Core 3: UHVA Neuropsychiatry

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Core 3 UH/VA Neuropsychiatry

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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.

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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

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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

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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.

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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

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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

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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

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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

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Design Features

• Orientation
• Neuroscience
• 8-9 am Neurological history and physical exam
  review
• 9-1030 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

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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

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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

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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

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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

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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

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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.

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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

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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

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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

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Personnel

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