1. science
2. medicine

SPRING 2009
University
of
Pittsburgh
School
of
Medicine
MINI-ELECTIVE
COURSES
Elective Opportunities for
First and Second Year
Medical Students
Office
of
Medical
Education
www.omed.pitt.edu
412.648.8714
1
© University of Pittsburgh 2009
MINI-ELECTIVES
SPRING 2009
University
of
Pittsburgh
School
of
Medicine
This brochure describes UPSOM’s Mini-Elective course offerings for Spring 2009.
Mini-Electives represent a golden opportunity to use small aliquots of time to
explore topics that complement the core medical student curriculum.
These course descriptions are also available at http://www.omed.pitt.edu/
curriculum/mini-electives.php.
The Mini-Elective course offerings are open to any first- or second-year student
who is able to commit to attending all course sessions.
NOTE: Students who have other assigned academic commitments at
the course times (e.g., Clinical Experience, Advanced Physical Examina
tion, or Clinical Procedures sessions) must meet those commitments.
Therefore, some students may not be able to enroll in some minielectives.
These courses are graded on a pass-fail basis. Students who successfully complete a mini-elective course will receive a certificate of completion, and a copy
will be placed in their permanent record. It will not be shown on their official
University transcript.
Registration will open by email notification on a specific date and at a specific
time, generally within approximately one month prior to the start date of the
course, to give every student an opportunity to register. Registration will also
close at a specified date and time.
There are limited spaces in these courses based on the maximum number of
students designated by the course director. If there are more interested students than can be accommodated, students will be selected on a first-come, first
-served basis, using the date and time of the email message to determine registration preference.
Once registration is closed, students will be notified by email of their registration
acceptance, or wait-list status.
Questions about how to register for these Mini-Elective courses should be directed to Betsy Nero, in the Office of Medical Education, at 412-648-9829 or
[email protected].
Questions about a specific Mini-Elective should be directed to the individual
course director.
Office
of
Medical
Education
Many Mini-Electives were inspired by student suggestions. If you have ideas for
new courses or suggestions for improvements to the Mini-Elective program,
please contact Dr. John Mahoney, Associate Dean for Medical Education, at
[email protected] or 412-648-8714.
www.omed.pitt.edu
412.648.8714
2
MINI-ELECTIVES SCHEDULE SUMMARY
SPRING 2009
COURSES FOR FIRST YEAR MEDICAL STUDENTS
Dates
Page
Stepping Out: Community Based Research
Thursdays, Jan 15, 22, 29, Feb 5, 12, 19
9
Art and Medicine
Thursdays, Jan 15, 22, 29, Feb 12
6
Introduction to Disaster Management
Wednesdays, Jan 21, *30, Feb 11, 18
25
Concepts in Human Motion
Mondays, Feb 1, 9, 16, 23
22
Natural History of Medicine: Evolutionary
Principles and Anthropological Applications
Thursdays, Feb 5, 12, 19, 26
The Healer’s Art: Awakening the Heart
Wednesdays, Feb 11, 18, 25, Apr 1, 15
20
Nutrition and Medicine
Mondays, Mar 23, 30, Apr 6, 13, 20, 27
51
Introduction to Anatomic Pathology
March 23, 30, April 6, 13
31
Human Patient Simulation
March 23, Apr 13, 20, 27
25
Medicine and Literature
Mondays, Mar 30, Apr 6, 13, 20
38
Mouth, Body & Medicine
Mondays, March 30, Apr 6, 13, 27
43
Emerging Infectious Diseases
Mondays, Apr 6, 13, 20, 27
15
The Emergency Expert
October 2008—March 2009
12
Essential Procedures in Clinical Medicine
September 2008—May 2009
17
48
Introduction to the Real World of Public Health
COURSES FOR SECOND YEAR MEDICAL STUDENTS
Dates
Introduction to Disaster Management
Wednesdays, Jan 21, *30, Feb 11, 18
Advanced Pediatric Interviewing
January 26—Orientation
Tuesdays, Feb 10, 17, 24, Mar 3, 10, 17
Wednesdays, Feb 11, 18, 25, Mar 4, 11, 18
Thursdays, Feb 12, 19, 26, Mar 5, 12, 19
Introduction to Medical Education
Mondays, Feb 9, 16, Mar 2, 9, 16
Page
28
4
34
Preventing and Managing Metabolic Syndrome Mondays, Feb 9, 16, Mar 2, 16
Among the Seriously Mentally Ill
40
Occupational Lung Diseases: A MultiDisciplinary Approach
Mondays, Feb 9, 16
Tuesdays, Feb 10, 17
53
The Real World of Medicine: Legal Aspects
Mondays, Mar 2, 9, 16, 23
58
The Real World of Medicine: Business Aspects Tuesdays, Mar 3, 10, 17, 24
56
Natural History of Medicine: Evolutionary
Medicine
Tuesdays, Mar 3, 10, 17, 24
45
The Emergency Expert
October 2008—March 2009
12
Essential Procedures in Clinical Medicine
September 2008—May 2009
17
3
Advanced Pediatric Interviewing
Mini-Elective
Spring 2009
University
of
Pittsburgh
Course Dates:
January 26—Orientation (5:30 pm)
February 10, 17, 24, March 3, 10, 17
Tuesday evenings, 5:30—7:00 PM
School
of
Medicine
February 11, 18, 25, March 4, 11, 18
Wednesday evenings, 5:30—7:00 PM
February 12, 19, 26, March 5, 12, 19
Thursday evenings, 5:30—7:00 PM
Maximum Students:
18
Class Year:
MS2
Course Directors:
Geoffrey Kurland, MD
Orooj Fasiuddin, MD
Contact Information:
Geoffrey Kurland, MD
[email protected]
Orooj Fasiuddin, MD
[email protected]
Registration:
Office
of
Medical
Education
www.omed.pitt.edu
412.648.8714
Marlynn Haigh, Course Coordinator
[email protected]
412-692-8260
Description:
This mini-elective course takes place over a six-week period with a single 11/2 hour meeting per week. For each meeting, two students are each assigned an illness or diagnosis. During the meeting, two other students are assigned the task of each interviewing one student who has a diagnosis/illness.
The “patient” student can portray a patient (say, a teenager) or a parent. The
interviewing student has about 20 minutes to direct the interview of the present illness in order to reach a reasonable differential diagnosis based solely
on history. Two members of the faculty are present for the sessions, in part
to provide direct feedback, and also to suggest different lines of questioning
for the interviewers. At the end of the 20 minute history, the interviewing student sums up the history and offers a differential diagnosis, if possible. The
“patient” student then provides the diagnosis, giving a brief discussion of the
typical presentation and history. All present then are able to critique the
“interviewing” student’s technique. Two “patients” are interviewed for each
session. The students each have a chance to be “patient” and “interviewer”
on several occasions.
This course has been enthusiastically received by students who have taken it
in the past. It is our impression that students who have participated in the
course had improved facility with pediatric interviews during their required
clerkship in Pediatrics.
4
Objectives:
•
•
•
•
•
•
•
•
To enhance directed interviewing skills.
To become familiar with aspects of the pediatric history.
To gain an appreciation of the skills involved in assimilating information obtained from the history.
To develop the ability to formulate a differential diagnosis.
To become familiar with the presentation of common pediatric illnesses.
To develop and refine interviewing techniques as they apply to pediatric diseases.
To become familiar with thought processes involved in determining a differential diagnosis.
To increase students’ understanding of more common diagnostic entities in terms of history and
common manifestations.
Requirements:
•
•
Active participation in all 6 course sessions
Out-of-class research on a specified medical condition, as preparation for in-class role play
related to the condition (2 sessions per student).
Course Overview:
Logistics of the Course:
The course will run for 6 weeks for 1½ hours per week. There will be a 30 minute orientation session
before the course commences.
Location:
All sessions: To be announced.
Groups of no more than 6 students will be enrolled for each section (each evening) of the course. This
will allow each student to be the patient and the interviewer twice. All students are welcome but we
would particularly encourage 2nd year students who have an interest in Pediatrics to participate.
Specifics of the Course:
•
For each session, one student will be the “patient” or “parent” (with an assigned illness) and the other
student will be the interviewer. The student with the assigned illness will be required to research that
particular illness prior to the session. Acting as “patient” or “parent”, the student will have a chief
complaint. It will be the duty of the interviewer to ascertain a reasonable differential diagnosis
through exploration of the history of present illness (HPI) in approximately 20 minutes.
•
As the interview progresses, it will be the responsibility of the preceptor to ask the interviewer what
he or she is thinking and try to keep the interviewer on track (by suggesting further questions or areas to cover, without being too obvious as to the diagnosis).
•
At the end of the 20 minutes, the interviewer will summarize the “patient’s” history and give some
ideas as to a possible diagnosis that may be responsible for the history.
•
Following this, the patient will reveal the diagnosis and give a brief talk on what the entity was and
what the key elements of the history were (or point out those areas not explored by the interviewer).
•
The discussion by the “patient” student may be accompanied by a printed handout that is distributed
to the group on the “diagnosis.”
5
Art and Medicine
Mini-Elective
Spring 2009
University
of
Pittsburgh
School
of
Medicine
Course Dates:
March 26, April 2, 23, 30
Thursdays, 1:00 –3:00 PM
Maximum Students:
12
Class Year:
MS1
Course Director:
Marilyn M. Russell
Curator of Education
Carnegie Museum of Art
Contact Information:
Marilyn M. Russell
412-622-3374
[email protected]
Registration:
Betsy Nero, Office of Medical Education
[email protected]
Description:
It is a little known fact that a 19th century doctor, Giovanni Morelli, invented
modern art connoisseurship by adapting the methods of comparative anatomy
to create a “scientific” approach to art. Today, modern connoisseurship and
modern medicine blend art and science in the observation and analysis of visual information, as well as in interpreting the expressive languages of the human body.
To explore these ideas, museum educators and curators will lead students
through a series of observations, discussions, and exercises based on works of
art in the galleries at Carnegie Museum of Art and at The Andy Warhol Museum. This 4-session course uses art to hone visual acuity skills while increasing awareness of factors that influence what we see, how we interpret it, and
subsequent assessments, evaluations, and decisions. Throughout the course,
implications for medical practice will be considered.
Office
of
Medical
Education
www.omed.pitt.edu
412.648.8714
Objectives:
• To enhance participants’ abilities for careful observation, description, and
interpretation of visual information;
• To gain an awareness and understanding of conscious and unconscious
factors that influence observation and interpretation of visual information
and the implications for decision making;
• To engage in thoughtful consideration of some implications of visual learning for medical practice;
• To deepen awareness of the arts as a vehicle for understanding the human
condition.
Requirements:
• Actively participate in all four course sessions including vigorous discussion.
• Complete reading assignments (fewer than 25-30 pages each).
• Reflect in writing on the week’s discussion (approx. 1 page each week except the first class meeting)
• Produce concluding statement (approximately 2-3 pages) indicating personal insights from or implications of the course.
•
6
Course Outline
Art and Medicine
Course Director:
Marilyn M. Russell
Curator of Education
Carnegie Museum of Art
Instructors:
Curatorial, Education and Conservation Staff at Carnegie Museum of Art and the Andy Warhol Museum.
Course Objectives:
• To enhance participants’ abilities for careful observation, description, and interpretation of visual information;
• To gain an awareness and understanding of conscious and unconscious factors that influence observation and interpretation of visual information and the implications for decision making;
• To engage in thoughtful consideration of some implications of visual learning for medical practice;
• To deepen awareness of the arts as a vehicle for understanding the human condition.
Location:
All sessions
Meet in the Lobby of the designated museum on each date.
Group will then proceed to the gallery in each museum.
Session 1: Looking is Only Part of Seeing
The Andy Warhol Museum, March 26, 1:00 – 3:00 p.m.
Through the lens of Andy Warhol’s life and art as well as contemporary art in the special exhibition, The
End: Analyzing Art for Troubled Times, the session will draw parallels between art and medicine and will
examine how point of view, context, and framing affect how we see. Group discussion and a variety of
interpretive activities will explore how looking is only part of interpreting what we see.
• Point of View: How You See Depends on Who is Looking. Personal and socio-cultural experience mediates how we process the world around us. As with a patient’s medical history, an artist’s biography may
hold the key to understanding an artwork. Yet does biography always matter? Are there circumstances
when our point of view may inhibit interpretation? Through an in-depth exploration of individual responses to a specific artwork the group will discuss the role of point of view in interpretation and whether
or not neutrality, objectivity, and emotional distance are indeed possible.
• Context. The art gallery’s white space and the doctor’s white coat have been two of the classic symbols
of art and science for our time. If symbols reflect our societal belief systems and values, what does our
predilection for whiteness suggest? How does the context of the white coat or the white space shape a
patient’s or viewer’s experience?
• Framing. How information is framed or presented is often critical to interpretation and analysis. In
medicine or art the influence of critical opinion and environmental factors can shape how we see, what
we notice, the questions we ask, and how we interpret what we are looking at. Students will explore and
discuss how our perception and modes of analysis are shaped by how something is presented to us.
Session 2: Seeing is Believing
Carnegie Museum of Art, April 2, 1:00 – 3:00 p.m.
Observation, hypothesis, analysis, interpretation, decision making----the processes of the scientist are
also those of the artist and the art historian. But recent studies of perception and cognition have shown
that our eyes and brains constantly process visual information in ways of which we are largely unaware
with important implications for decision making. In a series of individual and group experiences in the
galleries, participants will observe and describe a series of artworks uncovering what can be gleaned
from observation, discussing and debating what conclusions can be grounded in observation, and what
7
factors—conscious or unconscious—influence looking, seeing, and interpreting visual information. This
approach will be contrasted with a systematic process for decoding an unfamiliar work of art beginning
with observations of what is represented to consideration of the composition, materials, and context that
contribute to its impact and interpretation. Test your visual acuity a skill central to reading facial expression, body language, and other physical characteristics as well as image-based test results. Awareness
and understanding of intuitive and analytical responses to works of art are also reinforced through hands
-on activities.
Session 3: Art Doctors
Carnegie Museum of Art, April 23, 1:00 –3:00 p.m.
This session continues to explore methods for collecting and organizing visual information for the purpose
of decision making. Penetrating the surface of works of art is the job of the fine art conservator. Issues
such as what can be determined and how that information is ethically and productively used are the focus of this session. Two important works in the museum’s collection are the subjects. Conservators lead
a case study on what can be observed and understood in testing situations: examination under the microscope, with ultraviolet light, and with other equipment. The conservators will also lead a brief discussion of conservation ethics, covering key questions: when not to treat; how much to do; when to stop.
Students will then borrow from both data-driven and subjective analytical processes to recommend a
course of action regarding the two works of art.
Session 4: Practice: How You Work as a Key to Understanding
The Andy Warhol Museum, April 30, 1:00— 3:00 p.m. (Reception following)
Understanding process can often shed light on what is seen. Shifting the focus from the interpretation of
a specific object to an artist’s practice – the conceptual approach or method by which an artist goes
about making art - can reveal an organizing principle which deepens our understanding of not only an
artist’s work but its connection to human behavior. Warhol used framing devices to make his art including cardboard boxes, tape recorders, and cameras capture and organize information around him. Students will examine Warhol’s art practices and draw parallels with other professional practices. In the studio students will get first-hand knowledge of Warhol’s reproduction methods as they learn the photographic silkscreen process.
8
Stepping Out: Community Based Research
Tools and Techniques
Mini-Elective
Spring 2009
University
of
Pittsburgh
School
of
Medicine
Course Dates:
January 15, 22, 29, February 5, 12, 19
Thursdays, 1:00-3:00 PM
Maximum Students:
10
Class Year:
MS1
Course Director:
Thuy Bui, MD
Contact Information:
Thuy Bui, MD
412-692-4840
[email protected]
Registration:
Betsy Nero, Office of Medical Education
[email protected]
Description:
This six-session mini-elective will introduce students to community-based participatory research, general concepts in survey study, epidemiological investigation, qualitative methods and approaches to implementation and evaluation
of community-based interventions. This workshop will help student formulate
and implement innovative, effective, and culturally sensitive scholarly projects
involving diverse and marginalized populations. It is designed for students
interested in pursuing scholarly projects in the community whether with underserved populations in Pittsburgh or overseas. Each session will be composed of lecture followed by small group discussion. Students will have the
opportunity to share scholarly projects during the appropriate small group session to get feedback from faculty and peers.
Objectives:
• To understand the philosophy and general approaches in community-based
research.
• To become familiar with some of the tools used in community-based research.
• To encourage scholarly projects in health promotion and disease prevention in the community.
Requirements:
• Active participation in all sessions.
• Reading assignments (30 pages or less prior to each session).
Office
of
Medical
Education
www.omed.pitt.edu
412.648.8714
9
Course Outline
Stepping Out: Community Based Research
Course Director:
Thuy Bui, MD
[email protected]
412-692-4840
Faculty:
GSPH’s Department of Behavioral and Community Health Sciences
Martha Ann Terry, PhD
Center for Research in Health Care
Adam J. Gordon, MD, MPH
Galen E. Switzer, PhD
Department of Family Medicine
Michael Yonas, DrPH
Course Objectives:
• To understand the philosophy and general approaches in community-based research.
• To become familiar with some of the tools used in community-based research.
• To encourage scholarly projects in health promotion and disease prevention in the community.
Location:
All sessions
Scaife Hall, Rooms 460 A&B
Session one: Dr. Martha Ann Terry 1/15/09
Introduction to qualitative methods: The Ethnographic Approach
READINGS : Scrimshaw, S. (2006). Culture, Behavior and Health. In Merson, M.H., Black, R.E., & Mills,
A.J. (Eds.), International Public Health: Diseases, Programs, Systems and Policies (Second Ed., pp. 4368). Sudbury, MA: Jones and Bartlett Publishers.Miner, H. (1956). Body Ritual Among the Nacirema.
American Anthropologist 58, 503-507.
Objectives:
• Define ethnographic fieldwork and associated qualitative methods.
• Understand advantages and disadvantages of qualitative methods.
• Identify appropriate applications for the use of ethnography and associated methods.
• Review a recent publication utilizing ethnographic research methodology.
Session two: Dr. Michael Yonas 1/22/09
Introduction to community-based participatory research and ethics of community-based research
READING: http://www.pubmedcentral.nih.gov/picrender.fcgi?artid=1281296&blobtype=pdf
Objectives:
• Understand the components of CBPR and ethic issues involved in CBPR.
• Identify the challenges faced by partners of CBPR.
• Review a recent publication that illustrates the principles of CBPR.
Session three: Dr. Martha Ann Terry 1/29/09
Introduction to qualitative methods -- focus groups and key informant interviews
READING: Koffman, Morgan, Edmonds, Speck & Higginson, 2008. Cultural Meanings of Pain: A Qualitativ
Study of Black Caribbean and White British Patients with Advanced Cancer. Palliative Medicine 22:350359.
Objectives:
• Identify appropriate contexts/research questions for focus groups and key informant interviews.
• Know advantages and limitations of focus group and key informant interviews.
10
Session four: Dr. Adam Gordon 2/5/09
Community program evaluation
READING: http://www.springerlink.com/content/m7h31538649k7506/fulltext.pdf
http://www.implementationscience.com/content/pdf/1748-5908-1-23.pdf
Objectives:
• Be able to describe and implement outcome evaluation for community based participatory research
initiatives.
• Be able to describe formative evaluation and external facilitation means of outcome evaluation.
• Apply principles of community based participatory research outcome evaluation to various studentdriven projects.
• Understand difficulties (and means to overcome these difficulties) in evaluation of community based
participatory research.
• Evaluation of the mini-course!
Session five: Dr. T. Bui and guest faculty 2/12/09
Community epidemiology
REVIEW: http://www.dsf.health.state.pa.us/health/cwp/view.asp?a=175&Q=242623
Objectives:
• List at least three public use data files with information about US citizens' health, health behavior,
and/or health care use.
• List at least two data files with such information on a regional sample. What are the conditions of
their "public use"?
• List at least two weaknesses of secondary data analyses.
Session six: Dr. Galen Switzer 2/19/09
How to approach survey design and using questionnaires in research
Objectives:
• Understand how to choose the right survey method.
• Know the pitfalls in sampling, question wording, questionnaire design and survey implementation.
• Understand the general approaches to data analysis.
Resources:
• Community-based participatory research http://www.pubmedcentral.nih.gov/articlerender.fcgi?
artid=1281296
• Evaluation Toolkit http://www.wkkf.org/default.aspx?tabid=75&CID=281&NID=61&LanguageID=0
• Qualitative interviews http://www.bmj.com/cgi/content/full/311/6999/251
• Focus groups http://www.usaid.gov/pubs/usaid_eval/pdf_docs/pnaby233.pdf
• Surveys and questionnaires http://www.bmj.com/cgi/reprint/328/7451/1312.pdf
• NIMH Colaborative HIV/STD Prevention Trial Group. Design and integration of ethnography within an
international behavior change HIV/STD prevention trial. AIDS 2007, 21:S37-S48
11
The Emergency Expert
Mini-Elective
Spring 2009
University
of
Pittsburgh
School
of
Medicine
Course Dates:
October 2008—March 2009
Class Year:
MS1 and MS2
Course Director:
Stephanie Gonzalez, MD
Faculty:
Louis Alarcon, MD
Joe Suyama, MD
Anthony Pizon, MD
Panel of fellows and residents
Contact Information:
Stephanie Gonzalez, MD
412-647-9922
[email protected]
Registration:
Betsy Nero, Office of Medical Education
[email protected]
Description:
This 6 session mini-elective will introduce students to the field of Emergency
Medicine and various sub-specialties with an emphasis on emergent care of the
critically ill or injured patient. This noon-time lecture series is sponsored by the
Emergency Medicine Student Association and will cover various topics relevant to
Emergency Medicine and various emergency situations. Topics will include
trauma management, disaster planning and management, and toxicologic emergencies. Lectures include pathophysiology and clinical correlation, administrative
and social aspects of the specialty as well as provide information on current opportunities with the Department of EM and fellowship options. The lecturers are
all board certified faculty members or residents within the University of Pittsburgh
Emergency Medicine Residency Program.
Course Objectives:
• To provide framework of skills needed in the care of the critically ill or injured patient and various emergency situations.
• To expose students to the field of EM and provide information on the wide
range of practice opportunities and sub-specialties available.
• To provide a foundation to apply pathophysiology to actual clinical cases.
• To provide a direct source of information on ways to become involved in
the Department of Emergency Medicine such as research opportunities,
scholarly projects and summer projects.
Requirements:
Office
of
Medical
Education
Participate in 4 out of 6 offered course sessions.
www.omed.pitt.edu
412.648.8714
12
Course Outline
The Emergency Expert
Course Director:
Stephanie Gonzalez, MD
Assistant Professor of Emergency Medicine
412-647-9922
[email protected]
Faculty:
Louis Alarcon, MD
Assistant Professor of Critical Care Medicine and Surgery
Joe Suyama, MD
Anthony Pizon, MD
Course Objectives:
• To provide framework of skills needed in the care of the critically ill or injured patient and various
emergency situations.
• To expose students to the field of EM and provide information on the wide range of practice opportunities and sub-specialties available.
• To provide a foundation to apply pathophysiology to actual clinical cases.
• To provide a direct source of information on ways to become involved in the Department of Emergency Medicine such as research opportunities, scholarly projects and summer projects.
Location /Time:
Scaife Hall Lecture Rooms, 12 — 1 PM
Session 1 – October 21, 2008, LR2
Trauma Management
Dr. Louis Alarcon, MD
Learn about initial management principles of trauma patients. The focus of the lecture will be actual case studies of trauma patients focusing on mechanism of injury, anatomy and physical findings, diagnostic evaluation and clinical decision making.
Session 2 – November 11, 2008, LR3
Pre-hospital/Disaster Management
Dr. Joe Suyama, MD
Learn about disaster planning and implementation and the network of providers responsible for
management of mass casualty situations. Learn more about the role of Emergency Medicine and EMS in
such disaster situations.
Session 3 – December 2, 2008, LR3
Toxicology Cases
Dr. Anthony Pizon, MD
Learn about the subspecialty of toxicology, pathway to become a toxicologist, administrative aspects of the specialty and various practice options. There will also be clinical case studies of toxicology
patients with emphasis on critical ingestions and management principles as they relate to the pathophysiology of the toxin.
Session 4 – January 6, 2009, (Room TBD)
Prescription Narcotic Abuse
Dr. Stephanie Gonzalez, MD
Become familiar with the rising problem of prescription narcotic abuse, identify agents commonly
abused, learn how to recognize signs of abuse and learn practical techniques to avoid perpetuating the
problem.
13
Session 5 – February 17, 2009, LR3
International EM
Speaker to be determined
Learn more about international opportunities in Emergency Medicine. Lecture will focus on emergency support after natural disasters, medical relief organizations for nations with inadequate medical
resources, and establishment of advanced Emergency Medicine programs abroad.
Session 6- March 31, 2009, LR2
EM Fellowships/Summer Research Opportunities
Panel of fellows and residents
Learn more about the fellowships available after an EM residency and the practice opportunities
that these fellowships provide. Residents and fellows will also be on hand to explain the various research
opportunities available and discuss summer opportunities for medical students.
14
Emerging Infectious Diseases
and Global Climate Change
Mini-Elective
Spring 2009
University
of
Pittsburgh
School
of
Medicine
Course Dates:
April 6, 13, 20, 27
Mondays, 1:00—3:00 PM
Maximum Students:
8
Class Year:
MS1
Course Director:
Samuel Stebbins, MD, MPH
Director, University of Pittsburgh Center for Public
Health Preparedness
Contact Information:
Samuel Stebbins, MD, MPH
412-383-2400
[email protected]
Registration:
Betsy Nero, Office of Medical Education
[email protected]
Description:
This four-session mini-elective will introduce medical students to new microbial threats and the role of physicians in preparing for and responding to outbreaks and health emergencies. The course will cover a range of topics including:
•
Emerging Infectious Diseases including Pandemic Influenza, MRSA, Dengue and more!
• Global Climate Change.
• Use of computer modeling to simulate outbreaks and response.
•
Medical and Public Health preparedness at local, state, national and international levels.
• Personal Protective Equipment.
Office
of
Medical
Education
www.omed.pitt.edu
Objectives:
• Learn about emerging infectious diseases.
• Explore interactions between human and animal microbiology and the
zoonoses which result.
• Find out how climate change and global warming are changing infectious
diseases around the world.
• Improve understanding of infection control and personal protection.
• Explore uses of agent-based simulation to predict and describe outbreaks.
• Experience how physicians, emergency response officials and public health
professionals interact in preparing for and responding to outbreaks and
pandemics.
Requirements:
1. Actively participate in all 4 course sessions
2. Read assignments
3. Evaluate the course at the end of the last class
412.648.8714
15
Course Outline:
Emerging Infectious Diseases
Course Director:
Samuel Stebbins, MD, MPH
Director, University of Pittsburgh Center for Public Health Preparedness
Course Objectives:
• Learn about emerging infectious diseases.
• Explore interactions between human and animal microbiology and the zoonoses which result.
• Find out how climate change and global warming are changing infectious diseases around the world.
• Improve understanding of infection control and personal protection.
• Explore uses of agent-based simulation to predict and describe outbreaks.
• Experience how physicians, emergency response officials and public health professionals interact in
preparing for and responding to outbreaks and pandemics.
Location:
All sessions
Center for Public Health Practice
Room A731, Crabtree Hall
130 DeSoto St – Graduate School of Public Health
Week One–April 6, 2009
Emerging Infectious Diseases (1)
• Introduction
• Microbes, insects, animals and people
◊
New pathogens.
◊
Existing pathogens in new settings and/or with new resistance factors.
Week Two–April 13, 2009
Emerging Infectious Diseases (2)
• Local, national and international surveillance systems
• Computational modeling
• Pandemic Influenza
- Risk for the future
- Effectiveness of medications, vaccines, and non-pharmaceutical intervervention
Week Three–April 20, 2009
Emerging Infectious Diseases (3)
• Vaccines and vaccine development.
• Genetics of microbe pathogenicity.
• Laboratory testing.
Week Four–April 27, 2009
Preparation and Response
• Personal protection.
• Infection control in hospitals and other healthcare settings.
• Local, national and international readiness.
Texts:
• Reading materials will be e-mailed to students prior to each class.
16
Essential Procedures in Clinical Medicine
Mini-Elective
Spring 2009
University
of
Pittsburgh
School
of
Medicine
Course Dates:
September 2008 - May 2009
Class Years:
MS1 and MS2
Course Director:
Stephanie Gonzalez, M.D.
Department of Emergency Medicine
Contact Information:
Stephanie Gonzalez, MD
412-647-9922
[email protected]
Registration:
Betsy Nero, Office of Medical Education
[email protected]
Description:
This 8 session mini-elective will introduce students to key procedures in clinical
medicine. Many students have had experience with some clinical procedures before medical school or during clinical observation programs. This mini-elective,
offered in conjunction with the Emergency Medicine Student Association, provides
a structured laboratory-style experience for students who wish to have additional
opportunities to learn and practice common bedside procedures, under the supervision of experienced faculty and resident facilitators. The first hour of these sessions will be limited to course enrollees and will be taught in small group format.
Though many of these skills are also addressed later in required courses in the
curriculum, these are fundamental skills that are best developed through repeated exposure and practice – so there is a real benefit to having more than one
exposure to these techniques.
Course Objectives:
To practice key procedural skills commonly performed by medical students
• IV insertion
• Phlebotomy
• Simple laceration repair
• Non-invasive Airway Management
• Intubation
• Splinting
Requirements:
Participate in 4 out of 8 offered Workshops. (one each of IV & phlebotomy, Suturing, Airway, Splinting)
Office
of
Medical
Education
Supplemental instructional materials will be provided for class by the instructor at
the workshops.
www.omed.pitt.edu
412.648.8714
17
Course Outline
Essential Procedures in Clinical Medicine
Course Director:
Stephanie Gonzalez, MD
Assistant Professor of Emergency Medicine
412-647-9922
[email protected]
Course Objectives:
To practice key procedural skills commonly performed by medical students
• IV insertion
• Phlebotomy
• Simple laceration repair
• Non-invasive Airway Management
• Intubation
• Splinting
Location:
Scaife Hall, 5 PM—7 PM
Exact location details will be distributed to course participants prior to each session.
Session 1 – October 13, 2008, 5p-7p
IV/Phlebotomy Workshop
Learn indications and applications for saline lock insertion.
Become familiar with potential complications of IV insertion.
Practice proper technique for IV catheter insertion and phlebotomy on a partner.
Session 2- October 29, 2008, 5p-7p
Suturing Workshop
Learn indications and contraindications for suturing wounds.
Practice technique of common suture types on pig’s feet .
Session 3 – November 19, 2008, 5p-7p
Airway Workshop
Learn indications for airway support.
Become familiar with multiple non-invasive airway support measures.
Learn and practice endotracheal intubation on mannequins.
Session 4- December 10, 2008, 5p-7p
Splinting Workshop
Learn indications for splinting.
Become familiar with proper splint application
Practice various splint applications on a partner.
Session 5- ,January 21, 2009 5p-7p
IV/Phlebotomy Workshop
Learn indications and applications for saline lock insertion.
Become familiar with potential complications of IV insertion.
Practice proper technique for IV catheter insertion and phlebotomy on a partner.
Session 6- February 11, 2009 5p-7p
Suturing Workshop
Learn indications and contraindications for suturing wounds.
Practice technique of common suture types on pig’s feet.
18
Session 7- March 4, 2009, 5p7p
Airway Workshop
Learn indications for airway support.
Become familiar with multiple non-invasive airway support measures.
Learn and practice endotracheal intubation on mannequins Splinting Workshop
Learn indications for splinting.
Become familiar with proper splint application
Practice various splint applications on a partner.
Session 8- April 15, 2009, 5p-7p
Splinting Workshop
Learn indications for splinting.
Become familiar with proper splint application
Practice various splint applications on a partner.
19
The Healer’s Art: Awakening the Heart
of Medicine Mini-Elective
Spring 2009
University
of
Pittsburgh
School
of
Medicine
Course Dates:
February 11, 18, 25, April 1, 15
Wednesdays, 5:00-8:00 PM
Maximum Students:
20
Class Year:
MS1
Course Directors:
Judith Balk, MD
Chiara Ghetti, MD
Contact Information:
Judith Balk, MD
412-641-1403
[email protected]
Chiara Ghetti, MD
412-641-1440
[email protected]
Registration:
Betsy Nero, Office of Medical Education
[email protected]
Description:
The Healer’s Art addresses the hidden crisis in medicine, the growing loss of
meaning and commitment experience by physicians nationwide under the
stresses of today’s health care system. The Healer's Art is a process-based
curriculum that enables the formation of a community of inquiry between students and faculty. It takes a highly innovative, interactive, contemplative and
didactic approach to enabling students to perceive the personal and universal
meaning in their daily experience of medicine.
The course consists of five three-hour evening sessions spaced roughly two
weeks apart, each divided into large-group presentations, and small-group
discussions and exercises.
Objectives:
The Healer's Art course will encourage students to:
• Identify, strengthen and cultivate the human dimensions of the practice of
medicine Recognize the commonality of personal concerns among their
peers and gain support for personal development from peers and faculty.
• Accept the universality of loss and pain.
• Recognize grief as a self-care strategy for physicians, and identify strategies and tools of grieving.
• Trust the power of listening and presence to heal others.
Office
of
Medical
Education
www.omed.pitt.edu
Requirements:
• Participate in all 5 course sessions.
• Because of the experiential and process nature of this course, students are
required to attend all sessions.
• A supplemental text is recommended but there are no required readings or
out of class assignments.
412.648.8714
20
Course Outline
The Healer’s Art
Course Directors:
Judith Balk, MD
412-641-1403
[email protected]
Chiara Ghetti, MD
412-641-1440
[email protected]
Student Advisors:
Gail R. Joseph, MS2
718-930-6655
[email protected]
Tiffany Behringer, MS2
412-298-9687
[email protected]
Tara Miller, M2
404-610-8272
[email protected]
Faculty:
TBA
Course Objectives:
• Identify, strengthen and cultivate the human dimensions of the practice of medicine
• Recognize the commonality of personal concerns among their peers and gain support for personal development from peers and faculty
• Accept the universality of loss and pain
• Recognize grief as a self-care strategy for physicians, and identify strategies and tools of grieving
• Trust the power of listening and presence to heal others
Location:
All sessions
WPIC, Rooms 292, 293, 294, 295
Session
Date
Topic
One
February 11, 2009
Discovering and Nurturing Your Wholeness
Two
February 18, 2009
Honoring Loss
Three
February 25, 2009
Sharing Grief: The Healing of Loss
Four
April 1, 2009
Beyond Analysis: Allowing Awe in Medicine
Five
April 15, 2009
The Care of the Soul
Recommended Texts:
Remen, Rachel Naomi, MD. Kitchen table wisdom: stories that heal. Riverhead books: New York, NY
1996.
Supplemental materials will be provided for class by the instructor or on-line.
21
Concepts in Human Motion
Mini-Elective
Spring 2009
University
of
Pittsburgh
School
of
Medicine
Course Dates:
February 2, 9, 16, 23
Mondays, 2:00-4:00 PM
Maximum Students:
8
Class Year:
MS1
Course Director:
Cara Camiolo Reddy, MD
Contact Information:
Cara Camiolo Reddy, MD
412-648-6138
[email protected]
Registration:
Betsy Nero, Office of Medical Education
[email protected]
Description:
This four-session mini-elective introduces students to concepts in human motion using examples from the field of Rehabilitation Medicine. Sessions are
held at various locations for hands-on experience and observation including
the UPMC Sports Medicine Center, UPMC Center for Assistive Technology at
Forbes Tower, and the MUH Electromyography laboratory.
The goal of this program is to explore the relationship between anatomy,
physiology, and human motion. This course highlights rehabilitative efforts
in identifying and treating disorders of motion, as well as introduces
the adverse effects of motion and velocity on the human brain as evidenced
through sports concussion. Through both didactic and hands-on exposure at
these sites, this series covers topics including:
• The Anatomy and Biomechanics of Overhand Throwing
• Acceleration/Deceleration Forces in Head Injury
• Neuropsychological Evaluation following Sports Concussion
• Wheelchair Mobility
• Nerve Conduction Studies and Electromyography
Office
of
Medical
Education
www.omed.pitt.edu
412.648.8714
Objectives:
• To understand the anatomy and biomechanics of overhand throwing.
• To become familiar with common shoulder pathology and evaluation of
throwing athletes.
• To become familiar with manual and power mobility options.
• To become familiar with wheelchair prescriptions, including the patient
evaluation and physical examination.
• To understand the mild traumatic brain injury and the relationship to acceleration/deceleration forces in sports.
• To become familiar with methods for evaluating patients after sports concussion, including on-field assessments and neuropsychological testing.
• To become familiar with Nerve Conduction Studies and Electromyography
and understand its role as an extension of the physical examination.
22
To review nerve and muscle physiology, including muscle recruitment as demonstrated by EMG.
Requirements:
•
•
Active participation in all 4 course sessions.
Reading assignments – one article to be read prior to each session.
Course Outline
Concepts in Human Motion
Course Director:
Cara Camiolo Reddy, MD
[email protected]
412-648-6138
Faculty:
Dana Martini, DO
Brad Dicianno, MD
Gary Chimes, M.D., Ph.D.
Course Objectives:
• To understand the anatomy and physiology of overhand throwing.
• To become familiar with common shoulder pathology and evaluation of the throwing athlete.
• To become familiar with manual and power mobility options.
• To become familiar with wheelchair prescriptions, including the patient evaluation and physical examination.
• To understand the mild traumatic brain injury and the relationship to acceleration/deceleration forces
in sports.
• To become familiar with methods for evaluating patients after sports concussion, including on-field
assessments and neuropsychological testing.
• To become familiar with Nerve Conduction Studies and Electromyography and understand its role as
an extension of the physical examination.
To review nerve and muscle physiology, including muscle recruitment as demonstrated by EMG.
Location:
Various locations as outlined below.
Week One: February 1, 2009
Assistive Technology
Location: Center for Assistive Technology, Forbes Tower
Instructor: Brad Dicianno, MD
At the UPMC Center for Assistive Technology, students are introduced the process of evaluating patients
for assistive mobility, including manual and power wheelchairs. Wheelchair design is discussed and students participate in an Ultralight Wheelchair Skills class provided for patients by the CAT clinic.
Week Two: February 9, 2009
Understanding Muscle Physiology through Electromyography
Location: Scaife Hall, Rooms 464 A&B
Instructor: Dana Martini, DO
At the Electromyography Laboratory, students receive an introduction to Nerve Conduction Testing and
Electromyography and the role these tests play in identifying disorders of muscle and nerves. An
overview of muscle and nerve physiology is included in this hands-on demonstration.
23
Week Three: February 16, 2009
The Mechanics of Overhand Throwing
Location: Kaufman Building, Suite 201
Instructor: Gary Chimes, MD/PhD
Students will be introduced to the mechanics of overhand throwing, reviewing key shoulder anatomy and
physical exam techniques. Students will learn how changes in biomechanics can alter pitches. Shoulder
pathology will be discussed as students learn how physiatrists identify, classify, and treat such disorders.
Week Four: February 23, 2009
Acceleration and Deceleration Forces in Sports Concussion
Location: Sports Center, South Side
Instructors: Cara Camiolo Reddy, MD and Alex Taylor, PsychD
Students are introduced to the pathophysiology of mild traumatic brain injury and the effects of acceleration/deceleration forces on the brain. The discussion includes an introduction to the neuropsychological
evaluation of sports concussion and ImPACT testing program. The ImPACT test battery is observed and
the testing components are discussed in relation to brain injury and recovery.
24
Human Patient Simulation
Mini-Elective
Spring 2009
University
of
Pittsburgh
School
of
Medicine
Course Dates:
March 23, April 13, 20, 27
Mondays, 1:00-3:00 PM
Maximum Students:
6
Class Year:
MS1
Course Director:
William McIvor, MD
Assistant Professor of Anesthesiology
Director of Medical Student Education, WISER
Contact Information:
William McIvor, MD
[email protected]
412-303-2192
Registration:
Betsy Nero, Office of Medical Education
[email protected]
Description:
This will be a highly interactive course which will focus on the use of human
patient simulators (HPS) in medical education. Specifically, it will examine how
HPS is currently used at the University of Pittsburgh School of Medicine, and
try to envision how it can be employed in the future. Students will explore the
realm of simulation available at the Winter Institute of Simulation Education
and Research (WISER) and see some of the development efforts there and
other local facilities through hands-on experiences. The overall goal of the
course is give UPSOM students a feel for simulation education through experimentation and exploration.
Objectives:
1. Identify a partial-task trainer, full scale patient simulator, and screenbased simulator.
2. Describe the benefits that flight simulation has realized in aviation.
3. Describe the proposed benefits to medicine in HPS.
4. List the strengths and weakness of various simulators and partial-task
trainers for a variety of applications,
5. Present to the class an outline of a simulation the student believes should
be developed, focusing on the current ability to perform the simulation,
and what needs to be developed to make the simulation as realistic as possible.
Office
of
Medical
Education
Requirements:
• Active participation in all five course sessions
• Preparation of a clinical simulation that runs on a HPS at WISER
www.omed.pitt.edu
412.648.8714
25
Course Outline:
Human Patient Simulation
Course Directors:
William McIvor, MD
Course Objectives:
1. Identify a partial task trainer, full scale patient simulator, and screen based simulator.
2. Describe the benefits that flight simulation has realized in aviation.
3. Describe the proposed benefits to medicine in HPS.
4. List the strengths and weakness of various simulators and partial-task trainers for a variety of applications,
5. Present to the class an outline of a simulation the student believes should be developed, focusing on
the current ability to perform the simulation, and what needs to be developed to make the simulation
as realistic as possible.
Location:
WISER Center
Week One– March 23, 2009
Introduction
• Brief overview of the course.
• WISER scavenger hunt.
Students will be broken up into three teams of two and will explore the various simulators in
WISER. Each group will be responsible for exploring WISER to find a specific type of simulator
(partial-task trainer, full scale patient simulator, and screen-based simulator). Through self–
directed experimentation and exploration of the equipment, students will identify the type of
simulator they have found and try to determine how it works. Students will be able to alternate
between the control panel and the simulator to determine its functionality. Senior medical students will be on hand to help guide the search!
• Review of flight simulators.
Development
Recognized benefits
• Description of creating a simulation assignment (due at Session 4).
Week Two– April 13, 2009
How are HPS’s Being Used in Medical Education at the University of Pittsburgh School of Medicine?
• Undergraduate medical education, Graduate medical education, Continuing medical education, Board
certifications and credentialing.
• How could simulation be used at the UPSOM?
• Simulation development workshop.
Working in pairs, students will use actual simulation software to transform a clinical scenario into
a simulation. These simulations will be demonstrated to the course students and faculty.
Week Three– April 20, 2009
State of the Art in HPS
• Brief review of strengths and weaknesses of current partial-task trainers and HPS’s
• Discussion of ongoing research and development work at WISER, CMU and IngMar Medical
• Simulation Scenarios:
Students will be active participants in various programmed clinical scenarios which highlight the
simulators’ capabilities. Students will assume clinical roles and and practice various procedures.
This is your chance to be the physician trying to intubate a patient with airway compromise!
Week Four– April 27, 2009
26
Does it Fly?
• Student demonstrations
Students will give a 15 minute presentation of their personally designed simulation.
Course Logistics:
Six students may take the course. Five 2 hour sessions will be held at the WISER.
27
Introduction to Disaster Management (BLDS®)
Mini-Elective
Spring 2009
University
of
Pittsburgh
School
of
Medicine
Course Dates:
January 21, *30, February 11, 18
Wednesday evenings, 6:00-8:00 p.m.
*Friday, January 30, 1:00-3:00 p.m.
Maximum Students:
16
Class Year:
MS1 & MS2
Course Director:
Joe Suyama, MD
Assistant Professor of Emergency Medicine
Contact Information:
Joe Suyama, MD
412-647-8540; [email protected]
Registration:
Betsy Nero, Office of Medical Education
[email protected]
Description:
In 2003, the National Disaster Life Support (NDLS) training program was established to better prepare health care professionals and emergency response personnel for mass casualty events. The overarching goal was to standardize emergency response training nationwide and strengthen our nation’s public health system. During this 4 session mini-elective, we will use the Basic Disaster Life Support (BDLS®) framework to stress a comprehensive all-hazards approach to help
you deal with catastrophic emergencies from terrorist acts as well as from explosions, fires, natural disasters (such as hurricanes and floods), and infectious diseases, which are much more likely to occur. In large-scale mass casualty events,
medical students and other health care workers must:
• Be knowledgeable of the need for efficient coordination among local, state,
and federal emergency response efforts.
• Understand how to protect themselves and others from further harm.
• Be able to communicate effectively with other emergency personnel and the
media.
• Know how to address the unique psychological impacts and related social
chaos that may ensue.
Office
of
Medical
Education
www.omed.pitt.edu
412.648.8714
Course Objectives:
• To understand the scope of disasters (all hazards), including natural and accidental man made events; traumatic and explosive events; nuclear and radiological events; biological events; and chemical events.
• Be able to describe the health care professional’s role in the public health and
incident management systems, community mental health, and special needs
of underserved and vulnerable populations.
• Be able to manage the disaster scene and victims by applying the D-I-S-A-S-T
-E-R paradigm.
• To understand the need for a triage system (i.e. the BDLS® M.A.S.S. Triage
model and “Id-me”) and apply for response to a mass casualty event.
Requirements:
• Actively participate in all 4 course sessions - (students will receive a BDLS®
certification at the end).
28
•
Reading assignments prior to sessions 2, 3 and 4 (approximately 2 hours of material per session).
Chapters will be assigned from the BDLS® textbook.
Course Outline
Introduction to Disaster Management (BLDS®)
Course Director:
Joe Suyama, MD
412-647-8540
[email protected]
Course Objectives:
• To understand the scope of disasters (all-hazards), including natural and accidental man-made
events; traumatic and explosive events; nuclear and radiological events; biological events; and
chemical events.
• Be able to describe the health care professional’s role in the public health and incident management
systems; community mental health; and special needs of underserved and vulnerable populations.
• Be able to manage the disaster scene and victims by applying the D-I-S-A-S-T-E-R paradigm. (D –
Detect, I – Incident Command , S – Scene Security and Safety, A – Assess Hazards, S – Support, T Triage and Treatment, E – Evacuation, R – Recovery).
• To understand the need for a triage system (i.e. the BDLS® M.A.S.S. Triage model and “Id-me”) and
apply it for response to a mass casualty event.
Location:
Scaife Hall—Rooms 460 A&B
Wednesday evenings—6:00-8:00 p.m., except Friday, January 30, 1:00—3:00 p.m.
Session One – January 21, 2009
Introduction to Disasters and Disaster Medicine
Reading: None
Objectives:
• To understand the scope of disasters (all hazards), including natural and accidental man-made
events; traumatic and explosive events; nuclear and radiological events; biological events; and
chemical events.
• To understand National Incident Management System (NIMS) and Incident Command Structure (ICS)
for health care providers.
Session Two – January 30, 2009 (this is a Friday afternoon class—1:00-3:00 p.m.)
Traumatic and Explosive Events; Nuclear and Radiological Events; and Mass Casualty Incidents
Reading: Chapters 1-4
Objectives:
• To understand and identify the components of the D-I-S-A-S-T-E-R paradigm for Traumatic and Explosive Events (Chapter 3) and Nuclear and Radiological Events (Chapter 4). • To understand the M.A.S.S. Triage and “Id-me” application for Mass Casualty Incidents (MCI). Session Three – February 11, 2009
Biological Events; Chemical Events; and Introduction to Personal Protective Equipment and
Decontamination Techniques
Reading: Chapters 5-6
Objectives:
• To understand and identify the components of the D-I-S-A-S-T-E-R paradigm for Biological Events
(Chapter 5) and Chemical Events (Chapter 6). • To understand use of Personal Protective Equipment (PPE) and be familiar with Decontamination
techniques in the health care setting. Session Four – February 18, 2009
Psychosocial Aspects of Terrorism and Disasters (Critical Incident Stress Management (CISM);
the Public Health System in Disasters; and Introduction to Operational Medicine
29
Reading: Chapters 7-8
Objectives:
• Be able to describe the health care professional’s role in the public health and incident management
systems, community mental health, and special needs of underserved and vulnerable populations.
• To understand the scope of Operational Medicine.
• To understand the need for specialized training and skills for response to disasters.
Text:
• The BDLS® textbook will be provided at the first session.
30
Introduction to Anatomic Pathology
Mini-Elective
Spring 2009
University
of
Pittsburgh
School
of
Medicine
Course Dates:
March 23, 30 and April 6, 13
Mondays, 2:00—4:00 PM
Maximum Students:
4
Class Year:
MS1
Course Director:
Larry Nichols, MD
Contact Information:
Larry Nichols, MD
[email protected]
412-647-3936
Pager: 412-392-7376
Registration:
Betsy Nero, Office of Medical Education
[email protected]
Description:
Anatomic pathology can be described as the examination of tissues under a
microscope to make diagnoses. It is what most pathologists do most of each
workday. This mini-elective will show the students how diagnoses are rendered. It should provide an appreciation of the challenges of the specialty and
highlight the rewards of a career in pathology. Students will emerge from this
mini-elective with a basic knowledge of 12 diseases, many organ-specific, not
covered in the first year curriculum. Likely diseases include gastroesophageal reflux disease, Helicobacter pylori gastritis, colon cancer, melanoma, nevus, psoriasis, usual interstitial pneumonia, lung cancer, glioma, cerebral infarction, mixed germ cell tumor of parotid, and oral squamous cell carcinoma.
Some sessions will include radiographs and the gross pathology before the
slides to assist in developing a broader perspective on specific diseases.
Transportation will be provided to and from the remote sites of the rotation.
During the course sessions, students will be actively engaged in making observations and interpreting information. Comparable to the way in which residents and clinical year students learn through discussing cases, students, faculty and the course director will discuss cases in real-time. Through the process of questioning, students will be encouraged to apply what they know and
push ahead to develop deeper insights about the diseases, and hone their
critical thinking skills (the Socratic method). Students taking this elective
must be ready for being asked challenging questions in front of the group.
Office
of
Medical
Education
www.omed.pitt.edu
412.648.8714
Objectives:
• To prepare medical students to be astute users of biopsy results.
• To help medical students learn how and why it takes as long as it does to
get a good diagnosis from a biopsy or cytology specimen.
• To give students an appreciation that every anatomic pathology diagnosis
comes with a degree of uncertainty and fallibility, and with a differential
diagnosis.
• To provide students with a basic knowledge of key features of at least 12
common and important diseases.
31
•
To teach students some specific features of diseases they encounter in the form of tissue in a microscopic biopsy or cytology.
Requirements:
• Active participation in the four course sessions.
• Bring a pathology textbook and notebook to each course session, to look up information and record
key observations.
Course Outline:
Introduction to Anatomic Pathology
Course Directors:
Larry Nichols, MD
Faculty:
Jagit Singh, MD, Evan Baker, MD, Smiljana Istvanic, MD, Anjana Vijayvargiya, MD, Drazen Jukic, MD,
Jonhon Ho, MD, Arash Radfar, MD, Samuel Yousem, MD, Simion Chiosea, MD, Raja Seethala, MD, Karen
Schoedel, MD, Jon Davison, MD, Clayton Wiley, MD, Ron Hamilton, MD
Course Objectives:
• To prepare medical students to be astute users of biopsy results.
• To help medical students learn how and why it takes as long as it does to get a good diagnosis from a
biopsy or cytology specimen.
• To give students an appreciation that every anatomic pathology diagnosis comes with a degree of uncertainty and fallibility, and with a differential diagnosis.
• To provide students with a basic knowledge of key features of at least 12 common and important diseases.
• To teach students some specific features of diseases they encounter in the form of tissue in a microscopic biopsy or cytology.
Location:
Upmc St. Margaret’s Department of Pathology
UPMC Shadyside Place Dermatopathology
UPMC Presbyterian Department of Pathology
Week One– March 23, 2009
Community Hospital Pathology
Location: UPMC St. Margaret’s Department of Pathology
Instructors: Jagjit Singh, MD, Evan Baker, MD, Smiljana Istvanic, MD, Anjana Vijayvargiya,
MD
Students will gain an understanding of:
• The variety of tissue types submitted for diagnosis in community hospital pathology.
• The workflow of a busy laboratory, and time pressure under which pathologists make diagnoses.
Format
The students will be engaged in observing specimen processing and examining microscope slides at double-headed microscopes with the staff pathologists, including slides of biopsies, cytology specimens and
surgical resections. Students will rotate among the pathologists for these purposes. Students will look
up specific diseases as they encounter cases of those diseases and to take notes on key features of those
diseases. Students should bring a pathology textbook and a notebook to all 4 session for this purpose.
Students will finish the afternoon with a new rudimentary understanding of at least three diseases.
Week Two– March 30, 2009
Skin Pathology
Location: UPMC Shadyside Place Dermatopathology
Instructors: Drazen Jukic, MD, Jonhon Ho, MD, Arash Radfar, MD
Students will gain an understanding of:
32
• The subtle histopathologic differences between a nevus and a melanoma
• The wide spectrum of inflammatory dermatoses
Format
In this session, students will examine microscope slides at a multi-headed microscope, side-by-side with
the dermatopathology faculty team. Students will finish the afternoon with a new understanding of at
least two dermatologic diseases.
Week Three–April 6, 2009
Thoracic and Head and Neck Pathology and Cytology
Location: UPMC Presbyterian Department of Pathology
Instructors: Samuel Yousem, MD, Simion Chiosea, MD, Raja Seethala, MD, Karen Schoedel,
MD
Students will gain an understanding of:
• The difficulty of diagnosing lung cancer on small biopsies
• The important role of frozen section diagnosis of margins of resection
• The ability to make a diagnosis on fine needle aspiration cytology
Format
The students will begin looking at microscope slides with Dr. Yousem or one of the other pathologists if
the others have fresh cases and will be rotated to the frozen section room, the specimen processing
room and other multi-headed microscopes with other pathologists as needed to keep each student busy
with a variety of diagnostic activities. Students will finish the afternoon with a new rudimentary understanding of at least three diseases.
Week Four– April 13, 2009
Gastrointestinal and Brain Pathology
Location: UPMC Presbyterian Department of Pathology
Instructors: Jon Davison, MD, Clayton Wiley, MD, Ron Hamilton, MD
Students will gain an understanding of:
• The challenge posed by the very large number of biopsies in gastrointestinal pathology
• The difficulty of rendering a diagnosis on the tiny samples in brain biopsies
Format
During this session, students will examine microscope slides of fresh pathology cases with Dr. Davison or
one of the other pathologists. The session will include viewing cases with faculty at the frozen section
room, the specimen processing room and other multi-headed microscopes, with a variety of diagnostic
activities. Students will finish the afternoon with a new rudimentary understanding of at least three additional diseases.
References:
The recommended textbook to bring to each session is Robbins Pathologic Basis of Disease, Seventh Edition.
Course Evaluation:
Each student will be asked to complete an evaluation of the course at its conclusion.
33
Introduction to Medical Education
Mini-Elective
Spring 2009
University
of
Pittsburgh
School
of
Medicine
Course Dates:
February 9, 16, March 2, 9, 16, 23
Mondays, 4:00-6:00 PM
Maximum Students:
8
Class Year:
MS2
Course Director:
Melissa McNeil, MD
Contact Information:
Melissa McNeil, MD
412-692-4821
[email protected]
Registration:
Betsy Nero, Office of Medical Education
[email protected]
Description:
This 6 session course will be a hands-on introduction to the principles and practices of medical education. In the first 4 sessions, core topics will be presented in
an interactive small group format. The final session will provide students with an
opportunity to apply what has been learned by presenting a 10 minute presentation about a topic of their choice with critique from classmates.
Topics covered in didactics include: 1) Curriculum Development; 2) Lecture and
Presentation Skills; 3) Feedback and Evaluation; and 4) Managing the Problem
Learner.
Course Objectives:
• Understand the 6 step process for curriculum development.
• Be able to give a cohesive 10 minute presentation using PowerPoint effectively.
• Know the difference between feedback and evaluation and understand how to
effectively deliver both.
• Develop a framework for categorizing and managing the problem learner.
Requirements:
• Participate in all class sessions.
• Complete assigned readings (no more than one article, maximum of 15 pages
per week).
• One 10 minute in-class presentation during the final session of the course.
Office
of
Medical
Education
www.omed.pitt.edu
412.648.8714
34
Course Outline
Introduction to Medical Education
Course Director:
Melissa McNeil, MD
412-692-4821
[email protected]
Faculty:
Kathleen McIntyre-Seltman, MD, Professor of Obstetrics. Gynecology and Reproductive Sciences.
John Mahoney, MD, Associate Dean for Medical Education
Course Objectives:
• Understand the 6 step process for curriculum development.
• Be able to give a cohesive 10 minute presentation using PowerPoint effectively.
• Know the difference between feedback and evaluation and understand how to effectively deliver both.
• Develop a framework for categorizing and managing the problem learner.
Location:
All sessions
Montefiore, 9W
Division of Internal Medicine
Session One: 6 Steps of Curriculum Design
Objectives:
• Understand the concept of needs assessment.
• Learn to develop goals and objectives.
• Appreciate how curricula are implemented and evaluated.
Session Two: Giving an Effective Lecture; use of PowerPoint
Objectives:
• Review the principles of organizing/delivering an effective lecture.
• Review how to use PowerPoint to maximize success.
Session Three: Feedback and Evaluation
Objectives:
• Demonstrate the difference between feedback and evaluation.
• Understand the difference between formative and summative feedback.
• Practice giving both positive and negative feedback.
Session Four: Managing the Problem Learner
Objectives:
• Develop a strategy for classifying problem learners.
• Understand strategies for remediation.
Session Five: Student Presentations and Feedback
Objectives:
• Present a 10 minute presentation about a topic of the student’s choice.
• Practice critiquing and giving feedback.
35
Introduction to the Real World of Public Health
Mini-Elective
Spring 2009
University
of
Pittsburgh
School
of
Medicine
Course Dates:
April 6, 20, 27 (plus one additional self-scheduled
session)
Mondays, 3:00—5:00 PM
Maximum Students:
10
Class Year:
MS1
Course Directors:
Charles J. Vukotich, Jr., MS
Senior Project Manager,
Center for Public Health Practice
Samuel Stebbins, MD, MPH
Asst Professor of Epidemiology, GSPH
Associate Director for Public Health and Medicine,
Center for Public Health Practice
Contact Information:
Chuck Vukotich, Jr., MS
412-383-2400
[email protected]
Registration:
Betsy Nero, Office of Medical Education
[email protected]
Description:
This class will give students an opportunity to learn about the real world of
public health from practitioners in the community and two instructors who
have been there. Mr. Vukotich has 3 years experience as a former senior
management at the Allegheny County Health Department (PA). Dr. Stebbins
previously served 6 years as the Deputy Health Officer in San Mateo County
(CA). The highly participatory course will provide:
• A field experience in public health.
• The challenge of solving real world public health problems through case
studies.
• A better understanding of the important intersections of clinical medicine
and public health.
• The opportunity to work with both field- and research-based public health
practitioners.
Office
of
Medical
Education
www.omed.pitt.edu
412.648.8714
Objectives:
• Experience how public health is carried out in the community.
• Develop practical problem solving skills in public health.
• Learn the basic concepts of public health that are useful to practitioners.
Requirements:
• Actively participate in all 4 course sessions – the field session will be a selfscheduled half day.
• Read brief assignments for each lecture requiring less than 1 hour of time.
• Summary of field experience plus course evaluation.
36
Course Outline:
Introduction to the Real World of Public Health
Course Directors:
Charles J. Vukotich, Jr., MS
Senior Project Manager, Center for Public Health Practice
Samuel Stebbins, MD, MPH
Assistant Professor of Epidemiology, Graduate School of Public Health
Associate Director for Public Health and Medicine, Center for Public Health Practice
Course Objectives:
• Experience how public health is carried out in the community.
• Develop practical problem solving skills in public health.
• Learn the basic concepts of public health that are useful to practitioners.
Location:
All sessions
Center for Public Health Practice
Room A731, Crabtree Hall
130 DeSoto St – Graduate School of Public Health
Week One–April 6, 2009
Introduction to Public Health
• Review of major public health functions and organizations
• Role of the Institute of Medicine
• Public Health Practice for clinicians and practitioners
Week Two– April 20, 2009
Field Placements
Students will be able to arrange a field visit with working public health professionals for an experience in
the field, encompassing environmental or personal health, such as inspections (restaurant, sewage, land
fill, housing, etc.), or clinical (TB, STD, HIV, Maternal and Child Health, etc.). Upon registration confirmation, students should contact the course director to arrange a field experience matching their personal
interests.
Week Three–April 27, 2009
Report on field experience
• Students will prepare a 1 page type-written summary and prepare a 5-10 minute presentation to the
group.
• Discuss lessons learned.
• Integrate field and clinical experiences.
Week Four– Self-scheduled session
Case Study
Solve a detailed, complex, and real-life public health/medical challenge: Students will be placed in two
groups to problem solve a hypothetical case. Discussion will be student driven with faculty facilitator for
guidance.
Texts:
• Reading materials will be provided to students prior to each class requiring less than 1 hour of preparatory reading for each session.
• Review 3 public health web sites requiring less than 1 hour of time.
37
Medicine and Literature
Mini-Elective
Spring 2009
University
of
Pittsburgh
School
of
Medicine
Course Dates:
March 30, April 6, 13, 20
Mondays, 1:00-3:00 PM
Maximum Students:
8
Class Year:
MS1
Course Director:
Robin Maier, MD
Contact Information:
Robin Maier, MD
412-648-8714
[email protected]
Registration:
Betsy Nero, Office of Medical Education
[email protected]
Description:
Every text, every word we read or hear carries meaning because of all the
other contexts and situations in which we’ve heard those same words before.
This richly interconnected web of stories, words, phrases, and texts is the way
our culture helps us to interpret and “imagine” our particular experiences in
the world around us. This course will use many different kinds of culturally
relevant literature (drama, poetry, children’s literature, popular fiction, classics) to help us explore the ways our culture imagines and interprets the experience of medicine. Our goal is to understand better how our own words in
the office may echo the “divine healer”, the “mad scientist,” the “charlatan” or
other mythological healers in our patients’ ears—so that we can consciously
communicate more effectively with patients.
There will be four class meetings for two hours each. Each session will be conducted in a small group discussion format.
Students are expected to complete readings prior to the course sessions (20 –
80 pages of fiction, poetry or drama), reflect in writing on the week’s readings
(approximately 1 page each week except the first class meeting) and come
prepared for vigorous discussion. For the final class session, students will be
given the opportunity to suggest other culturally relevant texts for the class to
consider.
We will read selections from Moliere, Dr. Seuss, Nathaniel Hawthorne, Gwendolyn Brooks, Jane Austen, J.R.R. Tolkien, the Bible, Mother Goose and more.
Office
of
Medical
Education
www.omed.pitt.edu
412.648.8714
Objectives:
• To gain an appreciation for the various parts physicians play in the literature of our culture.
• To learn to use the tools and systems of literary criticism to analyze literature, and then in turn to analyze the “text” of a clinical medical encounter.
• To gain an appreciation for the complex ways in which our own words and
actions may be interpreted and misinterpreted within the clinical setting by
patients who listen to us with ears and minds which have been prepared
for the encounter by the literature, myths and stories of our culture.
38
Course Outline
Medicine and Literature
Course Director:
Robin Maier, MD
[email protected]
Course Objectives:
• To gain an appreciation for the various parts physicians play in the literature of our culture.
• To learn to use the tools and systems of literary criticism to analyze literature, and then in turn to
analyze the “text” of a clinical medical encounter.
• To gain an appreciation for the complex ways in which our own words and actions may be interpreted
and misinterpreted within the clinical setting by patients who listen to us with ears and minds which
have been prepared for the encounter by the literature, myths and stories of our culture.
Location:
All sessions
Scaife Hall, Room 460A&B
Requirements:
• Actively participate in all four course sessions.
• Complete reading assignments before each session, (20 – 80 pages of fiction, poetry or drama).
• Reflect in writing on the week’s readings (approx. 1 page each week except the first class meeting)
and come prepared for vigorous discussion.
39
Preventing and Managing Metabolic Syndrome Among
The Seriously Mentally Ill
Mini-Elective
Spring 2009
University
of
Pittsburgh
School
of
Medicine
Course Dates:
February 9, 16, March 2, 16
Mondays, 1:00—4:00 PM
Maximum Students:
8
Class Year:
MS2
Course Director:
Jason Rosenstock, MD
Director, Medical Student Education
Department of Psychiatry
Contact Information:
412-246-6495
[email protected]
Registration:
Betsy Nero, Office of Medical Education
[email protected]
Description:
This 5-week mini-elective builds on concepts and experiences from the Behavior, Illness and Society (BIS) course, helping students begin applying behavioral medicine principles and practices to help real patients improve their lives.
Following a series of three expert-led didactic sessions (weight management,
diabetes prevention, and motivational interviewing) with heavy emphasis on
practical skill training, students will be assigned a patient with a serious and
persistent mental illness who is working on behavior change as a way of preventing or managing metabolic syndrome. Students will provide individualized
lifestyle coaching for two sessions, with faculty supervision, collaboration with
primary health providers, and assessment of outcomes.
Objectives:
• Appreciate the importance of comorbidity of psychiatry and general medical conditions
• Understand basic principles and specific techniques for fostering behavior
change
• Learn how to collaborate effectively with health practitioners from different
disciplines
• Increase self-efficacy with respect to the treatment of chronically ill patients
• Feel more optimistic about the role/efficacy of behavior change in medicine
Office
of
Medical
Education
Requirements:
• Participate actively in all course sessions
• Read assignments
• Complete course evaluations
www.omed.pitt.edu
412.648.8714
40
Course Outline:
Preventing and Managing Metabolic Syndrome among the Seriously Mentally Ill
Course Director:
Jason Rosenstock, MD
Assistant Professor of Psychiatry
Director, Medical Student Education
Western Psychiatric Institute and Clinic
Participating Faculty:
Melissa Kalarchian, PhD
Assistant Professor of Psychiatry
Bruce Rollman, MD, MPH
Associate Professor of Medicine and Psychiatry
Allan M. Zuckoff, PhD
Assistant Professor of Psychiatry
Rohan Ganguli, MD
Professor of Psychiatry, Pathology, and Health and Community Services
Linda Siminario, RN, PhD, CDE
Assistant Professor of Medicine and Nursing
Director, Diabetes Institute
Course Objectives:
• Appreciate the importance of comorbidity of psychiatry and general medical conditions
• Understand basic principles and specific techniques for fostering behavior change
• Learn how to collaborate effectively with health practitioners from different disciplines
• Increase self-efficacy with respect to the treatment of chronically ill patients
• Feel more optimistic about the role/efficacy of behavior change in medicine
Location:
All sessions
Oxford Building (3501 Forbes Avenue)
6th floor conference room (Suite 650)
Week 1:
1:00p-1:15p
1:15p-2:45p
2:45p-3:15p
February 9, 2009
Course Overview
--Jason Rosenstock
Introduction to Metabolic Syndrome: Diabetes Prevention and Management
--Linda Siminario
Tour of 3501 Forbes
Metabolic syndrome, including obesity, type 2 diabetes, and hyperlipidemia—is commonly seen in the
SPMI population, occurring with a prevalence greater than national rates. SPMI patients tend to have
less knowledge about these general medical conditions and tend to receive inadequate primary care
interventions to address these problems. In week 1 of this mini-elective, students will receive didactic
sessions on metabolic syndrome, with a focus on diabetes prevention, emphasizing skills that the physician can use to help patients with behavior change. We will also take a tour of the facility housing the
programs of SRRSMI (Services and Research for the Recovery of Serious Mental Illness), orienting students to staff, resources, and space that will be useful in the coming weeks.
41
Week 2:
1:00p-2:00p
2:00p-3:30p
February 16, 2009
Observing Group Therapy (half)
Patient/Preceptor Assignments (half)
Weight Management: Diet, Nutrition, Exercise
--Melissa Kalarchian
In week 2, half the students will observe a group therapy session, exploring how behavior change is attempted in standard programming and meeting potential clients. The other half will get patient and preceptor assignments and take the initial steps to set up meetings and develop a basic “teaching plan” to
organize the individual counseling sessions. All students will then train on weight management techniques that can be useful for patients: diet, nutrition, and exercise strategies.
Students will then take part in a practicum on motivational interviewing (MI), with an emphasis on
speicifc techniques and approaches geared towards a psychiatrically-ill population. After the MI workshop, students will meet with faculty preceptors and get patient assignments. For homework, students
will be asked 1) to develop a basic “teaching plan” that would be used to organize the following week’s
individual counseling sessions, and 2) schedule time to meet with patients and preceptors.
Week 3:
1:00p-2:00p
2:00p-4:00p
March 2, 2009
Observing Group Therapy (half)
Patient/Preceptor Assignments (half)
Behavior Change: Motivational Interviewing
--Allan Zuckoff
In week 3, half the students will observe a group therapy session, exploring how behavior change is attempted in standard programming and meeting potential clients. The other half will get patient and preceptor assignments and take the initial steps to set up meetings and develop a basic “teaching plan” to
organize the individual counseling sessions. All students will then take part in a practicum on motivational interviewing (MI), with an emphasis on specific techniques and approaches geared towards a psychiatrically-ill population.
Week 4:
March 16, 2009
Flexible scheduling of individual coaching sessions and faculty supervision
Students will do two individual sessions with each patient, 30-60 minutes each, focusing on goal-setting
and then follow-through (practice, specific techniques, etc.), with supervision by faculty preceptors for
about 30 minutes each week. Students will help individual patients develop appropriate treatment plans
based on a review of their metabolic risk factors, using MI, materials, incentives (e.g., gift cards), and
equipment (e.g., pedometers) to help them achieve patient-specific goals. These goals will then be communicated back to the existing psychiatrist, therapist, and primary care physician in the form of a specific
treatment plan created by the student with the patient. On March 16, we will have a final wrap-up session for all students and faculty.
Reading:
• R Ganguli, “Metabolic disturbances associated with antipsychotic medication: effects on body weight,
diabetes, and cardiovascular disease risk in schizophrenia,” publication pending.
• M Peyrot and RR Rubin, “Behavioral and psychosocial interventions in diabetes: a conceptual review”
Diabetes Care 30:2433-2440 (2007)
• RE Glasgow and EG Eakin, “Medical Office-Based Interventions,” in Psychological Aspects of Diabetes
Care (eds F Snoek and C Skinner), pp141-168 (2008).
• R Ganguli, T Cohn, G Faulkner. “Behavioral treatments for weight management in schizophrenia,” in
Medical Illness and Schizophrenia (eds J Meyer and H Nasrallah), publication pending.
• M Tschoep (ed), “Obesity,” selected chapters in http://www.endotext.org/obesity/
• S Dunn and S Rollnick, Lifestyle Change (2003)
42
University
of
Pittsburgh
School
of
Medicine
Mouth, Body and Medicine:
How Dental Disease Impacts Medical Therapy
Mini-Elective
2009
Course Dates:
March 30, April 6, 13, 27
Mondays, 1:00-3:00 PM
Maximum Students:
4
Class Year:
MS1
Course Director:
Edward P. Heinrichs, D.M.D.
Contact Information:
Edward P. Heinrichs, D.M.D.
Assistant Professor, Periodontics/Anesthesia
412-383-8779
[email protected]
Registration:
Betsy Nero, Office of Medical Education
[email protected]
Description:
In medical school and in media, the eyes are often described as the gateway
to the soul. Perhaps this is the case, but the mouth is a pretty good gateway
to everywhere else. Yet most medical school courses bypass the mouth and
its vital links to keeping people well and to causing systemic disease.
This mini-elective course is designed to examine the interrelationship between
oral disease and systemic disease, and the physician/dentist interactive roles
in the preventive care and treatment of patients. After taking this course, students will have gained new clinical skills in oral examination, and unique perspectives on how significant a role oral health plays in determining the health
of the whole person. Students in this course will know this material in a way
that will distinguish them from the majority of non-dentists and prepare them
to communicate more effectively with dental professionals.
Objectives:
After completing this course, students will:
1. Understand the basic impact of common oral diseases on systemic health
and pathology.
2. Be able to examine the oral cavity to detect oral disease.
3. Be familiar with emerging scientific evidence on oral/systemic disease interactions.
4. Be able to appraise the basic health status of the oral cavity in order to
recommend dental evaluation/therapy as it relates to systemic disease.
Office
of
Medical
Education
www.omed.pitt.edu
412.648.8714
Requirements:
• Actively participate in all 4 course sessions.
• Read brief assignments before sessions 2, 3 and 4, each requiring less
than 1 hour.
• Give a brief article summary presentation to peers at the final course session.
43
Course Outline
Mouth, Body and Medicine: How Dental Disease Impacts Medical Therapy
Course Director:
Edward P. Heinrichs, D.M.D.
Assistant Professor, Periodontics/Anesthesia
412-383-8779
[email protected]
Course Objectives:
After completing this course, students will:
1. Understand the basic impact of common oral diseases on systemic health and pathology.
2. Be able to examine the oral cavity to detect oral disease.
3. Be familiar with emerging scientific evidence on oral/systemic disease interactions.
4. Be able to appraise the basic health status of the oral cavity in order to recommend dental evaluation/therapy as it relates to systemic disease.
Location:
All sessions—Salk Hall, School of Dental Medicine (Room TBA)
Session One: March 30, 2009
Anatomy, Pathophysiology, and Common Conditions
During an introductory lecture and small group discussion, students will be re-acquainted with basic hard
and soft tissue anatomy of the oral cavity, and gain perspectives on normal and diseased states. Common conditions will be surveyed, including: basics of periodontal disease; cariology; acute (emergency
department) dental trauma/disease; dental abscess; 3rd molar (wisdom teeth) problems; acute common
viral and bacterial infections; xerostomia associated with disease and medication; and cancerous and pre
-cancerous lesions.
Session Two: April 6, 2009
Diagnostic Imaging, and the Periodontal-Whole Body Connection
This two-part session will include:
• An interactive small group teaching session on dental radiology, demonstrating the variations in
dental radiographic films and scans and their application in clinical settings.
• A seminar presentation on the role of periodontal disease as a chronic inflammatory disease process, and its role in the alteration of systemic disease processes especially diabetes, cardiovascular
disease, pulmonary disease, and pregnancy complications such as premature labor.
Session Three: April 13, 2009
Clinical Skills Session
In the first segment of this two-part session, students will work in pairs to develop their clinical examination techniques and gain familiarity with normal findings. Students will then be paired with Periodontal
Residents to observe periodontal pathology, through examination of live patients and images, and radiographic findings. NOTE: Professional attire, including white coats and nametags, is required for this special patient care session.
Session Four: April 27, 2009
Oral/Systemic Interactions—Understanding and Applying the Science to Patients
One segment of this session will consist of student presentations. Students will present a brief summary
of a selected research article on oral/systemic interactions (approximately 5 minutes). Articles will be
selected together with the course director. The second segment will be a group discussion on how to apply oral disease findings (history and clinical) as part of determining the need for dental referral in the
overall treatment of the patient.
44
University
of
Pittsburgh
School
of
Medicine
Natural History of Medicine
Evolutionary Medicine
Mini-Elective
Spring 2009
Course Dates:
March 3, 10, 17 and 24
Tuesdays, 2:00-4:00 PM
Maximum Students:
15
Class Year:
MS2
Course Director:
Christopher Beard, PhD
Contact Information:
Christopher Beard, PhD
412-622-5782
[email protected]
Registration:
Betsy Nero, Office of Medical Education
[email protected]
Description:
This four-session mini-elective will introduce students to some of the numerous ways in which our common evolutionary history impacts modern health
care. Humans differ from our nearest primate relatives in several fundamental
ways, notably including the increased size of our neurocranium, our habitally
upright posture and our bipedal locomotion. We will investigate how the profound evolutionary changes in the human skull and appendicular skeleton
have left us with “anatomical baggage” that continues to plague patients and
frustrate physicians. The course will cover a range of topics including:
•
•
•
•
The impact of human evolution on obstetrics and gynecology
An evolutionary perspective on oncology
Maladies of the eyes, nose & throat attributable to human evolution
An archaeological perspective on the history of human health
During the course, students will have access to relevant parts of the museum’s
collections and exhibits. Class sessions will meet at the museum (4400 Forbes
Avenue), a short walk from the medical school campus in Oakland.
Office
of
Medical
Education
www.omed.pitt.edu
412.648.8714
Objectives:
• To understand how certain medical conditions arose through human evolution
• To appreciate that many diseases are ancient
• To draw connections between diseases affecting ancient and modern human populations
• To enhance your ability to explain medical phenomena to laypersons (i.e.,
patients)
Requirements:
1. Participate in all 4 course sessions
2. Complete a short paper that explores the intersections among human
anatomy, human evolution, and modern medicine
45
Course Outline
The Natural History of Medicine: Evolutionary Medicine
March 3, 10, 17 and 24, 2009 (2:00-4:00 PM)
Course Director:
Chris Beard, PhD, UPSOM Neurobiology and Carnegie Museum of Natural History
Phone 412-622-5782
Email: [email protected]
Faculty:
Zhexi Luo, PhD, UPSOM Neurobiology and Carnegie Museum of Natural History
Phone 412-622-6578
Email: [email protected]
Sandra Olsen, PhD, UPSOM Neurobiology and Carnegie Museum of Natural History
Phone 412-665-2606
Email: [email protected]
John Wible, PhD, UPSOM Neurobiology and Carnegie Museum of Natural History
Phone 412-665-2613
Email: [email protected]
Course Objectives
• To understand how certain medical conditions arose through human evolution
• To understand that many diseases are ancient
• To draw connections between diseases affecting archaeological and modern human populations
• To enhance your ability to explain medical phenomena to laypersons (i.e., patients)
Supplemental reading materials will be provided prior to each class.
Location:
All sessions meet in the Center for Museum Education, located on the lower level of the Carnegie Museum of Natural History, 4400 Forbes Avenue.
Session One – “Four Legs Good, Two Legs Bad: Obstetric Implications of Human Evolution”
March 3, 2009 (C. Beard)
• Introductions
• Phylogeny, the fabric of life
• Placentation in humans, primates and other mammals
• Anatomical compromises associated with human childbirth
• Application: During the second half of this session, we will examine skeletons of living mammals and
casts of fossils from the museum’s collection, with the goal of understanding how “historical contingencies” during human evolution have engendered many common medical conditions.
Session Two – “Evolution of the Axial Skeleton by Hox Genes and Fetal Cancer”
March 10, 2009 (Z. Luo)
• Introduction: axial skeletal variability
• Hox gene patterning of vertebrae and mammalian vertebral evolution
• Homeotic changes of human vertebrae and fetal cancer
• Anti-cancer selection as evolutionary constraint for vertebral segment pattern
• Application: During the second half of this session, we will examine axial skeletons of higher primates from the museum’s mammal collections. Discussion: homeobox gene influence on vertebral
segmental identity, and their pleiotropic link to fetal cancers; reciprocal illumination of medicine and
evolution.
46
Session Three – “An Evolutionary Perspective on Medical Conditions Affecting the Eyes, Nose,
and Throat”
March 17, 2009 (J. Wible)
• Paranasal air sinuses: morphology, evolution, function, and disease.
• Language: morphology, evolution, and increased susceptibility to choking.
• Evolution of color vision in mammals and color blindness in humans.
• Application: During the second half of this session, we will look at skulls of living mammals and
casts of fossils to understand how our evolutionary history has led to problems with our paranasal
sinuses, pharynx, and larynx.
Session Four – “Ancient Lifestyles and Their Impact on the Human Body”
March 24, 2009
(S. Olsen)
• Paleonutrition: assessing the evidence and determining ancient conditions
• Ancient working conditions and social status: impact on quality of life and life expectancy
• Warfare and its effects on ancient populations: treatment of wounds, recovery, and mortality
• Ancient and modern beauty treatments and their medical implications: foot binding, tattooing, body
painting and perforating, neck rings, cranial deformation, and more
• Ancient and modern religious practices and their effects on health
• Application: We will take a tour of the Alcoa Foundation Hall of Native Americans.
Requirement: Two weeks after final session: deadline for receipt of your ~2500 word term paper on
any topic related to human anatomy, human evolution, and medicine.
47
University
of
Pittsburgh
School
of
Medicine
Natural History of Medicine:
Evolutionary Principles and
Anthropological Applications
Mini-Elective
Spring 2009
Course Dates:
February 5, 12, 19 and 26
Thursdays, 2:00-4:00 PM
Maximum Students:
15
Class Year:
MS1
Course Director:
Christopher Beard, PhD
Contact Information:
Christopher Beard, PhD
412-622-5782
[email protected]
Registration:
Betsy Nero, Office of Medical Education
[email protected]
Description:
This four-session mini-elective will introduce students to the numerous intersections between natural history (particularly paleontology, archaeology, and
evolutionary biology) and medicine. Using examples drawn from the vast collections at the Carnegie Museum of Natural History, we will examine some of
the basic evolutionary principles underlying modern diseases and/or clinical
conditions. We will investigate the evolutionary biology and archaeological history of certain diseases, as well as the health status of ancient human populations. The course will cover a range of topics including:
•
•
•
•
•
Ecological and evolutionary aspects of disease
Clinical implications of our own evolutionary history
Archaeological evidence on the health status of ancient human populations
Biogeography of disease: Why do so many virulent pathogens arise in
Asia?
Biomedical insights regarding human evolution
During the course, students will have access to relevant parts of the museum’s
collections and exhibits. Class sessions will meet at the museum (4400 Forbes
Avenue), a short walk from the medical school campus in Oakland.
Office
of
Medical
Education
www.omed.pitt.edu
412.648.8714
Objectives:
• To appreciate that virulent microbes evolve
• To understand that the same diseases often affect humans and other animals, and that many diseases are ancient
• To comprehend some of the current health implications of human evolution
• To enhance your ability to explain medical phenomena to laypersons (i.e.,
patients)
Requirements:
1. Participate in all 4 course sessions
2. Complete a short paper based on any area of overlap between natural history and medicine
48
Course Outline
The Natural History of Medicine: Evolutionary Principles and Anthropological Applications
Course Director:
Chris Beard, PhD, UPSOM Neurobiology and Carnegie Museum of Natural History
Phone 412-622-5782
Email: [email protected]
Faculty:
Zhexi Luo, PhD, UPSOM Neurobiology and Carnegie Museum of Natural History
Phone 412-622-6578
Email: [email protected]
Sandra Olsen, PhD, UPSOM Neurobiology and Carnegie Museum of Natural History
Phone 412-665-2606
Email: [email protected]
John Wible, PhD, UPSOM Neurobiology and Carnegie Museum of Natural History
Phone 412-665-2613
Email: [email protected]
Course Objectives
• To understand how certain medical conditions arose through human evolution
• To appreciate that virulent microbes evolve
• To understand that many diseases are ancient
• To draw connections between diseases affecting archaeological and modern human populations
• To enhance your ability to explain medical phenomena to laypersons (i.e., patients)
Supplemental materials will be provided for class by the instructor or on-line.
Location:
All sessions meet in the Center for Museum Education, located on the lower level of the Carnegie Museum of Natural History, 4400 Forbes Avenue.
Session One – “Evolutionary Principles and Human Health”
February 5, 2009 (C. Beard)
• Introductions
• Evolutionary biology of infectious microbes
• Biogeographic rules and the Asian dominance of infectious microbes
• Some interesting examples of disease/pathology in the fossil record
• Application: During the second half of this session, we will examine skeletons of dinosaurs in the
new gallery Dinosaurs in Their Time.
Session Two – “Evolutionary Development of Early Mammals, and its Bearing on Human Skull
Abnormalities”
February 12, 2009 (Z. Luo)
• How and what do we know about the evolutionary development of mammal skulls?
• The problem of wisdom tooth impaction in humans: Heterochrony as a mechanism in skull and dental
evolution
• Cleft palate: Evolutionary perspective on variability of human abnormality
• Mandibulofacial dysostosis: Reciprocal illumination of medical and evolutionary approaches
• Application: During the second half of this session, we will examine heterochrony in primate skulls
from the museum collection and compare jaw structures of mammals and non-mammalian vertebrates.
49
Session Three – “The Evolution of the Auditory and Vestibular Systems in Humans”
February 19, 2009 (J. Wible)
• Hearing and balance: morphology, function, and evolution in humans.
• Medical consequences of auditory and vestibular evolution in humans and other mammals: otitis media and mastoiditis.
• Application: During the second half of this session, we will look at skulls of living mammals and
casts of fossils to understand how our evolutionary history has led to problems with our ears and
mastoid air cells, including otitis media and mastoiditis.
Session Four – “Ancient Diseases: Their Likely Sources and History of Dispersal”
February 26, 2009 (S. Olsen)
• The nature of the evidence: skeletons, mummies, histology, artifacts, and art
• Tracking the antiquity of diseases, their origins and dispersal
• Forensics and determining the cause of death in prehistoric cases
• Application: We will examine X-rays and CT scanned images of the Egyptian child mummy (the boy
from Abydos) and take a tour of the Walton Hall of Ancient Egypt where he is housed.
Requirement: Two weeks after final session: deadline for receipt of your ~2500 word term paper on
any topic related to natural history and medicine.
50
Nutrition & Medicine
Mini-Elective
Spring 2009
University
of
Pittsburgh
School
of
Medicine
Course Dates:
March 23, 30, April 6, 13, 20, 27
Mondays, 3:00-5:00 PM
Maximum Students:
20
Class Year:
MS1
Course Director:
Judith Balk, MD, MPH
Ronald Glick, MD
Contact Information:
Judith Balk, MD
412-641-5291
[email protected]
Registration:
Betsy Nero, Office of Medical Education
[email protected]
Description:
This six-session mini-elective will introduce students to aspects of nutritional
medicine pertinent to common health conditions and disease prevention. Sessions will be divided into three sections, including: an interactive content oriented discussion; observing preparation of and sampling of healthy snacks
pertaining to the topic of the day; and discussion of pertinent journal articles
and other educational resources. Topics covered will include:
• Introduction to nutritional medicine, gut ecology, and detoxification; discussion of nutritional analysis & elimination diet.
• Vitamins, fats, minerals snacks; f/u on nutritional analysis.
• Proteins, carbohydrates, accessory nutrients.
• Nutritional approaches to cancer prevention.
• Nutrition and prevention of syndrome X and heart disease.
• Putting it all together; functional medicine matrix; introduction to nutrigenomics; follow-up on students’ experiences with dietary changes.
Objectives:
• Gain familiarity with issues around research methodology for studies on
diet and supplements.
• Become comfortable with discussions with colleagues and potential patients around diet and the use of nutritional supplements.
• Develop a strategy for independently researching questions about the efficacy of nutritional supplements for specific health conditions.
• Gain experience with assessing one’s own diet and making dietary modifications.
Office
of
Medical
Education
www.omed.pitt.edu
412.648.8714
Requirements:
• Actively participate in all six course sessions.
• Students will be responsible for reviewing course material online and participating in the class discussion. Over the six weeks of the elective each
student will be responsible for giving a brief content-focused presentation.
• Students will be asked to monitor their diet for three days and perform a
nutritional analysis. While not required, students will be encouraged to
51
make dietary modifications and report the effects of this to the class. Finally, if students have a particular interest, they are welcome to participate in the snack preparation.
Course Outline
Nutrition & Medicine
Course Directors:
Judith Balk, MD, MPH
Ronald Glick, MD
Faculty:
Judith Balk, MD, MPH
Department of OB, Gyn, and Reproductive Services
Ronald Glick, MD
Departments of Psychiatry, Physical Medicine and Rehabilitation, and Family Medicine
Course Objectives:
• Gain familiarity with issues around research methodology for studies on diet and supplements.
• Become comfortable with discussions with colleagues and potential patients around diet and the use
of nutritional supplements.
• Develop a strategy for independently researching questions about the efficacy of nutritional supplements for specific health conditions.
• Gain experience with assessing one’s own diet and making dietary modifications.
Location:
All sessions: Scaife Hall Rooms, 464A&B
Week 1—March 23, 2009
• Introduction to nutritional medicine
• Discussion of proteins, carbohydrates, fats, vitamins, minerals, and accessory nutrients
• Discussion of nutritional analysis with assignment given
• Discussion of nutritional needs in critically ill patients
• Internet resources reviewed
• Sharing of healthy snack
Week 2—March 30, 2009
• Review of nutritional analysis
• Nutrition and cancer: molecular mechanisms, prevention, and treatment
• Sharing of healthy snack
Week 3—April 6, 2009
• Diabetes: Nutritional mechanisms and dietary management
• Sharing of healthy snack
Week 4—April 13, 2009
• Cardiovascular disease and nutrition: hypertension, lipoproteins, and other risk factors
• Sharing of healthy snack
Week 5—April 20, 2009
• Nutrition in special populations: athletes, pregnant/lactating women, pediatrics, geriatrics
• Sharing of healthy snack
Week 6—April 27, 2009
• Dietary supplements: decision making, reality check, and use in practice
• Sharing of healthy snack
Pre-Requisites: None
52
“Can Work Make You Sick?”
Occupational Lung Diseases: A Multidisciplinary
Approach Mini-Elective
2009
University
of
Pittsburgh
School
of
Medicine
Course Dates:
February 9, 10, 16, 17
Mondays and Tuesdays, 2:00-4:00 PM
*February 17 session will run 1:00-5:00 p.m.
Maximum Students:
8
Class Year:
MS2
Course Directors:
Anu Sharma, MD
Contact Information:
Anu Sharma, MD
412-647-5565
[email protected]
Registration:
Betsy Nero, Office of Medical Education,
[email protected]
Description:
This mini-elective is designed to introduce 2nd year medical students (MS-2) to
occupational lung diseases and the impact of these conditions on their clinical
practice. The nature of toxic agents and particulate matter at work place, disease causation by these agents and their diagnosis and clinical management
will be discussed with a special emphasis on the medicolegal implications and
workers’ compensation. The students will also explore these conditions in the
context of health surveillance, workplace hygiene and prevention.
Objectives:
1. To develop an understanding of the nature and pathogenesis of lung diseases caused by exposure to particulate matter and toxic chemicals in the
workplace.
2. To become familiar with common clinical presentations of occupational lung
diseases, techniques for diagnosing these disorders and the approaches to
their medical management.
3. To develop an understanding of basics of medical care for occupational
lung diseases in the context of workers’ compensation and regulatory issues.
Requirements:
• Active participation in all five sessions.
• Reading assignment, one article per session.
Office
of
Medical
Education
www.omed.pitt.edu
412.648.8714
53
Course Outline
Occupational Lung Diseases: A Multidisciplinary Approach
Course Directors:
Anu Sharma, MD
Faculty:
Department of Pathology:
Anu Sharma, MD
Tim Oury, MD
Department of Pulmonary and Critical Care Medicine:
Christopher Faber, MD
Course Objectives:
1. To develop an understanding of the nature and pathogenesis of lung diseases caused by exposure to
particulate matter and toxic chemicals in the workplace.
2. To become familiar with common clinical presentations of occupational lung diseases, techniques for
diagnosing these disorders and the approaches to their medical management.
3. To develop an understanding of basics of medical care for occupational lung diseases in the context of
workers’ compensation and regulatory issues.
Location:
All sessions
Scaife Hall, Rooms 349 A&B
Session 1: February 9, 2009
Introduction
Instructors: Anu Sharma, MD; Chris Faber, MD
• Overview and classification of Occupational lung diseases.
- The students will be introduced to various airborne hazards encountered in a work place setting.
- The pathobiology and mechanism of injury will be discussed.
• Workplace hygiene and medical surveillance.
Session 2: February 10, 2009
Evaluation by the Pulmonary Clinician
Instructor: Chris Faber, MD
A hands–on interactive exercise in history-taking and case evaluation of a “demo patient” with suspected
exposure to particulate dust at work place. This session will highlight the following:
•
When to suspect an occupational lung disease.
•
What questions to ask to establish potential occupational exposure?
•
Adjunctive testing: pulmonary function testing, radiological evaluation.
•
Need for tissue diagnosis.
•
Pulmonary impairment and disability evaluation.
Session 3: February 16 2009
Lung biopsy specimen: Pathology of occupational lung disease
InstructorS: Anu Sharma, MD and Tim Oury, MD
What does a lung biopsy tell you about occupational lung disease?
• Gross appearance of the lungs exposed to dust and toxins.
• Exposure to “dust”: varying microscopic presentations, can you spot silicates, asbestos, coal dust,
beryllium, or hard metals on a glass slide?
• So you identified the particulate matter on tissue, can you identify it’s source: An introduction
• to advanced technologies utilized in lung particulate analysis.
54
Session 4: February 17, 2009
Field Trip to a NIOSH Laboratory
Instructors: Anu Sharma, MD; Tim Oury, MD
55
The Real World of Medicine: Business Aspects
Mini-Elective
Spring 2009
University
of
Pittsburgh
School
of
Medicine
Course Dates:
March 3, 10, 17, 24
Tuesdays, 1:00-3:00 PM
Maximum Students:
8
Class Year:
MS2
Course Director:
Paul Rosen, MD, MPH, MMM
Assistant Professor of Pediatrics, UPSOM,
Clinical Director of Rheumatology,
Children’s Hospital of Pittsburgh
Contact Information:
Paul Rosen, MD, MPH, MMM
[email protected]
412-692-3294
Registration:
Betsy Nero, Office of Medical Education
[email protected]
Description:
This class considers topics that are not usually discussed during formal medical training. The goal is to give you a ‘heads up’ regarding what is coming
your way during your career in medicine. The course will use a case-study
method to introduce you to skills you will need whether you are working in private practice, academics, industry, or another setting. This course should
augment your learning from the ‘Basic Science of Care’ course. In this course,
we will focus on developing the non-medical skills required to become a successful physician.
Objectives:
1. Understand the diversity of career opportunities in medicine.
2. Introduce a framework for negotiation.
3. Understand the importance of contracts.
4. Understand the importance of human resources and office management.
5. Discuss the concepts behind billing, coding, and pay for performance.
6. Understand the role of the physician as a leader.
7. Introduction to quality measures and process improvement.
Requirements:
Read the cases and participate in class.
Office
of
Medical
Education
www.omed.pitt.edu
412.648.8714
56
Course Outline
The Real World of Medicine: Business Aspects
Course Directors:
Paul Rosen, MD, MPH, MMM
Assistant Professor of Pediatrics, UPSOM,
Clinical Director of Rheumatology, Children’s Hospital of Pittsburgh
Course Objectives:
1. Understand the diversity of career opportunities in medicine.
2. Introduce a framework for negotiation.
3. Understand the importance of contracts.
4. Understand the importance of human resources and office management.
5. Discuss the concepts behind billing, coding, and pay for performance.
6. Understand the role of the physician as a leader.
7. Introduction to quality measures and process improvement.
Location:
All sessions
Children’s Hospital Main Tower, Room 3889
Rheumatology Conference Room
Week 1– March 3, 2009:
Career Development
• Survey of traditional and non-traditional careers in medicine.
• Learn tools for a successful negotiation.
• Review the key elements of contracts.
Week 2—March 10, 2009
Medical Management
• Develop skills to evaluate personnel.
• Introduce the hiring/firing process
• Discuss the key components of running a practice: safety, quality, efficiency.
Week 3—March 17, 2009
Reimbursement
• Develop the concept that billing is a skill that requires training.
• Coding should reflect clinical documentation.
• Discuss physician reimbursement plans designed to maximize production.
Week 4—March 24, 2009
Health Care Delivery Improvement
• Develop metrics for process change management.
• Discuss the role of the physician in a complex healthcare system.
• Introduce the concept of the physician as a leader.
57
The Real World of Medicine: Legal Aspects
Mini-Elective
Spring 2009
University
of
Pittsburgh
School
of
Medicine
Course Dates:
March 2, 9, 16, 23
Mondays, 1:00-3:00 PM
Maximum Students:
8
Class Year:
MS2
Course Directors:
Paul Rosen, MD, MPH, MMM
Assistant Professor of Pediatrics, UPSOM,
Clinical Director of Rheumatology,
Children’s Hospital of Pittsburgh
Richard P. Kidwell, Esq.
UPMC Associate Counsel and Director
Of Risk Management
Contact Information:
Paul Rosen, MD, MPH, MMM
[email protected]
412-692-3294
Richard P. Kidwell, Esq.
[email protected]
412-647-7398
Registration:
Betsy Nero, Office of Medical Education
[email protected]
Description:
This class examines how the legal system may affect your medical practice.
The goal is to give you a basic understanding of the factors that can lead to
legal action. The course will rely on practitioners from law, finance, and insurance industries to share their perspectives and engage the class. This course
should augment your learning from the ‘Basic Science of Care’ course and the
‘Ethics, Law, and Professionalism’ course. In this course, we will focus on developing the awareness and behaviors that are required to become a successful physician.
Office
of
Medical
Education
www.omed.pitt.edu
Objectives:
1. Understand the behaviors you can adopt to reduce the risk of legal action.
2. Understand the legal risk of being a medical student and resident.
3. Understand the variation in insurance premiums.
4. Understand the costs involved with insurance and legal protection.
5. Discuss the concepts behind ‘defensive medicine.’
6. Understand the basics of asset protection.
7. Introduction to models of tort reform.
Requirements:
Class attendance and participation.
412.648.8714
58
Course Outline
The Real World of Medicine: Legal Aspects
Course Directors:
Paul Rosen, MD, MPH, MMM
Assistant Professor of Pediatrics, UPSOM,
Clinical Director of Rheumatology, Children’s Hospital of Pittsburgh
Richard P. Kidwell, Esq.
UPMC Associate Counsel and Director of Risk Management
Additional Faculty:
John Gismondi, John Conti, Andy Thurman, Pamela Grimm, Robert Voinchet, Chris Bosser
Course Objectives:
1. Understand the behaviors you can adopt to reduce the risk of legal action.
2. Understand the legal risk of being a medical student and resident.
3. Understand the variation in insurance premiums.
4. Understand the costs involved with insurance and legal protection.
5. Discuss the concepts behind ‘defensive medicine.’
6. Understand the basics of asset protection.
7. Introduction to models of tort reform.
Location:
All sessions
Children’s Hospital Main Tower, Room 3889
Rheumatology Conference Room
Week 1– March 2, 2009:
Malpractice (John Gismondi, Rick Kidwell, John Conti)
• Documentation and Communication.
• Plaintiff perspective.
• Psychological effects of being sued.
Week 2—March 9, 2009
Personal finance and Office Management (Andy Thurman and Pamela Grimm)
• Financial planning.
• Human resources.
• Legal risks in practice settings.
Week 3—March 16, 2009
Insurance (Robert Voinchet and Chris Bosser)
• Specialty and geographic rate variance.
• Underwriting.
• Claims
Week 4—March 23, 2009
Tort Reform (Robert Voinchet and Rick Kidwell)
• Health Courts
• Patient Safety
• No-fault compensation
• Managed-Care Organizations
59