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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: 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: Clinex DH team size change Increased VA and CPMC capacity Interactive lecture