Integrated Neuroscience Block Proposal
Mulligan and Sherk, Jan 2014
"Integrated Neuroscience" integrates all neuro-related basic science and clinical material listed in the NBME
Step 1 blueprint. The objectives of this block are to develop
1. a solid understanding of the principles that underlie normal neural function
2. a broad familiarity with types and mechanisms of neural dysfunction
3. clinical skills to assess, diagnose, treat and manage patients with neurological and psychiatric disorders.
At the conclusion of this block, students will enter the clerkship phase prepared to continue developing their
clinical skills, to learn from people with a diversity of neurological and psychiatric disorders, and to contribute
safely to patient care within the context of WWAMI healthcare systems.
The block incorporates all neuro-related material taught in the current curriculum. It involves 4 days of
instruction for 10 weeks, with about 20 hours per week. Unification of all neuro content into one block will
provide a more coherent and seamless educational experience. Redundancies will be eliminated, and gaps in
coverage will be apparent and correctable. Because of the breadth of material covered, the "Integrated
Neuroscience" block will require a highly engaged steering committee and faculty that includes basic scientists
and clinicians drawn from a variety of disciplines (eg primary care, neurology, neuropathology, rehab medicine,
HENT, neuroradiology, neurological surgery, psychiatry, etc). We envision an advisory group that includes
interprofessional expertise, because care of the neurological patient depends heavily on an integrated team of
health care professionals.
Basic science and clinical topics are interwoven throughout the block, and lecture hours are balanced with lab,
practical skill hours, small group sessions, and peer-teaching/peer-learning time. An example of one week’s
activities is presented for Week 5, Motor Systems I, in the lower part of the accompanying block diagram. The
block elaborates the successful lab component of Hubio 532, where students move through a series of stations
(featuring, for example, dissected brains, radiology and neuropathology images), answering questions and
receiving immediate feedback. Faculty are available in the lab for individualized support to accommodate both
faster and slower learners. Within the block, or concurrent with it, students will learn patient assessment skills
(eg. neurological exam) and clinical diagnostics (such as imaging, lumbar puncture) (in yellow) and the
relationship of these to the underlying science. A new feature of the block is weekly Friday teleconferences,
modeled on clinical grand rounds, in which WWAMI students from all sites participate. Faculty throughout the
region will take turns presenting real cases for interactive discussion across the whole group. This exercise
fosters community awareness and advances clinical reasoning skills.
For both clinical and basic science material, we plan to reduce traditional lecture presentation of some topics,
such as neuroanatomical pathways, and clinical signs and symptoms, instead using a portfolio of short on-line
lectures (vodcasts), supplemented with on-line interactive quizzes, using a software tool that we developed
and implemented last year. Weekly TBL sessions (tan in diagram) and small group work (such as jigsaw
sessions-in purple) encourage peer-teaching and learning. Each week, one disease (eg ALS in Week 5 example)
will be highlighted for group discussion of current and future therapeutic strategies, illuminating the linkage
between science and medicine, and offering a model of life-long learning. Where appropriate, ethical, lifespan, and population considerations will be addressed (eg. Life-span tie-in Day 3, ALS on Day 4).
Formative assessment will include boards-style MCQ, and individual and small group written and verbal
reports (eg concept maps, patient summaries) to allow practice of communication and team-work skills, along
with clinical skill assessment by clinicians. NBME subject tests will be used for summative assessment.
Integrated Neuroscience, Block Diagram
Weeks 1 and 2
Neuron and brain
Nervous system
over the lifespan
Neurological exam
Neurological
emergencies
Weeks 3 and 4
Sensory systems
Special senses
Acute pain
Weeks 5 and 6
Motor system
Reflexes
Movement disorders
Cerebellum
Basal ganglia
Week 7
Cognition
Learning and
memory
Language
Traumatic brain
injury
Week 8
Peripheral nervous
system
Autonomic nervous
system
Maintenance of
homeostasis
Weeks 9 and 10
Mind, mood, and
personality
Stress and brain
Chronic pain
Block review
threads
throughout
block
Clinical correlation: clinician and basic scientist joint presentation of patient cases to relate clinical presentation to basic science
Clinical skills & decision-making: neurological exam, neuroradiology, lumbar puncture, simulation, evidence-based medicine
Pathology and therapeutics, including pharmacology, stem cell therapy, role of PTs, OTs, and other health care professionals
Day 1
Day 2
Week 5: Motor Systems 1 (sample week)
Inter-day
Day 3
Day 4
Hour 1
Patient with spinal cord injury
Patient with stroke
Patient with balance
problems
Peer learning: jigsaw session
of small groups comprised
of Group A,B,C members
Hour 2
Motor system fundamentals,
motor cortex and control of
movement
Spectrum of movement
disorders and their
pathophysiologies
Clinical correlation: drugs
affecting balance, balance
in the elderly
ALS, current therapies, new
drug design, end of life
issues
Hour 3
Neurological exam, motor
part
Clinical diagnostics: CMAP
and EMG
Case-based interprofessional
exercise: OTs, PTs, prosthetists, nurses
TBL exercise on MS (1.5 hr)
Lab, Groups B & C: motor
structures, spinal cord, PNS
Lab, Groups A & C: motor
structures, spinal cord, PNS
Clinical
activity
Lab, Groups A & B: motor
structures, spinal cord, PNS
Hour 4
Hour 5
Group A: conferences with
instructors on lower motor
neuron disease & injury
Group B: conferences with
instructors on upper motor
neuron disease & injury
Group C: conferences with
instructors on balance and
brainstem damage
Clinical skills development:
reflex & strength testing
Clinical correlation:
neuroradiology of stroke
Life span tie-in: Cerebral
palsy
Week in review: Q and A
session (0.5 hr)
WWAMI grand rounds via
teleconference