Core 3: UH

1. Core 3: UH/VA Neuropsychiatry

2. Overall Design Structure Core 3 encompasses Neurology and Psychiatry ? 8weeks total duration Neurology rotation is 4weeks in length At UH, students spend two weeks on General Inpatient Neurology and 2 weeks on Neurosurgery or Subspecialty Neurology At VA, students spend four weeks doing a combination of inpatient/consult service and outpatient clinics Psychiatry rotation is 4weeks in length At UH, Psychiatry rotation is divided into two 2week segments At VA, students spend four weeks on an acute psychiatry ward.

3. Overall Design Structure - Sites Neuroscience � UH + Wade Park VA UH Psychiatry locations: UH main campus, at University Circle Hospital site for C/L clinical experiences Walker Building (corner of Stokes and Euclid) for orientation, weekly Grand Rounds, weekly didactics UH-Richmond Medical Center Hospital site for inpatient clinical experiences VA Psychiatry location: Louis Stokes Cleveland Department of Veterans Affairs Medical Center, Brecksville Division, Building 5

4. Overall Design Structure � Clinical Services UH Neurology clinical services: General Neurology Stroke Service Neurosurgery/Neurocritical Care Pediatric Neurology Ambulatory Neurology clinic at various sites VA Neurology clinical services: Inpatient/consult service Outpatient Neurology clinic

5. Overall Design Structure � Clinical Services UH Psychiatry clinical services: Consultation-liaison psychiatry service (UH main) Perform consultations as requested for general medical, surgical, OB, ICU patients Acute inpatient psychiatry (UH-Richmond) General adult psychiatry unit = 18yo to ~60yo Geriatric 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 aged 18 y.o. and above.

6. Weekly Schedule UH/VA Neurology Inpatient schedule depends on service One afternoon per week in outpatient Neurology clinic with faculty preceptor Conferences UH 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-Richmond M/T/W/Th = clinical experiences VA Psychiatry: Monday-Friday 0800-1630

7. Lectures/conferences UH/VA Neurology: Weekly Neurosurgery didactics Grand Rounds Neurology case-based discussion groups Weekly meetings with Dr. Cohen (Neurosurgery) Neuroradiology MWF Neuro-Ophthalmology, CPC, Journal Club

8. Lectures/conferences UH Psychiatry: Introductory lectures = orientation day AM Other core lectures = each Friday AM after Grand Rounds, from 0900-1200 Case conferences = Thursdays at 1300 at UH main hospital, only during the 2weeks that you are on C/L service VA Psychiatry: Introductory lectures during orientation Didactic series which meets every Thursday from 1300-1615 Cram for the boards; forget for the wardsCram for the boards; forget for the wards

9. Design Features Orientation Learning relationships (faculty + residents) Feedback Direct observation Exposure to career options On call schedules Inpatient-outpatient balance Incorporation of assigned Advanced Core learning objectives Core 1 � Peri-Op and Acute Pain Core 2 � Prevention + WH (Menopause, osteoporosis, etc.) Core 3 � Chronic Pain Cram for the boards; forget for the wardsCram for the boards; forget for the wards

10. Design Features Orientation: Neuroscience: 8-9 am: Neurological history and physical exam review 9-10:30 am: Distribution and explanation of schedules 11 am-12 pm: Introduction to Neuroradiology Psychiatry: General information, schedules, pagers/keys, introductory psychiatry lectures First morning of the rotation at 0830 in Walker Building (8th floor conference room) Learning relationships Work in typical team setting on inpatient settings, i.e. attending faculty, residents, interns, and other students Work one-on-one with faculty preceptor in outpatient clinic Students will work with faculty as well as residents/fellows during their rotation Learning will occur via direct patient contact, patient discussions, informal and formal learning opportunities, and case conferences Cram for the boards; forget for the wardsCram for the boards; forget for the wards

11. Design Features Continued Feedback Clinical Assessment System for specific patient-based experiences and presentations Mid-rotation feedback End-of-rotation feedback (one-on-one with Clerkship Director) Direct observation History 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 options On the Neuroscience rotations students have opportunity to preference experiences in Neurosurgery, Pediatric Neurology, or Neurology Subspecialty such as Stroke During 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 settings Younger adult-focused versus geriatric-focused practices

12. Design Features Continued On call schedules Neuroscience: Students required to take 2 calls (until 9 pm) only while on General Neurology service Students allowed to choose call days, and welcome to take more call as long as stay within duty hours No overnight call Psychiatry: One weekday evening of call during each week that you are on inpatient service at UH-Richmond from 5 PM to 10 PM. Duties: Shadow the on-call resident, participate in ER evaluations, participate in acute consultations, address unit issues/questions as needed

13. Design Features Inpatient-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 weeks UH Psychiatry: Experience primarily inpatient (either inpatient on the psychiatric unit or in the general medical/surgical hospital arenas), with opportunities available for interested students to visit outpatient psychiatric clinics

14. Design Features � Incorporation of Advanced Core learning objectives Core 3: Chronic pain Formal, joint Neuro-Psych conference relating to this topic On Neurology service, you will see inpatients and outpatients dealing with chronic pain, and didactics will include selected chronic pain topics On Psychiatry service, you will likely interact with patients for whom chronic pain is a significant issue Psychiatric consultations are often called in conjunction with the Pain Management team Chronic pain is highly comorbid with psychiatric illness

15. 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 neuroradiology Ability to spend four afternoons working one-on-one with a faculty neurologist in clinic, with progressive increase in responsibility over the course of rotation Ability to spend time in unique areas of Clinical Neuroscience, in order to tailor rotation to specific interests Combination of didactics, case-based discussions, and patient presentations to supplement learning on the wards

16. 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 options 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.

17. Personnel UH/VA Neurology personnel: Neurology Clerkship Director Colleen Tomcik, MD Neurology Clerkship Coordinator Kris Stacy Director of Neurosurgery Alan Cohen, MD Neurosurgery Clerkship Coordinator Lois Hengenius

18. Personnel UH Psychiatry personnel: Director of medical student education Kathy Clegg, MD ? ext 45061 UH site Psychiatry clerkship director Jeanne Lackamp, MD ? ext 35656 or pager 38383 (best) UH clerkship coordinator (schedules, pagers, keys, all routine questions!) Kelly Kelley ? ext 45987

19. Personnel (UH Psych cont) Consultation-liaison faculty David Agle, MD Jeanne Lackamp, MD Joseph Locala, MD Other personnel C/L coordinator: Sandy Wallack, RN C/L fellow: Sarah Parsons, DO Residents� Adult inpatient faculty David Hahn, MD John Heather, MD Geriatric inpatient faculty Philipp Dines, MD Luis Ramirez, MD Other personnel Inpatient coordinator Geriatric fellow: Irina Korobkova, MD Residents�

20. Personnel VA Psychiatry personnel: Clerkship Director David Blank, MD 440-526-3030, ext. 7882 Clerkship Coordinator Debra Turner 440-526-3030, ext. 7263