photo

Neurology Core and Advanced Clerkships at Massachusetts General Hospital

The Harvard Medical School Neurology Core and Advanced Clerkships at Massachusetts General Hospital instruct medical students in the core competencies of clinical neurology.

Under the direction of Dr. Tracey A. Cho, the goals of the clerkships are to instill an understanding of essential clinical neuroscience, and promote professionalism through patient care. The core and advanced rotations are active, interactive and use innovative methods of teaching and assessment.

When possible, students taking the core clerkship should have completed a clerkship in internal medicine. Students wishing to take the advanced clerkship must have completed a neurology rotation at their home institution.

Both the core and advanced clerkships are one-month rotations.

Clerkship Director Tutorials

Dr. Tracey A. Cho, Clerkship Director, and the Associate Clerkship Director, Dr. Tracey Cho, use the weekly forum of clerkship director tutorials to introduce and instruct students in the practice of beside examination and clinical neuroscience. This two-hour interactive personalized teaching session includes history taking, physical exam and differential diagnosis, lesion localization, plan of management, overall approach to the particular case, and understanding of basic neurological and psychosocial disease.

Recommended Reading

There is no single recommended textbook, we do, however, suggest that you chose a text that can be read in its entirety during the clerkship month.

Popular choices by students have included:

  • Clinical Neurology (Lange Medical Book Series) by Michael J. Aminoff, David Greenberg, Robert R. Simon, and Roger P. Simon, Blueprints Neurology (Blueprints Series) by Frank W. Drislane, Michael Benatar, Bernard S. Chang, and Juan A. Acosta
  • Neurology Pretest Self Assessment and Review, 6th Ed., by David J. Anschel Pretest (shelf exam preparation)

Standard neurology reference texts that students have found useful include:

  • Harrison’s Principles of Internal Medicine,17th Ed.,  Neurology Section., by Anthony Fauci, Eugene Braunwald, Dennis L. Kasper and Stephen L. Hauser
  • Adams, and Victor’s Principles of Neurology, 8th Ed., by Allan H. Ropper and Robert H. Brown
  • Office Practice of Neurology by Martin A. Samuels and Steven K. Feske
  • Merritt's Neurology Handbook by Pietro Mazzoni, Toni Pearson, and Lewis P Rowland
  • Neuroanatomy Through Clinical Cases by Hal Blumenfeld
  • Neurology in Clinical Practice: Text with Continually Updated Online Reference, 2 volume set by Walter G. Bradley , Robert B. Daroff, Gerald Fenichel and Joseph Jankovic

Other useful publications, used mostly by residents include:

  • The Washington Manual: Neurology Survival Guide (Survival Guide Series) by Dave Rengachary and Tammy L. Lin
  • The Massachusetts General Hospital Handbook of Neurology by Alice W. Flaherty and Natalia S. Rost.

Board Examination Exercises

Neurology Attending Faculty oversee the student examination and assessment of a patient that is not known student .The student takes the history and examines the patient. The student then presents the case to an attending faculty, showing pertinent positives and negatives on exam, discusses the diagnosis as well as the differential, and discusses a plan of management. This three hour, hands-on interactive experience with patient and faculty is designed to assess major competencies in clinical neurology and to serve as a teaching tool, an assessment of student performance, and as a guide to improvement in areas that need attention.

Shelf Examination

All students are required to take the neurology shelf examination of the National Board of Medical Examiners.

Neurology Resident Tutorials

Neurology residents rotating through Neuropathology present a series of bi-weekly lectures specifically for the medical students that cover the core knowledge base recommended by the American Academy of Neurology, and agreed upon by the Neurology Clerkship Director Committee at Harvard Medical School (HMS).

These semi-didactic sessions under the supervision of the clerkship director provide an opportunity for students to interact with each other, engage in interactive group learning, and gain exposure to topics they may not encounter on the clinical services. The topics are:

  • The neurological exam
  • Neurologic emergencies – cord compression, coma/confusion, subarachnoid hemorrhage, meningitis, Herpes simples encephalitis, Guillian Barre Syndrome
  • Stroke and TIA
  • Seizures; multiple sclerosis
  • Tumors and increased intracranial pressure; head injury; AIDS neurology
  • Dementia, aphasia, neglect, frontal lobe syndromes, depression as neurologic disease
  • Movement disorders – Parkinson’s Disease, Huntington’s Disease, ataxia, tremor
  • Outpatient neurology – headache, dizziness, neck/back pain and radiculopathy, peripheral neuropathy

Clinical and Neuroscience Lecture Series

Students participate in the series of lectures for the resident staff at least on a weekly basis. During the course of the year, members of the faculty give these lectures in the library over lunch, and students are active participants in these programs. A wide range of topics of clinical and basic science interest is covered.

Inpatient Services Rounds – C. Miller Fisher (CMF) and Raymond D. Adams (RDA) Services

Core neurology students are assigned to the CMF (predominantly stroke patients) and the RDA (general neurology) services spending two weeks on each service in order to gain experience with a wide variety of neurological cases. Ward rounds are used for the purposes of teaching, history taking, physical examination, differential diagnosis, record keeping, case management, treatment outcomes as well as patient and family relations. Reading assignments are given based on cases seen.

Inpatient Consult Services - General Consult and Stroke Consult

On the Inpatient General Consult and Stroke Consult services, students and faculty consult on patients referred from other services who require neurological assessment, follow-up and management. Students in the Advanced Neurology Clerkship evaluate patients, write notes in the records, and provide input to the consulting services, after intensive reading about each case and discussion with the senior resident and attending on the service.

Neurology Outpatient Clinic

The Mass General Neurology Clinic provides a teaching opportunity for students by including them in assessment and treatment of patients with neurological disability. This is ambulatory patient-doctor “in action”. Students participate in the examination of patients, discuss diagnosis and management with their attending physicians, and experience the interaction with both new and established cases at the medical-neurological level as well as at the humanitarian level. Students are in the outpatient setting once a week,

Daily Morning Report

Led by one of the neurology faculty members or senior residents, students are exposed every day to the discussion of the cases that presented the previous evening, including approach to diagnosis, results of investigations, and strategies for management.

Weekly Chief’s Rounds

Dr. Merit E. Cudkowicz, Chief of Mass General Neurology or Dr. Martin A. Samuels, Chief of Brigham & Women’s Hospital Neurology, participates in a weekly case review with neurology staff, residents, fellows, and medical students. Students may present the case to the Chief of Service, and benefit from the exposure of the presentation, examination, and discussion of difficult and unusual cases.

Grand Rounds

Students attend weekly Grand Rounds, which cover a spectrum of clinical and basic neuroscience topics.

Brain Cutting

Neurology faculty members are an integral part of the weekly Neuropathology Brain Cutting conference and have direct input into student learning. Neurology and Neuropathology residents and fellows guide students through the protocol (clinical summary) of a patient who has been autopsied. Students discuss the case with each other in the Harvard tutorial style during a dedicated one-and-a-half hour time slot prior to the Brian Cutting session. The students then lead off the discussion in the case conference presenting the results of their discussion regarding the anatomy, neurology, and pathology of the case.

Supervision and Tutoring of HMS students in Mass General Faculty Laboratories

Members of the Mass General faculty take many HMS students into their labs under arrangements that are not supervised by the clerkship director. These research opportunities provided to HMS students by Mass General neurology faculty form an integral part of the HMS student experience, and add to the fabric of responsibility that Mass General faculty has for the tutoring and mentoring of students in each stage of their medical school career.

Grade Determination

Students in both the core and advanced neurology clerkships receive a grade that is weighted 70% faculty and resident assessment, 15% score on the bedside examination exercise and 15% score on the shelf examination.

To apply for the clerkship students can contact the Harvard Medical School Registrar, which coordinates the Harvard Medical School Exchange Clerk Program that allows final year students from other medical schools to participate in clinical electives.

Email: exclerks@hms.harvard.edu
Phone: 617-432-1515
Website: http://www.hms.harvard.edu/registrar/

For more information regarding our clerkship program please e-mail Dr. Tracey A. Cho.