Sub-Internship in Neurology

This Clinical Neurology Sub-Internship is a 4-week inpatient-based rotation designed to transition the senior medical student into the role of a neurology intern. Students will function as acting interns with supervised responsibility for patient care on inpatient neurology services and consult teams.

Students will take ownership of their assigned patients, including performing initial evaluations, developing management plans, writing notes, and participating in daily clinical decision-making under supervision.

This rotation emphasizes increased autonomy, clinical reasoning, and preparation for residency-level responsibilities.

Students are expected to take ownership of 3–5 patients per week

General Objectives

By the end of the rotation, the student will be able to:

• Function at the level of an intern in the care of hospitalized neurological patients
• Perform comprehensive neurological histories and examinations
• Develop prioritized differential diagnoses and management plans
• Recognize and initiate management of common neurological emergencies
• Demonstrate increasing autonomy while maintaining safe, supervised care

Specific Objectives (Core Competencies)

Patient Care

• Evaluate and manage common inpatient neurological conditions (e.g., stroke, seizures, encephalopathy, neuromusculardisorders)
• Perform and document complete neurological examinations
• Formulate diagnostic and therapeutic plans
• Participate actively in inpatient care and consult services

Medical Knowledge

• Understand pathophysiology, diagnosis, and management of common neurological disorders
• Recognize neurological emergencies (e.g., acute stroke, status epilepticus, raised intracranial pressure)
• Interpret basic neuroimaging (CT/MRI) in clinical context
• Apply evidence-based medicine to patient care

Interpersonal & Communication Skills

• Present patients clearly and concisely during rounds
• Communicate effectively with patients, families, and healthcare teams
• Provide structured handovers

Professionalism 

• Demonstrate accountability and ownership of patient care
• Maintain ethical and professional standards
• Recognize limitations and seek appropriate supervision

Practice-Based Learning

• Use medical literature to answer clinical questions
• Incorporate feedback into clinical performance
• Participate in team-based learning

Systems-Based Practice

• Collaborate with multidisciplinary teams
• Understand discharge planning and transitions of care
• Recognize system-level factors affecting patient care

Student Expectations & Responsibilities

• Rounding: Pre-round and present assigned patients daily
• Patient Ownership: Manage assigned patients (3–5/week) as acting intern
• Documentation: Write daily progress notes and assist with admission notes under supervision
• Consult Service: Actively participate in consults, especially during call days
• Procedures/Exposure:
  • Assist with lumbar punctures (under supervision)
  • Participate in acute neurology evaluations (e.g., stroke consults)

• Call: 1 weekday/week (active consult involvement)
• Didactics: Attend neurology teaching sessions and team discussions

Evaluation and Assessment 

Students will be continuously evaluated through direct observation and feedback.

Final Grade: Pass/Fail

• Clinical Evaluations: Based on attending physician assessments (similar to Medicine Sub-I)
• Summative Evaluations (SPEs): Required from supervising attendings