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  • Strongly held principles
  • Cram for the boards; forget for the wards
  • Cram for the boards; forget for the wards
  • Transcript

    • 1. Core Block III MetroHealth Medical Center Department of Neurology Joseph Hanna, MD Jennifer Killik Department of Psychiatry Lendita Ehrhardt, MD Celia Lewandowski
    • 2. Neuropsychiatry Core Clinical Block <ul><li>The 8-week rotation, experience will consist of a combination of inpatient/outpatient care and consultation in the following areas: </li></ul><ul><li>Adult Neurology </li></ul><ul><li>Pediatric Neurology </li></ul><ul><li>Neurosurgery </li></ul><ul><li>Neuroradiology </li></ul><ul><li>Psychiatry </li></ul><ul><ul><ul><li>Adult Inpatient Unit </li></ul></ul></ul><ul><ul><ul><li>Consult Liaison Service </li></ul></ul></ul>
    • 3. Overall Design Structure <ul><li>PSYCHIATRY </li></ul><ul><li>2-week rotation of the Consult Liaison Service </li></ul><ul><ul><li>Hours 8:30 – 5:00 pm </li></ul></ul><ul><ul><li>Meet at 8:30 a.m. daily, with residents and attending for case presentation by resident or medical student. </li></ul></ul><ul><ul><li>Follow-up with consult liaison patients in a.m. hours </li></ul></ul><ul><ul><li>Meet at 1:30 p.m. daily to review CL patient log </li></ul></ul><ul><ul><ul><li>Update log and round with residents and attendings in the afternoon for new CL cases. </li></ul></ul></ul><ul><li>PSYCHIATRY </li></ul><ul><li>2-week rotation-Adult Inpatient Service </li></ul><ul><ul><li>Hours: 8:00 – 5:00 pm </li></ul></ul><ul><ul><li>Participation in team meetings and rounds on the unit </li></ul></ul><ul><ul><ul><li>2 teams/students split to cover teams </li></ul></ul></ul><ul><ul><ul><li>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 </li></ul></ul></ul><ul><li>NEUROSCIENCE </li></ul><ul><ul><li>2 week period; Monday – Friday </li></ul></ul><ul><ul><ul><li>Pediatric Neurology, Neurosurgery, Neuroradiology </li></ul></ul></ul><ul><ul><li>NEUROSCIENCE </li></ul></ul><ul><ul><li>2 week period; Monday – Friday </li></ul></ul><ul><ul><ul><li>0730-0800 Student Lecture </li></ul></ul></ul><ul><ul><ul><li>0800-1000 Rounding on Inpatient Units </li></ul></ul></ul><ul><ul><ul><li>1000-1400 Outpatient Clinic/Inpatient Consults </li></ul></ul></ul><ul><ul><ul><li>1400-1700 Rounding on Inpatient Units </li></ul></ul></ul>
    • 4. Neurology Rotation Features <ul><li>Orientation for the Neurology Rotation will occur day 1 of the rotation </li></ul><ul><li>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. </li></ul><ul><li>Students will be exposed to career opportunities in the departments of pediatric neurology, neurosurgery and neuroradiology. </li></ul>
    • 5. Neurology Rotation Features <ul><li>The students will rotate the responsibility of assessing patient with acute neurologic issues under direct supervision of the attending on service </li></ul><ul><li>Students will be exposed to both inpatient and outpatient experiences on a daily basis </li></ul><ul><li>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 </li></ul>
    • 6. Psychiatry Rotation Features <ul><li>2-week Inpatient Unit rotation. Supervised by an attending on the unit, rotation inclusive of; </li></ul><ul><ul><li>Admitting of patients </li></ul></ul><ul><ul><li>Conducting an evaluation of the patient </li></ul></ul><ul><ul><li>Appropriate treatment of the patient </li></ul></ul><ul><ul><li>Following patient through to discharge </li></ul></ul><ul><ul><li>Individual physical exam, as well as, appropriate lab testing </li></ul></ul><ul><ul><li>Student expected to follow minimum of 2 patients at a time during this rotation. </li></ul></ul>
    • 7. Psychiatry Rotation Features <ul><li>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: </li></ul><ul><ul><li>A variety of psychiatric illnesses with medical complications, integration of psychiatry and other medical fields </li></ul></ul><ul><ul><li>Variety of different psychological responses to medical illness </li></ul></ul><ul><ul><li>Medical students will understand the role of consulting teams under the primary service asking for a consult </li></ul></ul>
    • 8. Neurology Schedule <ul><li>4 week Rotation in Neurology: </li></ul><ul><ul><li>2 week period; Monday – Friday </li></ul></ul><ul><ul><ul><li>0730-0800 Student Lecture </li></ul></ul></ul><ul><ul><ul><li>0800-1000 Rounding on Inpatient Units </li></ul></ul></ul><ul><ul><ul><li>1000-1400 Outpatient Clinic/Inpatient Consults </li></ul></ul></ul><ul><ul><ul><li>1400-1700 Rounding on Inpatient Units </li></ul></ul></ul><ul><ul><li>2 week period; Monday – Friday </li></ul></ul><ul><ul><ul><li>Pediatric Neurology, Neurosurgery, Neuroradiology </li></ul></ul></ul><ul><ul><ul><li>Needs details of rotation in these areas </li></ul></ul></ul>
    • 9. Psychiatry Schedule <ul><li>2-week rotation-Adult Inpatient Service </li></ul><ul><ul><li>Hours: 8:00 – 5:00 pm </li></ul></ul><ul><ul><li>Participation in team meetings and rounds on the unit </li></ul></ul><ul><ul><ul><li>2 teams/students split to cover teams </li></ul></ul></ul><ul><ul><ul><li>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 </li></ul></ul></ul>
    • 10. Psychiatry Schedule <ul><li>2-week rotation of the Consult Liaison Service </li></ul><ul><ul><li>Hours 8:30 – 5:00 pm </li></ul></ul><ul><ul><li>Meet at 8:30 a.m. daily, with residents and attending for case presentation by resident or medical student. </li></ul></ul><ul><ul><li>Follow-up with consult liaison patients in a.m. hours </li></ul></ul><ul><ul><li>Meet at 1:30 p.m. daily to review CL patient log </li></ul></ul><ul><ul><ul><li>Update log and round with residents and attendings in the afternoon for new CL cases. </li></ul></ul></ul>
    • 11. Neurology Objectives <ul><li>Perform a complete Neurological Exam </li></ul><ul><li>Recognize and Interpret abnormal findings on the Neurological examination </li></ul><ul><li>Identify and provide the rationale for the region of the nervous system that is affected given specific symptoms and clinical findings from neurological exam </li></ul>
    • 12. Neurology Expectations <ul><li>Obtain exposure to a wide range of diseases and conditions affecting the nervous system and the different subspecialties that manage them </li></ul><ul><li>Become familiar with the diagnosis and presentation of common neurologic problems and system complexes </li></ul>
    • 13. Neurology Clinical Expectations <ul><li>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 </li></ul><ul><li>Students are expected to write a complete H&P on all patients they pick up and complete daily SOAP notes </li></ul><ul><li>Students should practice entering orders into the paper and electronic medical record however these need to be countersigned by the attending physician </li></ul><ul><li>Outpatient Setting – students are expected to evaluate along with the attending physician patients during the clinic sessions </li></ul>
    • 14. Conferences <ul><li>Morbidity and Mortality Conference </li></ul><ul><li>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. </li></ul><ul><li>Neurology Grand Rounds (monthly) </li></ul><ul><li>Medical Grand Rounds </li></ul>
    • 15. Psychiatry Conferences <ul><li>1-hour lecture series Monday – Thursday at 12 noon in the department of psychiatry. Lectures by residents or attendings. </li></ul><ul><li>Grand Rounds, Thursdays, 11:00 – 12 noon. </li></ul><ul><li>Resident didactics if topic pertains to education of student. </li></ul><ul><li>Morbidity/Mortality conference (M&M) </li></ul><ul><ul><li>Students expected to present patient cases, 1case every </li></ul></ul><ul><ul><li>4-week period. </li></ul></ul><ul><ul><ul><li>One 4-week M&M facilitated by Psychiatry and one 4-week M&M facilitated by Neurology </li></ul></ul></ul>
    • 16. Psychiatry Rotation Features <ul><li>Orientation </li></ul><ul><ul><li>1 st day of rotation orientation by program coordinator </li></ul></ul><ul><ul><ul><li>Departmental specific </li></ul></ul></ul><ul><li>Learning relationships (faculty + residents) </li></ul><ul><ul><li>One-on-one supervision by attending of inpatient and CL service </li></ul></ul><ul><ul><li>Resident guidance with EPIC inpatient and CL notes </li></ul></ul><ul><ul><li>Resident guidance with Sharepoint program (patient logs) </li></ul></ul><ul><li>Feedback </li></ul><ul><ul><li>CAS evaluations by residents and attending supervisors. </li></ul></ul><ul><ul><li>Mid-point review of Core Clinical Conditions (Blue cards) </li></ul></ul><ul><li>Direct observation </li></ul><ul><ul><li>Attending supervisor of student during rotation </li></ul></ul>
    • 17. Psychiatry Rotation Features cont. <ul><li>Exposure to career options </li></ul><ul><ul><li>Student participation in APA </li></ul></ul><ul><li>On call schedules </li></ul><ul><ul><li>One daytime inpatient unit Saturday call while on that rotation </li></ul></ul><ul><ul><li>5-11pm (2 evening calls working with Emergency Psychiatry resident </li></ul></ul><ul><ul><li>Meal tickets provided while on call </li></ul></ul><ul><li>Inpatient-outpatient balance N/A </li></ul><ul><li>Integration of Advanced Core learning objectives </li></ul><ul><ul><li>Interface with neurology by providing a Morbidity and Mortality conference 1x each 4 week rotation. </li></ul></ul>
    • 18. MetroHealth Neurology Unique Features <ul><li>Primary Stroke Center with neuro-interventional capabilities </li></ul><ul><li>Muscular Dystrophy Association grant supported Muscle Clinic/ALS </li></ul><ul><li>Intra-operative Monitoring Capabilities/EEG </li></ul><ul><li>Attending continuity and direct supervision </li></ul>
    • 19. Psychiatry Unique Features <ul><li>Chemical dependency treatment </li></ul><ul><li>Intellectual Disability Clinic </li></ul><ul><li>Partial Hospitalization Program and Group Psychotherapy </li></ul><ul><li>Child and Adolescent Behavioral Health </li></ul><ul><li>Psychoanalysis in “The Arts” (Movie Club) </li></ul><ul><ul><li>Students are exposed to discussion of various psychoanalytic theories based on review of movies chosen monthly </li></ul></ul><ul><li>Two written patient case vignettes with dx and treatment discussed extensively with Director. </li></ul><ul><li>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. </li></ul>

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