REQUIRED CLERKSHIP:

Sponsoring Department or Unit: Neurology

Duration:     Number of weeks:       4                     ...
Rds./Week                            10          10

 Patients Studied by Clerks
Number New Workups Per               Avg....
4. The student will describe the imaging methods commonly employed in
      the field of Neurology, particularly MRI and C...
15.The student will list and describe common gait disorders including
      Parkinson’s Disease, Normal Pressure Hydroceph...
The guides that we use to determine if clerkship objectives are being met
include:

   1. The students’ ability to present...
sessions in Pediatric Neurology. The students at the VAMC attend
       weekly brain cutting sessions.



   b. What perce...
1. structured and unstructured observations of the students by attending
      faculty (on the wards and in the outpatient...
Education will be appointed who will serve in the capacities of both Clerkship
Director and Residency Director.

List reco...
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  1. 1. REQUIRED CLERKSHIP: Sponsoring Department or Unit: Neurology Duration: Number of weeks: 4 Offered in: (X) Year 3 ( ) Year 4 Teaching Sites Used for Clerkships HospitalUniversityGeorgetown VAMC Name Teaching Sites: Resources Hospital Daily Bed Census, or Bed:1 Bed: Average Number of Daily Visits 0; 12; (for Ambulatory Sites) daily daily visits: visits: 40 30 Number of Students Per 8 6 Rotation Percent of Class Each Rotation ~8% total (at both sites) Number of Faculty Per 9 6 Rotation Number of Residents Per 4 6 Rotation Education Program No. of Lecture Hours Per Week Avg. 4 Avg. 4 No. of Conference Hours Per Avg. 5 Avg. 5 Week No. Hrs. Faculty Teaching Avg. Avg. IV. EDUCATIONAL PROGRAM FOR THE M.D. DEGREE: REQUIRED CLERKSHIP FORM – Page 1
  2. 2. Rds./Week 10 10 Patients Studied by Clerks Number New Workups Per Avg. 4 Avg. 2 Week Number of “Established” Avg. 6 Avg. 4 Patients Followed Per Week Student’s Workup and Both Both Presentation Reviewed/Corrected by Faculty (F) Or Resident (R)? Is Patient Log Kept/Reviewed Y Y to Assure Adequate Patient Number/Mix? (Y/N?) Objectives: Briefly state the objectives of the clerkship in terms of the scope of clinical experience and the expected learning outcomes for knowledge, skills, behaviors, and attitudes, and indicate how these are communicated to students. 1. The student will demonstrate how to obtain a history of neurological disorders including the onset and progression of symptoms, the presence or absence of associated relevant symptoms, and a thorough past medical history. 2. The student will demonstrate how to perform a thorough neurologic examination, including the following components: • Mini-Mental Status • Evaluation of affect and the presence of a thought disorder • Evaluation of language • Cranial nerve function including vision, ocular motility, facial movement and sensation, cervical muscle function, shoulder shrug and tongue movement • Motor examination including strength, tone and bulk • Deep tendon reflexes • Cortical and primary sensation • Gait 3. The student will demonstrate the ability to assign localization of the lesion for patients presenting with a specific neurologic symptom, and will be able to demonstrate that knowledge and ability in the acute clinical setting. IV. EDUCATIONAL PROGRAM FOR THE M.D. DEGREE: REQUIRED CLERKSHIP FORM – Page 2
  3. 3. 4. The student will describe the imaging methods commonly employed in the field of Neurology, particularly MRI and CT scanning. S/he will be able to demonstrate understanding of the anatomy and the imaging findings in common disorders including tumors, stroke and demyelinating diseases. S/he will be able to identify patterns of abnormality on imaging studies including enhancement of lesions and the presence of hemorrhage. 5. The student will discuss the mechanisms of ischemic and hemorrhagic stroke including risk factors and clinical presentation. The student will discuss the management of acute stroke and associated co- morbidities. 6. The student will describe the differences between an axonal versus a demyelinating peripheral neuropathy with respect to pathophysiology, clinical presentation, and different patterns of response on EMG and nerve conduction studies. 7. The student will list the common causes of peripheral neuropathy and the appropriate treatments, including pain medication. 8. The student will describe the pathophysiology of seizures, and will list the causes of congenital versus acquired seizures. 9. The student will list the commonly used anticonvulsants and recite the doses and commonly encountered side effects. 10.The student will describe the pathyphysiology of migraine and its ictal and interictal components. 11.The student will list the common causes of headache and their clinical presentation. 12.The student will list the medications commonly used to treat migraine including abortives, prophylactic and analgesics. 13.The student will describe the pathophysiology and treatment of Alzheimer’s Disease. 14.The student will describe the clinical presentation of Alzheimer’s Disease and differentiate it from other dementing illnesses. IV. EDUCATIONAL PROGRAM FOR THE M.D. DEGREE: REQUIRED CLERKSHIP FORM – Page 3
  4. 4. 15.The student will list and describe common gait disorders including Parkinson’s Disease, Normal Pressure Hydrocephalus, and ataxia. S/he will describe the pathophysiology of these mechanisms, their clinical manifestations, diagnostic evaluations, and treatments. 16.The student will describe other common features of Parkinson’s Disease and discuss the medical and surgical interventions available. 17.The student will discuss the pathophysiology of Multiple Sclerosis and the medical therapy available for MS, including immunomodulatory agents and steroids for acute exacerbations. 18.The student will discuss the approach to management of the patient with acute non-ocular visual loss, including the imaging modality that should be employed. 19.The student will list the common causes of dizziness, the clinical manifestations of each cause, the typical findings on neurologic examination, and the treatments available. 20.The student will describe the pathyophysiology of myasthenia gravis and the common clinical presentations of MG. S/he will list the surgical and non-surgical treatment modalities for MG. 21.The student will describe normal sleep architecture and common disorders of sleep. S/he will discuss the clinical presentations of these and treatment modalities available for each. 22.The student will describe different patterns of language impairment, particularly anterior vs. posterior aphasias. Describe the criteria for establishing the types of patients and clinical conditions, level of student responsibility, and clinical settings necessary to accomplish the clerkship's educational objectives. The types of patients and clinical conditions necessary to accomplish clerkship objectives are in accordance with the parameters of the Clerkship Subcommittee of the American Academy of Neurology. Based on the clinical conditions of the patients we require the students to see, it is necessary for the students to rotate through both the inpatient services, where time is spent on the wards and on consults, and in the outpatient clinics. How do you determine that the objectives are being achieved? IV. EDUCATIONAL PROGRAM FOR THE M.D. DEGREE: REQUIRED CLERKSHIP FORM – Page 4
  5. 5. The guides that we use to determine if clerkship objectives are being met include: 1. The students’ ability to present a neurological patient with all the pertinent aspects of the history and physical examination. 2. The ability of the students to generate an appropriate localization of the neurological process. 3. The ability of the students to generate a comprehensive differential diagnosis incorporating different mechanisms of disease affecting the neurological system. 4. The ability of the students to recognize general patterns of neurologic disease, i.e. movement disorders vs. stroke vs. progressive impairment from slowly expanding lesions. 5. The expertise with which the students performs a supervised neurological physical examination prior to the completion of the clerkship. 6. The ability of the students to interpret neuroimaging studies at a basic level, primarily with respect to the location and general type of abnormalities (ie, infarct vs. tumor). 7. The ability of the students to discuss and understand the initiation of neurological evaluation including obtaining pertinent tests. 8. The ability of the students to understand and participate in treatment of patients employing medications or recommendation for surgery. 9. The performance of the students as a whole on the written examination. Internal Clerkship Structure: a. Describe the length and location of any required rotations or special activities within the clerkship (e.g., a one-week NICU rotation at the Children’s Hospital in the pediatric clerkship, or a Tuesday afternoon “back to basic sciences” session at the main campus in the surgery clerkship.) The GUH and VAMC students all attend as a group a didactic lecture series covering the main topics of clinical neurology and neuro- imaging. The students at Georgetown also attend weekly clinical IV. EDUCATIONAL PROGRAM FOR THE M.D. DEGREE: REQUIRED CLERKSHIP FORM – Page 5
  6. 6. sessions in Pediatric Neurology. The students at the VAMC attend weekly brain cutting sessions. b. What percentage of the clerkship as a whole takes place in ambulatory settings? Currently 25% of the clerkship is in the ambulatory setting; this figure may be increased to 50% for the 2002-2003 academic year. Evaluation of Clinical Clerks: Mid-clerkship evaluation and feedback: Briefly describe the method of mid-clerkship evaluation of students. There is not at this time a formal method for evaluating students in mid- clerkship. Students are critiqued on their presentations and clinical performance as the month progresses. Indicate percent composition of clerk's final grade (should sum to 100%): NBME Other Subje Internally- Oral Faculty/Resi OSCE/Standard (descri ct Written Exam dent ized Patient be Exam Exams s Observation Exam below* ) 20% 80% *Other methods noted above: If NBME subject “shelf” exams are used, give mean scores for the last three classes: NA Year: 20___ 20___ 20___ Mean Score Describe how you assure that each student achieves satisfactory clinical proficiency. Identify the methods employed, including structured and unstructured observations by attending faculty and residents, standardized patients-objective structured clinical examination (OSCE), patient-management problems or simulations, CBX, etc. Is each student observed taking a history and examining a patient? Clinical proficiency of the students is assured by IV. EDUCATIONAL PROGRAM FOR THE M.D. DEGREE: REQUIRED CLERKSHIP FORM – Page 6
  7. 7. 1. structured and unstructured observations of the students by attending faculty (on the wards and in the outpatient clinics) and residents 2. student presentations at Morning Report 3. review of chart notes 4. Mandatory observation of the student as s/he performs a full neurological assessment including obtaining the history from a live patient and performing the neurological examination. Is a narrative description of each student's clinical skills included with the final grade? X Yes No Who gives final review/approval of the composite evaluation of each clerk? (Give name and title): Clerkship Director Clerkship evaluation: State what methods are used to assess clerkship quality, including peer and student feedback and measures of student and graduate achievement. The students complete a detailed questionnaire each month commenting on the content and structure of the clerkship, the individual lecturers in the didactic lecture series, and individual attending faculty and residents. Adjustments are made to clerkship curriculum and structure based on the questionnaire results. Give a critique of the clerkship in terms of scope of experience and teaching/learning methods; mention any deficiencies; and state how improvements can be made. The clerkship as it is currently structured allows students to see a broad variety of patients in a variety of clinical settings. The didactic lecture series is comprehensive. Student feedback is generally favorable. Increased administrative support would help to improve factors such as getting feedback from the student questionnaires to the attending faculty and speeding the process of obtaining and disseminating student grades. Integration of the student educational experience with that of the resident educational experience would also improve the clerkship; this will be accomplished in the upcoming academic year when a department Director of IV. EDUCATIONAL PROGRAM FOR THE M.D. DEGREE: REQUIRED CLERKSHIP FORM – Page 7
  8. 8. Education will be appointed who will serve in the capacities of both Clerkship Director and Residency Director. List recommended or required learning materials (textbooks, databases, Web sites, etc.): The required textbook is “Clinical neurology”, 3rd edition by Aminoff, Greenberg and Simon (Appleton and Lange, 1996 – new edition forthcoming). The students also are encouraged to use and have access in the Medical School library to a number of optional textbooks. Numerous journals are available in the departmental library and medical school library. On-line literature searches are available in the departmental library; all students have access to the Internet via this computer. IV. EDUCATIONAL PROGRAM FOR THE M.D. DEGREE: REQUIRED CLERKSHIP FORM – Page 8

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