Neurology 666

HMC-Harborview Medical Center
Seattle, WA

325 Ninth Avenue
Seattle, WA 98104
Site Director: Arielle Davis, MD
HMC Neurology Office Contact: Susan Guse
Phone: 206-744-3251

 

First Day & Clerkship Orientation

3 WEEKS BEFORE YOU START: Email your pager or cell phone number to Susan Guse at Harborview at  This email address is being protected from spambots. You need JavaScript enabled to view it.

Clerkship orientation: Orientation is at the UW at 8:00AM on the first day of your clerkship. The room number is on the Didactics page. Room information may change at the end of each rotation, so be sure to check the table the weekend before you begin.

After orientation: Report to Harborview. Page the chief resident when you arrive. Susan Guse will email resident names and pager numbers to you.

Equipment to bring: White coat and name tag, reflex hammer, tuning fork (128Hz), stethoscope, (Ophthalmoscope recommended).

Parking and transportation: Parking is not covered by the School of Medicine for required clerkships without evening or night duties.
Bus schedule:  http://tripplanner.kingcounty.gov/
Shuttle schedule:  https://www.washington.edu/facilities/transportation/uwshuttles/HealthSciencesExpress

 

Site Expectations, Schedule & Resources

General: You will be exposed to a variety of patients with neurologic problems while on the HMC neurology rotation. Students should be proactive about clinical opportunities, whether they are hands-on or shadowing experiences. On the first day of the rotation, you should find the senior neurology resident on the team to which you have been assigned. This person will be a key mentor during the rotation. During the introductions and orientation with this person, be sure to mention your own specific goals for the 4-week rotation.

Teams: Harborview Medical Center has two inpatient neurology teams named after two influential neurologists: Dr. Mark Sumi and Dr. Mike Copass. Each team is made up of an attending, senior neurology resident, junior neurology resident and two medicine R1s. A Health Care Specialist, an ARNP or PA-C, joins the post-call team to help things run efficiently. A separate Neurology Consult team includes an attending, senior neurology resident, and typically another non-neurology resident.

One student will be assigned to the Copass team, one student to the Sumi team, and two students will be assigned to the Consult team. Each inpatient team alternates admission days. Everyday at 7:30 AM, except 8:00 AM on Tuesdays, both teams meet for a brief Morning Report to review the activities on the teams since the last Morning Report. Work Rounds follow Morning Report. Every weekday at 9:30AM all teams review imaging studies with Neuroradiology.

Day-to-Day: Unless instructed otherwise by a senior neurology resident, each weekday all inpatient students will stay with their assigned team from 7:30 AM (8 AM on Tuesdays) to the end of Imaging Rounds. They should also attend all team teaching rounds. At other times, each student will do as outlined below, ultimately spending 2 consecutive weeks on the wards and 2 consecutive weeks on consults. For instance, the Copass ward and consult students will switch after two weeks. Each student will have one required clinic each week: Monday afternoon, Tuesday afternoon, or Thursday morning as per the schedule provided below.

You should pre-round and write a daily note on each patient you are following while on the wards and, as needed, while on consults. Notes should be written in a text document and given to your senior resident for review and feedback but should not be submitted to the electronic medical record, due to quality assurance issues. Note writing is a practiced skill. Be advised that a resident must also write a note on the same patient each day and this will go into the electronic medical record due to documentation rules but should not be seen as a reflection of the quality of your participation.

Important -- you are not allowed to stay overnight and do not get parking in order to stay past 7 PM, when the last shuttle leaves for UWMC, but many of the admits and a great deal of learning occurs between the hours of 5-10 PM. Feel free to stay at your own discretion.

Ward Student on Copass or Sumi Team: This medical student will admit and follow patients on the ward along with the R1s. On days that the team is admitting, the medical student will go with the senior neurology resident on all calls to the ER, except if the student is in clinic or at didactics. The student will see as many patients as possible, completing an admission note on no more than one patient. On the post-call day, the medical student may pick up other patients to follow at the direction of the team's neurology residents and attending. Ideally, the ward medical student should be managing, writing notes on, and following 2-3 patients at any one time. Notes on new patients should be submitted to the team's senior neurology resident for review and feedback but should not be placed in the electronic medical record due to quality assurance issues. The student attends one clinic a week per the schedule below.

Consult Student on Copass or Sumi Team: The consult medical students should be present for Morning Report each day and should touch base with the consult senior resident – if there are new patients from overnight or other consult patients to be seen, the consult students should be excused from morning rounds with the inpatient team so that they can focus on consults. However, if there are no new consults or urgent follow-ups between 7:30-9:30, the consult students should round with their respective inpatient team and then join the Consult team after Neuroradiology rounds. The two medical students on the Consult team will alternate between evaluating new consults and following up on old consults. Ideally, the consult medical student should be seeing at least 2-3 follow-up consult patients per day and 1-2 initial consults per week. Notes on new patients should be submitted to the Neurology Consult team's senior neurology resident for review and feedback but should not be placed in the electronic medical record due to quality assurance issues. However, notes on follow-up patients should be submitted into the electronic medical record with the consult attending as a co-signer. The student attends one clinic a week per the schedule below.

Clinic:  Clinic is an important setting to learn neurology. You will most likely see patients with diseases who are rarely admitted to the hospital. Holidays or clinic cancellations may occasionally disrupt the schedule.

Monday afternoon is a general neurology clinic starting at 12:15. It is the largest clinic and each student will attend this clinic twice. Tuesday afternoon is a lumbar puncture clinic with Dr. Zunt, and starts at 1 PM. Thursday morning clinic is general neurology clinic with Dr. Khot or Dr. Ho and starts at 8:30 AM, so the student may need to leave Work Rounds early. Optional clinics can be arranged for those who desire more clinic experience including Stroke, Epilepsy, and Movement Disorder clinics. Because they are optional, the clinics have been set up as a shadowing experience. If you are interested, check with the HMC site director, Dr. Arielle Davis ( This email address is being protected from spambots. You need JavaScript enabled to view it. ), to learn more.

See “Clinic Table” below:

 

MONDAY PM
GENERAL NEUROLOGY

TUESDAY PM
LUMBAR PUNCTURE

THURSDAY AM
GENERAL NEUROLOGY

WEEK 1

Copass ward
Sumi ward

Sumi consult

Copass consult

WEEK 2

Copass ward
Sumi ward

Copass consult

Sumi consult

**SWITCH ROLES AFTER WEEK 2**

WEEK 3

Copass ward
Sumi ward

Sumi consult

Copass consult

WEEK 4

Copass ward
Sumi ward

Copass consult

Sumi consult

Optional stroke and epilepsy clinics can be arranged for those who desire more clinic experience. Because these clinics are optional, they have been set up as a shadowing experience and no more than 2 students can do each clinic at one time (work this out as a group of 4). If you are interested check with your attending to learn more.

Tuesday PM:  Stroke (start 1PM)

Wednesday PM:  Epilepsy (start 1PM)

Didactics: The expectation is that you will attend the neurology lectures given at HMC and that you will always be freed up on Thursday afternoon to go to UWMC, arriving no later than 1 PM. Neurology educational offerings at HMC include a clinical conference at 7 AM on the 2 nd and 4 th Tuesdays of the month, weekly R1 lectures at 11 AM on Tuesday or Friday, and mixed conferences weekly on Wednesday. Finally every Wednesday at 1 PM, all medical students will meet with a neurology attending in the team room to discuss a patient who will be presented by one of the medical students. The students will decide beforehand which patient from the ward and consult teams will be the best to present, with the expectation that each student will present one patient over the 4-week rotation.

 

Online Resources

-Stroke algorithm with links to NIH Stroke Scale and links to American Heart/Stroke Association guidelines on intraparenchymal hemorrhage, ischemic stroke, and subarachnoid hemorrhage

https://depts.washington.edu/uwstroke/stroke_rx/HMC_Rx_Algorithm.pdf

-Archived lectures at the Department of Neurology website. Would recommend sampling the summer series of lectures, which focus on basic neurology topics: stroke, neuromuscular emergencies, epilepsy, and others. Also see section of archived stroke, neuromuscular, and movement disorder talks.

http://depts.washington.edu/neurolog/seminars.html

-Neuromuscular Disease Center at http://neuromuscular.wustl.edu/