I. Goals and objectives
This Clerkship provides students with the opportunity to gain a degree of clinical
knowledge and skills in neurology. By the end of the Clerkship students should
have the ability to perform an organized and complete neurological examination
and to interpret the signs and symptoms according to basic anatomical and pathophysiological
principles.
Students should be able to analyze clinical data for neurological localization
(i.e., to determine whether the effect of the disease on the nervous system
is primarily focal or diffuse and whether central or peripheral). If it is central,
they should be able to determine the disease location precisely in the spinal
cord, the brain stem, the cerebellum, or the cerebrum; if it is peripheral,
in the nerves, the roots, or the muscles.
In addition students should master a knowledge of the following broad areas
of neurological disease, with the cardinal presenting features, the etiology,
and the differential diagnosis of each:
Anatomical: (1) diffuse brain disease (metabolic disorder,
dementia (2) focal brain disease, (3) spinal cord disease, (4) disease of roots
and peripheral nerves, and (5) disease of muscle and neuromuscular junction.
Etiological: (1) traumatic disorders, (2) central nervous system
(CNS) neoplasms, (3) CNS infections, (4) CNS vascular disease, (5) demyelinating
disease, and (6) CNS degenerative disease.
Symptomatological: the main causes of (1) headache, (2) seizures,
(3) diplopia, (4) dysarthria, (5) vertigo, (6) focal weakness, (7) numbness,
and (8) other common neurological complaints.
Furthermore, students should acquire a specific knowledge of the management
(diagnosis and initial treatment) of neurological emergencies such as: (a) status
epilepticus/repeated seizures (including the appropriate use of anticonvulsants),
(b) acute bacterial meningitis, (3) cerebral herniation, and (d) spinal cord
compression. This knowledge should encompass recognition of the signs of the
comatose or stuporous patient, the methods available for evaluation, and the
fundamentals of caring for such a patient. Students should understand the indications
for common neurological diagnostic tests and their interpretation. Students
are expected to acquire specific skills regarding lumbar puncture: (a) indications
and contraindications, (b) proper performance, (c) appropriate work-up of the
cerebrospinal fluid, and (d) general interpretation of results. Also, students
should learn to interpret basic neuroradiologic studies including CT and MRI
scans.
Format
Students are assigned to the adult neurology ward or consult service at University
Hospital or the Veterans Affairs NJ Healthcare System East Orange, or to the
pediatric neurology service at University Hospital. The student is part of the
ward or consult team and works primarily with one resident in the evaluation
and care of patients. Each student is assigned approximately two patients per
week and assumes responsibility for obtaining their complete history, physical
and neurological examination. The student is expected to be familiar with the
assigned patient's hospital course. He/she is expected to present the patient
at attending rounds and may be asked to present at grand rounds or other conferences.
Students ordinarily attend outpatient clinics where they may see patients with
the resident or perform supervised work-ups. Students may perform procedures
on their patients, but lumbar punctures must be supervised.
A series of didactic lectures covering essential areas of neurology is given.
Informal tutorials with the students are held weekly by senior neurology residents.
In addition, students attend daily ward-attending rounds, weekly neurology grand
rounds, and chief-of-service rounds. An orientation sheet and monthly schedule
distributed at the beginning of the Clerkship provide further details about
duties and conferences. Students are expected to attend all clinical conferences,
ward rounds, etc. as delineated on their schedules.
Responsible faculty
Stephen Kamin, M.D., Associate Professor, Director of Neurology Clerkship, Medical
Sciences Building, room H-506; telephone: (973) 972-7407.
Peter C. Dowling, M.D., Professor and Chief of Neurology Service, Veterans Affairs
NJ Healthcare System East Orange; telephone: (973) 676-1000, X1561.
Andrea Hidalgo, M.D., Assistant Professor, University Hospital, room G135; telephone
: (973) 972-4748.
M. Richard Koenigsberger, M.D., Associate Professor, Medical Sciences Building,
room H506; telephone: (973) 972-5204.
Barry E. Levin, M.D., Professor, room 11-138B, Veterans Affairs NJ Healthcare
System East Orange; telephone: (973) 676-1000 X1442.
David Marks, M.D., Assistant Professor, University Hospital, room G246, telephone:
(973) 972-5892.
Jennifer Michaels, M.D., Associate Professor, University Hospital, room G136;
telephone: (973) 972-5865.
Benjamin H. Natelson, M.D., Professor, Veterans Affairs NJ Healthcare System
East Orange; telephone: (973) 676-1000, X1415.
Andrew Pachner, M.D., Professor, Medical Sciences Building, room H506; telephone:
(973) 972-5208.
Jayoung Pak, M.D. Assistant Professor, University Hospital, room G134, telephone:
(973) 972-3174.
Gary Sclar, M.D., Assistant Professor, University Hospital, room G133; telephone:
(973) 972-6462/5864.
Raymond A. Troiano, M.D., Associate Professor, Chief of Neurology Services,
University Hospital, room G246; telephone: (973) 972-5890.
Members of the clinical faculty also serve as hospital-based attendings.
Student evaluation and grades
The student's grade is based on clinical performance and examination scores.
The final examination is a "shelf exam" produced by the National Board
of Medical Examiners. The final exam constitutes 75% of the course grade.
In addition to passing the examination, the student must achieve a satisfactory
level of clinical performance. Candidates for a grade of HONORS must achieve
an honors evaluation on clinical performance. Independent evaluations of the
student's clinical performance are given by the attending physicians and the
senior resident. These evaluations are based on an assessment of factors including
quality of oral and written presentations, fund of knowledge, ability to conceptualize
and solve clinical problems, ability to perform an adequate neurological examination,
reliability, attendance, application, and rapport with patients.
Final grades will be assigned as follows:
HONORS 90 and above
HIGH PASS 85 - 89
PASS 70 - 84
FAIL Below 70
Unexcused absences are not allowed and will result in a deduction of 5 points
for each such absence. Excused absences are obtained from the Clerkship Coordinator,
Dr. S. Kamin. Documentation of personal illness or family emergency is expected
in accordance with school policy. Students missing more than 3 days due to excused
absences will have a grade of Incomplete recorded until departmental requirements
are fulfilled.
An attempt will be made to inform students performing unsatisfactorily approximately
two to three weeks after the beginning of the Clerkship. Recommendations for
self- improvement will also be made. However, whether or not such notification
is given, students must receive a satisfactory evaluation of their clinical
performance and a passing examination grade in order to achieve a passing grade
for the Clerkship