Geisel School of Medicine



Neurology Clerkship Review – 5/15/14MEC subcommittee: Dr. John Dick, Geisel Competencies -> Course Learning Objectives -> Assessment of Learning -> Learning ActivitiesCourse Description:This is a required 4 week clerkship taken in the 3rd or 4th year. Students get a mixture of inpatient and outpatient exposure amongst the various sites.Geisel CompetencyCourse ObjectiveHow Student is AssessedLearning ActivityMedical Knowledge1a.1Apply current neuroscience knowledge to diagnosis and treatment questions in patient care. Performance EvaluationsCase DiscussionsWrite UpsNBME examWards/ClinicsCase DiscussionsWrite Ups1c, 1d2Apply current clinical and translational sciences to diagnosis and treatment questions in patient care. Performance EvaluationsWrite UpsCase DiscussionsNBME examWards/ClinicsWrite UpsCase Discussions1eApply current knowledge of disease prevention, risk factor modification, end-of-life and palliative care, substance abuse, pain management, medical ethics, and medical-legal issues to clinical problems in neurology. Performance EvaluationsWrite UpsCase DiscussionsNBME examWards/ClinicsWrite UpsCase Discussions1fApply knowledge about the impact of social, economic, cultural, and personal factors on health to clinical problems in neurology.Performance EvaluationsWrite UpsCase DiscussionsNBME examWards/ClinicsWrite UpsCase DiscussionsClinical Skills2a3Establish comfortable and mutually respectful student-patient and student-family relationships with diverse patients and families and establishing a respectful basis for the doctor-patient relationship. Performance EvaluationsSkills FormWards/clinic2b4Interview patients skillfully, utilizing a neurologically focused history.Performance EvaluationsSkills FormWards/clinic2c5Examine neurologic patients skillfully and respectfully, with appropriate attention to student cleanliness, infection control, and patient comfort and privacy.Performance EvalSkills FormFormal Neuro Exam AssessementWards/clinic 2d6Define and prioritize the patientPerformance EvaluationsCase DiscussionsNBME examWards/ClinicsCase Presentations Discussions2f, 2gExplain the indications, complications, limitations, and performance of a CT scan, MRI, electrodiagnostic studies (EMG, NCV, evoked potentials and EEG) and lumbar puncture. Performance EvalsNBME ExamWards/ClinicsCase Discussions2hCorrectly identify, and prioritize, common abnormalities on CT, MRI and spinal fluid analysis. Performance EvalsNBME examWards/ClinicsCase DiscussionsInterpersonal Communication Skills3cCommunicate effectively with patients and families when special barriers to communication exist, including cultural, linguistic or those based on a neurologic disorder (e.g. aphasia). Performance EvalsSkills FormWards/ClinicsCase Discussions3dAssist patients appropriately in understanding their treatment options. To assist patients appropriately in understanding their prognosis. Performance EvalsWards/Clinics3e, 3f, 3g, 3hCommunicate effectively and collegially with physician colleagues and other members of the health-care team verbally, in writing and in the electronic medical record. Performance EvalsWrite UpsSkills FormWards/ClinicsWrite UpsCase DiscussionsFormation of Professional Identity4a, 4e10Behave respectfully and responsibly towards patients, families, colleagues, and all members of the health-care team and empathize and be respectful of each patient Performance EvalsCase discussionsWards/Clinics4bMeet professional responsibilities fully. Performance EvalsDelete this as it is too broad4d, 4f, 4gAdhere to high ethical and moral standards, accept responsibility for personal actions, accept constructive criticism and respect patient confidentiality. Performance Evals,Write UpsWards/Clinics 4h, 4jTake responsibility for his or her own medical education, and develop the habits of mindfulness and reflection.Performance Evals,Write UpsWards/Clinics4kDescribe barriers to access to basic health services and its effect on vulnerable populations. Do you assess this?Delete this objective as it is not uniformly covered.4lContribute constructive feedback during peer review. Delete as you are not doing this.Develop Habit of Inquiry into and improvement of one’s own personal practice5a, b, e, fIdentify and critically evaluate relevant information about evidence-based, cost-conscious strategies in the care of patients and populations and to apply this to patient care and to continuous updating of skills. Performance EvalsCase DiscussionsWrite UpsWards/ClinicCase DiscussionsWrite Ups5c, dAssess the effect of social environment on clinical care and outcomes and apply the concepts of improving quality of care, patient safety, and value of care in neurologically ill patients. Performance EvalStudentCase DiscussionsWards/ClinicsSystems-based practice / Science of healthcare delivery6a, 6b14Identify appropriate resources to support patient care and to collaborate effectively with all members of the inter-professional team. Performance EvalsWards/Clinics6e, 6f, 6gDescribe how healthcare is currently organized, financed, and delivered, and the larger environment in which healthcare occurs and the impact on neurologically ill patients. Is this assessed?Is this taught or focused on in your clerkship?6i, 6jIdentify the role of the physician in addressing the medical consequences of common social and public health factors, and to advocate for optimal care in neurologically ill patients. Is this assessed?Delete as you are not uniformly covering this in your clerkship.Essential Skills/ConditionsNEUROLOGY CLERKSHIPESSENTIAL CLINICAL CONDITIONLEVEL OF STUDENT RESPONSIBILITYCLINICAL SETTING% Performing at least 1Alternative Learning OpportunityBrain TumorParticipate in Care of (or simulation)ManageInpatient / Outpatient95Coma, stupor, altered mental statusManageInpatient / Outpatient99DementiaManageInpatient / Outpatient96Cerebral or SA HemorrhageManageInpatient98Headache (all types)ManageInpatient / Outpatient100Multiple SclerosisManageInpatient / Outpatient89Peripheral NeuropathyManageInpatient / Outpatient98Seizure, EpilepsyManageInpatient / Outpatient100TIA or StrokeManageInpatient100VertigoManageInpatient / Outpatient98Paralysis (ALS, GBS, etc.)ManageInpatient / Outpatient95ESSENTIAL CLINICAL SKILLHPI relevant to this clerkshipPerformInpatient / Outpatient100Neuro examPerformInpatient / Outpatient100Mental status examPerformInpatient / Outpatient100CT Head, InterpretAssistInpatient / Outpatient100MRI Head, InterpretAssistInpatient / Outpatient100EEG, InterpretAssistInpatient / Outpatient100dropLP (simple)AssistInpatient / Outpatient91dropEMG (complex)AssistInpatient / Outpatient92dropMedications counselingPerformInpatient / Outpatient100Oral presentation, inpatient initial evaluationPerformInpatient99Oral presentation, ambulatory encounterPerformOutpatient99Admission notePerformInpatient100Learning Assessment Tools:DMEDS – Assess progress on meeting essential skills and conditionsEssential Skills Competency Form – Students assessed as meeting level of skill expected of 3/4rd yearClinical Performance Evaluation Form – Competency based assessment, completed by faculty and residentsWrite Ups (4) – Graded –– consider moving to 2 write ups/add evidence base componentNeurologic Exam AssessmentNBME subject matter exam Mid-clerkship feedback formsFinal Feedback / Grade narrativeLearning Environments / Activities:OrientationFirst Monday of ClerkshipWards/Clinics/Night Call x 2 at DH1 outpt clinic per week at DHWrite Ups4 RequiredLecture Series – Case Based (M and Tuesday) – ppt available onlineFlipped classroomSelf StudyText recommendedCourse PlanningEducational Team StructureOne directorOne Clerkship CoordinatorSelf –Review/ Planning MethodsEducational Retreat AnnuallyMonthly Educational meetingsMethod and Frequency of Coordination with Non-DH sitesSemi annualFaculty PreparationHow are faculty members at each site oriented to the course objectives and grading system? Email annuallyResident PreparationDescribe process to provide clerkship objectives to residents who will be teaching students: Email, resident handbookDescribe process to prepare residents for their roles as teachers:How is this monitored by the departmentAnnualDuty HoursNo violations reported by studentsTopic of Interest and concern for integration across 4 yearsNeuro ExamLocalization of lesionsOpportunities for Inter-professional Education/Interaction to include all studentsAdd option to clinical skills form to have PT sign off on whether student understands function of PT/OT servicesOpportunities for Teaching High Value Health Care to include all studentsAdd cost/charge/value discussion to current lecture being given on brain imaging or cost effective work up of headache.Clerkship OutcomesNBME Subject Exam Raw ScoresYearMEDICINEGeisel/National10-1178.2/74.911-1279.4/75.512-1377.52/ 75.8Student Feedback – See Attached ReportNumerical Highlights:Overall Experience: Very Good: 3.94Site Directors and Clerkship Director: Very Good to Excellent: 4.48Quality of Teaching by Attendings: Very Good: 4.25Quality of Teaching by Residents: Very Good: 3.88Quality of MidClerkship Feedback: Very Good: 4.02How well did you learn neurologic exam skills: Very Good: 4.4Narrative Themes:CPMC Strengths: Excellent teaching, Neuro ICUDH Strengths: Interesting patients, Teaching, didactic sessionsVA Strengths: diversity of diseases, time for patient interaction, 1:1 learning with attendingCPMC Weakness: More structured outpt experience, less shadowing on outptDH Weakness: Lecturers not showing up; not enough outpt; not enough independent assessment of patientsVA Weakness: too few patients for 2 studentsSite ComparabilitySee attached ReportChanges since last MEC review:ClinexDH team size changeIncreased VA and CPMC capacityInteractive lecture ................
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