Henry Kaminski, MD
NEUROLOGY, UHC
email Dr. Kaminski
phone: 844-3744

ABSTRACT

The purpose of this new program is to provide the student an in-depth, rigorous exposure to a topic that cuts across several fields of medicine through a personal encounter with single patient. The subject is stroke, a major cause of death and disability that may occur at any age. The program will mimic the existing programs at the SOM that are designed to expose students early to patients by matching first year students to patients with acute cerebral infarcts. The students will participate in acute and longitudinal care of the patient. A formal curriculum of small group sessions will be developed that focus on various aspects of stroke, including tissue injury, anatomic-clinical correlation, health economics, disability, preventive medicine and several others. Students will attend physician visits and perform home visits. In their fourth year students will be expected to provide introductory lectures to first year students in program and educational sessions in stroke for the Cleveland community in addition to providing thesis appropriate for publication.

CURRICULAR PROJECT

The goal of this project is to develop a new vertically-integrated teaching program in comprehensive care of patients with stroke. Stroke is a leading cause of death in the United States and across the globe affecting all age groups. The individual, family, and social costs are obvious. Stroke, as a curricular focus envisioned in this proposal, offers the student exposure to the breath of medicine from acute hospitalization, clinical-pathological correlation, preventative medicine, medical economics, chronic illness, and social impact of disease.

In brief, a group of first year students electing this curriculum will be provided a "Brain Attack Pager". This pager is activated when a patient enters the University Hospital Emergency Room with an acute cerebral infarction (there is no reason the program cannot be instituted at all affiliated hospitals, I am most familiar with this one and therefore used UH as an example). This will be the first time the student encounters the patient they will follow for the next 4 years (appropriate informed consent will be provided to the patient and family to enroll patients into the educational program). The student follows the patient through the admission by meeting with the attending neurologist/neurosurgeon and when possible residents. All laboratory testing, radiological evaluation, patient notes, and billing procedures are reviewed with the student. The patient is examined with the student on a daily basis until discharge.

Upon discharge arrangements are made for the student to attend follow-up visits with the neurologist/neurosurgeon and primary care doctor (selection criteria for patients will need to be established to allow this, primary care doctors will need to agree to participation and be in a geographically appropriate distance of the medical center). Students participating in the program will meet every 6 months as a group with the participating faculty to discuss their experiences. A monthly, formal curriculum associated with the program will be geared to the year of the studentsŐ education. Prior to the patient identification stage, introductory lectures are provided to stroke in general terms (at the level a doctor should educate a patient and family regarding stroke cause, including acute care, future medical needs, stroke prevention, informed consent and pathophysiology of stroke) as well stroke impact on society. As the students progress through the curriculum, lectures are provided that discuss chronic care, risk factors of stroke (discussing for example pathogenesis of diabetes and tobacco abuse as a cause of stroke), and disability programs. During Year 2 greater emphasis is placed on pathophysiology, experimental treatments of acute and chronic stroke, and ethical aspects of stroke care. Year 3 curriculum is limited to group meetings at the start, middle, and end of the year. In Year 4 students will be expected to teach the introductory lectures under supervision to first year students and to provide lectures in warning signs of stroke and stroke prevention at various organizations in the City of Cleveland (for example church groups, hospital organized community activities, local libraries). During the 4-year program, the student will be expected to produce a 1- page thesis on a subject related to stroke. If the student has a particular interest in a research career, the thesis will take the format of NIH grant submission. It is hoped but not required that a publication will result from the student's experience.

CURRICULAR NEEDS

As I see our curricular needs, students are guided from an individual with minimal understanding of the complexities of caring for patients (which include understanding of how disease affects the human body, the impact of disease on a patient, their social circle, and society in general) to someone who has the basic skills to learn to be a physician throughout the course of their residency and the reminder of their career. This program offers the opportunity to expose a student to the full array of medical care, in fashion similar to existing programs that expose students to patient care early in the curriculum.

BENEFIT TO SOM AND EDUCATIONAL MISSION

I see benefit to the SOM in several ways. 1) The program offers a choice (or a supplement) to the program that allows students to follow a pregnant woman during their first years of study. 2) Provides direct correlation of the basic science of tissue injury, correlation of disease and anatomy, patient impact of disease, social and ethical aspects of patient care, and the economics of medicine. 3) The student is provided an opportunity to study highly focused area in great detail in their thesis preparation, the hallmark of a doctoral program. 4) The program provides the student in their fourth year the opportunity to themselves become an educator.