Minutes 05.22.08

Minutes 05.22.08

University of Virginia School of  Medicine
Curriculum Committee

Pediatric Conference Room, 4:00 p.m.                       

Present (underlined) were: Gretchen Arnold, Eve Bargmann, Megan Bray, Dan Becker, Robert Bloodgood,  Thomas Gampper, Wendy Golden, Donald Innes (Chair),  Howard Kutchai, Marcus Martin, Mohan Nadkarni, Chris Peterson, Jerry Short, Bill Wilson (Acting Chair)Kira Mayo, Jason Franasiak, Debra Reed (secretary)  Guests:  Kevin Lee, Mary K. Worden

  1. Medical Neuroscience Course Self Assessment.  Mary K. Worden, Director of the Medical Neuroscience, course updated the Committee on  course content objectives, time distribution, and the various types of learning activities in the course with examples.  The Clinical Course Director is Myla Goldman, M.D., M.S. and the lab directors are Serena Liu, Ph.D. and Scott Zeitlin, Ph.D.

    Course content objectives:
    •  Understand the functional neuroanatomy of each level of the nervous system. At each level students will identify key structures and pathways, understand their normal physiological functions, and predict the neurological consequences if these structures are damaged.
    • Understand the anatomy and physiology of sensory, motor, and integrative systems that extend over several levels of the nervous system.
    Specific learning goals of the Medical Neuroscience (in Fink's taxonomy) as determined from answering the question "A year or more after this course is over, I want and hope students will ________"  were distributed to the Committee.

    There are 82 total contact hours in the course.  For 2008, there were approximately 148 students including graduate students from Neuroscience Graduate Program, Biology, Psychology, Sports Medicine.  Senior NGP students (6-8 per year) assist in labs and problem solving sessions

    Faculty from  Neuroscience, Anesthesiology, Radiology, Physical Medicine and Rehab, Opthalmology,  Neurology, Cell Biology,  Neurosurgery and Pathology teach in the Neuroscience course.

    The 2008 distribution of instructional time in the various activities is outlined in the following table:

    A total of 73.2% of time is designated lecture time.

    Lecture (Basic science/clinical) - sometimes includes ARS questions
    Lectures impart foundational knowledge in the following subject areas:
                1.  Introduction to the CNS
                2.  Sensorimotor integration
                3.  CNS injury
                4.  Special Senses
                5.  Brainstem
                6.  Cortical and subcortical systems

    The lectures are designed to:
    Have students value basic science as the foundation of therapies for neurological disorders
    Get students excited about the recent scientific and medical advances that increase our understanding of health and disease in the mind and brain. 
    Help students appreciate how neurological disorders can impact a patient's quality of life.

    Clinical problem discussion sessions
    (8 hrs) - two hour small (n=30) group discussions of clinical scenarios mediated by a clinician/scientist team
    1.  Pre-session meeting of all faculty to review learning objectives and encourage faculty to run interactive sessions           
    2.  Handouts (written by Worden & Goldman):
         Pre-lab exercises (schematics, vocabulary, questions)
         Learning objectives
         3 to 4 Case scenarios (+/- CT/MRI accessed on course website) 
         Specific discussion questions for the case
         Bridging questions that span two or more cases
    3.  Post-discussion online quiz (2.5% of course grade: written by Worden & Goldman)
    This exercise is designed to:
    Levelize, lateralize, localize, and integrating anatomy and physiology
    Help students recognize patterns of symptoms associated with lesions
    Help students recognize abnormal signs on the neurological exam.

    Sylvius Challenges
    (2 hrs)  This is a new activity -  a  one hour large group discussions of structure/function questions based on neuroanatomy slides, and mediated by ARS clickers (MK Worden).
    1. Show the question slide, call for vote, display the answer histogram.
    2. Discuss the right/wrong answers or ask for re-vote. Answer any questions students raise.
    3. Ask two more questions about the same slide and have students volunteer the answers and discuss.
    This exercise is designed to give the students practice at:
    Recognizing major nervous system landmarks
    Integrating anatomy and physiology
    Recognizing patterns of symptoms associated with lesions
    Recognizing abnormal signs on the neurological exam. 

    Localizing Neurological Lesions (2 hrs) - Two hour large group discussion mediated by Dr. Fred Wooten
    1. Handout has 10 case scenarios, no images.
    2. Dr. Wooten directs a Socratic method discussion of how to localize the lesion.
    3. Dr. Wooten displays the relevant anatomy slides and confirms the localization. Be excited about neurology (and related specialties)
    This exercise is designed to help the student:
    Levelize, localize, lateralize
    Integrating anatomy and physiology
    Recognizing patterns of symptoms associated with lesions
    Recognizing abnormal signs on the neurological exam. 

    Problem-solving Sets (2 hrs) - This is a new activity  - One hour small group (n=6) discussion of structure/function questions associated with online images.  (Spinal Cord Wiki; CT/MRI images)
    1. Log into website and review the image and associated questions (one problem set is adapted from U.Mass, the other was created by Worden & Goldman)
    2. Discuss and agree on a group answer.
    3. Check answer against the correct answer posted after the session (not graded)
    4. Be more interested in neurology and neuroradiology.
    This exercise is designed to help the student:
    Interact with other students to solve problems
    Recognize major nervous system landmarks
    Integrate anatomy and physiology
    Recognize patterns of symptoms associated with lesions
    Levelize, localize, lateralize

    Lab dissections
    (4 hrs) - two hour lab sessions mediated by scientists and clinicians (surface anatomy, deep brain structures and cerebellum)
    1. Pre-lab review session with graduate student teaching assistants and new faculty
    2. Handout written by Dept. Neuroscience faculty 
                 Pre-lab exercises (schematics, tables, questions)
                 Dissection protocol
                 Post-lab exercises (using neuroanatomy software)
    3. Material subsequently appears in lectures, clinical problem sessions, and Sylvius challenges.
    This exercise is designed to help the student:
    Interact with other students to solve problems
    Recognize major nervous system landmarks
    Integrate anatomy and physiology

    Patient presentation
    (2 hrs + Brad Worrall, M.D.) One hour session mediated by a clinican who invites a patient.  Students wear white coats
    1. Clinician interviews patient.
    2. Clinician does neurological exam on the patient.
    3. Students ask questions of patient.
    This exercise is designed to help the student:
    Appreciate how neurological disorders affect a patient's quality of life
    Value basic science as a foundation of therapies.
    Be more interested in neurology and related specialties.
    Practice at recognizing patterns of symptoms associated with lesions. 

    Time distribution in 2009 will be reallocated to make lectures (clinical and basic science no more than 65.7% of the total time (down from 73.2% of the total class time).

    The Neuroscience Course evaluation scores have increased dramatically in the last two years.  The scores are now on a par with the rest of the first year courses.    Some students did complain that the course seemed disjointed - this will be addressed by Dr. Worden in the introduction of the course and by providing more clearly delineated outlines of course content.

    One student noted that all the students wearing white coats during the patient interview seemed to overwhelm the patient.  Students wearing white coats during this exercise was initiated to increase professionalism of the students during the interview session and the patient did not note any discomfort from the practice. 

    The Curriculum Committee thanked Dr. Worden for her in depth course self-assessment and review and applauded both Dr. Worden and the rest of the course faculty on the recent improvements in the Neuroscience course. 

Bill Wilson