Spring 2005
The
Post
Newsletter of the AAN Student Interest Group in Neurology Program
Greetings from the AAN
It was good to meet so many of you at the AAN
Annual Meeting in Miami Beach! Now that we’re
back in the office, it’s time to start planning the
2006 Annual Meeting in San Diego, April 1-8,
2006. Mark your calendars!
If you would like to ask other chapters’ advice or
have suggestions for them, please send it to me and
I will insert it into the next newsletter. Remember
to keep me updated on officer and faculty
advisor name and email changes, and submit
your expense reimbursements and your end-ofyear report. I’ve attached the end-of-year report
form to the email with this newsletter. Reports are
due by August 31, 2005.
Gloria Barnard
AAN Staff Liaison to SIGN
Phone 651-695-2733
Fax 651-361-4833
Email Gbarnard@aan.com
AAN 2005 Annual Meeting
SIGN Meeting Recap
The April 11 SIGN meeting was a huge success
with a record 100 attendees. There was a panel
of neurologists from academia, private practice
and research to give their perspectives and answer
questions, followed by a brief report by each
SIGN chapter representative on something their
chapter accomplished this year. A reception
followed the meeting.
Chapter representatives shared a wide range of
activities their chapters participated in this year,
including the most popular subspecialty lunch
seminars, Career Day/Freshman Orientation Day,
Brain Awareness Week activities, mentor/
shadowing programs, resident panels on the Match
and resident life, charity walks, working with their
CO-SIGN chapter, and visiting private practice
neurologists.
Some new activities this year were a book drive for
India, lobbying for mandatory third year neurology
clerkship at their school, a session with a
neuropathologist learning brain sectioning, faculty
reception, partnering with other interest groups,
such as the Psychiatry Interest Group, and getting
involved in the ANA’s Neuroscience Pathway.
SIGN chapter members continue to create new and
interesting ways to share their interest in
neurology. Bravo to all of you!
SIGN Annual Meeting
Scholarship Winners
The winners of the 2005 $1,000 SIGN Medical
Student Scholarship to the Annual Meeting are:
First Name
Julia Toub
Debra Green
Mariam Garuba
Laura Tormoehlen
Marc Lazzaro
Lisa Philipose
Margaret Fonder
Marina Novikova
Mark Robert Keezer
Nojan Valadi
Anil Yallapragada
Jacqueline Leis
Raissa Villanueva
Kristi Mahaffey Nord
Rikki Racela
Institution
Albany Medical College
Columbia College
Creighton University
Indiana University
Indiana University
Johns Hopkins
Johns Hopkins
LECOM-Bradenton
McGill University
Medical College of Georgia
Medical Univ of So Carolina
New Jersey Medical School
New York Medical College
Penn State
Robert Wood Johnson
2
The SIGNPost – Spring 2005
Joel Mack
Ani Aydin
Valeriya S. Poukas
Katie Wiltshire
Bryan Riggeal
Aaron Boes
Brittany Andriot
Thuy An Hoang
Michelle Stalnaker
Jenelle Ferry
Jodi Warman Chardon
Stephanie Merhar
Adib Abla
Kavita Kadiwar
John Ross Scherer
David Pritchard
M. Zelime Ward
Holly Hinson
Brandon Foreman
Robert Riley
Courtney Schadt
Liya Beyderman
Emmanuel Botzolakis
Larry Charleston IV
SUNY Buffalo
SUNY Stony Brook
Temple University
University of Alberta
University of Florida
University of Iowa
University of Louisville
University of Minnesota
University of North Carolina
University of Oklahoma
University of Ottawa
University of Pennsylvania
University of Pittsburgh
University of Rochester
University of Rochester
University of Tennessee
University of Texas
University of Texas San Antonio
University of Texas SW
University of Virginia
Vanderbilt University
Vanderbilt University
Vanderbilt University
Wayne State University
Thank you to all who applied for the award.
SIGN Summer Research
Scholarship Winners
The winners of the 2005 $3,000 SIGN Medical
Student Summer Research Scholarship are as
follows:
Name
Christie E. Tung
Jennifer Rebecca Reavis
Le H. Hua
Mark Robert Keezer
Kamal Shemisa
Jonathan Law
Kelly Sweerus
Amelia Ciofani
Irim Salik
Steven Schendel
James Saunders
Joyce Ma
Jonathan Hemmert
Laura Owens
Bradley D. Raetzke
Christian Andres Rosado
Jacob Jentzer
Alissa Jade Wright
Dustin Anderson
Andrew Reinink
Institution
Case School of Medicine
Duke University
Keck School of USC
McGill University
Northeastern Ohio
Ohio State
Oregon H&S University
St. Michael's Hospital
SUNY Stony Brook
University of Alberta
Univ of British Columbia
University of California
University of Chicago
University of Cincinnati
University of Cincinnati
University of Florida
University of Rochester
University of Toronto
University of Utah
Washington University
The quality of the research projects submitted was
excellent this year. All SIGN members are
encouraged to explore research by applying for the
next Summer Research Scholarship.
What to Expect from Your
Neurology Clerkship
From the AAN website
http://www.aan.com/students/medical/training.cfm
In most medical schools, students learn about the
anatomy, physiology, pharmacology, and
pathology of the nervous system during the
preclinical portion of the curriculum, and they
learn about the treatment of patients with
neurological diseases during the clinical portion.
The specific organization varies from school to
school. Some schools cover neuroanatomy in a
general anatomy course, neurophysiology in a
general physiology course, and so forth, whereas
many schools have a neuroscience course or
sequence that covers all these topics. Most
schools have a required neurology clerkship in the
third or fourth year, but in some schools neurology
is an elective. Most neurology clerkships last four
weeks, but some last two or three weeks, and a few
last longer than four weeks. In some schools,
clinical training in neurology is combined with
training in one or more related clinical specialties,
e.g., psychiatry, neurosurgery, in a longer
clerkship. In some schools, the pre-clinical
neuroscience curriculum and clinical neurology
clerkship are organized and taught by the same
people; in other schools, they are independent of
each other.
Regardless of your ultimate career path, you are
likely to encounter patients with neurological
problems frequently, and you will need to know at
least some basic principles of evaluation and
management, if for no other reason than to
recognize true emergencies. For many of you,
your neurology clerkship will be your only
sustained experience taking care of patients with
neurological problems. In any case, it will be your
first such experience. Here are some tips for
making the most of the clerkship:
1. Review Neuroscience
You may feel like you forgot all the
neuroscience you learned as soon as you took
3
The SIGNPost – Spring 2005
the final exam, but you would be surprised by
how quickly you can relearn it, especially the
main points. And those points do come up
regularly in patient care. The first step in
diagnosing neurological disease is localization
(see number 3 below), and for this you must
remember at least a few major nervous system
pathways and where they run. Treatment
decisions obviously require some
understanding of neurophysiology and
pharmacology. Review these topics before the
clerkship if you can, and certainly review the
topics that are relevant to any patient you see.
2. Learn the Neurology Exam
Many students (and many physicians) are
intimidated by the neurology exam. It is not
that tough. As with other parts of the physical
exam, the trick is to develop a systematic
approach that you can follow almost without
thinking, and this takes practice. The
neurology clerkship is the ideal time to get this
practice, because you will be seeing lots of
patients with abnormal exams (making it easier
for you to get a sense of what you are looking
for when you check the plantar response, for
example) and you will be working with
neurologists, who do the exam for a living and
can provide you with feedback on your
technique and your findings. Your principal
goal during the clerkship should be to learn to
do a reliable screening exam. Your secondary
goal should be to learn how to supplement the
exam with additional tests when a patient’s
history or screening exam warrants it. You
may wish to consult some of the books
available on this topic.
3. Learn to Localize
With all medical problems, the first step in
diagnosis is determining where the problem is.
This can be especially tricky with neurological
symptoms, because nervous system pathways
can run literally from head to toe. The tests
you order (and the treatment you offer) will be
very different depending on whether you think
a patient’s foot drop is caused by a brain tumor
or peroneal compression at the knee, for
example. For this reason, neurologists make a
big deal of neuroanatomical localization.
Whenever you present a patient on the
neurology service, you should be prepared to
answer the question, “Where’s the lesion?”
Localization is often difficult for medical
students, and you should be sure to ask your
instructors for help if you’re having trouble.
You may also wish to consult textbooks that
cover this topic.
4. Imagine You Were First on the Scene
Each time you begin a new clerkship, you face
the daunting task of learning a new system,
with new people, new procedures, new forms,
and new expectations. You must learn your
role in the team, and do your part to facilitate
efficient patient care. It is important to focus
on these issues, but do not forget your primary
learning objectives. With each patient you
see, you should be sure to ask the patient (or
informant) how the symptoms started, and then
ask yourself, “What would I have done if I had
seen the patient at that point? Would I have
realized the patient had a neurologic problem?
What tests would I have ordered? What
treatment would I have started?”
These are the questions most relevant to your
future practice. Unless you become a
neurologist yourself, it is far less important for
you to know how to treat a patient with
refractory epilepsy than it is for you to know
how to recognize seizures in the first place.
You will probably never be responsible for
treating brain tumors, but you are very likely
to encounter patients with headaches, and you
need to know how to distinguish benign
headaches from those caused by structural
disease.
Ironically, many of the patients you see during
your neurology clerkship will be far beyond
the point of initial presentation. In most cases,
by the time patients see a neurologist they have
already been evaluated by one or more primary
physicians who have already determined that
there appears to be a neurological problem. In
some cases, you will be seeing patients whose
diagnosis was determined long ago, for routine
follow-up or for an acute management issue.
For such patients, you must balance two
objectives. On one hand, you want to do your
part to help your team deliver efficient patient
care. From this standpoint, questions about
4
The SIGNPost – Spring 2005
the patient’s initial presentation and
management may be irrelevant and timeconsuming. On the other hand, you must
remember to ask yourself such questions at
some point, and if you don’t know the
answers, then you should ask your instructors
(at an appropriate time, which may have to be
after the interaction with the patient is
complete).
5. Read, Read, Read
This advice applies to all of your clinical
clerkships. Patient care is absorbing and timeconsuming, and it is easy to become so caught
up in it that you neglect to read. Indeed, time
constraints may prevent you from ever having
a block of several hours at a time to read a
book in the usual way. Instead, you may do
much of your reading "on the fly." You should
generally carry at least one textbook with you
at all times, for use during those 15-minute
"down periods" that occur unpredictably
throughout the day. A variety of textbooks are
available. Most clerkships provide a list of
required or recommended books. You should
be sure to read about the topics relevant to the
patients you are following. Of course, you
will not have the opportunity to see patients
with every possible neurological problem; over
the course of the clerkship you will also need
to learn about the entire spectrum of clinical
neurology. An outline of the topics to cover is
included in the document, “Neurology
Clerkship Core Curriculum Guidelines,” which
has been adopted nationally.
In addition to an introductory neurology clerkship,
many schools offer the opportunity to elect
specialized or advanced training in neurology,
usually during the fourth year. Examples include
rotations on inpatient, consultation, or outpatient
neurology services (often similar to the
introductory clerkship, but with greater
responsibilities and expectations for the student);
rotations with a specialty service, e.g., a rotation
with a neuromuscular service that includes time in
the outpatient clinic, the EMG lab, and the
consultation service; clinical research; or
laboratory research. In addition to the
opportunities available in your own institution, you
may wish to explore the possibility of doing an
elective at another medical school.
Interview with a Neurology
Resident
By: S. Andrew Josephson, MD
Dr. Ken Nakamura, MD, PhD, is currently a senior
resident (R4) at the University of California San
Francisco. Dr. Nakamura graduated from Cornell
undergrad with a B.A. in Chemistry and Biological
Sciences before completing an MD, PhD in
Neurobiology at the University of Chicago.
What made you first interested in neurology as
a career and what experiences during medical
school led you to the field of neurology?
My interest in neurology began when I was a first
year medical student, during a neurology
preceptorship with Dr. Jean-Paul Spire at the
University of Chicago. I loved the analytical
process of diagnosing neurologic disease, and
became fascinated at the complexity of the brain
and its pathologies. It also became clear to me that,
contrary to my initial impressions, neurologists are
able to make significant contributions to the
quality of life of many of their patients.
My interest in neurologic disease continued to
grow during my dissertation work with Dr. Un
Kang. During this period, I became particularly
intrigued with understanding the etiology of
neurodegeneration in Parkinson’s disease. By
attending a number of clinics, I also realized that I
enjoyed treating patients with Parkinson’s disease
and other movement disorders.
What factors did you consider when looking for
a neurology residency?
I looked for an institution with faculty who were
both leaders in their fields and committed to
providing outstanding clinical training. I also felt it
was important that the program have an
established track record of promoting careers in
academic medicine. Finding a location where I
would be happy and comfortable also factored into
my decision. I was fortunate to find all of these
things at UCSF.
5
The SIGNPost – Spring 2005
Have you enjoyed your residency and how do
you find the time to juggle research and clinical
duties?
Residency has been an amazing period of learning
and development as a physician. Faculty treat us
well, and education is a high priority. Further, the
residents are both multi-talented and diverse,
which always keeps life exciting!
I have enjoyed participating in some clinical and
basic research during my residency. Of course, this
is challenging given our clinical obligations. I have
tried to be efficient and to involve myself in
focused investigations.
What type of career in neurology do you
envision and what are your subspecialty
interests?
I hope to become an academic neurologist
specializing in movement disorders. My goal is to
see patients with movement disorders clinically,
and to participate in basic research directed at
understanding the pathogenesis of Parkinson’s
disease.
What options have you considered for
fellowship and what did you decide upon?
I am interested in a fellowship that combines
clinical training in movement disorders and basic
science research. During my fellowship, I will be
working in Dr. Robert Edwards’ lab, investigating
mechanisms by which alpha-synuclein contributes
to neurodegeneration. I will also be seeing patients
with movement disorders on a weekly basis. I
haven’t considered any other options seriously,
partly because my wife and I are so happy in the
area.
What do you do in your spare time when you
are not working during residency?
I spend time with my wife, friends, and family,
who are scattered across the continent. I also enjoy
a number of sports, particularly karate, soccer, and
skiing. Being Canadian, I’m a huge hockey fan,
although we are in desperate times currently with
the recent professional work stoppage.
Are there individuals in your career whom you
have felt served as a role models?
Both my former advisor Dr. Un Kang and my
future advisor Dr. Robert Edwards. They are ideal
role models for me, balancing excellence in basic
research with their clinical interests in movement
disorders.
From a more general perspective, our program
director Dr. John Engstrom, continues to serve as a
role model of clinical excellence and
professionalism to all UCSF neurology residents.
There are many other individuals here at UCSF
who have contributed to my education, and whom
I have tried to emulate in many ways.
AAN’s Latest Partnership Offers
50% Student Discount on
Epocrates Software
The AAN has partnered with Epocrates, Inc., a
market leader in providing clinical information to
physicians and other healthcare professionals at
the point of care through mobile and web-based
software applications. The new partnership offers
a fifty percent discount to students on all Epocrates
software.
As you may know, the Epocrates® Essentials suite
of products provides up-to-date, easy-to-use,
trusted content that improves patient care and
safety, and results in greater efficiency. The
mobile clinical reference suite features key
decision support applications required for today’s
healthcare professional, including drugs, diseases,
and diagnostics. Essentials includes Epocrates Rx
Pro™—premium drug reference, Epocrates
Dx™—disease reference, and Epocrates Lab™—
lab diagnostic reference. Each of these products is
available separately as well.
All Epocrates products are available for download
as one-year and two-year subscriptions, and all
software is compatible with Pocket PC and Pal OS
handheld devices synchronizing to a Windows PC
or Mac.
The AAN launched the AAN Partners Program in
March 2005, to coordinate with established
companies to offer competitively priced, highquality products and services to meet members’
6
The SIGNPost – Spring 2005
needs. Its first partnership was with Forrest T.
Jones & Company, Inc. to provide a portfolio of
insurance benefits designed exclusively for AAN
members.
While several universities have also partnered with
Epocrates to provide a 50% student discount, AAN
is the first medical specialty society to provide a
discount on Epocrates software for students (50%)
and other members (20%).
This AAN student discount is available only
through the AAN website. For more information
about this and other AAN Partners Programs, and
to register at the AAN student rate, visit
ww.aan.com/professionals/partners.
Interview with a
SIGN Faculty Advisor
By: Jeremy Cholfin, medical student member of
the Undergraduate Education Subcommittee
Cheryl Jay, M.D.
Department of Neurology
University of California, San Francisco
What interests you about neurology? How did
you decide to go into the field?
I started medical school interested in pediatric
hematology—I had majored in biochemistry and
volunteered in a bone marrow transplant unit.
That really shaped my concept of a doctor as
someone who takes care of people who are
complicated and sick. As a second-year student, I
really enjoyed my neuroscience course, which was
run by Eric Kandel, a spectacular teacher.
Neurology was the first major clerkship of third
year. I seemed to have a knack for it and wound
up using those skills the rest of that year, including
the first neurologic diagnosis I ever made on my
own—a postoperative nondominant parietal
infarct. In addition to the fast-moving science and
medical complexities of neurology, I like the
variety of roles and settings: primary provider and
consultant, clinic and inpatient. It’s also
interesting and challenging to work in a field that
has something to add about many of the major
bioethical issues of our time.
What has been your role in your local SIGN
chapter? What other roles do you have at
UCSF?
I am the faculty sponsor for our chapter. I spend
nearly all my time at San Francisco General
Hospital. I run the third-year clerkship neurology
there. It’s a graduation requirement that about a
third of each class completes at the General. I
attend on the inpatient ward and consult services
for several months each year and spend several
half-days in clinic each week, including an AIDS
neurology clinic. I am a coinvestigator on a
randomized clinical trial, nearing completion, of
marijuana for HIV-related neuropathy pain.
How did you get involved with SIGN initially?
Wade Smith, who is the other faculty sponsor,
thought we should resurrect the chapter, which had
become somewhat inactive.
What makes the UCSF chapter of SIGN
unique?
Our chapter has a different name—the Brain
Interest Group (BIG). As the name suggests, it’s
open to students interested in pursuing a career
pretty much anywhere in the neurosciences.
Obviously this means neurology, but we also
welcome students interested in neurosurgery,
psychiatry, physiatry, neuroradiology, etc.
What types of activities has your SIGN chapter
organized? Please describe.
We have monthly meetings with scientists and
clinicians from various neuroscience disciplines.
Some speakers discuss their research, but many
talk about how they got interested in their field,
what the training is like, and why they think it’s
interesting. Many of our speakers have been from
UCSF, but we’ve also had speakers from the
community and other academic institutions. A
common story is that their path was often
somewhat circuitous. I think that’s an important
message for students to hear—that it’s ok not to
know exactly what one wants to do and that people
can and do change their plans along the way.
How often does your chapter meet? How many
students attend your meetings?
We meet monthly during the academic year.
Turnout varies, depending on exam schedules and
other campus events, but ranges from a half-dozen
or so students to over 30. Our average is probably
something like 10-12.
7
The SIGNPost – Spring 2005
How does your SIGN chapter and role as
advisor prepare students for careers in
neurology?
We provide a forum for students to learn about
careers in neurology and related fields, from
people who work in them. Steve Finkbeiner, a
physician-scientist, is our neuroscience liaison and
has helped students interested in research to find a
suitable laboratory or clinical research project.
Other students have been able to set up shadowing
and similar activities with some of our speakers.
And BIG lets students know they are welcome to
contact other faculty, such as Wade and me, if
they’re trying to sort out their career choices.
Anything else you would like to add?
What I get out of BIG is a reminder of how fun, if
daunting, it is to face that question, “Well, what
AM I going to do?” Arguably, physicians delay
that choice, at least in a specific sense, more than
just about any other profession. It also forced me
to learn HTML, so I can maintain our website
(http://missinglink.ucsf.edu/BIG); that’s been a
useful skill for other projects. I think our
multidisciplinary approach has been helpful,
because it helps students explore our field and
related ones, so they can make the best possible
career choices.
Surfing
Surviving Medical School
http://fmignet.aafp.org/x40.xml
San Francisco Matching Program
http://www.sfmatch.org
National Resident Matching Program
http://www.nrmp.org/
Association of American Medical Colleges
http://www.aamc.org/
AAMC Careers in Medicine
http://www.aamc.org/students/cim/
CO-SIGN at Hunter College
Sanskriti Mishra, President
Evert Borgia, Secretary
CO-SIGN, Hunter College
New York City
The initiation of the CO-SIGN Chapter at Hunter
College in Fall 2004 began on a good note. We
gathered many students who showed interest in
becoming a part of the establishment of CO-SIGN
at Hunter. Since that time, we have become
affiliated with SIGN Chapters at Mount Sinai
School of Medicine and SUNY Downstate
Medical Center in New York City, and have
started shadowing programs with them and are
working on setting our students in research labs at
the two institutions. We are also working on our
CO-SIGN and T-Shirts and have offered our
students the opportunity to become members and
enjoy the benefits of the New York Academy of
Sciences.
Our lectures have been the most interesting – we
recently had Dr. Angulo from our Biology
Department tell us about his research regarding
neuroprotection from methamphetamine (an
addictive neurotoxin) and one of our students has
recently started working in his lab. We have also
had Dr. Mellado give us a talk about his work with
Dr. Marie Filbin on spinal cord injury and axonal
regeneration in the adult nervous system. Hunter
College has done pioneering research in this field,
first proposing that MAG (myelin-associated
glycoprotein) is an inhibitor in axonal
regeneration. These types of insight into the
research as well as clinical aspects of neurology
have built our foundation and interest in the field.
As a strong student group, we see the chance to do
more than this. We were aiming at giving our
students maximum exposure to neurology and
medicine. There are fewer people in the world that
can give us such information than people are
currently experiencing it firsthand. And that would
mean medical school students. We will not ask
much from you (because if nothing else, we do
know that medical school is hectic), but we are
hoping for guidance.
We would appreciate it if you could suggest some
reading material: neurology journals, books,
medical school material, MCAT reviews that you
found helpful and websites with good information.
We would appreciate if you could talk to us about
medical school experience, your neurology
rotation experience and the path to a neurology
residency and career. In addition, a tour of your
facility would be so helpful to us in understanding
the aspects of the medical practice and how the
8
The SIGNPost – Spring 2005
science of neurology is put into practice. Perhaps
we can sit in your lectures and patient case
seminars and follow the diagnosis and treatment of
neurodegenerative diseases. An e-mail to us about
your events would suffice to make us aware so we
can also partake in this journey of discovery and
knowledge. Email to: _huntercollege@yahoo.com
**********************************
Have a great
summer!
**********************************