Student-run clinics

The ever-increasing age of the population worldwide, together with the range and diagnostic sensitivity of tools used to assess brain and cognitive function, have increased the need for and improved the capabilities of clinical neurology services in hospital settings. In a large metropolitan academic hospital in Melbourne, Australia, since 2014, 3,000 patients with a variety of clinical neurologic issues have been awaiting a triage category 2 appointment prior to being placed on a waiting list to make an appointment to see a neurologist.¹ Currently, our Neurology Department sees 140–150 patients a week in ambulatory outpatient clinics; there are at least 200 new referrals weekly from the primary care physicians in our academic hospital network and an additional 150 new referrals every week from our own and other inpatient departments. These figures highlight how our current weekly 10 subspecialty ambulatory outpatient clinics are unable to cope with potential new patient demand along with ongoing monitoring and provision of rehabilitation facilities for return patients. Each of the subspecialty neurology clinics is staffed by at least one board-certified neurologist (sometimes 2 board-certified neurologists) and a minimum of 2 junior doctors, who in Australia are not necessarily neurology residents. The majority of the junior doctors are basic physician trainees in the first 3 years of basic training in preparation for the fellowship examination at the successful completion of basic physician training as per the Royal Australasian College of Physicians Physician's Readiness to Expert Practise (PREP) program (handbooks.racp.edu.au/#/all). These doctors have not yet entered formal advanced training to become physicians in a variety of disciplines in internal medicine. Many of these young doctors are practicing clinical neurology for the first time in these ambulatory clinics. They are given their own consulting rooms and expected to initiate independent case history, symptoms assessment, and documentation of the interview, under supervision and management advice from a board-certified neurologist attending the relevant clinic. Our program requires additional clinic room space for this plan to be practical and successful.