Brain & Behavior | Syllabus 2016

Brain & Behavior | 2016

Course Syllabus
Course description
Brain & Behavior explores the functional organization and neurophysiology of the central nervous
system, and the neurobiological foundation for understanding disorders of human behavior. This course
employs a variety of instructional methods and learning experiences, including video tutorials, problem
solving through clinical cases, instructor-facilitated discussion, live tutorials and seminars from expert
scientists and clinicians, patient-interviews, and hand-on examination and dissection of human brain
specimens. In-class learning will be organized around the principles of team-based learning, with students
organized in small teams for Readiness Assurance, Team Applications and Laboratory Discovery. The
overall goal of this course is to provide the foundation for understanding the integrative actions of the
nervous system and the impairments of sensation, action and cognition that accompany injury, disease
or dysfunction in the central nervous system. The course will build upon knowledge acquired in Molecules,
Cells & Tissues and Normal Body, and it will provide a framework for understanding the neurological basis
for the physical examination and the pathophysiological considerations that are featured in Body &
Disease.

Course directors
Leonard E. White, PhD (primary course director)
Associate Professor
Orthopaedic Surgery; Neurobiology
Duke Institute for Brain Sciences
[click here for professional profile]

Andrew Krystal, MD
Professor
Psychiatry and Behavioral Sciences (Outpatient Psychiatry)
[click here for professional profile]

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Eric Thompson, MD
Assistant Professor
Neurosurgery; Pediatrics
Duke Cancer Institute
[click here for professional profile]

Course objectives
At the completion of this course the student will:
1. Demonstrate the major embryological subdivisions of the central nervous system as seen on the
surface of the human forebrain, hindbrain and spinal cord.
2. Demonstrate the four lobes of the cerebral hemispheres in the human brain, including the
neuroanatomical landmarks that define their boundaries.
3. Sketch the lateral and medial views of the cerebral hemispheres of the human brain, with all
primary gyri and sulci of the human cerebral cortex identified.
4. Discuss the major, clinically significant functions that are localized to each of the four pairs of
lobes in the cerebral hemispheres of the human brain.
5. Describe the means for blood supply to the brain and spinal cord, including the principle vessels
that supply each of the major subdivisions of the central nervous system.
6. Identify internal components of the central nervous system in cross-sectional preparations and
histological presentations, including ventricular spaces, major white matter structures and deep
gray matter structures.
7. Sketch the organization of deep gray matter in the human forebrain relative to the ventricular
system and major white matter structures.
8. Describe the organization of the major ascending and descending tracts of the brain and spinal
cord, including neural systems for pain and temperature sensation, touch and pressure
sensation, motor control, and vision.
9. Describe the location and function of the major neuroanatomical structures involved in motor
control and sensory processing.
10. Discuss the major systems in the central nervous system for maintaining homeostasis,
promoting allostasis, and governing the functions of visceral motor effectors.
11. Discuss the mechanisms responsible for axon guidance, synapse formation and developmental
plasticity in the central nervous system.
12. Discuss the functional impairments associated with injury or disease affected major sensory and
motor structures in the forebrain, hindbrain and spinal cord.
13. Describe the neural mechanisms that regulate sleep and wakefulness.
14. Discuss the neurobiological mechanisms of emotion, reward and motivation.
15. Discuss the neurobiological mechanisms of stress and anxiety.

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16. Discuss the brain mechanisms that support and modulate attention, executive function, and
decision-making.
17. Describe major forms of anxiety, mood, and personality disorders.
18. Discuss the functional impairments associated with injury or disease affected major cognitive
systems in the forebrain and hindbrain.

Learning resources
We will mobilize and employ a variety of instructional resources for this course, including:
Bluedocs website for Brain & Behavior [check frequentlydailyfor announcements, updates to
schedule, and information pertaining to each learning event including session objectives]
Sakai website for Brain & Behavior [for daily TBL assessments and scores] (click here)
Medical Neuroscience website on Coursera (click here) [participation is OPTIONAL; cost is FREE]
primary textbook:

Purves D, Augustine GJ, Fitzpatrick D, Hall WC, LaMantia A-S, McNamara JO,
White LE (2011) Neuroscience, 5th Ed. Sunderlund MA: Sinauer Associates, Inc.
cost:

hardcopy: $100.26 (bundled with Sylvius4 Online)

loose-leaf: $65.17 (bundled with Sylvius4)
CourseSmart eBook: $53.08 (6 month digital rental)

supplemental reader: White LE and Cant NB (2016) A Laboratory Guide for Learning Functional Human
Neuroanatomy.
cost:

reference media:

hardcopy distributed gratis to enrolled users

(printed compliments of the Office of Curriculum Affairs and the
Duke Institute for Brain Sciences)
PDF available on Bluedocs and Sakai

Williams SM, White LE (2013) Sylvius4 Online: An Interactive Atlas and Visual
Glossary of Human Neuroanatomy. Sunderlund MA: Sinauer Associates, Inc.
cost:

bundled with purchase of Neuroscience, 5th Ed.

without Neuroscience, 5th Ed., free when accessed via Duke Health
i.p. address (50 simultaneous users enabled)
$25 (one-year subscription)

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recommended text:

Blumenfeld H (2010) Neuroanatomy through Clinical Cases, 2nd Edition.

Sunderlund MA: Sinauer Associates, Inc.
cost:

$74.76 (hardcopy)
CourseSmart eBook: $40.48 (18 month digital rental)
YUZU eBook: $35.43 (180 day digital rental)
BryteWave eBook: $40.48 (180 day digital rental)

Instructional methods
We will employ a variety of instructional methods to enhance your learning experiences in this course.
Traditional teaching methods will include in-class tutorials/seminars and active laboratory experiences.
Additional methods will employ the principles and practices of team-based learning, including individual
and team Readiness Assurances (iRAs and tRAs, respectively) and Team Applications, during which you
will problem-solve and promote collaborative learning among the members of your team. In addition,
video tutorials, tutorial notes, and assigned readings and animations from Purves et al., Neuroscience 5th
Ed. and the Laboratory Guide, will provide structure for individual and team learning in advance of each
class session.

Course policies
Requirements. Each learner and instructor is expected to uphold the Duke Community Standard in all
academic and non-academic endeavors associated with this course.
Duke University is a community dedicated to scholarship, leadership, and service and to the
principles of honesty, fairness, respect, and accountability. Citizens of this community commit
to reflect upon and uphold these principles in all academic and non-academic endeavors, and to
protect and promote a culture of integrity.
To uphold the Duke Community Standard:

I will not lie, cheat, or steal in my academic endeavors;

I will conduct myself honorably in all my endeavors; and
I will act if the Standard is compromised.

This Standard emphasizes dedication to scholarship, leadership, and service, and to the principles of
honesty, fairness, respect, and accountabilityall values that we will uphold in our studies of Brain &
Behavior. Furthermore, all medical students are bound to uphold the Duke University School of
Medicine Code of Professional Conduct.
Readiness Assurances. Each learner will come to class having prepared for the days activities, be they
faculty-led tutorials and seminars, laboratory experiences, team discussions or team applications.
Readiness Assurances (RA) are designed to encourage you to meet this expectation. RAs will sample your
knowledge of core, foundational content that you will be expected to study and learn outside of the
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classroom through the use of through video tutorials, assigned readings, and other digital resources. You
should expect a Readiness Assurance on nearly a daily basis (as scheduled in Bluedocs). You will take these
assessments first on an individual basis (called an individual Readiness Assurance; iRA), and then again as
a team (called a team Readiness Assurance; tRA). Thus, following the iRA, you will have the opportunity
in real time to consolidate your knowledge, fill-in any gaps, and improve your understanding of the
foundational material; this will set the stage for the applied learning that follows. You will also have the
opportunity to improve your overall performance on the sessions RA by working with other members of
your team on the tRA. iRAs/tRAs will typically comprise 15-25, multiple-choice questions. As the course
progresses, the number of questions will increase slightly as questions from previous iRAs/tRAs will be
incorporated to assess your retention of cumulative course material. Each RA session will last, on average,
about 50 minutes. This will include facilitated discussion among teams as well as clarifying input from your
course instructors. During each RA session, all questions in both phases of the RA (iRA/tRA) are to be
completed without the aid of any external sources (i.e., closed book and closed internet). As a significant
percentage of your score on each assessment will be determined by your teams performance (see below),
you have a strong incentive to work together effectively as a team both in and out of the classroom setting.
Applications. Following the Readiness Assurance process, you will be challenged on a daily basis to apply
your knowledge through a variety of learning experiences. These will include laboratory-based
explorations of neuroanatomy using human brain specimens, in-class demonstrations, neurobiological or
clinical seminars on topics of special interest, and clinical presentations with patient interviews.
Application of core knowledge will also be facilitated by structured Team Applications (TA), which are
designed around clinical cases from the neurology practice of Dr. Hal Blumenfeld (MD, PhD), as presented
in Blumenfeld (2010), Neuroanatomy Through Clinical Cases, 2nd Ed., or cases from the practice of
neurologists at Duke Hospitalmost notably from the practice of Dr. Talmage L. Peele (MD). TA sessions
require mobilization and application of foundational content from previous weeks of study in the course,
but no specific preparation by you ahead of time (other than review and study of cumulative course
content). During TA sessions, you will work in your teams to master a concept or series of concepts or to
address the neuroanatomical bases for a specific set of presenting clinical signs and symptoms. Typically,
TA sessions will be open resource.
Self/Peer Assessment. To succeed in your learning throughout
Brain & Behavior it will be essential to exercise the LEAD (Leadership,
Education and Development) model for leadership in healthcare.
This requires personal responsibility, accountability, and a desire to
receive constructive feedback from your teammates. To promote
optimal teamwork as you move forward in the curriculum in the MS1
year, team members will assess one anothers contributions to the
functioning of the team near the midway point of Brain and
Behavior. This process will be directed and implemented by the LEAD
curriculum for first-year medical students. You will begin with a selfassessment, and then for each team member, you will be asked to
respond to a brief survey that is designed to assess cooperative learning skills, self-directed learning and
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interpersonal skills. This procedure is designed to encourage reflection, introspection, evaluation and
professional formation. During the process of facilitated discussion with teammates, please do
communicate openly, graciously, and constructively as potential challenges to team effectiveness arise,
so that they can be quickly identified, and appropriate strategies for improvement can be implemented
before the conclusion of this course.
Team membership. To facilitate the formation of highly functional teams of learners for team-based
learning activities, MS1 students have been assigned to teams of 5-7 learners each by the Office of
Curricular Affairs, Duke University School of Medicine. Please note, there is no option for changing teams.
Teams have been and will continue to function according to the form storm norm perform
model, meaning that some friction among teammates is to be expected as part of the process required
for normalizing the contributions of all team members and achieving a high level of team performance.
Problems within teams should be dealt with within the team. Individual contributions to team success can
and should be governed by team members. The course directors and the Office of Curricular Affairs may
facilitate resolution of conflict within a team, but only after teams have exhausted their capacity to do so
on their own.
Attendance. Given the compressed timeframe for Brain & Behavior in the MS1 curriculum (just 19 days
in January 2016, and then the final exam day!), attendance of all course sessions is encouraged in the
strongest terms. However, illness, family emergencies, and other legitimate life-events occur that require
your presence elsewhere. When such events do occur, you must inform the primary course director in
advance of the learning event or as soon as possible thereafter. Excused absences from Readiness
Assurances will be remediated by completion of the individual Readiness Assurance via a time and
mechanism to be determined by the primary course director and Office of Curricular Affairs staff.
However, it is simply not possible to recreate teamwork (team Readiness Assurances, Team Applications,
laboratory experiences, etc.) when an absence occurs. Therefore, absences will result in no points earned
by the absentee for the team components of those learning events.
Out of respect and appreciation for the generosity of our guests, course sessions with patient interviews
are coded in Bluedocs as mandatory. Likewise, the exam on February 1st is mandatory (for obvious
reasons). All other course sessions are coded as optional (non-mandatory), with the understanding
that it is up to the learners to decide how best to apply their efforts in the course, given the course policies
outlined here. Please refer to Bluedocs for the updated list of learning events that involve some form of
assessment (Readiness Assurance; Team Application).
Grading. The assessment strategies for this course will be weighted as follows:

Readiness Assurances
Team Applications
Final Exam (NBME)

Individual
Assessment
50%
--100%

Team
Assessment
50%
100%
---

Percentage of Final Grade

50%
25%
25%

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The distribution of weight between iRA and tRA means that 50% of the final grade for the course is
achieved on the basis of individual work, and 50% is based on teamwork.
There is a final exam in Brain & Behavior. This year, as was the case last year, the final will take the
form of a customized exam selected from a pool of retired USMLE Step 1 questions. This exam will be
accessed via a website managed by the National Board of Medical Examiners (NBME). This experience is
designed to assist you in gaining experience with NBME questions and logistics, as well as to assess your
cumulative knowledge of neurophysiology, clinical neuroanatomy and biological psychiatry.
Please note: in order to achieve a passing grade in Brain & Behavior, you must obtain a score of 60%
or greater on the individual component of the final exam. Failure to achieve this minimal competency
standard will result in ONE opportunity to remediate, which must be done before the start of Body &
Disease (or at a time appointed by the primary course director). The overall passing standard for Brain
& Behavior is a final course score of 70% or greater.

Course calendar
Topic outline. The following table provides a session-by-session listing of topics to be covered in
Brain & Behavior, as well as video tutorials and assigned readings for preparation in advance of the
course session. The topic list in the table provides the daily structure for the learning sequence;
however, changes may be made by the course directors as the course progresses to facilitate
achievement of course objectives, as well as to manage any emerging contingency (e.g., inclimate
weather; clinical emergencies, etc.). Please rely on Bluedocs as your primary calendar for the learning
events in Brain & Behavior.

DAY

TOPIC

TBL EVENT

ASSIGNED READINGS

VIDEO
TUTORIALS

1
[Jan. 4]

Course overview &

Embryological
Subdivisions of the
Brain

iRA/tRA
Hands-On
Application

Laboratory Guide, Lab 1

00_0000_05
01_01, 01_04, 01_07
& 05_01

2
[Jan. 5]

Cerebral Cortex &

Brain Blood Supply

iRA/tRA
Hands-On
Application

Laboratory Guide, Lab 2

01_0501_11

3
[Jan. 6]

Synaptic Transmission
& Postsynaptic
Mechanisms

iRA/tRA
Clinical
Application

Neuroscience, 5 Ed.,
Chapters 5-7

02_1002_17
(for additional
background, view
01_02, 01_03 &
02_0102_09)

4
[Jan. 7]

Sectional Anatomy of
the Brainstem and
Spinal Cord

iRA/tRA
Hands-On
Application

Laboratory Guide, Lab 3

01_1101_17

th

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DAY

TOPIC

TBL EVENT

ASSIGNED READINGS

VIDEO
TUTORIALS

5
[Jan. 8]

Cranial Nerve Nuclei

and Neuromodulatory
Nuclei of the
Brainstem

iRA/tRA
Hands-On
Application

Laboratory Guide, Lab 4

01_1701_24

6
[Jan. 11]

Somatic Sensation &

Pain

iRA/tRA
Clinical
Application

Neuroscience, 5th Ed.,

Chapters 9-10; Laboratory
Guide, Appendix 1

03_0603_16
(for additional
background, view
03_0103_05)

7
[Jan. 12]

Auditory & Vestibular

Systems; Chemical
Senses

iRA/tRA
Clinical
Application

Neuroscience, 5th Ed.,

Chapters 13-15

03_2903_50

8
[Jan. 13]

Vision

iRA/tRA
Clinical
Application

9
[Jan. 14]

Lower & Upper Motor

Neuronal Systems

iRA/tRA
Clinical
Application

10
[Jan. 15]

Sectional Anatomy of
the Forebrain

11
[Jan. 19]

Modulation of
Movement

12
[Jan. 20]

Visceral Motor System

Neuroscience, 5th Ed.,

Chapters 11-12; Laboratory
Guide, Appendices 2 & 5
Neuroscience, 5th Ed.,
Chapters 16-17; 20;
Laboratory Guide, Appendix
3

03_1703_28

04_0104_16 &
04_2804_35

iRA/tRA
Hands-On
Application
iRA/tRA
Clinical
Application
iRA/tRA
Clinical
Application

Laboratory Guide, Lab 5

01_2501_28;
06_18

Neuroscience, 5th Ed.,

Chapters 18-19; Laboratory
Guide, Appendix 3

04_1704_27

Neuroscience, 5th Ed.,

Chapter 21

04_3604_43

Neuroscience, 5th Ed.,

Chapters, 26-27 & 31 (see
Learning Event description in
Bluedocs for annotations on
prioritizing reading
selections)

06_01, 06_02;
06_0506_09

13
[Jan. 21]

Associational Cortex of
the Temporal Lobe

iRA/tRA
Clinical
Application
Motor Learning
Experiment

14
[Jan. 22]

Sleep & Wakefulness;

Disorders of Cognition

iRA/tRA
Clinical
Applications

Neuroscience, 5th Ed.,

Chapters 28

Dr. Krtsyals new

video tutorials on
sleep and sleep
disorders

iRA/tRA
Neurobiology
Application

Neuroscience, 5th Ed.,

Chapters 22-23 (see Learning
Event description in Bluedocs
for annotations on
prioritizing reading
selections)

05_0205_12

15
[Jan. 25]

Early Brain Development

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DAY

16
[Jan. 26]

17
[Jan. 27]

18
[Jan. 28]

19
[Jan. 29]
20
[Feb. 1]

TOPIC

TBL EVENT

Brain Development in
Childhood

iRA/tRA
Neurobiology
Application

Emotion; Attention

iRA/tRA
Clinical &
Neurobiological
Applications

Associational Cortex of
the Frontal & Parietal
Lobes; Stress &
Anxiety; Reward &
Addiction
Decision Making &
Executive Functions;
Future Horizons
NBME Final Exam

ASSIGNED READINGS
Neuroscience, 5th Ed.,
Chapters, 8, 24-25 (see
Learning Event description in
Bluedocs for annotations on
prioritizing reading
selections)
Neuroscience, 5th Ed.,
Chapters 26 & 29 (see
Learning Event description in
Bluedocs for annotations on
prioritizing reading
selections)

VIDEO
TUTORIALS

02_1802_22;
05_1305_23

06_1806_24

iRA/tRA
Clinical
Application

Neuroscience, 5th Ed.,

Chapter, 26

06_03, 06_04,
06_10, 06_11,
06_23, 06_24

Neurobiology
Application

review Neuroscience, 5th Ed.,

Chapter 26

n.a.

n.a.

n.a.

n.a.

Please note: topics and schedule are subject to change.

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