The goal of the third-year neurology clerkship is to prepare the student to identify diseases and situations in which neurological evaluation is appropriate so that the student understands as a practitioner when neurological consultation is appropriate and when emergent neurological intervention is needed. Each student will have two-week inpatient and outpatient rotations.
Outpatient rotations will take place in Lavin subspecialty clinics or with selected private adjunctive faculty, and hours vary based on where you are placed. In some Lavin clinics, this will be an observership. Use this as an opportunity to watch how an experience physician examines, interviews and interacts with patients. You will go through a variety of subspecialties while still having continuity with a few doctors. In the private clinics, you’ll work with one to two physicians and see a variety of diagnoses.
Inpatient rotations vary based on where you are placed. You will typically come in between 6:00 and 6:30 a.m. in order to get sign-out and pre-round on your patients. You leave when the work is done at the end of the day, around 5 p.m. There is one weekend day rounding requirement during your inpatient weeks. On ER service, you will work 12 p.m. to 9 p.m., Monday through Friday.
Program Objectives (Competencies)
Clerkship Goals & Objectives
Find comprehensive Neurology Clerkship Goals and Objectives.
Assessment & EPAs
Neurology Clerkship Assessment & Grading Policy
Students are responsible for being aware of the following assessment policies:
Section I: Components of the grade
Your clerkship grade will be derived from the following components.
The final grade will be out of 100 points, with the following breakdown:
% (or points) towards final grade
Faculty/resident clinical performance assessment
Professionalism / Assessments
An explanation of each component follows the above table
Clinical Score: 40 points
There will be an evaluation meeting with all evaluators who worked with you during your inpatient and outpatient rotations that will be held at the end of the month to discuss your performance. Resident and attending evaluations are given equal weight. Using evaluations from this meeting and CPA form assessments. The final grade on the evaluation form will be assigned points (60 - 100). This will be multiplied by 40%. Based on CD’s assessment of grading patterns of faculty and residents, as well as other extenuating factors (e.g. professionalism issues) the CD may modify the final clinical grade. Included in your clinical grade is assessment of professionalism.
Students must demonstrate professional behavior by being punctual, attending required conferences, completing electronic clerk log completely and on time, turning in all assignments (e.g. Ethics and H&P/MDM) on time, and alerting the clerkship administration and appropriate team members (e.g. attending and senior resident) to any unforeseen absences (e.g. due to illness) in a timely fashion. You must also maintain professional dress and demeanor and develop professional relationships with peers, faculty and staff.
Based on the clerkship director’s assessment of rating patterns of faculty and residents, as well as other extenuating factors (e.g. professionalism issues) the clerkship director may modify the final clinical grade.
OSCE: 35 points
You will be assigned 1 Standardized patient case (20 points) and 2 short cases (5 points each) and 2 multiple choice cases (2.5 points each).
NBME: 10 points
National Board of Medical Examiners- Neurology Exam provides one took for measuring examinees' understanding of the basic biomedical and clinical sciences.
Student will obtain a full 10 points for the Shelf/NBME section of their grade if they obtain a “passing score.” Our passing score is based on the Hofstee Compromise procedures in 2017. This is a score of 62%. This is the 2nd percentile nationally based on the 2018-19 academic year. Students scoring below the cutoff will need to retake and successfully pass the exam and the highest possible final grade will be a ‘pass’ by NU FSM policy. If a student does not achieve a passing score on second attempt, will need to remediate the rotation with extra time and retake the exam again.
H&P Assignment: 10 points
You will be asked to turn in one H&P assignment at the end of the rotation as well as create a clinical question relevant to the care of this patient, and use the literature to answer it. In order to obtain the full 5 points, the history needs to contain all the pertinent information in a clear and concise manner, examination needs to be relevant, complete and organized, and pertinent ancillary studies must be included. You must include a relevant differential diagnosis, prioritizing the entities you think most likely, and supporting your choices. Your assessment and plan must be well thought out, clearly written, and appropriate.
The case does not need to be a zebra, but it must be one in which you can demonstrate your thought process. For the clinical question, you need to create a searchable clinical question (PICO = patient/population, intervention, comparison, outcome) relevant to the care of your patient, provide your search strategy as well as the citation of the publication you used to answer your clinical question. You will then need to critically appraise the publication and apply your findings to your patient’s case by:
- Making a declaring action for the care of your patient (i.e. what would you do for the patient based on your findings)
- Provide justification for your declaring action based on your critique of the literature (i.e. summarize the evidence for your conclusion)
Professionalism/Assessments: 5 points
Each student is required to complete 3 EPA assessments by the end of the clerkship (1 must be EPA1). Additionally, all other assignments including completion of the clerklog must be turned in on time and have not lost physicianship points in any other area.
Section II: Calculation of Final Grades
Requires extra time**
**In order to be eligible for honors, your overall score must fall between a 90-100. When a numerical score falls closely between two grades, the clerkship director will evaluate all components of the student’s performance to determine the final grade.
** A clerkship director may decide a student needs additional time on the clerkship to meet the objectives. The amount of time needed will vary. In this case, the grade will be “Pass” and the number of additional weeks needed will be noted on the transcript.
*** A grade of fail will be given in the following circumstances.
- Failing the NBME SHELF exam three times.
- Being unable to meet the clinical requirements of the clerkship after completing additional time twice.
- An egregious professionalism issue.
Honors student is one who:
- Overall nearing independence
- Consistently performs thorough work-ups on even the most complicated neurological patients. This includes eliciting pertinent information unprompted, and being able to clearly present the cases in a logical manner.
- Demonstrates superior neurological physical examination skills. They should have the proper techniques and be able to perform a focused neurological examination.
- Formulates a well thought out and broad but relevant neurological differential diagnosis and thorough treatment plan, even on neurologically complex patients.
- Reads independently and uses the literature to support their plans and their thinking. They should also demonstrate in their presentations and performance that they have a superior knowledge base in Neurology.
- Is independent and proactive in the execution of their patient care duties.
- Consistently demonstrates initiative in caring for their patients and is independent and proactive in the execution of their daily patient care duties.
- Is professional, courteous and has excellent interpersonal skills with strong work ethics.
High Pass student is one who:
- Overall Performing at a “Do; I’ll intervene at times”
- Performs thorough work-ups and elicits pertinent information on all routine and some/ most neurologically complicated cases. They should be able to present the cases in a logical manner.
- Formulates a relevant differential diagnosis and thorough treatment plan on all routine and some/ most neurologically complicated cases. They may occasionally need direction and prompting to reach their goal on complex cases. But they take the initiative to do so.
- Demonstrates above average neurological physical examination skills. They are thorough with the techniques and are able to perform a focused examination. They may occasionally miss findings.
- Consistently formulates a well thought out differential on all of the common diagnoses, and occasionally on the complex cases.
- Shows that they are reading independently and have an above average knowledge base in neurology.
- Consistently demonstrates initiative in caring for their patients and is independent and proactive in the execution of their daily patient care duties. They may occasionally need direction in performing their duties.
- Is professional, courteous and has above average interpersonal skills with very good work ethics.
Pass student is one who:
- Produces complete work-ups and elicits pertinent information on all or most routine neurological cases.
- Is able to formulate a relevant differential diagnosis and treatment plan on routine cases. They may occasionally need guidance and prompting.
- Demonstrates average neurological physical examination skills. They should be familiar with the examination techniques, and should be able to perform a focused examination most of the time, occasionally needing guidance.
- Is able to formulate a well thought out differential diagnosis on routine cases, occasionally needing guidance.
- Demonstrates that they are reading and have an average knowledge base.
- Is an independent worker, but may need prompting and direction to understand their daily duties.
- Is professional and courteous with average interpersonal skills and good work ethics.
A student who requires extra time is one who:
- Is unable to complete work-ups or elicit pertinent information on routine neurological cases.
- Is unable to formulate a relevant differential diagnosis and treatment plan on routine cases, even with prompting and guidance.
- Is unable to perform a neurological examination and is unfamiliar with the proper examination techniques.
- Demonstrates an extremely poor knowledge base.
- Is unable to perform daily clinical care duties, despite regular prompting and guidance.
- Demonstrates unethical or unprofessional behavior. Other professional grounds for failing include dishonesty, unexcused absences or poor work ethics including willful negligence in patient care duties.
Section III: Additional information
Your final grade and evaluation will be available no later than 6 weeks after the end of the clerkship.
Required Clerkship Clinical Experiences (Clerklog) & Tools
- Download the Clerkship Clerklog
- Access the Clerklog online (requires NetID)
Gelb, Douglas James. Introduction to Clinical Neurology. New York: Oxford UP, 2016.
- Teaches you the approach to neurological disorders.
Gould, Douglas J., Jennifer K. Brueckner-Collins, and James D. Fix. High Yield Neuroanatomy. Philadelphia: Wolters Kluwer, 2016.
- Reviews neuroanatomy very well.
Frequently Asked Questions
What are the daily expectations for a M3 on this clerkship?
During the inpatient blocks students are expected to pre-round on their patients (this does not apply to ER), round with their team, write daily notes, and order/ follow up on tests etc as appropriate. You are expected to take ownership of your patients and do the tasks necessary for patient care.
During outpatient you will see patients and write notes as per your preceptor.
What is the typical schedule (number of days worked/hours per day) for this clerkship?
During inpatient (except ER) you typically come in by 6:30 or 7 a.m., depending on which service you are on, to get sign out and pre round on your patients. You leave when the work is done at the end of the day, around 5 p.m. There is a short call and one weekend day rounding requirement during your inpatient weeks.
On ER, you work noon to 9 p.m., Monday to Friday.
Outpatient: You work your preceptor’s clinic hours.
What is pre-rounding? Rounding? Note writing expectations for this particular clerkship?
Pre rounding is going to see your patients before you round with your team to:
- Check on how they are doing
- Do the relevant parts of the neuro exam
- Check on their vitals.
It is also important to go through the chart to determine if there were any results that came back or consult recommendations that were not previously reported. It is making sure you have all the relevant information to present to your attending on rounds.
Rounds with the team means presenting the patient (new and follow up) to the attending (knowing all the relevant information about your patient) and then going to see the patients as a team.
You should be writing notes every day.
What does “Call” mean on this particular clerkship?
One short call day is assigned during your inpatient block. It is seeing new patients, admissions as appropriate and doing cross coverage with your resident as appropriate.
What do I do if I have a question about my clerkship grade?
If you have a question about your clerkships grade you should discuss this directly with the clerkship director.
What do I do if I have experienced or witnessed Student Mistreatment during this clerkship?
If you have experienced or witnessed student mistreatment, there are many avenues to report this. You can discuss this with the clerkships director, mentor, any of the deans or Lisa Rone, MD, the ombudsperson.
What do I do if I feel burnt out or overwhelmed during this clerkship?
If you feel burnt out or overwhelmed during a clerkship there are a number of people you can speak with. The clerkship director, your mentor or anyone in the dean’s office are available to talk. CAPS can also be extremely helpful in this situation. You can contact CAPS at 847-491-2151.
Who do I contact if I am sick or have a personal appointment?
Your clerkship director, your clerkship coordinator, and a member of the team whom you were supposed to work with that day.
Any required equipment?
Neurology tools including reflex hammer and tuning fork. You also need a stethoscope.
Policies & Procedures
For Faculty & Residents
- Safe and Healthy Learning Environment
- Medical Student Supervision and Level of Responsibility Policy
- Duty Hours Policy
- Assessment and Health Providers Policy
- Non-Discrimination Statement
- Non-Retaliation Policy
- Assessment Policy for Clerkships & Electives (Phases 2 and 3)
- Visiting Resident Policy
- Phases 2 and 3 Attendance Policy and Procedure
- Patient Caregiver Preferences and Refusal of Care by Caregivers Policy
- Performing Sensitive Physical Exams Policy
- Needle Stick and Other Blood-Borne, Body Fluid and or Respiratory Pathogen Exposure Policy