Department of Medicine
Neurology
Location: Health Sciences Centre and St. Boniface General Hospital
Training Objectives for Clinical Clerks:
The Section of Neurology offers medical students exposure to the inpatient
service, consult service and outpatient clinics. The number of inpatients is
relatively small. Most activity involves seeing consults throughout the hospital
and in the emergency department.
The medical student must attend the weekly Neurology rounds as listed in the
document given out at the start of the rotation, "Guidelines for housestaff
rotating on the Neurology Services of HSC and SBGH". The medical student is
expected to partcipate in the presentation and discussion of cases at those
rounds where this is expected of other housestaff.
The medical student will become part of the Neurology housestaff team during
their rotation and is expected to work with the team in a cooperative effort,
following the direction of the most senior housestaff. The medical student will
review the objectives and conduct of the rotation with the Program Director or
designate at the beginning of the rotation. These same individuals will be
responsible for a mid-rotation review and will discuss same with the medical
student if there are deficiencies noted in the student's ability to achieve the
objectives of the rotation by that time.
Objectives:
Most medical students will be doing a one-month rotation. As they are relatively
inexperienced and because the rotation is brief, objectives are limited, as should
the expectations of the medical student be realistic.
-
Develop proficiency and confidence in eliciting, interpreting, documenting
and presenting a complete neurological history and physical examination.
-
Become familiar with the major clinical manifestations, as well as the basic
investigation and treatment of common neurological problems.
-
Become familiar with the value and limitations of the major neurodiagnostic
tests available, including EEG, EMG, evoked potentials, lumbar puncture,
and diagnostic imaging (CT and MRI particular).
-
Appreciate the types of clinical problems appropriate for referral for
neurological consultation.
Methods to Achieve Objectives:
The student will see neurological consultations on inpatients and outpatients.
They will be given ample time to perform a history and examination and will
review same with the more senior housestaff and the attending neurologist.
Coincident with this, the student should re-read a textbook on the neurological
examination, revising the clinical skills they learned earlier in the medical school
curriculum. The student should alert the senior housestaff and attending staff
about specific parts of the examination they have difficulty with so that they can
be specifically reviewed.
The student will attend the Clinical Neurophysiology Lab where, in consultation
with the senior technologist, spend time observing the conduct of EEG, EMG and
evoked potentials. The intent is to appreciate what the test is, the impact it has
on the patient and in general terms, its value and limitations.
The student will review CT and MR and other x-rays on the patients they see.
They should discuss the findings with the senior housestaff, attending staff and
radiologists to gain an appreciation of the value and limitations of each radiologic
procedure.
The student should review basic and clinical neuroscience material previously
presented in the medical school curriculum to obtain an appreciation of the more
common neurological conditions (see list presented later on). The student should
use a basic reference source such as Cecil's Essentials of Medicine, supplementing
it with Harrison's as needed for understanding of selected topics. The student
should avoid becoming bogged down in more exhaustive neurology references as
this is impractical for a one-month rotation.
Evaluation:
The assessment forms provided by the Undergraduate Office are used for this
evaluation. Students meet with the program director or designate at the
beginning and end of the rotation. The presence of any major weakness is
brought to the
attention of the student by mid-rotation or sooner.
Recommended References:
- How to Examine the Nervous System, RT Ross
- Basic and clinical neuroscience notes and references provided earlier in the
medical school curriculum, supplemented by Harrison's.
- A "short" textbook of Neurology may be used instead of, or in addition to,
#2. There are many short textbooks available. The student should discuss
choosing one with the Neurology faculty.
Knowledge To Be Gained:
The following is a list of neurological conditions that a clinical clerk should be
familiar with by the end of the one-month rotation:
- Encephalitis (e.g. herpes simplex)
Meningitis (common causes of bacterial and viral meningitis)
Headache (migraine, tension-type headache, temporal arteritis,
headache associated with increased intracranial pressure, headache
suggesting subarachnoid hemorrhage)
Epilepsy (seizure types/classification, status epilepticus)
Cerebrovascular Disease (TIA, stroke, subarachnoid hemorrhage)
Intervertebral disc disease
Syncope (differentiation from epilepsy)
Peripheral neuropathy (differential diagnosis, Guillain-Barre)
Motor neuron disease (as an example of anterior horn cell disease)
Multiple sclerosis
Transverse myelopathy due to metastatic lesions to the spinal column
Dementia (Alzheimer's disease, differential diagnosis
Parkinson's disease
Bell's palsy
Trigeminal neuralgia
Carpal tunnel syndrome
Ulnar neuropathy
Polymyositis (as an example of how a myopathy might present or appear)
To arrange this elective, please contact:
Electives_Administrator@umanitoba.ca
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