UC COM :: M3/M4 Course Syllabi

M3/M4 Course Offerings

2022-2023 M3/M4 Course Syllabi

Neurology

COURSE NUMBER:

10 30 01

TITLE:

Dementia and the Arts Service Learning
Despite the evidence that small-group interactions around the expressive arts improve function, mood, and behavior in individuals with cognitive disorders, medical professionals and students often lack the knowledge and skills related to non-medical interventions. This longitudinal on-line course brings aspiring artists in CCM and medical professionals in the COM together with families impacted by neurodegenerative disorders in one-hour weekly interactive music and art-based activities in order to learn from each other and adapt specific arts-based approaches to match the individual needs of patients and caregivers. This is an opportunity for students in the arts and medical sciences to collaborate with each other and to serve and learn alongside an underserved population, particularly at a time when community resources are restricted due to the COVID pandemic.

PREREQUISITES:

No prerequisites, but students who sign up for this elective should enjoy arts and music and engaging with individuals with cognitive disorders.

expand all

GENERAL INFORMATION

COURSE YEAR:

CREDIT HOURS:

CREDIT WEEKS:

DOMESTIC VISITING:

INTERNATIONAL VISITING:

GRADED:

Pass/Fail

COURSE QUALIFICATIONS:

Longitudinal,

COURSE TYPE:

Clinical

STATUS:

Part-Time (PT Elective) - Extended
OFFERED AS FULL-TIME AND PART-TIME: NO
ALLOWS OVERLAP: YES

COURSE LENGTH:

Extended elective starting August 31st and ends in May, 2021

DIRECTOR:

Rhonna Shatz, DO
shatzra@ucmail.uc.edu

ADMINISTRATIVE SUPPORT PERSON:

Angela Bustamante
bustamam@uc.edu
513-558-1754
MSB, 7103A

SITE(S):

Remote

MAX ENROLL:

ROTATIONS:

Rotation	Dates	Max
1	06/06/2022 - 07/01/2022	0
2	07/04/2022 - 07/29/2022	0
3	08/01/2022 - 08/26/2022	0
4	08/29/2022 - 09/23/2022	0
5	09/26/2022 - 10/21/2022	0
6	10/24/2022 - 11/18/2022	0
7	11/21/2022 - 12/16/2022	0
8	01/02/2023 - 01/27/2023	0
9	01/30/2023 - 02/24/2023	0
10	02/27/2023 - 03/24/2023	0
11	03/27/2023 - 04/21/2023	10
12	04/24/2023 - 05/19/2023	0

Please check course length. Some PT courses may extend beyond the noted 4 week blocks above.
NOTE: If a rotation is offered in both 2 and 4 week slots, the max capacity is limited to the actual spots offered for the 4 weeks. (ie: the 2 week rotations listed share the max of the 4 week rotation)

WORKING HOURS:

4 hours/week; time to be determined by COM student, CCM student collaborator, patient and caregiver

REPORT 1^ST DAY:

You will receive an email with detailed information prior to the elective. This is an on-line elective and will not require any in-person meetings.

INSTRUCTION

LEARNING ACTIVITIES:

Patient Presentation--Faculty
Reflection
Research

LEARNING ENVIRONMENT POLICIES:

UCCOM strives to provide medical students with a learning environment that is conducive to their professional growth. All UCCOM and visiting medical students are encouraged to review the Student Handbook.

The Office of Student Affairs and Admissions is available to all UCCOM and visiting medical students to discuss any concerns/questions related to the learning environment. Please call 558-6796 to access faculty/staff that can assist you.

TEACHING:

50%	Attending Physician
45%	Other Faculty
5%	peers and patient/caregivers

FEEDBACK:

Faculty

ASSESSMENT:

FINAL GRADE:

GRADE ASSIGNED BY: Principle instructor

OBJECTIVES

Curricular Resources :

Sample readings:

Medaglia JD et al. Cognitive network neuroscience. J Cogn Neurosci 2015; 27(8):1471-91

Jung J et al. Establishing the cognitive signature of human brain networks derived from structural and functional connectivity. Brain Struct Funct 2018;223(9):4023-38

Papagno C. Memory deficits. Handb Clin Neurol 2018; 151:377-393

Klinzing JG et al. Mechanisms of systems memory consolidation during sleep. Nat Neurosci 2019;22(10):1598-1610

Eichenbaum H. The role of hippocampus in navigation is memory. J Neurophysiol 2017;117(4):1785-1796

Gilmore AW et al. A parietal memory network revealed by multiple MRI methods. Trends Cogn Sci 2015;19(9):534-43.

Eichenbaum H. On the Integration of Space, Time, and Memory. Neuron 2017;95(5):1007-18

Dronkers NF et al. What do language disorders reveal about brain-language relationships? From classic models to network approaches. J Int Neuropsychol Soc 2017;23(9-10):741-754

Shafto MA et al. Language in the aging brain: the network dynamics of cognitive decline and preservation. Science 2014;346(6209):583-7

Nasios G et al. From Broca and Wernicke to the Neuromodulation Era--Insights of brain language networks for neurorehabilitation. Behav Neurol 2019;:9894571.

Misic B et al. From regions to connections and networks: new bridges between brain and behavior. Curr Opin Neurobiol 2016;40:1-7

Noonan MP et al. The structural and functional brain networks that support human social networks. Behav Brain Res 2018;355:12-23

Ismail Z. et al. The Mild behavioral impairment checklist: A rating scale for neuropsychiatric symptoms in pre-dementia populations. J Alz Dis 2017;56(3):929-38

Smith K et al. Habit formation. Dialogues Clin Neurosci 2016;18(1):33-43

Andrews et al. Association of Alzheimer's genetic loci with mild behavioral impairment. Am J Med Genet 2018;177B:727-35

Lanctot K et al. Neuropsychiatric signs and symptoms of Alzheimer's disease: New treatment paradigms. Alz and Dementia 2017;3:440-449

Le Heron et al. The anatomy of apathy: a neurocognitive framework for amotivated behavior. Neuropsychologia 2018;118:54-67

Wang S et al. The neuroscience of music: a review and summary. Psychiatr Danub 2018;30(suppl 7):588-594

Schlaug G. Musicians and music making as a model for the study of brain plasticity. Prog Brain Res 2015;217:37-55

Karageorghis CI et al. Brain mechanisms that underlie music interventions in the exercise domain. Prog Brain Res 2018;240:109-25

Fernandez NB et al. Brain networks mediating the influence of background music on selective attention. Soc Cogn Afect Neurosci 2019;14(12):1441-1452

Gove D et al. Stigma and GPs perception of dementia. Aging Ment Health 2016;20(4):391-400.

Hand MD. Every 3 seconds: A review of an innovative documentary on reserach and stigma surrounding dementia across the globe. J Gerontol Soc Work 2019;62(3):369-373

Weisman de Mamani A et al. Stigma, expressed emotion, and quality of life in caregivers of individuals with dementia. Fam Process. 2018;57(3):694-706.

Fletcher JR. Destigmatising dementia: The dangers of felt stigma and benevolent othering. Dementia 2019;Nov 5:147130129884821

Burns NC et al. The impact of Creative Arts in Alzheimer's disease and Dementia Public Health Education. J Alzheimers Dis 2018;63(2):457-463

Baba Yaga stories

Trolls and elf stories

Love in the Time of Cholera Gabriel Garcia Marquez

Instructional Methods:

On-line modules

Virtual group meetings with feedback and review of reflections

Virtual specialty workshops and lectures with Community Music Therapy specialist (Melodic Connections) and National Educators (Judith-Kate Friedman of Songwriting Works)

Reading list with student led virtual group discussions with faculty

Knowledge/Skills:

Knowledge/Skills The student should be able to:

1. Demonstrate improved skills in leadership, communication, active listening, improvisation, and adaptation through intergenerational learning with people with neurodegenerative disorders.

2. Understand how artistic engagement stimulates increased brain functioning and alters the human capacity for remembering

3. Address stigmas and biases related to Alzheimer's disease, other dementias, and aging through exploration of stories, scientific literature, and interactions with patients and caregivers

4. Identify brain networks associated with specific cognitive functions (memory, language, music, and behavior) and dementia signs and symptoms including cognition, movement, mood, and behavior.

5. Understand the roles of medical and non-medical and arts based strategies to address behavioral disturbances in dementias

Procedures/Performance The student should be able to:

1. Construct activities that foster agency and decision making opportunities for people with dementia in a supportive and nurturing environment.

2. Integrate learning models from neuroscience, arts education, and health care through collaborative learning outside of the classroom.

3. Develop skill in working in teams of individuals with a diverse set of expertise and experiences.

4. Develop skill in working with on-line platforms for learning, teaching, and collaboration

Attitudes (include professional attitudes/behaviors) The student should:

1. Engage in a respectful and supportive manner with individuals with dementia, their caregivers, and other members of the team

2. Share knowledge and seek knowledge from all members of the team

3. Model behaviors that reduce stigma and trauma related to cognitive impairment

Main Course Topics :

Dementia

Music

Service Learning

Procedures:

N/A

SAMPLE WEEK

Monday:

6:00AM

6:00PM

Determined by each group

Tuesday:

6:00AM

6:00PM

Determined by each group

Wednesday:

6:00AM

6:00PM

Determined by each group

Thursday:

6:00AM

6:00PM

Determined by each group

Friday:

6:00AM

6:00PM

Determined by each group

SCHEDULE NOTE:

Each group will determine what time they will meet each week. Feedback will be virtual. The bi-weekly didactics will be set up at a time determine to be convenient for all college of medicine students.

The schedule for this remote elective is :

1. During the first week of the semester: CCM and COM students will attend two training and information sessions. After the first session, students will receive an information packet and questionnaire in which they detail their artistic strengths/interests, any relevant experience with people with cognitive disorders (CD), and their availability for meeting times throughout

the semester. This information will allow the course graduate assistant to create small groups consisting of at least one CCM student, COM student, patient, and caregiver. Ideally, all group members will have a shared background and/or an interest in one or more arts-based approaches (e.g., creative movement, vocal performance, improv theater).

2. During Weeks 1 and 2 of the semester: While the graduate coordinators are setting up the groups and scheduling weekly meetings, the course supervisors will hold one training and information session for student participants.

Dr. Shatz will lead a session about memory and concepts underlying the characteristics of major neurodegenerative dementias, the role of the arts in cognition and function, and practical issues related to communication challenges or behaviors in individuals experiencing cognitive impairment.

Dr. Fiol will lead a session that introduces a number of different arts-based, collaborative strategies for working with people with CDs.

Both supervisors, alongside the social workers who are working closely with the patients, will provide specialized guidance and lead students through a series of arts-based improvisation exercises that will help to instill values for spontaneity, adaptability and active listening required when working with people with CDs.

4. Following weeks: students are expected to be in regular communication with the course graduate assistant in order to schedule regular weekly meeting with a patient/caregiver at a time that works for everyone. Although they may exceed these requirements, student participants are required to meet in these small groups for a minimum of eight one-hour sessions during each semester.

5. Initial Self-Assessment and Weekly Reflection Assignments

During the first or second week of the course, after the initial training sessions but before meeting with the patient and caregiver, students will submit a reflection paper in which they critically examine their personal backgrounds and expectations for this experience and articulate a number of different learning objectives for this experience.

Then, after their first session in small groups, students will meet with supervisors for evaluation of previous sessions, identification of any issues with patient/care partner interactions or session content, and plan for next sessions. Working with people with CDs requires unlearning and relearning a whole new set of skills, and it is expected that there will be bumps along the way. The course grad assistant and the supervisors assist students throughout this proces. The weekly supervisor sessions should address the following questions:

1. Overall how would you describe the last session?

2. What were the most successful aspects of the collaboration?

3. What were the least successful aspects of the collaboration?

4. How do interactions with patients influence your understanding of cognitive impairment?

5. How do interactions with caregivers inform you about communication strategies with cognitively impaired individuals? With their caregivers?

6. Could you have used more or less direction before or during the session?

7. What information are you lacking and need for future planning?

8. In what way do cultural or generational experiences influence

interactions?

9. In what ways would you like to sustain or alter the process to create a better experience for all members of the group?

6. COM students (optional for CCM students) will also be assigned biweekly readings on topics related to the following. Students will rotate in creating an on-line power point review, discussion, and/or case example based on the reading. During the first week of the two week cycle, the designated student will create a presentation, review with faculty, and identify discussion points. During the second week of the cycle, the student will present the powerpoint and co-lead the discussion with all the remaining students. Materials used for this section will be archived to use as resources for future classes.

1. The network basis of cognition.

2. Brain networks underlying memory, language, behavior, and music

3. Brain networks underlying major neurodegenerative dementias (Alzheimer's, Lewy body disease/Parkinson's disease with dementia, Frontotemporal dementia syndromes): how symptoms reflect network dysfunction

4. Mechanisms of neurodegeneration

5. Mechanisms of neurogenesis and cognitive reserve

6. Neurology of memory

7. Neurology of music and memory

8. Concept of mild behavioral impairment in neurodegenerative disease

9. Neurological basis of behaviors in neurodegenerative disease

10. Medical approaches to behavior management (and their limitations)

11. Non-medical approaches to behavior management

12. Principles of caregiver education and support

13. Dementia and Alzheimer's disease in art and literature: stigma and bias

7. Final Self-Assessment

At the completion of the course, students will turn in a self-assessment that asks them to reflect on their process of learning and discovery. After the students answer each of the following questions, the supervisor(s) will provide feedback in response, ultimately resulting in a summary conclusion. This provides both the students and the supervisors a sense of next steps.

• In general, how would you assess your performance during this course?

• Could you have used more or less direction prior to starting the sessions? During the sessions?

• What did/do you enjoy and what did you not enjoy about the sessions?

• In what ways did the experience differ from your expectations?

• List your agreed-upon learning objectives for the course. Evaluate your work based on your learning objectives--are there areas in which you feel that you could use more focused work? Do you feel that you made good progress in each of the specified learning objectives? How might you achieve greater mastery in the areas of your specific learning objectives?

• Could you see yourself doing this on an everyday basis in the future? Why or why not?

• From this learning experience, what skill sets do you feel you've developed and what have you learned you need to develop further in order to pursue your long-term goals or next steps? How can we help you get there?

• In what ways did this experience alter your understanding of people with cognitive impairment and the caregiving role?

ATTENDANCE AND ABSENCE POLICY

Session Attendance for M4 Students

Students may miss no more than two days of planned excused absences on a four week rotation without being required to make-up the work, at the discretion of the clerkship/elective/course director or his/her designee.
Non-AI Rotations - Per the Student Duty Hours Policy, an average of one day (24 hours) in every seven must be free of clinical responsibilities (including seminars, clinic, rounds, lectures) averaged over a four week period. These days off are assigned by the clerkship director to best align with the site schedule. Students may request to schedule 1 or more of these 4 days for planned absences that fall under 1 of the categories listed below for excused absences during non-AI rotations, in consultation with the course/elective director, who may or may not approve such planned absences.
AI Rotations - Per the Student Duty Hours Policy, an average of one day (24 hours) in every seven must be free of clinical responsibilities (including seminars, clinic, rounds, lectures) averaged over a four week period. These days off are assigned by the course director to best align with the site schedule. Students may request to schedule 1 or 2 of these days for planned absences that fall under 1 of the categories listed below for excused absences during AI rotations, in consultation with the course director, who may or may not approve such planned absences. Students must avoid scheduling Step 2 examinations during an Acting Internship.
Excused Absences - The following will be considered excused absences:
- Diagnostic, preventative, and therapeutic health services (e.g. doctor appointments, physical therapy, counselling, etc).
- Personal illness, accident or a major catastrophic event
- Death or serious illness of immediate family members. Immediate family members, as defined by UC, are Grandparents, Brother, Sister, Brother-in law, Sister-in-law, Daughter-in-law, Son-in-law, Father, Mother, Mother-in-law, Father-in-law, Step-sister, Step-brother, Step-mother, Step-father, Spouse or domestic partner, Child, Grandchild, legal Guardian or other person who stands in place of parent (in Loco Parentis)
Whenever possible, planned absences should be requested a minimum of six weeks in advance of the start of the clerkship/elective/course in which the absence will occur; this enables the clerkship/course/elective to help plan for educational event scheduling (e.g. a known appointment could be scheduled around with enough notice and the student might not have any required coursework to make up). Absences requested less than 1 week prior to the planned absence may not be considered for a possible excused absence unless extenuating circumstances prevented the student from providing timely notification per the policy. Students should first submit their request for a planned absence to the clerkship/elective/course director using the online MSSF. All planned/excused absences for any reason should be documented on the MSSF.
The COM abides by the UC Religious Observance Policy that respects the religious diversity of its students by providing opportunities, where possible, for accommodation in cases where conflicts exist between students’ religious beliefs/practices and educational activities. In clinical settings, such accommodations must honor the primacy of a commitment to patient care and avoid unduly burdening faculty, staff and the general student population involved in the affected educational and/or patient care activity.
The following items are explained in detail in the Medical Student Handbook:
- Excused/unexcused/unplanned absence, religious holidays, jury duty, and make-up work

See Attendance and Absences Policy, Religious Observance Policy, Medical Student Handbook.