Transcript Neurology Clerkship Orientation

NEUROLOGY CLERKSHIP
ORIENTATION
2012-2013
ROB NAISMITH M.D.
APPLYING KNOWLEDGE AND
CLINICAL SKILLS
• Apply Knowledge from DNS to Patient Care.
• Read about patient’s differential and condition
• Synthesize the case for diagnosis
• Use the primary literature for patient management
• Learn and Refine Clinical Skills
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Obtain patient experience and communicate with family
Collect all the data
Communicate with health care team
Work productively to help team and guide care
• Professionalism and Attitude
• Enthusiastic about trying to help the patient
• Proactive about learning
• Contribute to discussion and education
CLERKSHIP COMPONENTS
Clinical
Exposure
Clinical
Skills
Workshops
Core
Lectures &
Reading
Neurology
Clerkship
Objectives
Clinical
Exposure
Didactics –
Lectures are Over!
Adult, Peds, NSurg,
Inpatient, Outpatient,
Consults, ED
Ethics Conference
Working-up &
Presenting Patients
Neurology &
Neurosurgery Core
Conferences
Rounding with Team
Professor’s Rounds
Patient Ownership
Clinical Skills and
Localization Workshops
OBJECTIVES
• Perform a Comprehensive Clinical Assessment
• Synthesize the Case for Prioritized & Logical Differential
• Summarize the Case and Your Assessment for Oral
Presentations and Write-Ups
• Develop your Knowledge and Use Literature
• Follow and Advocate for your Patients
• Work with Team and Increase Independence
SYMPTOM-BASED APPROACH
THE CHIEF COMPLAINT!
•Disorders of consciousness
•Mental status and/or behavioral changes
•Memory complaints
•Pain in the head, neck, and back
•Numbness, paresthesias, and neuropathic pain
•Weakness and clumsiness
•Dizziness and vertigo
•Disorders of language
•Vision loss and diplopia
•Dysarthria and dysphagia
•Abnormal movements
•Sleep-related complaints
DISEASE CATEGORIES
• Stroke & Hemorrhages
• Structural Coma
• Metabolic
Encephalopathies
• Neuro-Toxicology and
Vitamin Deficiencies
• Meningitis &
Encephalitis
• Dementia & Memory
• Seizures & Syncope
• Vertigo
Headaches
Myelopathies
Radiculopathies
Neuropathies
Immunologic
Diseases
• Movement disorders
• Neuromuscular
disorders
• Brain tumors
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Details found on Clerkship Website
REQUIRED CONFERENCES
GOOGLE CALENDAR
• Core Clinical Conference
• Neurosurgery Lectures (Tues morning)
• Localization and Imaging Workshops
• Professor’s Rounds
• Grand Rounds (Fri morning)
• Oral Presentation Skills Workshop (1st Fri)
• Neurologic Exam Skills Workshop (1st Mon)
• Landau Ethics Conference (last Wed afternoon)
• LP Simulation Session with Chief Resident (1st Week)
You are welcome to attend most other lectures. Speak to your
resident. (Resident Report, Summer Stock, Residents as Teachers
are just for residents).
CONFERENCE AIMS
• Professor’s Rounds
• Synthesize the case history, Pro-actively localize, Create a prioritized differential
diagnosis, and Build expectations for neuro exam
• Sign-up (no Peds Cases, no more than 1 Stroke Case)
• Oral Presentation Skills Workshop
• Provide clear, concise, and well-organized patient presentations for rounds
• Sign-up
• Neurologic Exam Skills Workshop
• Master the technique and flow for the screening neurologic exam
• Localization and Imaging Workshop
• Review neuroanatomy, Interpretation imaging studies, and Apply localization for
differential diagnosis
• LP Simulation Workshop
• Consent and perform a lumbar puncture with good technique
INPATIENT STRUCTURE
• Two Teams: Stroke and General
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One Attending, One Chief, Four Residents
Students belong on a team
Assigned a resident for call
Student on Stroke Call caries tPA pager
• Both Teams take call each night
• Call typically every 4th
• Schedule typically synchronized with assigned resident
• Day admissions (Short) through 5pm or cap
• Call admissions (Long) typically start at 5pm
OVERNIGHT CALL
• Work with resident on New Admits and Sign-Outs
• Read about Patients, Prepare Write-Up and Presentation
• Students typically get around 2 patients.
• Take early patients
• Bed on 4th floor
• Leave post-call at 1pm if required noon student conference, or
12pm if no noon student conference
• Do not go to conference at 1pm or later
• If post-call, and you have a new patient presentation in conflict
with morning conference: Go to the conference, but let the
conference attending know you will need to excuse yourself just
prior to the patient presentation
START DAY
• Pick-up several patients to follow
• Review charts for patients on your team
• Have patients to present on rounds for Day 2
• Inpatient Adult during the second half of the block
begins on the weekend
CLINICS
• Inpatient Adult Service:
• Often matched with your assigned resident (adult or peds)
• BJC Center Outpatient Care, ConnectCare, Children’s Clinic
• Peds Consults
• Will pick one ½ day clinic each week, Dr. Larsen to advise
• Adult Consults
• Pre-scheduled based upon your choices
• Neurosurgery
• Weekly ½ day resident clinic
PATIENT LOGS
• Required log of Neurology Symptoms, Diagnoses,
and Situations done on New Innovations
• Enter 2-3 patients per day
• Enter your patients daily
• Comment field FYI
• Not evaluated
• Can enter one thing you learned, brief summary, etc
• Do not need to write in full sentences
BOOKS
• Review Diseases of the Nervous System notes
• Pick one - Lange Neurology, Blue Prints, Case Files
• Consider supplementing with Pre-Test
• Review Disease List on Clerkship Website
• Text books, on-line websites, primary literature for
patients
EVALUATIONS
REPORTER
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Good knowledge of
Neurosciences and
Neurology
Can get an essential history
and reliable/complete
exam
Enthusiastic about new
patients and helping team
Shows steady improvement
Very good with patients
and families
Presentations are
organized and concise
with good differential
Hard-working, reliable,
cares about getting
everything done correctly
No deficiencies
Meets Expectations
Pass
INTERPRETER
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Apply knowledge toward
patient management
Gain independence
Proactive about education
Contributes to rounds and
didactics
History geared towards
functional impact and
differential
Access primary literature
for patient questions
PE integrates
observations/findings
Patients and families
identify them as their
doctor
Differentials are honed
towards presentation and
preliminary testing
Exceeds Expectations
High Pass
MANAGER
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Consistently impacts patient
care
Uses neuroanatomy and
pathophysiology to make
diagnoses
Makes clear ties across HPI, PE,
and tests to have
concise/complete differential
with rationale
Consistently knows more about
the patient than anyone else
Takes an interest in all patients
on service to learn and help
team
Adapts PE to situation and adds
additional testing observed on
rounds
Able to self identify tasks they
can accomplish with good
judgment
Advocates for their patient to
improve stay
Greatly Exceeds Expectations
Honors
EXAMPLES
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Teaching topic on the approach to neuropathies
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Wheels their patient to cardiac echo when transport doesn’t show so they can go to rehab same day
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History includes how the disease impacted ADLs and ambulation
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Recognizes Horner’s syndrome and lists lung cancer high in the differential
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When asked on rounds, knows that a diabetic 3rd can spare the pupil
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Teaching topic reviews evidence and guidelines for using steroids and acyclovir for patient with Bells Palsy
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Differential for headache complete, but includes some extremely unlikely considerations
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Patient presentation summarizes exam findings as normal but notes specific negative findings based upon
differential
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Returns to see patients after clinic to review the chart, find out about developments, and update them on progress
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Asks resident “What can I do to help?”
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After holiday break, emails resident and asks which patients they should pick-up before rounds on their day
back.
FEEDBACK AND EVALUATION
Reporter – Interpreter - Manager
• Objective
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Criterion based
No curves of cutoffs
Emphasizes level of thought process and ability to adapt
• Individual
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You are not compared to one another
Teamwork among students is positive
• High Expectations
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A Reporter is someone I could recommend to a residency or feel comfortable having them
care for my family
• We Want You To Do Well
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Feedback so you know where you stand
Detailed comments
Dr. Larsen’s Experiential Learning Project
“Greatly Exceeds Expectations” is a success for us all
WELCOME TO MAKE
APPOINTMENT
•Come if you have questions, requests, or concerns.
ANY QUESTIONS