In order to provide some focus and emphasis on clerkship learning opportunities and to provide more complete exposure to Neurosurgery practice, there will be a mentor-preceptor for each of your weeks here. You will be assigned to a different preceptor for each week, and it is hoped that with a designated preceptor, the attention and exposure will give you a rewarding experience in Neurosurgery. Please report to your preceptor on Monday for a schedule and plan of his activities, and planning for your week. You should attend the residents’ morning rounds from 0615 – 0730, and following this make arrangements to meet with your preceptor in his daily activity. You will have the opportunity to go on rounds, go to his office, or go to the operating room with him. It is expected that you will accompany him in his clinical patient care related activities. You should see his patients on admission, and he will be responsible for reviewing some of your histories and case reports. Nurses on T5 & T6 will help you learn ward procedures.
One of the important objectives is to learn a System of Analysis of clinical problems and their management. The Clinical Judgement of knowing “what to do and when to do it, is learned by considering alternatives to the “first thought”. A schematic analysis of a problem could follow these guidelines:
- Data gathering (History and Physical Examination)
- Anatomic or Regional Diagnosis
- Differential Pathologic Diagnosis
- Clinical diagnosis
- Confirmatory investigation
- Provisional (working) Diagnosis
- Natural History
- Alternatives for Management
- Expectations, Risks and Complications
- Treatment Plan and Recommendation
During the rotation on the neurosurgical service clinical clerks and junior residents should learn:
- Examination, Diagnostics and management of the unconscious patient.
- Management of acute head injuries; acute and chronic intracranial hematomas.
- Recognition and primary management of subarachnoid hemorrhage.
- Recognition and management of spinal cord compression
- Diagnosis and management of cervical and lumbar complications of degenerative disc disease.
- Causes, pathophysiology and management of increased intracranial pressure.
- Basic technical skills in the O.R.
When you are not busy with your preceptor, and he does not have clinical activities, you should participate in other patient care activities such as ward rounds, work rounds, admission history and participation in the operating room. If there are any problems of any sort during your rotation with us, please do not hesitate to contact Dr. Thomas Zwimpfer.