Requirements/ Grading

Evaluation/ Grades

Your grade for the Longitudinal Neurology Clerkship will be based on a combination of objective testing, observed skills assessments, clinical evaluations, the quality of your written materials, and your level of participation in core clerkship activities in the following breakdown:

Evaluation Method

%age of grade

%age by component

Method of Evaluation

Written Tests

30%

20%

10%

NBME Neurology SHELF Examination

Monthly Practice and Post Module Quizzes

UNC Core Competencies and Milestones being assessed:

  • Recognize symptoms that may signify neurologic disease (UNC #1, MS 3001)
  • Localize the likely site or sites in the nervous system where a lesion could produce a patient's symptoms and signs (UNC#1, MS 3001)
  • Explain various causes (genetic, developmental, metabolic, toxic, microbiologic, autoimmune, neoplastic, degenerative, behavioral, and traumatic) and pathogenesis of major neurological diseases and conditions (UNC #2, MS 3002)
  • Describe the scientific principles underlying laboratory and radiologic diagnostic methodologies commonly used in Neurology (UNC #4, MS 3005)
  • Interpret an Emergent Head CT (UNC #10, # 11) (MS 3018)
  • Identify the core elements of a compassionate, ethical, and culturally competent family meeting to discuss prognosis and end-of-life care in the comatose patient (UNC #16) (MS 3033, 3034)
  • Identify the core elements of an appropriate hospital discharge plan that provides for patient safety during transitions of care (UNC #32) (MS 3036)
  • Identify necessary elements for coordinated team care of patients with complex and chronic neurological diseases with regard to the roles of nursing, discharge coordinators, social work, orthotics, rehabilitation, physical therapy, occupational therapy, and speech therapy. (UNC #34, #37
  • Identify and apply the core principles of evidence based primary and secondary prevention of stroke (UNC #38, 39)
  • Develop an appropriate plan of diagnostic evaluation and management for the following diseases from the UNC School of Medicine Case Book:  Adverse Medication Reaction, Agitated Patient (acute), Altered Mental Status, Back Pain or Sciatica, Cancer (depression), Dizziness or Vertigo, Epilepsy, Fall, Headache (including migraine), Intellectual Disability (mental retardation, ADHD, etc), Neuropathy (diabetic, carpal tunnel), Stroke/Transient Ischemic Attack, Syncope or Pre-Syncope, (UNC #11, #13) (MS 3020, 3026)
  • Develop an appropriate plan of diagnostic evaluation and management for the following diseases from the UNC School of Medicine Case Book:  Adverse Medication Reaction, Agitated Patient (acute), Altered Mental Status, Back Pain or Sciatica, Cancer (depression), Dizziness or Vertigo, Epilepsy, Fall, Headache (including migraine), Intellectual Disability (mental retardation, ADHD, etc), Neuropathy (diabetic, carpal tunnel), Stroke/Transient Ischemic Attack, Syncope or Pre-Syncope, (UNC #11, #13) (MS 3020, 3026)

Written Assignment

Oral Presentation

Patient Log

25%

5%

10%

10%

Written Communication

Topic Lecture to Medical Assistance

Patient Log

UNC Core Competencies and Milestones being assessed:

  • Obtain a complete and reliable neurological history (UNC#8, MS 3014, 3015, 3016)
  • Develop an appropriate plan of diagnostic evaluation based on an understanding the appropriate of use and interpretation of these common tests (UNC #11) (MS 3020, 3021, 3022)
  • Formulate a differential diagnosis based on lesion localization, time course, and relevant historical and demographic features (UNC #12) (MS3023, 2024, 3025)
  • Develop an appropriate plan to manage common and emergent neurologic problems, including the recognition and management of situations that are potential emergencies (UNC #13, #14, #15, #16) (MS 3026, 3027, 3028, 3029, 3030)
  • Prepare a clear, concise, and thorough written presentation of a patient's history and examination (UNC #19) (MS 3042)
  • Identify gaps in medical knowledge as they arise in clinical context and develop a self- directed learning strategy to fill in that gap (UNC#28) (MS3055)
  • Demonstrate skills in retrieving, critically assessing, and integrating biomedical information into clinical decision-making. (UNC #30) (MS3059)

Observed Skills Assessments

17.5%

7.5%

2.5%

5.0%

2.5%

Awake Neuro Exam Observation

Coma Neuro Exam Observation

Admission Order Entry Observation

Medication Reconciliation Observation

UNC Core Competencies and Milestones being assessed:

  • Perform a focused and reliable neurologic examination (UNC #9, MS 3017
  • Distinguish normal from abnormal findings on a neurologic examination (UNC#3, MS 3003)
  • Examine patients with altered level of consciousness or abnormal mental status (UNC#9, MS 3017)
  • Write Admission Orders (UNC #33)
  • Perform medication reconciliation in the electronic medical record during outpatient appointments (UNC #33)

Attending Evaluation

20%

10%

10%

Attending Oral Presentation Skills Assessment

Attending Oral Clinical Reasoning Assessment

UNC Core Competencies and Milestones being assessed:

  • Formulate a differential diagnosis based on lesion localization, time course, and relevant historical and demographic features (UNC #12) (MS3023, 2024, 3025)
  • Develop an appropriate plan to manage common and emergent neurologic problems, including the recognition and management of situations that are potential emergencies (UNC #13, #14, #15, #16) (MS 3026, 3027, 3028, 3029, 3030)
  • Deliver a clear, concise, and thorough oral presentation of a patient's history and examination (UNC #19) (MS3041, 3042
  • Demonstrate honesty, integrity, and ethical behaviors in all interactions with patients, families, and colleagues (UNC #21, #22, #25, #26) (MS 3045, 3052)
  • Protect patient privacy and confidentiality. (UNC#24) (MS 3050)
  • Actively seek and exchange constructive feedback about professional performance. (UNC#29) (MS 3056, 3057, 3058)




UNC Core Competencies and Milestones being assessed:

  • Demonstrate gender and cultural sensitivity in educational and clinical care settings. (UNC #17) (MS 3036, 3037)
  • Develop empathetic, caring relationships with patients. (UNC #18) (MS 3038)
  • Communicate effectively with patients, patient, families, colleagues, and other health care professionals. (UNC#19) (MS 3040, 3041, 3042)
  • Demonstrate collaborative teamwork skills, including dependability and punctuality, and the ability to work effectively with other members of the health care team (UNC#20) (MS 3044)

 

  • Demonstrate honesty, integrity, and ethical behaviors in all interactions with patients, families, and colleagues (UNC #21, #22, #25, #26) (MS 3045, 3052)
  • Protect patient privacy and confidentiality. (UNC#24) (MS 3050)
  • Actively seek and exchange constructive feedback about professional performance. (UNC#29) (MS 3056, 3057, 3058)

Self Evaluation

7.5%

7.5%

Self Professionalism Assessment

UNC Core Competencies and Milestones being assessed:

  • Demonstrate gender and cultural sensitivity in educational and clinical care settings. (UNC #17) (MS 3036, 3037)
  • Communicate effectively with patients, patient, families, colleagues, and other health care professionals. (UNC#19) (MS 3040, 3041, 3042)
  • Demonstrate honesty, integrity, and ethical behaviors in all interactions with patients, families, and colleagues (UNC #21, #22, #25, #26) (MS 3045, 3052)
  • Protect patient privacy and confidentiality. (UNC#24) (MS 3050)
  • Maintain personal health and well-being and achieve a balance between priorities of patient care and personal and professional development.(UNC #27) (MS 3053, 3054)




 

NBME Shelf Exam

The Shelf Exam will be administered in the spring 2012. It will make up 20% of your final Neurology Clerkship Grade.  The curriculum has been designed to help you do well on this exam. Further study outside of assigned preparation for didactic sessions is not necessary. Any additional study should be done with the aim of learning more about your patients. So far students are doing well on the exam with our mean being one half of a standard deviation above the mean.  More information concerning the examination can be found at the following link: http://www.nbme.org/programs-services/medical-schools/subject-examinations/clinical-science-disciplines.html

A shelf test score of less than the 10th percentile will result in a Condition grade.  Students who earn less than the 10th percentile on the shelf test but a passing grade overall must retake the shelf test only.

Quizzes
Pre-Test quizzes will be administered just before each didactic session as per the schedule. The questions will come directly from the assigned Neurology Pre-Test questions for the case-based sessions from that week. Therefore, any student who is doing their homework will have the opportunity to make 100% on these quizzes.  Also, there are three post-module quizzes to document competencies that are not felt to be adequately tested by the NBME Shelf Examination:  Systems Based Practice, Stroke Prevention, and Head CT/Coma.  The instructions for the Systems Based Practice Quiz and Stroke Prevention Quiz are at the end of their respective modules.  You will receive the Head CT/ Coma Quiz at the end of the Neuroradiology Module.  Together the three Pre-Test quizzes and three post-module quizzes make up 20% of your Neurology Clerkship Grade.

Quiz

Score

One Pre-Test Quiz

 

Two Pre- Test Quiz

 

Three Pre- Test Quiz

 

Post Quiz- Stroke Prevention Module

 

Post Quiz-Systems Based Practice Module

 

Post Quiz-Family Meeting in Coma and Head CT Modules

 

Average Quiz Score

 

Skills Observations

Every student will have an observed Neurological Exam on one of his or her own Neurology patients which will be evaluated by your assigned out-patient neurology attending.  This will be done toward the end of your out-patient months and your participation in the monthly half hour sessions on each other prior to clinic will help prepare you for this.  Additionally, throughout the year you should practice portions of the exam with your attending so that you are acquiring the skills necessary to perform a skilled neurological exam and detect relevant abnormalities. Please refer to the Grading/ Feedback Checklist for Observed Neurological Exams for guidance.  You and your attending will determine when this will occur.

Additionally, students will perform an observed Neurological Examination in the patient with Depressed Consciousness during their inpatient portion of the rotation.

Admission Order Entry and Medication Reconciliation are observed and documented for pass/ fail only.  Both these documentation forms are due by the end of the year. Admission order entry should be observed during the in-patient portion of the year and the medical reconciliation can be observed during  the inpatient portions of the year.

Graded Neurological Write Up

During the rotation you will turn in 1 write-ups for evaluation via e-mail to your out-patient preceptor as a word document without patient identifiers.  The practice write-up is due during your outpatient months and according to your preceptor. . This write-up will be graded and will make up 5% of your overall grade.  Please refer to the Graded Write-Up  Form for guidance.

Clinical Evaluations

During the rotation you will be evaluated  by your assigned attending on your professionalism, clinical reasoning, and ability to present cases on rounds. Please see the Attending Evaluation Form.  Finally you will be asked to fill out an Outpatient Professionalism Self Assessment Form on on45.  Together these clinical evaluations will make up 25 % of your grade for the Clerkship.

 

You are also required to fill out evaluations of your inpatient and outpatient attending physicians.