Educational Activities

UNC Neurology Clerkship Educational Methods

Experiential

Outpatient Clinics

Each student will be assigned to outpatient clinics biweekly during the continuity months. The goal of this experience is to provide exposure to a breadth of different neurological exam findings and diseases for the purpose of gaining competence in the performance and interpretation of the neurological examination. Also, the student will learn practical skills regarding medication reconciliation and time management in the outpatient setting.  You will each spend 3 afternoons with Dr. William Huffstutter, pediatric neurologist.

 

Neurology Clerkship Competencies with UNC Core Competencies and Milestones:

  • Obtain a complete and reliable neurological history (UNC#8, MS 3014, 3015, 3016)
  • Perform a focused and reliable neurologic examination (UNC #9, MS 3017)
  • Develop an appropriate plan of diagnostic evaluation based on an understanding of the appropriate of use and interpretation of these common tests (UNC #11) (MS 3020, 3021, 3022)
  • Demonstrate gender and cultural sensitivity in educational and clinical care settings. (UNC #17) (MS 3036, 3037)
  • 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)
  • Perform medication reconciliation in the electronic medical record during outpatient appointments (UNC #33

Inpatient Services

Each student will spend one week on Mission Neurology adult inpatient services.  The goal of this experience is to gain in depth exposure of the neurological assessment and management of common inpatient neurological problems such as epilepsy, stroke, and altered mental status for the purpose of furthering competence in Patient Care, Communication, Interpersonal Skills, Professionalism, Practice Based Learning and Systems Based Practice. Throughout the experience students are encouraged to assume responsibility for their assigned patients.

 

Neurology Clerkship Competencies with UNC Core Competencies and Milestones:

  • Obtain a complete and reliable neurological history (UNC#8, MS 3014, 3015, 3016)
  • Perform a focused and reliable neurologic examination (UNC #9, MS 3017)
  • 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)
  • Demonstrate gender and cultural sensitivity in educational and clinical care settings. (UNC #17) (MS 3036, 3037)
  • 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)
  • 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)
  • Deliver a clear, concise, and thorough oral presentation of a patient's history and examination (UNC #19) (MS3041, 3042)
  • 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)
  • Actively seek and exchange constructive feedback about professional performance. (UNC#29) (MS 3056, 3057, 3058)
  • Demonstrate skills in retrieving, critically assessing, and integrating biomedical information into clinical decision-making. (UNC #30) (MS3059)
  • 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)
  • Examine patients with altered level of consciousness or abnormal mental status (UNC#9, MS 3017)
  • Write Admission Orders (UNC #33

Observed Structured Clinical Experience

When the students are rotating in the outpatient clinic they will arrive half an hour earlier (at 1:00) one day per month to perform the neurologic exam under supervision on each other or on staff in the clinic.  These will be observed by a Neurologist preceptor and structured formative feedback is given.  You will be expected to apply this learned skill to your assigned patients and to be able to detect abnormalities.  You will be observed performing portions of the exam on your assigned patients and will be given immediate feedback on that as well.

 

Neurology Clerkship Competencies with UNC Core Competencies and Milestones:

  • Perform a focused and reliable neurologic examination (UNC #9, MS 3017)

 

 

 

Didactic

Case Based Sessions

One session per month, there are 2 hour didactic sessions which may be case based, question based  or discussion based as described below:  case based sessions cover high yield topics for the SHELF Examination. There are assigned readings in the provided Pre-Test and Case Files books, as well as DVD videos of real cases to prepare for each session. The goal of these sessions is to help teach and reinforce medical knowledge competence as it pertains to Neurological disease and health. There are 10 sessions, organized by topic, Diseases of Neuromuscular Transmission, Diseases of the Peripheral Nerve, Muscle Disorders, Dementia, Multiple Sclerosis, Child Neurology, Epilepsy, Movement Disorders, Coma, and Stroke.

 

Neurology Clerkship Competencies with UNC Core Competencies and Milestones:

  • 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)
  • Distinguish normal from abnormal findings on a neurologic examination (UNC#3, MS 3003)
  • Describe the scientific principles underlying laboratory and radiologic diagnostic methodologies commonly used in Neurology (UNC #4, MS 3005)
  • 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)

Small Groups

Question Based

During the monthly didactic sessions the students will be asked to present a short assigned topic.  Each student will also present a ½ hour lecture to the out-patient medical assistance as assigned (The second Friday of each month). The purposes of these activities are to help foster communication and teaching skills and to reinforce medical knowledge.

Neurology Clerkship Competencies with UNC Core Competencies and Milestones:

  • 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
  • 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)

Discussion Based

The students will discuss important topics of professionalism and cultural competence with their inpatient and outpatient preceptors throughout the year as  relevant patient circumstances arise. Additionally there is a self directed module on coma and end-of-life communication.

Neurology Clerkship Competencies with UNC Core Competencies and Milestones:

  • 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)
  • Demonstrate gender and cultural sensitivity in educational and clinical care settings. (UNC #17) (MS 3036, 3037)
  • 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)

Modules

Group

The group modules are designed to vertically and horizontally integrate Neurology with the many interrelated fields, including Ophthalmology, Neuroradiology, Neuroanatomy, Physical Medicine and Rehab, and Fundamentals of Acute Care.

 

Neurology Clerkship Competencies with UNC Core Competencies and Milestones:

  • Interpret an Emergent Head CT (UNC #10, # 11) (MS 3018)

Independent- Computer Based

There are two independent computer based modules required during the clerkship to ensure that our goals regarding Health of Populations and Systems Based Practice are addressed. One module is designed to teach Systems Based Practice by working through the complex process of discharge planning for a stroke patient. The other is a computer based module that is a designed to teach the fundamentals of primary and secondary stroke prevention.

Neurology Clerkship Competencies with UNC Core Competencies and Milestones:

  • Identify the core elements of an appropriate hospital discharge plan that provides for patient safety during transitions of care (UNC #32) (MS 3036)
  • Identify and apply the core principles of evidence based primary and secondary prevention of stroke (UNC #38, 39)