Course Objectives

Goals and Competencies for the Neurology Clerkship

Goals:

The goal of the Neurology Clerkship is to ensure that every UNC student is able to recognize and manage the neurologic problems that a general medical practitioner is most likely to encounter in practice while effectively contributing to students' longitudinal development of the UNC Core Competencies in medical knowledge, patient care, professionalism, communication, practice based learning, systems based practice, and the health of populations.

Competencies:

At the successful completion of the Neurology Clerkship all students will be able to:

Medical Knowledge

• Recognize symptoms that may signify neurologic disease. (MK3A1, MK3C1, MK3E1, MK3E2) 
• Localize the likely site or sites in the nervous system where a lesion could produce a patient's symptoms and signs. (MK3A1, MK3B1)
• Explain various causes (genetic, developmental, metabolic, toxic, microbiologic, autoimmune, neoplastic, degenerative, behavioral, and traumatic) and pathogenesis of major neurological diseases and conditions. (MK3B1)
• Distinguish normal from abnormal findings on a neurologic examination. (MK3C1)
• Describe the scientific principles underlying laboratory and radiologic diagnostic methodologies commonly used in Neurology. (MK3D, PC3D1)

Patient Care/ Clinical Skills

• Obtain a complete and reliable neurological history. (PC3A)
• Perform a focused and reliable neurologic examination. (PC3B1)
• Examine patients with altered level of consciousness or abnormal mental status. (PC3B1)
• Develop an appropriate plan of diagnostic evaluation based on an understanding of the appropriate of use and interpretation of these common tests. (PC3D)
• Interpret an Emergent Head CT. (PC3C1)
• 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. (PC3D, PC3F1)
• Formulate a differential diagnosis based on lesion localization, time course, and relevant historical and demographic features. (PC3E)
• Develop an appropriate plan to manage common and emergent neurologic problems, including the recognition and management of situations that are potential emergencies. (PC3F, PC3G) 
• 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 (PC3I, PR3B1)
• Demonstrate gender and cultural sensitivity in educational and clinical care settings. (PR3H)
• Apply the basic principle of therapeutic pain management to the care of patients with chronic painful conditions and at the end-of-life. (PC3F1, PC3I3, IC3D, PR3B1)

Interpersonal and Communication Skills

• Develop empathetic, caring relationships with patients. (PC3G2, IC3A)
• Communicate effectively with patients, patient, families, colleagues, and other health care professionals. ( IC3A)
• Deliver a clear, concise, and thorough oral presentation of a patient's history and examination. (IC3A2, IC3A3)
• Prepare a clear, concise, and thorough written presentation of a patient's history and examination. (IC3A3, IC3B)
• Demonstrate collaborative teamwork skills, including dependability and punctuality, and the ability to work effectively with other members of the health care team. (IC3A2)

Professionalism

• Demonstrate honesty, integrity, and ethical behaviors in all interactions with patients, families, and colleagues. (PR3A1, PR3F1)
• Protect patient privacy and confidentiality. (PR3D1)
• Maintain personal health and well-being and achieve a balance between priorities of patient care and personal and professional development. (PR3G)

Lifelong Learning

• Identify gaps in medical knowledge as they arise in clinical context and develop a self- directed learning strategy to fill in that gap. (PR3J1, LL3C1)
• Actively seek and exchange constructive feedback about professional performance. (PR3K)
• Demonstrate skills in retrieving, critically assessing, and integrating biomedical information into clinical decision-making. (LL3A1)
• Identify the core elements of an appropriate hospital discharge plan that provides for patient safety during transitions of care (PC3F3)

Systems-based Practice

• Write Admission Orders (SB3A) 
• Perform medication reconciliation in the electronic medical record during outpatient appointments (SB3A) 
• 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. (SB3B, SB3C SB3E)

Improving the Health of Populations

• Identify and apply the core principles of evidence based primary and secondary prevention of stroke (HP3A, HP3B)

  • Identify the impact of financial policies on health and health care of individual patients seen in clinical rotation (Medicare and Medicaid funding of Stroke recovery) (HP3C,HP3D)

Additionally, a significant portion of students will leave their Neurology Clerkship able to:

• Perform a Lumbar Puncture (PC3C)
• Participate in emergent care of stroke and status epilepticus (PC3H2, IC3C1)
• Participate in end-of –life discussions with patients and family members (IC3D)