Electives - Neurology
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)
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
Number of students per rotation: 1 (2 by special
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
During the ACE experience externs will:
o Demonstrate the ability to document the following in an organized manner:
-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:
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
Deep tendon reflexes
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
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
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
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
- 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.