NEUU-4010 - Acting Internship in Neurology

NEUU-4010 - Acting Internship in Neurology

Elective Title: Acting Internship in Neurology
Course Number: NEUU-4010
Elective Type: clinical Duration/Weeks: 4 Max Enrollment: 2
Prerequisites: Successful completion of Year 3
Additional Requirements: Completion of the required Neurology Clerkship. C-Form required to register, please send to coordinator, Lori Ellis
Responsible Faculty Director: Elena Shanina, MD Periods Offered: 1,2,3,4,5,9 excluding holiday period 8 
Coordinator: Lori Ellis & Jeanene DeLaRosa Other Faculty:
Location to Report on First Day:
JSA 9.128

1. To gain further experience in the evaluation and treatment of patients with neurological disorders.
2. To gain necessary skills and work habits needed to function as a house officer independently.

1. To gain skills in recognizing common diagnosis in the field of general neurology.
2. Develop basic familiarity with the management of disorders associated with neurological subspecialties.
3. To be able to formulate a rational approach for use of various diagnostic modalities as well as their limitations.
4. Demonstrate the ability to use the medical literature (evidence based medicine) as it relates to specific patient problems.
5. Become comfortable with the increased level of responsibility in the management of patients.

Description of course activities
Within the limits by law and hospital regulations, the student will function with the same responsibilities as a first year house officer, with the same hours and call responsibilities. Since our residents do not serve on the daytime rotations when they are on night call, the AI would be treated in the same manner. In general, the 4-week time period would be divided into 3 weeks of wards and 1 week of consult service. On wards, the AI would be working from Monday through Saturday with the ward resident from 7:30 am to 5:00 pm. Time permitting, they can utilize the opportunity to attend EEG/EMG sessions in the afternoons. The ward student would not be expected to take night call; unless he/she chooses to do it (some of our most interesting patients come in after hours). If night call was taken, appropriate reductions in daytime hours would be made. On their consult week, the students would be working from 8:00 am to 5:00 pm or until the rounds are over.

Type of students who would benefit from the course
All students, but especially those interested in Neurology, Neurosurgery or Physical Medicine and Rehab.

    Weekly Schedule
          Estimated Course Activities (Start-Time/Finish-Time):
Day of Week   AM   PM
Monday Clinical (4 hours) Clinical (4 hours)
Tuesday Clinical (4 hours) Clinical (4 hours)
Wednesday Clinical (4 hours) Clinical (4 hours)
Thursday Clinical (4 hours) Clinical (4 hours)
Friday Clinical (4 hours) Clinical (4 hours)
Saturday off off
Sunday off off

 Average number of patients seen per week: 10
 Call Schedule: voluntary

Research / Other Course Activities
(estimated schedule)
Activity Hours per Week
Faculty Contact-Time
Self-Directed Study

Method of Student Evaluation
1.  Clinical Observation
  A. Where are students observed on this elective?
    Inpatient Service   Ambulatory   Surgery   Standardized patients
Patients simulators   Other
  B. Frequency - How often are students observed clinically?
  C. Format - What method(s) are used to document the student's clinical performance?
    Daily oral feedback   End of period oral feedback   Written feedback

2.  Oral Presentation
  A. Audience - To whom does the student present?
    To Neurology faculty, residents, rotating residents and other students.
  B. Frequency / Duration of Presentation(s)?
  C. Format - What guidelines are set for the student's presentation?
    Case presentations.
  D. Assessment - Who assesses the student's presentation performance?
    Self-assessment   Peer assessment   Faculty assessment
  E. Method of content selection
    Current cases  Student-selected topic   Assigned topic

3.  Written Assignment (H&P's, notes, papers, abstracts, etc.)
  A. Frequency of written assignment(s)?
    H&P's on new patients, daily progress notes.
  B. Format - What guidelines are set for the student's written work?
    SOAP format.
  C. Length of written assignment(s)?
    Abstract   Annotated bibliography   1 - 2 page paper   3+ page paper
  D. Are recent references required?   No    If yes, how are they selected?
    May be desirable on selected cases.
  E. Method of content selection - e.g. student-selected, relate to cases, etc.?
    Student selected with guidance from resident and faculty.
  F. Audience - Who assesses the student's written performance?
    Peer Assessment     Faculty Assessment     Other

4.  Examination
    Oral   Written multiple choice   Written essay / short answer   OSCE

5.  Extra Course Activities
  What expectations do you have for the student to demonstrate participation in the elective (e.g. small group activities, seminars, thoughtful questions, providing resources, journal club, resident lecture attendance)?
    Students are expected to attend grand rounds, journal club, and any lectures given for the residents.

6.  Additional Costs
  Please list any additional costs and/or purchases (books, materials, movies to watch, etc.) that are required for this course. Include an estimated total cost. If there are no additional costs, please enter "None".

7.  Other Modes of Evaluation
  Please explain below.
    Students will present a 20 minute power point presentation with appropriate review of the medical literature.

8.  If this course is an Acting Internship, please complete the following:
  A. Objectives for the AI should relate directly to the Entrustable Professional Activities (EPAs). Each AI should describe how the four key Year-4 EPAs that our school has identified as being Year-4 skills are assessed. The Year-4 objectives are:
1. Entering and discussing orders/prescriptions.
2. Give or receive patient handover to transition care responsibility.
3. Recognizing a patient requiring urgent or emergent care and initiating management.
4. Obtaining informed consent for tests and procedures.
Specify how the student will be given formative feedback on their clinical skills.

Year-4 students should demonstrate mastery of EPAs they developed in the clerkship year, including recommending and interpreting common diagnostic and screening tests, and performing general procedures of a physician. They should be able to demonstrate masterfully and independently skills they mastered in Years 2-3, including efficiently performing comprehensive admission-notes and succinct daily progress notes and perform accurate, concise, and hypothesis-driven clinical presentations, form clinical questions and retrieve evidence to advance patient care. They should be able to demonstrate basic understanding of and beginning mastery of collaborate as a member of the interprofessional team and identify system failures and contribute to a culture of safety improvement.

List advanced clinical skills that a student will be assured an opportunity to practice.
    1) Elicit a detailed neurological history relevant to patients neurological problems.
2) Perform a detailed neurological examination.
3) Perform a focused neurological examination in a patient with altered level of consciousness.
4) Write a detailed initial history/examination and progress note.
5) Perform a simulated lumbar puncture under supervision of a senior resident or attending.
6) Obtain consent and write appropriate procedure notes under supervision.
7) Write appropriate admission and discharge orders with supervision.
8) Recognize clinical presentation of different neurological disorders including neurological emergencies.
9) Generate an appropriate differential diagnosis for each neurological problem identified in clinical context.
10) Identify and utilize appropriate diagnostic tests (such as MRI, EEG, and EMG) in different clinical scenarios.
11) Know and apply the standard of care for neurological disorders
12) Provide information to patients and educate them about common neurological conditions.
13) Interact with allied health professionals and develop a teach approach to patient care.
14) Review neurological literature and analyze date appropriately for the level of training.

How specifically will this AI build on developing skills from the clerkship year to prepare students for internship?
    1. Perform lumbar puncture with assistance and supervision of faculty or resident
2. Perform trigger point injections with assistance and supervision of faculty or resident
3. Perform occipital nerve block with assistance and supervision of faculty or resident
4. Perform nerve conduction test with assistance and supervision of faculty or resident

What opportunities will typically be available to all students who take this AI (procedures, required presentations, etc.)? What opportunities may be available based on patient load/presentation or student initiative (ie. Writing a case report)?
    Acting Interns (AI) will spend their rotation on the inpatient setting where they will be assigned patients and will assume primary responsibilities for their care. (S)he will participate in hospital rounds and report to PGY2 neurology resident. After seeing patient independently AI will report findings and updates to neurology resident and they will round together before teaching rounds with the faculty. AI will write admission orders, notes and discharge orders under supervision of the senior resident.

An AI should have expectation of a minimum of 32 hours per week of clinical responsibilities. Duty hours should be capped at ACGME limits for an intern, thus up to 24 hours followed by 4 hours of activities related to patient safety, education, and handoff. Students cannot work more than 80 hours per week averaged over 4 weeks. They can only have 1 day off in a 7-day work week with 8 hours off between shifts.

Clinical responsibilities will vary depending on specialty, but how is the student functioning with work commensurate to a PGY1 with an appropriate level of training?
    This course will prepare students to residency in neurology and prepare to internship in internal medicine, as AIs will take care of general medical and neurological problems of the patients admitted to Neurology wards under supervision of neurology resident and faculty.

How is the student demonstrating drawing clinical conclusions and/or developing a management plan and documentation as an intern would do?
    Midpoint feedback will be obtained by the student from the ward attending neurologist and senior neurology resident. Students are responsible for having their midpoint feedback form completed.
Evaluations are based on the quality of their clinical work throughout the rotation, taking into account knowledge and problem solving skills, clinical skills, oral presentations written notes, patient care skills, procedures, ability to organize care, patient interaction skills, teamwork, attitude and approach to learning.

How and by whom will midpoint feedback be provided to the student? How will you remediate deficiencies identified at midpoint?
    There will be different faculty member working with the student every 1-2 weeks. Usually students work 5-10 days with the same faculty, depending on the schedule. Per students request and if schedule permits, AI may work with the same faculty during entire 4 week period; request should be send to program director in advance. AI will have direct interaction with teaching faculty daily. AI and PGY2 neurology resident will work as a team on in-patient neurology service.

Acting Internship students often seek letters of recommendation following their experience. How many different Faculty will work directly with the student and have knowledge of the student's abilities to detail in a written evaluation? Describe the degree of supervision and interaction with faculty vs. residents or other providers and how feedback will be obtained if more direct work is with residents or other providers.
    During AI rotation students will work under direct supervision of the faculty and therefore letters of recommendations can be obtained. Students also work with the residents and other team members; their input and impression of student performance is usually taken into consideration. Student may request to work with the same faculty (when possible), or with different faculty each week.