Policies and Guidelines

FIRST DAY

  • Orientation, Didactics, Meet your Team
  • After you meet with your resident to review expectations and procedures, run the patient list and ask which patients you should begin to follow. The chief resident and attending can also help assign good patients to follow.
  • Ask to access the most current patient census so you can follow patients and their issues on rounds.
  • If your picked-up patient(s) has already been worked-up and presented on rounds, you do not need to do a full initial H&P. Perform a thorough chart review and meet with your patient to personally review their history and physical exam. Help with a progress note and any coordination of care for that day, and resume care beginning with pre-rounding the following day.

DAYS OFF

  • Everyone will have at least 5 days off during the rotation.
  • Days off are provided so you can catch-up with reading and exam preparation.
  • Any planned absences for personal or professional reasons should be cleared with the Clerkship Director ASAP and prior to making any travel arrangements.
  • If you are going to be absent for any reason, you must immediately inform your Supervising Resident and the Clerkship Director.
  • If you are sick for more than 2 days, we will need a note from student health. We follow the absence policy in the online Bulletin of WUSM Admissions and Educational Program Guide.

LAST DAY

  • Clerkship ends at 1pm on the final Friday.

DUTY HOUR POLICY FOR MEDICAL STUDENTS

The Neurology Clerkship follows the Washington University duty hour policy for medical students. This policy is similar to what the ACGME has instituted for residents. If your Neurology Clerkship experience is not consistent with this policy, please let Dr. Naismith know.

  • Students must not have more than 80 clinical duty hours during a 7 day week, averaged over a 4 week period.
  • Students must have four 24-hour periods off over four weeks.
  • Students must not be on overnight call more than every third night.
  • Students cannot be on call for more than 24 successive hours, with an added period of up to 6 hours for continuity, educational debriefing, and didactic activities. No new patients should be assigned to students after 24 hours.
  • For a WU holiday, students are dismissed at 5pm the day prior, and return the day following the holiday.
  • Planned days-off need to be cleared well in advance with the clerkship director, and shall follow the absence policy for Clerkships. Make-up days will likely be required for any time off. The resident and the rest of the team need to be informed if you are not coming for any planned or unplanned reasons.

POLICY ON POST-CALL MORNING CONFERENCE

Morning rounds typically begin at 7:30 am Mon/Tue, 8:15 am Wed/Thu, and 9:00 Fri during Grand Rounds season, and 7:15 Fri during summer when there is no Grand Rounds. Check with your resident for details and updates.

  • If a conference overlaps with the time to present a new patient on rounds, the student may be excused just prior to that presentation time. This is not for follow-up presentations.
  • The student should remain in conference for as long as they could. If they need to present a patient at 7:30am, they will still go to 7am conference through 7:25am.
  • If a student is post-call, and does not have a new patient to present, s/he should remain in conference.
  • The student should let the lecturer know before the start of conference (in a courteous and professional manner) if they need to leave in the middle. If the conference has a chance to go slightly over time, the student may let the lecturer know before the conference begins, that they will need to leave on time for their patient care responsibility.

PATIENT LOGS

  • Enter your patients into New Innovations on a daily basis. Don’t let your list accumulate over days or week.
  • Indicate whether you did full work-up, followed patient progress but did not do the initial work-up, or if you saw the patient on rounds of in clinic.
  • Do not enter falsified patients into New Innovations.
  • Be proactive in seeking out the required neurologic presentations on New Innovations. Ask other students and residents so that you will have these all done by the end of the rotation.

TEXTBOOKS

  • Recommend one general neurology overview (i.e. Lange Clinical Neurology, Blue Prints, Case Files, Lange First Exposure) and reviewing your Diseases of the Nervous System Lecture Notes.
  • Many students like the Pre-Test Series, and it is good practice and a tool for active learning. Be aware, the NBME written exam is case-based and not necessarily in the style of Pre-Test.
  • Patient-specific knowledge from derived from a more detailed textbook or online reference. You should have a thorough understanding of the patient’s condition, including the differential, diagnostic criteria, controversies, and treatments.
  • The residents may have a number of textbooks available, and there are several on-line textbooks carried by Becker Library. Emedicine and Up To Date are good sources for high-yield information on your patients. Use Ovid to pull-up a pertinent review or clinical trial if applicable.

H&P FORMATTING

  • Do not use pre-printed forms for inpatient admission notes.
  • Do use pre-printed forms when on adult consults to save time.
  • Use handwritten lined paper, or type your note on a computer.
  • Notes must have a 1 ½ inch margin on the left for the hole punch, and room for addressograph on both front AND back.
  • Clearly label your note, include ID sticker, include the date and time, and sign it legibly with your pager #.

DRESS

  • Professional appearance will help with patient rapport and trust, and will impact the perception of your colleagues.
  • White coat should be clean, pressed, and not overstuffed.
  • Hair should be clean, neat, and kept trimmed.
  • Men should shave daily or keep facial hair trim.
  • No exposed tattoos.
  • Men: Tie, dress shirt, dress pants, dress socks, dress shoes. Clothes should fit well, be neat, clean, and pressed. Button and tuck-in your shirt.
  • Women: Dress professionally, conservatively, and modestly. Blouse or dress shirt, slacks or long skirt, dress shoes. Jewelry should be conservative. Clothes should fit properly and be neat. Shirt should be tucked or long enough as not to ride-up when bending over. No skin below neckline or above knees.

PHONE AND PDAS

  • Do not use your PDA during rounds or conference.

COMPUTER ACCESS

  • Call Chrissy (362-3998) or Neurology Computing Services (747-1165) with any problems or questions.
  • To log on to the computers in the 11400 conference room and in the clinics please use the login information that was emailed to you in your Welcome email that was sent to you prior to the start of your clerkship.