Description of project

Localizing a neurological lesion requires an understanding of the human nervous system and complex crisscrossing paths. It is a difficult skill for UCSF medical students and residents to master, and even for non-neurologist attending physicians to maintain, especially for who do not use the skill regularly. However, we believe that some of the complex thought process behind localizing a neurological exam can be captured and executed by a handheld application that can aid both students learning the skill and clinicians providing patient care.

Such an application would take as inputs pertinent positives on a neurological exam, generate a list of possible locations for a neurological lesion, and then display a ranked differential to the user accompanied by explanations behind each item on the list. For providers in a fast-paced environment like the Emergency Department, this would facilitate preliminary localization of a lesion from the exam and guide appropriate imaging.  For students and residents learning neurology, this could be used to reinforce the link between a clinical exam and conceptual pathways.  Although no handheld application can replace human interpretation of a physical exam in the context of a careful patient history, we hope that this tool will support clinician decision-making and improve both education and patient care.

Deliverables

Web application or web application wrapped in native mobile code. User-derived inputs would include pertinent positives on a neurological exam (e.g. right arm and leg weakness, right facial droop, asphasia) and outputs would include likely localizations for the lesion (left precentral gyrus, likely left MCA stroke).

Impact on UCSF's mission and/or community

This would supplement UCSF’s commitment to the education hundreds of medical and nurse practitioner students, as well as neurology, emergency medicine, internal medicine, neurosurgery, and other residents in their training.  Furthermore, attending physicians in the aforementioned specialties might find it useful in expediting care.

List of team members and their roles

Michael Lin, MD (Internal Medicine resident) - visionary, lead programmer

David Ouyang, MS3 – lead designer

Jessica de Leon, MD (Neurology resident) – end-user, subject expert

Amar Dhand, MD (Fellow in Neurohospitalist Care) – subject expert

Estimated time devoted by each team member

Michael Lin: 40 hours

David Ouyang: 40 hours

Jessica de Leon: 8 hours

Amar Dhand: 15 hours