Senior Clinical Neurosciences Clerkship Passport
Welcome to the LSU School of Medicine Clinical Neurosciences Clerkship. T...
Student Name/Clerkship Block:_____________________________________________
Basic Competencies: Senior Clinical Neuroscienc...
Student Name/Clerkship Block:_____________________________________________
Basic Competencies: Senior Clinical Neuroscienc...
Student Name/Clerkship Block:_____________________________________________
Basic Competencies: Senior Clinical Neuroscienc...
Student Name/Clerkship Block:_____________________________________________
Basic Competencies: Senior Clinical Neuroscienc...
Signed:__________________________________________________________
Printed Name/Title:_____________________________________...
Signed:__________________________________________________________
Printed Name/Title:_____________________________________...
I observed this student perform this skill and attest that he/she met the specified criteria
Signed:______________________...
Resident/Faculty Signature:______________________________________________
3) Date: ___________ Age/Diagnosis of Patient:__...
Paroxysmal: (Headaches, Seizures, Epilepsy Management, Myotonia or other
“Channelopathies”, etc.)
Vascular: (Childhood Str...
Student Name:_______________________________________________________________
Patient Log
Paroxysmal Disorders:
Age/Diagnos...
1)__________________________________ ______________________________
2)__________________________________ _________________...
3) Date:__________ Topic Covered:_________________________________________
Resident/Faculty Comments:
Resident/Faculty Sig...
II. Physical Examination
Does the student’s physical examination contain the following:
• An adequate general medical exam...
• Does the student demonstrate an adequate understanding of healthcare systems (government
vs 3rd
party payment systems, j...
Narrative comments concerning the student’s overall performance during the
Clinical Neurosciences Clerkship:
Student Name:...
will fail this clerkship. Also, unprofessional or unethical conduct during the rotation may result in course failure.
Stud...
II. Physical Examination
Does the student’s physical examination contain the following:
• An adequate general medical exam...
• Does the student demonstrate an adequate understanding of healthcare systems (government
vs 3rd
party payment systems, j...
Narrative comments concerning the student’s overall performance during the
Clinical Neurosciences Clerkship:
Student Name:...
will fail this clerkship. Also, unprofessional or unethical conduct during the rotation may result in course failure.
Stud...
Use the following section to describe those aspects of your clerkship experience (Clinical Experience,
Bedside Teaching, F...
Note: Your feedback is extremely important and will allow us to continually update and adjust different
aspects of the Cli...
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Neuroscience Passport

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Neuroscience Passport

  1. 1. Senior Clinical Neurosciences Clerkship Passport Welcome to the LSU School of Medicine Clinical Neurosciences Clerkship. There are two neurology clerkships during this “overlap year”; a Junior Neurology Clerkship which lasts two weeks and is incorporated into the Medicine Clerkship and a Senior Clinical Neurosciences Clerkship which will be phased out following the 2010-2011 academic year. This Passport is for the Senior Clinical Neurosciences Clerkship. Students rotating on the required Senior Neurosciences Clerkship are required to do 2 weeks of Neurology (or Child Neurology) as well as 2 weeks of Neurosurgery (unless they are rotating in Baton Rouge. In that case, these students will do all four weeks of adult neurology with Dr Barkemeyer). Final grades for the clerkship will be based on a combination of your scores on the two Clinical Skills Narrative Evaluations and your score on the USMLE Subject Examination in Neurology (SHELF Exam). The Clinical Neurosciences Passport (or just “Passport” from here forward) for this last year of the senior clerkship contains the necessary paperwork to document Basic Competencies in taking a pertinent neurological (or neurosurgical) history and in performing a neurological examination (as well as a neurosurgical examination), a Procedure form, a Student Presentation form, a Patient Log, two copies of your Student Narrative Evaluation forms (one for the 1st two weeks of the clerkship and one for the 2nd two weeks of the clerkship), and finally, a Student Feedback about the Senior Neurosciences Clerkship form. Further information about the Passport is contained within the “Duties of Students” handout. Each student, upon completing their Clinical Neurosciences coursework, will be required to turn in their Passport (along with both of their Clinical Skills Narrative Evaluation Forms) to the Clerkship Coordinator in the Neurology Department on the day of the written examination. Students who do not turn in their Passport will not be able to take the written examination and will not be able to receive credit for completing their Clinical Neurosciences Clerkship. Lost or misplaced Passports will be dealt with on an individual basis with the Clinical Neurosciences Clerkship Director. The following sections are included in the Passport: I. Neurological History Taking Competency Forms II. Neurological Examination Competency Forms III. Direct Observation of Procedures Form IV. Patient Log V. Student Presentations VI. Clinical Skills Narrative Evaluation Forms VII. Clerkship Student Feedback
  2. 2. Student Name/Clerkship Block:_____________________________________________ Basic Competencies: Senior Clinical Neurosciences Clerkship Adult Neurology Pertinent History Taking Skills Minimum Criteria: • The history contains enough information to begin the process of localization • The history contains enough information to gain an understanding of the chronology and severity of the disease process • Information is obtained concerning psychosocial functioning of the patient as it pertains to his/her illness • Medication dosages and allergies are accurately listed Overall Student Competence (circle one): Above Average Satisfactory Unacceptable (needs to be repeated) I observed this student perform this skill and attest that he/she met the specified criteria Signed:__________________________________________________________ Printed Name/Title:________________________________________________
  3. 3. Student Name/Clerkship Block:_____________________________________________ Basic Competencies: Senior Clinical Neurosciences Clerkship Neurosurgery Pertinent History Taking Skills Minimum Criteria: • The history contains enough information to begin the process of localization • The history contains enough information to gain an understanding of the chronology and severity of the disease process • The history contains enough information to help with triage decisions concerning the timing for surgical intervention (when indicated) • Information is obtained concerning psychosocial functioning of the patient as it pertains to his/her illness • Medication dosages and allergies are accurately listed Overall Student Competence (circle one): Above Average Satisfactory Unacceptable (needs to be repeated) I observed this student perform this skill and attest that he/she met the specified criteria Signed:__________________________________________________________ Printed Name/Title:________________________________________________
  4. 4. Student Name/Clerkship Block:_____________________________________________ Basic Competencies: Senior Clinical Neurosciences Clerkship Child Neurology Pertinent History Taking Skills Minimum Criteria: • The history contains enough information to begin the process of localization • The history contains enough information to gain an understanding of the chronology and severity of the disease process • A thorough developmental history/school performance history is identified • Medication dosages and allergies are accurately listed Overall Student Competence (circle one): Above Average Satisfactory Unacceptable (needs to be repeated) I observed this student perform this skill and attest that he/she met the specified criteria Signed:__________________________________________________________ Printed Name/Title:________________________________________________
  5. 5. Student Name/Clerkship Block:_____________________________________________ Basic Competencies: Senior Clinical Neurosciences Clerkship Adult Neurology: Neurological Examination Skills Minimum Criteria: • The Neurological Examination demonstrates completeness by: o Containing components from each of the six sub-sets of the neuro exam (mental status, cranial nerves, motor, sensory, coordination and gait) • Application of the Neurological Examination by: o Correctly interpreting normal and abnormal findings to aid in localization of the disease process o Use of the neurological examination to quantify the severity of any neurological deficits identified • Professionalism o The approach to the patient during the examination shows respect for the patient’s privacy and dignity Overall Student Competence (circle one): Above Average Satisfactory Unacceptable (needs to be repeated) I observed this student perform this skill and attest that he/she met the specified criteria
  6. 6. Signed:__________________________________________________________ Printed Name/Title:________________________________________________ Student Name/Clerkship Block:_____________________________________________ Basic Competencies: Senior Clinical Neurosciences Clerkship Neurosurgery: Neurological Examination Skills Minimum Criteria: • The Neurological Examination demonstrates completeness by: o Containing components from each of the six sub-sets of the neuro exam (mental status, cranial nerves, motor, sensory, coordination and gait) • Application of the Neurological Examination by: o Correctly interpreting normal and abnormal findings to aid in localization of the disease process o Use of the neurological examination to quantify the severity of any neurological deficits identified • Professionalism o The approach to the patient during the examination shows respect for the patient’s privacy and dignity Overall Student Competence (circle one): Above Average Satisfactory Unacceptable (needs to be repeated) I observed this student perform this skill and attest that he/she met the specified criteria
  7. 7. Signed:__________________________________________________________ Printed Name/Title:______________________________________________________ Student Name/Clerkship Block:_____________________________________________ Basic Competencies: Senior Clinical Neurosciences Clerkship Child Neurology: Neurological Examination Skills Minimum Criteria: • The Neurological Examination demonstrates completeness by: o Containing components from each of the six sub-sets of the neuro exam (mental status, cranial nerves, motor, sensory, coordination and gait), even if just by observation o Pertinent “non-neurological” aspects of the examination are demonstrated (head circumference, dysmorphic features, cutaneous findings, etc) • Application of the Neurological Examination by: o Correctly interpreting normal and abnormal findings in an age-specific fashion o Use of the neurological examination to aid in localization of the disease process • Professionalism o The approach to the patient shows courtesy and respect for the child’s modesty and parental concerns Overall Student Competence (circle one): Above Average Satisfactory Unacceptable (needs to be repeated)
  8. 8. I observed this student perform this skill and attest that he/she met the specified criteria Signed:__________________________________________________________ Printed Name/Title:________________________________________________ Student name:__________________________________________________ Direct Observation of Lumbar Puncture or Other Procedure 1) Date: ___________ Age/Diagnosis of Patient:___________________________________ Type of Procedure:_______________________________________________ Consent Obtained?___________ Resident/Faculty Comments: Resident/Faculty Signature:______________________________________________ 2) Date: ___________ Age/Diagnosis of Patient:___________________________________ Type of Procedure:_______________________________________________ Consent Obtained?___________ Resident/Faculty Comments:
  9. 9. Resident/Faculty Signature:______________________________________________ 3) Date: ___________ Age/Diagnosis of Patient:___________________________________ Type of Procedure:_______________________________________________ Consent Obtained?___________ Resident/Faculty Comments: Resident/Faculty Signature:______________________________________________ Patient Log During your Senior Neurosciences Clerkship, each student should have significant patient contact with at least two patients from the following categories: Paroxysmal, Vascular, Neuromuscular, and Progressive/Degenerative diseases. Within each of your rotations during the Clinical Neurosciences Clerkship, please document your involvement with patients from each of the categories. Examples of these different categories for each rotation are provided to help you accomplish this task. Please document the age and diagnosis of each patient and the setting of your encounter (specifically, clinic visit, inpatient ward, ICU, or surgical intervention). Neurosurgery: Paroxysmal: (Headaches or Seizures due to tumors, vascular malformations, cerebral hemorrhage, or trauma) Vascular: (Aneurysms, AVM’s, Subarachnoid Hemorrhage, Cerebral Hemorrhage, Decompressive Craniectomy following CVA, etc.) Neuromuscular: (Degenerative Disc Disease causing radiculopathy or myelopathy, Spinal Stenosis, Degenerative Lumbar Spondylolisthesis, etc.) Progressive/Degenerative: (Essential Tremor, Parkinson’s Disease, or Dystonia being evaluated for deep brain stimulation, Normal Pressure Hydrocephalus, Brain Tumors, etc.) Child Neurology:
  10. 10. Paroxysmal: (Headaches, Seizures, Epilepsy Management, Myotonia or other “Channelopathies”, etc.) Vascular: (Childhood Stroke, Neonatal Intraventricular Hemorrhge or Periventricular Leukomalacia, Hypoxic-Ischemic Encephalopathy, etc.) Neuromuscular: (Congenital Myopathies, Muscular Dystrophy, Guillan-Barre Syndrome, Spinal Muscular Atrophy, Charcot-Marie-Tooth Disease, Myasthenia Gravis, Erb’s Palsy, etc.) Progressive/Degenerative: (Leukodystrophy, Neurodegenerative Disorders, Metabolic Disorders, Coma, Brain Tumors, etc.) Adult Neurology: Paroxysmal: (Headaches, Seizures, Epilepsy Management, “Channelopathies”, etc.) Vascular: (Stroke, Hypertensive Encephalopathy, Hypoxic-Ischemic Encephalopathy, etc.) Neuromuscular: (Myopathies, Guillan-Barre Syndrome, CIDP, Charcot-Marie-Tooth, Diabetic Neuropathy, Amyotrophic Lateral Sclerosis, Traumatic Neuropathies, etc.) Progressive/Degenerative: (Alzheimer’s Disease and other Dementia’s, Huntington’s Disease, Parkinson’s Disease, Vascular Dementia, etc.)
  11. 11. Student Name:_______________________________________________________________ Patient Log Paroxysmal Disorders: Age/Diagnosis Setting of Contact 1)__________________________________ ______________________________ 2)__________________________________ ______________________________ Vascular Disorders: Age/Diagnosis Setting of Contact 1)__________________________________ ______________________________ 2)__________________________________ ______________________________ Neuromuscular Disorders: Age/Diagnosis Setting of Contact
  12. 12. 1)__________________________________ ______________________________ 2)__________________________________ ______________________________ Progressive/Degenerative Disorders: Age/Diagnosis Setting of Contact 1)__________________________________ ______________________________ 2)__________________________________ ______________________________ Student Name:____________________________________________________________________ Student Presentations Students are generally encouraged to volunteer to give short presentations about the disorders that their patients are experiencing as a way to “bring something to the table” and demonstrate independent learning and “Management/Educator” properties on the “RIME” grading system. Please list any presentations that you are able to share with your rounding team, a resident or attending physician. 1) Date:___________ Topic Covered:________________________________________ Resident/Faculty Comments: Resident/Faculty Signature:____________________________________________ 2) Date:__________ Topic Covered:_________________________________________ Resident/Faculty Comments: Resident/Faculty Signature:__________________________________________
  13. 13. 3) Date:__________ Topic Covered:_________________________________________ Resident/Faculty Comments: Resident/Faculty Signature:____________________________________________ Student Name_________________________________________________________ Student Clinical Skills Narrative Evaluation Form (First Two-Week Rotation) Rotation: Neurology (West Jeff) Neurology (Baptist) Neurology (University) Neurology (Ochsner) Neurosurgery (University) Neurosurgery (West Jeff) Pediatric Neurology Block Number_______________ Dates of Rotation_______________________ Name/Title of Evaluator___________________________________________________ Core Competency Minimal Criteria Rating A=Above Average S=Satisfactory U=Unacceptable Patient Care I. Neurological History Does the historical information obtained from the student provide adequate information for the following: • To allow for some degree of localization of the disease process? • To allow for an adequate understanding of the chronology and severity of the disease process? • Pertinent information about past medical and surgical history, neurological review of systems, medical/surgical review of systems, medications/dosages, drug allergies, and family history? • Pertinent information concerning psychosocial functioning (or developmental milestones/school performance for children)? Neurological History Taking Skills Rating: A S U
  14. 14. II. Physical Examination Does the student’s physical examination contain the following: • An adequate general medical examination as it pertains to the neurological disease process? • Pertinent components for each of the 6 realms of the neurological exam (mental status, cranial nerves, motor, sensory, coordination, and gait)? • Enough information to localize the disease process? Neurological Examination Skills Rating: A S U Student Name:________________________________________________________________ Practice Based Learning and Improvement I. Initiative/Self-Directed Learning • Does the student demonstrate an eagerness to learn, identifying their own questions, reading literature related to their patients’ problems, and share this information with the treating team (Educator/Manager on the RIME protocol)? Practice Based Learning Rating: A S U Medical Knowledge I. Differential Diagnosis • Does the student create an adequate problem list to generate a reasonable differential diagnosis? • Does the student incorporate neurological localization into their differential diagnosis? II. Basic Mechanisms of Disease Process: • Does the student demonstrate an adequate understanding of the mechanisms underlying neurological diseases? (This should include some understanding of the pathophysiology, pathology,and anatomy of the disease process). III. Approach to Management: • Does the student demonstrate competence in developing a treatment plan/intervention for his/her patients? (Consider delineation of treatment goals, risk/benefit assessment, monitoring for treatment effect and adverse effects.) Medical Knowledge Rating: A S U Systems Based Practice I. Knowledge of Healthcare Systems
  15. 15. • Does the student demonstrate an adequate understanding of healthcare systems (government vs 3rd party payment systems, justificationfor admissions, prior authorizations, billing and coding)? II. Efficiency and Cost Effectiveness of Patient Care • Does the student demonstrate efficiency, speed, organization, and cost effectiveness with patient care? Systems Based Practice Rating: A S U Student Name:________________________________________________________________ Interpersonal and Communication Skills I. Communication with other Health Care Members • Does the student demonstrate good communication skills with other students, residents, attending physicians as well as with nursing and other non-physician staff? II. Communication with Patients and Their Families • Does the student accurately and effectively communicate treatment plans, diagnostic study results, and other medical information to their patients and their families? • Does the student demonstrate respect and confidentiality towards their patients and their medical conditions? • Does the student demonstrate an appropriate understanding as to how their patient’s cultural, gender, race and socioeconomic status may affect their disease process and consider these factors in the treatment plan? Interpersonal and Communication Skills Rating: A S U Professionalism I. Reliability • Can the student be relied upon to fulfill his/her clinical duties (timely and legible chart writing, attending clinics and didactic sessions on time, following up on patient diagnostic studies)? II. Honesty/Integrity • Is the student honest and ethical with regards to their assignments and patient care activities? Do they acknowledge their own mistakes? Professionalism Rating: A S U
  16. 16. Narrative comments concerning the student’s overall performance during the Clinical Neurosciences Clerkship: Student Name:________________________________________________________________ Recommended Final Grade Based on the Narrative Student Evaluation (Please Circle One To Indicate A Final Clinical Grade) Honors Students earning an Honors grade should be functioning on an “Educator/Manager” level on the R-I-M-E format. They must demonstrate excellent patient care and communication with their patients. They must demonstrate advanced history taking and physical examination skills. They demonstrate advanced medical knowledge as well as a willingness to engage in independent study to learn more about their patients’ conditions. They must also demonstrate excellent communication skills through their chart notes and on patient rounds. Professional and ethical conduct is also consistently demonstrated. High Pass Students earning a High Pass grade should be functioning on at least an “Interpreter” level on the R-I-M-E format. This means that they are familiar with all of the pertinent details of their patients’ history, physical findings, and diagnostic studies and are able to “interpret” these findings as it relates to patient care and treatment. They should demonstrate above average skills with patient history taking and physical exam skills. Chart notes are complete and pertinent. Professional and ethical conduct is consistently demonstrated. Pass Students receiving a Pass grade should be functioning at least on a “Reporter” level on the R-I-M-E format. This requires an adequate knowledge base to be able to care for their patients. They are expected to write timely chart notes on their patients each day. They should be aware of all the pertinent historical, physical exam findings, and diagnostic studies on their patients. Professional and ethical conduct is consistently demonstrated. Fail Any student who is unable to demonstrate adequate neurological history taking skills, perform at least a basic neurological exam or who is consistently unaware of pertinent details as it pertains to their patients medical care
  17. 17. will fail this clerkship. Also, unprofessional or unethical conduct during the rotation may result in course failure. Students who do not attend required didactic lectures may also be in jeopardy of failure of this required clerkship. I have met with the student to provide direct feedback about their performance based on the results contained within the Clinical Skills Narrative Evaluation Form Yes_________(Date)________________ No__________ Signature of Evaluator:___________________________ Printed Name/Title:__________________________ Signature of Student Documenting Receipt of Feedback______________________________________________ Student Name_________________________________________________________ Student Clinical Skills Narrative Evaluation Form (Second Two-Week Rotation) Rotation: Neurology (West Jeff) Neurology (Baptist) Neurology (University) Neurology (Ochsner) Neurosurgery (University) Neurosurgery (West Jeff) Pediatric Neurology Block Number_______________ Dates of Rotation_______________________ Name/Title of Evaluator___________________________________________________ Core Competency Minimal Criteria Rating A=Above Average S=Satisfactory U=Unacceptable Patient Care I. Neurological History Does the historical information obtained from the student provide adequate information for the following: • To allow for some degree of localization of the disease process? • To allow for an adequate understanding of the chronology and severity of the disease process? • Pertinent information about past medical and surgical history, neurological review of systems, medical/surgical review of systems, medications/dosages, drug allergies, and family history? • Pertinent information concerning psychosocial functioning (or developmental milestones/school performance for children)? Neurological History Taking Skills Rating: A S U
  18. 18. II. Physical Examination Does the student’s physical examination contain the following: • An adequate general medical examination as it pertains to the neurological disease process? • Pertinent components for each of the 6 realms of the neurological exam (mental status, cranial nerves, motor, sensory, coordination, and gait)? • Enough information to localize the disease process? Neurological Examination Skills Rating: A S U Student Name:________________________________________________________________ Practice Based Learning and Improvement I. Initiative/Self-Directed Learning • Does the student demonstrate an eagerness to learn, identifying their own questions, reading literature related to their patients’ problems, and share this information with the treating team (Educator/Manager on the RIME protocol)? Practice Based Learning Rating: A S U Medical Knowledge I. Differential Diagnosis • Does the student create an adequate problem list to generate a reasonable differential diagnosis? • Does the student incorporate neurological localization into their differential diagnosis? II. Basic Mechanisms of Disease Process: • Does the student demonstrate an adequate understanding of the mechanisms underlying neurological diseases? (This should include some understanding of the pathophysiology, pathology,and anatomy of the disease process). III. Approach to Management: • Does the student demonstrate competence in developing a treatment plan/intervention for his/her patients? (Consider delineation of treatment goals, risk/benefit assessment, monitoring for treatment effect and adverse effects.) Medical Knowledge Rating: A S U Systems Based Practice I. Knowledge of Healthcare Systems
  19. 19. • Does the student demonstrate an adequate understanding of healthcare systems (government vs 3rd party payment systems, justificationfor admissions, prior authorizations, billing and coding)? II. Efficiency and Cost Effectiveness of Patient Care • Does the student demonstrate efficiency, speed, organization, and cost effectiveness with patient care? Systems Based Practice Rating: A S U Student Name:________________________________________________________________ Interpersonal and Communication Skills I. Communication with other Health Care Members • Does the student demonstrate good communication skills with other students, residents, attending physicians as well as with nursing and other non-physician staff? II. Communication with Patients and Their Families • Does the student accurately and effectively communicate treatment plans, diagnostic study results, and other medical information to their patients and their families? • Does the student demonstrate respect and confidentiality towards their patients and their medical conditions? • Does the student demonstrate an appropriate understanding as to how their patient’s cultural, gender, race and socioeconomic status may affect their disease process and consider these factors in the treatment plan? Interpersonal and Communication Skills Rating: A S U Professionalism I. Reliability • Can the student be relied upon to fulfill his/her clinical duties (timely and legible chart writing, attending clinics and didactic sessions on time, following up on patient diagnostic studies)? II. Honesty/Integrity • Is the student honest and ethical with regards to their assignments and patient care activities? Do they acknowledge their own mistakes? Professionalism Rating: A S U
  20. 20. Narrative comments concerning the student’s overall performance during the Clinical Neurosciences Clerkship: Student Name:________________________________________________________________ Recommended Final Grade Based on the Narrative Student Evaluation (Please Circle One To Indicate A Final Clinical Grade) Honors Students earning an Honors grade should be functioning on an “Educator/Manager” level on the R-I-M-E format. They must demonstrate excellent patient care and communication with their patients. They must demonstrate advanced history taking and physical examination skills. They demonstrate advanced medical knowledge as well as a willingness to engage in independent study to learn more about their patients’ conditions. They must also demonstrate excellent communication skills through their chart notes and on patient rounds. Professional and ethical conduct is also consistently demonstrated. High Pass Students earning a High Pass grade should be functioning on at least an “Interpreter” level on the R-I-M-E format. This means that they are familiar with all of the pertinent details of their patients’ history, physical findings, and diagnostic studies and are able to “interpret” these findings as it relates to patient care and treatment. They should demonstrate above average skills with patient history taking and physical exam skills. Chart notes are complete and pertinent. Professional and ethical conduct is consistently demonstrated. Pass Students receiving a Pass grade should be functioning at least on a “Reporter” level on the R-I-M-E format. This requires an adequate knowledge base to be able to care for their patients. They are expected to write timely chart notes on their patients each day. They should be aware of all the pertinent historical, physical exam findings, and diagnostic studies on their patients. Professional and ethical conduct is consistently demonstrated. Fail Any student who is unable to demonstrate adequate neurological history taking skills, perform at least a basic neurological exam or who is consistently unaware of pertinent details as it pertains to their patients medical care
  21. 21. will fail this clerkship. Also, unprofessional or unethical conduct during the rotation may result in course failure. Students who do not attend required didactic lectures may also be in jeopardy of failure of this required clerkship. I have met with the student to provide direct feedback about their performance based on the results contained within the Clinical Skills Narrative Evaluation Form Yes_________(Date)________________ No__________ Signature of Evaluator:___________________________ Printed Name/Title:__________________________ Signature of Student Documenting Receipt of Feedback______________________________________________ Student Feedback about the Clinical Neurosciences Clerkship Dates on Neurosurgery Service:_____________________________________ Names of Supervising Faculty/Residents:_________________________________________ Dates on Neurology/Child Neurology:_________________________________ Names of Supervising Faculty/Residents:_________________________________________ Overall, how would you rate the following aspects of the clerkship? Please use the following rating scale: A=Above Average, S=Satisfactory, U=Unacceptable. (circle your ratings) Orientation Day Neurology Activities: A S U Orientation Neurosurgery Activities: A S U Thursday Neurology Case Discussions: A S U Student Professor’s Rounds: A S U Thursday Basic Science Lectures: A S U Didactic lectures (Neurosurgery): A S U Dr Deputy’s “Afternoon Report”: A S U Passport: A S U Clinical Experience: Neurology: A S U Child Neuro: A S U Neurosurgery: A S U Faculty Teaching: Neurology: A S U Child Neuro.: A S U Neurosurgery: A S U Resident/Fellow Teaching : Neurology: A S U Child Neuro: A S U Neurosurgery: A S U
  22. 22. Use the following section to describe those aspects of your clerkship experience (Clinical Experience, Bedside Teaching, Formal Lectures, Case Discussions, Passport and Administrative Issues, etc.) that you felt were beneficial to your educational experience. Also describe those aspects that you felt were either counterproductive to your education or needed improvement. Please be as specific as possible. Useful Aspects of the Clerkship: Counterproductive/Needs Improvement Aspects of the Clerkship: Changes that you would suggest for the Clerkship:
  23. 23. Note: Your feedback is extremely important and will allow us to continually update and adjust different aspects of the Clinical Neurosciences Clerkship. Negative feedback will in no way influence your final grade. Please feel free to directly email the Clerkship Director at sdeput@lsuhsc.edu if you have any further suggestions or comments about your experiences during the rotation.

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