junior Neurology Clerkship essentially states that students should try to minimize absences during required clerkships.  During this relatively short 3 week rotation, you will be allowed no more than 2 days off for  excused personal absences. It is expected that you inform your resident as well as other students on the team of any planned absence so that your patient care duties can be covered.  You must also inform the Clerkship Coordinator as well as the Clerkship Director in writing (by email) of your planned absences at the beginning of the 3 week block and receive permission to take said absence; otherwise it will be considered unexcused.  Unexcused absences may be grounds for failing or repeating the clerkship.  In the event a student needs to take more than 2 days off for personal matters, this student will generally need to make up extra time within the clerkship at the Clerkship Director’s discretion.  The LSUHSC policy regarding absences from Junior Clerkships is listed below:          

“Policies and Guidelines Regarding Absences from Junior Clerkships Adopted by the Ad Hoc Curriculum Oversight Committee 2/27/07”

We understand that situations may arise when a student will need to request absence from daily responsibilities on a required clerkship in the junior year for a brief period of time.  The school has adopted the guidelines listed below to give you insight as to what might be considered an acceptable request.  Note that these are institutional guidelines and some of the clerkships may have more specific policies.   

All requests for leave must be presented to the Clerkship Director; it is your responsibility to make certain that they are approved.  Recognize that some clerkships are shorter than others, making absences for non-emergencies unacceptable.  

1) Emergent Absence: The Clerkship Director should be notified as soon as possible.

Illness:  Your illness will be excused.  An excuse from your physician must be provided if you are out for 2 days or more.  Serious illness of a family member may be an acceptable reason for leave depending on the circumstances.  Leaves of more than two days will require remediation prior to completion of the clerkship.

Funeral Leave:  The death of immediate family members which include spouse, child, parents, grandparents or siblings will be excused.  Other funeral leave may be acceptable depending on the circumstances.  Leave of more than two days will require remediation prior to completion of the clerkship.

2) Non-emergent Absence:  Clerkship Directors must be asked about these absences prior to the start of the clerkship.

Wedding:  Requests for leave may be considered if the student is part of the wedding ceremony.  Requests of this type must be made in writing or via e-mail prior to the start of the clerkship.  Some of the required clerkships may not approve these requests.  Leave of more than two days will require remediation prior to completion of the clerkship.

Educational leave or School Business: Students may be asked to participate in conferences to present research findings or to represent the school at local or national meetings.  Requests of this type must be made in writing or via e-mail prior to the start of the clerkship.  Some of the required clerkships may not approve these requests if others can represent you or the school.  Leave of more than two days will require remediation prior to completion of the clerkship.

Extenuating circumstances may arise which do not fall in the categories as listed above.  As stated above, all requests should be made to the clerkship director.  Over the course of the clerkship, leave totaling more than two days may require remediation prior to completion of the clerkship.  Remediation may involve additional call nights, additional weekend responsibilities or clinical work on days normally set aside for shelf exam preparation.  Sufficient remediation will be established at the discretion of the clerkship director.  Additionally, absences for non-emergencies may be reflected in the evaluation of your work habits or professionalism.”