Companion Course in the Block
The primary source of integration will be with the four-week Mental Health clerkship that is included with Neurologic Care in this eight-week block. The sites for the Neurologic Care rotation are listed above and those for Mental Health are covered by Dr. Weissberg. A major emphasis will now be on the neurobiological basis of behavior, and both rotations will adhere to this principle in all the sites where students are taught. There will be substantial overlap of content, which is justified by the complexity inherent in the evaluation of human behavior that necessitates much practice and clinical experience. Specific examples of integration will be the inclusion of the Mini- Mental State Examination (MMSE) and the Frontal Assessment Battery (FAB) in the Mental Health curriculum, and the FAB and the SIG E CAPS depression screen in the Neurologic Care curriculum. Students will be exposed to these procedures in both rotations so they will come to appreciate the value of detailed mental status assessments in dealing with the great variety of patients seen in these diverse clinical settings. At the same time, traditional neurologic and psychiatric topics that are not directly related to brain-behavior relationships will continue to be taught as before.

Intrasession
The fifth Monday of the eight-week block will include a two-hour seminar for all students on both rotations devoted to the issue of competency. One faculty member from Neurology and one from Psychiatry will co-direct the session, each emphasizing different aspects of the topic. The neurologic component will cover the neurobiological reasons why competence may be compromised, such as stroke, Alzheimer’s Disease, and major psychiatric illness, and the psychiatry component will delineate the physician’s role in evaluating competency and guiding patient care and counseling in light of that determination. Initial plans for the intrasession also included an observed standardized clinical examination (OSCE) during the intrasession, but resource limitations have obliged us to defer this session for the present.

Threads
The thread most appropriate to the Neurologic Care and Mental Health curriculum is Humanities, Ethics, and Professionalism. The competency seminar discussed above is an ideal setting for the purpose of addressing this Thread in the Mental Health /Neurologic Care block. For Neurologic Care students, the topics of brain death, the vegetative state, and the minimally conscious state will be emphasized as the basis for considering a host of complex issues involving patient care, counseling, ethics, and medical-legal implications. These conditions are regularly encountered at all the hospitals, and the residents and faculty have extensive experience in the diagnosis, management, and decision-making regarding these cases.

Translational Basic Science
Many aspects of basic neuroscience relevant to patient care in neurology will have been covered in the second year course, and the extensive syllabus for this eight-week block also serves as the primary educational material for the Neurologic Care rotation. Supplemental readings in basic science aspects of neurology are also recommended. On the clerkship, all of the formats for learning listed below include relevant discussions of the basic science pertaining to the clinical area being considered. Linking of the bench to the bedside has traditionally been emphasized in the rotation. The basic science most crucial neurology is neuroanatomy; correlation between neuroanatomy and patient symptoms and signs is the foundation of clinical neurology, and these are emphasized in every case. Neuropathology, neurophysiology, neuropharmacology, microbiology, and genetics also receive special attention in the context of patient care. Students are tested on their understanding of these areas on the final examination.

Other
In collaboration with Dr. Rubinstein in Neuroradiology, we are instituting a weekly Neuroradiology conference for the medical students based on the imaging tests available from the patients currently on the various hospital services. Additional teaching in this area is desirable and has been a frequent request by past students, and we are pleased to respond by initiating this conference with the inaugural four-week rotation.