Electronic Case Log

The electronic case log for neurology is similar to the case log used in the medicine clerkship. It can be found at http://ecl.med.cornell.edu. Please log all patients that you work up this month. At the end of the month, please print out a summary report and bring the report with you to the final examination for submission to Laurel.

Write-ups

Students are required to submit three formal write-ups in order to successfully pass the clerkship. These should be organized, and contain an academic discussion. Write-ups must be handed in to the resident or attending who evaluated the patient with you. In addition, all three write-ups must be emailed to the clerkship central email at neurologyclerkship@yahoo.com as three attachments in one message by the Monday after the final examination. Write-ups should conform to the following format:

• Chief Complaint
• History of Present Illness
• Past Medical/Surgical History
• Medications and allergies
• Family History
• Social History
• General medical examination
• Neurological examination
• Mental Status
• Cranial nerves (listed individually)
• Motor examination
• Sensory examination
• Deep tendon reflexes
• Cerebellar examination
• Gait examination
• Ancillary data
• Serum analysis
• CSF analysis
• Radiologic data
• Neurophysiologic data (EEG, EMG, etc.)
• Other data
• Assessment
• Localization of the lesion(s) if focal or multifocal process suspected
• Etimology-based different diagnosis
• Most likely diagnosis with the current data
• Plan
• Diagnostic plan
• Therapeutic plan
• Academic Discussion
• Should include a review of the literature about a feature of the diagnosis or presentation. The literature review should tie in the significance to the case presented. Limit the discussion to 1000 words and 4 references.

Written Examination

On the last Friday of the clerkship (week four), the final examination is administered. The examination administered is the National Board of Medical Examiners Clinical Neurology Shelf Examination. This is a standardized examination, and is similar in format to the USMLE Step 2 examination. The exam consists of 110 multiple-choice questions, and is timed for two hours, 10 minutes. Unless otherwise notified, the examination takes place in the neurology library, F-610, at 10:00am, It is a proctored exam. By administering this exam, students can compare their knowledge to others nationwide, and the clerkship leadership can assure that the materials taught and methods of teaching in the clerkship are adequate to prepare students for a national exam. If a student misses the exam due to an emergency or conflict, it can only be made up at the end of the subsequent clerkship block.

Oral Examination

On the last Friday of the clerkship, after the written examination, each student will meet with the clerkship director for a brief oral examination. The examination will consist of discussion of three clinical vignettes. The student will be asked to read each vignette, and then discuss the diagnosis and therapy with the examiner. Five minutes will be allotted to each vignette, for a total exam time of 15 minutes.

Feedback

Students must request verbal feedback at the end of weeks two and four and note this on their clerkship card. In addition, at the end of the course, students should hand evaluation forms to the residents and faculty members who supervised them. Written evaluations from interns, nurse practitioners and PAs cannot be accepted. In addition, we appreciate student feedback about the course and students have the opportunity to provide written feedback on the day of the written examination.

Textbooks and Reading Assignments

The required textbook for this course is Introduction to Clinical Neurology by Douglas Gelb (3rd edition, 2005). Although no one textbook is perfect, this book is most appropriate for medical students and the philosophy of the book most closely matches the philosophy of this course. So as not to have students incur additional expenses, the Department of Neurology has purchased 15 copies of the book which are available for checkout from the WCMC medical library. Please make sure to return the book on the last day of the course so that it is available for the next group of students. The textbook purchase was made possible by a generous grant from Dr. Frank Petito.

Students must come up with a structured reading plan. $quot;Reading around cases$quot; is encouraged but will not suffice in learning the required materials. The successful student will read through the required text, cover to cover. It has been selected for its length, so that it can be read in four weeks.

In addition to the required reading, students will occasionally need to consult more advanced neurology texts for the purpose of reference. These are especially useful when preparing write-ups. The following is a partial list of neurology textbooks. All are available in the Neurology departmental library and the WCMC library.

• Adam and Victor's Principles of Neurology by Ropper and Brown
• Neurology in Clinical Practice by Bradley, Daroff, Fenice and Jankovic
• Merritt's Neurology by Rowland
• Textbook of Clinical Neurology by Goetz (Available on MD Consult)

Grading

Like other clinical clerkships, neurology is graded on the Cornell system of:

• Honors
• High Pass
• Pass
• Marginal
• Fail

As mentioned above, poor attendance is the easiest ticket to a failing grade. Grades are based on performance in multiple domains and are weighted as follows:

• Clinical Performance 35%
• Written examination 35%
• Write-ups 15%
• Oral examination 15%

Grading in this clerkship is transparent. A blank student assessment form can be found after this section. A failing grade on the written examination does not ensure that the student will fail the clerkship. However, if the student performs below the 20th percentile nationally, a marginal grade for the clerkship will be given, and the test will have to be retaken and passed in order to pass the course. There is no set number of students that will receive a certain grade. Each student is assessed on his/her own work and graded accordingly. Grades are usually available 6-8 weeks after the clerkship is completed. Students have the right to discuss their grading decision with the clerkship director if clarification is requested.

If a student misses the written examination for an excused reason, the test can only be made up on another date when it is being administered at its usual time, the last Friday of a clerkship. Make-up oral examinations should be scheduled directly with the clerkship director.