• Articles of Interest to Medical Students
• Medical Student Clerkship
• Conferences & Grand Rounds
• Integrated Neurology Residency Program
• Student Interest Group in Neurology (SIGN)

Neurology Clerkship Student Orientation

Welcome to the Neurology clerkship rotation!

The goal of this clerkship is to help medical students acquire an understanding of the general principles of clinical neurology & their application in a patient centered setting.

It starts with learning to take a thorough medical history related to neurologic disorders & performing a complete physical exam especially the neurologic examination.

The next step is to be able to - make an anatomic diagnosis (where is the lesion and in what systems), then pathophysiologic diagnosis (what type of disease process), & then think about the various causes (etiologic diagnosis) of a given neurologic presentation.

This is followed by understanding of evaluation methods and management of the neurologic disorders.

The medical students will achieve this goal through a variety of methods including:
Didactics, case conferences, direct observation and participation in patient care.

Please review this introductory packet with the following information:

Objectives of Core Clerkship in Neurology
Rotation Assignments
Expectations / responsibilities
Documentation
On call responsibilities
Additional recommended activities
PLOG, Lecture and case conference schedule
Overall Evaluation & Grading system
Suggested reading list

We welcome your suggestions in helping improve this clerkship. When you complete your online evaluations, please be honest and forthright with your comments. We value your input & would like to make this an interesting and exciting experience for you.

So, welcome to Neurology! Hope you have an excellent educational experience!!

Objectives for Core Clerkship in Neurology

Objective 1 – Patient Evaluation
(Competence in neurological history taking, examination and analytical skills)

1. History Taking: be able to obtain complete and reliable history – presentation and evolution of symptoms; Know the importance of pertinent history from family, caregiver, witness, etc., i.e. in patients with impaired sensorium, cognition, speech, or history of seizures
2. Physical Examination: Perform complete and reliable neurological examination
3. Analysis: Be able to analyze the signs and symptoms to localize the likely site(s) of lesion in the nervous system, and formulate a differential diagnosis.

Objective 2 – Patient Management
(Competence in evaluation & management of common & emergent Neurologic disorders)

1. Evaluation & Management: Demonstrate an understanding of clinical features, diagnostic workup and essentials of treatment of neurological disorders likely to be encountered in general medical practice, i.e. Seizures, headache, stroke, dementia, MS, neuromuscular, movement and sleep disorders.
2. Emergency Neurology: Demonstrate familiarity with management of emergent neurological conditions – i.e., status epilepticus, comatose patient, acute stroke, meningitis, increased intracranial pressure, spinal cord injury, Guillain-Barre syndrome and myasthenic crisis.
3. Risks & risk factors: Demonstrate awareness of risk factors and appropriate precautions in neurological disorders, such as stroke, seizures, headaches, head injury and CNS infections.
4. Specific Neurodiagnostic tests: Develop awareness of indications, safety concerns, and cost-effective approach to neurological investigations, i.e., Lumbar Puncture, neurophysiological & neuroradiological tests.

Objective 3 – Presentation, Interaction and Communication
(Competence in analysis, presentation and communication skills)

Presentation: Develop competence in doing a clear, systematic oral and written presentation of patient’s history, examination, and problem analysis (localization and differential diagnosis) and clinical evaluation.
1. Communication skills: Learn the importance of honest and compassionate communication with patient and/or family in different situations, i.e., outcome of acute stroke, informing diagnosis of progressive illness such as amyotrophic lateral sclerosis, discussing end of life issue.
2. Multi- D management and interaction: Understand the role of multidisciplinary management of neurological disorders, and be able to interact and communicate with other members of the patient care team. Rotation Assignments

At MU, you will see a larger share of inpatients. You will also be able to attend the clinics with your service attending (with the approval of the attending physician).

At the VA, it is accomplished by a larger emphasis on outpatients. You will attend the VA neurology clinics with the assigned VA attending & resident.

At MU consult service, you will see & follow inpatients with neurologic disorders. You will also attend clinics with consult attending (with approval of attending physician).

Assignments/Schedules will be provided during orientation or prior to start of rotation.

Expectations/Responsibilities of Students

You will have the opportunity to see patients with serious neurologic disorders. Repeated examination & evaluation will help (watch the resident/ attending as you start). Ward rounds with residents and attending staff take place regularly. You will be assigned inpatients – you will be expected to evaluate and follow them closely. You will present your patients on daily rounds and take active part in their care. You are expected to be on time, every day. Scheduled time for ward rounds will be available from the resident physician of your assigned service. The resident will also help you with details of your assigned service activities. As you see a patient, you should look up that neurologic condition and be prepared. This is the best time to learn. Ask your resident or attending physician for additional references if you wish.

Documentation

You will write a minimum of 2 H&Ps and 2 follow up notes-in Microsoft WORD at MU & forward them to the resident; directly on computer system at VA & forward it to the attending physician (also email a copy to Chris Bethel for record). They will review this, give you feedback. You will also be required to complete the patient log (PLOG).

On Call responsibilities

Each student will serve no more than 3days on call during 2 week rotation (barring emergency, no call switch please; and even in emergency, only with knowledge and approval of coordinator so appropriate personnel are informed). Call times are 4:30PM-2:30AM, Monday to Friday; 7.00AM-2.30 AM, Saturday/Sunday. INFORM THE ON CALL RESIDENT WHEN YOU START YOUR CALL (give your pager #) - so they can contact you as they see a patient. The resident physician will page you to come in & involve you to workup the patient. The weekend call starts at 7 AM as you are expected to attend morning rounds. The call can be off site. But you must be able to come to the hospital in 15 minutes. If you can’t do so, please remain on site & let the resident know.

Additional recommended activities
Take the opportunity to participate in an LP, review EEG, and see an EMG being done.
Your assigned service resident can help – if you bribe them with your work & charm.

PLOG & coverage of specific neurologic conditions

This is a brief 2 week rotation. But every attempt will be made to cover key Neurologic topics. PLOG review will show you areas requiring full participation & others that can be covered by observation or simulation e.g. case conferences, lectures, & grand rounds.
Aside from learning the full neurologic examination, these specific areas include:

Epilepsy
Coma, impairment of consciousness
Dementia, neurodegenerative disorders
Headaches, CNS infections, Tumors, Lumbar puncture
Multiple sclerosis/ demyelinating disorders & diseases of spinal cord
Neuromuscular disorders- disorders of nerve, muscle and neuromuscular junction
Parkinson’s disease and other Movement disorders
Stroke Sleep and Sleep disorder.

Lectures (Didactics)

2. Rotation evaluation
You must complete the online rotation evaluation before you take the Neurology exam. This is your chance to give constructive critique and help make this rotation better.

Key personnel

Upinder Dhand MD, Clerkship Director 882-8668 dhandu@missouri.edu
Christina Bethel, Clerkship Coordinator 882-2260, bethelch@missouri.edu

Suggested Reading

Neurological differential diagnosis by Patten – excellent concise source focused on differential diagnosis (with touch of Neuroanatomy)

Companion Handbook to Principles of Neurology by Adam & Victor – concise review

Pocket Companion to Neurology & Clinical Practice by Bradley, Daroff, Fenichel and Marsden – concise review

On call Neurology by Marshall & Mayer – very practical, complete with elevator thoughts as you are called to see a patient

Clinical Neurology by Simon, Aminoff and Greenberg – ~ 300 pages textbook

*Harrison’s or Cecil’s textbook of Medicine
Most of you have may have the textbook of medicine - either Harrison’s or Cecil’s.
Both have excellent sections on neurological disorders and evaluation of a patient with neurologic problems.

Online sources
There are several online sources. They include - Entrez pubmed, med-line search, Up to date, e-journals.

More Detailed Information

Principles of Neurology by Adams & Victor

Merrit’s Text of Neurology

Localization in Clinical Neurology by Brazis, Masdeu, Biller

Continuum issues (by topic) –available from your resident (each issue addresses a topic)

Attending and resident as a source
Please ask your resident/attending physician for interesting articles in areas of interest.

Conferences & Grand Rounds

Neurology Lecture Series
Regularly scheduled lectures by the faculty for the residents and medical students.

Neuroanatomy Didactics
Didactic conferences focused on clinical correlation of neuroanatomy are conducted every Tuesday.

Grand Round Schedule
Grand rounds are scheduled every Wednesday from 8:15am to 9:15am in Acuff Auditorium. Distinguished physicians and residents from the Department of Neurology and Division of Neurosurgery and visiting professors present on various topics throughout the year.

Integrated Neurology Residency Program

The Department of Neurology allocates one position each year to the integrated residency program for MU students only. The Integrated Residency Training Program in Neurology allows the new resident several options including research projects in neuromuscular diseases, movement disorders, stroke, epilepsy; specialty clinics; and rural outreach programs. Students selected for the Integrated Residency Program meet with the Residency Director to discuss their personal areas of interest and design their externship accordingly.

• The integrated resident position is designed for MU medical students wanting to pursue residency training at the MU School of Medicine.
• Program will receive applications from 3rd year medical students interested in the integrated program for their 4th year until May 1st. Notice of acceptance by the departments will be made to the medical school on June 1st.

Student Interest Group in Neurology (SIGN)

SIGN is sponsored by the American Academy of Neurology & aims to offer academic & research opportunities to students and encourage student interest in the growing and exciting field of Neurology and Neurosciences.

It is fun! SIGN members get to meet and socialize with students, residents, & faculty who appreciate your interest in Neurology. You can shadow neurologists and explore your interest in Neurology. You can attend patient presentations and seminars to get a feel for what we do. You may participate in research & past members have presented abstracts at national meetings. There are opportunities to develop experience, leadership skills, and valuable contacts in Neurology – at local & national level. There are volunteering opportunities e.g. RAMS. The idea is to get involved.

OTHER BENEFITS:

Free membership to American Academy of Neurology
Join the nationwide SIGN network & meet other SIGN members at the Annual Meeting

Apply for SIGN scholarships:

• $3,000 AAN Summer Research Scholarship
• $1,000 AAN Annual Meeting Scholarship
• Plan an activity by yourself & get up to $ 400 a year from AAN for it
• AAN has a cash award and certificate for a graduating student who shows excellence and aptitude for neurology during clerkship.

WHAT ARE THE OPPORTUNITIES at MU (& VA Hospital)
We offer a variety of exciting clinical and research opportunities:

1. CLINICAL:
Spend time in a variety of specialty clinics & explore your interest – including Movement disorders, Multiple sclerosis, Headaches, Sleep Disorders, Epilepsy, Dementia & neuromuscular/ MDA clinics. Participate in clinical research with the residents and faculty.

2. BASIC NEUROSCIENCE RESEARCH:
Participate in cutting edge research (you have to work with Rats!) under the supervision of Dr. Thakkar. He’s a sleep researcher who recently came here from Harvard. He is doing some very exciting work on understanding the mechanisms of sleep.

3. SUMMER FELLOWSHIP:
Do a summer fellowship in MS (you can get paid thru Welliver scholarship).

RECENT STUDENT ACCOMPLISHMENTS:

HOW WILL THIS HELP YOU:

• Integrated Residency in Neurology
• Learn about INTEGRATED RESIDENCY IN NEUROLOGY & its financial benefits.
• Link to web site:

HOW TO KNOW MORE & JOIN:
Link to AAN SIGN website: http://www.aan.com/go/education/students/medical/sign

CONTACTS: University of Missouri- Columbia chapter

• Clerkship Director – U Dhand MD - dhandu@missouri.edu
• Resident Contact – Chief Resident Neurology Aarti Sarwal, MD; sarwala@missouri.edu
• Clerkship Co-ordinator – Christina Bethel; bethelc@missouri.edu
• Chairman – P Sahota MD; sahotap@missouri.edu

Contact us with any questions and want to know more about these opportunities!

So SIGN up for SIGN! You will enjoy learning about Neurology!