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Northwestern University Feinberg School of Medicine
MD Education

Neurology Clerkship

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.

 Goals & Objectives

Detailed Goals and Objectives

Find comprehensive Neurology Clerkship Goals and Objectives.

 Assessment and EPAs

EPAs

Neurology Clerkship CPA Form

Mobile Observation Forms (eMerg)

STUDENT GRADING POLICIES FOR THE NEUROLOGY CLERKSHIP

The final grade will be out of 100 points, with the following breakdown:


Component

% (or points) towards final grade

Clinical grade:

35 points

OSCE:

35 points

H&P Assignment:

10 points

 

Your clinical grade will be determined by your evaluators based on the following characteristics:

 

Honors student is one who:

  • 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:

  • 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.

 

Failing Student 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.

 

A student who receives 60% or less fails the clerkship and will need to take more time or repeat the clerkship.  In addition failure on clinical grounds will result in a failure of the clerkship regardless of results of the objective testing.  The extra time needed will depend on the individual student’s weaknesses, and will be determined by the CD after discussion with Deans Sandra Sanguino and Marianne Green.  In this case you will be given an incomplete until you have mastered the skills necessary to pass the clerkship and your MSPE and transcript will reflect the time needed to successfully complete the clerkship

 

 

Clinical evaluations 35 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. The final grade on the
evaluation form will be assigned points (60 - 100). This will be multiplied by 35%. 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. 

 

Shelf exam 20 points:

The percentile rank from the SHELF exam will be multiplied by 20%.

 

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). 

 

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 10 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:

A: Making a declaring action for the care of your patient (i.e. what would you do for the patient based on your findings)

B: Provide justification for your declaring action based on your critique of the literature (i.e. summarize the evidence for your conclusion)

 

Grading Scale

 

Honors**

85-100

High Pass

73-84.99

Pass

60-72.9

Fail

Below 60

 

**In order to be eligible for honors, your overall score must fall between 85-100 AND you must receive at least a HIGH PASS clinically, your score on the SHELF must be >50% percentile of the national mean, and you may not have lost any points for professionalism. 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.

 Required Clerkship Clinical Experiences (Clerklog) and additional tools

Download the Clerkship Clerklog

Access the Clerklog online (requires NetID)

Books

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:

  1. Check on how they are doing
  2. Do the relevant parts of the neuro exam
  3. 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.

Contacts

Stephen VanHaerents, MD 
Director

Sean Lynge
Coordinator
312-503-2465