Neurology Clerkship

The Neurology Clerkship is a required 3-week rotation in the third year that provides a mixture of clinical exposure and conference discussions to provide a well-rounded introduction to clinical neurology. We understand that only a few of you will select neurology as a career, but neurological disorders are seen in almost every specialty, and you will need to know how to assess a patient with a neurological problem, how to determine where in the nervous system that problem might be, how to treat a few common or life-threatening neurological diseases, and when to call neurological consultants for help.

Clerkship Goals

By the end of the rotation, you should be able to:

  • Obtain a comprehensive history from patients with nervous system disorders.
  • Perform a thorough and organized neurological examination.
  • Use neuroanatomical principles to localize a lesion in the nervous system.
  • Describe the pathophysiology of common neurological diseases, how to evaluate them and the basics of treatment.

Organization

The clerkship is divided into 3 one-week rotations to which you will be assigned in groups of 1 to 3 students. These clinical experiences are based at UConn John Dempsey Hospital, Hartford Hospital, and a third week with several sites including the UConn Health Outpatient Pavilion, Connecticut Children’s Medical Center, and the Hospital for Special Care. Each of these sites provides exposures to different neurological subspecialties, patient populations and health systems, providing you with a multifaceted introduction to clinical neurology in a variety of settings. You will also participate in two “Required Observations in Neurology” (RONs) which will help you hone your neurological examination skills, and in 3 half-day (Monday afternoon) didactic sessions. Case discussions in which common neurological disorders are presented for detailed discussion occur on the first two Monday afternoons of this rotation. Students present interesting cases to a neurology faculty member on the third Monday of the rotation. At the end of the clerkship you will have an opportunity to evaluate the entire clerkship experience. We take these comments very seriously and are always looking for ways to improve the educational experience.

Preparation for the Rotation

Prior to starting the rotation, you should prepare for a session regarding Neurological Exam Techniques by viewing the PowerPoint summary slides and the Neurological Exam video on Blackboard before your RON session with Dr. Waitzman.

Conference Case Discussions

The first conference session occurs on Monday afternoon of the first day of the rotation. You should prepare for this and the following conference one week later by going through the PowerPoint summary slides and videos on Blackboard. You need to view these independently before each session in order to get the most out of them. The first Monday’s session is from 1:30 to 5 p.m. and covers Cases #1-4, and the second is from 1 to 5 p.m. for Cases #5-8.

Student Case Presentations

On the third Monday of the rotation from 1 to 5 p.m., students will present interesting cases they have seen during the rotation. Each student will have a 30-minute time slot to allow for extended discussion of the neurological issues raised by the patient’s condition. This is an excellent opportunity for you to display the knowledge and understanding of neurological issues you have acquired over the prior 2 weeks of the rotation, and to firm up any concepts that are still unclear to you.

On the Friday preceding the Monday Case Presentations session, you will need to send a summary of the patient’s history, examination and labs/investigations by email to our clerkship coordinator, Ms. Elizabeth Pelland (pelland@uchc.edu) and to the attending neurologist who will be hearing the cases. You should follow the format provided in the Portfolio. You must send these materials before 4 p.m. on Friday afternoon to ensure that the cases are received before the close of day.

Please prepare your case discussion presentation in PowerPoint format or distribute copies to all attendees (fellow students). You should incorporate the laboratory, pathology, and critical images from imaging studies in your presentation. Please review the PowerPoint presentations of others as well, since all students are expected to participate in the case discussions to provide peer feedback.

Required Observation for Neurology (RON)

The RONs are an opportunity to perform a complete neurological examination under the watchful eye of an expert clinical neurologist. These occur on Mondays and Wednesdays from 8:15 a.m. to noon with Dr. David Waitzman in the Outpatient Pavilion 5th Floor Ophthalmology Clinic. The first is performed in your first week or early in the second week and the second one will be at the end of the second week or early in the third week. Two students will be assigned per day. The goal of these sessions is to determine your level of competence in performing the exam at the start of the rotation (RON 1) and again at the end of the clerkship (RON 2) when your neurologic exam skills should have improved. You will need to review the preparatory neuro-ophthalmology handouts provided by Dr. Waitzman (on Blackboard) before the session.

Clinical Experiences

UConn John Dempsey Hospital (JDH)

During your 1-week rotation at JDH, you will be a member of the Neurology Consult team and participate actively in consultations performed in the Emergency Department and on the hospital floors. You will be assigned responsibility to follow specific patients and write chart notes. You will also be assigned during specific half days to work with an attending or resident in the Neurology Clinic located on the 3rd floor (East) of the Outpatient Pavilion. You will have the opportunity there to see a demonstration of EEG recording and interpretation, and may also be able to observe EMG testing for neuromuscular problems.

Hartford Hospital (HH)

You will spend 1 week at HH assigned to the Neurology Consult Service, during which you will participate in neurological consultations on hospital inpatients and Emergency Department consultations. Due to the high acuity and patient volume on the Stroke Service, you will not be assigned to this service specifically, but you will be able to experience emergency stroke calls. You will carry a stroke pager that will notify you when the Stroke Service is being paged to an acute stroke emergency and will respond with the team. The pagers are in the HH library (where morning report takes place).

Pediatric Neurology, UConn John Dempsey Hospital, Hospital for Special Care

During the 3rd week of the rotation, you will spend time at several different locations and services to round out your exposure to a variety of neurological experiences. You will join the Pediatric Neurology Clinic at Connecticut Children’s Medical Center on Tuesday and Wednesday, where you will see a diverse mixture of outpatient neurological conditions in children. On Monday morning, Thursday morning and afternoon, and Friday afternoon, you will be assigned to the JDH adult Neurology Clinic on the 3rd floor of the Outpatient Pavilion. On Friday morning, you will attend the Neuromuscular Clinic at the Hospital for Special Care (HSC), where you will experience a multidisciplinary ALS clinic.

Evaluation of Performance

You will receive feedback on your performance in the Neurology Clerkship from your attending physicians in 3 different settings:

  • After the RON sessions, which will help you firm up your neurological examination skills.
  • At the mid-rotation point, where strengths and opportunities for improvement will be discussed.
  • After your case presentation on the third Monday of the rotation, which can help identify areas for more intensive review prior to the final examination.

Your performance will be evaluated in 3 ways: your final grade, comments from your attending physicians posted onto uchc.oasisscheduling.com, and a final narrative summary. Your final grade will be based upon your performance on the “Shelf” exam, the RONs, and the case presentation.

Clerkship Milestones

  • By the end of the first week, you should have completed the pre-block self-assessment questionnaire.
  • By the end of your first week of consults (end the first week if you are assigned to consults at JDH or HH, or end of the second if you have the outpatient week first), you should have completed your mid-block evaluation with your attending physician (or resident).
  • By close of business on Thursday of the third (final) week, you need to have completed:
    1. Two (2) required observations for Neurology (RONs).
    2. Clerkship Composite Evaluation and Oasis/Blackboard Conference evaluations.
    3. An evaluation of a Neurology Attending.
  • Before sitting for the final examination on Friday afternoon, you need to have completed:
    1. Your Portfolio, including the post-rotation self-assessment. This includes having entered information into the Required Clinical Encounter database (formerly ED2 Log).
    2. Your Case Presentation Assessment with attending signature.

Final Examination

On the last Friday of the rotation, beginning promptly at 1 p.m. you will take the USMLE Neurology Shelf Examination. The NBME Clinical Neurology Exam has 110 multiple choice questions. You will have 2 hours 45 minutes to complete the test. There are a variety of ways to prepare for this examination, including pretest question books, concise neurology textbooks, and other study materials. You will likely do best if you follow the cardinal rules for neurology:

  • Localize the lesion
  • Think broadly about the differential diagnosis
  • Address any potential emergencies or “worst case scenarios”
  • Choose the most likely answer

Read advice to medical students studying neurology from the American Academy of Neurology.

Student Interest Group in Neurology (SIGN)

UConn has a chapter of SIGN which is supervised by two Neurology faculty members: your clerkship director, Dr. Marie Eugene and Dr. Matthew Tremblay. Even if you are not considering neurology as a career (and we know that applies to most of you), joining SIGN has numerous benefits including access to study questions that can help you prepare for the Shelf exam. The cost of membership ($25) is less than buying a textbook! Learn more about SIGN.