| Objectives:
1. Obtain a thorough neurological history, emphasizing the character of symptoms, their mode of onset and evolution. Often this will be sufficient to deduce the nature of the disease process.
2. Perform a complete neurological examination of mental status, cranial nerves, motor and sensory function, coordination, reflexes and gait.
3. Use the examination and symptoms together to deduce the location (along the neuraxis) of the disease.
4. Recognize neurologic emergencies. Be able to provide initial management and triage.
Necessary Materials:
Stethoscope, 128 Hz tuning fork, reflex hammer, and bedside visual acuity chart.
Expectations:
The neurology portion of the clerkship consists of three one-week blocks: two inpatient and one outpatient. (Note: the pediatric neurology rotation is a three–week block.) This structure provides a broader exposure to clinical neurology, as each of the potential experiences is quite different. During the inpatient blocks, the students’ primary base of operation is one of the specialty teams (i.e., stroke, general inpatient, or consults). To ensure that students have adequate patient encounters and opportunities to develop their patient care skills all students complete a log of required activities and each activity requires an attending’s sign-off. Required activities include presenting histories, performing parts of the neurological examination, presenting differential diagnosis and attending clinic. Students are required to repeat these activities a required number of times over the course of the three weeks, providing a breadth, as well as depth, of experience, and opportunity for ongoing and constructive feedback from the faculty. While on the inpatient blocks (and during the 3-week pediatric neurology block) students attend additional clinics in the afternoon to broaden their experience.
Students are expected to schedule time to evaluate their patients and follow up on diagnostic testing before rounding with the firm attending. During rounds students should be prepared to present a well-organized history, neurological examination, lab, and imaging findings for each patient they are following. It is best to summarize the examination in a brief but complete manner. For example, one might say, “The vital signs, cardiovascular, mental status, cranial nerve, motor, deep tendon reflex, sensory, and gait examinations are normal." Students are also required to submit two SOAP or full admission history and physical notes to a service attending or resident for critique. All students (except those assigned to 20 S. Park) are expected to attend morning report (Monday-Friday) and bedside teaching rounds on Wednesday afternoons.
During the neurology portion of the clerkship, students take two short call nights that start after lecture and extend until 10 p.m. On these evenings students are expected to follow two different residents: the first one will be the short call resident who covers until 8 p.m. and then the night float resident who covers from 8 p.m. until the next morning.
Click on the links below to learn more about each rotation:
Inpatient General Neurology
The patient population of this service includes any neurological disorder necessitating admission, other than stroke (which is a separate service); common diagnoses include epilepsy, multiple sclerosis, myasthenia gravis, intracranial tumors, and acute neuropathies.
Inpatient Stroke
The patient population of this service includes cases that appear to have cerebrovascular disease on presentation (although that is often not the ultimate diagnosis); common diagnoses on this service include ischemic stroke, transient ischemic attack, intracranial hemorrhage, aura of migraine, and psychogenic stroke-like episodes.
Neurology Consult
The patient population of this service includes people with neurological symptoms or signs discovered during an admission to another service; common diagnoses on this service include delirium, seizures, hypoxic brain injury, stroke, and the Neurological complications of various organ failures and/or systemic infections.
Pediatric Neurology
The pediatric neurologists offer consultation, evaluation, diagnosis and treatment for children with a variety of neurological conditions, including: epilepsy and seizures, tics, headache, developmental delays, CP diagnosis, autism, and movement disorders.
20 S. Park Outpatient Neurology
This is one of the outpatient weeks that students may be assigned to. Most days students see patients with a staff neurologist in the office or the hospital, and usually work with a neurologist a half a day at a time. Students have the opportunity to do at least part of the history and exam on each new patient they see. When possible, students see the patient first.
During the week students sign up for one short call (until 10:00 p.m.) during which they are expected to work up emergency inpatient admissions and consults and discuss the cases with the on-call neurologist. Students are expected to go to the clerkship lectures and Friday Grand Rounds, both held at the UW Hospital/Clinics.
UW/VA Outpatient Neurology Clinics
This is one of the outpatient weeks students may be assigned to, and it consists of a structured week of clinics at the UW or VA Neurology Clinics. Because the clinic schedule may vary considerably from week to week, there is a rank-order list of clinics that students are assigned to for each half-day: this means that for each half day a student will present his or her self to the first attending on the list, and if their clinic is not occurring at that time, students then move down the list until they find an attending who is available. |
