JUNIOR NEUROLOGY CLERKSHIP

Welcome to the Neurology Clerkship.

Neurology Student Education Director: Jeffery Nicholl, M.D.
Office: (504) 988-5406
jnichol@tulane.edu

Course Education Coordinator: Pamela Roquemore
Tidewater Bldg. Room 1056:
Office: (504) 988-5406
proquem@tulane.edu

Administrative Assistant: Zenobia Colon
Tidewater Bldg. Room 1053
Office: (504)988-3888
zcolon@tulane.edu

***updated 8/22/2007***

On this Page
Goals and Objective | Questions, Problems, Complaints | Absences | Safety | Reading | Clerkship Requirements | Location of Rotations | Grading | Service Assignments | Case of the Week | Grand Rounds |
Neurology Information Goals | Student Presentations

Goals and Objectives

• To perform a neurological exam on conscious and unresponsive patients.
• To learn indications for ordering neuro-diagnostic studies.
• To learn core neurological symptoms and illness.
• To learn therapeutic medications and procedures.

What to do if you have Questions, Problems, or Complaints

Call or go see Pamela Roquemore, the clerkship coordinator, and she will help you to resolve the issue. If a personal or medical issue or problem interferes with your performance on the rotation ,contact Dr. Nicholl or her designee so that we are aware of this issue at the time of the occurrence not at the end of course. “The definition of a problem” is any event or action, which makes the student feel uncomfortable or may interfere with student performance. Please feel free to contact Dr. Nicholl personally, by phone or e-mail.

Absences

A leave of absence for any reason must be authorized in writing by the Office of Student Affairs and forwarded to Pamela Roquemore. If you have authorized absence, let your attending and resident know. All authorized absences from Student Affairs Office are accepted without question. No one else is authorized to grant leave. If you are ill for more than one day, please obtain medical leave from Student Affairs.

Safety

• Always observe Universal Precautions when interacting with patients.
• Do not use your reflex hammer or key to check for Babinski signs. Your tool could become a vector of serious disease. Instead, use a clean wooden swab or tongue blade and throw it away after one use.
• Do not use a hollow or beveled needle (Eg. Gelco) to test for pinprick because these needle types are too sharp. Use safety pins and dispose of them after one use in a sharps box.
• Always guard yourself from crime, patient violence, and all types of danger. Lock your call room doors. Be street-smart. Wear I.D. badge at all times.

Reading

The course's official textbook is Essentials of Clinical Neurology by Drs. Weisberg, Strub, and Garcia. This book is updated (Oct 2004) and is on neurology website and two hard copies are available in library. You should read in more depth about your own patients' medical problems. Recommended for this purpose are Principles of Neurology by Adams and Victor and Textbook of Neurology by Merritt and the Neurology Chapters in Harrison Textbook of Medicine, both, which are on reserve in the library. Most if not all lectures can be viewed on our Web site, read and come prepared to the lectures. If you are on the Pediatric Neurology rotation, ask your attending to direct you to appropriate resources.

Clerkship Requirements

In order to pass this course, you must fulfill all of the following requirements:

1. Fully participate in your assigned service team. This includes presentation of the patients on rounds.
2. Take the shelf exam (T-3’s only) AY 2007-2008 This is the shelf exam transition year.
3. Complete a “portfolio.” This is to be submitted to the Student Coordinator and will include the following:
   • Responses to two “cases of the week” or “clinical case studies.”
   • One clinical report and discussion of one patient evaluated during the rotation. This should be at least two pages in length.
   • Student Log.
4. A student log card must be completed documenting patients seen on in-patient and consult services as well as clinic and on-call experiences ( All Students.)
5. One standardized patient evaluation.
6. You are to be observed by resident/staff performing the patient assessment at least once.
7. Obtain mid-course evaluation signed by student, House Officer and attending. This should also be on your card.
8. Attend Neurology Grand Rounds and Case Conferences each week.
9. Give a presentation to your service team on topic of your interest.

Location of Rotations

• Tulane Hospital and Clinic: Drs. Jeffery Nicholl, and Patricia Colón will be preceptor-attendings. Three to four (3-4) students will be assigned and the students are expected to follow their Residents to other hospitals and/or clinics.
• Ochsner Foundation Hospital: Three (3) students will be assigned. Course Education Coordinator will assign students to Faculty/Resident. Students may accompany their Residents to downtown clinics with permission of the Ochsner Staff-Faculty.
• Neurology: This rotation is for student interested in Child Neurology and going into a related Field. This is only available at the discretion of the doctors availability.
• One (1) student will work with Dr. Africk at Ochsner Foundation Hospital
• One (1) student will work with Dr. Willis at Ochsner Foundation Hospital.
• Culicchia Neurological Group: Three (3) students will work with Faculty and will be supervised by Dr. John Freiberg (former Tulane Neurology Course Director). Students may also take the opportunity to be exposed to Neurosurgery with Drs. Culicchia and Steck. This is located at West Jefferson medical Center.
• Advanced Neurodiagnostic Center (ANC): One to two (1-2) students will rotate with Dr. Shamsnia at his private clinic in Metairie and travel with him to Bogalusa and sometimes to the Tulane Clinic. Students will have the opportunity to be exposed to sleep studies, EEGs, and the business aspects of neurology.
• Tulane Clinic and VA Clinic: One (1) student will rotate with Dr. Jeffrey Nicholl at both clinics and will focus on seizure activity and epilepsy
• University Hospital:. Three (3) students will be assigned to consult-clinic service.
• Out-of-region rotations: These are only at the request of the students and housing will need to be arranged on your own.
• Dr. Shelly Savant in Lafayette
• Drs. Sconzert and Best and in Lake Charles
• Individual faculty: Students may be assigned to a specific Resident/Fellow/Faculty, who do not have specific service requirements during that time period.

Grading

• 60% of your grade will come from your clinical evaluation and 20% percent from your Portfolio (T-4’s only) and Shelf exam (T-3’s only.) Standardized Patient Exam is 10% of your final grade. Your Student Log is 10% of your final grade. The clinical evaluation includes assessment of your “activities” as assessed by your “student card . ”
• Students need to know their residents and attending (preceptor). They are expected to give you a verbal assessment of your performance at mid and end of clerkship so that you will know your strengths and weaknesses. If you do not get this assessment, ask for it. The mid-course evaluation is to turned in to the Student Coordinator at the end of week two.
• Your clinical evaluation will be given by your team's residents and attending. The grade and evaluation is given by your primary resident and attending. If you have any concerns please discuss with Dr. Nicholl. It is the student responsibility to review their assessment and if there are any concerns, discuss with the attending and resident. Dr. Nicholl is not at liberty to modify these evaluations or grades but is available to review them and discuss with student.
• Students are to maintain their student log given to them at orientation. In this card you are to use it to log your daily activities. This card is to be turned in to the clerkship coordinator at the time of the shelf exam/ Portfolio. Please view your notes later in the packet for instructions on the card.

Service Assignments

A . Your responsibilities here include participating in rounds and taking care of your patients. Be aware you are students who are here to learn and need guidance and supervision. You are not the hand-maiden of the physicians, and are not expected to do tedious or unnecessary work. It is expected that you are treated with dignity and respect. Taking care of your patients includes:

• Doing a complete history and physical for your own purposes and reviewing all prior records.
• Forming a care plan for your patients: Take every opportunity to write the orders for your patients, but remember these must be immediately signed by your resident or attending.
• Checking up on your patient frequently to assess progress and detect complications.
• Talking to nurses, therapists, dietitians, and consultants to get information about your patient.
• Writing progress notes on your patients.
• Following up on all test results and interpreting these results.
• Reading in depth about your patient's medical problems.
• Participating in morning report.
• In an effort to standardize the clinical experience, the faculty/house officers are required to review a series of clinical problems in neurology with you. It is expected that preceptor (staff) will meet with students twice weekly to discuss topics in neurology (examples are listed here). The time is to be mutually agreeable. There are no neurology seminars on Friday afternoon; therefore this would be an ideal time to conduct this didactic teaching. There should be no conflicts on Friday afternoon. Your residents have been “schooled” in these topics and you should review with House Officer and staff.

  The topics include:

  1. episodic loss of consciousness
  2. evaluation of the "confused" patient
  3. assessment of "comatose" patient
  4. evaluation of new onset headache
  5. management of acute stroke
  6. evaluation of "dizzy patient"
  7. approach to neck and back pain
  8. meaning of "brain death"

B. Some services require weekend rounds. This is determined by attending and house officers.

Case of the Week (not clinical cases)

• You are expected to prepare for the cases of the week beforehand. You are to come prepared for the Seminars/Lectures that are given each Monday. Prepare by reading the appropriate sections of your assigned textbook. Also, read any handouts that are included in this packet or read up on each lecture as they are on our Web Site. This includes the clinical problems, which you should be prepared to discuss at time of seminar. The handouts are labeled as to which seminar they pertain. On the web site there are clinical problems and those which apply to the weeks seminar will be updated weekly. They are setup for you to print.
• You should attend all neurology seminars. Seminars take precedence over service duties; no team resident or attending should cause you to miss seminars for rounds or patient care. If this happens, bring it to Pamela Roquemore’s attention immediately.
• All seminars scheduled will be given. If the speaker is late, contact Pamela Roquemore and a substitute speaker will be obtained. The faculty-residents have been encouraged to use case presentation and not lecture format .

Grand Rounds

Neurology Grand Rounds occur each week (Monday) starting at 1pm at the Tidewater Building Room 1027. Attendance is mandatory while you are on Neurology. Neurology Grand Rounds focuses on clinically relevant issues and is geared to student and resident level. Case Conference will be held on Monday afternoon beginning at 2pm in room 1037. Attending case conference is also mandatory for Neurology.

Neurology Information Goals

It is expected that the student will accomplish these educational informational goals during the clerkship. This can be achieved by evaluating patients on the in-patient, consult, and clinic services as well as participating in clinical problem solving during the lectures and conferences. The student is expected to know the clinical history, examination findings and appropriate decision analysis for patients with the following disorders:

• Headache and face pain
• Dizziness-vertigo and episodic loss of consciousness
• Weakness and gait impairment
• Stupor and coma
• Cerebrovascular disease
• Seizures and epilepsy
• Traumatic injury - brain and spine
• Neurobehavioral disorders, including dementia, amnesia and aphasia
• Central nervous system infection
• Abnormal involuntary movements, including Parkinsonism
• Demyelinating disorders (multiple sclerosis and its mimics)
• Neurological complication of medical illness
• It is expected that students will read each topic in the text book.

Student Presentations

You should (but are not required) to give a presentation to your service team on a topic related to clinical neurology in which you find a particular interest and should be one of “topics” listed above under Service Assignments. , a-h. Your presentation should be five to ten minutes in length but no longer. You are free to choose any topic that you wish. You can analyze a case that you encounter while on the clerkship or give a seminar on a specific topic. There are books on reserve in the library relating to neurological disorders.

You are not required to look any further than these references to make your report. These references will provide enough information to complete your assignment, but feel free to expand your research. Your subject matter should be focused.

The Neurology Clerkship Web Page

You can access Neurology Web Site via the url below :
www.psychneuro.tulane.edu/neurolect

Note: Our Web site is up to date and accurate. If there are inaccuracies or missing material, let Pamela Roquemore know and she will fix it. She maintains the Web Site and she will want to have it in top shape.

Please contact the resident you are assigned when orientation is over.

On this Page
Goals and Objective | Questions, Problems, Complaints | Absences | Safety | Reading | Clerkship Requirements | Location of Rotations | Grading | Service Assignments | Case of the Week | Grand Rounds |
Neurology Information Goals | Student Presentations

Updated 03/17/2008