NEUU-4056 - Ambulatory Neurology

NEUU-4056 - Ambulatory Neurology

Elective Type: clinical
Ambulatory Neurology
Course Number
Prerequisites: Successful completion of Year 3 
      Additional Requirements:
C-form is required, please send to Jeanene DeLaRosa ( with 2-week or 3-week request.
Responsible Faculty Director:
Elena Shanina, MD
Other Faculty:
Laura Wu, MD; Xiang Fang, MD; Anand Patel, MD; Chilvana Patel, MD; Kamakshi Patel, MD; Arun Chhabra, MD; Howard LaRoche, MD; Prashant Rai, MD
Location to Report on First Day
8:00am, John Sealy Annex, 9.128, ask for Jeanene DeLaRosa
Periods Offered
including holiday period 8
Maximum Enrollment

The student will encounter patients with a wide variety of neurological complaints in an outpatient setting. They will become familiar with diagnostic and therapeutic aspects of ambulatory clinical neurology. Patient presentations and discussions will encourage critical evaluation of the medical literature.

The student will be able to:
1. Elicit neurological history and master neurological examination skills (screening exam, comprehensive exam, neuromuscular and movement disorders subspecialty exam).
2. Formulate differential diagnosis of common neurological complaints,
3. Outline the initial work-up of and explain the rationale used in determining the diagnosis and treatment plan.
4. Review and apply evidence from medical literature to patient care.

Description of course activities
1. The student will be assigned to work in the outpatient neurology clinics on Monday through Friday. They will be working under the supervision of the Neurology faculty, residents, and fellows.
2. The student will directly participate in obtaining historical information and performing neurological examinations on clinic patients. Each case will be presented to and discussed with faculty. 3. The student will develop algorithms for 1-3 common neurological complaints and present references, which validate the rationale used in the algorithms.
4. The student will be responsible for creating clinic notes in the EMR as allowed by institutional policy.
5. Students will have an opportunity to participate in common outpatient neurological procedures.
6. Students are invited to attend a weekly grand round, ambulatory morning reports, epilepsy, neuroradiology and neuromuscular conferences (schedule will be provided).

Type of students who would benefit from the course
Students interested in clinical neurology and considering Neurology residency

Weekly Schedule
  Clinical Activities (estimated schedule)
  Day of Week AM PM
  Monday 8:00 - 12:00 1:00 - 5:00
  Tuesday 8:00 - 12:00 1:00 - 5:00
  Wednesday 8:00 - 12:00 1:00 - 5:00
  Thursday 8:00 - 12:00 1:00 - 5:00
  Friday 8:00 - 12:00 1:00 - 5:00
   Average number of patients seen per week: 10  
   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, Residents and Fellows
  B. Frequency / Duration of Presentation(s)?
    Daily, each patient encounter
  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)?
    daily patient encounter
  B. Format - What guidelines are set for the student's written work?
    Neurology templates for EPIC notes, flexible format for algorithm
  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?
    student selected related to cases
  E. Method of content selection - e.g. student-selected, relate to cases, etc.?
  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.

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.