Neurology and Rehabilitation Medicine Clerkship

Neurology and Rehabilitation Medicine is a six-week clerkship that includes inpatient and ambulatory experiences as well as a week working in an inpatient rehabilitation facility. This clerkship fosters students’ abilities to obtain a neurologic history, perform the neurological exam, and deepen their understanding of rehabilitation services.

Neurology and Rehabilitation Clerkship Objectives

At the end of this rotation, the student should be able to do the following:

Medical Knowledge for Practice (MK)

1. Describe the known causes and pathogenesis, epidemiology, risk factors, and the course of commonly encountered conditions in neurology. (MK1) 
2. Describe the normal structure and function of the nervous system. (MK3) 
3. Describe how altered structure and function of the nervous system is exhibited through common neurologic conditions and aging. (MK4) 
4. Describe the scientific principles underlying diagnostic methods, including laboratory and radiologic testing, and treatment approaches (pharmacologic and non-pharmacologic) that may be applied to major neurologic diseases and conditions. (MK5) 
5. Explain how preventive measures, health behaviors and social determinants affect disease, injury and health in individual patients and across populations. (MK7) 
6. Describe the etiology, pathogenesis, and course of commonly encountered conditions seen in a rehabilitation hospital, such as spinal cord injury, traumatic brain injury, and stroke.  (MK3) 
7. Describe common medical complications that affect patients in the rehabilitation setting (e.g., decubitus ulcers, deep venous thrombosis, spasticity, neurogenic bowel and bladder, and autonomic hyperreflexia), and strategies to prevent these complications (MK4) 
8. Describe ways that commonly utilized therapeutic modalities (including speech language pathology, physical therapy, occupational therapy and recreational therapy) can be used to improve the functional status of patients with rehabilitative care needs (MK6)

Patient Care (PC)

1. Obtain a complete and reliable neurologic history appropriate to the age and presentation of the patient. (PC1) 
2. Perform a focused, thorough, and reliable neurologic examination on patients who are alert and cooperative as well as patients with an altered level of consciousness. (PC1) 
3. Assess and describe a patient’s functional status based on the findings of the history and physical exam (PC1) 
4. Recognize abnormal findings on the neurologic examination and localize these findings to the most likely causative site within the nervous system. (PC2)  
5. Formulate a differential diagnosis based on lesion localization, time course, relevant historical features, and interpretation of commonly used laboratory and radiologic test data. (PC2)  
6. Develop an appropriate evaluation and management plan utilizing patient information and preferences, evidence-based medicine and clinical judgment. (PC3) 
7. Work within a neurologic care team to follow patient progress and ensure continuity of care that is safe and effective. (PC6) 
8. Counsel patients and their families on the plan for their neurologic condition and prevention of neurologic disease with evidence based information. (PC5) 
9. Describe the risks, benefits, and procedure of a lumbar puncture. (PC7) 
10. Obtain a complete and thorough history on a patient presenting for admission to an acute rehabilitation medicine unit, with appropriate focus on the patient’s functional status and goals for rehabilitation (PC1) 
11. Work within a multidisciplinary care team to provide care for a patient admitted to an acute rehabilitation hospital in a way that is safe and effective (PC6) 
12. Using input from therapeutic subspecialties including physical therapy, occupational therapy, speech-language pathology and recreational therapy, develop a multidisciplinary management plan for a patient admitted to an acute rehabilitation hospital (PC3) 

Interpersonal and Communication Skills (CS)

1. Demonstrate effective and professional interpersonal and communication skills, including interviewing patients from diverse cultural and socioeconomic backgrounds. (CS2) 
2. Demonstrate sensitivity, honesty, and compassion during difficult conversations with patients regarding their neurologic disease (CS3) 
3. Create clear and organized progress notes which include appropriate information for the review by other health professionals. (CS5) 

Professionalism (PR)

1. Demonstrate honesty, integrity, respect, and compassion in all interactions with patients, peers, faculty, staff, and other health care professionals in all settings. (PR1) 
2. Demonstrate ethical, patient-centered decision-making and respect for the confidentiality of patient information in all settings (i.e., clinical, academic, electronic or web-based).  (PR2) 
3. Demonstrate sensitivity and responsiveness to the personhood of the patient inclusive of culture, race, ethnicity, spirituality, gender, sexual orientation, age, physical characteristics, medical condition, disabilities, socioeconomic status, family-context and other aspects of personal and health beliefs, practices and decisions. (PR3) 
4. Demonstrate accountability for academic and patient care responsibilities, and a commitment to continuous professional development. (PR4) 
5. Demonstrate responsiveness to patient needs that supersedes self-interest. (PR5)  

Personal and Professional Development (PD)

1. Acknowledge personal limitations and mistakes openly and honestly, and critically evaluate mistakes to promote professional development. (PD1) 
2. Demonstrate strategies for analyzing, identifying and improving personal deficiencies in knowledge and skills by setting learning and improvement goals (PD2) 
3. Demonstrate a commitment to personal health and well-being, and recognize and address personal attributes, attitudes, and behaviors that may adversely influence one’s effectiveness as a physician. (PD3) 

Practice-based and Lifelong Learning (PL)

1. Integrate evidence-based information into patient care and clinical decision making (PL3) 
2. Use technology to optimize learning and improve patient care outcomes (PL2) 

Systems-based Learning (SL)

1. Develop quality, cost effective plans for patients with neurologic disease (SL2) 
2. Describe how health and health care disparities can affect neurologic disease (SL4)

Interprofessional Collaboration (IP)

1. Recognize the role of members of a multidisciplinary rehabilitation team and describe when it is appropriate to refer to different healthcare professionals within the team. (IP1) 
2. Work with other health professionals to establish and maintain aclimate of mutual respect, dignity, diversity, ethical integrity, and trust.  (IP2) 
3. Develop management plans collaboratively with interprofessional clinicians from other health related fields (i.e., physiatrists, physical therapy, occupational therapy, speech and language therapists) in providing care for individual patients, families of patients, or groups of patients. (IP4) 

Neurology and Rehabilitation Medicine Clerkship PxDx Log

Procedure	Output or Input
Participate in family counseling session or support group meeting to address rehabilitation needs	I
Participate in physical therapy (Interprofessional Experience)	I
Participate in speech therapy, cognitive therapy, or recreational therapy (Interprofessional Experience)	I
Diagnosis: Participate in the care of patients with the following diagnoses:	Output or Input
Cognitive impairment, acute or chronic. Examples include: dementia, agnosia, altered mental status, aphasia, apraxia, dementia, developmental delay, toxic-metabolic encephalopathy, dyslexia	O,I
Neurologic emergencies.  Examples include: Acute stroke, acute hemorrhage, TIA, acute vision loss, brain death, CNS infection, Gullain-Barre, Encephalopathy, head trauma, increased intracranial pressure, neuromuscular respiratory failure, status epilepticus, spinal cord injury or dysfunction	O,I
Transient neurologic event (examples: seizures, dizziness, vertigo, migraine, sleep disorder, syncope, TIA)	O,I
Sensory dysfunction-hyperesthesia, sensory loss, paresthesia.  Examples include: central causes of sensory disturbances, neuropathy, plexopathy, radiculopathy	O,I
Focal or diffuse motor disturbance, acute or chronic.  Examples include: ataxia, tremor, dystonia, dysarthria, dysphagia, gait impairment, weakness, incontinence	O,I
Pain, acute or chronic. Examples: back pain, facial pain, headache, neck pain, neuropathic pain, thalamic pain	O,I
Exam	Output or Input
Perform a cranial nerve examination on a patient	I,O
Perform a motor examination on a patient, including evaluation of muscle strength and tone	I,O
Perform a full mental status examination on a patient (including evaluation of orientation, language, attention, fund of knowledge and memory)	I,O
Perform a full sensory examination on a patient (including evaluation of vibratory, proprioceptive, temperature and pinprick /sharp-dull sensation)	I,O
Perform a coordination and gait examination on a patient	I,O
Perform a neurologic examination in a patient who is comatose, obtunded or encephalopathic	I
Perform a brief, screening neurologic exam in a patient without acute neurologic symptoms	I,O