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Brain and Mind

Leopold Streletz, M.D., Course Director
Samar Al Amad, Basic Science Curriculum Coordinator

Brain and Mind is an integrated course that ranges from basic neuroscience and gross anatomy of the head and neck to neurological diagnosis and psychopathology. The faculty is drawn from the Departments of Neurology & Neuroscience, Pathology, Pharmacology, Physiology & Biophysics, Psychiatry, and Radiology. The course synthesizes basic science and clinical aspects of information about the central nervous system to promote both the acquisition of fundamental knowledge and the development of diagnostic skills. The teaching modalities that are utilized emphasize active student participation. Important features are the problem-based analysis of classical neurological and psychiatric disorders, and the opportunity to examine individual patients in clinic settings. Information on key topics is provided in the form of lectures, patient presentations and small-group tutorials, as well as laboratory sessions on neuroanatomy and gross anatomy of the head and neck. Acquaintance with contemporary research ideas and techniques is fostered by journal club sessions that review papers from the current literature. Computer-based educational and research tools enhance many of these activities.

Problem-Based Learning (PBL)

The backbone of the course is a series of cases embodying important clinical entities in Neurology and Psychiatry. These cases have been selected to provide the basis for an orderly development of knowledge in basic and clinical neuroscience.

Lectures and Patient Presentations

Lectures deal with key topics in both the basic science and clinical areas. Lecturers have been selected for their skill in this form of teaching as well as their expertise in particular subjects.

Laboratories and Small Group Sessions

Clinical Anatomy Dissection and Imaging Laboratory. The anatomy of the head and neck is an important component of this course, leading into a view of the brain, spinal cord, sense organs and the viscera of the Head and Neck, in relation to their surrounding structures. The laboratory sessions include dissection, examination of prosections and models, and correlations with radiological images.

Functional Neuroanatomy Laboratory. Computer-based exercises and small-group tutorials are used to convey a three-dimensional perspective of brain structure and its functional correlations.

Small Group Tutorials. These include sessions on neuropathology, neuroradiology, neuropharmacology, brain imaging and behavioral science. Various learning modalities are involved, including problem sets, discussion of scientific papers and computer-based exercises.

Clinical Experiences

Afternoon sessions in diagnosis of neurological disease and psychopathology provide direct patient contact to enable students to develop their interview and diagnostic skills in these areas.

Psychopathology. The clinic sessions take place on Monday mornings at the Hamad Medical Center, with the class in three groups.

Physical Diagnosis of Neurological Disease. In two periods the students are instructed in the principles of neurological examination and practice the exam in the Clinical Skills Center. Two periods involve examination of patients in a clinic or the hospital at Hamad Medical Center. This series also includes patient presentations and clinical problem-solving sessions on motor, sensory and visual disorders.

Journal Clubs

Articles selected from the current literature in basic neuroscience research are discussed, with emphasis on the analysis of experimental design and technique, as well as the significance of the results. Related articles for general readers highlight the broader scientific and social significance of the Journal Club articles. Six sessions review articles identified in the course.

Knowledge:

• Gross brain morphology (including the brain’s developmental configuration and its blood supply) and dynamics of CSF.
• Functional properties of nervous tissue in the CNS, as a basis for understanding its normal activity (including memory and sleep) and how activity is disturbed by pathological processes, e.g. ischemia, neurodegeneration, traumatic injury, epilepsy.
• Anatomy and function of motor and sensory pathways and their control centers in relation to the principles of neurological testing and localization of neurological lesions.
• Neuropathology of important clinical entities, including neoplasms, degenerative disorders, infections, vascular disease and autoimmune disease.
• Pharmacology of clinically important drugs, including analgesics, anesthetics, anti-epileptics, anti-depressants, anti-psychotics, anxiolytics and drugs of abuse.
• Gross anatomy of the head and neck, including its implications for clinical problems, especially in relation to the nervous system.
• Use of brain imaging (i.e., CT, MRI, PET, SPECT, angiography) for clinical and experimental purposes.
• Epidemiology, etiology, clinical manifestations, diagnostic procedures and treatment of common psychopathological syndromes, including schizophrenia, depression, bipolar disease, suicide, anxiety, personality disorders, eating disorders, substance abuse somatoform disorders and childhood disorders.
• Epidemiology, etiology, clinical manifestations, diagnostic procedures and treatment of common neurological disorders, including nerve compression, dementia, aphasia, pain syndromes, Parkinson’s disease, multiple sclerosis, epilepsy, neoplasms, headache, paraplegia, peripheral neuropathies, stroke, and Tourette’s syndrome.
• Introduction to neurological surgery.
• Basic principles of the neurological and neuro-opthalmological examinations

Skills and Attitudes:

• Essentials of history-taking and diagnosis in psychiatric and neurological patients (with particular emphasis on approach to interview skills in cognitively and psychiatrically impaired patients.
• Instruction in the performance of a complete mental status examination in psychiatric and neurological patients.
• Instruction in the performance of a complete ophthalmologic and neurological examination.
• Instruction in the oral and written presentation of the history, physical findings and diagnostic formulation of patients with neurological and psychiatric disorders.

Quizzes and Practical Exams

A 50-minute quiz each week, usually on Sunday at 8 a.m., is used for an objective assessment of the student’s comprehension of substantive information from the lectures, small group tutorial sessions, patient presentations, PBL case, Journal Club, Functional Neuroanatomy Laboratories and Clinical Anatomy Laboratories. The quizzes are generally a test of the previous week’s material. Although the quizzes include questions on the Clinical Anatomy and Functional Neuroanatomy components, the final course grades for these components are determined by practical exams of cumulative knowledge in each of these areas, given toward the end of the course.

Clinical Skills Assessment

The clinical Preceptors at HMC will provide assessments of student performance, including patient write-ups. In the Psychopathology Clinics and the Neurological Physical Diagnosis sessions each student is required to produce patient write-ups, which are graded by their respective Preceptors.

Triple Jump Examination

During the last two days of the course, students undergo an examination based on a case similar to those discussed in the PBL sessions, consisting of three components: a written analysis of the case, overnight independent study of the original case material plus additional information about the case, and written answers to questions on the studied material. The students use classroom computers for the written portions of the examination.

Other Performance Assessments

The Preceptors in the PBL sessions and Journal Clubs will provide quantitative assessments of each student’s performance on the basis of attendance, participation in discussion and quality of contribution. These Preceptors, as well as those in the various small group activities, will also provide narrative comments about student performance where appropriate.

Course Grades

The final grade in the course is based on the following components:

1. Exams:
   • Weekly quizzes 30%
   • Clinical Anatomy 10%
   • Functional Neuroanatomy 10%
   • Triple Jump Examination 10%
2. Analytical skills and professional attributes:
   • PBL 20%
   • Journal Club 5%
   • Psychopathology Clinics 10%
   • Neurology Physical Diagnosis 5%

Grading Process

The grades assigned at the end of the course are Honors (top 20% of the class), Pass (65% or above in each of the above components), Marginal (65% or above for the overall course grade but below 65% in any one or more of the above components) and Failure (below 65% for the overall course grade). A Marginal grade will require remediation of each of the individual components that were below 65%; a Failure will require remediation of all components. The remediation will consist of further study and/or examination, as determined by the Course Directors, to be completed at a time specified in the Academic Calendar. Failure of remediation of any component will result in a grade of Failure for the course as a whole, which will require appropriate further remediation as indicated in the Guidelines for Promotion and Graduation.