Medical Mondays: General Neurology

note: this post contains my opinions and experiences and as such, is very subjective - basically a public service announcement that I'm not writing the neurology NBME shelf exam or handing out any clerkship grades ;)

After my 10-week internal medicine clerkship, neurology felt so short! I honestly like the five-week clerkships better. Ten weeks is such a long time to be studying for one exam. Five weeks is much more manageable!

Clerkship Overview

I'll start off by giving a broad overview of how my time was spent. My first week - which only ended up being about 3 days due to orientation and Columbus Day - was spent on the stroke service. The hospital I work at, is a major stroke center and receives patients from lots of surrounding hospitals. I really enjoyed the stroke service because the patients we treated generally made improvements during their hospital stay. I was also able to see a lot of the dramatic neurologic problems you learn about in basic neuroscience. Several patients had neglect syndrome which occurs with major strokes and causes the person to not recognize one side of their body (very obvious when you try doing a neurologic exam and the person can't recognize their own hand!). One of my favorite experiences on that service occurred while evaluating a patient in the emergency department. He had come in because he thought he was having a stroke, but after further work-up the resident and I realized that he was experiencing symptoms due to a much less serious illness known as Bell's palsy. I'll never forget the look of relief on the patient's face when I told him he was unlikely to be experiencing a stroke.

I spent the second week in outpatient offices with several different neurologists. Most of these patients were being seen for seizure disorders, dementia, movement disorders, and headaches. Since I worked with several different doctors, every day was different. I really liked the wide variety of neurologic problems that I encountered this week and the doctors I worked with were incredible.

Third week was neurosurgery which I've already written about in this post. In summary, really exciting surgeries and LONG hours. Possibly my favorite week in spite of the lack of sleep.

Fourth week was spent on consult service which evaluates all the new neurology patients admitted to the hospital. I saw lots of different patients, but also got a generous amount of study time which was perfect for this time in the clerkship.

The final week was spent on the non-stroke hospital service. I was able to work with patients with lots of the major chronic diseases you hear about in neuroscience - multiple sclerosis, myasthenia gravis, etc. The attending physician and resident I worked with were both incredible and made this week a great learning experience.

My Typical Day as a Medical Student

My typical days in the hospital-based services started around 6:30 AM. I actually had enough time most mornings to do my hair and makeup before arriving at the hospital around 7:30. From 7:30 to 9:30 I would see new patients and check up on any old patients. Morning rounds would start around 9:30 and end around 11 or 12. We got an hour for lunch and then had time to write notes, study or see new patients from 1 to 3. Afternoon rounds were usually brief (from 3 to 4), and we often got to head home early. The rest of my days would be spent studying and doing whatever else I wanted. This clerkship was much more relaxed than others I've done and I can't deny that I enjoyed it!

Pros and Cons:

PROS:
- Lots of unusual and interesting diseases.
- Appears to allow a good work-life balance. The doctors all work very hard, but the hours seem to be lighter than other areas of medicine.
- Lots of opportunities for further education - see this list from the American Academy of Neurology.
-NOTE: very site specific! - Very positive work environment for the residents. Attending physicians treated the residents incredibly well. The neurologists seemed universally happy in their field.

CONS:
- Many of the diseases you see are not curable, only treatable (and sometimes not even that). It can be really difficult to see young patients with awful diseases and poor prognoses.
- Oftentimes, LONG patient histories that require quite a bit of time to piece together.
- Some of the hardest exams I've done were on comatose or severely disabled patients.
- Not a lot of procedures in general neurology  (this doesn't hold true for some of the sub-specialties like intervention neuroradiology).

Shelf Studying

The NBME Neurology Shelf is a major part of our clerkship grade and lucky me, I got to take it this past Friday. I used lots of different resources for this exam and felt well-prepared for the questions I encountered on it. I did all of the Neurology and Opthalmology questions in the UWorld and Kaplan Q banks. I also did most of the questions in Pre-Test Neurology. I found Pre-Test to be really helpful with the more obscure diseases and actually remember thinking that I got several questions based on things I'd only encountered in Pre-Test. Blueprints Neurology was my textbook resource and I felt it to be more than sufficient when combined with the other resources I used. The First-Aid section on Neurology (yes, the miserable book I basically memorized early this summer), was an excellent concise review for the couple days before the exam. I haven't gotten my score back yet, but I felt pretty good while taking the exam and really don't know of many other highly recommended resources out there with the exception of Case Files Neurology. I simply didn't have enough time to go through Case Files!

Phew, this was probably one of my longest posts ever, but it should be an ultra-thorough review of the past five weeks! Have a wonderful start to the week!