SYLLABUS College of Medicine AY 2015-2016 Course title and number Term (e.g., Fall 200X) Meeting times and location IMED 875-00T Neurology Offered year round except June Contact resident on the General or Stroke Neurology service one week Course Description and Prerequisites The faculty will strive to: 1. Teach the principles and skills underlying the recognition and management of neurologic diseases that a general practitioner is most likely to encounter in practice. Instructor Information Elective Director Jeffrey Clark, D.O. Name 254-724-2776 Telephone number jclark@sw.org Email address By appointment Office hours Clinic, 5th Floor - 554 Office location Coordinator Shelley Keas Name 254-724-5272 Telephone number smkeas@sw.org Email address By appointment Office hours Clinic, 5th Floor - 557 Office location Learning Outcomes & Objectives COM Competency Based Learning Objectives: http://medicine.tamhsc.edu/academicaffairs/curriculum/objectives/ Principles and Guidelines for Curriculum Development: http://medicine.tamhsc.edu/policies/pdf/curriculum-principles-guidelines.pdf Course Objective: 1. Obtain an accurate history and physical. Date Created/Revised: _____ By: _____ COM Competency Based Learning Objectives (CBLO): PC1: Obtain both complete and system-focused medical histories that include psychosocial and behavioral determinants of health Taught (T) and/or Evaluated (E): Evaluation: Taught AND Evaluated Clinical Performance Rating/Checklist 2. Perform a complete and reliable neurologic examination. 3. Deliver a clear, concise and thorough oral presentation of a patient’s history and examination. Date Created/Revised: _____ By: _____ ICS1: Demonstrate effective listening skills ICS2: Discuss diagnostic and treatment options in a manner comprehensible to the patient ICS5: Maintain accurate medical records PC1: Obtain both complete and system-focused medical histories that include psychosocial and behavioral determinants of health PC2: Perform both complete and systemfocused physical examinations ICS1: Demonstrate effective listening skills ICS2: Discuss diagnostic and treatment options in a manner comprehensible to the patient ICS5: Maintain accurate medical records ICS2: Discuss diagnostic and treatment options in a manner comprehensible to the patient ICS3: Communicate effectively with patients, patients' family members, peers, and other members of the health care team PC3: Develop appropriate differential diagnoses by Taught AND Evaluated Clinical Performance Rating/Checklist Taught AND Evaluated Clinical Performance Rating/Checklist Clinical Performance Rating/Checklist Taught AND Evaluated Clinical Performance Rating/Checklist Taught AND Evaluated Clinical Performance Rating/Checklist Taught AND Evaluated Clinical Performance Rating/Checklist Taught AND Evaluated Taught AND Evaluated Clinical Performance Rating/Checklist Clinical Performance Rating/Checklist Taught AND Evaluated Clinical Performance Rating/Checklist Taught AND Evaluated Clinical Performance Rating/Checklist Taught AND Evaluated Clinical Performance Rating/Checklist Taught AND Evaluated 4. Prepare a clear, concise and thorough written presentation of a patient’s history and examination. 5. (Ideally) perform a lumbar puncture. 6. Have the ability to recognize symptoms that may signify neurologic disease, including disturbances of consciousness, cognition, language, vision, hearing, equilibrium, motor function, somatic sensation, and autonomic function Date Created/Revised: _____ By: _____ integrating collected clinical information PC4: Develop contextual and individualized diagnostic and treatment plans based upon collected clinical information PC4: Develop contextual and individualized diagnostic and treatment plans based upon collected clinical information PC5: Interpret the results of commonly used laboratory and radiologic studies ICS2: Discuss diagnostic and treatment options in a manner comprehensible to the patient ICS5: Maintain accurate medical records PC9: Perform technical procedures including: venipuncture and arterial puncture; insertion of intravenous, central venous, and urethral catheters; insertion of a nasogastric tube; lumbar puncture; basic suturing; and basic airway management MK1: Demonstrate knowledge of normal human structure and function at the organ-system, tissue, cellular and molecular Taught AND Evaluated Clinical Performance Rating/Checklist Taught AND Evaluated Clinical Performance Rating/Checklist Taught AND Evaluated Clinical Performance Rating/Checklist Taught AND Evaluated Clinical Performance Rating/Checklist Clinical Performance Rating/Checklist Taught AND Evaluated Clinical Performance Rating/Checklist Taught AND Evaluated Clinical Performance Rating/Checklist Taught AND Evaluated 7. Have the ability to localize the likely site or sites in the nervous system where a lesion could produce a patient’s symptoms and signs. Date Created/Revised: _____ By: _____ level; and of the interaction of human systems in maintaining homeostasis MK2: Describe the basic mechanisms involved in the causation of human disease and their influence on clinical presentation and therapy MK3: Demonstrate an understanding of how healthy lifestyles, psychosocial factors, and behavioral factors influence heath MK4: Apply evidenced-based methods to clinical problem solving MK5: Demonstrate an understanding of the epidemiology of common diseases within a population and the approaches which are useful in reducing their incidence and prevalence PC6: Recognize common immediately lifethreatening conditions and initiate therapy MK1: Demonstrate knowledge of normal human structure and function at the organ-system, tissue, cellular and molecular level; and of the interaction of Taught AND Evaluated Clinical Performance Rating/Checklist Taught AND Evaluated Clinical Performance Rating/Checklist Taught AND Evaluated Clinical Performance Rating/Checklist Taught AND Evaluated Clinical Performance Rating/Checklist Taught AND Evaluated Clinical Performance Rating/Checklist Taught AND Evaluated Clinical Performance Rating/Checklist 8. An awareness of how to use and interpret common tests used in diagnosing neurologic disease. Date Created/Revised: _____ By: _____ human systems in maintaining homeostasis MK2: Describe the basic mechanisms involved in the causation of human disease and their influence on clinical presentation and therapy MK3: Demonstrate an understanding of how healthy lifestyles, psychosocial factors, and behavioral factors influence heath MK4: Apply evidenced-based methods to clinical problem solving MK5: Demonstrate an understanding of the epidemiology of common diseases within a population and the approaches which are useful in reducing their incidence and prevalence PC9: Perform technical procedures including: venipuncture and arterial puncture; insertion of intravenous, central venous, and urethral catheters; insertion of a nasogastric tube; lumbar puncture; basic suturing; and basic airway management Taught AND Evaluated Clinical Performance Rating/Checklist Taught AND Evaluated Clinical Performance Rating/Checklist Taught AND Evaluated Clinical Performance Rating/Checklist Taught AND Evaluated Clinical Performance Rating/Checklist Taught AND Evaluated Clinical Performance Rating/Checklist 9. An awareness of the principles underlying a systemic approach to the management of common neurologic diseases, including the recognition and management of situations that are potential emergencies. Click here to enter text. Click here to enter text. Click here to enter text. Click here to enter text. Date Created/Revised: _____ By: _____ PC5: Interpret the results of commonly used laboratory and radiologic studies PC1: Obtain both complete and system-focused medical histories that include psychosocial and behavioral determinants of health PC2: Perform both complete and systemfocused physical examinations PC3: Develop appropriate differential diagnoses by integrating collected clinical information PC4: Develop contextual and individualized diagnostic and treatment plans based upon collected clinical information PC5: Interpret the results of commonly used laboratory and radiologic studies PC6: Recognize common immediately lifethreatening conditions and initiate therapy PC8: Demonstrate an understanding of the principles involved in the care of patients across the spectrum of the human life cycle PC9: Perform technical procedures including: venipuncture and Taught AND Evaluated Clinical Performance Rating/Checklist Taught AND Evaluated Clinical Performance Rating/Checklist Taught AND Evaluated Clinical Performance Rating/Checklist Taught AND Evaluated Clinical Performance Rating/Checklist Taught AND Evaluated Clinical Performance Rating/Checklist Taught AND Evaluated Clinical Performance Rating/Checklist Taught AND Evaluated Clinical Performance Rating/Checklist Taught AND Evaluated Clinical Performance Rating/Checklist Taught AND Evaluated Clinical Performance Rating/Checklist arterial puncture; insertion of intravenous, central venous, and urethral catheters; insertion of a nasogastric tube; lumbar puncture; basic suturing; and basic airway management PC14: Properly utilize clinical, laboratory, radiologic, and pathologic examinations to diagnose and treat common maladies Click here to enter text. Taught AND Evaluated Clinical Performance Rating/Checklist Textbook and/or Resource Material 1. 2. 3. 4. Neurologic texts and manuals Files with landmark, interesting historical articles. Neurology journals. Video tapes on Neurologic Exam, Speech and Language Disorders, Coma, Movement Disorders, Epilepsy. 5. Web sites. Grading Policies GRADING SCALE Satisfactory 70-100 Unsatisfactory 69 and below Should the course director determine remediation is required, the remediation plan will be at the discretion of the course director and on a case by case basis depending on the issues involved. Remediation plans could entail some (or all) of the following examples: Additional clinical shifts, research papers, presentations, article reviews, exams, directed reading, web-based modules, etc. If the student performance results in a failure of the elective, it will be recommended that the elective be taken again in its entirety. 1. Attendance and Make-up Policies The Department of Internal Medicine adheres to attendance policies and duty hours as set forth in the College of Medicine Student Handbook, http://student-rules.tamu.edu/rule07 In the case of personal illness, critical illness within your immediate family, family death, or other circumstances where you will Date Created/Revised: _____ By: _____ not be able to participate in required activities, you must contact the Internal Medicine Medical Education Coordinator and contact the attending Faculty. Students who miss more than 20% of a 4 th year elective for any reason (2 weekdays during a two-week rotation or 4 weekdays during a 4-week rotation), will require a remediation plan. The Course Director will consider student attendance and remediation if the student is requesting extended time off during interview season. Course Topics, Calendar of Activities, Major Assignment Dates Responsibilities and Expectation of Students Students will follow an assigned schedule by attending. Students are expected to be present for the various elective activities that will be noted by your residents and staff. Attendance is expected at the various clinical activities including morning ward rounds, operating room when assigned, afternoon rounds, conferences, and any activity specifically requested by your attending. Students are expected to be punctual for all of the various activities noted on the weekly schedule. Failure to adhere to the schedule will result in undue delays and inconveniences to patients, students and faculty. Dress Code: It is expected that students carry themselves in professional manner; this includes appropriate clothing while engaged in patient care. If you are to be in clinic with your staff physician or resident, please dress accordingly. If you are in the operating room or on the ETS service, scrubs are acceptable. IX. Learning Materials and Activities 1. Students will be assigned a schedule which will include inpatient and outpatient rotations. In addition, rotations on neurosurgery, neuroradiology and pediatric neurology will be offered based on availability and staffing. 2. The Neurology Clerkship functions from 6:00 am -5:00 pm, Monday through Friday. Work schedules depend on Staff. 3. Please be at the 5-A Brindley Circles (East) by 6 am on your first day, or (preferably) come during the day the week before to obtain orientation materials, a book, and your schedule. 4. If you must be absent, please email Shelley Keas before 8:00 am on the day of your absence (Monday-Friday), please do not call unless entirely necessary. Unexcused absences will result in a grade of incomplete, and the lost time must be made up on the inpatient wards or in the outpatient clinics, day for day. Extended illnesses require explanation in a note from your family physician and should include the nature of your illness and date we can expect you to return to work. Content of subjects to be taught The neurologic examination (as an integral component of the general medical examination): 1. How to perform a complete neurologic examination. 2. How to perform a screening neurologic examination. 3. How to recognize and interpret abnormal findings on the neurologic examination. Localization – general principles differentiating lesions at the following levels: Date Created/Revised: _____ By: _____ 1. 2. 3. 4. 5. 6. Cerebral hemisphere Posterior fossa Spinal cord Nerve root/plexus Peripheral nerve (mononeuropathy, polyneuropathy, and mononeuropathy multiples). Neuromuscular junction, Muscle Disease Management – general principles governing (urgent and non-urgent) evaluation and management of: 1. 2. 3. 4. 5. 6. 7. 8. 9. 10. 11. 12. 13. 14. 15. Acute mental status changes. Strokes Seizures Chronic Mental status changes Headache and facial pain Low back pain Neck pain Peripheral neuropathies (especially subacute toxic and metabolic neuropathies and GuillainnBarre syndrome). Cranial neurophathies (notably Bell’s palsy, third nerve palsy Common movement disorders (notably Parkinson disease, essential tremor, tardive dyskinesia) Meningitis and encephalitis Multiple sclerosis Myasthenia gravis Polymyositis Primary and metastatic CNS tumors Americans with Disabilities Act (ADA) The Americans with Disabilities Act (ADA) is a federal anti-discrimination statute that provides comprehensive civil rights protection for persons with disabilities. Among other things, this legislation requires that all students with disabilities be guaranteed a learning environment that provides for reasonable accommodation of their disabilities. If you believe you have a disability requiring an accommodation, please contact Disability Services, in Cain Hall, Room B118, or call 845-1637. For additional information visit http://disability.tamu.edu Any student with a disability who needs accommodation should inform the instructor at the beginning of the course. Academic Integrity For additional information please visit: http://aggiehonor.tamu.edu “An Aggie does not lie, cheat, or steal, or tolerate those who do.” College of Medicine Professionalism and integrity Statement (Academic Honesty and Plagiarism) All College of Medicine students are required to comply with the student code of conduct and the academic integrity and honesty standards published in each component’s Student Handbook. Disciplinary action will be taken in accordance with the policies of each component. Students found guilty of Academic Dishonesty will receive an “F”/Unsatisfactory in the course. For a full list of actions qualifying as academic dishonesty, please review the College of Medicine Student Handbook at http://medicine.tamhsc.edu/student-affairs/docs/handbook.pdf. Date Created/Revised: _____ By: _____ According to the Aggie Honor System Office, plagiarism is defined as the appropriation of another person's ideas, processes, results, or words without giving appropriate credit. Intentionally, knowingly, or carelessly presenting the work of another as one’s own (i.e., without crediting the author or creator). Plagiarism and other academic misconduct definitions can be viewed on the Aggie Honor System Office website; http://aggiehonor.tamu.edu/RulesAndProcedures/HonorSystemRules.aspx#definitions. E-mail Access and FERPA The College of Medicine is communicating all official information to students through the students’ TAMHSC e-mail accounts. Please check the account frequently during the semester for updates. This course is supported with web-based and/or e-mail activities. In order to take advantage of these additional resources and participate fully in the course, you have been assigned an e-mail address by the Texas A&M Health Science Center. This e-mail address is for internal use only, so that faculty may communicate with you and the entire class. By registering for this course, you are agreeing to allow your classmates to have access to this e-mail address. Should you have any questions, please contact the TAMU’s Office of the Registrar at 979-845-1031. The Family Educational Rights and Privacy Act of 1974 (FERPA), which the HSC complies fully, is intended to protect the privacy of education records, to establish the rights of students to inspect and review their education records and to provide guidelines for the correction of inaccurate or misleading data through informal and formal hearings. Students also have the right to file complaints with the Family Educational Rights and Privacy Act Office of the Department of Education in Washington, D.C., concerning alleged failures by the HSC to comply with the act. Mistreatment of Students The College of Medicine is committed to providing a positive learning environment in which students can meet their academic goals based on mutual respect in the teacher/learner relationship. Both parties must be sensitive to the needs of others and differences in gender, race, sexual orientation, religion, age or disability. As outlined in the Student Handbook under the section titled Standards of Conduct in the Teacher-Learner Relationship, belittlement, intimidation and humiliation are unacceptable for effective learning and undermine self-esteem. Breaches involving student mistreatment may result in a faculty or staff member being sanctioned or the loss of faculty and/or staff appointment. These policies address student mistreatment involving College of Medicine employees, residents, affiliate staff, or patients. Mistreatment may be reported through the College of Medicine telephone hotline, 1(855)-397-9835 or through an online form at http://medicine.tamhsc.edu/current/student-mistreatment-form.html. For a full list of reporting avenues, please refer to the Student Handbook under the Mistreatment Policy. Exposure and Occupational Hazard The Needle Stick Policy and Bloodborne Pathogen Exposure information for Medical Students may be accessed in the Student Handbook at: http://medicine.tamhsc.edu/student-affairs/docs/handbook.pdf Note: More information is available on the aforementioned topics to all students on the College of Medicine website. Date Created/Revised: _____ By: _____ Date Created/Revised: _____ By: _____