OVERVIEW DIRECTOR: STEVEN E. ARNOLD, MD The brain is different from every other organ because it is the place where our cognition, emotion and unique human consciousness reside. An understanding of the functioning of the nervous system is closely bound up with the questions that have preoccupied philosophers throughout history. For this reason, the nervous system is the only system of the body that is commonly represented by an undergraduate major, and many medical students come to the University of Pennsylvania School of Medicine especially interested in Neurology, Psychiatry, Neurosurgery and related specialties, the clinical neurosciences. The Clinical Neuroscience Track (CNST) was developed at Penn in 1993 to nurture this interest and maintain students' intellectual involvement in the neurosciences throughout medical school. Administered under the auspices of the David Mahoney Institute of Neurological Sciences, an interdisciplinary neuroscience institute on the Penn campus, the goal of the CNST is to train clinical neuroscientists who will participate on the forefront of academic practice and disease oriented research. The program combines curricular enrichment in the neurosciences with special extracurricular activities and research opportunities within the four-year medical school structure. Departments and divisions which contribute to the CNST include: Department of Neurology Department of Neurosurgery Department of Psychiatry Division of Neuropathology Division of Neuroradiology Admission into the Program The Clinical Neuroscience Track, under the direction of Steven E. Arnold, M.D., is open to all students who have been accepted to the University of Pennsylvania School of Medicine and who have an interest in pursuing a career in the clinical neurosciences. Many students have had previous neuroscience experience, but this is not a prerequisite to admission. Although the CNST was designed for four-year medical students, many combined degree students participate. Special arrangements have been made to accommodate their schedules. By participating in the CNST, these students gain respect for the complexities of clinical research and appreciation for its importance. Interested students should contact the Coordinator of the Clinical Neuroscience Track at (215) 662-3396 or dorevans@mail.med.upenn.edu. STRUCTURE OF THE CLINICAL NEUROSCIENCE TRACK The CNST consists of several components: Mentoring Luncheon Series of Clinical Case Conferences, Journal Club, and Research and Career Seminars Special Academic and Social Events Expanded Clinical Neuroscience Curriculum Opportunities and Financial Support for Clinical Neuroscience Research Mentoring Program During the first year, CNST students are provided with a list of clinical faculty who have agreed to serve as mentors and a succinct description of their academic interests or research. Each student selects a mentor, but the mentor may be changed as students’ interests develop. The mentors serve as career advisors and guides to the curricular and other intellectual resources available at the medical school that could assist students in reaching their career goals. Luncheon Series A weekly rotating schedule of conferences, seminars and meetings with CNST faculty offers students the opportunity to appreciate the breadth of neuroscience at Penn and learn about faculty with whom they may want to develop a mentoring relationship. Lunch is provided and the atmosphere is informal. - Clinical Case Conferences: Case presentations by faculty will serve as a springboard for discussion of clinical care and research into the causes, complications, prevention and treatment of nervous system disorders. Cases will emphasize the interdisciplinary nature of clinical neurosciences. We will have roundtable discussions by faculty from different departments to present their approaches to a particular clinical problem. - Journal Chalk Talks: These are student organized and led meetings aimed at learning to critically read and evaluate research literature. At each meeting, one or two students review one or a small group of journal articles on a topic or controversy in clinical neuroscience. Students invite a guest faculty expert to lend additional critical perspective. - Careers in Neuroscience and Research: At these meetings, faculty, residents, fellows, and non-faculty (e.g., physicians working in pharmaceutical/biotech industry) discuss how their academic or research careers evolved and share information on their research and the current states of their fields. - Variety Neuroscience: On these Fridays, we will have various activities. For example, we may have group visits to the MRI facility, specialized inpatient units such as the Epilepsy Monitoring Unit, “brain cutting” in the autopsy suite, or informal, open-ended lunch meetings with faculty. Special Academic and Social Events Students are encouraged to develop an esprit de corps by attendance at seminars, special lectures and social get-togethers. They are also invited to the special lectures, dinners and research colloquia of the Mahoney Institute of Neurological Sciences. Examples include the Louis B. Flexner Lecture and Dinner, the Frank Elliott Lecture in Cognitive Neuroscience and the Institute of Neurological Sciences Annual Retreat. In this way, CNST students are encouraged to have intellectual exchanges with basic and clinical neuroscientists and with neuroscience graduate students. Expanded Clinical Neuroscience Curriculum The design of the medical school curriculum incorporates the integrated approach to teaching the clinical neurosciences that was pioneered by the CNST. A 12-week block is devoted to Psychiatry, Neurology and the specialties of Ophthalmology, Otorhinolaryngology and Orthopaedic Surgery, all of which have strong neuroscience aspects. An integrated lecture series encourages students to view the brain as a unit rather than subdividing its functions artificially among clinical specialties. CNST students may also include four weeks of Neurosurgery during their 12-week Surgery block. During the final 18 months of medical school, CNST students are offered a special course consisting of two to four rotations on clinical neuroscience subspecialty rotations. These are oriented largely around outpatient clinics. Available rotations include Neuro-Ophthalmology, Neuropsychiatry, Mood Disorders, Substance Abuse, Epilepsy and many others. Each rotation lasts 2 to 3 weeks and will be selected by the students. The Divisions of Neuroradiology and Neuropathology also have organized a special course, “Integrative Neuroradiology and Neuropathology,” which provides select CNST students the opportunity to view the clinical neurosciences from a unique anatomical perspective. Clinical Neuroscience Research CNST students may participate in neuroscience research throughout their medical school career, but the greatest opportunities occur in the summer between the first and second years and in the 12- to 24-week period of “Scholarly Pursuit” during the final 18 months of the medical school curriculum. Summer stipends and other types of financial assistance are available for these research projects through a unique education grant awarded to PENN by the National Institute of Mental Health to support the CNST. Timeline of Activities Orientation week. The Director of the CNST, Dr. Steven Arnold, describes program to new students. September of Year 1. Students register with CNST Office and attend an open welcome reception, where they can meet faculty and other students. Some students decide to join the CNST after hearing more about it at the reception. Students begin to find mentors. This may take a few months until the students have had a chance to consider their interests and speak with faculty. Year 1. Students participate in luncheon seminars and conferences. They also attend special lectures and social events of the David Mahoney Institute of Neurological Sciences. Summer after Year 1. Some students engage in CNST-supported research. Year 2, 1^st semester. Same as Year 1. Year 2, 2^nd semester and Year 3, 1^st semester (corresponding to Module 4 of the medical school curriculum). Students take the regular Brain and Behavior block of Module 4. In addition, CNST students receive priority for selection of Neurosurgery as one of their three rotations on the Surgery block of Module 4. Students attend Faculty Research Seminars and special lectures and social events of the David Mahoney Institute of Neurological Sciences. Though always welcome, many students stop attending the luncheon seminar series due to conflicts with clinical rotations. Year 3, 2^nd semester through Year 4 (corresponding to Module 5 of the medical school curriculum). Students receive priority for special elective courses designed for CNST. These include Integrative Neuroradiology & Neuropathology and Clinical Neuroscience Subspecialties (ID 301). Students attend Faculty Research Seminars and special lectures and social events of the David Mahoney Institute of Neurological Sciences. Students receive help selecting a research mentor and project for Scholarly Pursuit and may receive financial support for supplies and travel to meetings. A description of their activities in the CNST is included in the Dean’s letter of recommendation. Privileges and Requirements of CNST Membership Participation in the CNST includes several privileges not available to other medical students. These privileges include: 1) Stipend and laboratory support for summer research; 2) Invitation to dinners sponsored by the David Mahoney Institute of Neurological Sciences; 3) Priority for acceptance to the Neurosurgery rotation as part of the required Surgery Block of Module 4; 4) Priority for acceptance to CNST-sponsored courses (Correlative Neuroradiology/Neuropathology; Clinical Neuroscience Subspecialties) during Module 5; 5) Financial support for research expenses and travel during Scholarly Pursuit in Module 5; 6) Description of CNST participation in the Dean's letter of recommendation. In order to qualify for these privileges, students must meet the following requirements: 1) During the first 16 months, adequate attendance at the CNST luncheon series will qualify students for future participation in CNST privileges, mentoring, research benefits, and special mention in their Dean’s letter. 2) After the second semester of Year 2, students must take at least 8 hours of Clinical Neuroscience Courses, which could include Neurosurgery in Module 4 (4 hrs), Clinical Neuroscience Subspecialties (4-8 hrs), Correlative Neuroradiology & Neuropathology (4 hrs), any subinternship in the Clinical Neurosciences (4 hrs), and any other elective offered by the Departments/Divisions of Neurology, Neurosurgery, Psychiatry, Neuropathology or Neuroradiology (most are 4 hrs). 3) During Module 5, with guidance from an identified research mentor, students must engage in a Scholarly Pursuit activity relevant to the Clinical Neurosciences.