Clerkship Training Programs

Introduction 

The Department of Neurology in the Neurological Institute is responsible for four weeks of training of clerkship for fifth grade medical student of National Yang Ming University, and offers internship program for domestic 6th and 7th grade medical student and international trainees. Clerks participate in the teaching and training team, constituting by an attending physician, a neurological resident or a postgraduate year (PGY) resident, and an intern. In the four-week training program, trainees can attend two teams, and two weeks for each team. Under the supervision of the attending physician and the resident, clerks take the opportunity to primary care, and learn the clinical skills in managing patients with neurological diseases, such as neurological examination and lumbar puncture. Clerks also gain knowledge by the instruction of attending physicians and residents. Through the course of our training program, progressively greater independence comes with greater experience.

 

Objective

1. To learn and practice how to construct an integrated patient history, perform neurological examinations, and further conduct accurate neurological localizations and differential diagnoses.
2. To learn comprehensively the indications and essential interpretations of specialized neurological tests.
3. To practice evidence-based medicine.

 

For movement disorders…

1. To analyze the phenomenology of involuntary movements, further classified and make differential diagnosis of the possible diseases.
2. To learn treatable or easily neglected movement disorders, as well as the diseases most commonly encountered.

 

For dementia and cognitive disorders…

1. To know the definition, pathophysiology, and management of dementia, delirium, and depression. To distinguish and make differential diagnosis of these three diseases.
2. To utilize various tools for cognitive assessment
3. Medical and non-pharmacological treatment for behavior disorders of the dementia patients.
4. Ethical and legal issues of the dementia individuals.

 

For migraine and other types of headache…

1. To approach a headache patient and make differential diagnosis.
2. To know the acute and preventive treatment of migraine.
3. To learn the clinical manifestation and treatment of medication overuse headache (MOH).
4. To comprehend the clinical manifestation, characteristic of neuroimaging, and treatment of cluster headache, thunderclap headache, and low pressure headache.
5. To understand the indication of lumbar puncture and the interpretation of cerebrospinal fluid analysis.

 

For cerebrovascular diseases…

1. To apply the neuroanatomy and seminology to conduct accurate neurological localizations.
2. To familiar with the diagnosis, classification, and treatment guidelines of stroke.
3. To learn the diagnosis and treatment alternatives of carotid stenosis.
4. To distinguish between central and peripheral vertigo.
5. To correctly interpret the specialized neurological examinations, such as cerebrovascular ultrasonography, tilting table and cerebral hemodynamic test, vestibular function test, and Ankle-brachial index (ABI).

 

For epilepsy…

1. To discriminate between epileptic seizure and syncope.
2. To know the diagnosis, classification, workup, and treatment of epilepsy.
3. To obtain the patient’s detailed clinical history and to describe the manifestation accurately.
4. To know the indication of electroencephalogram.
5. To learn how to manage seizure attack and status epilepticus.

 

For peripheral nervous system disorders…

1. To learn the symptoms and signs of peripheral nervous system disorders
2. To localize the peripheral nervous system disorders to root, nerve, neuromuscular junction, or muscle, and further perform the ancillary tests and treatment.
3. To know the differentiation between nociceptive pain and neuropathic pain, and know how to treat.
4. The indication of nerve conduction study, electromyogram, nerve biopsy and muscle biopsy.

 

Program Overview

Workload

1. Document the history, including admission note, progress note and weekly summary.

2. Trainees should perform primary care for 1-3 not critical-ill patients under the supervision of the resident and attending, report the condition of the patient to the supervisor, and complete the progress notes everyday.

3. Interns are the first-line doctor on-call to evaluate patients. One can report the condition to the second-line residents.

4. Participate in inpatient care with residents and attend service round with the leading of attending physicians. On Saturday and Sunday, the interns on duty should attend the teaching round as well.

5. Attend the teaching round once a week. The attending physician holds teaching round at bedside, with comprehensive review from taking medical history, neurological examination, differential diagnosis, and treatment.

6. Attend basic core lectures, and conferences. Visit the neurological laboratories.

7. Present one case with a brief clinical history and neuroimaging in the Case presentation on Friday.

8. Interns can visit the “neurological clinics with teaching” to learn how to manage outpatient. The “outpatient teaching clinics” allow trainees to approach new patients.

9. Participate in neurological consultations with supervisors 3 times a week.

 

Schedule

	Mon.	Tue.	Wed.	Thu.	Fri.
08:00-08:30	Clinical Challenges	Clinical Challenges	Discussion of ethical, legal and social issue in medical care	Didactic lectures	Case presentation by interns & clerks
9:00-12:00	Impatient care Service round	Impatient care Service round	Impatient care Service round 10-11am Teaching round	Impatient care Service round 10-11am Teaching round	Impatient care Service round
13:30-16:00	Impatient care Service round	Impatient care Service round 2-3pm Neurology/Radiology Conference	Impatient care Service round	Impatient care Service round	Impatient care Service round
16:00-17:00	Journal reading & Grand round	Case demonstration		Mortality & morbidity conference	Epilepsy Surgery Case Conference

 

Basic Core Lectures

Topic	Frequency	Speaker
Neurological examination	1/month	Dr. Yen-Feng Wang Dr. Yo-Tsen Liu
Conscious disturbance and brain death	2/month	Prof. Pei-Ning Wang Dr. Chih-Ping Chung
Movement disorders	1/month	Prof. Din-E Shan
Headache and dizziness	1/month	Dr. Wei-Ta Chen Dr. Shih-Pin Chen
Overview of epilepsy * Include visiting EEG lab and V-EEG lab	1/month	Dr. Hsiang-Yu Yu Dr. Chien Chen
General concept of stroke	1/month	Dr. Li-Chi Hsu Dr. I-Hui Lee
Indication of neuroimaging	1/month	Dr. Yi-Chu Liao Dr. Kuan Lin Lai
Indication of specialized neurologic tests	1/month	Dr. Kuan Lin Lai Dr. Chien-Chen Chou

 

Visit neurological laboratories (optional)

	Frequency	Supervisor
NCS/EMG, EP, TMS	1/month	Dr. Yi-Chu Liao
Cerebrovascular ultrasonography	1/month	Dr. Chun-Jen Lin
Botox injection	1/month	Dr. Yen-Feng Wang

* Trainees can also other visit neurological laboratories (hemodynamic test, neuromuscular pathology and neurogenetic/ neuroimmunological tests) with the supervision of the attending (optional).

 

On call

The clerks have one on-call time until 10 pm that day.

 

Avaliable Supervisors

Deputy Head of Neurology Institute

Shuu-Jiun Wang 

Division of Cerebrovascular diseases

Chief: Dr. Yung-Yang Lin
Attending physician: Dr. Li-Chi Hsu, Dr. I-Hui Lee, Dr. Chih-Ping Chung, Dr. Chun-Jen Lin

Division of Peripheral Nervous System Disorders

Chief: Dr. Bing-Wen Soong
Attending physician: Dr. Kon-Ping Lin, Dr. Kwong-kum Liao, Yi-Chung Lee, Dr. Yi-Chu Liao

Division of General Neurology

Chief: Dr. Din-E Shan
Attending physician: Dr. Jong-Ling Fuh, Dr. Pei-Ning Wang, Dr. Wei-Ta Chen, Dr. Shih-Pin Chen, Dr. Yen-Feng Wang

Division of Epilepsy

Chief: Dr. Der-Jen Yen
Attending physician: Dr. Shang-Yeong Kwan, Dr. Hsiang-Yu Yu, Dr. Chien Chen, Dr. Yo-Tsen Liu, Dr. Chien-Chen Chou

 

Assessment

1. The supervisor will assess the document of medical history by the trainee every two weeks.
2. Student’s performance was assessed mainly by so-called “TPS two-way feedback system”, which is a workplace-based evaluation by other team members and the supervisors. 
3. To evaluate the clinical skills and provide real time feedback to the trainees, the supervisors will perform the mini clinical evaluation exercise, or mini-CEX, and 360-degree feedback by the end of the training program.
4. Symposium for interns will take place every month, allowing interactive feedback with the chairman of program director. Trainees can provide practical recommendations to improve the training program.

 

Program Directors

Deputy Head of Neurology Institute and
Chairman of National Yang-Ming University School of Medicine
Prof. Shuu-Jiun Wang
TEL:02-28757578
Email: sjwang@vghtpe.gov.tw

Chairman of Program Director
Prof. Bing-Wen Soong
TEL:02-28757578
Email: bwsoong@vghtpe.gov.tw

Program Director
Prof. Jong-Ling Fuh  
TEL:02-28757578
Email: jlfuh@vghtpe.gov.tw

Program Designer
Dr. Chien-Chen Chou
TEL:02-28757578
Email: ccchou5@vghtpe.gov.tw

Secretory of Education Programs
Ms. Yang
TEL: 02-28757578
Email: tlyang@vghtpe.gov.tw
Ms. Feng
TEL: 02-28757578
Email: ccfeng@vghtpe.gov.tw

 

References

Books

1. Neurology and Neurosurgery Illustrated. Renneth W. Lindsay. 5thedition, 2010
2. Merritt’s Neurology. Lewis P Rowland. 13th edition, 2015
3. Adams and Victors Principles of Neurology. Allan H. Ropper, Martin A. Samuels, Joshua P. Klein. 10th edition, 2014
4. Technique of the Neurologic Examination. William E. Demyer, M.D. 5th edition, 2004.
5. Topical Diagnosis in Neurology. Peter Duus. 5th completely revised edition, 2011

Links

VGHTPE Library
E-learning
Neurology 
Lancet Neurology
UpToDate