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Neurology

Students participate in a 1/2 day OSCE during the Neurology Clerkship. The OSCE is composed of 3 interview stations where students will interview standardized patients and receive feedback from faculty as well as 4 paper case stations. The students are allowed 10 minutes for the interview and 5 minutes is given for feedback. After all students have rotated through the 7 stations a debriefing is held between all the students and faculty. At the debriefing each case is discussed. The discussion covers student's questions/difficulties as well as the main teaching points. Readings are provided before the OSCE to prepare the students for each of the cases.

OSCE

Station #1-Dementia

  • Goals:
    · Establish an atmosphere of trust with a fearful, cognitively impaired patient who is minimizing symptoms.
    · Take a functional neurological history from a "poor historian". This should include eliciting the evolution of the patient's illness in terms of how it has affected his ability to perform daily activities.
    · Use specific concrete questions to identify sentinel changes in social and professional function (shifting of responsibilities at work and home, retirement, socializing, getting lost)
  • Patient Scenario:
    You are a retired business executive, age 67. At your wife's persistent urging you have agreed to see a neurologist because of memory problems and social withdrawal.
  • Student Instructions:
    You are a medical student rotating through the private offices of a neurologist. You are to meet with and get a history from Mr. Jones.

Station #2-Severe Headache

  • Goals:
    · Perform a focused, structured interview specific to the chief neurological complaint
    · Identify headache danger signals
    · Use appropriate relationship building skills
    · Use of Ophthalmoscope correctly to examine the fundi

  • Patient Scenario:
    You are a 45 y.o. person who has been suffering from a terrible headache for 3 hours. If given a chance you will say "This is the worst headache of my life." You have seen this neurologist several times in the past for migraines, although this headache is much different from your migraines. You are in pain, sensitive to light, but cooperative.
  • Student Instructions:
    Mr./Ms. Hatchet is a middle-aged patient who has a headache. You are working with a local neurologist in her private office. Take a focused history and conduct a fundus exam using the Ophthalmoscope provided.

Station #3-Educating a Patient about Seizures

  • Goals:
    · Convey some necessary health and safety information, including the possibility of seizure recurrence and limitations on activity to a person with epilepsy
    · Reassure and return a sense of control to a patient who continues to be at significant risk of seizure recurrence
  • Patient Scenario:
    You are a 26-year-old graduate student in your second year and you have had two seizures in the past 6 months.
  • Student Instructions:
    You are a medical student working in the neurology clinic. You have been asked to see Mr./Ms. Lerner discuss her concerns, and educate her about key issues for people with epilepsy.

Resources:
Faculty
Standardized Patients

 



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