Neurology 666

HMC-Harborview Medical Center
Seattle, WA

325 Ninth Avenue
Seattle, WA 98104
Site Director: Arielle Davis, MD
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Serena Wong
Clerkship Administrator
Harborview Neurology Department
325 9th Ave Rm 3CT-70 | Box 359775 | Seattle WA  98104
Phone 206.744.9389 | Fax 206.685.8100 | This email address is being protected from spambots. You need JavaScript enabled to view it.

First Day & Clerkship Orientation

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

Clerkship orientation: A video orientation of the clerkship is online to be watched before the first day. Please see the Didactics page for links.  Site orientation will occur in the first couple days.  Please make sure that you have read and understand the site expectations below.

First Day: Report to Harborview by 7:30AM for morning rounds. You should receive an email with resident names and pager numbers in the week prior to the start day.  The team room is on 3 West Hospital, 3WH-22.  The door code is 979-979.

Dr. Davis will contact you by email for a brief in-person site orientation on the first day.  If you don't hear anything by mid-morning the first day, feel free to email This email address is being protected from spambots. You need JavaScript enabled to view it. or page 206-680-1997.

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

Course Requirements

Pocket syllabus: A “pocket syllabus”, referenced in the orientation video, will be available at your site or first didactics.  A printable (PDF) version is also available on the Pocket Syllabus page.

Didactics: Didactics take place on Thursdays, 1:00-4:00PM at the UW. The room schedule and details are 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.

Cases: Two case write-ups are due each week. The clerkship director will email the assigned case numbers to you on or before the first day of the clerkship. Further information is available in the orientation video and on the Cases page. Please note that the first cases are due on the first Thursday of your clerkship by 1:00PM Pacific fime.

Patient log: You are required to log in the patients you have seen each week. The log is described in the clerkship orientation video. Additional details are on the Patient Log page.

Clinical & Bioethical CEX exercises: You are required to do both a clinical and a bioethical mini-CEX for this course. See the Mini-CEX page for details.

Presentations: Presentation requirements are described in the orientation video and are available on the Presentations page.

Final exam: The scheduling/notification process runs through UW Testing Services and the contact email is This email address is being protected from spambots. You need JavaScript enabled to view it.. See the Final Exam page for information about the exam.

Site Expectations, Schedule & Resources

Hours: Monday-Friday, 7AM to 5PM but will vary depending on the team's workload.  You are not expected to take overnight call, work weekends or holidays.  Important -- you are not allowed to stay overnight and do not get parking in order to stay past 7PM, when the last shuttle leaves for UWMC, but many of the admits and a great deal of learning occurs between the hours of 5-10PM. Feel free to stay at your own discretion.

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. 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, junior neurology resident and two medicine R2s.  There is an emergency department consult resident who admits patients to each team, and you should plan on spending the day with this resident when your team is admitting. A Health Care Specialist, an ARNP or PA-C, joins the post-call team to help things run efficiently. A separate Neurology Consult team is named after Dr. Christina Marra. This team includes an attending, senior neurology resident, and typically another non-neurology resident.

This table explains how students are assigned to teams and switch mid-clerkship.  Starting week 1, one student will be assigned to the Copass team, one student to the Sumi team, and two students will be assigned to the Marra Consult team.  Starting week 3, students switch.  Student "A" always stays student "A" at the switch.  The same for "B, C, D". 

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 1PM. It is the largest clinic and each student will attend this clinic twice. Tuesday afternoon clinic is movement disorders with Dr. Hu starting at 1PM.  You can also see from the table above (and the didactic table below) that the ward students always go to Monday clinic and the consult students to Tuesday clinic.  Clinic location is the Ninth and Jefferson building, 9th floor.

Optional clinics can be arranged for those who desire more clinic experience including Stroke and Epilepsy. 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.

• Tuesday PM:  Stroke (start 1PM)
• Wednesday PM:  Epilepsy (start 1PM)

Ward Students Day-to-Day: Students should pre-round on their patients.  At 7:30AM both inpatient teams meet for a brief morning report to review activity from the last 24h and the day's conference/clinic schedule. Work Rounds follow Morning Report. Every weekday at 9:30AM all teams review imaging studies with Neuroradiology. 

After neuroradiology your day may vary.  Teams alternate admission days.  The emergency department resident admits patients to each team, and so you should plan on spending the day with this resident when your team is admitting.  Exceptions are that we want you to attend all team teaching rounds, the didactics listed below, and clinics. Daily notes or admit notes should be written on the patients you are following and will be handled in this way.  Admit notes should be written in a text document rather than the chart and sent to the neurology resident for feedback.  Daily notes should be written in a text document rather than the chart and sent to the R2 medicine resident following the patient with you for feedback.  Note writing is a practiced skill.  Due to quality assurance issues, 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.  Ideally, ward students should be managing, writing notes on, and following 1-2 patients at any one time.  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 to meet this goal.

Consult Students Day-to-Day:  Because we are not the patient's primary team, students should meet first thing with the senior resident each morning.  Consult patients will be active or inactive on any given day.  Also, pre-rounding may require physical examination, or only need a chart biopsy.  Figure this out together as a team.  At 7:30AM, join morning report with the ward teams.  Every weekday at 9:30AM all teams review imaging studies with Neuroradiology. 

After neuroradiology your day may vary.  There will be new patients to see.  Rounding with the consult attending.  We want you to attend all team teaching rounds, the didactics listed below, and clinics.  Consult notes should be written on the patients you are following and will be handled in this way.  New notes should be written in a text document rather than the chart and sent to the neurology resident for feedback.  Due to quality assurance issues, a resident must also write a note on the same patient and this will go into the electronic medical record due to documentation rules.  Follow-up notes can be written in the chart.  Ideally, each consult student should be seeing 2-3 follow-up consult patients per day and 2+ new consults per week. 

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. The weekly schedule looks like this:

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