Neurology Core & Advanced Clerkships

Overview

Under the direction of Dr. Haatem Reda, Dr. Isabel Arrillaga-Romany, Associate Clerkship Director, and Dr. Kate Brizzi, Assistant Clerkship Director, the goals of the clerkships are to instill an understanding of essential clinical neuroscience and promote professionalism through patient care. The core and advanced clerkships are active, interactive, and use innovative methods of teaching and assessment.

Requirements

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.

Curriculum

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

Clerkship Director Tutorials

Dr. Haatem Reda, Clerkship Director, and Dr. Isabel Arrillaga-Romany, Associate Clerkship Director, use this weekly forum of tutorials to instruct students in the practice of beside examination and clinical neuroscience. This interactive personalized teaching session includes history taking, physical examination, lesion localization, differential diagnosis, plan of management, 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:

• Lange Clinical Neurology and Neuroanatomy: A Localization-Based Approach by Aaron L. Berkowitz
• 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.

Observed Clinical Examination (Mini-CEx)

Neurology attending faculty oversee the student’s examination and assessment of a patient that is not known to the student. The student takes the history and examines the patient. The student then presents the case to an attending neurologist, demonstrating pertinent examination findings, discusses the differential diagnosis and 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 core students are required to take the neurology shelf examination of the National Board of Medical Examiners. The score required to pass the clerkship is above the 5th percentile.

Clerkship Didactics

Students will attend a weekly lecture series given by HMS faculty covering the core knowledge base recommended by the American Academy of Neurology and agreed upon by the Neurology Clerkship Director Committee at Harvard Medical School. The topics include:

• The neurological examination
• Neurologic emergencies
• Cerebrovascular disease
• Epilepsy
• Multiple sclerosis
• Behavioral neurology
• Movement disorders
• Neuromuscular medicine
• Headache
• Neuro-oncology

Clinical Experience

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

Core neurology students spend two weeks each on the CMF (cerebrovascular) and the RDA (general) neurology inpatient services to gain experience with a wide variety of neurological disease. Ward rounds are used for the purposes of teaching, history taking, physical examination, differential diagnosis, record keeping, case management, treatment outcomes, and patient and family relations. Reading assignments are given based on cases seen.

Inpatient Consult Services – Comprehensive Consult and Stroke Consult Services

On the Comprehensive Consult and Stroke Consult services, students and faculty consult on patients referred from other services for neurological assessment, follow-up, and management. Students in the Advanced Neurology Clerkship evaluate patients, write notes in the record, and provide input to the consulting services after 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 neurologic disease. 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 patients.

Daily Morning Report

Led by one of the neurology faculty members, students are exposed to a daily discussion of recently admitted patients, including the approach to localization, diagnosis, results of investigations, and management.

Weekly Chief’s Rounds

The Chiefs of Neurology at Mass General and BWH participate 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 inpatient cases.

Grand Rounds

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

Neuropathology

Neurology and neuropathology residents and fellows guide students through the protocol (clinical summary) of a patient who has undergone autopsy. Students will have reviewed the case beforehand and will then be called on to discuss their localization of the lesion, differential diagnosis, and expected pathological findings. The discussion is then broadened to include residents, fellows, and faculty, followed by a guided examination of the patient’s brain.

Research Experience

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 the core neurology clerkship receive a grade of either Satisfactory or Unsatisfactory based upon faculty and resident evaluations of entrustable professional activities (EPAs). Advanced students receive a grade of Pass, Honors, or Honors with Distinction that is similarly derived.

How to Apply

To apply for the clerkship, please visit https://meded.hms.harvard.edu/exchange-clerkship-program.

Email: exclerks@hms.harvard.edu
Phone: 617-432-1515

For more information regarding our clerkship program please email Dr. Haatem Reda.