Neurology Clerkship Clinical Evaluation
Students will be assigned a Clinical Grade for their performance on the Neurology Clerkship towards the
end of their two week rotation based on the results on their Neurology Clerkship Evaluation. Beginning
in the 2012-2013 academic year, the Neurology Clerkship Evaluation will be done online through New
Innovations. At the end of your two-week rotation, an email will be sent to your attending physicians.
You may be evaluated by more than one attending, depending on the rotation. When this occurs, the final
Clinical Grade will be determined by averaging each of the evaluation scores. Each Neurology Clerkship
Evaluation covers areas in Patient Care, Medical Knowledge, Interpersonal Relationships and
Communication Skills, Practice-Based Learning and Improvement, Systems Based Practice and
Professional Behavior, and uses the following guidelines:
Medical Knowledge
1. Demonstrates adequate understanding of the pathology, pathophysiology, and anatomic
features of neurological diseases.
a. A student who does not meet Basic Expectations for training:
i. Cannot describe factual knowledge regarding common or simple disease
processes
ii. Is unable to recall factual knowledge regarding diseases pertinent to his own
patients
b. To meet Basic Expectations for level of training, students should be able to:
i. Describe the basic clinical features expected for the disease processes of their
patients
ii. Broadly localize what part of the nervous system is affected by the disease
iii. Have a basic understanding of the pathological features of the disease process
c. To exceed Basic Expectations for level of training, students should be able to:
i. Translate the specific features of their patient’s clinical presentation and
neurological deficits to known features of the disease process
ii. Accurately localize what part of the nervous system is affected by the disease
process
iii. Describe how the pathophysiology of the disease causes neurological dysfunction
iv. Describe the neuropathological features of their patient’s disease process
2. Participates regularly in activities that advance knowledge and competence
a. A student who does not meet Basic Expectations for training:
i. Misses conferences and other required didactic activities
ii. Attends but does not engage in required didactic activities (e.g. is otherwise
occupied)
b. To meet Basic Expectations for level of training, students should:
i. Attend and be active participants in all required conferences and didactic lectures
c. To exceed Basic Expectations for level of training, students should:
i. Engage in independent reading and literature evaluation for the disease processes
of their patients
ii. Bring scholarly articles to rounds and discussions about their patients
iii. Take an active role in teaching his/her teammates
iv. Give one or more topic presentations to their rounding teams
Patient Care
1. Takes a pertinent and thorough Neurological History containing information which
provides some degree of neurological localization and allows for an understanding of the
chronology and severity of the disease process.
a. A student who does not meet Basic Expectations for training:
i. Fails to ask basic components of the history, such as the chief complaint, time
course of symptoms, past medical/surgical history, medications, and allergies
ii. Is unable to organize basic data from the History of Present Illness in a coherent
fashion
b. To meet Basic Expectations for level of training, the student’s history should:
i. Contain the patient’s chief complaint and as well as a basic history of present
illness
ii. Include the clinical features of the patient’s neurological deficits
iii. Include the onset and time course of the neurological deficits
iv. Allow for a rough general localization of the disease process within the nervous
system
c. To exceed Basic Expectations for level of training, the student’s history should:
i. Contain a history of present illness that is expansive for the details of the
patient’s neurological symptoms
ii. Include a neurological review of systems that includes both positive and pertinent
negative features
iii. Contain information about the functional disability the patient is experiencing
due to their neurological deficits
iv. Allow for precise localization of the disease process within the nervous system
2. The history contains accurate medication dosages, formulations and drug allergies
a. A student who does not meet Basic Expectations for training:
i. Fails to list medications or does not know the dosages of the patient’s
medications
b. To meet Basic Expectations for level of training, the student’s history should:
i. Include all medications the patient is taking
ii. Include a list of all medications causing prior allergic reactions
c. To exceed Basic Expectations for level of training, the student’s history should:
i. Include a list of all medications and their respective dosages that the patient is
taking including OTC medications
ii. Elucidate any side effects from the current medications that the patient is taking
iii. Include a list of all medications causing prior allergic reactions or adverse
tolerance reactions
3. Is able to demonstrate a thorough Neurological Examination that contains pertinent aspects
from each of the 6 realms of the neurological exam and contains enough detail to localize
the disease process.
a. A student who does not meet Basic Expectations for training:
i. Consistently fails to include pertinent components of the neurological
examination necessary to provide localization and quantification of their patient’s
deficits
ii. Is unable to adequately perform basic components of the neurological
examination (such as examining pupillary function, eliciting DTR’s, evaluating
gait, etc)
b. To meet Basic Expectations for level of training, the student’s Neurological Exam
should:
i. Mention enough details to include at least a screening evaluation for mental
status, cranial nerves, motor , sensory, coordination, and gait (or whatever is
appropriate for their patient)
ii. Be able to properly demonstrate neurological deficits in their patients
iii. Allow the student to generally localize neurological deficits
c. To exceed Basic Expectations for level of training, the student’s Neurological Exam
should:
i. Include a basic screening neurological examination covering mental status,
cranial nerves, motor, coordination, sensory and gait (or whatever is appropriate
for their patient)
ii. Allow the student to accurately localize neurological deficits
iii. Include as well an expanded neurological exam that quantifies the severity of the
deficits
4. Generates a pertinent Differential Diagnosis that takes into account disease localization and
prioritizes the most likely diagnosis
a. A student who does not meet Basic Expectations for training:
i. Is unable to formulate a potential list of plausible diagnoses for simple
complaints
ii. Is unable to use discriminating features of the disease process (e.g. acute vs.
chronic) to determine likely disease processes
b. To meet Basic Expectations for level of training, the student’s Differential Diagnosis
should:
i. List neurological disorders that occur within the broad localized region of the
nervous system where their patient’s neurological deficits exist
ii. Include the most likely disease processes based on the history and physical
examination findings
c. To exceed Basic Expectations for level of training, the student’s Differential Diagnosis
should:
i. Apply localization based on both the neurological examination and on historical
features of the disease process
ii. Take into account the onset and time course and severity of the disease process
iii. Take into account the patient’s past medical, surgical and medication use
histories
iv. Prioritize common disorders which are most likely to cause the patient’s disease
process as well as those disorders considered to be neurological emergencies
5. Develops an appropriate Diagnostic Plan specific to the unique aspects and needs of their
patients
a. A student who does not meet Basic Expectations for training:
i. Is unable to explain the rationale for tests that are ordered
ii. Orders a long list of tests that are not pertinent to the differential diagnosis or
management of the patient’s illness
b. To meet Basic Expectations for level of training, the Diagnostic Plan should include
investigations that:
i. Pertain to those diagnoses entertained within their Differential Diagnosis
ii. Are justifiable with results that will alter the diagnosis or management of the
disease process and not be obtained “just to get a baseline”
iii. The results of which can be interpreted correctly by the student as they pertain to
their patient
c. To exceed Basic Expectations for level of training, the Diagnostic Plan should include
investigations that:
i. Pertain to the most likely diagnoses within their Differential Diagnosis
ii. The student is able to connect to the pathophysiology of the disease process
iii. Are justified by the patient’s clinical presentation and do not include superfluous
investigations that are likely to be normal or not directly affect patient care
6. Develops an appropriate Treatment Plan specific to their patient’s illness
a. A student who does not meet Basic Expectations for training:
i. Fails to develop a basic plan for treatment based on the patient’s condition
ii. Does not understand the rationale for their patients’ treatment plans
b. To meet Basic Expectations for level of training, the Treatment Plan should:
i. Positively affect the outcome of the patient’s disease process
ii. Include interventions that are cost effective for the patient
iii. Be understood by the student as to the expected benefits and risks associated with
the treatment
c. To exceed Basic Expectations for level of training, the Treatment Plan should:
i. Be understood by the student and justified by available literature or standard of
care arguments
ii. Include alternative options for treatment that can be weighed against one another
with regards to cost, benefits and risks
iii. Include appropriate monitoring and follow up for the patient to assess risks and
benefits
7. Provides effective care with respect to the patient’s psychosocial level of functioning and
their cultural beliefs
a. A student who does not meet Basic Expectations for training:
i. Is insensitive to or does not accept the cultures or backgrounds of patients
ii. Fails to consider a patient’s cultural beliefs when providing care
b. To meet Basic Expectations for level of training, Care Plans should:
i. Include treatment options that individuals will most likely be able to comply with
based on cultural or religious beliefs
ii. Be sensitive to the patient’s culture, sexual orientation and religious belief system
c. To exceed Basic Expectations for level of training, Care Plans should:
i. Include treatment options that consider medical compliance (eg. frequency of
treatments, need for follow up, etc) as well as the patient’s ability to pay for the
prescribed treatments
ii. Be explained to the patient in a way that is commensurate with the patient’s level
of medical sophistication and understanding
iii. Allow patients to question the treatment plan and provide answers to those
questions
Interpersonal Relationships and Communication
1. Clearly and accurately presents patients findings to team members
a. A student who does not meet Basic Expectations for training:
i. Is frequently unaware of pertinent aspects of their patients’ diagnostic workup
ii. Is frequently unaware of their patient’s current clinical status
b. To meet Basic Expectations for level of training, students should:
i. Have a thorough understanding of their patients’ current clinical status
ii. Be able to provide the results of all diagnostic testing obtained on their patients to
the treating team
iii. Be able to provide details of their patients’ neurological examinations
c. To exceed Basic Expectations for level of training, students should:
i. Be organized in presenting patient findings, pointing out pertinent abnormal and
normal results from diagnostic evaluations
ii. Present their patients’ neurological examination and deficits in a systemic and
quantitative fashion
2. Maintains clear, complete, accurate, timely and legible medical records
a. A student who does not meet Basic Expectations for training:
i. Does not complete daily notes within the time frame set forth by expectations
ii. Does not address the patient’s primary problem on the medical record
iii. Does not follow the expected order of providing information on the medical
record (e.g. SOAP note, etc)
iv. Provides inaccurate details of their patient’s clinical findings or diagnostic
workup.
v. Provides inaccurate information concerning their patient’s care (diagnostic
studies, vitals, examination findings, medications and dosages) on the medical
record
b. To meet Basic Expectations for level of training, student progress notes should:
i. Contain a daily general and neurological examination on each patient being
followed
ii. Contain the results of diagnostic evaluations and current medications
iii. Consist of legible writing
c. To exceed Basic Expectations for level of training, student progress notes should:
i. Accurately define and quantify neurological deficits found in their patients
ii. List and interpret results of diagnostic evaluations for their patients
iii. Suggest treatment plans and further diagnostic evaluations for their patients
3. Shows empathy and respect to patients and their families
a. A student who does not meet Basic Expectations for training:
i. Demonstrates insensitivity or rudeness when speaking to a patient or a family
ii. Openly shows bias or prejudice against a patient or family
iii. Ignores or minimizes a patient’s or family’s concerns
b. To meet Basic Expectations for level of training, students should:
i. Acknowledge their patients’ concerns regarding their treatment
ii. Demonstrates sensitivity and courtesy when speaking to a patient or family
c. To exceed Basic Expectations for level of training, students should:
i. Directly communicate treatment plans to patients and their families
ii. Be available to directly answer their patients’ questions in an empathetic way
iii. Demonstrate an understanding for the burden that their patients’ disease process
plays in their personal lives and seeks to alleviate that burden
Practice Based Learning and Improvement
1. Uses evidence from practice guidelines and scientific studies to develop appropriate
diagnostic and treatment plans
a. A student who does not meet Basic Expectations for training:
i. Is unable to identify potential sources of information regarding patient care
ii. Is unable to identify gaps in one’s own knowledge in order to guide further
inquiry
b. To meet basic expectations for level of training, students should:
i. Can identify and search potential sources of reliable information (such as “Up to
Date”, “E-Medicine”, “MD Consult” etc.) regarding their patients’ conditions
and treatment plans when directed to do so
ii. Identifies gaps in one’s own knowledge in order to guide further inquiry
c. To exceed basic expectations for level of training, students should:
i. Refer to diagnostic and treatment guidelines contained within practice parameters
or pivotal studies when developing plans of care without being directed to do so
ii. Is able to identify characteristics of studies and guidelines that suggest reliability
or a lack of applicability to their patients
2. Shows an eagerness to learn, identifying their own questions and reviewing the literature
concerning their patients’ illness
a. A student who does not meet Basic Expectations for training:
i. Does not read about their own patient’s conditions
ii. Is not concerned with their own lack of knowledge concerning their patients’
conditions
b. To meet basic expectations for level of training, students should:
i. Read background information (e.g. textbooks or review articles contained within
“MD Consult”, “E-Medicine”, “Up-to –Date”) about their patient’s conditions
ii. Identifies questions that need to be answered before determining a plan of care
c. To exceed basic expectations for level of training, students should:
i. Use their own initiatives including background (e.g. textbook and review articles)
and foreground (e.g. evidence-based literature, pivotal trial articles, and
guidelines) to review the relevant literature concerning their patients’ disease
processes
ii. Develop their own independent questions about the care of their patients to guide
reading and literature searches
iii. Spontaneously share what they have discovered during rounds or clinic patient
presentations