Medical School Curriculum

Dr. Laurie Knepper is the director of the University of Pittsburgh School of Medicine Neurology Clerkship and the Neurology fourth year electives. The Clinical Neurology clerkship is a third-year core clerkship. Students are scheduled per preference in one of six clinical sites: the inpatient ward service, the inpatient consults service, the VA medical center, Shadyside Hospital, Children’s Hospital, and neurology outpatient clinics. Students who are on the inpatient service are also scheduled for one half-day weekly outpatient clinics, as are students who are rotating at Children’s Hospital.

Students attend case-based didactic lectures given by neurology faculty and residents. These include Neuroradiology, Peripheral Nerve Diseases, Stroke, Movement Disorders, Seizures, Headache, Multiple Sclerosis, and an NBME subject examination review. Neurology residents have also put together four neurologic emergency cases which they take turns presenting as one of the student didactics. Students attend a pediatric Neurology case conference via teleconference at Children’s Hospital. Students perform an OSCE neurologic exam on a standardized patient at the end of their first week as a formative exercise; they receive feedback on professionalism and accuracy/ completion of components. They also attend a Neuropathology small group session which includes gross sections of brain and review of neuropathology. Finally, the students take an evening of stroke night call until 11 pm with the senior resident. This enables the students to observe the patient sign-out process and the acute evaluation and management of stroke patients.

The main educational emphasis of the clerkship is on being able to perform a complete and organized neurologic examination by the end of their rotation. This is demonstrated by Dr. Knepper at orientation and the OSCE neurologic exam is at the end of the first week. The students receive a hard copy of a syllabus, which is also available online on the UPSOM Navigator System. This outlines the clerkship goals and objectives and how these are assessed. It also includes information about required forms and conferences, as well as a list of suggested neurology texts and websites available either online or through the Scaife Health Science Library. The neurology faculty has also put together a topical syllabus that contains a chapter for each of the major neurologic disorders, which the students are encouraged to read as they progress through their rotation. Each student is also loaned a copy of the book Neurology Blueprints.

The students are evaluated in several ways throughout the clerkship. A mid-clerkship evaluation of each student is done by faculty or a resident and includes feedback as well as student self-reflection on their progress. Faculty and residents also observe a complete patient history and physical exam for each student and fill out a form that is signed by students and preceptors. This year there is a redesigned an EMR note review exercise. Each student is now required to submit one note in the middle of the rotation, for which they receive formative feedback, and a second note at the end, on which they are graded by one of five reviewers per a standardized form. Students maintain an online learning log detailing patients they encounter, reviewed weekly by the course director. The standard UPSOM clinical evaluation form is distributed through Medhub to all faculty, fellows, and residents with whom each student has worked and they submit them as they see fit. This evaluation encompasses clinical knowledge, clinical skills, data reporting (oral and written, clinical reasoning, problem-solving, and differential diagnosis), professionalism and communication.