Clerkship Faculty Objectives


As the new academic year begins, it is appropriate to provide the faculty with a guide to the structure and requirements of the third year medical student clerkship in Neurology. There are some changes that have been made to the clerkship, (in bold italics) and it is anticipated that refinements will continue to be made throughout the year. As always, faculty participation and input are the critical factors in making this a successful educational experience for our students.

GOAL

To teach the principles and skills underlying the recognition and management of the neurologic diseases a general medical practitioner is most likely management of the neurologic diseases a general medical practitioner is most likely to encounter" (ANN Neurology Core Curriculum Guidelines 2000)

OBJECTIVES

At the completion of the third year clerkship, the student should have acquired the ability to:

  • Recognize common neurologic disease presentations.
  • Perform a screening neurologic history and examination.
  • Localize a lession based on clinical information.
  • Generate a differential diagnosis for common neurologic complaints.
  • Develop a practical approach to the evaluation and management of common neurologic complaints.
  • Appropriately order and interpret information from common neurologic diagnostic evaluation, e.g. neuroimaging, lumbar puncture.
  • Recognize and appropriately respond to neurologic emergencies.
  • Be Familiar with ethical and psychosocial problems encountered in the care of neurologically ill patients.

OVERVIEW

The Neurology/Psychiatry clerkship is implemented in six rotations of 8 weeks each. The students spend either the last three or first three weeks of the rotation on Neurology, leaving two weeks in the middle of the rotation during which there are no students rotating on the Neurology service. Students are assigned to one of four teaching sites:

TEACHING TIPS FOR UCLA NEUROLOGY ATTENDINGS WORKING WITH THIRD YEAR MEDICAL STUDENTS

Congratulations to the UCLA Neurology Department! Thanks to you, our student satisfaction ratings of the clerkship have risen noticeably, more students are entering neurology residencies, and now roughly 805 of students report having been observed by an attending performing the neurological exam (up from 55% last year). Here are some tips for this coming academic year 2006-2007:

  • Raise the bar: Students rise to the level of their expectations and according to our evaluations, they expect you to expect more of them. This includes pre-rounding, presenting patient information, writing notes and orders, and giving talks.
  • Impatient attendings, try some of these standard techniques on rounds sometime:
    • Observe the full neurological exam done by the student at least once
    • Teach how to incorporate the neurological exam into a general physical. The HEENT exam provides most information about cranial nerves, sensory exam showa us the skin/edema, etc. to make it more applicable to students pursuing other specialties.
    • Demonstrate the physical exam and model respect for the patient (close curtains or doors, keep the patient's body covered, let the patient know what you are doing, etc.)
    • DOING IS BETTER THAN WATHCHING: Send the students to the ER or ward first to see the patients if possible. Studies show that the patients identify with the early care giver and students hence feel more responibility for the patient.
  • Fun techniques for inpatient teaching:
    • Have you or a resident pretend to be a "new" patient with simulated neurological findings.
    • If the students get good at above, have them pretend to be a patient
    • "Ministry of Silly Walks":Try out a new neurologic gait on the way to radiology, like parkinsonian, ataxic, trendelenberg, etc.
    • "Tag team neuro exam": Have each student specialize in a different portion of the neurological exam for a set period of time, like a week. So on every patient that morning during rounds, the student would examine the cranial nerves while his partner does strength testing. Next week, he would examine the reflexes on all the patients, etc.
    • "Forcused daily ward rounds": On any given day, decide to demonstrate how to do the ankle jerk, babinski, visual fields, etc on all the ward patients.
    • "Cold patient exercise": Have the student perform the neurologic exam on rounds on someone else's patient admitted overnight. This is good at simulating "real life."

(Above adapted by Dr. William Campbell, "Teaching the Neurologic Examination in the 21st Century" from Unformed Services University of Health Sciences, Bethesda, MD)

  • Outpatient teaching techniques:
    • Answer a pertinent question for your patient using PubMed, or Cochrane Database.
    • Use website to demonstrate your ideas. Try metasite http://www.neuropat.dote.hu/neurology.htm for links to neuro sites on any number of topics. Also, for a good simulation of eye movement abnormalities check http://www.richmondeye.com
    • Show them videos of common patient problems if available
    • Ask them what they have in their PDA patients log already (students required by medical school to log their patients), and what diagnoses they haven't seen yet.
    • Have your students write a "Best Bet" analysis to answer a three-part question encountered in clinic and bring it in next week.

Example: "In patients with [relapsing-remitting muliple sclerosis] are [high dose interferons or low-dose interferons] better at [relapse rate reduction]? All UCLA students are trained in this form of analysis and it takes 2-3 hours to compile. This can also be used for the inpatient services. Check out http://www.bestbets.org for examble.