HOME HELP FEEDBACK SUBSCRIPTIONS ARCHIVE SEARCH		QUICK SEARCH:   [advanced] Author: Keyword(s): Year:  Vol:  Page:

Correspondence to:

RESIDENT & FELLOW SECTION: Larry E. Davis, Molly K. King, and Betty J. Skipper Education Research: Assessment of neurology resident clinical competencies in the neurology clinic Neurology 2009; 72: e1-3e [Abstract] [Full text] [PDF]

Correspondence: Submit a response to this article

Correspondence published:

Education Research: Assessment of neurology resident clinical competencies in the neurology clinic

Marc Gotkine   (23 February 2009)

Reply from the authors

Larry E. Davis, Molly K. King, Betty J. Skipper   (23 February 2009)

Education Research: Assessment of neurology resident clinical competencies in the neurology clinic 23 February 2009
Marc Gotkine, Department of Neurology, Hadassah University Hospital Jerusalem, 91120, Israel Send Correspondence to journal: Re: Education Research: Assessment of neurology resident clinical competencies in the neurology clinic marc{at}gotkine.com Marc Gotkine	Davis et al. describe a novel method for neurology resident assessment. [1] While the form addresses the stages from anatomical localization to the management plan, it does not include a section requiring the resident to commit in writing to the core clinical symptoms and signs. For example, the ability to localize the components of Wallenberg syndrome to the lateral medulla is important yet the elicitation of clinical features always forms the foundation. Taken to the extreme, a resident challenged by a ptotic, diplopic patient with myasthenia gravis (MG) may detect all the clinical signs and erroneously localize the lesion to the brainstem. Another resident may miss the ophthalmoparesis but still diagnose MG solely on the basis of the ptosis. As residents often report their clinical findings to an attending by phone, the second type of resident is more likely to "fail" as a junior physician. Moreover, the very process by which clinical features are searched for requires a firm grasp of neuroanatomical localization in order to direct the examiner to the correct locus. This is in contrast to the robotic "screening process" approach observed in novices. There is no doubt that the process of committing a clinical formulation on paper concentrates the mind and sharpens the diagnostic ability of neurology residents. However, it is essential that residents are thoroughly assessed for the elicitation and interpretation of neurological symptoms and signs. Reference 1. Davis LE, King MK and Skipper BJ, Assessment of neurology resident clinical competencies in the neurology clinic. Neurology 2009;72;e1-e3. Disclosure: The author reports no disclosures.
Reply from the authors 23 February 2009
Larry E. Davis, New Mexico VA Health Care System 1501 San Pedro Dr., Albuquerque, NM, 87108, Molly K. King, Betty J. Skipper Send Correspondence to journal: Re: Reply from the authors ledavis{at}unm.edu Larry E. Davis, et al.	Dr. Gotkine suggests a potentially useful addition to our form evaluating clinical competence in a clinic setting. In essence, the trainee is asked in a separate column to define the core signs and symptoms that led them to localize the problem in the nervous system and make the diagnosis. This new column would be most useful if the trainee failed to make the correct diagnosis. The trainee’s answer could thus serve as a basis to review the cardinal clinical features of the correct diagnosis that were present in the patient. Disclosure: The authors report no disclosures.