MODULE MEETING TIME AND LOCATION
The module meets Monday through Friday from 8 AM to 12 PM. Due to the variety of learning formats, meetings are held in different locations, which can be found in the module schedule. In general, lectures are located in Farber G26, laboratories are held in rooms 353-360 in the Biomedical Education Building, and Small Group Sessions are held in laboratories on the second floor of the Biomedical Education Building.
GOALS AND OBJECTIVES
The goal of this module is to provide all future physicians, regardless of specialization, the knowledge and skills to recognize neurological and psychiatric problems and to understand treatment strategies. This is accomplished through our school´s Educational Objectives by understanding:
K1: anatomical structure and physiological function of pathways that process and transmit information in the nervous system
K2: molecular and cellular mechanisms that are the basis of neuronal signaling
K3,6: the causes of nervous system disorders and their gender and age-related issues
K4: pathological processes underlying nervous system disorders
K7,9: pharmacological therapeutics for nervous system disorders and their application to analgesia
K8: CSF testing, neuroimaging
K10: characteristics of behavioral disorders and their treatment that form the basis of psychiatry
K12,16,17: effects of exercise and nutrition on nervous system, nervous system regeneration, ethical issues of opioid usage
S2,3: mini mental status exam and mental status exams, lumbar puncture
S4: deductive reasoning – the ability to localize lesions to specific levels of the central nervous system based on application of basic principles to neurological symptoms
S7,8,11: ability to work cooperatively and communicate effectively in lab and small group sessions
Gross anatomy and development of the central nervous system
Cell biology of nervous tissue
Degeneration and regeneration of the nervous system
Neurophysiological and pharmacological principles of resting potentials, action potentials, and synaptic transmission
Imaging of the central nervous system
Sensory pathways and sensory disorders
Pharmacological control of pain
Headache and its pharmacological treatment
Control of movement
Pharmacological and pathological analysis of movement disorders
Structure and function of the cerebral cortex
Infectious diseases of the nervous system
Autonomic nervous system
Limbic system: Emotion and memory processes
Blood supply to the brain and spinal cord and consequences of its interruption
Aging and dementia
EEG and sleep
Development of cognition and language
Learning theory and Behavior modification
Frontal lobe function and consequences for brain Injury
Analysis of clinical problems caused by damage to the nervous system
Substance and alcohol abuse
Introductory psychiatry including topics on schizophrenia and mood, anxiety, and personality disorders
Pharmacological therapeutics of psychiatric disorders
Module notes span the content of multiple textbooks, provide you with faculty perspectives, and organize concepts to aid your understanding of the foundations of medicine. However, module notes are abbreviated versions of information. They do not always provide the general understanding and background that are necessary for a comprehensive understanding of topics. Thus, notes in Powerpoint format make lectures easy to follow, but they provide a fraction of the information necessary for complete understanding. In addition, modules notes often do not provide the summaries, outlines, graphics, and other features that publishers use to enhance learning. There are many sources you can use to help your understanding including any of the textbooks listed below (available at reduced prices from amazon, on reserve in the library, or on loan from Dr. Cohan and online web sites (check the links page on the module web site).
1. USEFUL TEXTBOOKS (#2 – required for Psychiatry). Neuroscience textbooks cover anatomical, physiological, and neurological components with varying detail. Strengths and weaknesses of selected neuroscience texts appear below.
Basic Clinical Neuroscience, 2nd Ed., by P.A.Young, P.H.Young, and D.L.Tolbert, LippincottWW 2008. – a very concise text with a strong clinical emphasis and adequate coverage of topics.
The Human Brain, by J. Nolte, any Ed., Mosby, 2002-16 – this book is easy to read and understand and it contains good pictures with some 3D reconstructions. It combines both anatomy, physiology and clinical information. It also has a study guide containing summaries of the book chapters.
Essential Neuroscience, by A. Siegel and H.N.Sapru, LippincottWW, 2006, – a concise, but very complete text covering many topics and with excellent pictures. Each chapter contains example cases and Board-style questions.
Clinical Neurology, D.A. Greenberg, M.J.Aminoff, R.P. Simon, 6th Ed., Appleton and Lange, 2005 – an excellent reference for Neurology and a clinical companion for many of the module topics. This book also is used for the Neurology clekship. (available online)
Neuroscience, by D.Purves, GJ Augustine, D Fitzpatrick, et al., ed., 5th Ed., Sinauer, 2012 – this is a comprehensive text that covers neuroanatomy and neurophysiology. It has beautiful illustrations, but there is less emphasis on clinical examples.
Lippincott´s Illustrated Review of Neuroscience, by C.Krebs, J.Weinberg, E.Akesson, LippincottWW, 2012 – a new text – concise, excellent pictures, and board-style questions in each chapter.
Neuroanatomy Through Clinical Cases, H.Blumenfeld, Sinauer Assoc, MA, 2002. – This comprehensive text has a clear, clinical focus throughout each chapter. It uses many clinical cases to illustrate neuroanatomical concepts.
Clinical Neuroanatomy, by S.G.Waxman, ed., 25th Ed., McGraw Hill, 2003 – a very concise book that´s easy to read. It covers many topics, has many clinical examples and cases, and has a great appendix with much useful information on peripheral nerves, muscles, and body distribution.
Especially for board review:
Neuroanatomy (Board Review Series) by J.D.Fix, 3rd Ed, LippincottWW, 2002- presents the essentials of neuroanatomy and clinical information in outline format that is easy to follow. It serves as an excellent overview or review of pathways. Student recommended!
High Yield Neuroanatomy, J.D. Fix, LippincottWW, 2000 – similar to above, but even more concise.
High Yield Pathology, I.Damjanov, LippincottWW, 2000 – excellent, concise review of neuropathology.
Behavioral Science, B.Fadem, 4th ed, LippincottWW, 2005 – excellent review of behavioral and Psychiatry components of module. Includes sections on ethics and epidemiology too!
2. Introductory Textbook of Psychiatry, N.C. Andreasen and D.W. Black, 4rd ed., American Psychiatric Press, 2010.
3. ATLAS: (Recommended because it is more complete than the module lab manual, but you may wait before deciding). Can be borrowed from Dr Cohan.
Neuroanatomy, D.E.Haines, 8th Ed., Urban and Schwartzenberg, 2011 (other editions OK) – contains much information including stained cross sections, excellent gross pictures, blood supply, unstained horizontal and parasagittal brain slices with MRIs, and pathway diagrams. The newer editions have many improvements. Haines figures are referenced in the lab manual. However, other atlases are also adequate and can be substituted.
4. Module Notes and Laboratory Manual (Required)- updated yearly and available online .
This module consists of lectures, laboratories, problem-based learning in small group sessions, and in-class case presentations. These activities are coordinated to provide an integrated, stimulating, and interactive learning environment. Lectures provide important overviews and insight into module material and focus attention on faculty-designated topics. You should realize that lectures require further reading to understand topics adequately. Relevant selections from texts can be located by chapter titles. Laboratories are an integral part of this module and a significant amount of time has been allocated to these sessions. They occur regularly during the second half of the morning on select days. They are interactive sessions intended to personalize and reinforce your educational experience. Small group sessions are also interactive periods that occur usually on select Fridays. They are intended to help you understand how to apply basic knowledge to clinical conditions. Both the lab and small group sessions provide an active learning environment in which you challenge yourselves to understand and apply module concepts. Objectives listed at the end of each handout from the lectures and laboratories should guide you in what is considered most important to each topic. In your approach to studying, you should start with these objectives and organize your studies around them.
Audio/video copies of lectures are available online
SMALL GROUP CASE SESSIONS
Cases integrate clinical and basic science information and they provide an active learning environment that depends on your discussion. This requires that you prepare adequately for each session and that you participate with members of your group in developing and discussing answers. One or two case histories will be presented each session and a list of questions will be provided for you. You will work in groups of 3 students to prepare answers before the session. On the morning of each session, questions will be assigned to groups for discussion. The goal is for you to talk about the information you have learned to demonstrate your understanding, to develop verbal communication skills, and to promote group discussion, which will be assessed by facilitators. All students in each group are expected to present case answers. Neurosurgeons, neurologists, and pathologists serve as facilitators to help you appreciate the multifaceted aspects of disease management. At 10 AM, we will return in G26 to learn about current treatment strategies. This provides an opportunity for patient and physician guests who can personalize the discussion of disease and its treatment. No unexcused absences are allowed in the small group sessions. Also, it is unprofessional to use solution handouts from previous years as answers for cases. Learning comes from discovery of knowledge, which is minimized if you do this.
The purpose of the laboratory sessions is to provide an active learning experience for you to explore the basic principles of neuroanatomy, neuropathology, and clinical testing. They are crucial to understanding module concepts and they provide a basis for understanding and solving clinical cases involving neurological disorders. Each exercise has been carefully designed with input from both module faculty and students to demonstrate and reinforce the understanding of neuroanatomical structures and pathways.
The laboratory sessions are conducted in small groups that depend on collaborative learning in which interaction, sharing of knowledge, and discussion of multiple perspectives are essential components of learning. This depends upon and requires your participation. Groups of about 4 students that occupy each lab table will be organized at the start of the module. Beginning with the lab on Tactile Sensation, students at each lab group/table should prepare for the following responsibilities: 1) Anatomist: 1-2 people read the lab exercise ahead of time, find the structures, get the slides together, and lead the slide show to their group, 2) Question Guru: one student helps with answers to the questions in each exercise, 3) Neurologist: one person emphasizes some clinically relevant information. You should alternate these tasks. This an effective way to learn the material, but it requires your participation in all sessions.
Laboratory teaching aids include: a comprehensive set of 35mm slides of human brain sections produced at UB and dissected brain specimens on display in the Museum of Neuroanatomy in room 360BEB. The Museum of Neuroanatomy offers you a unique opportunity to view the structure of the human brain as displayed through a variety of exquisite dissections. This is one of very few neuroanatomy museums throughout the world and you should take full advantage of its resources to facilitate your learning. The 35 mm slide collection and Museum of Neuroanatomy were created by Dr. Harold Brody, Dept. of Pathology and Anatomical Sciences.
PARTICIPATION, ATTITUDE, AND ATTENDANCE
As a medical student you must demonstrate that you have acquired the knowledge, skills, behaviors, and attitudes expected by the medical profession and the public. A detailed list of these items is outlined in the Educational Objectives of the School of Medicine. These objectives state what students are expected to learn and, moreover, exhibit as evidence of their achievement. Although these are obvious and important aspects of clinical training in years 3 and 4, they increasingly are being applied to years 1 and 2 as qualities expected of all medical students as they prepare to become health care professionals. Faculty are required to assess student competencies in multiple ways (in Structures and Functions of a Medical School, 2008, LCME of AAMC):
Evaluation of student performance should measure not only retention of factual knowledge, but also development of the skills, behaviors, and attitudes needed in subsequent medical training and practice, and the ability to use data appropriately for solving problems commonly encountered in medical practice.
Narrative descriptions of student performance and of non-cognitive achievement should be included as part of evaluations in all required courses and clerkships where teacher-student interaction permits this form of assessment.
The educational objectives established by the school, along with their associated outcome measures, should reflect whether and how well graduates are developing these competencies as a basis for the next stage of their training.
As a medical student, you should understand that the competencies that the medical profession and the public expect of a physician must be demonstrated by you throughout your 4 years in medical school and thereafter.
We have developed policies consistent with this understanding. Medical education is more than reviewing handouts, watching video recordings, or passing exams. The classroom functions as a community where students and faculty all interact in a learning environment. Every module activity is an opportunity to develop a better understanding of Neuroscience and Behavior concepts. You are expected to be present, to be prepared, and to be on time for all activities. Lectures are prepared to introduce and organize information for you and we expect you to attend them regularly. Video recordings should be used to review rather than to substitute for presence at lectures. The laboratory and small group sessions are active, personal learning experiences that require your participation at each session, which will be verified by attendance. Lack of attendance or participation in activities can have serious consequences on your progress (see below).
We recognize that each of you has different learning needs and styles that influence the effectiveness of module activities for you. However, the laboratory and small group sessions are particularly important for you because your application of module knowledge and development as a student cannot be obtained simply from readings. Learning occurs in a collaborative atmosphere where ideas are shared, skills in verbal communication and working in teams are acquired, and multiple perspectives are appreciated that help you construct an understanding of module concepts. Each of your groups depends on this and each is impaired when you do not participate.
You will be required to sign your initials on an attendance sheet in each lab room as you complete each session, starting with the Tactile lab. Lab absences are excusable for any reason, but they must not be excessive and you must make-up the laboratory as soon as possible. The goal is to complete the work with your group and learn the material in a timely fashion. If you do miss a lab, complete it and then sign-off.
The small group sessions also require your participation in preparing the assignments and sharing your understanding with other students. Attendance and participation will be verified by facilitators. No unexcused absences are allowed in these sessions. If it is not possible for you to attend a session, you must discuss this with Dr. Cohan.
The following circumstances are considered inappropriate and unprofessional behavior:
repeated absence from lecture
not attending a lecture or leaving a lecture when it involves case discussion or patient presentation
an unexcused absence from small group sessions or repeated absence from laboratory
arriving at lab, signing-in, and then leaving
using case solutions from previous years to answer small group questions
Any of these conditions can result in a report of unprofessional conduct to the Office of Medical Education, a lower final grade, or, in extreme circumstances, a grade of Unsatisfactory.
The neuroscience laboratories in rooms 353, 355, 357, 358 and museum (360) are located on the third floor of the Biomedical Education building. They are open from 9 AM until 8 PM on weekdays. On weekends, a key to open all labs and museum may be obtained from the front desk in Medical Computing lab during normal hours of operation.
Online instruction in neuroscience is available through the module web site (tutorials page). A labeled slide atlas and many tutorials including animations developed by Dr. Cohan and previous students to help you are available on the web site.
INFORMATION ACCESS/WEB SITE
A web site for the module was established to provide easy and immediate access to module information. This site contains up-to-date information on the course schedule, policies, faculty, exams, lecture material, a Neuroanatomy slide collection, and other material. For the greatest efficiency, all information will be transmitted to you by email or listed on the web site. You are responsible for module information transmitted to your UB email account. Accordingly, check your email account regularly.
EXAMINATIONS AND WEIGHTING
There will be four scheduled examinations during this module. The spacing of these examinations is based on continuity of topics. Final grades for medical students will be calculated based on the following weighting:
Exam 1 20%
Exam 2 22%
Exam 3 30%
Exam 4 25%
Examinations 1, 2, and 3 will consist of a practical portion, based on laboratory (slide and gross) material, and a written portion composed of multiple choice, short answer, or discussion questions based upon lectures, notes, and readings. For Exams 1 – 3, the practical exam contributes 20% of the grade.
Examinations will depend upon cumulative information about each functional pathway that will enable you to solve case studies and localize lesions. Clinical material will be integrated into exams.
Questions almost exclusively will be USMLE format using case scenarios to test your understanding of concepts and your ability to apply information to diagnose medical problems. These questions place less emphasis on smaller details of systems, which may be important for your overall understanding, but will not be included in exams. Consequently, your strategy for studying should reflect this emphasis. All questions are scrutinized to ensure that they are fair, accurate, and unambiguous. In the event you feel an answer is unfair, you may submit a challenge (verbal or written) to Dr. Cohan anytime during the module.
Laboratory and Small Group Case Session Assessment
Both the laboratory and small group case sessions are integral parts of the module. Your group’s learning experience depends on your attendance and participation. Small Group activities will be assessed by facilitators for attendance, knowledge, verbal communication, and participation. The 3% of grade earned for Case/Lab work requires regular attendance at laboratory sessions and full attendance at small group sessions unless illness or extreme situations arise.
Determination of Satisfactory Grade and Knowledge Competency
We expect you to show competency in the two significant components in this module, Neuroscience/Neurology during the first 9 weeks and Psychiatry during the last 3 weeks. Therefore, to receive a grade of Satisfactory, you must achieve an average grade of at least 70% on the two Neuroscience component exams (using the designated weighting) AND a grade of at least 70% on the Psychiatry component exam. If you achieve less than 70% in either component (even though your combined grade may be greater than 70%), you will receive a grade of Unsatisfactory, which will be referred to the Phase 1 Committee for a recommendation on remediation. Determination of Satisfactory will be made without consideration of the 4 points for small group sessions/labs. Those 4 points will be used in the calculation of the final grade only if the criteria for Satisfactory are met. In addition, you must also attend the small group and laboratory sessions. Any unexcused absence from small group sessions or consistent unexcused absences from laboratory sessions will affect your overall assessment of professional behavior and may result in an Unsatisfactory grade.
Final Grades will be calculated as follows (Numeric grades are rounded to the nearest whole number):
Honors >= 90
High Satisfactory 85-89
Absentee Exams You are required to complete the exams as normally scheduled because make-up exams are not normally given. In case you are too ill or experience the loss of a family member prior to an exam, you must notify Dr. Cohan immediately and submit appropriate documentation validating your excuse if requested. Under these circumstances, a make-up exam may be scheduled by Dr. Cohan. The format of make-up exams will be similar to the regular exam.
Academic Difficulty If you experience difficulty with module material before an exam, you should speak to Dr. Cohan or to one of the course instructors or TAs so that opportunity for tutoring can be arranged. If you fail an exam, it is expected that you will contact Dr. Cohan to seek remedial help. Anyone can have difficulty learning new material. What is most important is how you respond to these difficulties in the corrections you make to overcome them.
REMEDIATION OF AN UNSATISFACTORY GRADE
You are expected to make a serious commitment to your studies in this module while it is in session. That is the time when module activities and module faculty are organized to provide the most help to you in understanding material. However, in the event you receive a grade of unsatisfactory the following steps must be followed:
You must contact Dr. Cohan at the completion of the module to discuss remediation.
You will be given an appropriate period of time to review module material. A list of faculty knowledgeable in the major topic areas of this module is available in the syllabus and you may consult them during the process of reviewing module material. It is your responsibility to learn the material presented in the curriculum of this module.
You will take a comprehensive re-exam, normally during the summer session after the academic year has ended. The comprehensive re-exam will involve material from the component in which you received an Unsatisfactory grade – Neuroscience, Psychiatry, or both. The format of the examination will be comparable to the module exams you have already taken.
If you achieve a grade of at least 70% in EACH component of the comprehensive re-exam, you will be considered competent in the module material. If you achieve below 70% in any component of the comprehensive re-exam, you will fail the remediation experience, which is considered a second failure of this module.
Dr. Cohan, as well as all module faculty, welcome suggestions and feedback from you on module material at any time. It is particularly helpful to receive your input concerning the organization and presentation of module topics. Polity reps will meet several times with Dr Cohan to provide detailed feedback about teaching methods and any student concerns. In addition, a web-based questionnaire will be available at the conclusion of the module. It is expected that you will complete the evaluation to provide information for module revision.
In accordance with University policies: “The University has a responsibility to promote academic honesty and integrity and to develop procedures to deal effectively with instances of academic dishonesty. Students are responsible for the honest completion and representation of their work, for the appropriate citation of sources, and for respect for others´ academic endeavors. By placing their name on academic work, s udents certify the originality of all work not otherwise identified by appropriate acknowledgments.”
STUDENTS WITH DISABILITIES
It is our goal to make all activities in this module accessible to you, to provide an optimal opportunity for your learning, and to ensure a reasonable opportunity for assessment of your performance. If you believe that special accommodations are necessary as a result of a disability, you must discuss this with Dr. Cohan in a timely manner so that reasonable accommodations can be made for you.
HELP FOR EMOTIONAL, STRESS-RELATED, OR FINANCIAL PROBLEMS
As a medical student, you may become overwhelmed in trying to fulfill your responsibilities. Outside pressures of personal life, family, and life situations may have a negative impact on your ability to focus on your learning. Dr. Cohan is available at any time to talk with you about problems that may arise in your life. Dr. Charles Severin in the Office of Medical Education also is available to help you. Alternatively, the university provides a resource person to help with such situations. Immediate referrals for any student problems (emotional, financial, or other life situation) can be made by contacting: Colleen Connelly, Student Support Coordinator, 645-6154. The Department of Psychiatry at our school offers help to any student in need. Contact Dr. Sergio Hernandez (firstname.lastname@example.org) to obtain a referral.