Multi- Disciplinary Clinic Sessions

• Neurology has several multidisciplinary clinics that are disease focused. Physicians, social workers, physical, occupational, speech therapist and nutritionist work with patients and their families to optimize their quality of life as they are progressing through the disease process.
• You will be an observer of the process of the multiple disciplinary clinics. You will attend the planning session that occurs prior to the start of the clinic. You will go into one patient’s clinic room and observe as the various specialists interact with the patient and their families. You are to stay in the room with the patient and their family and watch how the different members of the team work with the patient and their family. You will then attend the wrap up session after the clinic.
• The clinics are held at the Fontaine Research Park Building 500 in the Adult Neurology Clinic and start at 8 AM unless noted on your assignment sheet except for the DBS Clinic that is held at Fontaine Building 415 spine center on the third floor. DBS starts at 8 AM with a conference.
• You will be assigned to attend one of the multi-disciplinary clinics. There is only room for the assigned students in each of the multi-disciplinary clinics.
• In preparation for attending the clinic, you may want to think about what you expect to occur during the sessions. At the end of the clinic you may want to reflect on the experience of the clinic. Please let the clerkship director know if you have any questions about your experience in the clinic.

Teaching Sessions

Clinical Skills Sessions

• Students will be assigned to one of three small groups. Check the schedule for your assigned time.
• Each group will meet with Dr. Ivan Login for one 2 hour session.
• Students in the group should each choose an adult patient with signs on neuro exam signs that would be valuable and informative to explore in detail.  We will not work with pediatric patients.
• It is the student’s responsibility to obtain - BEFORE THE MEETING - verbal approval from the patient or family to have a small group of students and attending examine them as a teaching exercise. If there are insufficient patients on your service, coordinate access to other potential cases with the senior resident on the inpatient or adult consultation services. Failure to obtain permission in advance may be construed as unprofessional behavior.
• At the meeting, 2-4 patients will be selected to examine, depending on complexity.
• Attendance is mandatory at your assigned session and contributes to the professionalism element at the grading algorithm.
• Meetings will occur on the second, third and fourth week of each rotation at 2:00 pm at the nursing station on 6 C. Check your schedule for the date of your clinical skills session.

Ethical, Legal, and Social Matters Affecting the Clinical Practice of Neurology Seminar

• The meeting site, unless otherwise indicated is in the Bio Ethics Conference Room (as per your clerkship schedule)
• Location: Bioethics Conference Room 5382 in the West Hospital.

Directions to the Bioethics Conference room from the Health Sciences Library:

Make a left out of the Health Sciences Library and walk towards the link that will take you to

the main hospital. At the link you will make a left and continue past the West Hospital

Cafeteria. Just past the Cafeteria take the Davis Elevator (on your right) to the 5th floor,

make a right out of the elevator, at the end of the hall you will find the reception

office/library and conference room. The conference room number is: 5382.

• Faculty: Donna Chen MD MPH and Lois Shepherd JD
• During the ethics session all students on the Neurology clerkship will meet together one afternoon to discuss cases of patients seen and situations experienced during the rotation, with emphasis on the ethical dimensions of neurological practice and care. This workshop will be conducted much like “ethics rounds”, with students presenting cases of interest that are challenging, troubling, meaningful, and so on. Faculty members of the Center of Biomedical Ethics and Humanities will lead discussion of the cases brought by students to explore ethical, legal and social matters related to the clinical practice of neurology, including the patient’s experience of illness; the doctor’s reactions/ responses and role in providing care; the challenges and opportunities presented by today’s complex healthcare system; and the relationship between the patient and physician as well as relationships with families, staff, and colleagues.
• To prepare: students should
• • Observe cases and situations during your clinical experiences and consider these for the presence of ethical concerns or dilemmas. Sometimes ethical issues are obvious, as when someone refuses treatment, or insists on treatment that is not medically indicated, but issues may also be more subtle, as when a patient’s decision-making capacity seems to waver or when family members receive conflicting information about a patient from different team members.
  • Bring a case involving an ethical situation to present to the discussion group. The workshop discussion will be based in large part on cases and situations brought and presented by the students.

• Optional Extra-Credit Assignment for Ethics Seminar

Experts in medical education find that much learning at all levels of medicine occurs outside of the “formal” curriculum and that the “informal” curriculum (what is actually modeled in practice) reinforces and augments goals and values explicitly articulated by the profession, or in some cases, conflicts with and undermines articulated goals and values.

Objectives:

By the end of this learning experience, the learner should be able to:

1) Identify an example of a positive or negative experience of the “informal” curriculum as compared to the “formal” curriculum in the area of ethics, law, or professionalism;

2) Evaluate the impact of the described experience on his or her own professional development

3)   Discuss the role of the “informal” curriculum in medical education and suggest ways for other students to learn optimally from the “informal” curriculum.

Directions:

From the neurology clerkship, identify and write about an example of a positive or negative experience and/or observation of the “informal” curriculum in the area of ethics, law, or professionalism.  Discuss the impact this experience has had on your own professional development and the role you see the “informal” curriculum playing in your learning about ethical, legal, and/or professional norms.  Come up with some ideas or suggestions for preparing students to learn productively from the positive and negative aspects of the “informal” curriculum.

Your essay should be 1-2 pages, double spaced. You will be evaluated on how well you:

Describe the experience, briefly but with relevant detail, including the role you played (e.g., what you did or did not do that contributed to this being a positive or negative experience);

Evaluate the impact this experience has had on your own professional development;

Discuss the role the “informal” curriculum plays in learning about ethical, legal, and/or professional norms;

Explain your suggestions for preparing students to learn from the positive and negative aspects of the “informal” curriculum.

Your essay should be 1-2 pages, double spaced. You will be evaluated on how well you:

Describe the experience, briefly but with relevant detail, including the role you played (e.g., what you did or did not do that contributed to this being a positive or negative experience);professional development.

Discuss the role the “informal” curriculum plays in learning about ethical, legal, and/or professional norms.

Explain your suggestions for preparing students to learn from the positive and negative aspects of the “informal” curriculum.

A maximum of one point will be allocated to each of these 4 criteria for a maximum total of 4 percentage points.  Full credit is sufficient to raise a letter grade one interval (e.g., B+ to A-).

Send your completed essay as an e-mail attachment to Drs. Donna Chen (dtc6k@virginia.edu), Lois Shepherd (lls4b@virginia.edu), Carrie Gumm (cg2b@virginia.edu., Guillermo Solorzano (ges3b@virginia.edu), and Ms. KarenMarie Smith(karenmarie@virginia.edu) by 5PM on the last Wednesday of the clerkship. The email subject line should read: Neuro Ethics Essay, and your name and the date should be on the assignment.   Late assignments will not be accepted for credit. Your name must be on the essay for credit to be given.