PPT

Core Block III

MetroHealth Medical Center

Department of NeurologyJoseph Hanna, MDJennifer Killik

Department of PsychiatryLendita Ehrhardt, MDCelia Lewandowski

Neuropsychiatry Core Clinical BlockThe 8-week rotation, experience will consist of a

combination of inpatient/outpatient care and consultation in the following areas:

Adult Neurology

Pediatric Neurology

Neurosurgery

Neuroradiology

PsychiatryAdult Inpatient UnitConsult Liaison Service

Overall Design Structure

NEUROSCIENCE

2 week period; Monday – Friday

0730-0800 Student Lecture

0800-1000 Rounding on Inpatient Units

1000-1400 Outpatient Clinic/Inpatient Consults

1400-1700 Rounding on Inpatient Units

NEUROSCIENCE

2 week period; Monday – Friday

Pediatric Neurology, Neurosurgery, Neuroradiology

PSYCHIATRY

2-week rotation-Adult Inpatient Service

Hours: 8:00 – 5:00 pm

Participation in team meetings and rounds on the unit

2 teams/students split to cover teams

Rounds start at 9:00 am and students are expected to have seen patients that they follow and be ready to present to the attending

PSYCHIATRY

2-week rotation of the Consult Liaison Service

Hours 8:30 – 5:00 pm

Meet at 8:30 a.m. daily, with residents and attending for case presentation by resident or medical student.

Follow-up with consult liaison patients in a.m. hours

Meet at 1:30 p.m. daily to review CL patient log

Update log and round with residents and attendings in the afternoon for new CL cases.

Neurology Rotation Features

Orientation for the Neurology Rotation will occur day 1 of the rotation

Students will have the opportunity to work directly with a Neurology Attending and be evaluated based on direct observation. Feedback will be offered on a continual basis throughout the rotation.

Students will be exposed to career opportunities in the departments of pediatric neurology, neurosurgery and neuroradiology.

Neurology Rotation Features The students will rotate the responsibility of

assessing patient with acute neurologic issues under direct supervision of the attending on service

Students will be exposed to both inpatient and outpatient experiences on a daily basis

The advanced core learning objective for this rotation is Chronic Pain. Students will receive a lecture on this topic and exposure to patients with chronic pain in the outpatient setting

Psychiatry Rotation Features 2-week Inpatient Unit rotation.

Supervised by an attending on the unit, rotation inclusive of; Admitting of patients Conducting an evaluation of the patient Appropriate treatment of the patient Following patient through to discharge Individual physical exam, as well as,

appropriate lab testing Student expected to follow minimum of 2

patients at a time during this rotation.

Psychiatry Rotation Features 2-week Consult Liaison Service rotation.

Supervised by an attending on the service, as well as by PGY I – III rotation medical students will be exposed to: A variety of psychiatric illnesses with medical

complications, integration of psychiatry and other medical fields

Variety of different psychological responses to medical illness

Medical students will understand the role of consulting teams under the primary service asking for a consult

Neurology Schedule

4 week Rotation in Neurology: 2 week period; Monday – Friday

0730-0800 Student Lecture 0800-1000 Rounding on Inpatient Units 1000-1400 Outpatient Clinic/Inpatient Consults 1400-1700 Rounding on Inpatient Units

2 week period; Monday – Friday Pediatric Neurology, Neurosurgery,

Neuroradiology Needs details of rotation in these areas

Psychiatry Schedule

2-week rotation-Adult Inpatient Service Hours: 8:00 – 5:00 pm Participation in team meetings and rounds on

the unit 2 teams/students split to cover teams Rounds start at 9:00 am and students are expected

to have seen patients that they follow and be ready to present to the attending

Psychiatry Schedule

2-week rotation of the Consult Liaison Service Hours 8:30 – 5:00 pm Meet at 8:30 a.m. daily, with residents and

attending for case presentation by resident or medical student.

Follow-up with consult liaison patients in a.m. hours

Meet at 1:30 p.m. daily to review CL patient log Update log and round with residents and attendings

in the afternoon for new CL cases.

Neurology Objectives

Perform a complete Neurological Exam Recognize and Interpret abnormal

findings on the Neurological examination Identify and provide the rationale for the

region of the nervous system that is affected given specific symptoms and clinical findings from neurological exam

Neurology Expectations

Obtain exposure to a wide range of diseases and conditions affecting the nervous system and the different subspecialties that manage them

Become familiar with the diagnosis and presentation of common neurologic problems and system complexes

Neurology Clinical Expectations Inpatient and Consult Services – students are

expected to be active participants, carrying 1-3 patients. Students will be expected to present these patients to the attending

Students are expected to write a complete H&P on all patients they pick up and complete daily SOAP notes

Students should practice entering orders into the paper and electronic medical record however these need to be countersigned by the attending physician

Outpatient Setting – students are expected to evaluate along with the attending physician patients during the clinic sessions

Conferences

Morbidity and Mortality Conference This conference will be held once every 8 weeks. This conference will be facilitated by the departments of Neurology and Psychiatry. Residents will be expected to present patient cases with an open forum for discussion.

Neurology Grand Rounds (monthly)Medical Grand Rounds

Psychiatry Conferences

1-hour lecture series Monday – Thursday at 12 noon in the department of psychiatry. Lectures by residents or attendings.

Grand Rounds, Thursdays, 11:00 – 12 noon. Resident didactics if topic pertains to education of

student. Morbidity/Mortality conference (M&M)

Students expected to present patient cases, 1case every

4-week period. One 4-week M&M facilitated by Psychiatry and one 4-

week M&M facilitated by Neurology

Psychiatry Rotation Features Orientation

1st day of rotation orientation by program coordinator Departmental specific

Learning relationships (faculty + residents) One-on-one supervision by attending of inpatient and

CL service Resident guidance with EPIC inpatient and CL notes Resident guidance with Sharepoint program (patient

logs) Feedback

CAS evaluations by residents and attending supervisors.

Mid-point review of Core Clinical Conditions (Blue cards)

Direct observation Attending supervisor of student during rotation

Psychiatry Rotation Features cont. Exposure to career options

Student participation in APA On call schedules

One daytime inpatient unit Saturday call while on that rotation

5-11pm (2 evening calls working with Emergency Psychiatry resident

Meal tickets provided while on call Inpatient-outpatient balance N/A Integration of Advanced Core learning objectives

Interface with neurology by providing a Morbidity and Mortality conference 1x each 4 week rotation.

MetroHealth Neurology Unique Features

Primary Stroke Center with neuro-interventional capabilities

Muscular Dystrophy Association grant supported Muscle Clinic/ALS

Intra-operative Monitoring Capabilities/EEG

Attending continuity and direct supervision

Psychiatry Unique Features

Chemical dependency treatment Intellectual Disability Clinic Partial Hospitalization Program and Group Psychotherapy Child and Adolescent Behavioral Health Psychoanalysis in “The Arts” (Movie Club)

Students are exposed to discussion of various psychoanalytic theories based on review of movies chosen monthly

Two written patient case vignettes with dx and treatment discussed extensively with Director.

CL will teach by textbook during rounds and conduct chapter summaries, question and answer sessions during a.m. sessions in a collaborative format with residents, attending and students.