NEUU-4053 - Clinical Neurology and Neurosurgery: from Basics to Bedside

NEUU-4053 - Clinical Neurology and Neurosurgery: from Basics to Bedside

Elective Title: Clinical Neurology and Neurosurgery: from Basics to Bedside
Course Number: NEUU-4053
Elective Type: clinical Duration/Weeks: 2 Max Enrollment: 6
Prerequisites: Successful completion of Year 2
Additional Requirements: C-form required
Responsible Faculty Director: Aaron Mohanty, MD Periods Offered: 6A & 10A excluding holiday period 8 
Coordinator: Jennifer Low Other Faculty: Chilvana Patel, MD
Location to Report on First Day:
Dept. of Neurosurgery, Clinical Discussion Room, JSA 9th floor, 9.113 at 9:00am

The course aims to bridge the gap between understanding the basic neuroanatomy and neurophysiology and commonly encountered neurological conditions. For an aspiring neurosurgeon or neurologist, it is essential that the basis of the diagnosis and treatment plan is well conceptualized prior initiating the treatment plan. Instead of making the student a master in anatomical details and then introducing clinical application of their recently gained knowledge, during the course, clinical cases will be used as teaching instruments with discussion of the anatomical and physiological background.

The course will specifically try to discuss several neurological and neurosurgical conditions, with emphasis on the neuroanatomical and neurophysiological basis of some common neurological and neurosurgical conditions. The course will utilize Neuroradiology images (CT, MRI, Angiography) to teach students the relevant anatomy and pathology to have a strong correlation between the clinical and anatomical relationship

Description of course activities
The course will comprise of several sections
a. Several neurological and neurosurgical clinical topics will be discussed during the course. Each section of this part of the course will start with a short didactic introduction to the subject including anatomical background, and its clinical relevance and application. A clinical case presentation will follow. The participants will then be required to critically analyze the clinical findings based on the anatomical localization and arrive at a clinical diagnosis. The pertinent radiological findings of the case will be then discussed and the extent of correlation between clinical diagnosis and radiological findings will be discussed. At the end, for objective assessment, participants will have to answer few open-ended short questions and/or multiple-choice questions and responses which will be graded.
b. One to two half day sections will be devoted for clinical neurological evaluation. Included in this section will be basic neuro examination techniques and their clinical application, differential diagnosis, and diagnosis of common neurological conditions.
c. One or two half days will be devoted to dedicated neuroradiology sessions with initial didactic presentation, and then interpretation or neuroimaging studies including plain radiographs, ultrasound, CT, MRI imaging and angiography.
d. Interested participants would be able to view live neurosurgical procedures in the operating room at Jeanie Sealy Hospital on some of the course days (Tuesday, Wednesday), Electrophysiological studies (Wednesday AM at Clearlake Campus) and angiograms and neuro-intervention procedures (if possible). There is another location you will have to go too and it is in Webster. The address is 250 Blossom St., 4th floor, Neurology/Neurosurgery Clinic.

Type of students who would benefit from the course
Students who are interested in neurology or neurosurgery.

Weekly Schedule
  Clinical Activities (estimated schedule)  
Day of Week   AM   PM
Monday 9:00 - 12:00pm 1:00 - 4:00pm
Tuesday 8:00am - 12:00pm 1:00pm - 4:00pm
Wednesday 9:00am - 12:00pm 1:00pm - 4:00pm
Thursday 9:00am - 12:00pm 1:00pm - 4:00pm
Friday 9:00am - 12:00pm 1:00pm - 4:00pm

 Average number of patients seen per week: 20
 Call Schedule: N/A

Research 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?
    Faculty and Residence
  B. Frequency / Duration of Presentation(s)?
  C. Format - What guidelines are set for the student's presentation?
  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)?
  B. Format - What guidelines are set for the student's written work?
    objective assessment with multiple type of questions
  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?
  E. Method of content selection - e.g. student-selected, relate to cases, etc.?
    see above
  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)?

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.
    Objective assessment with multiple type of questions at the end of the session/ day with grading.
Where are the students observed during this elective? Surgery, Clinics, Other (interactive discussion)
Frequency: During closure of every session by the faculty
Format: End of session feedback, End of course feedback

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.

How specifically will this AI build on developing skills from the clerkship year to prepare students for internship?

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)?

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?

How is the student demonstrating drawing clinical conclusions and/or developing a management plan and documentation as an intern would do?

How and by whom will midpoint feedback be provided to the student? How will you remediate deficiencies identified at midpoint?

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.