Neurology Clerkship Learning Goals and Objectives
HISTORY TAKING: obtain accurate, efficient, appropriate, and thorough history.
Develop and demonstrate the ability to take an accurate, efficient and thorough neurological history, including relevant psychosocial background.
PHYSICAL EXAM: perform and interpret findings of a complete and organ-specific exam.
Develop and demonstrate the ability to perform a comprehensive neurological examination, select elements appropriate for the clinical presentation, and accurately elicit and interpret clinical signs.
DIAGNOSIS I: articulate a cogent, prioritized differential diagnosis based on initial history and exam.
Develop and demonstrate the ability to identify the neurological problem(s) for diagnosis, select the appropriate tests/procedures as necessary, and make an accurate interpretation of the diagnosis.
DIAGNOSIS II: design a diagnostic strategy to narrow an initial differential diagnosis demonstrating knowledge of pathophysiology and evidence from the literature.
Develop and demonstrate the ability to consider the basic mechanisms of neurological and psychosocial disease and principles of therapy for the neurology patient.
MANAGEMENT: design a management strategy for life-threatening, acute, and chronic conditions demonstrating knowledge of pathophysiology and evidence from the literature.
Develop and demonstrate the ability to establish treatment goals, consider the risk/benefits, monitor response, and make appropriate modifications to management.
COMMUNICATION I: present patient information concisely, accurately, and in timely fashion to members of a health care team in a variety of settings and formats including verbally and in writing.
Develop and demonstrate the ability to maintain concise, accurate, and detailed follow-up notes on patient care; develop and demonstrate the ability to give an accurate and succinct presentation.
COMMUNICATION II: keep patient and family involved and informed.
Develop and demonstrate a caring approach to patients; develop a style of giving clear and appropriate information that will keep the patient/family informed and involved.
PROFESSIONALISM I: be selfless, reliable, honest, and respectful of patients, colleagues and staff.
Demonstrate the ability to form collaborative relationships, develop a style of giving clear and appropriate information, and demonstrate the ability to implement constructive criticism.
PROFESSIONALISM II: take initiative and responsibility for learning, achieving personal growth and improvement, and supporting the learning objectives of others.
Develop and demonstrate the ability to convey an enthusiastic attitude, anticipate team needs, and maintain composure under stressful situations.
PROFESSIONALISM III: demonstrate knowledge and affirmation of ethical standards.
Demonstrate an eagerness to learn by identifying questions about the practice of neurology, seeking out answers to such questions, reading the literature related to patients’ neurological problems, and assessing one’s own progress.
Neurology Inpatient Ward Services
The Neurology ward services admit patients from the ED, transfers from the ICU, transfers from other hospitals, and planned admissions from home. Students have the opportunity to follow patients through their hospital course, participating in initial evaluation, diagnosis, treatment, and discharge. Students are involved in all aspects of patient care, including the evaluation of patients, team rounds, patient and family discussions, clinical conferences, and documentation.
There are two Neurology ward services:
- The General Neurology and Epilepsy Service admits patients with neurologic conditions other than stroke or vascular injuries, including central inflammatory disorders, CNS malignancies, seizures, and neurodegenerative conditions. Many patients present without a clear diagnosis, providing ample opportunities to participate in present with illnesses not yet diagnosed, and students participate in the diagnostic workup and management. The Epilepsy service (with a separate attending neurologist and fellow but the same resident and student team) includes a Long Term Monitoring Unit, which uses video EEG to help characterize epileptic seizures and seizure-like events, diagnose epilepsy, safely adjust and change anti-seizure medications, and evaluate patients for the possibility of epilepsy surgery.
- The Stroke Service admits patients with vascular neurologic disorders, including ischemic strokes, hemorrhages, or transient ischemic attacks as well as less common conditions such as complex migraine, reversible cerebral vasoconstrictive syndrome, vasculitis or transient global amnesia. This service provides rich opportunities for review of neuroanatomy and structure-function correlation.
Consultation Services:
The Neurology Consultation services evaluate and help manage patients admitted to other wards or ICU teams, with possible or confirmed neurologic disorders needing urgent evaluation, diagnosis and management. Students have the opportunity to evaluate and examine patients from a neurologic perspective, integrating the patient’s acute and chronic medical problems. Students learn about common and rare complications of systemic medical illnesses with neurologic manifestations.
There are two Neurology Consultation services:
- West Consult: The West Consultation service evaluates patients on the BIDMC West campus. Common problems include encephalopathy, seizures, vascular disease, movement disorders, and cognitive deficits, including aphasia.
- East Consult: The East Consultation service evaluates patients on the BIDMC East Campus and also covers Neurology consultations in the ED, 8-11 am. Many East campus patients are on the Oncology or OB-GYN services. Common consultations include encephalopathy, ataxia, weakness, sensory loss, headaches, infection, seizures and several neurologic illnesses related to cancer or pregnancy and deliver, as well as those occurring on general medical services.
Neurology Clerkship Grading
Grading in the neurology clerkship follows the HMS Grading System for the PCE
https://medstudenthandbook.hms.harvard.edu/203-grading-and-examination#gradingsystem2
Assessment:
Students will be evaluated by attending neurologists and neurology residents who have worked with a student for a minimum of 3 days. Rotating residents from other services will not evaluate students during their Neurology Clerkship.
HMS and BIDMC Policies
Duty Hours:
Policy on Student Conduct
Policy on Student Conduct and Responsibility
BIDMC Policies for Contact Exposures
AY17 BIDMC PCE Exposure to Blood Body Fluid Policy and Procedure
PCE Log Requirement:
Students are required to record their encounter with each log topic once, inclusive of the highest level of patient interaction displayed in that encounter during the rotation. Individual clerkship directions may choose to use the PCE Log for additional purposes, so long as students meet the minimum requirement of recording the highest level of encounter with each one of the specified topics.
HMS Policy on Mistreatment:
Harvard Medical School and its affiliated hospitals are committed to a culture of mutual respect and trust and to providing an environment free from discrimination, sexual harassment, unprofessional relationships, and abuses of authority. We take student mistreatment seriously and aspire to a culture of zero tolerance for instances of abuse, mistreatment, and disrespect. All faculty, students, house officers, fellows, and staff are expected to contribute to sustaining an environment of collegiality and mutual support that is conducive to learning and working. Students experiencing mistreatment personally or witnessing such behavior in others are expected to report such incidents in clerkship surveys and/or through an anonymous online form accessible through the HMS Student Service site.
HMS Ombuds Office:
As an impartial complaint handler, the Ombudsperson strives to see that people are treated fairly and equitably at Harvard Medical School, Harvard School of Dental Medicine, and the Harvard School of Public Health. The Ombudsperson is a designated neutral person and, as such, does not advocate for any individual or point of view. The office is independent of any existing administrative or academic structures and is responsible only to the dean of each school. The official supplements the existing resources available to members of our communities.
Advanced Elective in Neurology
Advanced Neurology Clerkship (NN501M.23)
Students interested in building their neurologic skills beyond the clerkship are invited to participate in the Advanced Elective in Neurology, where they will have the opportunity to join the inpatient services or select outpatient clinics as an acting intern. The advanced elective is also available to visiting students through the Visiting Students Program at Harvard Medical School; applications are accepted through the AAMC’s Visiting Student Learning Opportunities (VSLO) program. Please note that site placements are assigned by the registrar’s office.