Neurology and Neurosurgery Electives and Selectives

Inpatient Neurological Consults (NEU4 904B-2)

Attendance: Students may not take time off on the start date but must attend check-in and system orientation with Visiting Student Affairs. See the attendance policy for more details.

Location: Carilion Roanoke Memorial Hospital

Available: July – June

Duration: 2 or 4 weeks, starting any Monday, ending Friday

Number of students per rotation: 1

Prerequisites:

Completion of year 3 Neurology Clerkship (preferred)
Letter of Intent by Chair or Advisor

Overview: This elective will be offered to fourth-year medical students seeking a more extensive exposure to inpatient Neurology and is intended for students interested in intensive care or hospitalist medicine, ER, neurology or neurosurgery. It deals with inpatients suffering from strokes, metabolic encephalopathies, seizures and neurologic complications of non-neurologic conditions. In this setting, students will work with faculty attendings to evaluate patients on a busy consult service. Students will present their findings directly to the consult attending who will review the case with them. There will be time to review the relevant literature prior to presenting these cases.

Goals: Familiarize students with the techniques of neurological history and examination as applied to outpatients with a variety of neurological diseases and neurological complications of systemic diseases; to learn about neurodiagnostic procedures and management of disease of the nervous system. Emphasis will be on learning how to evaluate and manage critically ill patients with concomitant neurological problems.

Objectives: Become more familiar with common practices of inpatient neurological consultation and gain further experience in selected subspecialties within the field of Neurology by working closely with faculty. Students should become familiar with the following clinical areas:

Acute neuromuscular disorders
Metabolic and toxic encephalopathies
Coma
Acute alterations in mental state
Epilepsy and status epilepticus
General inpatient Neurology

Elective Elements and Activities: Students will work directly with attending physicians and learn how to manage a broad range of inpatient neurological problems. The student will be the primary historian and examiner and will discuss the case and review the exam findings directly with the attending physician. The student will be expected to work up and present at least one new consult patient every 1/2 day.

Readings: Additional readings and articles on current neurological diagnosis and management will be provided during the rotation.

Websites:

American Academy of Neurology, family practice curriculum in neurology: aan.com/go/education/curricula/family/toc
American Academy of Neurology, Approach to Common Neurological Symptoms in Internal Medicine: aan.com/go/education/curricula/internal/toc

Students will be evaluated based on clinical performance as judged by the faculty preceptors; emphasis will be placed on the ability to deliver a clear, concise and thorough oral presentation of a patient's history and examination, and present a logical differential diagnosis and management plan. Questions asked during clinical experiences, and participation in clinical discussions will also be evaluated. Evaluations by the individual attending physicians and collated for a final grade.

Acting Internship - Neurosurgery (NSG4 909Q-4)

Attendance: Students may not take time off on the start date but must attend check-in and system orientation with Visiting Student Affairs. Students may not take time off during this AI. See the Attendance Policy for other details.

Location: CRMH

Available: August – June

Duration: 4 weeks, starting any Monday and ending Friday

Number of students per rotation: 1

Prerequisites:

USMLE required (PASS Step 1, Step 2 Preferred if available)
Personal Statement must include reasons why student is interested in coming to Virginia Tech/Carilion Clinic
Letter of Intent from Chair/Advisor stating applicant’s interest in Neurosurgery Residency

Overview: The student acts essentially as a neurosurgical intern, and is assigned a palette of inpatients they care for and follow throughout the patient's hospitalization. Students will spend considerable time in the ICU's, on the floors, and in the operating room. They will write regular notes and will interact intimately with patients and their families. They will take neurosurgical call with a resident one in every four nights and will participate in Resident Clinic every Tuesday morning. They will be exposed to the full gamut of neurosurgical issues encountered in a busy academic/clinic practice and participate in inpatient and outpatient neurosurgical evaluation, the neurological exam, surgical tissue manipulation, neurological critical care, neuroradiology, patient and family interaction, and much more.

The student will become progressively proficient and knowledgeable in the following:

Comfortably evaluating patients with acute neurological disorders
Performing a thorough yet focused neurological exam
Interpreting routine radiographic studies of the brain and spine including x-rays, MRIs, angiograms, myelograms, CT scans, CTAs, MRAs, MRVs, etc.
Recognizing the radiographic characteristics of common disorders of the nervous system and spinal column
Generating a thoughtful, well-reasoned, and reasonable differential diagnosis for patients presenting with neurological disorders
Communicating comfortably, rationally, and with clarity issues relating to disorders of the spine and nervous system and their evaluation and management
Discussing the basic physiology and pathologic process involved in a patient's neurological disorder
Discussing the indications, risks, benefits, outcomes and alternatives to the surgical treatment of various common neurological and spinal disorders
Evaluating and formulating treatment options in the care of low back pain, radiculopathy and neck pain
Identifying ventriculo-peritoneal shunt failure
Relaying clinical information clearly and succinctly to neurosurgical patients and their families
Managing seizures, increased intracranial pressure, and spinal column fractures
Recognizing caudal equine syndrome and a profound myelopathy, brain hernia, aneurismal rupture, stroke and meningitis

Neurosurgical Intensive Care (NSG4 909E-4)

Attendance: Students may not take time off on the start date but must attend check-in and system orientation with Visiting Student Affairs. See the attendance policy for details.

Location: Carilion Roanoke Memorial Hospital

Available: August – June

Duration: 4 weeks, starting any Monday and ending Friday

Number of students per rotation: 1

Prerequisites:

USMLE required (PASS Step 1, Step 2 Preferred if available)
Personal Statement must include reasons why student is interested in coming to Virginia Tech/Carilion Clinic
Letter of Intent from Chair/Advisor stating applicant’s interest in Neurosurgery Residency

Overview: Students will work predominantly in the emergency room evaluating acute neurosurgical issues and in conjunction with the trauma team and in the ICU once the acute situation has been initially identified and evaluated.

The student will become progressively proficient and knowledgeable in the following:

Comfortably evaluating pediatric patients with acute neurological disorders
Performing a thorough yet focused neurological exam
Interpreting routine radiographic studies of the brain and spine including x-rays, MRIs, angiograms, myelograms, CT scans, CTAs, MRAs, MRVs, etc.
Recognizing the radiographic characteristics of common disorders of the nervous system and spinal column
Generating a thoughtful, well-reasoned and reasonable differential diagnosis for patients presenting with neurologic disorders
Communicating comfortably, rationally and with clarity issues relating to disorders of the spine and nervous system and their evaluation and management
Discussing the basic physiology and pathologic process involved in a patient’s neurological disorder
Discussing the indications, risks, benefits, outcomes and alternatives to the surgical treatment of various common neurological and spinal disorders
Evaluating and formulating treatment options in the care of low back pain, radiculopathy and neck pain
Identifying ventriculo-peritoneal shunt failure
Relaying clinical information clearly and succinctly to neurosurgical patients and their families
Managing seizures, increased intracranial pressure, and spinal column fractures
Recognizing caudal equine syndrome and a profound myelopathy, brain hernia, aneurismal rupture, stroke and meningitis

Pediatric Neurosurgery 2 wks (NSG4 909D-2) or 4 wks (NS

Attendance: Students may not take time off on the start date but must attend check-in and system orientation with Visiting Student Affairs. See the attendance policy for details.

Location: Carilion Roanoke Memorial Hospital and the Institute of Orthopaedics and Neurosciences (ION)

Available: August – June

Duration: 2 or 4 weeks, starting any Monday and ending Friday

Number of students per rotation: 1

Prerequisites:

USMLE required (PASS Step 1, Step 2 Preferred if available)
Personal Statement must include reasons why student is interested in coming to Virginia Tech/Carilion Clinic
Letter of Intent from Chair/Advisor stating applicant’s interest in Neurosurgery Residency

Overview: Students will work closely with two pediatric neurosurgery-oriented neurosurgeons learning the nuts and bolts of pediatric neurosurgery and learning how to relate to critically ill children and their families in the outpatient and inpatient settings. Students will have exposure to patients with disorders such as hydrocephalus, spina bifida, tethered spinal cord, head trauma, spine trauma, brain tumors, non-accidental trauma, chiari malformation, skull masses, craniofacial synostosis and deformity, and more. The pediatric volume of the service varies so some adult neurosurgery may be mixed into the rotation. Students will participate in Tuesday afternoon academic sessions and will always be welcome on rounds and in the operating room.

The student will become progressively proficient and knowledgeable in the following:

Comfortably evaluating pediatric patients with acute neurological disorders
Performing a thorough yet focused neurological exam
Interpreting routine radiographic studies of the brain and spine including x-rays, MRIs, angiograms, myelograms, CT scans, CTAs, MRAs, MRVs, etc.
Recognizing the radiographic characteristics of common disorders of the nervous system and spinal column
Generating a thoughtful, well-reasoned and reasonable differential diagnosis for patients presenting with neurological disorders
Communicating comfortably, rationally and with clarity issues relating to disorders of the spine and nervous system and their evaluation and management
Discussing the basic physiology and pathologic process involved in a patient’s neurological disorder
Discussing the indications, risks, benefits, outcomes and alternatives to the surgical treatment of various common neurological and spinal disorders
Relaying clinical information clearly and succinctly to neurosurgical patients and their families
Managing seizures, increased intracranial pressure, and spinal column fractures
Recognizing caudal equine syndrome and a profound myelopathy, brain hernia, aneurismal rupture, stroke and meningitis

Neurosurgery OR 2 wks (NSG4 909F-2) or 4 wks (NSG4 909F

Attendance: Students may not take time off on the start date but must attend check-in and system orientation with Visiting Student Affairs. See the attendance policy for details.

Location: Carilion Roanoke Memorial Hospital

Available: August – June

Duration: 2 or 4 weeks, starting any Monday and ending Friday

Number of students per rotation: 1

Prerequisites:

USMLE required (PASS Step 1, Step 2 Preferred if available)
Personal Statement must include reasons why student is interested in coming to Virginia Tech/Carilion Clinic
Letter of Intent from Chair/Advisor stating applicant’s interest in Neurosurgery Residency

Overview: For the surgery hound! Students will spend the vast majority of their time in the operating room participating in the daily operating schedule. They will evaluate the patients and their radiographs in the pre-op area and then discuss the choice and execution of procedures with attending surgeons and residents involved in the procedure. They will become skilled in sterile technique, prepping and draping, operative positioning, opening and closing of surgical wounds, control of bleeding, tying, suturing, drain placement, burr hole placement, pedicle screw insertion, laminectomy, ventricular catheter placement, lumbar catheter placement, craniotomy, bone drilling, and more. They will develop an appreciation for the fragility of the nervous system and will develop skills in the delicate manipulation of such tissues. Students will participate in Tuesday afternoon academic sessions and will always be welcome on rounds and in the operating room.

The student will become progressively proficient and knowledgeable in the following:

Comfortably evaluating pediatric patients with acute neurological disorders
Performing a thorough yet focused neurological exam
Interpreting routine radiographic studies of the brain and spine including x-rays, MRIs, angiograms, myelograms, CT scans, CTAs, MRAs, MRVs, etc.
Recognizing the radiographic characteristics of common disorders of the nervous system and spinal column
Generating a thoughtful, well-reasoned and reasonable differential diagnosis for patients presenting with neurological disorders
Communicating comfortably, rationally and with clarity issues relating to disorders of the spine and nervous system and their evaluation and management
Discussing the basic physiology and pathologic process involved in a patient’s neurological disorder
Discussing the indications, risks, benefits, outcomes and alternatives to the surgical treatment of various common neurological and spinal disorders
Evaluating and formulating treatment options in the care of low back pain, radiculopathy, and neck pain
Identifying ventriculo-peritoneal shunt failure
Relaying clinical information clearly and succinctly to neurosurgical patients and their families
Managing seizures, increased intracranial pressure, and spinal column fractures
Recognizing caudal equine syndrome and a profound myelopathy, brain hernia, aneurismal rupture, stroke and meningitis