Dear Members of the Application Phase Committee,

We the undersigned students write in regards to our concern over the changes in the neurology clerkship. We would like to formally request that changes in the curriculum that place neurology as a “coil” or a “thread” be abandoned for a more substantial experience in inpatient neurology. We strongly urge the committee to consider the importance of immersion in a neurology experience that would allow students to see first presentations of neurological emergencies and hospital courses of common neurological issues that affect patients, regardless of future chosen specialty. We also hope that you would take into account the need for students to be exposed to neurological conditions and their appropriate management and diagnosis, not just for board exams, which are certainly important to us, but also for our future success as physicians, especially physicians who will one day serve the state of North Carolina. North Carolina lies directly in the “stroke belt” and we feel that it would do a disservice, not only to us, but also to our future patients, to not have some experience in seeing how acute strokes present, are managed, and the general hospital course and discharge of stroke patients. Again, we feel that this cannot be achieved through a “thread” that is mostly composed of the occasional outpatient experience and didactic sessions sewn throughout the Application Phase.

While we understand that time is a limited resource in any medical curriculum, and some topics need to be compressed or eliminated, we do not understand the rationale for the proposed changes that would substantially reduce our exposure to neurological patients. We oppose these changes for the following reasons:

1) The previous curriculum included 1 year of core clerkships that included neurology, as well as the other clerkships required by the LCME. Our current core clerkship experience is also 1 year in length, so we do not understand why neurology has to be taken out of the Application Phase given that there is the same time frame as before. Unlike the Foundation Phase, which changed preclinical curriculum from 20 months to 15 months that therefore necessitated eliminating material, the Application Phase, theoretically, should not have had to work under the same constraints. Theoretically, all material that existed in the previous iteration should have been able to exist in some form in our current curriculum.

2) A point of consensus (a rarity) amongst current Application Phase students is that the 16-week longitudinal outpatient clerkships or “CBLC” is too long, and too spread out. While we enjoy having more time to ourselves due to the more relaxed schedule during this block, we feel that we could get the same experience in a shorter, more compressed schedule, possibly even just 2-4 weeks shorter, with regular clinic days scheduled more often than the current 3 days a week.

3) A point of less strongly held consensus, is that the current curriculum has many days already scheduled that are less helpful in our medical education. For instance we are taken out of clinic once a month for Intensive Integration, which is often useful, but once a month seems exceed the usefulness of these days. Also CBLC is filled with half days of what amounts to shadowing a physician in an outpatient specialty clinic, which we feel we could do on our own if we are interested in a given specialty. These experiences are certainly viewed as more “low yield” with regards to our development as physicians, especially when compared to the essential experiences we gain during our time in neurology. It is no question to us that if experiences need to be compressed or omitted from the Application Phase, there are certainly other places to look than neurology.

We understand that a 4-week formal neurology clerkship might not be feasible now that the curriculum has changed so substantially; however, we cannot overstate how essential we feel that some contiguous inpatient neurology experience be included, to, at the very least, give us exposure to stroke, seizure, and altered mental status patients. Similar to psychiatry, there is no specialty within the walls of medicine that will not treat patients with neurological conditions. Thus, we would propose that at least a 2-week inpatient experience be added to the 16-week CBLC clerkship, where students would rotate through their choice of neurology wards, peds neurology, or neurology consults. The 4 adult, and 2 pediatric clinic days that would be missed in those 2 weeks of CBLC could seemingly be easily fit into the other 14 weeks. We realize that would mean a busier schedule for us, but given what we would be giving up otherwise, we feel that this is a more than worthy cause for us to have a few weeks with 4-5 days of clinic during CBLC.

Building a new curriculum is a very difficult endeavor, and we appreciate your efforts to build one that better prepares us to deliver quality patient care. We hope that you will take our feelings into account as your make your final plans for Application Phase 2.0.

Sincerely,