Neurology & Neurosurgery

Neurology & Neurosurgery

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:  CRMH
Available:  July - June
Duration:   2 weeks, starting any Monday, ending Friday
Number of students per rotation:  1
Prerequisites:  Completion of year 3 Neurology Clerkship
 
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.

Student 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:  at the AAN site -  Family practice curriculum in neurology - -http://www.aan.com/go/education/curricula/family/toc
Approach to Common Neurological Symptoms in Internal Medicine ---http://www.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.

Outpatient Neurology  (NEU4 904C-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:  Riverside 3
Available:  July - June
Duration:   2 weeks, starting any Monday and ending Friday
Number of students per rotation:  1
Prerequisites:  Completion of year 3 Neurology Clerkship
 
Overview:  This elective will familiarize students with the techniques of neurological history and examinations as applied to outpatients with a variety of neurological diseases and neurological complications of systemic diseases.  Students will observe and participate in neuro-diagnostic procedures and learn simple exam skills and clinical principles that make it much easier to evaluate and manage neurological complaints in an efficient and cost-effective manner.  Students may choose from a wide variety of neurological subspecialty experiences including movement disorders, epilepsy, EMG and neuromuscular disease, amongst others, but will also spend at least 50% of the time seeing general neurology consultations.
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 outpatient neurological consultation and gain further experience in selected subspecialties within the field of Neurology by working closely with faculty.

Student 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 outpatient 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:  Family practice curriculum in neurology - -http://www.aan.com/go/education/curricula/family/toc
Approach to Common Neurological Symptoms in Internal Medicine ---http://www.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: 3

Prerequisites: None

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:

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

Complex Spine 2 wks (NSG4 909C-2) or 4wks (NSG4 909C-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: CRMH and Institute of Orthopaedics and Neurosciences Clinic (ION)

Available: August  - June

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

Number of students per rotation: 1

Prerequisites: None

Overview: Students on this rotation will partner with the Director of Complex Neurosurgical Spine Surgery and go through the work week “joined at the hip” with him. The elective is intense and action-packed with approximately 40% of the week in neurosurgery and/or the Spine Center Clinic, and 60% in the operating room and inpatient floors. The student will participate in the evaluation and management of degenerative spinal disorders, radiculopathy, myelopathy, spinal column tumors, spinal column fracture, spinal column deformity, chronic spinal pain, scoliosis, and more. Surgical experiences will include the opening and closing of large spinal wounds, pedicle screw placement, laminectomy, fusion, kyphoplasty, and more. 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:

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

Neurosurgical Consults 2 wks (NSG4 909P-2) or 4 wks (NSG4 909P-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: CRMH

Available: August  – June

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

Number of students per rotation: 2

Prerequisites: None

Overview: Students will spend the majority of their rotation evaluating Neurosurgery and Spine Center outpatients, participating in history taking, exam, differential diagnosis, synthesis, and treatment planning. They will partner with attending neurosurgeons and residents each day, independently evaluate each of their patients, review the patient’s studies, and formulate a diagnosis and treatment plan prior to discussing with their neurosurgical partners. They will learn how to efficiently move a number of patients through a clinic and will follow their patients through their entire neurosurgical experience including inpatient care and surgery. Students will participate in Tuesday afternoon didactics and will always be welcome on rounds and in the operating room.

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

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

Available: August  – June

Duration: 4 weeks, starting any Monday and ending Friday

Number of students per rotation: 1

Prerequisites: None

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:

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

Neurosurgery Night Call 2 wks (NSG4 909M-2) or 4wks (NSG4 909M-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: CRMH

Available: August  – June

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

Number of students per rotation: 2

Prerequisites: None

Overview: For the night owls but not the faint of heart! This is an intense experience providing broad exposure to emergency room and hospital consultations. Fifty-percent of all trauma consults to neurosurgery come in after midnight at our institution. Students will work four 12- hour night shifts a week partnering with the on-call resident and attending surgeon, attending all urgent inpatient issues on the floors and in the ICU’s, and accompanying patients to the operating room when needed. Students will become familiar with urgent neurological situations and develop a strong acumen for urgent neurological care and neuroradiology and emergent neurosurgical procedures. Students will participate in Tuesday afternoon academic sessions and would be welcomed on rounds and in the operating room.

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

  1. Comfortably evaluating pediatric patients with acute neurological disorders
  2. Performing a thorough yet focused neurological exam and com
  3. Interpreting routine radiographic studies of the brain and spine including x-rays, MRIs, angiograms, myelograms, CT scans, CTAs, MRAs, MRVs, etc.
  4. Recognizing the radiographic characteristics of common disorders of the nervous system and spinal column
  5. Generating a thoughtful, well-reasoned, and reasonable differential diagnosis for patients presenting with neurological disorders
  6. Communicating comfortably, rationally, and with clarity issues relating to disorders of the spine and nervous system and their evaluation and management
  7. Discussing the basic physiology and pathologic process involved in a patient’s neurological disorder
  8. Discussing the indications, risks, benefits, outcomes, and alternatives to the surgical treatment of various common neurological and spinal disorders
  9. Evaluating and formulating treatment options in the care of low back pain, radiculopathy, and neck pain
  10. Identifying ventriculo-peritoneal shunt failure
  11. Relaying clinical information clearly and succinctly to neurosurgical patients and their families
  12. Managing seizures, increased intracranial pressure, and spinal column fractures
  13. 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 (NSG4 909D-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: CRMH and Institute of Orthopaedics and Neurosciences Clinic (ION)

Available: August  – June

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

Number of students per rotation: 1

Prerequisites: None

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:

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

Available: August  – June

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

Number of students per rotation: 2

Prerequisites: None

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:

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

Outpatient Neurosurgery 2 wks (NSG4 909B-2) or 4 wks (NSG4 909B-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: Institute of Orthopaedics and Neurosciences Clinic (ION)

Available: August  – June

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

Number of students per rotation: 2

Prerequisites: None

Overview: Students will spend the majority of the rotation evaluating patients in the Neurosurgery and Spine Center Clinics. They will participate in neurological history taking, exam, differential diagnosis, synthesis, and treatment planning and learn how to efficiently move patients through a clinic. They will develop skills in patient interaction, neuroradiologic evaluation, and the evaluation and management of spinal disorders and various brain and peripheral nerve disorders. They will partner with attending neurosurgeons and residents each day but independently evaluate each patient, review the patient’s studies, and formulate a diagnosis and treatment plan before discussing with their neurosurgical partners. Students will be encouraged to follow their patients through their entire neurosurgical experience including inpatient care and surgery. 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:

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

Research 2 wks (NSG4 909G-2) or 4 wks (NSG4 909G-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: Institute of Orthopaedics and Neurosciences Clinic (ION)

Available: August  – June

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

Number of students per rotation: 3

Prerequisites: None

Overview: Students will work predominately on on-going projects of the team although we are open to initiating novel proposed projects and will participate in Tuesday afternoon academic sessions and are welcome on rounds and in the operating room. Students will work with a faculty mentor and a resident mentor/partner and build skills in study design, literature search, data accumulation, and synthesis. hey will share authorship of finished research projects with team members (posters, presentations, papers).