Download Neurology Clerkship Review - Geisel School of Medicine

Neurology Clerkship Review – 5/15/14
MEC subcommittee: Dr. John Dick,
Geisel Competencies -> Course Learning Objectives -> Assessment of Learning -> Learning Activities
Course Description:
This is a required 4 week clerkship taken in the 3rd or 4th year. Students get a mixture of
inpatient and outpatient exposure amongst the various sites.
Geisel Competency
Medical Knowledge 1
1a.
1c, 1d
1e
2
Course Objective How Student is
Assessed
Apply current
Performance
neuroscience
Evaluations
knowledge to
Case Discussions
diagnosis and
Write Ups
treatment
NBME exam
questions in
patient care.
Apply current
clinical and
translational
sciences to
diagnosis and
treatment
questions in
patient care.
Apply current
knowledge of
disease
prevention, risk
factor modification,
end-of-life and
palliative care,
substance abuse,
pain management,
medical ethics,
and medical-legal
issues to clinical
problems in
Learning Activity
Wards/Clinics
Case Discussions
Write Ups
Performance
Evaluations
Write Ups
Case Discussions
NBME exam
Wards/Clinics
Write Ups
Case Discussions
Performance
Evaluations
Write Ups
Case Discussions
NBME exam
Wards/Clinics
Write Ups
Case Discussions
neurology.
1f
Clinical
Skills
2a
3
2b
4
2c
5
2d
6
2f, 2g
Apply knowledge
about the impact
of social,
economic, cultural,
and personal
factors on health
to clinical
problems in
neurology.
Establish
comfortable and
mutually respectful
student-patient
and student-family
relationships with
diverse patients
and families and
establishing a
respectful basis for
the doctor-patient
relationship.
Performance
Evaluations
Write Ups
Case Discussions
NBME exam
Wards/Clinics
Write Ups
Case Discussions
Performance
Evaluations
Skills Form
Wards/clinic
Interview patients
skillfully, utilizing a
neurologically
focused history.
Examine
neurologic patients
skillfully and
respectfully, with
appropriate
attention to
student
cleanliness,
infection control,
and patient
comfort and
privacy.
Define and
prioritize the
patient
Performance
Evaluations
Skills Form
Wards/clinic
Performance Eval
Skills Form
Formal Neuro
Exam
Assessement
Wards/clinic
Performance
Evaluations
Case Discussions
NBME exam
Performance
Evals
NBME Exam
Wards/Clinics
Case Presentations
Discussions
Explain the
indications,
complications,
limitations, and
performance of a
CT scan, MRI,
electrodiagnostic
studies (EMG,
Wards/Clinics
Case Discussions
NCV, evoked
potentials and
EEG) and lumbar
puncture.
2h
Correctly identify,
and prioritize,
common
abnormalities on
CT, MRI and
spinal fluid
analysis.
Performance
Evals
NBME exam
Wards/Clinics
Case Discussions
Interpersonal
Communication
Skills
3c
Communicate
effectively with
patients and
families when
special barriers to
communication
exist, including
cultural, linguistic
or those based on
a neurologic
disorder (e.g.
aphasia).
Assist patients
appropriately in
understanding
their treatment
options. To assist
patients
appropriately in
understanding
their prognosis.
Performance
Evals
Skills Form
Wards/Clinics
Case Discussions
Performance
Evals
Wards/Clinics
Communicate
effectively and
collegially with
physician
colleagues and
other members of
the health-care
team verbally, in
writing and in the
electronic
medical record.
Performance
Evals
Write Ups
Skills Form
Wards/Clinics
Write Ups
Case Discussions
Behave
respectfully and
responsibly
towards patients,
Performance
Evals
Case discussions
Wards/Clinics
3d
3e, 3f, 3g, 3h
Formation of
Professional
Identity
4a, 4e
10
families,
colleagues, and all
members of the
health-care team
and empathize
and be respectful
of each patient
4b
Meet professional
responsibilities
fully.
Performance
Evals
Delete this as it is too
broad
4d, 4f, 4g
Adhere to high
ethical and moral
standards, accept
responsibility for
personal actions,
accept
constructive
criticism and
respect patient
confidentiality.
Performance
Evals,
Write Ups
Wards/Clinics
4h, 4j
Take responsibility
for his or her own
medical education,
and develop the
habits of
mindfulness and
reflection.
Describe barriers
to access to basic
health services
and its effect on
vulnerable
populations.
Contribute
constructive
feedback during
peer review.
Performance
Evals,
Write Ups
Wards/Clinics
Identify and
critically evaluate
relevant
information
about evidencebased, costconscious
strategies in the
care of patients
and populations
and to apply this
to patient care
Performance
Evals
Case Discussions
Write Ups
4k
4l
Develop Habit of
Inquiry into and
improvement of
one’s own personal
practice
5a, b, e, f
Do you assess
this?
Delete this objective
as it is not uniformly
covered.
Delete as you are not
doing this.
Wards/Clinic
Case Discussions
Write Ups
and to continuous
updating of skills.
5c, d
Systems-based
practice / Science
of healthcare
delivery
6a, 6b
6e, 6f, 6g
6i, 6j
14
Assess the effect
of social
environment on
clinical care and
outcomes and
apply the concepts
of improving
quality of care,
patient safety, and
value of care in
neurologically ill
patients.
Identify
appropriate
resources to
support patient
care and to
collaborate
effectively with all
members of the
inter-professional
team.
Describe how
healthcare is
currently
organized,
financed, and
delivered, and the
larger environment
in which
healthcare occurs
and the impact on
neurologically ill
patients.
Performance Eval
Student
Case Discussions
Wards/Clinics
Performance
Evals
Wards/Clinics
Is this assessed?
Is this taught or
focused on in your
clerkship?
Identify the role of
the physician in
addressing the
medical
consequences of
common social
and public health
factors, and to
advocate for
optimal care in
neurologically ill
patients.
Is this assessed?
Delete as you are not
uniformly covering
this in your clerkship.
Essential Skills/Conditions
NEUROLOGY CLERKSHIP
ESSENTIAL CLINICAL
CONDITION
Brain Tumor
LEVEL OF
STUDENT
RESPONSIBILITY
Participate in Care
of (or
simulation)Manage
Coma, stupor, altered mental
status
Dementia
Cerebral or SA Hemorrhage
Headache (all types)
Multiple Sclerosis
Peripheral Neuropathy
Seizure, Epilepsy
TIA or Stroke
Vertigo
Paralysis (ALS, GBS, etc.)
Manage
Manage
Manage
Manage
Manage
Manage
Manage
Manage
Manage
Manage
CLINICAL
SETTING
Inpatient /
Outpatient
% Performing
at least 1
Alternative
Learning
Opportunity
95
Inpatient /
Outpatient
Inpatient /
Outpatient
Inpatient
Inpatient /
Outpatient
Inpatient /
Outpatient
Inpatient /
Outpatient
Inpatient /
Outpatient
Inpatient
Inpatient /
Outpatient
Inpatient /
Outpatient
99
Inpatient /
Outpatient
Inpatient /
Outpatient
Inpatient /
Outpatient
Inpatient /
Outpatient
Inpatient /
Outpatient
Inpatient /
Outpatient
Inpatient /
Outpatient
Inpatient /
Outpatient
Inpatient /
Outpatient
100
96
98
100
89
98
100
100
98
95
ESSENTIAL CLINICAL SKILL
HPI relevant to this clerkship
Neuro exam
Mental status exam
CT Head, Interpret
MRI Head, Interpret
EEG, Interpret
LP (simple)
EMG (complex)
Medications counseling
Oral presentation, inpatient
initial evaluation
Oral presentation, ambulatory
encounter
Admission note
Perform
Perform
Perform
Assist
Assist
Assist
Assist
Assist
Perform
Perform
Inpatient
Perform
Outpatient
Perform
Inpatient
100
100
100
100
100
drop
91
drop
92
drop
100
99
99
100
Learning Assessment Tools:
1) DMEDS – Assess progress on meeting essential skills and conditions
2) Essential Skills Competency Form – Students assessed as meeting level of skill expected of
3/4rd year
3) Clinical Performance Evaluation Form – Competency based assessment, completed by
faculty and residents
4) Write Ups (4) – Graded –– consider moving to 2 write ups/add evidence base component
5) Neurologic Exam Assessment
6) NBME subject matter exam
7) Mid-clerkship feedback forms
8) Final Feedback / Grade narrative
Learning Environments / Activities:
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

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Orientation
o First Monday of Clerkship
Wards/Clinics/Night Call x 2 at DH
o 1 outpt clinic per week at DH
Write Ups
o 4 Required
Lecture Series – Case Based (M and Tuesday) – ppt available online
o Flipped classroom
Self Study
o Text recommended
Course Planning





Educational Team Structure
o One director
o One Clerkship Coordinator
Self –Review/ Planning Methods
o Educational Retreat Annually
o Monthly Educational meetings
Method and Frequency of Coordination with Non-DH sites
o Semi annual
Faculty Preparation
o How are faculty members at each site oriented to the course objectives and
grading system?
 Email annually
Resident Preparation
o Describe process to provide clerkship objectives to residents who will be
teaching students:
 Email, resident handbook
o
Describe process to prepare residents for their roles as teachers:
 How is this monitored by the department
 Annual
 Duty Hours
o
No violations reported by students
 Topic of Interest and concern for integration across 4 years
o Neuro Exam
o Localization of lesions
 Opportunities for Inter-professional Education/Interaction to
include all students
o Add option to clinical skills form to have PT sign off on
whether student understands function of PT/OT services
 Opportunities for Teaching High Value Health Care to include all
students
o Add cost/charge/value discussion to current lecture being
given on brain imaging or cost effective work up of headache.
Clerkship Outcomes
NBME Subject Exam Raw Scores
Year
10-11
11-12
12-13
MEDICINE
Geisel/National
78.2/74.9
79.4/75.5
77.52/ 75.8
Student Feedback – See Attached Report
 Numerical Highlights:
o Overall Experience: Very Good: 3.94
o Site Directors and Clerkship Director: Very Good to Excellent: 4.48
o Quality of Teaching by Attendings: Very Good: 4.25
o Quality of Teaching by Residents: Very Good: 3.88
o Quality of MidClerkship Feedback: Very Good: 4.02
o How well did you learn neurologic exam skills: Very Good: 4.4
 Narrative Themes:
o CPMC Strengths: Excellent teaching, Neuro ICU
o DH Strengths: Interesting patients, Teaching, didactic sessions
o VA Strengths: diversity of diseases, time for patient interaction, 1:1 learning
with attending
o CPMC Weakness: More structured outpt experience, less shadowing on outpt
o DH Weakness: Lecturers not showing up; not enough outpt; not enough
independent assessment of patients
o VA Weakness: too few patients for 2 students
Site Comparability

See attached Report
Changes since last MEC review:

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Clinex
DH team size change
Increased VA and CPMC capacity
Interactive lecture