PATU-4011 - Neuropathology

PATU-4011 - Neuropathology

Elective Title: Neuropathology
Course Number: PATU-4011
Elective Type: clinical Duration/Weeks: 4 Max Enrollment: 2
Prerequisites: Successful completion of Year 2
Additional Requirements: C-form required to enroll
Responsible Faculty Director: Gerald A. Campbell, MD, PhD Periods Offered: 1-13 including holiday period 8 
Coordinator: Tracy Wilkins Other Faculty: Dr. Michelle Felicella
Location to Report on First Day:
5.144 Clinical Service Wing (CSW)

To acquaint the student with the gross and microscopic examination of the nervous system, both in the autopsy and surgical pathology settings, and to provide the student an opportunity to become familiar with the spectrum of neurological pathology through study of individual cases and correlation of clinical history, anatomic findings, laboratory results and hospital course.

At the completion of this elective the student should:
1. Be able to perform a satisfactory gross examination of the central nervous system (CNS) from an autopsy case and produce an appropriate written description and gross diagnosis.
2. Have a general understanding of the principles of histopathologic preparation and microscopic examination of specimens.
3. Be able to distinguish normal from abnormal histology and recognize the major types of pathologic change in the CNS.
4. Be familiar with the requirements for acceptable specimens for muscle and nerve biopsy interpretation, the methods of preparation and processing, and recognize the main pathologic changes encountered.
5. Correlate autopsy or surgical pathologic findings with the clinical record and identify the relevant neurologic disease processes.
6. Complete appropriate research, collect clinical data and materials, prepare and present a case or topical discussion to peers and faculty

Description of course activities
Additional course description information provided: This option occupies a four-week period during which students will participate in ongoing activities in Neuropathology, identify a topic for study, and make an oral presentation using PowerPoint slides at a designated Autopsy Division conference. Scheduled activities in which student participation is required are listed below. Unscheduled activities include intra-operative frozen section consultations and consultations for ongoing autopsies. Students will be on call for these activities by leaving a pager or mobile phone number with the Neuropathology office so that they can respond when these events occur. Students may also attend any lectures that neuropathology faculty present for residents or medical school courses during the rotation. Students who expect to be absent due to interviews, etc. during part of this rotation should inform the faculty on service, at the beginning of the elective, and must reschedule their presentation if a conflict arises. However, requirements for successful completion of the elective include satisfactory completion of the presentation and attendance with no more than 3 working days absence during the elective.
In addition to the conferences scheduled below, there will be about 18.5 hours of faculty time, 12 hours of self-directed study and Unscheduled (Frozen Sections): Avg. 2 hours weekly; Unscheduled (Autopsy Participation - optional): Avg. 4 hours weekly

Type of students who would benefit from the course
Students with an interest in careers in Neurology, Neurosurgery, Neuroradiology or Pathology, or those who wish to increase their understanding of neurologic disease will benefit from this course.

    Weekly Schedule
          Estimated Course Activities (Start-Time/Finish-Time):
Day of Week   AM   PM
Monday 8:00 - 9:00 Autopsy Gross-Micro Conference 3:30-5:00 Surgical Microscopic Slide sign-out
Tuesday 8:00 - 9:00 Autopsy Gross Conference 3:30-5:00 Surgical Microscopic Slide sign-out
Wednesday 8:00 - 9:00 Neuro Multidisciplinary Conference 1:00-3:00 Autopsy Brain Conference, continued
Thursday 8:00 - 9:00 Autopsy Gross Conference 3:30-5:00 Surgical Microscopic Slide sign-out
Friday 3:30-5:00 Autopsy Brain & Surgical slide sign-out

 Average number of patients seen per week: N/A
 Call Schedule: Please see below (5) for additional course schedule activities

Research / Other Course Activities
(estimated schedule)
Activity Hours per Week
Faculty Contact-Time
Self-Directed Study

Method of Student Evaluation
1.  Clinical Observation
  A. Where are students observed on this elective?
    Inpatient Service   Ambulatory   Surgery   Standardized patients
Patients simulators   Other
  B. Frequency - How often are students observed clinically?
    At each faculty encounter (conferences, frozen sections, presentations, etc.), generally occur daily.
  C. Format - What method(s) are used to document the student's clinical performance?
    Daily oral feedback   End of period oral feedback   Written feedback

2.  Oral Presentation
  A. Audience - To whom does the student present?
    Clinical faculty and residents in Neuropathology, Neurology, Neurosurgery, Neuroradiology, and 4th year medical students in Neurology Course.
  B. Frequency / Duration of Presentation(s)?
    Once per 3-week rotation.
  C. Format - What guidelines are set for the student's presentation?
    The choice of topic or case is made by discussion with faculty. The student is required to include a presentation of histopathology and pathogenesis of the disease process and current research directions in addition to clinical data. Presentations are made using PowerPoint, and instruction is provided for students not familiar with that format.
  D. Assessment - Who assesses the student's presentation performance?
    Self-assessment   Peer assessment   Faculty assessment
  E. Method of content selection
    Current cases  Student-selected topic   Assigned topic

3.  Written Assignment (H&P's, notes, papers, abstracts, etc.)
  A. Frequency of written assignment(s)?
  B. Format - What guidelines are set for the student's written work?
    Students are required to prepare a copy of their presentation as a teaching unit.
  C. Length of written assignment(s)?
    Abstract   Annotated bibliography   1 - 2 page paper   3+ page paper
  D. Are recent references required?   No    If yes, how are they selected?
    Relevant to presentation topic/cases. Students are encouraged to do Medline and Web searches on their topics.
  E. Method of content selection - e.g. student-selected, relate to cases, etc.?
    Content is selected through discussion with faculty, taking into consideration the students interests, topics recently presented by other students and current cases.
  F. Audience - Who assesses the student's written performance?
    Peer Assessment     Faculty Assessment     Other

4.  Examination
    Oral   Written multiple choice   Written essay / short answer   OSCE

5.  Extra Course Activities
  What expectations do you have for the student to demonstrate participation in the elective (e.g. small group activities, seminars, thoughtful questions, providing resources, journal club, resident lecture attendance)?
    The student is expected to attend scheduled activities listed above, attend frozen sections (intraoperative consultations) when paged, prepare and deliver a one hour conference presentation on a topic or case relevant to neurologic disease, and hand in the written version of the presentation formatted as a teaching unit. A student may not be absent for more than 3 working days for successful completion of the elective. Additional Schedule Information: Wednesdays: 9:00-10:00 Neurology - Neurosurgery Grand Rounds 10:00-12:00 Autopsy Brain Conference 1:00-3:00 Autopsy Brain Conference continued 3:30-5:00 Surgical Microscopic Slide sign-out

6.  Additional Costs
  Please list any additional costs and/or purchases (books, materials, movies to watch, etc.) that are required for this course. Include an estimated total cost. If there are no additional costs, please enter "None".

7.  Other Modes of Evaluation
  Please explain below.
    The preferred evaluation is assessment by the Neuropathology faculty of the students participation and completion of the stated objectives. Assessment of satisfactory performance is based on the following criteria:

1.Intellectual process, (by displayed ability to interpret history, physical and laboratory findings, and use information resources).
2.Problem-solving skills (by displayed ability to make clinicopathologic correlations).
3.Communications skills (by quality of oral conference presentation).
4.Reliability and dependability (by completion of assigned tasks, participation in scheduled activities and availability for unscheduled activities).
5.Professionalism (by practice of accepted professional ethics, professional relationships and physician role).

8.  If this course is an Acting Internship, please complete the following:
  A. Objectives for the AI should relate directly to the Entrustable Professional Activities (EPAs). Each AI should describe how the four key Year-4 EPAs that our school has identified as being Year-4 skills are assessed. The Year-4 objectives are:
1. Entering and discussing orders/prescriptions.
2. Give or receive patient handover to transition care responsibility.
3. Recognizing a patient requiring urgent or emergent care and initiating management.
4. Obtaining informed consent for tests and procedures.
Specify how the student will be given formative feedback on their clinical skills.

Year-4 students should demonstrate mastery of EPAs they developed in the clerkship year, including recommending and interpreting common diagnostic and screening tests, and performing general procedures of a physician. They should be able to demonstrate masterfully and independently skills they mastered in Years 2-3, including efficiently performing comprehensive admission-notes and succinct daily progress notes and perform accurate, concise, and hypothesis-driven clinical presentations, form clinical questions and retrieve evidence to advance patient care. They should be able to demonstrate basic understanding of and beginning mastery of collaborate as a member of the interprofessional team and identify system failures and contribute to a culture of safety improvement.

List advanced clinical skills that a student will be assured an opportunity to practice.

How specifically will this AI build on developing skills from the clerkship year to prepare students for internship?

What opportunities will typically be available to all students who take this AI (procedures, required presentations, etc.)? What opportunities may be available based on patient load/presentation or student initiative (ie. Writing a case report)?

An AI should have expectation of a minimum of 32 hours per week of clinical responsibilities. Duty hours should be capped at ACGME limits for an intern, thus up to 24 hours followed by 4 hours of activities related to patient safety, education, and handoff. Students cannot work more than 80 hours per week averaged over 4 weeks. They can only have 1 day off in a 7-day work week with 8 hours off between shifts.

Clinical responsibilities will vary depending on specialty, but how is the student functioning with work commensurate to a PGY1 with an appropriate level of training?

How is the student demonstrating drawing clinical conclusions and/or developing a management plan and documentation as an intern would do?

How and by whom will midpoint feedback be provided to the student? How will you remediate deficiencies identified at midpoint?

Acting Internship students often seek letters of recommendation following their experience. How many different Faculty will work directly with the student and have knowledge of the student's abilities to detail in a written evaluation? Describe the degree of supervision and interaction with faculty vs. residents or other providers and how feedback will be obtained if more direct work is with residents or other providers.