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Neurology, Rheumatology and Orthopaedics

NEUROLOGY, RHEUMATOLOGY AND ORTHOPAEDICS – NRO

NRO is a 6-week placement at Addenbrooke’s followed by 2 weeks at the GP.

How you will spend your time

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The NRO placement has the heaviest schedule of all, but I also found it the most rewarding placement in terms of how much you learn. You need to attend a list of clinics in neurology, rheumatology and orthopaedics and have regular teaching sessions on the wards. In addition, you have lectures and seminars every day and can spend additional time on the wards. Even though this sounds a lot, it is possible to get all the clinics out of the way in the first few weeks of the placement, so that you can free some time for revision in-between scheduled sessions later on.

How to fit in path

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There is a lot of relevant neuropathology to link in, and rheumatology and orthopaedics match musculoskeletal histopathology and the autoimmune-section of the immunology syllabus. It’s possible to work through them all throughout the placement. This kept me really busy though, so I did not have time for any other pathology on top of that. Thus if NRO is your last placement, try to get the rest of path out of the way beforehand and/or try to start on the NRO-related topics earlier if you can.

Which books to use

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For neurology, I used the Illustrated Colour Text in Neurology, which was extremely useful, as it gives a nice overview of all the different central and peripheral neurological problems. There is a combined Crash Course in Orthopaedics and Rheumatology, which makes for some useful light reading during the placement. In Orthopaedics, make sure you read the chapter on Orthopaedics in Surgical Talk. This contains pretty much everything you need to know and is really well written, too.

How to use the resources on Medportal

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The huge amount of material relating to NRO on Medportal lead me to believe it is important, so I made sure I worked through it all, which took a lot of time. I even used lectures and podcasts as the basis for my pathology notes. In the end, I was disappointed that this extra-effort still left significant gaps and lacked structure, without leaving sufficient time to properly work through everything once more in the books. Occupational therapy Cambridge-style! If I could do it again, I'd use the podcasts (some of them are very painful) for superficial guidance only and focus more on the pathology books. However I'd definitely recommend the online cases and presentation as preparation for the NRO final.

Assignments

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During your NRO placement, you'll have to tick off an attendance list with a number of clinics and ward activities. During R&I week, you will have to take an OSCE exam of 7 stations and sit a 1-hour MCQ exam.

What came up in the exam

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The OSCE consists of five short six-minute stations and two twelve-minute stations. Among the short stations are three examination stations, i.e. shoulder or hand examination, hip, knee or spinal examination and a neurological examination such as cranial nerves, upper or lower limbs. There are two short practical skills stations covering knee aspiration and ophthalmoscopy.
The long stations are performing a lumbar puncture on a model and carrying out an explanation and planning session with a simulated patient and a scenario that you are allowed to prepare for in advance.

The written exam covers all aspects of the placement, i.e neurology, rheumatology and orthopaedics. The questions are a mix of case-formats asking for the diagnosis, questions about which investigations may be necessary in a particular case (CT, CSF analysis etc.) or interpretation of X-rays and other investigations. Unfortunately I don't remember any questions in detail, but be prepared that the most important diseases of each specialty will come up..

How to prepare for the exam

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For the written exam, I found that making the NRO-related path notes and working through the online cases, bedside-teaching cases and lectures during the placement was enough to pass comfortably (This includes taking a look at the books mentioned above).

For the OSCE, make sure you know your examinations and practical skills well enough. As the stations are so short, it's not worth preparing much for the viva and you'll probably also be forgiven if you make the wrong diagnosis ;-).

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