LSU Clinical Neurosciences Clerkship L4
Duties of Students
Each student should own or have access to the following equipment in order to adequately exam patients with neurological or neurosurgical disorders:
- Ophthalmoscope (with traditional or PanOptic head)
- Reflex Hammer (preferably Queen Square type and not Tomahawk type)
- Flashlight (or penlight)
- Snellen Visual Acuity Chart
- Tuning Fork (C-128 for vibration sense detection +/- C-256 or 512 for hearing)
- Your Brain!
II. Didactic Lectures
Each student is expected to attend all didactic lectures and conferences as per their schedule. Generally speaking, required lectures will include a Neurology resident-led Student Clinical Case Conference, a Basic Science lecture in Clinical Neurophysiology or Neuronal Cellular Metabolism and Cell Death, and Dr Sumner’s Student Professor’s Rounds. You will attend these lectures during the first 2 week cycle.
For the 3rd week of the block, you will attend a 90 minute “Afternoon Report” with Dr. Deputy at Children’s Hospital. For the last Thursday afternoon of the block, you will be excused from clinical duties to study for your SHELF exam the following day. Attendance will be taken and students who are absent without permission from the Clerkship Director will be assigned an “Incomplete” at the end of the course and additional work will be required from the student to achieve a final grade for the course.
Required didactic lectures are always on Thursday afternoons to allow for the maximum amount of time for students to spend with their patients. All students must attend the Thursday afternoon didactics (even if rotating on a neurosurgery service) with the exception being those students who are rotating through Neurology in Baton Rouge under the guidance of Dr. Barkemeyer.
The resident-led Clinical Cases Conference will go over one of two cases that are written up in advance and provided as part of your Orientation Day materials. Each of the cases has several discussion points highlighted and students should come prepared to the Conference by reading over the cases and going through the discussion points before the conference begins. Student participation in this course is mandatory and you may be the person “picked on” to answer some key questions about the cases, so come prepared.
Basic Science Lectures are given on a rotating cycle every other week and consist of either a Neuronal Cellular Metabolism and Cellular Death or a Clinical Neurophysiology lecture. The lectures last 90 minutes and are designed to be a “refresher course” of sorts for information that you had already been taught, but perhaps forgotten from the Freshman Neurosciences Course. Lectures are given by Dr. Weyand, Dr. Mize or Dr. Deputy.
Student Professor’s Rounds are led weekly by Dr. Sumner and are geared towards each medical student’s level of understanding of neurological disorders. Cases will be discussed and analyzed and student participation is encouraged. Dr. Deputy’s “Thursday Afternoon Report” conference will be held the third week of each block from 1pm to 3 pm at Children’s Hospital. It is a version of the more typical “Morning Report” format where the students talk about a case they have seen and how it was worked up. Each student should be prepared to present a single case, meaning that detailed history and physical examination findings, pertinent laboratory findings and imaging studies (try to get a CD of the images if possible) will all need to be made available as well as information about the clinical course and any therapeutic interventions undertaken. Because of time limitations, I will need to randomly pick 3 to 6 cases to go over. This conference is intended to help with clinical management of patients with neurological disorders and not be a formal powerpoint presentation. So think about gathering information for your case before the 3rd Thursday of the block.
III.Clinical Neurosciences Passport
The Clinical Neurosciences Passport is your link to documenting basic competencies in performing a neurological examination and in taking a pertinent neurological history, any invasive procedures performed, a patient log, along with 2 copies of the Student Narrative Evaluation forms (don’t lose these) and a Student Feedback form. The Passport is to accompany each student each day during the rotation and must turned in at the end of the rotation in order for the student to be able to sit for the final written examination. Lost or misplaced Passports may be reconciled on a case-by-case basis by the Clerkship Director. Each Passport will have the following components:
- Direct Observation of Your Neurological Examination
After demonstrating a thorough Neurological Examination, have your attending physician or resident physician sign off on your Basic Competencies: Neurological Examination Skills Form. There is a specific form for each rotation that you are on (Adult Neurology, Child Neurology, and Neurosurgery). A minimum of one documented Neurological Exam is necessary to pass the course, but students are encouraged to practice their neurological examination skills under supervision as many times as possible during their Neurosciences Clerkship.
- Evaluation of Taking a Pertinent Neurological History
After demonstrating a thorough, yet pertinent Neurological History, have you attending physician or resident physician sign off on your Basic Competencies: Pertinent History Taking Skills Form. As with the Neurological Examination Basic Competency Forms, there is a specific Neurological History Competency Form for each of the rotations. You are likewise expected to have at least one documented pertinent neurological history to pass the course. Even after this requirement has been met, seek feedback from your history taking skills from neurology or neurosurgery residents or child neurology fellows or attending physicians to hone your skills. Remember that most of the useful information you will obtain on your neurology patients comes from the neurological history (and not necessarily from the exam, imaging, or other diagnostic studies).
- Direct Observation of a Lumbar Puncture or Other Procedures
Every time that you are observed obtaining consent for or performing a lumbar puncture or another procedure, have the observer date and initial your Direct Observation of Lumbar Puncture or Other Procedure form within yourPassport. Although performing a lumbar puncture is not part of the requirements to pass the clerkship and every student may not have the opportunity to perform or observe a lumbar puncture, every effort should be taken to try to observe or perform at least one during the clerkship.
- Student Presentations
Students are encouraged to give short presentations covering topics that directly pertain to the diagnosis, treatment, pathogenesis, and/or prognosis of disorders that their patients are suffering from. Taking the initiative to educate yourself and others on your team is an important aspect of functioning on the “Manager/Educator” level within the “RIME” evaluation paradigm. Documentation of any presentations given by students is contained within the Student Presentations section of your passport.
- Patient Log
The Liaison Committee on medical Education requires that each clerkship specify the number and kinds of patients that students must evaluate in order to achieve the objectives of the clerkship. The Neurology Clerkship Grading Committee has determined that each student must be involved in the care of at least two patients with the following conditions:
1. Paroxysmal Disorders
2. Vascular Disorders
3. Neuromuscular Disorders
4. Progressive Degenerative Disorders
Specific examples of diseases that fit within each category are provided within your passport. It would be ideal to have experience caring for patients from each of the four categories within both of your two week rotations. However this is not always possible. For example, students rotating on Child Neurology will have less exposure to patients with vascular disorders or degenerative diseases. Under these circumstances, students should attempt to see both of their vascular disorders patients and degenerative disorders patients during their Adult Neurology or Neurosurgery rotations. Likewise, many of the paroxysmal disorders will not be covered during the neurosurgery rotation and students should try to get their patient experience in this category from their Adult or Child Neurology rotations.
· Formal Faculty and Resident Feedback
Students will be provided a grade for their clinical performance by faculty or a senior neurology resident or a child neurology fellow at the end of each two week block as part of the Student Clinical Skills Narrative Evauation Form contained within your Passport. This grading tool has individual sections concerning your clinical performance within several of the ACGME core competency areas as well as a section for assigning a final clinical grade for each student based on the RIME format grading paradigm. It is essential that all sections of this form be filled out, including the final grade section (Don’t accept the form back if it does not have a final grade!). At the bottom of the form there is a section for signatures by both the person doing the evaluation as well as by the student which documents that you have received direct face-to-face feedback about your clinical performance from your evaluator. Each student should have a Student Clinical Skills Narrative Evaluation Form filled out for each of the two week rotations within the clerkship. That means that two separate forms need to be filled out for each student completing the clerkship. For those students completing all four weeks on a single service, two forms will still be required to be completed (one about half way through the rotation and another at the end of the rotation. It is imperative that you hold on to these forms at all times as they are required to be turned in (along with the rest of your Passport) at the end of the rotation to qualify for sitting for the final written examination. Finally, do not wait until the last day of the rotation to get your evaluation form filled out. It is difficult for busy residents to have to fill out up to 5 of these forms in a single day, meet with the students to provide feedback, and take care of patients all at the same time. So be courteous and start asking about having the evaluation form filled out a few days before the end of the rotation.
- Clerkship Student Feedback
Please fill out the student feedback section of your Passport prior to the end of the rotation. The Clinical Neurosciences Clerkship is frequently updated and changed based largely on your anonymous feedback. You can detach the form from your passport and mail it to Dr Deputy if you are concerned about confidentiality. His mailing address is 200 Henry Clay Ave, New Orleans, LA 70118
IV. Progress Notes
Progress notes should be written as frequently as the patient’s condition warrants. These can be written on hospital Progress Notes sheets but should be identified as L-IV with signature and should be cosigned by staff or resident.
The official Student Leave Policy During the Clinical Neurosciences Clerkship essentially states that students should try and minimize absences during required clerkships such as the Clinical Neurosciences clerkship. It is recognized that many of you will have residency interviews that will conflict with your clinical duties during this clerkship. Students are allowed up to a total of 3 missed days for interviews (including time for travel).
It is expected that you inform your resident as well as other students on the team of your scheduled absence so that your patient care duties can be covered. In order to be excused for interviews, you must also inform the clerkship administrator (JB) as well as the Clerkship Director in writing (by email) of your planned absences before you take them or they will be considered unexcused.
Unexcused absences may be grounds for failing or repeating the clerkship. There have occasionally been students who needed to take more than 3 days off for interviews. These students have generally needed to make up extra time within the clerkship at the clerkship director’s discretion.
Policy on Absence from Required and Elective Senior Clerkships
Adopted by LSU Clerkship Directors 3/20/08
Situations may arise when a student will need to request a brief absence from daily responsibilities on a required or elective clerkship in the senior year. Guidelines for emergent and non-emergent absence during the junior clerkships also apply to the senior clerkships. In addition, seniors may be excused from daily responsibilities for the purpose of their residency interviews. These requests are considered non-emergent and must be presented to the clerkship director for approval in advance. Note that these are institutional guidelines and some of the clerkships may have more specific policies.
Residency Interviews: Senior clerkships are shorter than those in the junior year, so absences for non-emergencies should be minimized. Students should make every attempt to schedule residency interviews during block 7 or at other times when they are not on a clerkship rotation. We recognize that this is not always possible. However, we consider your adherence to these policy guidelines a matter of professionalism. Clerkship directors should receive requests for absence due to a residency interview prior to the start of the rotation. Absence for more than a total of two days from an acting internship and for more than a total of three days from all other clerkships is strongly discouraged and may require remediation prior to completion of the clerkship. Remediation may involve additional call nights, additional weekend responsibilities or clinical work on days normally set aside for vacation. Sufficient remediation will be established at the discretion of the clerkship director. Additionally, excessive absences for interviews may be reflected in the evaluation of your work habits or professionalism.
VI. Call Schedule
Staying overnight for call is not required during any of the Neurology or Child Neurology portion of this Clerkship. If however, you are working with a particularly engaging resident and wish to take call with that person, feel free to do so. There is a lot that one can learn from working one-on-one with a resident. During your Neurosurgery rotation however, you may be asked to come in to round on one weekend day during the two weeks you are on the Neurosurgery service. Your Neurosurgery attending or resident will explain this requirement more completely on Orientation Day.
VII. Work Hours
In recognizing the time commitment required of medical students during clinical rotations and taking into account the effects of fatigue and sleep deprivation on learning, clinical responsibilities, and student health and safety, the following duty hour limitations have been adopted by the LSU Clerkship Directors as of 5/22/08 and are to be followed without exception:
“Duty hours must be limited to 80 hours per week averaged over a four-week period, inclusive of all clinical and didactic learning activities. Students who are assigned to overnight call in the hospital should not have patient care responsibilities after 1:00 PM on the following day. Students will be expected to attend mandatory didactic activities even after overnight call.”
Any breeches of this policy should be immediately reported to any of the following:
Director of Clinical Sciences Curriculum, the Associate Dean for Student Affairs, the Assistant Dean for Student Affairs, or the Assistant Dean for Undergraduate Medical Education.