Core 3: UH/VA Neuropsychiatry

Overall Design StructureCore 3 encompasses Neurology and Psychiatry 8weeks total durationNeurology rotation is 4weeks in length At UH, students spend two weeks on General Inpatient Neurology and 2 weeks on Neurosurgery or Subspecialty NeurologyAt VA, students spend four weeks doing a combination of inpatient/consult service and outpatient clinicsPsychiatry rotation is 4weeks in lengthAt UH, Psychiatry rotation is divided into two 2week segmentsAt VA, students spend four weeks on an acute psychiatry ward.

Overall Design Structure - SitesNeuroscience UH + Wade Park VAUH Psychiatry locations:UH main campus, at University CircleHospital site for C/L clinical experiencesWalker Building (corner of Stokes and Euclid) for orientation, weekly Grand Rounds, weekly didacticsUH-Richmond Medical CenterHospital site for inpatient clinical experiencesVA Psychiatry location: Louis Stokes Cleveland Department of Veterans Affairs Medical Center, Psychiatry Service 116A(W) 10701 East Blvd.

Overall Design Structure Clinical ServicesUH Neurology clinical services:General NeurologyStroke ServiceNeurosurgery/Neurocritical CarePediatric NeurologyAmbulatory Neurology clinic at various sitesVA Neurology clinical services:Inpatient/consult serviceOutpatient Neurology clinic

Overall Design Structure Clinical ServicesUH Psychiatry clinical services:Consultation-liaison (C/L) psychiatry service (UH main)Perform consultations as requested for general medical, surgical, OB, ICU patientsAcute inpatient psychiatry (UH Richmond)General adult psychiatry unit = 18yo to ~60yoGeriatric psychiatry unit = ~60yo and over, or younger if the patient has many medical complications

VA Psychiatry clinical services:Acute adult psychiatry wards with a predominantly male population, ages 18yo and above

Weekly Schedule UH/VA NeurologyInpatient schedule depends on serviceOne afternoon per week in outpatient Neurology clinic with faculty preceptorConferencesUH Psychiatry:Monday through Friday, 0800-1700**Evenings = one evening of call per week, only during the 2weeks that you are on inpatient service at UH-RichmondM/T/W/Th = clinical experiences, Friday = didacticsVA Psychiatry:Monday-Friday 0800-1630

Lectures/conferencesUH/VA Neurology:Weekly Neurosurgery didacticsGrand RoundsNeurology case-based discussion groupsWeekly meetings with Dr. Cohen (Neurosurgery)Neuroradiology WNeuro-Ophthalmology, CPC, Journal Club

Lectures/conferencesUH Psychiatry:Introductory lectures = orientation day AM Other core lectures = each Friday AM after Grand Rounds, from 0900-1200Case conferences = one presentation per student, days/times vary, done during the 2weeks that you are on C/L service VA Psychiatry:Introductory lectures during orientationDidactic series every Thursday from 1300-1615

Cram for the boards; forget for the wards

Design FeaturesOrientationLearning relationships (faculty + residents)FeedbackDirect observationExposure to career optionsOn call schedulesInpatient-outpatient balanceIncorporation of assigned Advanced Core learning objectivesCore 1 Peri-Op and Acute PainCore 2 Prevention + WH (Menopause, osteoporosis, etc.)Core 3 Chronic Pain

Cram for the boards; forget for the wards

Design FeaturesOrientation:Neuroscience:8-9 am: Neurological history and physical exam review9-10:30 am: Distribution and explanation of schedulesPsychiatry: General information, schedules, pagers/keys, introductory psychiatry lecturesDone on first morning of the rotation, usually at Walker Building (times vary)Learning relationships Work in typical team setting on inpatient settings, i.e. attending faculty, residents, interns, and other studentsWork one-on-one with faculty preceptor in outpatient clinicStudents will work with faculty as well as residents/fellows during their rotationLearning will occur via direct patient contact, patient discussions, informal and formal learning opportunities, and case conferences

Cram for the boards; forget for the wards

Design Features ContinuedFeedbackClinical Assessment System for specific patient-based experiences and presentationsMid-rotation feedback End-of-rotation feedback (one-on-one with Clerkship Director)Direct observationHistory taking, physical exam, and team communication will be directly observed by faculty, residents, and interns in various inpatient and outpatient settings with feedback verbally and through CAS.Exposure to career optionsOn the Neuroscience rotations students have opportunity to preference experiences in Neurosurgery, Pediatric Neurology, or Neurology Subspecialty such as StrokeDuring the two parts of your Psychiatry rotation, you will be exposed to clinical faculty and fellows who are pursuing various different career options including Inpatient, consultation, and outpatient settingsYounger adult-focused versus geriatric-focused practices

Design Features Continued

On call schedulesNeuroscience:Students required to take 2 calls (until 9 pm) only while on General Neurology serviceStudents allowed to choose call days, and welcome to take more call as long as stay within duty hoursNo overnight callPsychiatry:Students required to take 2 weekday evening calls (from 5pm until 10pm, one call per week) only while on UH-Richmond inpatient serviceDuties: Shadow the on-call resident, participate in ER evaluations, participate in acute consultations, address unit issues/questions as neededOne weekend day of rounding, only while on UH-Richmond inpatient

Design FeaturesInpatient-outpatient balance Neuroscience - Students see a mixture of inpatients, consults, and outpatients during their four week rotation, regardless of how they preference their second two weeksUH Psychiatry: Experience primarily inpatient (inpatient on the psychiatric unit and in the general medical/surgical hospital arenas), with opportunities available for interested students to visit outpatient psychiatric clinics as electives in M4 year

Design Features Incorporation of Advanced Core learning objectivesCore 3: Chronic painOn Neurology service, you will see inpatients and outpatients dealing with chronic pain, and didactics will include selected chronic pain topicsOn Psychiatry service, you will likely interact with patients for whom chronic pain is a significant issuePsychiatric consultations are often called in conjunction with the Pain Management teamChronic pain is highly comorbid with psychiatric illness

What are the unique features of this rotation?UH/VA Neurology:Relevant and interesting introduction to rotation, with review of the neurologic history and exam, neuroanatomy, neuropathology, and neuroradiologyAbility to spend four afternoons working one-on-one with a faculty neurologist in clinic, with progressive increase in responsibility over the course of rotationAbility to spend time in unique areas of Clinical Neuroscience, in order to tailor rotation to specific interestsCombination of didactics, case-based discussions, and patient presentations to supplement learning on the wards

What are the unique features of this rotation?UH Psychiatry: Through diversification of the psychiatric experience, including both inpatient and hospital-based services, students will get broad exposure to psychiatric patients, diagnoses, and treatment optionsThere is a specially-designated resident liaison who helps with student orientation, and also meets with students periodically throughout the rotation for extra teaching and support!VA Psychiatry: Students are responsible for the management of up to four patients. They are expected to do admission notes, daily notes, orders, and discharge summaries for their patients. There are no evening or weekend requirements.

PersonnelUH/VA Neurology personnel:Neurology Clerkship DirectorColleen Tomcik, MDNeurology Clerkship CoordinatorDoris EvansDirector of NeurosurgeryAlan Cohen, MDNeurosurgery Clerkship CoordinatorLois Hengenius

PersonnelUH Psychiatry personnel:Director of Psychiatry medical student educationKathy Clegg, MD ext 45061UH site Psychiatry clerkship directorJeanne Lackamp, MD ext 35656 or pager 38383 (best)UH clerkship coordinator (schedules, pagers, keys, all routine questions!)Debbie Martin ext 48911

Personnel (UH Psych cont)Consultation-liaison facultyJeanne Lackamp, MDJoseph Locala, MDSusan Stagno, MDStefani Parrisbalogun, MDOther CL personnelCL coordinator: Sandy Wallack, RNCL residents and sometimes fellows

Adult inpatient facultyDavid Hahn, MDLuis Ramirez, MDGeriatric inpatient facultyPhilipp Dines, MDIrina Korobkova, MDInpatient Child facultyPeter Corpus, MDOther inpatient personnelInpatient coordinators/RN/SWGeriatric fellowResidents

PersonnelVA Psychiatry personnel:Clerkship DirectorDavid Blank, MD 216-791-3800, ext. 6795Clerkship CoordinatorDecey Cabarle 216-791-3800, ext. 6808

Cram for the boards; forget for the wardsCram for the boards; forget for the wardsCram for the boards; forget for the wards