Neurology Clerkship

Overview

The Neurology Clerkship is a four-week introduction to Clinical Neurology for 3^rd year medical students. Various sites are used within the Rochester metropolitan area for the Clerkship, including Strong Memorial Hospital, Highland Hospital, Rochester General Hospital, Unity Hospital, and several private practice offices. Although most students will be assigned to an adult neurology service, some students will be assigned to the child neurology or neurorehabilitation services. We view the teaching of neurology at the University of Rochester School of Medicine as a continuum, beginning with the second year Mind, Brain and Behavior course, continuing with the second year seminar course "The Weak Patient," and concluding with the third year neurology clerkship and fourth year neurology electives. Material learned in each of these courses is cumulative.

Clerkship Personnel

Clerkship Director: Robert Thompson Stone, M.D.
Clerkship Co-Director: Ralph F. Józefowicz, M.D.
Clerkship Coordinator: Lorie Wolfanger, B.S.

Neurology Clerkship Objectives

1. To elicit an accurate neurological history, and to perform and interpret a neurological examination.
2. To appropriately order laboratory studies in neurology:  EEG, EMG, nerve conduction studies, evoked potentials, lumbar puncture, CT and MR imaging of the brain and spinal cord.
3. To appropriately evaluate and treat common neurological problems:
   • Neurological Emergencies:  Coma and mental status changes, stroke, seizures.
   • Common outpatient neurological problems:  Headache, dizziness, back and neck pain, peripheral neuropathies.
4. To appropriately evaluate less common neurological problems, including multiple sclerosis, Parkinson's disease and other movement disorders, neuromuscular diseases, dementia, central nervous system infections, and tumors of the nervous system.
5. To acquire the many personal attributes necessary for becoming an effective physician, including honesty, compassion, reliability, and effective communication skills.

• Neurology Attending: The Neurology Attending will have direct responsibility for supervising and teaching the student. He/She also has primary responsibility for providing frequent and timely feedback, including mid-clerkship feedback, and for evaluating the student at the conclusion of the rotation.
   
• Neurology Chief Resident: The neurology chief resident will primarily interact with the students assigned to the adult and child neurology services at Strong Memorial Hospital. He/she will assign students to one of the resident teams and will meet the students on the first day, providing a brief orientation and introducing the students to the assigned resident teams. The neurology chief resident will also organize and conduct teaching conferences for the neurology clerks once or twice weekly.
   
• Neurology Resident: The neurology resident will have direct responsibility for supervising and teaching the student. He/she will assign new patients to the student and will review and critique the student's work-up and plan of care, as well as countersign student orders. The neurology resident will also be responsible for providing frequent and timely feedback, including mid-clerkship feedback, and will independently evaluate the student at the end of the rotation.

• Obtain a complete history, perform a complete general and neurological examination, generate a differential diagnosis and formulate a plan of treatment for all patients that are assigned to him/her.
• Present each assigned patient as needed on rounds, and complete the work-up on the same day that the patient is evaluated. Progress notes are to be written daily on all inpatients that are followed by the student.
• Work as a member of the team to which he/she is assigned, and participate in all work rounds, attending rounds, and resident conferences.
• Review all laboratory studies obtained on his/her patients, including CT and MR scans, EEGs, EMGs, evoked potentials, and lumbar punctures.
• The student is encouraged to perform lumbar punctures, under supervision by the neurology resident or attending, on his/her patients if indicated.
• Take night call with his/her neurology resident until 9:00 PM at least two or three times during the four-week rotation.

• Ropper AH, Brown RH: Adams and Victor’s Principles of Neurology. (9th ed.), New York, McGraw Hill, 2009
• Rowland LP, Pedley TA: Merritt’s Neurology. (11th ed.), Baltimore, Lippincott Williams & Wilkins, 2009
• Patten J: Neurological Differential Diagnosis. (2nd ed.), Springer, London, 1996
• Brazis P, Masdeu J, and Biller J: Localization in Clinical Neurology. (5th ed.), Baltimore, Lippincott Williams & Wilkins, 2006
• Posner JB, Saper CB, Schiff N, Plum F: Plum and Posner’s Diagnosis of Stupor and Coma. (4th ed.), Oxford University Press, 2007.

Neurology Clerkship Site Descriptions