LCME Site Visit and Neuro Rotation

Case's LCME review began on March 22. (Remember, the LCME is the organization that accredits all American and Canadian allopathic medical schools.) The review took place over several days because the committee members had to meet with various faculty, administrators, and students on both campuses. I attended the clinical student meeting, which was held over at Case during lunchtime on Wednesday. Since I was scheduled to have outpatient neurology clinics that day, I was given permission to leave the morning clinic half an hour early and come back to afternoon clinic an hour late. Unfortunately, somehow no one told my afternoon preceptor that I would be late, so I had some explaining to do once I got to his clinic!

After all the flurries of emails we got from the administration, the meeting itself was kind of anticlimactic. There were two other CCLCM upperclassmen, as well as several UP upperclassmen and several reviewers. I think the reviewers are all administrators of some type at other medical schools. Most of the questions they asked us were pretty basic things, like who we would contact if we got stuck by a needle (depends on the hospital, but at CCF, you call the exposure hotline). Surprisingly, the reviewers wanted to know if our rotations required more than 80 hours per week. That work-week limit is actually for residents, not medical students, but Case has an 80 hour work-week rule in place for us anyway. We also got asked about why the OB/gyn rotation had received such low evaluations by M3s and M4s in both programs. I haven't done OB/gyn yet, so I couldn't add much to this discussion. But I was already dreading it based on the horror show stories I've heard from friends, and today's discussion didn't do much to allay my fears. :-P

It will take a couple of months for the reviewers to decide whether our school can be reaccredited. Once the LCME decides that we've passed muster, Case will be accredited until the 2016-2017 academic year. That's a long time. To put it in perspective, I will be done not only with residency but even with fellowship by then, assuming I do a fellowship.

This week, I also had some neuro peds clinics that were kind of awkward. Since I haven't had peds yet, I don't know very much about the development of children, and the pimping was pretty painful for me. One child's parents had brought their 14-month-old toddler in because the child wasn't walking yet. The attending asked me in front of the parents if this was normal or not. Beats me! I have no idea what age children normally learn to walk. It's not like I have any kids at home to study! (For the record, children learn to walk around age 12 months, but it is not considered to be a problem unless they're still not walking after around 15-18 months.)

On my last day in the headache clinic, I had a patient with trigeminal neuralgia. This is a pain syndrome that occurs in the distribution of the fifth cranial nerve (the trigeminal nerve). The patient gets an intense, shooting pain down one or more branches of the nerve. Commonly, the second branch (V2), which innervates the middle of the face, is affected. (See picture.) It's not known exactly why trigeminal neuralgia occurs, but it may be associated with a blood vessel compressing the nerve. When I examined the patient, I unfortunately reproduced her pain, even though I tapped her face lightly.

One other thing I learned was that I haven't been using the reflex hammer correctly. My preceptor explained that it should be more of a movement in the wrist, and I've apparently been using my entire arm too much. I practiced on several patients, and she said I am starting to get the hang of it. Who ever knew that hitting people's tendons with a hammer could require such perfection of technique!