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ACE - Externship in Clinical Neurology

Elective Number: 1701

Rotation Supervisor: Dr. Binit Shah

Coordinator: Karen Smith; McKim room 2001; 924-5548

A pager is required, but it not provided by the department.

Duration: 4 weeks maximum; 2 weeks minimum (as non-ACE option)

Available:Rotations 1- 12

Report to: Contact Dr. Shah for details

Time to Report: TBA

Place to Report: TBA

Typical day: 7:00 am - 5:00 pm

Attendance: A student may not take time off during an ACE.

Attendance at elective activities is mandatory.

  • Anyone who is ill or has a personal or family emergency must contact Student Affairs and the Attending on Service.
  • Students are allowed to take off up to 1 day per week to interview between November 1 and February 1.
    • Specific days missed must be approved by the Attending on Service.

Number of students per rotation: 1 (2 by special arrangement)

Course Description: One externship position is offered during each four-week rotation block during the academic year. The extern, under supervision of a neurology resident and attending, assumes the responsibility for the evaluation and daily care of hospitalized adult patients with neurological disorders. The extern participates in daily work and teaching rounds. The rotation is divided into at least two blocks. Two-to-three weeks are spent on the adult consults /general neurology/stroke or neurological intensive care unit and one week will be on the night-float service. The extern is expected to attend the daily resident didactic sessions as well as attend Neurology grand Rounds while not on the night-float service. On an individually arranged basis, the extern may participate in Neurology Outpatient Clinics where s/he will encounter a wide variety of neurological problems seen in the office practice. There the extern examines selected new and return patients, reviews findings with a Neurology Resident and with members of the Neurology faculty, and assists in designing a plan of patient evaluation and therapy. The student will be assigned to at least one period of 24 contiguous hours off, on average, per week. There will be weekend rounds while on the consults/stroke/general neurology and ICU services. The extern will take short call if on the stroke or general neurology service.

Learning Objectives:
During the ACE experience externs will:
o Demonstrate the ability to document the following in an organized manner:
-Admission/Consult Note
-Daily Progress Note
-On-call emergencies/cross-cover notes during night float week
o Demonstrate the ability to perform a screening neurological examination based on the video listed in the Neurology Clerkship Website.
o Demonstrate the ability to perform an adapted neurological examination on a patient with altered level of consciousness patient focusing on:
+Mental Status:
• Level of arousal
• Response to auditory stimuli
• Response to visual stimuli
• Response to noxious stimuli (centrally and to each limb individually)
+ Cranial Nerves:
• Response to visual threat
• Pupillary light reflex
• Oculocephalic reflex
• Corneal Reflex
• Gag Reflex
+ Motor
• Voluntary movements
• Reflex withdrawal
• Spontaneous movements
• Tone
+ Reflexes
• Deep tendon reflexes
• Plantar Responses
+ Sensation:
• To noxious stimuli
o Demonstrate the skills of clinical localization of lesions with in the nervous system based on history and physical findings.
o Create differential diagnoses for each patient they individually assess and present them in a written and verbal form organizing the list of differential diagnoses in order of relevance to the clinical scenario.
o Synthesize a specific plan of care or recommendations of care for each patient they assess.
o Name guidelines governing patient confidentiality in verbal communication with patient’s family members.
o Identify the importance of cultural issues governing health care decision making by patients.
o Demonstrate the ability to communicate effectively with patients and their family members (e.g, utilize lay terms chosen to reflect the level of education of the patient and family as well as explain jargon; communicate abnormal results to patients)
o Demonstrate the ability to clearly summarize a patient’s reason for admission and justify the plan of care/recommendations for care.
o Demonstrate the ability to clearly and concisely present oral summaries of patients to the health care team with special focus on the synthesis of a treatment plan.
o Demonstrate the ability to effectively communicate and cooperate with physician and non-physician members of the health care team including:
- Physical therapists
- Occupational therapists
- Speech-language pathologists
- Nurses
- Pharmacists
- Mid-Level Practitioner

o Explain the rationale, risks, and benefits of lumbar punctures in language that is understandable by a patient.
o Demonstrate the ability to obtain and document informed consent for a lumbar puncture with a patient or in discussion with attending or senior resident.
o Demonstrate the ability to write a procedure note.