Four-Week Electives for the Clinical Continuum - Department of Psychiatry and Neurology

Child and Adolescent Psychiatry - Southeast Louisiana State Hospital, Lafouche Mental Health Center, and Tulane/JPHSA Infant Team, Tulane /University Pediatric Consult-Liason, East Jefferson Mental Health Center (MDPY PED TAD)

The Selective will be primarily clinically oriented, and the student will have the opportunity to participate in the following activities of the Division of Child Psychiatry:

1. Inpatient developmental neuro-psychiatry and adolescent psychiatry at SELH.
2. Pupil appraisal at LaFourche Parish schools..
3. Infant psychiatry at Tuland/JPHSA infant team.
4. Consult/Liaison Child Psychiatry at Tulane and University Hospitals.
5. Outpatient evaluations at DePaul-Tulane and at East Jefferson Mental Health Center.

Instructors: Drs.Brian Stafford, Betty Muller, Charles H. Zeanah, Jr., Richard Dalton, Neil Boris, Ellen Gandle, Josh Cabrera, and Michael Scheeringa.
Quota: 2 students (exceptions may be made in special circumstances)
Duration: 1 month
Period: July through May (Blocks 01-10)
Prerequisite: None

Electroconvulsive Therapy - ECT (MDPY ECT TMC)

This elective is a high volume ECT experience which consists of initial consultation for appropriateness, initial patient w/v (both inpatient and outpatient) for an ECT series, inpatient management of ECT patients, performing ECT, and determining termination of ECT vs. maintenance planning.  Student will perform 100-150 TXs.  In addition, student will learn to select and administer appropriate anesthesia for ECT.

Objectives:

Students will be trained via Abrahm Text on ECT, will learn to operate an ECT device, perform ECT, and be able to qote the latest research and techniques on ECT.

Outline:

• Mondays, Wednesday, Fridays--8 AM -Noon--ECT TX day
• Mondays, Wednesdays, Fridays--12 Noon - 3 PM--Patient Rounds
• Tuesdays--Consults/Patient Rounds
• Thursdays--8 AM - 12 Noon--Text/Research
• Thursday--12 Noon - 3 PM--Patient Rounds

Geriatric Psychiatry (MDPY GP VAN)

This is a fairly flexible experience.  It primarily will be specialty consultations to select geriatric patients in the VA's Transitional Care Unit.  Educational experiences include direct staffing with myself and a PGY-III psychiatry resident, participation inweekly geriatric medicine team rounds, attendance at geriatric psychiatry lectures formultiple departments, and current literature readings as appropriate to the student's level of knowledge.  In addition, voluntary participation may be available in the VA's geriatric psychiatry outpatient clinic, research and writing, and other current projects.

Objectives:

To expose medical studnts with an interest in geriatrics to the field of psychiatry as it pertains to geriatric medicine and the realm of geriatric care throughout systems.

To provide additional training in geriatric psychiatry to medical students considering psychiatry as their field of study.

Outline:

Non-urgent consultation provided weekly at student & staff's determination.  Staffing of consultations bi-weekly.  Geriatric Medicine Team Meeting on Thursdays.  One to three hours of lecture per week as scheduled previously for psychiatry residents, geriatric medicine fellows, medicine residnts, psychology students, dentistry, etc.

Director:  March Van Gerpen, M.D., Assistant Clinical Professor and chief of the Division fo Geriatric Psychiatry
Quota: one student
Time Offered: four weeks (Block 1)
Duration: one month
Prerequisite: Successful completion of T-3 year.  Dr. Van Gerpen's permission.
Method of Evaluating Student's Performance:  Direct observation and clinical supervision by Dr. Van Gerpen.

How is this course evaluated by the Course Director:  Tulane University School of Medicine, Department of Psychiatry, Student Evaluation form

How is this course evaluated by students:  Tulane University School of Medicine, Owl Club Evaluation, Psychiatry  

Medicine Psychiatry Elective (MDPY MPE TMC)

A broad range of clinica experience is possible, including inpatient medicine, inpatient psychiatry, and med/psych clinics under the supervision of the director.  The student will have first hand experience in management of patients who present with both medical and psychiatric disorders, some of which will fall in the categories of somatoform disorders and psychosomatic disorders (psychological factors affecting medical condition).

Objectives:

1. Increase awareness of psychiatric issues in medical patients,
2. Gain knowledge and experience treating psychiatric disorders and medical illness simultaneously,
3. Gain exposure to Tulane combined med/psych residency program.

Inpatient Psychiatry - Medical Center of Louisiana (MDPY INP TMC)

Student will participate on a full-time basis in total psychiatric care, beginning with admission and evaluation of patients.  The student will be supervised in writing admission treatment orders and formulating therapeutic plans.  The student can then follow patients through inpatient hospitalization and discharge.  The student will be expected to participate in departmental conferences, residents' didactic lectures, literature seminars, staff conferences, consultative conferences, etc.  Individual reading assignments will be made as they correlate with clinical material presented.  This clerkship is designed to give students an in-depth exposure to care and management of  inpatient Psychiatry patients.

No final exam.

Instructor:  Pat O'Neill, M.D. and staff
Quota: 1 student
Duration: 1 month
Time Offered: Any month
Prerequisite: Permission of Instructor

Addiction Medicine/Addiction Psychiatry:  Depaul Hospital (MDPY AMP DEP)

The medical student will accompany faculty member on hospital rounds and participate in staffings.  The student will be given the opportunity to participate in treatment groups on an experimental basis.  The student will observe and participate in new patient assessments and follow-up visits.

Multidisciplinary Team Treatment is the backbone of treatment for substance dependence (DSM IV).  In these sessions, representatives from each of the participating professional disciplines assemble to discuss patient progress, recommend interventions, and to develop a discharge plan.  The usual disciplines represented are MD, RN, MSW, and AT, as well as their trainees.

The student will be required to attend multidisciplinary staff meetings at River Oaks Hospital each weekday under the direct supervision of the Clerkship Director.  There will also be required group attendance as an experiential training each morningas an observer and co-therapist.  In addition, the student will attend monthly multidisciplinary staffing and group at the Family House Program for pregnant women with dependent children, as well as the multidisciplinary team staffing of ARRNO Intensive and Residential Treatment Center program, each once weekly.

In the afternoons and/or evenings, the student will attend groups of the Intensive Outpatient Progam or Residentail Treatment Center program.  Attendance at two 12-step meetings will be required during the rotation.

At all of the above described events, the student will be under the direct supervision of the Clerkship Director.  This includes the multidisciplinary team staffing, patient examinations, and most of the group therapy sessions.  In addition, an hour a week will be set aside with the faculty member for review and supervision.

Objectives:

A student will have first-hand experience with the identification and treatment of Addictive Disease in patients with early and middle stage illness.

The student will also be exposed to effective treatments for a variety of chemical dependency patients in a variety of settings.

Outline:

Students will be assigned specific readings in the American Society of Addiction Medicine (ASAM) textbook entitled "Principles of Addiction Medicine" and will have individual time with a faculty member to discuss patient encounter experiences.  The hours will be as follows:

• 8 am - noon, Monday through Friday, at River Oaks Hospital
• 1 p.m. - 3:30 p.m., Monday through Friday with RTC Group at Addiction Recovery Resources of New Orleans (ARRNO) for two weeks.
• 6 p.m. - 9 p.m., Monday through Friday with IOP Group at Addiction Recovery Resources of New Orleans (ARRNO) for two weeks.
• Trip to Family House every third Tuesday of the month.

How Selective Is Evaluated By Course Director:  Exit Assessment Survey - Faculty and course director evaluation will occur through interacting with students.

How Is Selective Evaluated By Students: Will be developed and maintained on file.  This will be the basis for improvements in the clerkship.

Addiction Psychiatry - Ochsner ClinicFoundation (MDPY ADD OCH)

Note to Visiting Students:  Ochsner Clinic Hospital requires all visiting students (non-Tulane students) to make arrangements for senior electives directly with their Medical Education Department by calling (504) 842-3260.

This Selective will expose students to both inpatients and day patients undergoing treatment for chemical dependency and/or pathological gambling.  The program combines intensive cognitive/behavioral therapy with an emphasis on 12 Step Recovery Programs.  Patients participate in group therapy in addition to individual psychotherapy. Students will also attend liver transplant patient selection meetings regarding patients recovering from chemical dependency.

Objectives:

Upon completion, students should be able to do a comprehensive history and pertinent physical exam and develop an acute and long-term treatment plan utilizing the biopsychosocial model.

Outline:

Program usually has a census of 5-10 patients attending Monday through Friday, 8:00 a.m.-4:00 p.m.  The average length of patient stay is 2-3 weeks. Hours of student attendance are Monday through Friday, 8 a.m. through 4:00 p.m.

Director:  Dean A. Hickman, M.D.; Medical Director, Addictive Behavior Unit; Ochsner Foundation Hospital; Board Certified Psychiatrist
Faculty:  Eileen Correra, Ph.D., Enrique Ortiz, L..C.S.W.
Quota: 2 students per block
Duration: 4 weeks (1 block)
Time Offered: Blocks 01-10
Prerequisite: None
Method Of Evaluation Of Student Performance:  Summary letter by course director or evaluation sheet.

How Selective Is Evaluated By Students:  Each student is given a course evaluation sheet to complete and return to the Tulane Department of Psychiatry/Neurology.

How Selective Is Evaluated By Course Director:  Feedback would be solicited directly from the students and from the Tulane Department of Psychiatry/Neurology after the course evaluation sheets have been returned by the students.

Consultation-Liaison Psychiatry (MDPY CLP CH)

This selective will focus on the psychiatric evaluation of patients on medical/surgical services and in intensive care units.  Under faculty and resident supervision, students will evaluate and follow such patients throughout their hospital stay with the attending psychiatrist and psychiatry resident.  The students will also work with primary treatment teams and assist in providing liaison services to coordinate optimum patient care.  Assigned readings and discussions of appropriate medical literature will occur on a weekly basis with the attending psychiatrist and residents.

Objectives: 

1. Increased awareness of somatizaiton in the general population.
2. Increased appreciation of the combined medical/psychiatric problems experienced by specialists and subspecialists in medical and surgical fields.
3. Increased expertise in diagnosis and treatment of such patients.
4. Increased understanding of the imperative for communication across specialities to appropriately manage complex biopsychosocial problems.

Students will round daily with the attending psychiatrist and residents and will be responsible for comprehensive evaluations and follow-up of patients with combined medical/psychiatric problems.  Recommendations fro treatment will be considered with the supervising psychiatrist and residnts in a conference setting.  Students will be involved in the liaison component with medical and surgical faculty and residents.

Course Director: Jack Roniger, M.D.
Quota: 2 students
Time Offered: Blocks 1-12
Duration: one month
Prerequisite: None
Method Of Evaluation Of Student Performance: Daily clinical supervision.

How is this course evaluated by the Course Director: Resident and student feedback.

How is this course evaluated by students: Tulane University School of Medicine Selective Evaluation form.

Clinical Neurology Clerkship - Tulane Medical Center (MDNE NEU TMC)

Students will be assigned to one of the Tulane affiliated hospitals under the direct supervision of a Neurology resident and staff physician.  He will work on the inpatient service and his responsibilities will include direct primary care of patients, under supervision, on the Neurology service, from admission to discharge.  An alternative rotation attending the many outpatient Neurology subspecialty clinics is also available. During this time the student will be instructed in the utilization of all neuro-diagnostic procedures. The student will be assigned to one staff physician who will be directly responsible for the student's didactic teaching.  The student may also participate in neurological consultation.  No final exam.

Instructors:  Neurology faculty
Quota: 2 students
Duration: 1 month
Prerequisite: Permission of Instructor
Time Offered: Full academic year (Blocks 01-10)

Pediatric Neurology - Medical Center Of Louisiana And Tulane Medical Center (MDNE PED C/T)

Under the direction of the Child Neurology faculty, the student will function as a "Junior Fellow" in the care of inpatients and outpatients at Medical Center of Louisiana and TMC.  Goals will be to develop proficiency in the neurological exam including growth and development and to learn approaches to the evaluation of major problems in Child Neurology.  No night call.  No final exam.

Quota: 1 student
Duration: 1 month
Prerequisite: Permission of Instructor

Independent Study In Neurology  Adult and/or Child - Tulane Medical Center (MDNE IS TMC)

Student will work (by mutual agreement) with individual faculty member(s) on a basic or clinic research project.  The student will be encouraged to take this Selective early in the fourth year such that the project can be carried through the year.  The ultimate goal would be the production of an abstract and/or manuscript for publication.  The student may alternatively wish to undertake an in-depth review of a particular topic with the faculty serving as a tutorial guide.  There is no final examination.  This Selective is to be arranged with the individual faculty member and approved by Dr. Weisberg.

Quota: 1 student
Duration: 1 month minimum
Period: July through May (Blocks 01-10)
Prerequisite: Permission of Instructor

Pediatric Neurology - Tulane Medical Center (MDNE PED TMC)

The student will have the opportunity to work both on the outpatient and inpatient services under the tutelage of the consultants and residents in Pediatric Neurology.  Students work with one consultant at a time on a rotating basis so that he or she has a broad exposure both to staff as well as to clinical material.

When assigned to the hospital service, the student is expected to make morning rounds with the consultant and residents.  He or she will then present the patients they have worked up and participate in the decision making process and follow the patient throughout the hospitalization.  The student is also expected to make afternoon rounds with the residents and is encouraged to be available to see emergent and acute problems as they present and to perform appropriate procedures under the guidance of the resident.

In the outpatient department the student will be expected to work-up assigned patients and to appropriately record the findings formulating an appropriate differential diagnosis as well as appropriate investigative studies.  The student will present the patient to the consultant discussing the case after the consultant has also examined the patient, and participate in the order of appropriate studies.  The student is expected to follow the patient through clinic evaluation, ultimately presenting a final formulation to the consultant upon completion of appropriate studies.

During his or her clerkship the student has the opportunity to observe various neurodiagnostic procedures including EMG, EEG, and neuroradiologic procedures as well as formal evaluations of cognitive and intellectual functions.  This allows the student to become more familiar with the limitations as well as the specific contributions that these procedures may have in contributing specific diagnostic information.  The student is expected to attend the clinical and didactic Neurologic and Pediatric Conferences during his or her clerkship.

Specific Goals Of The Clerkship:

The goals of this clerkship are that the student:

1. Learn to elicit an adequate Pediatric Neurologic history and perform a neurologic examination on the Pediatric patient;
2. Develop increasing sophistication in interpreting the clinical findings and synthesizing them into a rational differential diagnosis,
3. Develop an increased understanding of the selection of appropriate laboratory tests both in terms of sequence and nature necessary to establish a specific diagnosis, and
4. Attain an increased understanding of management principles including appropriate choice of therapeutic modalities and the inherent risks of each.

Outline:

Clinical Activities - Workup of a broad variety of patients and active participation in the evaluation, goal-setting management and coordination of patients' rehabilitation programs.

Program Coordinator:  Diane Africk, M.D.
Quota: 1 student
Duration: 1 to 2 months
Prerequisite: Permission of Instructor

Behavioral Neurology - Tulane Medical Center And V.A. Hospital (MDNE BEH T/V)

Clinical rotation at Tulane Hospital/Clinic and VA Hospital.  Participation in outpatient Memory Disorders Clinic and inpatient consultation services.  Student will work with Neurologist, Psychiatrist, and Neuropsychologist in listening about various neurobehavioral syndromes, especially dementia and delirium.

Objectives:

The student will learn:

1. How to do a complete mental status examination;
2. Differential diagnosis of dementia and delirium;
3. Principles of management of patients;
4. Current literature on Alzheimer's disease and related disorders.

Attend Memory Disorders Clinic at TMC and VA. Do inpatient consultations, under supervision.  Participate in team meetings and didactic sessions.  Reading lists provided.  Discussions with faculty.

Director:  Benjamin Seltzer, M.D.
Faculty:  Benjamin Seltzer, M.D.; F. W. Black, Ph.D.
Quota: 1 per month
Time Offered: Full academic year (Blocks 01-10)
Duration: 1 month or more
Prerequisite: Junior Neurology Clerkship and permission of the instructor.
Method Of Evaluation: Interaction with patients and staff.  No examination.

How This Selective Is Evaluated By Students:  Written comments.

Headache Diagnosis And Management - Tulane Medical School (MDNE HED TMC)

A clinical rotation at the Tulane Headache Center will be provided.  The student will work with the Neurologist and Psychophysiologist in learning all aspects of headache evaluation and treatment.

Objectives:

The student will become familiar with:

1. Diagnosis of benign recurrent headache syndromes such as tension-type, migraine, clusters, etc.;
2. headache management in a clinic and inpatient setting;
3. emergency diagnosis of cranial and cervical pathology causing headache;
4. psychophysiologic approaches to headache;
5. the pathophysiology of chronic headache.

The student will attend headache clinics, weekly headache meetings, and biofeedback sessions.  The student will manage all patients admitted to the hospital for headache management, under close supervision of the attending faculty at all times.  Reading lists will be provided and informal discussions will take place with the faculty.

Directors:  Debra Elliott, M.D.; Barry D. Schwartz, Ph. D.
Quota: 1 per month
Time Offered: Full academic year (Blocks 01-10)
Duration: 1 month
Prerequisite: Junior Clinical Neurology clerkship and Permission of Instructor.
Method Of Evaluation Of Student Performance:  Clinical interaction with patients and participation in clinic.  No final exam will be required.

How This Selective Is Evaluated By Students:  Via written comments at the end of each rotation.

Outpatient Neurology - Tulane Medical Center, Medical Center Of Louisiana, and Veterans Administration (MDNE OUT CTV)

This is a clinical Neurology experience at various outpatient neurologic settings.  Students will have a wide variety of subspecialty clinics and General Neurology clinics from which to organize their own supervised daily schedule.  Students will both observe patients in private neurologic clinics as well as examine their own patients in the Charity Hospital Neurology clinic and present to the faculty member.  There is no final examination.

Objective:

1. To become more familiar with common practices of outpatient Neurology in various practice settings.
2. To gain further experience in selected subspecialties within the field of Neurology by working closely with faculty.
3. Toward the end of the month, the student should become familiar with at least four of the following clinical areas:
   1. Neuromuscular Disorders
   2. Chronic Headache
   3. Sleep Disorders
   4. Ataxia and Movement Disorders
   5. Multiple Sclerosis
   6. Memory Disorders
   7. Adults with Static Encephalopathy (mental retardation)
   8. AIDS
   9. Epilepsy
   10. General Outpatient Neurology

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