Neurology Clerkship

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Enjoy this clerkship—you will be around some of the best teaching faculty in the country (who also happen to be very nice and fun). You will learn a lot about the brain and nervous system and your work hours should be pretty reasonable along the way. This clerkship includes a lecture series (mostly live with some recorded and posted online) with an online quiz over the lecture material, clinical evaluations, a graded neurological physical exam, and the NBME shelf.

Structure and Grading

Your clinical experience may be a combination of inpatient and outpatient Neurology and potentially Neurosurgery. In your clerkship preferences you will have the opportunity to rank what type of experience you would like to have (e.g., 2 weeks of inpatient + 2 weeks of outpatient, 4 weeks of inpatient, outpatient downtown vs. community settings, neurosurgical component, etc.) and typically the clerkship is very good at giving you an opportunity to revise your preferences if your rotation comes later in the year. Becky Radford (the clerkship coordinator) is extremely helpful and organized and quite willing to work with you if you have specific interests or goals from the clerkship, as is Dr. Joanne (clerkship director).

Information for the lecture series/quiz is very high yield for the shelf exam so make sure to study that material well. Additionally, there will be a few questions from specifically listed sections in Blueprints Neurology and High Yield Neuroanatomy, both books which will be loaned to you for the clerkship.

The graded neurological exam is meant to be more for participation and feedback. You can select any faculty member to observe you performing a complete neurological exam and this year they logged your grade (Honors, High Pass, Pass) on CERTTS immediately afterwards. Again this was not meant to be a high pressure event and most people do extremely well on this.

Be aware that although clinical evaluations do make up the majority of your grade in terms of percentages, most of the grade distribution (in terms of Honors, High Pass, Pass) comes from the differential in the shelf +/- lecture quiz scores.

You will have the opportunity to use any of several books (Blueprints, High Yield Neuroanatomy, Case Files, etc.) on loan from the neurology department for the month. The staff personally sponsors this wonderful gift to us. The Neurology Blueprints is better than many of the other Blueprint texts, and much of the material goes hand-in-hand with lectures. Other helpful resources per previous students: USMLE World questions, Neurology PreTest, First Aid for Step 2 CK, CaseFiles. Most students suggests picking 1-2 resources at the most and being able to work through those at least twice.

The content part of the Neurology Pearls comes from prior lecture material. Neurosurgery material has also been added to help with the basics. This should NOT be substituted for studying the lecture material as well as other readings, but it will give you a pretty good starting point.

General tips for making the most out of the Neurology clerkship

  • Read about your patients, including signs and symptoms, diagnosis, management, and applications to your patients.
  • There is some overlap with Psychiatry, particularly in terms of Pharmacology, so doing one first will help you with the next rotation
  • Be supportive of your peers, interns, residents, fellows, attendings . . . well-functioning teams have the most fun, learn the most, provide the best care, and leave each other with the best impression and evaluation.
  • Start your studying early and be steady (1–2 hours a day). This is a quick rotation with a lot of material but you should have more non-committed time than in other rotations.
  • Residents are your friends. If they offer to discuss a clinical topic with you take them up on it!
  • Bread and butter subjects can include: stroke, dementia, MS, movement disorders, seizures

Other useful resources/websites

  • American Academy of Neurology - you can follow links to education for medical students and there are tips for studying, study books they recommend, and tips to applying/interviewing for a neurology residency
  • Whole Brain Atlas - Free interactive atlas with great neuro-imaging through the Harvard Medical School website
  • A number of other Neurology and Neurosurgery texts and handbooks are available through the Ruth Lilly Medical Library website via Access Medicine
  • Consider getting involved in SIGN (student interest group in Neurology)

Helpful Terms to Know

Amaurosis fugax:  transient, painless, monocular blindness from embolus in ophthalmic artery.  Most commonly originating from the carotid artery.

Anosognosia: Unawareness or denial of a neurological deficit such as hemiplegia.

Aphasia: Disorder of speech content

Athetosis:  writhing, repetitive movements

Delusion: A false belief that is firmly maintained in spite of incontrovertible and obvious proof or evidence to the contrary and in spite of the fact that other members of the culture do not share the belief.

Dysarthria:  Motor-speech disorder characterized by poor articulation

Dysdiadochokinesia:  abnormality of the rate and rhythm of a movement demonstrated by asking the patient to perform a rapid alternating movement.  It is a common feature of cerebellar ataxia.

Disequilibrium:  sensation of impending fall or of the need to obtain external assistance for proper locomotion.

Dysmetria: abnormality of the range and force of a movement; manifests as erratic, jerky movements with over- and undershooting the target (hence limb or ocular dysmetria).  Often caused by lesions to the cerebellum.

Dystonia: sudden, tonic contraction of tongue, neck (torticollis), back (opisthonos),mouth, eyes (oculogyric crisis)

Gait ataxia: broad-based and unsteady, with an inability to walk in a straight line and a tendency to lurch from side to side

Hallucination: A sense perception without a source in the external world; a perception of an external stimulus object in the absence of such an object.

Light-headedness:  feeling faint; presyncopal state

Truncal ataxia:  impaired control of truncal posture; when severe, unable to even sit unsupported

Vertigo:  an abnormal sensation of movement that is usually rotary but may be linear