Scholarly Concentrations Areas

Concentration in Aging

Concentration Co-Directors

Lynn McNicoll, MD
Associate Professor of Medicine, Director of Education
Division of Geriatrics and Palliative Medicine, Department of Medicine 
Warren Alpert Medical School of Brown University 
c/o Rhode Island Hospital 
593 Eddy St., POB 438, Providence, RI 02903 
Email: lmcnicoll@lifespan.org 
Phone: 401-444-5248

Renée Shield, PhD 
Professor in Health Services, Policy and Practice (Clinical)
Center for Gerontology and Healthcare Research 
Email: Renee_shield@brown.edu  
Phone: 401-863-9958 
Box G-121 (6), Brown University, Providence, RI 02912

Overview

The Scholarly Concentration (SC) in Aging addresses the broad areas of aging, encompassing the basic sciences, social sciences, community health, psychology, ethics, and medical education that are central to an understanding of healthcare and society in the context of aging. Under the guidance of a mentor expert, students choosing the SC-Aging will design a project that will be the centerpiece of the Concentration. In the SC-Aging, students will explore a particular clinical issue or health/public health area related to older adults that results in a major product, such as a publishable paper, new curricular content, innovative pedagogical approach (see examples of possible projects below) or a community intervention. The SC leadership is committed to flexibility regarding student-initiated ideas for the SC-Aging.

Curriculum

All students selecting the SC in Aging will be expected to access, appropriate to the student level, a defined body of clinical information and clinically relevant basic science information on aging beyond that in the core medical school curriculum. In addition, students will utilize the SC to bridge disciplines in the pursuit of a targeted project. During the years of the SC, students will be expected to 1) undertake self-directed learning to acquire knowledge related specifically to their final product/project; 2) choose and work closely with a faculty mentor for guidance in the pursuit of the concentration; 3) attend the summer lecture series on geriatric medicine and psychiatry if in Providence for the summer following Year I; 4) participate in an aging-related summer experience (e.g., Summer Assistantship [SA]); 5) shadow a geriatrician; 6) attend Concentrators’ Small Group evening discussion meetings and field trips; 7) establish and maintain an “elder guide” relationship with an older person living in the community; and 8) meet in individual progress meetings with the Directors of the Scholarly Concentration in Aging at least once each semester.

Timeline of Activities

Year 1

  • August-December: Attend orientation, learn about SCs, and identify an interest in aging;
  • December-February: After consultation with the SC-A directors, identify a project and mentor; arrange an in-depth aging-relevant summer experience; make application to the SC program and outline plan of study with proposed end product; consider application for external funding (e.g. MSTAR or MSTREAM - see below).
  • Summer: Participate in summer project on aging that launches the project; begin to meet with an assigned elder guide during medical school; spend ½ day monthly shadowing a geriatrician; attend evening and small group discussion meeting; and attend Concentrators’ first field trip. If at Brown, attend weekly Fundamentals of Geriatrics lecture series held at Rhode Island Hospital.

Year 2

  • In early fall, make a presentation of the work completed during the summer to the Oversight Committee;
  • Allocate, on average, half of the day protected for self-directed learning each week to the concentration (e.g., project work - collect data, do experiments, work in the community, do literature review);
  • Engage regularly in self-directed learning about aging in greater depth than offered in the standard curriculum;
  • Attend the geriatrics-related offerings at Rhode Island Hospital (weekly Fundamentals, brown bag seminars) and Division of Geriatrics (RI, TM, Memorial, VA, Butler Hospitals) when possible;
  • Submit poster on summer work for December’s Summer Showcase event;
  • Attend Concentrators’ field trips held twice in Semester 1, once in semester 2;
  • Attend evening SC-Aging small group discussion meetings held twice in Semester 1, once in semester 2;
  • Shadow a geriatrician monthly; and
  • Continue monthly elder guide relationship with older person.

Year 3

  • If not already done, complete the project’s data collection early in the year as clerkship demands permit (e.g., continue to collect data, do experiments, work in the community, do literature review, write up abstract &/or manuscript); depending on the project, it may be possible to continue/complete the work during the Community Health clerkship;
  • Choose 1 or 2 electives related to the concentration;
  • Attend mandatory evening SC-Aging small group discussion meetings held once in summer, twice in semester 1, and once in semester 2;
  • Attend weekly Fundamentals, brown bag seminars, grand rounds related to geriatrics when possible;
  • Shadow a geriatrician when possible;
  • Continue elder guide relationship with older person when possible.

Year 4

  • Prepare first draft of the SC project report or manuscript by November 1 for submission to mentor for review and suggestions;
  • Do 1 or 2 electives based on concentration; Attend weekly Fundamentals, brown bag seminars, grand rounds related to geriatrics when possible;
  • Attend mandatory evening SC-Aging small group discussion meetings held once in summer, twice in semester 1, and once in semester 2;
  • Shadow a geriatrician when possible;
  • Continue elder guide relationship with older person when possible;
  • Complete scholarly project report or manuscript and submit by end of SEMESTER 1;
  • Write a 2-page reflective statement that reviews the SC-A project, describes its meaning to the student and identifies ways the SC-A  project impacted his/her medical school career; and
  • Present scholarly project and reflective statement at Scholarly Concentration in Aging Oversight Committee’s “Concentrator Day” in spring of fourth year.

Field trips: The first field trip will be held in the summer after 1st year; two field trips will be held in semester 1 and one in semester 2, year 2, to acquaint concentrators with services and facilities for the older person in RI; e.g., Alzheimer’s adult day care center, inpatient hospice, model of nursing home “culture change” movement. 
SC-Aging evening small group discussion meetings: Each year, Scholarly Concentrators in Aging of all years will meet once in the summer, twice in semester 1, and once in semester 2 with SC-Aging directors and mentors to discuss important issues related to aging and complex cases encountered on rotations and to share progress on projects.  Recent examples include an expert on narcotics use in elderly emergency room patients or a visit from a local author who wrote a book on Cambodia based on her life experience as a CIA agent.

Concentration Related Electives

Clinical: 
Geriatrics and Rehabilitation 
Hospice and Palliative Medicine 
Psychiatry of Late Life

Learning Objectives and Evaluation

Students will be able to demonstrate:

  • knowledge of geriatrics materials developed for the new integrated curriculum;
  • extensive knowledge of a particular aspect of aging, of a disease important in older patients, or of a geriatrics syndrome, and understand the social, clinical, epidemiological and psychological consequences of the chosen topic;
  • extensive clinical experience in working with older patients in a variety of settings, including nursing home, assisted living facility, hospital, hospice, outpatient clinic or office; and
  • an appreciation of the experience of healthy aging as well as a deeper understanding of the experience of living with chronic and multiple medical conditions often associated with aging.

For the above learning objectives, students will be evaluated by 1) their mentor; 2) the shadowing geriatrician; 3) curricular advisor(s) in the case of a curriculum development project; and 4) the SC-Aging Oversight Committee.  Students will also be expected to discuss ongoing progress and/or interim results of their work in Concentrators’ evening small group discussion meetings.

An Oversight Committee consisting of interdisciplinary faculty (medical and other faculty) will provide review of students’ work culminating in the final project. Committee members include Lynn McNicoll, MD, Alicia Curtin, PhD, GNP-BC; Richard W. Besdine, MD; Renée Shield, PhD; Paul Greenberg, MD; Nadia Mujahid, MD.

Project Examples

  • A student interested in neurological disorders in older adults might become proficient in the etiology, treatment and consequences of Alzheimer’s disease, and conduct a set of interviews with affected persons and selected family members to better understand the broader implications of the disease. The resulting project could be a publishable paper or poster on the topic.
  • A student could conduct a basic science project with one of our biology of aging faculty (Drs. Helfand, Reenan, Sedivy or Tatar).
  • A student could become proficient in a topical area or course domain and perform an extensive systematic literature review suitable for publication.
  • A student could focus on exploring the literature on how to teach the non-cognitive aspects of geriatrics (shaping attitudes, values, skills), and then work with advisors to devise educational strategies that could then be implemented.
  • A student could lead the development of a new geriatrics curriculum product for a targeted area or course.
  • In addition to traditional research projects, community-based work and scholarly reviews, there will be the opportunity for students to undertake quality improvement (QI) projects in the multiple settings applicable to care of older adults. The settings include nursing home, home health, hospital, and ambulatory care. This work will be conducted in collaboration with Healthcentric Advisors of Rhode Island (the Quality Improvement Organization holding the Medicare contract for QI in RI).

Other project ideas could include 1) producing a series of thematically related research papers, 2) developing and documenting a legislative campaign related to an issue important in aging, and 3) creating a visual or oral history project related to the pursuit of a topical area in aging.

2014 Accepted Students & Scholarly Concentration Projects:

Student Project Title Mentor
Alison Chen Sudden visual loss and mortality in African Americans Dr. Paul Greenberg
Maggie Chung Lower gastrointestinal bleeding: Indicators to increase diagnostic yield of catheter angiography following scintigraphic screening Dr. Sun Ho Ahn
Adam Henderson Prescription opioid use and misuse in older emergency department patients Dr. Francesca Beaudoin
Connie Wu Cataract surgery quality of care: An evaluation of US and Canadian cataract surgery clinical practice guidelines Dr. Paul Greenberg

 

Maximum Number of Students

The Concentration can accommodate up to 5 students annually.

Faculty Resources and their fields of interest

Susan Allen, PhD - public health, community care, VA nursing homes
Richard W. Besdine, MD, FACP - geriatrics
Lesley Bostom-Robinson, MD - dermatology mentor
Melissa Clark, PhD - public health, survey methods
Sevdenur Cizginer, MD - geriatrics, colorectal surgery
Alicia Curtin, PhD, GNP-BC - Family Medicine at Memorial
Julio Defillo-Draiby, MD - geriatrics, joint replacement surgery
Clarisse Dexter, GNP - geriatric nursing home
Kim Dodd, MD - geriatrics, VA
David Dosa, MD - VA, nursing homes, disaster medicine
Mary Fennell, PhD - health care organizations, rural medicine, long term care
Pedro Gozalo, PhD - health care economist
Paul Greenberg, MD - VA ophthalmology mentor
Daithi Heffernan, MD - surgery mentor
Marianne Hurley, GNP - geriatrics nursing home
Sylvia Kuo, PhD - public health, health care economist
Linda Laliberte, JD, MS - legal aspects of aging
Ed Martin, MD - palliative care and hospice
Lynn McNicoll, MD - geriatrics, quality improvement
Edward Miller PhD - federal and state policies affecting elderly
Susan C. Miller, PhD, MBA - public health, hospice care, culture change NHs
Vincent Mor, PhD - public health
Nadia Mujahid, MD - geriatrics, orthopedics
John Murphy, MD - geriatrics
Aman Nanda, MD - geriatrics
Paul Pirraglia, MD - pulmonary mentor
William Rakowski, PhD - public health
Linda J. Resnik, PhD - public health, VA, veterans, physical rehabilitation
Rachel Roach, GNP - geriatrics
Renée R. Shield, PhD - anthropology, transitions, culture change NHs, hospice
Joan M. Teno, MD, MS - geriatrics, palliative care and hospice, transitions, epidemiology
Amal Trivedi, MD  - public health epidemiologist
Ana Tuya-Fulton, MD - Butler, consultative geriatrics
Mary-Beth Welesko, GNP - geriatrics
Terrie Wetle, PhD - public health epidemiologist
Lidia Vognar, MD - geriatrics, VA, elder neglect
Ira Wilson, PhD - public health, phsyician-patient communication

Funding Opportunities (alternatives to Summer Assistantships)

Scholars in Aging are encouraged to apply for the Medical Student Training in Aging Research (MSTAR) Program  (due 1/31/12) and/or the M-STREAM program (due ~3/12) for summer funding.

Concentration in Medical Technology and Innovation
Concentration in Medical Technology and Innovation

Concentration Director

Selim Suner, MD, MS
Associate Professor
Email: SSuner@lifespan.org
Phone: 401-639-3483
CORO Suite 106
One Hoppin Street Providence RI 02903

Concentration Co-Director

Gregory Jay, MD, PhD
Professor of Emergency Medicine
Email:  GJay@lifespan.org
Phone: (401) 444-6656
CORO Suite 106
One Hoppin Street Providence RI 02903

Overview

Innovation in science and engineering has been the dominant source of productivity gains and new enterprises in the United States economy over the last 50 years, accounting for as much as 50% of U.S. economic growth.  In our increasingly complex, technologically oriented economy, technology and science savvy professionals with the expertise to manage human and financial, in addition to technological, resources are in great demand.  No one person has all of the solutions in situations where the state of the art is a moving target, change is relentless, technology is pervasive, and global competition is fierce.

Whether it is in the fields of biotechnology, neuroscience, microelectronics, information technology, or others, it is widely agreed that science, engineering, and medical education must undergo significant changes in order to properly train students. Many science, engineering, and medical school graduates will find themselves in job environments demanding additional skills beyond those offered by traditional programs.  With aspirations of wanting to chair or lead a department within a hospital setting, medical school students need to be trained in a new way.  With many hospitals having not-for-profit models for each individual department, entrepreneurial skills are of the utmost importance.  In addition, high technology infrastructure and equipment will need to be procured and the hospital will have to make a business case for the investment.  In addition, some physicians will recognize a need for a new technology and will ultimately want to create a business out of it so others can benefit. 

We must therefore educate medical students to meet the challenges they will face in the future where innovation, technology management and entrepreneurship will play a key role.  Innovation has generated astonishing, tangible benefits to society, including improved healthcare. Today’s challenges center on managing innovation in a rapidly changing global economy and high technology health care setting.

This scholarly concentration is an educational solution designed to address the many issues a medical professional will encounter.  By committing to this scholarly concentration during their medical studies, students will receive a set of unique core competencies to lead them in the high technology, innovation, and entrepreneurship workplace. The proposed program has many educational objectives:

  • To train medical students who understand both the technical and business aspects of technology as well as the intimate and intricate interrelationship between the two;
  • To combine the study of the development of embryonic idea generation and emerging technologies (fuzzy front end) with contemporary principles of innovation and management to bring medical students to the forefront of high technology leadership and entrepreneurship;
  • To develop an innovative learning environment where students discover the value of cutting across disciplinary boundaries to solve complex problems in the medical environment;
  • To prepare medical students to lead within and across interdisciplinary organizations, such as hospitals;
  • To train medical students to be actively engaged in organizations where understanding and exploiting rapidly changing technology is a key to success;
  • To converge the core expertise of enthusiastic engineering faculty with the experience of other professionals, serving as adjunct faculty, who will bring to students strategic innovation and technology management perspectives with regard to the challenge of emerging technology;
  • To leverage Brown University’s research infrastructure to seed student project ideas and satisfy their innovation and entrepreneurship experience;
  • To develop medical leaders who will be successful in a world of accelerating technology change.

Curriculum

Year I

In collaboration with concentration area Directors, students will identify a project mentor and outline a proposal for their concentration area work. 

Summer between Years I & II

Students will undertake a concentration-related summer project of 8-10 weeks duration. 

Year II

In addition to continuing with their scholarly project work, students will participate in the “Topics in Translational Research and Technologies” seminar.  The seminar generally takes place weekly January through April on Friday afternoons for ~2 hours.  The seminar deals with such topics as “New Modalities in the Triage of Acute Medical Emergencies”, “Development of the LRS Thermosuit: A Device for rapid Whole Body Cooling”, “Novel Medical Devices as Therapeutic Toys”, “Marketing Medical Devices- Who Needs It?”, “Institutional Review Boards and Human Subjects Protection”, and “Nanotechnology for Regenerative Medicine”.

Students will also participate in regular meetings with faculty and peers.

Years III & IV

Students will continue to work on their concentration project, culminating in a final scholarly product to be submitted to concentration area faculty for review in Year IV.

Concentration Related Electives

Biotechnology

Project Examples

These are examples of medical related projects in the past – of course, students are not limited to such projects, they only serve as examples:

  • Electronic medical records;
  • Novel device to facilitate oxygen delivery for COPD patients;
  • Novel vest to monitor post-cardiac patients during rehabilitative exercise;
  • Devices for Neuro-implants;
  • Devices for non-invasive medical diagnostics;
  • Nanoscience in drug delivery and toxicity.
  • Biomedical Optics and Photonics;
  • Biomedical Imaging;
  • Bedside Diagnostic Devices;
  • Microfluidics for infectious disease;
  • Mechanics of Lubricin;

2010 Accepted Students & Scholarly Concentration Projects:

Student Project Title Mentor
Guenette, Jeffrey Use of Percutaneous, Image-Guided Therapies in Cancer Treatment Dr. Damian Dupuy
Laiwalla, Farah Development and translation of a wearable neural recording system for seizure-focus localization in patients with medically refractory Epilepsy Dr. Arto Nurmikko
Luo, John From Across the Table: A Guide for Academic Entrepreneurs Dr. Selim Suner

Maximum Number of Students

The concentration will accept up to 5 students per year.

Faculty Mentors

There are a number of faculty members who are able to provide mentorship in this area.

Funding Opportunities

(alternatives to Summer Assistantships)

Faculty members may be able to write summer internships into their grants. 

Concentration in Women's Reproductive Health

Concentration Directors

Melissa Nothnagle, MD, MSc
Associate Professor of Family Medicine
Email:Melissa_Nothnagle@brown.edu
Phone: 401-729-2236
Memorial Hospital of Rhode Island, 111 Brewster St, Pawtucket, RI 02860 

Rebecca Allen, MD, MPH
Assistant Professor of Obstetrics and Gynecology
Email:RHAllen@wihri.org
Phone: 401-274-1122, x42724
Women and Infants Hospital of RI, 101 Dudley Street, Providence RI 02905

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Overview

Women's reproductive rights and freedom are key determinants of women's health and are highly influenced by women's roles in society. In the U.S. and abroad, women's reproductive health is threatened by limited access to effective contraception, timely diagnosis and treatment of sexually transmitted infections, safe abortion, skilled maternity care, and infertility treatments.
The purpose of the Women's Reproductive Health scholarly concentration is to prepare graduates to promote and advance women's reproductive health through patient care, education, research, and advocacy. Research has documented the need for comprehensive reproductive health education in U.S. medical schools. Few schools adequately address issues surrounding contraception, adolescent pregnancy and parenting, or causes and consequences of infertility. Effective reproductive health care also requires skilled history taking, patient education and counseling. Understanding of non-biological determinants of health and illness, including economic, psychological, social and cultural factors, is critical to ensuring quality reproductive health care for women. Physicians and other health professionals have a key role as advocates in protecting women's reproductive health, especially for underserved and/or vulnerable populations (including adolescents, incarcerated women, immigrants and refugees, women with disabilities, minorities, and LGBTQ women).
Concentrators will gain an in-depth understanding of the relevance of reproductive health and rights in clinical practice and public health. Given the scope of the Women's Reproductive Health initiative, concentrators are encouraged to engage in projects related not only to clinical and basic science research, but also medical education and advocacy.

Curriculum

Learning Objectives:

By graduation, students will be able to:

  1. Provide patient-centered counseling for reproductive health issues, such as unwanted pregnancy and abortion, contraception (including emergency contraception, prenatal health, breastfeeding, and STI prevention).
  2. Apply advanced knowledge in one or more of the following reproductive health content areas to care of patients: Human sexuality, contraception, abortion, pregnancy and birth, postnatal care and breastfeeding, sexual health, sexually transmitted diseases, sexual abuse, gender-based violence, infertility, cervical cancer/HPV, breast cancer, and adolescent reproductive health.
  3. Discuss the effects of gender inequality on women's reproductive health, rights, and freedom.
  4. Describe legal and other restrictions on access to reproductive health services and their effects on individual and public health, especially for vulnerable populations.
  5. Apply principles of medical ethics to resolve dilemmas regarding assisted reproductive technologies, limited access to resources, and conflicts between providers' beliefs and patient autonomy in reproductive health.
  6. Recognize the physician's role in protecting and advocating for reproductive health.

Evaluation
For each learning objective, mastery will be evaluated as follows:

1-2. Each student will participate in a clinical elective involving reproductive health in the 3rd or 4th year.
2-6. During the 2nd year, students will attend the women’s reproductive health seminar series
2-4. During the 2nd year, each student will write a position paper on a reproductive health issue, addressing gender inequality, legal, and/or public health issues that affect reproductive health.
1-5. Each student will design, implement, evaluate, and present a concentration project involving research, education, or advocacy related to women’s reproductive health.

  • Students will identify a faculty advisor to mentor their project activities and will submit a project plan to be approved by the concentration directors
  • Students will submit annual written reports describing progress on their concentration project
  • Students are encouraged to present their projects at national conferences in their field of study
  • Students will prepare a portfolio of their concentration work including their final project for a review committee of reproductive health professionals  
  • Students will present their projects to the concentration faculty and students 

 

Timeline

 

Year 1

Year 2

Year 3

Year 4

Coursework 

  • Attend seminar series (4-5/semester)

 

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  • Write position paper on reproductive health issue (Fall)

 

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  • Participate in one reproductive health clinical elective

 

 

 

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Concentration Project 

  • Identify faculty mentor (Fall)
  • Establish concentration project with faculty mentor and apply for summer research assistantship (Spring)
  • Summer Research Assistantship

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  • Project progress reports

 

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  • Present project at national meeting
  • Submit report for publication (if applicable)

 

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  • Complete Reproductive Health Portfolio
  • Present final project to concentration faculty and students

 

 

 

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Concentration Related Electives
Pre-clinical
BIOL 6650: Medical Students Outreach to Mothers to Be (MOMS)

BIOL 6657:  Sexual Health Elective

Clinical

  • Breast Disease
  • Care of Patients with Women's Cancers
  • Clinical Urogynecology and Reconstructive Pelvic Surgery
  • Subinternship in Gynecologic Oncology and Pelvic Surgery
  • Intro to Women's Diagnostic Imaging
  • Subinternship in Maternal and Child Health
  • Subinternship in Maternal Fetal Medicine
  • Reproductive Endocrinology and Infertility
  • Reproductive Health
  • Subinternship in Women's Ambulatory Obstetrics and Gynecology
  • Gynecologic and Breast Pathology
  • Clinical Cancer Genetics

Project Examples
Scholarly products will most likely take the form of written reports.  Current and past student project topics include:

  • Partner access to emergency contraception
  • High-risk sexual behaviors among female sex workers in Shanghai, China
  • Improving prenatal patient education using Electronic Medical Record prompts
  • Prenatal SSRI exposure effects on placental SERT expression
  • Quality of care after sexual assault
  • Barriers to breast cancer screening and genetic testing for Latina women
  • Birth experiences of Karen refugees in Buffalo, NY
  • Family medicine residents’ preparation to care for women with unintended pregnancy
  • Exploring the implications of fetal origins of postnatal disease for practitioners and patients

Maximum Number of Students
The scholarly concentration will be limited to 4-6 medical students per year.  


Faculty Mentors
Faculty (including but not limited to the following):

Family Medicine

  • Susanna Magee, MD, MPH:  maternal child health, prenatal care
  • Melissa Nothnagle, MD: medical education, family planning
  • Julie Taylor, MD, MSc:  breastfeeding

Internal medicine

  • Susan Cu-Uvin MD: infectious diseases, HIV infection, international health
  • Christine Duffy, MD: sexuality, cancer survivors
  • Amy Gottlieb, MD: women's health, medical education
  • Joseph Harwell MD: infectious diseases, HIV infection, international health
  • Kelly McGarry, MD: women's health, medical education
  • Jennifer Clarke, MD: health of incarcerated women

OB/GYN

  • Rebecca Allen, MD, MPH: gynecology, family planning
  • Brenna Anderson, MD, MPH: maternal fetal medicine, infectious diseases
  • Sarah Fox, MD: pelvic pain, family planning, gynecology
  • Kristin Matteson MD, MPH: gynecology, health care outcomes, family planning
  • Katina Robison, MD: gynecologic oncology
  • Kelly Pagidas, MD: reproductive endocrinology

Psychiatry and Human Behavior

  • Laura Stroud, PhD: physiological responses to stress, nicotine dependence, and sex differences in depression

Pediatrics

  • James Padbury, MD: perinatal biology
  • Michelle Forcier, MD: adolescent health, LGBTQ health

Funding Opportunities (alternatives to Summer Assistantships)
The concentration has received a gift from Ann Glazer '80 and Barkley Sutart '81 to support student projects and travel.

Concentration in Advocacy and Activism
Concentration in Advocacy and Activism

Concentration Directors

Esther Entin, MD
Clinical Associate Professor of Family Medicine
Email: ejentin@aol.com

Liz Tobin Tyler, JD, MA
Clinical Assistant Professor of Family Medicine
The Warren Alpert Medical School of Brown University
Clinical Assistant Professor of Health Services, Policy and Practice
Brown School of Public Health
Adjunct Professor
Roger Williams University School of Law
Email: elizabeth_tobin-tyler@brown.edu 

The Alpert Medical School has a longstanding commitment to community service, patient advocacy and population health. The mission statement of the Alpert Medical School lists two major goals for its graduates: “that they be broadly and liberally educated men and women, and that they view medicine as a socially responsible human service profession.” The Medical School curriculum also emphasizes the importance of understanding health in its broader social, economic and cultural context and teaches the valuable role that physicians play in promoting health equity and advocating for vulnerable patients and populations.

The Scholarly Concentration in Advocacy/Activism will promote student work and scholarship that explore these concepts.  Topics might include:

  • The role of physicians in addressing the social determinants of health
  • Collaborative (cross-disciplinary) approaches to reducing health disparities and advocating for the underserved (this includes participating in interprofessional collaborations such as medical-legal partnerships as well as partnering with concentrations with similar goals such as Caring for Underserved Communities, Health Policy, and Women's Reproductive Health)
  • Understanding and shaping law and public policy as it relates to the health of vulnerable and underserved populations
  • Connecting clinical care and the health care system with community and population health goals
  • Elevating the voice of marginalized and underserved populations about their health needs
  • Identifying community resources, organizations, stakeholders, and infrastructure toward collaboration.

CURRICULUM

Learning Objectives

  • Concentrators will gain an understanding of advocacy on behalf of patients and their communities as an essential part of professionalism.
  • Concentrators will examine the role of social determinants and societal injustice in creating health disparities.
  • Concentrators will learn to identify issues and analyze health and social policies that affect the health of vulnerable patients and populations.
  • Concentrators will develop skills and experience in: (1) translating patient information into data that can inform policy; (2) using their voices as clinicians to advocate for patients and communities; and (3) organizing effective policy advocacy strategies for different audiences - healthcare institutions, policymakers, the media, and the legislature.

Concentrators will design and carry out a summer research project between years I and II.  Students will continue to pursue their advocacy and activism project throughout the remainder of their medical school education, particularly during the second year.  Concentrators will  produce a scholarly product such as a published paper in a peer-reviewed journal, a presentation at a national meeting,  or a policy brief with a targeted distribution to key area decision-makers of a quality that is suitable for broader distribution. This  product should be created with the guidance and feedback of their project mentor. The student will be expected to communicate regularly with the concentration directors about the direction and status of their scholarly work and advocacy activities.  

Timeline of Activities

Year I: Through the Healthy Systems and Policy course, all students receive didactic sessions on a wide range of issues related to health disparities, the social determinants of health and the role of physicians in policy advocacy that can help them to shape a project proposal.  Students interested in pursuing the advocacy and activism concentration will identify a mentor and propose a project for summer following Year I. The mentor will continue working with the student through completion of the scholarly product.

Summer between Years I & II: Experiential Learning/ in-depth study. Experiential opportunities may include workingat a state or local government agency, such as the RI Department of Health, a community-based organization, or a policy or advocacy organization.  Research and policy analysis should focus on an issue related to health disparities, the social determinants of health and/or promotion of health at the community or population level.  Ideally, summer immersion experiences should include direct service work with vulnerable patient populations and their communities.

The rationale for direct service learning is that (1) it connects policy analysis and advocacy efforts with the needs and concerns of the people most affected by it; and (2) it promotes investment by the student in the community s/he is studying and advocating for. 

Year II: Students are encouraged to pursue coursework in electives related to health disparities and health equality,  health policy and community health, or other areas related to their areas of interest. In addition, Poverty, Health and Law is a six-session evening seminar offered each spring and is held jointly with Roger Williams University Law and Rhode Island College Masters of Social Work students. Concentrators are required to participate in the seminar.

Year III:  Throughout their third year core clerkships, advocacy and activism concentrators will be encouraged to keep a case-series related to their chosen issue. They will keep a reflective journal as they complete various clerkships, documenting ways in which the issue they are studying affects their patient population as they encounter the health care system.  They may also reflect on opportunities for advocacy and activism within the clinical care experience.  For example: obtaining adequate translators both linguistically and culturally to meet the patients' needs and improve compliance with health care recommendations; becoming knowledgeable about appropriate community resources for patients' legal, social, and economic concerns; educating clinical team members about the social determinants of health and identifying ways to incorporate this knowledge into direct patient care.

Year IV: Concentrators will be encouraged to take electives related to their areas of interest, including clinical electives, study electives, and coursework.  Concentrators will share their scholarly project with classmates.  The project will be (1) an article for a peer-reviewed journal (2) a presentation suitable for a regional or national meeting; or (2) a policy paper with a targeted distribution to key area decision-makers that is suitable for broader distribution.

Concentration Related Electives

Pre-clinical:

BIOL 6503: Poverty, Health and Law
BIOL 6655: Health Care of Underserved
BIOL 6504: Health Care in America

Clinical:
Child Maltreatment
Controversies in the Health Care Policy
HIV/AIDS
Occupational and Environmental Medicolegal Medicine

Project Examples

  1. A study of Access to Health Care of Undocumented Children in Rhode Island.
    1. An in-depth analysis of the issue and its demographics in RI
    2. An understanding of policies and regulatory issues that help or hinder access
    3. Identifying and meeting with people in RI including families, community activists, legislators, policy makers and other stakeholders in RI
    4. A study of model programs across the US
    5. A proposal, plan and implementation strategy to improve access
  2. Nutrition and Exercise for Rhode Island Teens
    1. An in-depth analysis of the issue and its demographics in RI
    2. An understanding of laws, policies, and regulations that impact the issue
    3. Identifying groups and initiatives addressing the issue, including teens
    4. Study model programs from around the US
    5. Develop a proposal, plan, and implementation strategy to improve nutrition and exercise among teens in RI
  3. Improving Recreational Opportunities for Special Needs Youth in South Providence
    1. An in-depth analysis of the issue and its demographics. (follow families and kids, map playgrounds, analyze for access and safety)
    2. An understanding of policies, laws, and regulations that impact the issue. Explore planning/zoning processes. Perhaps do “Child heath Impact” study on proposed building or roads projects
    3. Identify groups and initiatives already involved, key stakeholders, policy makers, and neighborhood organizations
    4. Develop a proposal, plan, and implementation strategy to improve opportunities for recreation for Special Needs children in South Providence
  4. For more examples of potential projects, please visit the Patient Advocacy Coordinating Council's list of "orphaned" projects

2011 and 2012 Accepted Students and Scholarly Concentration Projects

Student Project Title Mentor
Damiano, Ella
Increasing SNAP usage at RI Farmers’ Markets
Dr. Edward Feller
Burke, Colin
Putting a face to Providence’s homeless veteran population: A population study
Dr. Thomas O'Toole
Chu, Katrina
Socioeconomic Disparities in Cancer Care: a Broad-Based Analysis and Multi-level Advocacy Dean Marjorie Thompson, PhD
Hussain, Rashid
Global and Local Health Inequities
Stephen McGarvey
Mohan, Suresh
Recording Ethnicity, Race and Language: A comparison of documented and self-identified demographics Dr. Megan L. Ranney, MD, MPH

Maximum Number of Students

Four students per year

Faculty Mentors

The concentration directors and staff will help you identify appropriate mentors for projects.

Funding Opportunities (alternatives to Summer Assistantships)

At the present time there are no resources other than the generally available Summer Assistantships (SA’s) that can be used by students in an Advocacy & Activism Concentration.

Concentration in Contemplative Studies
Concentration in Contemplative Studies

Concentration Directors

Harold D. Roth, PhD
Professor of Religious Studies and East Asian Studies
Director, Contemplative Studies Initiative
Box 1927
Brown University
Providence, RI 02912
(o) 401-863-3104
(f)  401-863-3109
Harold_Roth@Brown.edu
Contemplative Studies Initiative

Ellen Flynn, MD
Clinical Assistant Professor
Psychiatry and Human Behavior
eflynn@lifespan.org
Tel: (401) 453-7955

Overview

The Scholarly Concentration in Contemplative Studies is a branch of the Brown University Contemplative Studies Initiative.  The Contemplative Studies Initiative is a group of Brown faculty with diverse academic specializations who are united around a common interest in the study of a particular range of beneficial mental states (deemed “contemplative”) that exhibit characteristics that include focused attention, deep concentration, and complete absorption in activity. We are involved in studying the nature of these states from a variety of perspectives that include their underlying philosophy, psychology, physiology and their links with human creativity.

Contemplative Studies in Medicine

In 2004, The World Health Organization defined health as a “complete state,” consisting of the presence of positive states of wellbeing as well as the absence of disease or infirmity.

Contemplative Studies is a cutting edge interdisciplinary and multicultural field that focuses on the possible uses of contemplative states and mental training practices to promote such “Complete Health.”   The use of contemplative practices, such as mindfulness, has been integrated into psychiatry and is now considered part of a “Third Wave” of psychological treatments and a standard practice in behavioral medicine. However, comprehensive training in contemplative methods, history, and theory within clinical contexts is not widely available and is typically cursory. In addition, contemplative methods in clinical contexts tend to be abbreviated and decontextualized from the traditions that created them. The Brown Contemplative Studies Initiative aims to study contemplative practice and states within their original contexts, as well as within the newer applications in science and medicine, in order to identify the most beneficial elements for health and wellbeing.

We approach this study through three large disciplinary areas: Science (the study of human consciousness and mental and emotional development within the context of neuroscience, cognitive science, and psychology; the study of the mind and culture; applications of contemplative practices within clinical science and basic and behavioral medicine, focusing on how these practices contribute to improved mental and physical health); Humanities (the study of the nature of contemplative experiences in philosophy, the major religious traditions of the world, in world literature, in the classical texts of antiquity and in a variety of other related disciplines); Creative Arts (the study of the contemplative experiences in the visual and fine arts, creative writing, and in the various performing arts of dance, drama, and music). We study contemplation through traditional third-person approaches and innovative “critical first-person approaches.” The latter involve direct experience with the various arts and methods of contemplation.

Curriculum

Medical students choosing Contemplative Studies as their scholarly concentration will take the foundational course, UC 54 “An Introduction to Contemplative Studies” (offered on Wednesday afternoon, 3-5:20 in 2008 and all subsequent years) or its equivalent through a Summer Study Project, and at least two other courses that will be offered on Wednesdays during the student’s second year that include critical first-person approaches. These are the core courses of the Contemplative Studies Initiative. Please see our website for a list of the core course offerings for any given academic year.

Students would be required to include one or more Contemplative Retreats of their own choosing in the program. There are a wide range of possible contemplative retreat programs in the Massachusetts-Rhode Island area. These include the Kripalu Yoga Center in Lennox MA, The Insight Meditation Society in Barre MA, The Cambridge Insight Meditation Center in Cambridge, MA and The Providence Zen Center in Cumberland RI. As a complement or an alternative to a tradition-based retreat program, students are encouraged to consider receiving training in Mindfulness-Based Stress Reduction, a widely used clinical program developed by Jon Kabat-Zinn at the Center for Mindfulness (MBSR), University of Massachusetts Medical School in Worcester. Students may participate in an MBSR course that is open to the general public, or a highly motivated student could participate in the Center for Mindfulness’ Oasis Program, a training for instructors that consists of a seven-day summer program followed by a flexible series of practicum opportunities that could be integrated into the student’s program.

Learning Objectives

  1. Developing an understanding of the newly developing field of contemplative studies: how is it defined? What are its major works? What are the ways in which it is relevant to clinical practice? How might a clinician answer patient questions regarding meditation or other “stress reduction” treatments?
  2. Establishing a comprehensive and empirically-grounded knowledge base of the scientific research literature on the effects of contemplative practices. Research has typically been divided into three main categories: Cognitive Neuroscience (effect of contemplative practices on basic cognitive functions such as attention, memory and synaptic plasticity); Affective Neuroscience or Psychiatry (the effects of contemplative practices on emotional regulation, emotional/behavioral disturbances and psychiatric disorders); General Medical Applications (the effects of contemplative practices on physiological systems, including neuroendocrine, cardiovascular and immune functioning).
  3. Understanding the types of contemplative practices currently under scientific scrutiny and having a firm grounding in the contemplative traditions from which they are derived.
  4. Understanding how to apply contemplative practice in a clinical medical context. This would be developed by student’s working as interns in a “Clinical Contemplative Program” with mentors from the larger Brown medical community who are using contemplative practices in their clinical work.
  5. Contemplative self-development: having the opportunity to engage in one’s own contemplative practice. This is an essential part of the concentration and recent research has shown very positive clinical outcomes showing reduced stress in medical students.

Timeline

By the middle of Year I: the student will meet with the Director and possible Advisory Committee members to begin planning a program.

Summer after Year I: Student chooses one of two possible tracks:
Track A: Summer Study Project (8-10 weeks) in which the student takes a course (either an independent reading course or one in the Brown Summer school that could be developed) that covers the same ground as the UC 54 course, “Intro To Contemplative Studies.” The student would also attend the Mind and Life Summer Research Institute, a week long program that presents cutting edge research on the science of meditation. The student would also complete a contemplative retreat of 2-7 days at one of the area’s tradition-based Contemplative Retreat Centers.

Track B: Summer Study Project (8-10 weeks) in which the student takes a course (either an independent reading course or one in the Brown Summer School that could be developed) that covers the same ground as the UC 54 course, “Intro to Contemplative Studies.” The student would also attend the Mindfulness Based Stress Reduction course in the community or one of the instructor training opportunities through the Oasis Program for Clinicians at the Center for Mindfulness.

Written reports will be expected for either Summer Study Project.

By the end of the Summer of Year I, students will form an Advisory Committee consisting of the Concentration Director and at least one other member of the Contemplative Studies Scholarly Concentration faculty (see list below).

Year II: Student uses Wednesday elective time taking relevant Contemplative Studies Initiative courses:: The specific choice of courses will depend on which Track is chosen in Year I and will be made in consultation with Advisory Committee.  The Contemplative Studies Initiative will endeavor to have a range of possible courses taught on Wednesday afternoons to assist medical students. The following courses will definitely be offered on Wednesday afternoon in the 2007-08 academic year: RS 0500: “The Theory and Practice of Buddhist Meditation;” UC 54: “Introduction to Contemplative Studies.” In addition, a new course, “The Contemplative Life: Meditation in Psychology and the Creative Arts” (UC 55) is currently being developed. The student will also be encouraged to continue his/her own contemplative practice by participating in Wednesday CSI course “Meditation Labs,” occasional CSI Contemplative Retreats, and relevant Tradition-Based Contemplative Retreats. No later than the middle of Year II the student will meet with his/her Advisory Committee to decide upon the student’s Contemplative Studies Capstone Project, which will be interwoven into the student’s program during the next two years. Two basic categories of Capstone will be available: Scholarly Research and Clinical Contemplative Practice.

Years III and IV: Contemplative Studies Capstone Projects will be individually tailored by the student and his/her advisory committee based on student interest and scheduling constraints. Scholarly Research Capstones will result in summary statements of research in a given field. These will be fundamentally oriented to reading and writing about relevant literature and will not involve specific clinical research or practice. Students who choose the Clinical Contemplative Practice Capstones will choose a member of the Brown Medical Community who uses contemplative practices in his/her clinical work and decide upon an appropriate form of internship with that person. This “Clinical Contemplative Mentor” will oversee the student’s apprenticeship and will help the student chose a suitable Capstone Project, in consultation with the Advisory Committee. With both categories of Capstone Project, the student will be expected to write a summary of the work he or she accomplished during the past two years. This is not intended to be a “Thesis” level original research project but rather more of a report on the work accomplished.  However, should a student wish to do an original research project, the program will be pleased to support and accept it. Throughout these two years the student would be encouraged to continue his/her own contemplative development whenever possible.

Throughout the four-year program, the Contemplative Studies Initiative will hold events in which students in the Scholarly Concentration can share their expertise and experience with one another and the interested Contemplative Studies faculty.

Concentration Related Electives

Pre-clinical:
BIOL 3710 N: Mindfulness in Clinical Practice: A Primer for Medical Students
BIOL 3710 N: Seminar in Mindfulness and Healthy Living

HMAN 1971 E: Cross-Cultural Approaches to Death and Dying 

Project Examples

Students will design a Contemplative Studies Capstone Project in which they bring their interests in doing a scholarly concentration in Contemplative Studies to bear on a particular problem or set of problems.  These projects fall into two basic categories : Scholarly Research Projects and  Clinical Contemplative Practice Projects. Examples of each category are as follows:

Scholarly Research Projects
“The Essential Neuroscience of Contemplative Experience;”
“The History of Mindfulness Based Stress Reduction and its South Asian Buddhist Origins;”
“Applying Contemplative Techniques to the Treatment of Eating Disorders.” 

Clinical Contemplative Practice Projects
“The Philosophy and Clinical Applications of Indian Yoga Techniques;” 
“The Clinical Application of Mindfulness Based Stress Reduction to the Treatment of Depression;”
“Mindfulness Meditation in the Treatment of Attention Deficit Disorder.” 

Capstone Projects will be evaluated by the student’s Advisory Committee in conjunction with the Clinical Contemplative Mentor where relevant.

2010 Accepted Students & Scholarly Concentration Projects:

Student Project Title Mentor
Schmidhofer, Sarah Yoga for PTSD Dr. Geoffrey Tremont

Maximum Number of Students

We can train up to five students per year.

Faculty Mentors

The following CONTEMPLATIVE STUDIES INITIATIVE CORE FACULTY would be able to advise students in their concentration:
Michelle Bach-Coulibaly , Theatre Arts, who works with contemplative states induced through African dance and drumming;

Susan Bernstein , Comparative Literature, who works on contemplative aspects of post-modernist thought and literature;

Ruth Colwill , Psychology, who works on consciousness in animals;

Albert Dahlberg, Molecular Biology, Cell Biology, & Biochemistry, who is interested in complementary and alternative medicine, consciousness and creativity;

John Emigh , Theatre Arts, who often works with contemplative materials in his explorations of the various performing artistic traditions of the world;

Thalia Field, English and Creative Writing: a poet and performance artist whose works are grounded in the study of consciousness;

Forrest Gander, English and Creative Writing: a poet and essayist whose interests include the interplay of subjective and objective elements in the act of creation;

Paget Henry , Sociology and Africana Studies, who has studied, among other things, the contemplative practices of African and Afro-Caribbean religion;

Dore Levy , Comparative Literature, who studies contemplative aspects of Chinese literature;

Hal Roth , Religious Studies, who works on the early Chinese mystical tradition of Taoism;

Peter Scharf , Classics, who does research in Indian linguistics and philosophy;

Donna Wulff , Religious Studies, who works with contemplative practices associated with South Asian religious drama.

Furthermore, CLINICAL CONTEMPLATIVE MENTORS may be chosen from the following list:
Bruce Becker, MD, MPH; Associate Professor of Community Health; Attending Physician, Rhode Island Hospital and Hasbro Children’s Hospital Department of Emergency Medicine.  Dr. Becker has completed research on yoga as an adjunctive intervention for behavioral change and is currently working on an NIH funded initiative using yoga as an adjunct for smoking cessation in women.

Willoughby Britton, PhD; Psychology Intern in Behavioral Medicine.  Dr. Britton’s research has focused on neuroscience correlates of varied states of consciousness and the effects of mindfulness based cognitive therapy on sleep and depression.  Dr. Britton is an instructor of mindfulness based stress reduction.

Michael Fiori, MD; Clinical Assistant Professor of Psychiatry; Director of the Alcohol and Drug Inpatient Unit, Butler Hospital.  Dr. Fiori is interested in objective measurement and neuroscience correlates of contemplative states.

Ellen Flynn, MD; Attending Psychiatrist, Women and Infants’ Hospital.  Dr. Flynn is assisting with the provision of a research project investigating mindfulness based stress reduction (MBSR) as a treatment for pelvic pain.  Dr. Flynn is an instructor of MBSR.

Brandon Gaudiano, PhD; Assistant Professor of Psychiatry (Research).  Dr. Gaudiano has expertise in Acceptance and Commitment Therapy (ACT).  His current NIMH-supported research is to develop an adjunctive behavioral treatment for psychotic depression.

Neeta Jain, MD; Clinical Assistant Professor of Psychiatry; Attending Psychiatrist, Women and Infants’ Hospital.  Dr. Jain recently served as the medical director of the Mind-Body Program at Bellevue Hospital in New York.

Mitchell M. Levy, MD; Professor of Medicine; Director of Critical Care Services, Rhode Island Hospital.  Dr. Levy’s research includes the development of interventions regarding ICU care at the end of life.

Gary Epstein-Lubow, MD; Assistant Professor of Psychiatry; Assistant Unit Chief of Geriatrics, Butler Hospital.  Dr. Lubow’s research has included pilot studies of mindfulness based stress reduction for distressed family caregivers.  Dr. Lubow assisted as Co-Director of the Scholarly Concentration in Contemplative Studies from 2007 – 2010.

Maria McKay, RN, MA. CIC, Manager Infection Control and Employee Health; Butler Hospital.  Holistic Counseling and Consulting, Private Practice. Ms. McKay completed her holistic counseling masters degree at Salve Regina University and is currently completing the requirements for a CAGS in Mental Health Counseling.  Her interests are in helping people process grief using mindfulness and the body.

Barbara Ostrove, OTR/L; Director of Occupational Therapy, Butler Hospital.  Ms. Ostrove has initiated a Holistic Work Group with the initial goal of implementing and investigating a “Sensory De-escalation Milieu Project” designed to reduce the use of seclusion and restraint.

Keith W.L. Rafal, MD, MPH; Clinical Assistant Professor in the Department of Family Medicine; Director of Healing Choices an integrative medical practice specializing in the management of Fibromyalgia, Chronic Pain and the rehabilitation and treatment of other chronic medical conditions.  Dr. Rafal is Medical Director of the Rehabilitation Hospital of Rhode Island.  He is currently developing a new approach that incorporates the power of Belief and Intuition as the centerpiece of care.

Karen Ryder, M.A.; Ms. Ryder is a psychotherapist in private practice who is a former associate of Jon-Kabat-Zinn at the Center for Mindfulness and a trained instructor of Mindfulness Based Stress Reduction. She teaches courses in MBSR for the Division of Behavioral Medicine at the Miriam Hospital.

Ronald Thebarge, PhD, MA; Clinical Assistant Professor of Psychiatry; Psychologist, Division of Behavioral Medicine, The Miriam Hospital.  Dr. Thebarge organizes the department’s Spirituality and Religion interest group.  He is a board member of The Center for Mindful Eating.  Prior research includes use of MBSR with breast cancer survivors.

Geoffrey Tremont, PhD; Assistant Professor of Psychiatry; Director of Neuropsychology, Rhode Island Hospital.  Dr. Tremont’s research includes family interventions for distressed dementia caregivers.  Dr. Tremont is a Vinyasa yoga instructor.

 

Funding Opportunities (alternatives to Summer Research Assistantships)

At present there are no funds for summer projects other than the SRA’s.

Selected Bibliography

BOOKS

  1. Austin, James. Zen and the Brain. Cambridge: MIT Press, 1998.
  2.  -------. Zen-Brain Reflections. Cambridge: MIT Press, 2006
  3. Barnard, G. William, and Jeffrey J. Kripal, Crossing Boundaries: Essays on the Ethical Status of Mysticism. Seven Bridges, 2002.
  4. Conze, Edward (trans.).Buddhist Wisdom : The Diamond Sutra and The Heart Sutra. Reprint, Vintage, 2001.
  5. Csikszentmihalyi, Mihalyi. Flow: The Psychology of Optimal Experience. NY Harper, 1990.
  6. Davidson, Richard and Anne Harrington eds., Visions of Compassion . Oxford and New York, Oxford U Press, 2002. (selections)
  7. DeWit,  Han F. Contemplative Psychology. Marie Louise Baird (trans.) Pittsburgh: Duquesne UP, 1991.
  8. Goleman, Daniel. The Meditative Mind. Putnam, 1988.
  9. James, William. The Varieties of Religious Experience. Reprint, Touchstone, 1997.
  10. Kabat-Zinn, Jon. Full Catastrophe Living. Delacorte Press, 1990.
  11. ------------------.Wherever You Go You Are There. Hyperion, 1995.
  12. Mair, Victor. Lao Tzu: Tao Te Ching. Reissue edition. Bantam, 1990.
  13. Rosenberg, Larry, Breath by Breath: The Liberating Practice of Insight Meditation. Shambala, 1999.
  14. Roth, Harold D. Original Tao: Inward Training and the Foundations of Taoist Mysticism. Columbia, 1999.
  15. Segal, Z. V., Williams, J. M., & Teasdale, J. D. Mindfulness-based cognitive therapy for depression: a new approach to preventing relapse. London: Guilford, 2002.
  16. Sekida, Katsuki, Two Zen Classics. Weatherhill, 1977.
  17. Thompson, Evan (ed.), Between Ourselves: Second-Person Issues in the Study of Consciousness. Imprint, 2001. (selections)
  18. Varela, Francisco, Evan Thompson, and Eleanor Rosch. The Embodied Mind: Cognitive Science and Human Experience. Cambridge: MIT Press, 1991.
  19. Wallace, B. Allan. The Taboo of Subjectivity: Towards a New Science of Consciousness. Oxford UPress, 2000.

ARTICLES

  1. Astin, J. A. (2004). Mind-body therapies for the management of pain. Clin J Pain, 20(1), 27-32.
  2. Baer, Ruth A. “Mindfulness Training as a Clinical Intervention: A Conceptual Review.” Clinical Psychology: Science and Practice, 10#2 (Summer 2003): 125-43.
  3. Barnard, G. William. “Debating the Mystical as the Ethical: A Response.” In Barnard and Kripal, Crossing Boundaries: Essays on the Ethical Status of Mysticism, 0-99
  4. Barnes, V. A., Davis, H. C., Murzynowski, J. B., & Treiber, F. A. (2004). Impact of meditation on resting and ambulatory blood pressure and heart rate in youth. Psychosomatic Medicine, 66(6), 909-914.
  5. Bishop, Scott, Mark Lau, Shauna Shapiro, Linda Carlson, Nicole Anderson, James Carmody, Zindel Segal, Susan Abbey, Michael Speca, Drew Velting, and Gerald Devins. “Mindfulness: A Proposed Operational Definition.”  In Clinical Psychology: Science and Practice, 11#3 (Fall 2004): 230-41.
  6. Brown, Kirk Warren, and Richard M. Ryan. “The Benefits of Being Present: Mindfulness and Its Role in Psychological Well-Being.” Journal of Personality and Social Psychology, 84#4 (2003): 822-48.
  7. Carlson, L. E., Speca, M., Patel, K. D., & Goodey, E. (2003). Mindfulness-based stress reduction in relation to quality of life, mood, symptoms of stress, and immune parameters in breast and prostate cancer outpatients. Psychosomatic Medicine, 65(4), 571-581.
  8. Davidson, Richard. “Towards a  Biology of Positive Affect and Compassion.” In Visions of Compassion, 107-30.
  9. Davidson, R. J., Kabat-Zinn, J., Schumacher, J., Rosenkrantz, M., Muller, D., Santorelli, S. F., et al. (2003). Alterations in brain and immune function produced by mindfulness meditation. Psychosomatic Medicine, 65, 564-570.
  10. Nancy Eisenberg. “Empathy-Related Emotional Responses, Altruism, and Their Socialization.” In Visions of Compassion, 131-64.
  11. Epstein, R. M. (1999). Mindful Practice. Journal of the American Medical Association, 282 (9): 833-839.
  12. Grossman, Paul (2004). MBSR and health benefits: a meta-analysis. Journal of Psychosomatic Medicine , 57, 35-43.
  13. Kabat-Zinn, Jon. “Mindfulness-Based Interventions in Context: Past, Present, and Future. Clinical Psychology: Science and Practice, 10#2 (Summer 2003): 144-56.
  14. Kohn, Livia. “The Sage in the World: Mysticism and Moral Responsibility in Chinese Religions.” In Barnard and Kripal, Crossing Boundaries: Essays on the Ethical Status of Mysticism, 288-308.
  15. Kripal, Jeffrey. “Debating the Mystical as Ethical: An Indological Map.” In Barnard and Kripal, Crossing Boundaries: Essays on the Ethical Status of Mysticism, 15-69.
  16. Lazar, Sarah, Herbert Benson, et. al. ”Meditation Experience is Associated with Increased Cortical Thickness.” NeuroReport
  17. Loy, David. “The Lack of Ethics and the Ethics of Lack in Buddhism.” In Barnard and Kripal, Crossing Boundaries: Essays on the Ethical Status of Mysticism, 265-87.
  18. Lutz, Antoine, and Evan Thompson. “Neurophenomenology: Integrating Subjective Experience and Brain Dynamics in the Neuroscience of Consciousness.” Journal of Consciousness Studies (JCS), 10(2003): 21-52.
  19. Lutz, Antoine, Laurence Greischar, Nancy Rawlings, Mattieu Riccard, and Richard Davidson, “Long-term Meditators self-induce high amplitude gamma synchrony during mental practice.” Publications of the National Academy of Sciences vol. 101 #46 (November 2004): 16360-16373.
  20. Ott, MJ, Norris, R., and Bauer-Wu, S (2006): Mindfulness Meditation for Oncology Patients: A Discussion and Critical Review. Integrative Cancer Therapies, 5, 98-108.
  21. Preston, Stephanie, and Frans deWaal. “Empathy: Its Ultimate and Proximate Bases.” Behavioural and Brain Sciences. 25 #1 (2002): 1-20.
  22. Shapiro, Shauna, Gary Schwartz, and Ginny Bonner.” Effects of Mindfulness-Based Stress Reduction on Medical and Premedical Students.” In Journal of Behavioral Medicine, 21#6 (1998): 581-99.
  23. Thompson, Evan, “Empathy and Human Experience.” In James D. Proctor (ed.), Science, Religion, and Human Experience. Oxford, 2005.
  24. Thompson, Evan, “Empathy and Consciousness.” In Between Ourselves, 1-32.
  25. Wallace, B. Allan. “Intersubjectivity in Indo-Tibetan Buddhism.” In Between Ourselves, 209-30.
  26. Zahavi, Dan. “Beyond Empathy: Phenomenological Approaches to Intersubjectivity.” In Between Ourselves, 151-68.
  27. Young, Shinzen, “How Meditation Works.” Shinzen.org
Concentration in Disaster Medicine and Response
Concentration in Disaster Medicine and Response

Concentration Director:

Selim Suner, MD, MS
Associate Professor
Email: SSuner@lifespan.org
Phone: 401-639-3483
CORO 106 Suite 106
One Hoppin Street Providence RI 02903

Overview

The organization and delivery of healthcare during disasters and the preparedness of communities to maintain healthcare functions during disasters requires cross-disciplinary cooperation.  Teaching students the unique challenges encountered in preparing for and responding to healthcare needs during disasters likewise requires a multidisciplinary team.  This concentration will involve educators from multiple clinical departments as well the involvement of non-clinical elements including the social sciences, political sciences, government agencies and representatives of non-governmental organizations.  The concentration will be organized to utilize the expertise of faculty in these areas at Brown University as well as outside speakers.

Curriculum

The Disaster Medicine and Response concentration is an immersive experience into medical management of disasters. The student will complete a series of encounters (field experiences), didactic lecture and seminars in addition to readings and a focused project in an effort to gain mastery into the functions of multiple agencies, organizations and individuals in preparation for emergencies and disasters. Particular emphasis will be given to the study of the interaction and cooperation among key agencies and medical disciplines.

Each student in the concentration will receive didactic lectures on the core topics of disaster medicine and response.  This seminar will take place 2 hours a week during the self-directed learning time in Year II.  The instruction for this seminar will be from a multidisciplinary faculty including the Departments of Emergency Medicine, Surgery, Medicine (Renal, Infectious Disease, Tropical Medicine), Psychiatry, Pediatrics and Toxicology.  The lectures could be held at the Emergency Medicine Conference rooms in Claverick or CORO (The medical Simulation Center) or at a site on the Brown Campus.  The core topics would include.  Medical Disasters, Systems to Respond to Healthcare needs during and after a disaster, National Incident Management System, Incident Command System, Weapons of Mass Destruction, Pandemic Influenza, Refugee health care (in cooperation with the Global Health concentration), Mental Health in disasters and after terrorist events, Syndromic surveillance, Hospital Surge Capacity, Evacuation, Care of Special populations, Community planning, Hospital disaster planning, Alternative care sites, Community-Government interface in disaster planning and response, Communications, Technology insertions (for detection, treatment and rehabilitation) Case studies (Tokyo Sarin, 9-11, SARS, US Anthrax, Katrina, Pacific Tsunami), medical team work training, the ethics of rationing care in large scale disasters (in cooperation with the medical ethics concentration). 

This seminar series will be supported by readings from textbooks, published manuscripts, policy statements and on-line training modules (FEMA: NIMS, ICS).  Students will have access to other lecture series and seminars during this time period and throughout their 4 years (Rescue Rounds-monthly, RI Disaster Medical Assistance Team Lecture series, monthly, etc.).  In addition grand rounds and related seminars will feature nationally recognized guest speakers.

Potential encounters would include attending disaster preparedness meetings at the RI Department of Health; Emergency Management Association, RI Hospital Disaster Preparedness Committee; Pandemic Flu planning at RIH and Brown. Other activities may include EMS time with Lifeguard Critical Care Transport Ambulance service, Simulation Center Experience, relevant Emergency Medicine Residency conferences. Potential field experiences include (depending on timing of events): participation at mass gathering events to provide health care with the Rhode Island Disaster Medical Assistance Team (Tall ships, Snickers Soccer Tournament, RIANG Airshow, etc.).  The annual Rhode Island Disaster Initiative Disaster Conference.  Field experiences in the offices of HHS and FEMA in Boston or Washington DC.
Learning Objectives and Evaluation Modalities
1-To understand some of the misconceptions in disaster epidemiology- evaluated through
2-To list essential components of hospital disaster preparedness.
3-Be able to describe the various types of chemical warfare agents and recognize the signs and symptoms of exposure. 
4-Be able to describe how to properly manage, decontaminate, and treat victims of a chemical attack.
5-Understand how to protect against the threat of cross-contamination by verifying the adequacy of patient decontamination.
6-Be able to describe the various types of radiological hazards.
7-Understand the acute health effects from radiation contamination and exposure.
8-Know the principles of self-patient rescue, triage, and transportation of radiation casualties.
9-Be able to describe the various types of biological warfare agents and recognize the signs and symptoms of exposure.  The student will also be able to describe how to properly manage and treat infectious victims and know which agents are a risk for secondary transmission and how to protect against this spread using personal protective equipment (PPE).

Evaluation
Students will be evaluated on their participation in discussions of readings and lecture materials.  For final scholarly products, a review committee will be established.  The members of the committee will be chosen based on the specific project to include subject matter experts and a broad representation.  The committee will meet after receiving the final project and generate a consensus review.  The committee will also help the instructor advise the student as she/he is working to develop the project.

Supporting Textbooks
Disaster Medicine. Eds: Ciottone, Darling,Anderson,Auf Der Heide, Jacoby,Noji and Suner, Mosby 2006.
Medical Response to Terrorism: Preparedness and Clinical Practice. Eds: Keyes, Burstein, Schwartz and Swienton.  Lippincott Williams and Wilkins 2005.
Disaster Medicine Eds: Hogan and Burstein .  Lippincott Williams and Wilkins 2002.
The Great Influenza.  John M. Barry.  Penguin Group, 2004.
Holy Terror: Armageddon in Tokyo.  D.W. Brackett.  Weathehill, New York, 1996.
Emergency Relief Operations.  Ed. Kevin Cahill, MD.  Fordham University Press, New York, 2003.
Emergency Medicine Clinics of North America: Disaster Medicine.  Eds: Morres,Burkle, Lillibridge.  W.B. Saunders, Philadelphia, May, 1996.
Health and Medical Aspects of Disaster Preparedness. Ed: Duffy.  Plenum Press, New York, 1990.

References for the Crush Injury module are listed below as an example:

  1. Zager RA. Rhabdomyolysis and myohemoglobinuric acute renal failure. Kidney Int1996; 49: 314–326
  1. Ron D, Taitelman U, Michaelson M, Bar-Joseph G, Bursztein S, Better OS. Prevention of acute renal failure in traumatic rhabdomyolysis. Arch Intern Med1984; 144: 277–280
  1. Lameire N, Matthys E, Vanholder R et al. Causes and prognosis of acute renal failure in elderly patients. Nephrol Dial Transplant1987; 2: 316–322
  1. Gabow PA, Kaehny WD, Kelleher SP. The spectrum of rhabdomyolysis. Medicine1982; 61: 141–152
  1. Poels PJE, Gabreëls FJM. Rhabdomyolysis: a review of the literature. Clin Neurol Neurosurg1993; 95: 175–192
  1. Brumback RA, Feeback DL, Leech RW. Rhabdomyolysis in childhood: a primer on normal muscle function and selected metabolic myopathies characterized by disordered energy production. Pediatr Clin N Am1992; 39: 821–858
  1. Bywaters EGL, Beall D. Crush injuries with impairment of renal function. Br Med J1941; 1: 427–432
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Project Examples

Potential projects include:
1. Pandemic Flu Planning for Rhode Island – affects on altering standards of care.  Project may include surveys of ICU, ED directors; review of potential ethical considerations; review of plans from other jurisdictions, etc. culminating in a publication quality manuscript and a presentation of results and recommendations to the state DOH.

2. Evaluation of state preparedness.  With this project, the student could review evaluation methodology for preparedness activities used by FEMA, HHS and other agencies, modify the criteria and improve methodology and apply the new criteria to evaluate the state of preparedness for emergencies in Rhode Island.  The project could culminate in manuscript and report to the state EMA or DOH

3. Syndromic surveillance.  With this project the student could utilize the statewide syndromic surveillance database to determine if the parameters could be modified to use this platform to perform surveillance for trauma and other conditions.  The student will produce a publication quality manuscript and report to the state trauma care committee.

4. Technology to enhance disaster preparedness.  With this project, the student could review the literature for technology insertions which could improve disaster preparedness and response.  Working with the department of engineering at brown and with the Memorial Hospital center for bioterrorism and emerging pathogens, identify the projects which are currently under development and hypothesize potential applications for disaster response.  The project would culminate in a publication quality manuscript.

2009 Accepted Students & Scholarly Concentration Projects:

Student Project Title Mentor
Hua, Angela Injury and Illness Patterns of Workers During the 9/11 Rescue and Recovery Operation at the World Trade Center Selim Suner, MD

Maximum Number of Students

The number of students is only limited by the availability of funding for summer grants and availability of faculty to sponsor and mentor projects.  We have a large number of faculty available to mentor students in this concentration.

Faculty Mentors

Bruce Becker, Community Health; Andrew Artenstein, Medicine; Christopher Born, Orthopaedic Surgery; Michael T. Bailin, Anesthesiology; David M. Dosa, Geriatrics; Kim Boekelheid, Environmental Studies, The Watson Institute;  Kenneth Williams, Emergency Medicine; Angela Anderson, Pediatrics, William Kirkpatrick, Clinical Social Work, William Cioffi, Surgery.

Funding Opportunities
(alternatives to Summer Assistantships)

Depending on the project funds could be available from DHHS, DHS or other agencies (unlikely).

Concentration in Global Health
Concentration in Global Health

Concentration Directors

Timothy Empkie, MD, MPH
Email: Timothy_Empkie@brown.edu
Phone: (401) 863-2019
Box G-B222, Brown University

Jennifer Friedman, MD, MPH, PhD
Associate Professor of Pediatrics
Email: Jennifer_Friedman@brown.edu
Phone: (401) 444-7449
Center for International Health Research

55 Claverick Street

Delma-Jean Watts, MD
Clinical Instructor, Dept of Pediatrics
Email: Delma-Jean_Watts@brown.edu
Phone: (401) 444-8531
Potter Suite 200, Rhode Island Hospital

Global Health Advisory Board

Susan Cu-Uvin, MD
Professor of Obstetrics and Gynecology
Email: SCu-Uvin@lifespan.org
Phone: 401-793-4775
Box G-MH, Brown University

Stephen McGarvey, PhD, MPH

Professor of Community Health
Email: Stephen_McGarvey@brown.edu
Phone: (401) 863-1354
Box G0S121-2

Timothy P. Flanigan, MD

Email: Timothy_Flanigan@lifespan.org
Phone: 401-793-7152
Box G-MH, Brown University

Overview

There are two purposes of the Global Health Scholarly Concentration. First, to educate medical students about the breadth and depth of global health, with an emphasis on populations in lesser developed countries characterized as resource-poor communities who are medically underserved. These communities will have low levels of population health measured by general measures of mortality and morbidity and by specific measures of disease and risk factor prevalence and incidence.  Second, to provide and support a close mentoring relationship between medical students and both Brown University and hospital-based faculty. Students will conduct a scholarly activity in global health under the direction of a faculty member.
The final result of this mentored relationship and the three and one-half years of learning is a scholarly product in global health. This product may take the form of a scholarly abstract, manuscript, technical report, or another output defined by the student and faculty mentor(s), and approved by the leaders of the global health scholarly concentration. 

Curriculum

The timeline of the Scholarly Concentration in Global Health is as follows: 1) Recruitment, applications and admission in Year I; 2) Preparation for, and implementation of, summer experience between Years I and II; 3) Year II Global Health Seminars; 4) Year IV Scholarly Product

Recruitment, applications and admission

The first component pertains to annual selection of students for the Global Health Scholarly Concentration.  Early in Year I and well prior to the February application date, interested students will meet with concentration leaders to identify an area of interest and a specific faculty mentor. Together, they will develop a summer experience, investigate summer funding opportunities, and outline a plan to complete the concentration requirements in the next years.  The completed applications for entrance into the Global Health Scholarly Concentration will be due to the Scholarly Concentrations Office in February.  The faculty leaders of the Global Health Scholarly Concentration will review applications for project merit and determine program acceptance.  A list of faculty and their international interests can be found on the Global Health Initiative site.

Summer experience between Years I and II

 A global health summer experience must be preceded by adequate preparation and close mentoring by faculty. Ideally, the summer experience would occur after intensive training in interdisciplinary aspects of global health perspectives and methods, but the realities of the regular medical school curriculum prevent that. Though clinical electives are highly valuable and inspire many students, these alone rarely meet requirements of the concentration. Further, at this juncture in medical student training, many students are not sufficiently prepared to make significant contributions to direct patient care. Thus, students should articulate in a GH concentration application not only what they will do during first summer, but how that will evolve, how it can continue over the ensuing 3 years, how it impacts human health beyond what they might have done clinically, and a plan for what the scholarly product will be.

The period of March to June will be a very busy and critical time for Year I students in the global health concentration. In Spring semester of Year I, after entry into the global health concentration and proceeding the summer, Year I students will be required to work closely with their faculty mentor to prepare. March through early May, Year I students and faculty mentors should meet every 2 weeks. The faculty leaders of the concentration will meet with students 3-4 times from acceptance in the concentration and summer departure to review progress and share with other students their plans. These meetings will emphasize general aspects of a foreign experience and specific items related to conduct of a research or clinical project.  Using the basic plan provided by the student in the SC Program Application form as a starting point, students and faculty will more fully outline plans for the summer experience.  Students and faculty may also use this time to apply for additional funding of the summer experience if necessary.

During this planning period, possible discussion topics with concentration leaders and mentors include:
A. Clinical Science and Practice
1. Clinical Care challenges in LDCs
2. Ethical dilemmas in delivery of clinical care in LDCs for US medical students & faculty
3. Understanding cultural barriers to adherence
4. Clinical translational and implementation issues in communities
B. Research Concepts, Methods and Conduct:
1. Demonstrate understanding of fundamental epidemiological and clinical research concepts and methods: study designs, rates and proportions, definition of populations and sampling, bias, and confounding.    
2. Demonstrate understanding of screening and surveillance concepts and methods.
3. Understand purpose, design & conduct of experimental trials at community & individual levels.
4. Understand qualitative methods and utility in global health research.
5. Identify a medical or public health problem with a defined population deserving of further study.
6. For a specific health problem, contrast generalizability and limitations of data from different sources.
7. Discuss ethical issues related to human research participants.
8. Discuss ethical issues related to the conduct of global health research.
9. Read and critique medical and public health research literature.
10. State a global health research problem in terms of a research hypothesis.
11. Develop research methods for study of a particular public health problem.
During the summer months between Years I and II, students will engage in in-depth summer experiences (~8-10 weeks). 
Although summer experiences at foreign sites will be encouraged, experiences at domestic sites with underserved and resource poor communities are entirely suitable as well. Ideally this summer work will provide the basic direction and topical interest for the four-year concentration and the final scholarly product, but since global health research and clinical opportunities can change quickly, there will be a lot of flexibility.
Upon return to Brown in the fall, Global Health concentrators will be expected to give public presentations on their summer projects.
For tips on requirements and preparation for foreign travel, please review the Foreign Travel Guide

Year II Global Health Seminars

Substantial time has been scheduled for students in Year II to work on their mentored projects that they conducted in the preceding summer. They should be meeting also regularly with their faculty mentors to make progress on their projects and plan for the scholarly product. During Year II, the Global Health Scholarly Concentration will meet regularly as a group with faculty leaders every 2-3 weeks at lunch time from September to March.  Students will be required to attend at least 75-80% of these meetings. The structure and format of the meetings will be a combination of small group discussions and presentations, faculty panels on global health careers, and seminars on selected global health topics.  The guest lecture series will focus on Brown or invited faculty working in global health in the area of service, public health, clinical research or education.  The format will be a 30-45 minute talk followed by 30 minutes of active discussion. These meetings will stop in March due to the 2nd years students need to prepare for the USMLE Step 1 exam.  

In addition, Brown University Framework in global health sponsors approximately 4-5 evening lectures, generally on the Brown campus. These lectures are often given by guest speakers from around the country. Concentrators are strongly encouraged to attend these evening lectures during their entire tenure as concentrators in global health at Brown.

 

Students in Year II will be expected to submit an abstract and present a poster at the Brown Global Health Poster Session in the Fall.

Additionally, the current Tropical Medicine elective course for medical students will be strongly suggested as a vital part of the scholarly concentration.

 

A list of Global Health activities at Brown can be found on the IHI lecture page.

Year III Activities

Although Year III will be very busy with clinical training rotations, it is essential that students maintain contact with their faculty mentors and discuss the progress on their scholarly product. Year III students will submit two brief cases/reflections from their clinical experiences that have global health relevance.   These may include cases of less common infectious diseases, experiences with refugee or immigrant patients, cultural or interpretation challenges, or reflections on specific differences seen in health care utilization here and in previous global health experiences. In addition, most students have more optional time in Year IV, so it is wise to plan far ahead for global health activities in the last year.

There is a funding opportunity for students via International Clinical Research Scholars Program which offers overseas fellowships in Global Health and Clinical Research. This program is administered through Vanderbilt University.  Several Brown medical students have taken advantage of this program. Dr Flanigan and Kenneth Mayer can tell you about the students who have done this.

Year IV Scholarly Products

The final component of the Scholarly Concentration consists of a fourth year elective and the submission of a scholarly product. It is envisioned that well over half of the students that participate in this Scholarly Concentration will go overseas in their 4th year and participate in an international elective in a resource poor setting, although international travel is not required.  Students will also have the ability to pursue an in-depth elective on health issues in the United States that are pertinent to global health. These might include evaluation of health problems in the Dominican or Haitian communities in New England, refugee clinic, or an in-depth study on vaccine or medication availability or the benefits and weaknesses of non-governmental organization programs providing health care overseas.  The fourth year elective must include a clinical component requiring students to interact in a meaningful fashion utilizing their clinical skills. 
Students will be required to submit a scholarly product for review by their faculty mentor and the concentration leadership by April of their fourth year. Approval of this product will indicate successful completion of the global health scholarly concentration.

Concentration Related Electives

Pre-clinical:
BIOL 3710: An Introduction to Tropical Medicine

Clinical:
Crossing Borders
Elective in Guatemala
HIV/AIDS
Internal Medicine in the Dominican Republic
Pediatrics in a Developing Country
Public Health and Primary Care in Rural Honduras
Tropical Medicine in East Africa

Project Examples

Scholarly products may take the form of a manuscript conforming to peer review standards, a curriculum contribution or a policy paper relevant to global health. Presentation at a regional or national conference will also be encouraged.

2010 Accepted Students and Scholarly Concentration Projects

Student Project Title Mentor
Andiman, Sarah A Clinical Archive and Photographic Atlas from Sihanouk Hospital Center of Hope, Phnom Penh, Cambodia Dr. Joseph Harwell, Dr. Susan Cu-Uvin, and Dr. Kruy Lim
Cohen, Caitlin "Action for Health": An innovative model to increase child survival by replacing user-fees with action-fees Dr. Timothy Empkie and Dr. Diakaridia Traore
Crawford, Camia Protective human immunity as a vaccine discovery tool for P. falciparum malaria Dr. Jonathan Kurtis
Gilbert, Elizabeth Burden of Disease of Actue Respiratory Infections in Children under 5 in Damanhour District, Egypt Dr. Marguerite Neill, Dr. Lisa Peters and Dr. Erica Dueger
Molina, John The Capability Approach and Health: The Role of Access to Care in Breaking the Intergenerational Transmission of Poverty in Indigenous Kichwa Communities Dr. Timothy Empkie
Perez, Will Public Health Education and Training Program for Haitian Youth in Rural Haiti Dr. Timothy Flanigan
Rochon, Hildred Rhode Island Cape Verdean AIDS Initiative Dr. Timothy Flanigan

Maximum Number of Students

We anticipate that the concentration will be able to provide adequate guidance and mentorship to 7-8 scholars per year.

Faculty Mentors and Advisors

A critical goal of the scholarly concentration will be to match students with faculty mentors in the 1st year of medical school. The application for joining the concentration which is due in February of Year I requires a mentor at that time. We recognize that students’ interests change, faculty resources change and other factors will influence students to seek out new mentors as they progress through the concentration. It is crucial that faculty mentors understand the need to provide ongoing mentorship beyond the first summer experience. This includes assurance of safety and adequate supervision at the field site as well as continued mentorship in creation of the scholarly product. The faculty mentor is primarily responsible for overseeing the work related to the scholarly concentration product. The concentration directors will work hard to provide guidance and counseling throughout all four years and assess the quality of the student and mentor fit.  The global health scholarly concentration will also attend and oversee didactic and other educational opportunities in the concentration. In addition, each student will be assigned a faculty advisor, whose role is to review progress reports and suggest changes over years 2-4 if a student is at risk for not completing concentration goals.   Often the advisor will be a concentration director or co-director, but not always.
There is a large number of faculty who have declared their interest and others who are potentially interested. We anticipate having no problems finding good matches, as the opportunity for long-term mentoring and collaboration is very attractive to faculty.

Funding Opportunities
(alternatives to Summer Assistantships)

There are several internal sources of funds that could provide financial support for proposed foreign global health experiences. The International Health Institute also provides useful information on its web site about outside funding sources.


We also believe that the training and mentoring offered by the Global Health Scholarly Concentration will prepare students to compete successfully for external funds for their proposed experiences.

In the Fall of 2008 Brown University received an education grant titled “Framework in Global Health at Brown University”, from the NIH Fogarty International Center. Dr Susan Cu-Uvin is the PI and Prof. Stephen T. McGarvey is the Co-PI.  The goal of the Framework program is to provide an academic structure and initial resources for faculty collaborations on curricular developments and mentoring of students in practical global health experiences. The Framework will take advantage of Brown’s flexible boundaries to help form new global health research collaborations, thus furthering incentives for faculty participation and opportunities for practical experiences for students and clinical trainees.  In addition to promoting the coordination of global health activities at Brown, this grant also funds the Framework Global Health Scholarship program. Please visit the Framework in Global Health page for more information and an application.

Visit AMS Global Health Initiative for further information about research, training and funding opportunities as well as global health events at Brown.

Concentration in Health Policy
Concentration in Health Policy

Concentration Director

Eli Y Adashi, MD, MS, CPE, FACOG
Professor of Medical Science 
Email: Eli_Adashi@brown.edu 
Phone: 401-863-9037  
Women & Infants Hospital
101 Dudley Street
Providence, RI 02905

Concentration Co-Director:

Michael H. Lee, MD, MS  
Asst Professor of Emergency Medicine 
Email: mlee2@lifespan.org
Phone: 401-427-7782
18 Imperial Place, Suite 1D 
Providence, RI 02903 

Overview

The concentration will foster familiarization with the statutory, regulatory, financial, and administrative “scaffolding” of health care financing such as Medicare, Medicaid, and SCHIP (The State Children's Health Insurance Program) as well with key administrative constructs such as CMS (Centers for Medicare & Medicaid Services), AHRQ (The Agency for Healthcare Research and Quality) and HRSA (The Health Resources and Services Administration) to name a few. Most importantly, students will progressively appreciate the policy-setting implications of the statutory, regulatory, and administrative framework underpinning the practice of medicine in the United States.  
Healthcare in America: Pre-clinical Elective Schedule

Timeline of Activities

Years I & II

Students enrolled with the Health Policy concentration will be encouraged to identify one or more project areas deemed of special interest and to identify appropriate mentors as their guide. Students will be advised to familiarize themselves with the topic(s) of their choosing with the clear understanding that the deliverable will be a submitted article to a peer-reviewed mainstream medical journal. So that students may have enough time to see their projects to completion, topics will be limited to qualitative and/or quantitative analyses of existing data sources or issues of the day. Upon selection of a topic, students will be expected to tackle the fine points of the subject matter through reading as well as through inquiries with relevant external parties if and when required. The latter could take the form of telephone calls or of meetings with relevant sources. When appropriate and feasible, a student may in fact choose to visit a relevant organization such as the RI Department of Health or more ambitiously, CMS (mostly in Baltimore, MD) or HRSA (Rockville, MD).

Given the demands of the academic calendar of the medical school, Health Policy students will be expected to make significant progress in their area of scholarly inquiry during prior to starting the clinical rotations. Concentration students will meet regularly with the co-directors at a frequency of once a month. Planned for the early evening hours past the end of the business day (field trips excepted), the meetings will take the form of one of the following formats: Student-led discussions, Guest faculty-led seminars, Guest faculty-led lectures, Faculty Co-Directors-led field trips. In addition to the expected summer research experience, student members of the “Health Policy” concentration will also be expected to participate in the preclinical elective “Health Care in America.” This elective consists of a series of evening lectures in which local and national health policy experts discuss important topics in US health policy. This lecture series will help participating students to develop a solid understanding of health policy concepts which then can be applied to their individual scholarly projects. 

Years III and IV

  During years III and IV, communication with the students will rely on email exchanges, phone calls, and pre-coordinated meetings as needed, which, depending on availability, may include participating in pertinent monthly health policy concentration meetings as well as lectures in the “Health Care in America” series. Students will be strongly encouraged to use an Independent Study Elective during their fourth year to complete work on their scholarly projects if required. There will be a Year IV April session during which students will present final deliverables with an eye towards evaluation (please see below under Project Evaluation).

Project Evaluation

The evaluation of student work will be dictated by the rigor of the scholarship involved. Special emphasis will be place on synthetic, analytic, and creative qualities which though based on facts, lead to novel reflections, conclusions, or recommendations. Put another way, significant weight will be attached to the ability to connect dots and to create a whole that is more than the sum of its parts. While other scholarly products are appropriate, the stated intent of the “Health Policy” concentration is the submission of an article to a peer-reviewed mainstream medical journal. As such, peer-reviewed articles lend themselves well to evaluation as per Glassick’s principles which will be applied as a matter of course.

Project Examples

Subject to the aforementioned premise, potential sample projects that students might complete in the context of the proposed concentration could include:

  • Reducing Preventable Hospital Readmissions: Evolving Payment Reforms.

In principle, this project will trace the evolution of the relevant concepts and the payment reforms designed to address this all important - if difficult - health care delivery challenge. Apart from drawing on national initiatives such as spearheaded by CMS, the student will be encouraged to explore the unique efforts launched by the State of Maryland by way of its Health Services Cost Review Commission (HSCRC). Assessing the performance of Rhode Island Hospitals in this context could also be entertained. To state the obvious, redress of the readmission dilemma will constitute a sea change in provider accountability, coordinated care, and pay for performance. As such, the centrality of the subject matter cannot be overemphasized.

  • Healthcare-Acquired Conditions (HACs) and the Patient Protection and Affordable Care Act.

In principle, this project will examine several facets of this all too common and critically important health care delivery dilemma. At a minimum, the nature of the issue and past efforts to address it will be thoroughly mastered and discussed. Special attention will be paid to the fact that effective 2011, the Patient Protection and Affordable Care Act will discontinue Medicaid payments to states for services related to HACs. The impact of this measure and others like it on the welfare of the patients in question and on the nation’s health care expenditures will be carefully reviewed. Inevitably, the relevant policies of Medicare and of commercial insurance plans will also be detailed, discussed, and compared. 

  • The Primary Care Workforce: Progress and Incertitude.

In principle, this project will explore the primary care workforce crisis, describe its origins, and detail its various solutions. Front and center will be the changes anticipated in the representation of those insured and in the growing needs of the old and frail.  Special emphasis will be paid to evolving solutions such as “teaching community health centers,” payment reforms, and the expansion of the National Health Service Corps. In this regard, the contributions of the Affordable Care Act towards the resolution of this critical issue will be the subject of significant attention.

 

Maximum Number of Students

This concentration can currently accommodate a total of five students per year.

Funding Opportunities  
(alternatives to Summer Assistantships)

 

At the time of this writing, no sources of student funding can be identified other than the Summer Assistantship Program. However, subject to the nature of the project, a reassessment of potential sources of student funding will be undertaken at the State, Federal, Foundation, and Brown University levels. In fact, students, having been appropriately guided, will be encouraged to go online and/or call potential funding organization such as The Commonwealth Fund, The Robert Wood Johnson Foundation, and The Fogarty Center to name a few possibilities.

Concentration in Integrative Medicine
Concentration in Integrative Medicine

Concentration Director:

Robert Heffron, MD 
Clinical Asst Professor in Family Medicine 
Email: Robert_Heffron@brown.edu 
Phone: 401-578-6345  
Memorial Hospital of RI
111 Brewster Street
Pawtucket, RI  02860

Concentration Co-Directors:

Catherine Kerr, PhD 
Principle Investigator at the Neuroscience of Meditation, Health and the Sense of Touch 
Email: Catherine_Kerr@Brown.edu 
Phone: 617-384-8583

John McGonigle, MD 
Clinical Instructor in Family Medicine 
Email: John_McGonigle@brown.edu 
Phone: 401-688-2782  
182 Gano Street 
Providence, RI 02906

Julian D. Ginsberg-Peltz, MD 
Clinical Asst Professor in Family Medicine 
Email: drjulesorama@gmail.com 
Phone: 401-688-2782  
182 Gano Street 
Providence, RI 02906

Donna Parker, ScD 
Asst Professor in Family Medicine (Research) 
Email: Donna_Parker@brown.edu 
Phone: 401-729-2531  
111 Brewster Street 
Pawtucket, RI 02860

Overview

In the past few decades, the public’s use of complementary and alternative medicine (CAM) has steadily increased. A National Health Interview Survey in 2002 revealed that 62% of U.S. adults had used CAM within the 12 months prior to being interviewed, while 54.9% believed that the combination of CAM and conventional medical care would provide added benefit. Despite the major advances of biomedical science during the 20th century, doctors have become increasingly burdened by the difficulties and challenges of treating chronic illnesses, and patients have grown wary of medicine’s over-reliance on technology and the harmful side effects of pharmaceuticals and invasive procedures. These factors, among others, have contributed to the public’s seeking of alternative forms of healing.

In the wake of these recent developments in CAM, integrative medicine has emerged as a promising field that draws from the best of the world’s healing modalities to provide safe, individualized care to patients. Integrative medicine acknowledges the role of mind, body, spirit and community as vital to the healing process and seeks to foster a healing partnership between doctors and patients. While it recognizes the power of conventional biomedicine, integrative medicine also recognizes and attempts to facilitate the body’s own healing response; it promotes the use of less invasive methods where safe and when possible; and it seeks to integrate CAM with conventional therapies in the pursuit of disease prevention, wellness, and the treatment of illness. Integrative medicine rejects the notion of an “alternative” medicine by proposing that all safe and efficacious healing modalities have a place in our medical paradigm. It seeks to broaden a doctor’s options so that he or she is able to apply the most appropriate treatment to a particular patient’s ailments. If there is a healing modality that is safer and more effective than conventional methods, then it should be included in the doctor’s toolkit.

Learning Objectives

The goal of the program is to deepen and broaden students’ conceptual and clinical understanding of CAM, and to incorporate this knowledge into the framework of integrative medicine. 

Students who complete this concentration shall be able to demonstrate the following:

  1. Discuss the core concepts of the integrative medicine model
  2. Identify the strengths and limitations of conventional biomedicine and the various healing
  3. modalities of CAM
  4. Apply an interdisciplinary approach to clinical thinking that incorporates a broad range of
  5. medical worldviews
  6. Consider the role of the mind, body, spirit, and community in illness, health, and healing
  7. Discuss issues and methods of research concerning CAM
  8. Analyze the scientific literature and evidence on CAM
  9. Participate in experiential learning that develops skills in several areas of CAM,
  10. including acupuncture, bodywork techniques, nutritional guidance, and others
  11. Establish a healing relationship with patients
  12. Advise patients in their use of CAM and conventional treatment methods
  13. Understand the importance of physicians and patient self-care in the promotion of health
  14. and treatment of illness

Timeline of Activities

Year I

Those who elect to pursue a Scholarly Concentration in Integrative Medicine will begin to develop a curriculum and plan for an intensive project to complete during the Summer of Year I. Under the supervision of their mentors, students will design an intensive 8-10 week summer project, which may be clinically-oriented, research-focused, or both. 

Summer of Year I

Brown has partnerships with an extensive network of other schools and clinics that feature

programs in integrative medicine.

Year II

After the Summer of Year I, the Director and students’ mentors will evaluate students’ posters at the Summer Showcase. Students will be encouraged to organize workshop events that promote awareness of integrative medicine and spark dialogue within the Brown community. This will mostly be done in conjunction with the student-run Brown Integrative Medicine Initiative (BIMI). Students will also be encouraged to attend the monthly integrative medicine “grand rounds” that take place at the Memorial Hospital at 6:30 pm on the first Thursday of every month during the academic year.

In the fall semester, students will be required to take BIOL3710-J: “Integrative Medicine: From

Alternative to Mainstream,” a preclinical elective. In this course, students will have the opportunity to experience CAM therapies, learn from clinicians who practice CAM, and discuss the scientific literature and research in this emerging field.  Learning in the course is both didactic and experiential.

Mentors will be available throughout the year for monthly meetings to advise students and to

receive updates on student progress. During these meetings, students will be working with

mentors to craft a long-term project that will be completed in the next two years. 

Years III & IV

During this time, students will have opportunities to complete clinical rotations in certain healing modalities at several of Brown’s partner schools and clinics. Depending on the students’ interests, projects may take various forms. Students pursuing research-focused projects may choose to present their work in the form of a paper, poster, and/or a conference presentation, whereas students with clinically-oriented projects may choose a format that enables them to practice and develop their clinical skills.

 Mentors will be available throughout the year to advise students. They will also continue to hold monthly meetings with students to receive an update on their projects.

In early April of Year IV, the Director and the students’ mentors will evaluate students’ presentation of their final projects. Because the format of these projects will vary, each mentor will decide on an appropriate method of evaluation. For projects that are research-focused, mentors may choose to evaluate students’ work in the form of a paper, poster, or conference presentation. For projects that are more clinically-oriented, mentors may choose to evaluate the students’  skills and performance in a clinical setting. Regardless of the format, project evaluations should enable students to demonstrate competency in each of the areas outlined in the Overview section. 

Project Examples

  1. The Acupuncture Clinic at Memorial Hospital, is a potential site for a student project. Students may design a clinically-oriented project, in which they explore how acupuncture is used in a clinical setting while learning the appropriate acupuncture points and needling techniques. Or students may choose a research-focused project, in which they use outcome studies to examine the efficacy of acupuncture for certain medical conditions, such as chronic back pain
  2. Clinical experience in the Ocean State Holistic Medical Collaborative in Providence. At this site students will have the opportunity to work with physicians practicing family medicine, pediatrics and psychiatry, complemented by homeopathy, acupuncture, functional medicine, and bodywork.

Potential Sites

Below is a list of potential sites where students can complete a summer project; students are not required to choose from this list.

Students who choose these sites will have the option of joining an existing project or creating their own.

  • Acupuncture Clinic, Memorial Hospital, Department of Family Medicine, Alpert Medical School (Chinese medicine)
  • Integrative Care Program in Women’s Oncology, Women and Infants Hospital (acupuncture, Reiki, bodywork, hypnotherapy, art/music therapy)
  • Hasbro Children’s Hospital and Bradley Hospital (art/music therapy)
  • Ocean State Holistic Medical Collaborative, 182 Gano Street, Providence, RI (homeopathy, Chinese medicine, mind-body medicine)
  • Way of the Dragon School, Providence, RI (Qi Gong, Tai Chi, mind-body medicine)
  • Pathways to Wellness, Boston, MA (Chinese medicine, bodywork)
  • College of Naturopathic Medicine, Univ. of Bridgeport, Bridgeport, CT (naturopathy)
  • Center for Mind-Body Medicine, Georgetown University (mind-body medicine)
  • School of Classical Chinese Medicine, National College of Naturopathic Medicine, Portland, OR (Chinese Medicine, naturopathy)
  • National Cheng Kung University, Taiwan (Chinese medicine)
  • Zhejiang University, School of Medicine, China (Chinese medicine)

Maximum Number of Students

This concentration can currently accommodate a total of 2-4 students per year. However, if there

is significant interest, additional faculty members can be recruited to serve as mentors.

Funding Opportunities  
(alternatives to Summer Assistantships)

1. Students who participate in the five-day training session offered by AMSA’s Leadership and

Education Program for Students in Integrative Medicine (LEAPS into IM) will be eligible to apply for small project grants of $300.

2. Students with interests in art/music therapy may apply for the Student Scholarship ($1000) or various research grants offered by the Society for the Arts in Healthcare.

3. Students who are committed to research in the field of naturopathy may be eligible to apply for funding provided by the Institute for Natural Medicine (INM).

4. The National Center for Complementary Alternative Medicine (NCCAM) may provide research supplements to students who are committed to health-related research.

Concentration in Medical Education
Concentration in Medical Education

Concentration Director

Richard Dollase, EdD, Director, Office of Medical Education 
Email Address: Richard_Dollase@brown.edu
Phone:  401 863-3198
Mailing Address:  Box G-B 215, Providence, RI  02912

Other participating faculty:
Luba Dumenco, MD, Department of Pathology and Office of Medical Education
Paul George, MD, Department of Family Medicine and the Office of Medical Education
Thais Mather, PhD, Office of Medical Education
Dale Ritter, PHD, Department of Ecology and Evolutionary Biology

Overview

Students participating in the Scholarly Concentration in Medical Education develop an interdisciplinary perspective on the teaching and learning processes related to patient-centered health care. Specifically, the concentration program integrates the study of education, philosophy, and psychology to enable students to gain a holistic view of medical education in the context of academic medicine and clinical care. The seminars and workshops focus on active teaching-learning processes including current assessment strategies in the field of psychometrics.  Concentrators gain competence in lecturing, leading small groups, tutoring, motivating and counseling students, and assessing individual student progress and a student’s small-group and class performance.

Moreover, in developing an educational philosophy that is based on moral and ethical standards related to clinical practice, students draw upon the literature in the field of philosophy and clinical ethics.  Students also gain perspective on the underlying principles related to information technology and its impact on teaching and learning in the classroom and in medical practice. 

Curriculum

Timeline of Activities

Summer after Year I:  Students are involved in curriculum-development activities related to developing or revising first- or second-year preclinical courses. Students may also be engaged in developing preclinical electives or constructing self-learning modules related to the first-year or second-year curriculum.

Year II:  Students participate in teaching and learning seminars on Wednesdays that address such topics as students’ various learning styles; how to lead a small group or how to effectively use technology in teaching and in patient care. In the second-year, students are expected to assume a leadership role in teaching and mentoring other preclinical students. They often serve as coordinators and tutors  in  the Doctoring Teaching Academy, the Content Tutoring Program or a preclinical elective they have created. Medical Education Concentrators may also give workshops related to such topics as health disparities or aged-based stereotyping or serving as small-group leaders, participate in undergraduate basic science courses that are offered on Wednesday mornings or afternoons.

Years III & IV:  After completing a core clerkship, medical education concentrators are asked to serve as Teacher Assistants in the third-year Clinical Skills Clerkship, the transition course preparing third-year students for the clinical experience. As a Teaching Assistant, the medical education concentrator leads daily seminar sessions that further develop third-year students’ clinical skills and working knowledge about how to “survive” and succeed in the core clerkships. The Teaching Assistants also evaluate third-year students’ clinical performance and their professionalism by administering and grading an end-of-the course OSCE.        

Students may also undertake an independent study at the end of the third year or during the fourth year to prepare a final project. Medical Education Concentrators who are interested in teaching in the preclinical classes may also be able to work in a basic science course or the Doctoring course during the fall or spring semester. 

Learning Objectives

The medical education concentrators 1) develop an interdisciplinary perspective on the teaching and learning processes related to patient-centered health care; 2) employ active-learning strategies that enable them to become highly effective teachers and mentors; 3) self-reflect and effectively self-evaluate their effectiveness as tutors, teachers, and mentors.

Specifically, the medical education concentrators will demonstrate competence in

  • Lecturing and preparing effective PowerPoint Presentations
  • Leading a small-group discussion
  • Tutoring and counseling other students
  • Applying the latest educational technology to improve instruction
  • Developing curriculum
  • Creating  written examinations and  OSCE cases
  • Evaluating the clinical performance of other students
  • Utilizing self-evaluation strategies to assess their teaching effectiveness

Evaluation

Teaching:  During their teaching and tutoring, students are observed and evaluated by faculty who are members of the Medical Education Concentration faculty and by other faculty members who may supervise students as tutors and/or teacher assistants in preclinical and clinical courses.  There are also peer observations and evaluations by other medical students who may be concentrators or in the Teaching Academy.

Curriculum Development:  In planning, developing and implementing new curriculum modules, students are assigned faculty mentors who review and critique their curriculum at each stage of development; and then, if feasible, the faculty mentors observe the students teaching some of the teaching material. The faculty also review the evaluation of the materials by students who participated in the curriculum project. A final report is developed by the Medical Education Concentrators that is reviewed by the faculty mentors and then the students make oral presentations to the Medical Education Concentration faculty.

Portfolio:  Under the supervision of a faculty mentor, the student develops an educational portfolio that details students’ curriculum development and teaching achievements. The portfolio is critiqued by a faculty advisor. The student then makes an oral presentation to the Medical Education Concentration faculty and to other students in the concentration.  

Resources

Participating students work closely with Medical Education Concentration faculty, composed of excellent teachers and mentors.  Standardized patients may also be used to help develop and refine the Medical Education Concentrators’ clinical teaching skills. The University libraries have a substantive collection of books and articles on medical education.  

Concentration Related Electives

Clinical:
Teaching Medical Interviewing

Project Examples

1) Develop a curriculum module or workshop in a preclinical course that involves creating an interdisciplinary curriculum unit, helping teaching the material, and evaluating the curriculum innovation. Once the curriculum module has been completed, the student presents the written document for review and then makes an oral presentation to the Medical Education Concentration faculty and other students in the concentration on its educational goals, pedagogy and overall effectiveness.   

2) Undertake an evaluation project related to the effectiveness of an interdisciplinary component of a preclinical course or clinical course, or conduct a study of the effectiveness of one or more elements of the new integrated preclinical curriculum. The written report is reviewed by a faculty mentor and the student makes an oral presentation to the Medical Education Concentration faculty and other students in the concentration.

3) Create and design an interdisciplinary preclinical or clinical elective that focuses on a topic of interest and that employs active-learning strategies and valid assessment protocols. The student offers the elective to 5 or more students. The student develops the curriculum, teaches a substantive part of the material, and receives feedback on its effectiveness from students who take the elective and from a faculty mentor who has reviewed the material and observed a number of the classes. The student then writes a final report and makes an oral presentation to the Medical Education Concentration faculty and other students in the concentration.

4) Teach for a semester or half-a-semester in first- and second-year basic science courses or an undergraduate PLME course and/or the two-year Doctoring course. Collaborating with course faculty, the student develops and implements lesson plans in lecturing or helping lead small-groups; also assesses or critiques the academic and/or clinical performance of students; and works effectively as a team member with senior faculty in the course. The student is systematically observed by faculty and is also evaluated by students in the course. The Medical Education Concentrator keeps a journal of reflections on the teaching experience and develops a substantive reflective essay related to the individual’s strengths and weaknesses as a teacher and mentor; what important “lesson” the student has learned during the teaching rotation; and recommendations for improving the teaching component of the concentration. 

2010 Accepted Students and Scholarly Concentration Projects

Student Project Title Mentor
Anderson, Thomas Teamwork in Medical Education Dr. Richard Dollase
Drapkin, Zachary Improving pre-Clinical and Clinical Teaching Methods by Emphasizing the “Big Picture” Dr. Richard Dollase
Engler, Zachary The Adaptation of Medical Education to Diverse Learning Styles Dr. Richard Dollase
Heneghan, Julia Confronting the Lion in the House: Using Education to Address Late Effects of Pediatric Cancer Treatment Dr. Christine Trask

Maximum Number of Students

We are able to accommodate 5-10 students each year.  

Faculty Mentors

Presently, there are five faculty members who mentor students annually.

Funding Opportunities
(alternatives to Summer Assistantships)

Each summer, curriculum-development funds from the Dean of Medical Education are available to two Medical Education Concentrators interested in developing or revising the preclinical curriculum. 

Concentration in Medical Humanities and Ethics
Concentration in Medical Humanities and Ethics

Concentration Co-Directors

Michael P. Steinberg, PhD
Director, Cogut Center for the Humanities
Barnaby Conrad and Mary Critchfield Keeney Professor of History
Brown University
194 Meeting Street
Box 1983
Providence, Rhode Island 02912
Phone: (401) 863-6074
Email: Michael_Steinberg@brown.edu

Jay Baruch, MD
University Emergency Medicine Foundation
Director, Ethics Curriculum
Warren Alpert Medical School at Brown University
593 Eddy Street, Claverick Building, 2nd Fl.
Providence, RI 02903
Ph: 401-444-5120
Email: jay_baruch@brown.edu

Christine Montross, MD
Assistant Professor of Psychiatry and Human Behavior
345 Blackstone Boulevard
Providence, RI 02906
Email: Christine_Montross@brown.edu
http://www.christinemontross.com/

Michael Felder, DO (Bioethics)
Assistant Director, Medical Ethics
Clinical Asst Professor of Medicine
Email: Michael_Felder@Brown.EDU 

Overview

The Scholarly Concentration in Medical Humanities and Ethics is about taking on big questions.

As defined by Felice Aull, the term "medical humanities" refers to the interdisciplinary field of humanities (literature, philosophy, ethics, history and religion), social science (anthropology, cultural studies, psychology, sociology), and the arts (literature, theater, film, and visual arts) and their application to medical education and practice. Dr. Aull goes on to note that these disciplines, by providing insight into the human condition, promote the qualities and skills that are essential for humane medical care – empathy, observation and self-reflection. They also provide for a cultural and social context for the practice of medicine.

Biomedical ethics is, similarly, a multidisciplinary pursuit. Ethical dilemmas, sometimes defined as “genuine conflicts of moral belief, perspective, or position,” emerge in a range of fields from medicine to the humanities, technology, industry, policy and human rights.

Medicine is perhaps the most humane art and science. Its tasks of caring and healing focus first on the body but its goals of individual and collective well-being affect all aspects of physical, mental, and social life. The Medical Humanities and Ethics Scholarly Concentration encourages students to draw from broad, interdisciplinary approaches and resources to examine the field of medicine and the countless dilemmas which arise within it.

Some students may design a project that falls squarely within the auspices of either Medical Humanities or Ethics, or they may choose to create a project in the shared interspace of the two.

Expectations

  • Students enrolling in the medical ethics and medical humanities scholarly concentration enjoy the opportunity to pursue multiple avenues of scholarly and creative projects. 
  • Students who desire to focus more narrowly on either medical ethics or medical humanities should anticipate scheduled opportunities to discuss their projects in a group forum and to have conversations and interdisciplinary dialogues with their colleagues. We hope such an exchange will also serve as an incubator for new ideas and collaborations. 
  • Students will participate in periodic discussions regarding topics that will inform their own work as well as nourish their understanding of their fields. 
  • Students are required to complete a scholarly project, which can be satisfied by a ‘portfolio’--examples of portfolio work include academic papers, didactic presentations, curriculum development, community projects, creative work or research. Students are expected to submit reports of their work every six months to their faculty mentor. 
  • Students will benefit from the community of fellow ethics and humanities concentrators and directors, but their primary working relationship will be with their faculty mentors. The concentration directors will assist students in establishing this critically important relationship which will then be cultivated and sustained by the student and mentor.

Timeline of Activities

Year 1

Meet with scholarly concentration directors to discuss your interests and goals, develop a well-defined summer project, and identify a project faculty mentor. Draft your funding application for a summer research assistantship. You should begin to think about the shape of your scholarly portfolio over the next three years.

Year 2

Group conversations and discussions as noted above. Students will be expected to present their summer work as part of the seminar experience. Seminar for medical ethics will have a parallel track, led by medical ethics faculty, but we anticipate certain topics to be of general interest and explored as a group.

Years 3 & 4

We hope students will attend discussions and events should their schedule permit in MS3 and MS4.

Year 3, we expect students to submit three 2500 word pieces of scholarly activity that emanates from clerkship experiences--these can include formal essays or thought pieces, reflective essays, creative work, or scholarly analysis. By February of Year 3, you should meet with your project mentor or scholarly concentration directors to review the status of your portfolio in preparation for year 4.

Year 4, Take a teaching/leadership role in discussions and didactic activities. Give formal presentation on one part of your portfolio, which must include a publishable article, a formal presentation, performance, or a publicly available body of original work. We encourage students to help shape medical ethics and humanities curricula for the medical school.

The portfolio will be reviewed by the medical ethics and medical humanities core faculty, as well as by the student's faculty mentor.

You are invited to take advantage of all aspects of the Cogut Center’s developing programs and resources, including visiting lecture series, conferences, and the exhibition, installation and interactive possibilities of the Humanities Lab. There will also be medical ethics lectures, visiting ethics speakers, and opportunities to participate in medical ethics education.

Curriculum

Each student in the Medical Humanities and Ethics Scholarly Concentration will participate in a core seminar course, the schedule of which will be designed around the existing medical curriculum. This course, tentatively entitled ‘Special Topics in the Medical Humanities,’ will be a weekly series of hour-long lectures on a range of topics in bioethics and the medical humanities. These lectures will be delivered by various faculty members from different university departments, each one presenting a lecture or series of lectures on topics in which they specialize.

As a new program of Brown University, charged with encouraging collaboration and growth in the humanities, the Cogut Center for the Humanities is pleased to act as co-sponsor of the Medical Humanities concentration. The resources, programs, and networks of the Cogut Center will be made available to the concentration with the goal of encouraging widespread participation on the part of Brown faculty and students. You are invited to take advantage of all aspects of the Cogut Center’s developing programs and resources, including visiting lecture series, conferences, and the exhibition, installation and interactive possibilities of the Humanities Lab.

There will also be medical ethics lectures, visiting ethics speakers, and opportunities to participate in medical ethics education.

Concentration Related Electives

Pre-clinical:
BIOL 3710 M: No Innocent Eye: Knowledge and Interpretation in Art and Medicine

HMAN 1971 E: Cross-Cultural Approaches to Death and Dying

Learning Objectives
Medical ethics concentrators will develop moral reasoning skills to identify and clarify the ethical dilemmas that occur in both medical education and clinical practice, engage in scholarship, and belong to a community of support and mentorship. 
A concentrator in medical ethics will be prepared to serve as a resource for colleagues faced with ethical dilemmas. They will also develop skills in ethics teaching, be involved in development and refinement of the ethics curriculum, and gain experience on hospital ethics committees.

Project Examples

Some students may design a project that falls squarely within the auspices of either Medical Humanities or Ethics, or they may choose to create a project in the shared interspace of the two.

Medical Humanities projects will be engaged principally in the study of human experience, human understanding and self-understanding. Over time, humanistic disciplines have developed in conjunction with the components of human understanding and representation. These aspects--language, image, movement, sound, as well as the political and social modes of their distribution-at once involve and transcend the body. Both scholarly and creative projects will be welcomed.

Projects in Clinical Ethics will ask students to choose as a project an ethical dilemma—preferably one that gnaws at them and keeps them up at night. The project will help students identify the source of their discomfort with the issue, and will provide students with the ability to examine the deeply held moral values of all participants in the conflict; to learn to sensitively tease out the latent principles contained in the dilemma, and to provide justifications that support their opinions.
The ultimate requirement of ethical analysis is action. In the medical context, as opposed to theoretical and philosophical construct, problems demand practical solutions.

Accepted Students and Scholarly Concentration Projects

Student Project Title Mentor
Liou, Kevin Humanities as Medical Instruments: A Teaching Fellows Program Drs. Jay Baruch, Christine Montross, and Arnold Weinstein
Peng, Bo Breaking the Silence: A Documentary about my first semester of medical school Dr. Jay Baruch
Grossman, Joseph The Role of Broca’s Area in the Resolution of Competition: An fMRI Investigation Sheila Blumstein, PhD
Amos, Emily Physician in a Changing World Dr. Jay Baruch
Bravo, Michelle Brown Longitudinal Advanced Spanish Training for Medical Doctors (BLAST MD) Dr. Jay Baruch
Brooks, Katie Doctor Patient Communication with the Medically Underserved-The Ethics of Competent Care Michael Barton-Laws
Butler, John Developing and Articulating a Thomistic Medical Ethics Dr. Michael Felder

Rodriquez,
Nicolette

 

The length and severity of nicotine withdrawal symptoms for female inmates: Developing a narrative centered smoking cessation intervention

Dr. Jennifer Clarke

Maximum Number of Students

There is currently no maximum number of students that can participate in the concentration.

Faculty Mentors

Jay Baruch, MD - Areas of interest:

  • Medical humanities program development
  • Medical humanities and arts as form of community engagement on medical issues.
  • Medical ethics
  • Fiction and creative work as means to better explore and understand individuals and the work of medicine
  • Creativity and writing as clinical tools.

Christine Montross, MD – Areas of interest:

  • Creative Nonfiction
  • Poetry
  • Balancing/integrating medicine with other creative, intellectual and personal pursuits
  • Medical Humanities program development

Funding Opportunities 

There are currently no identified funding sources beyond the traditional Summer Assistantships.

Physician as Communicator
Concentration in Physician as Communicator

Concentration Director

Teresa L. Schraeder, MD
Graduate Medical Education Editor
New England Journal of Medicine
tlschraeder@gmail.com

Overview

In recent years, it has become clear that many medical students and physicians are interested in writing and even clearer that the medical school education of physicians can and should include an education in effective communications.

The Physician as Communicator Scholarly Concentration will encompass all aspects of communication. Whether a medical student has a particular interest in writing an article or a book, producing a documentary or podcast, or just learning to speak more effectively in front of others, this concentration will offer guidance, support, and the structure to produce a major project for publication.

Physicians and physicians-in-training who can effectively communicate no doubt benefit in various ways, but they also may ultimately provide better care and service to the public, their patients, and their profession.

This concentration is designed for the medical student who is interested in the power of the word – in all forms of media.  The written, spoken, electronically broadcast or visually displayed forms of expression will all be part of the curricula. The student will focus on their particular area of interest in their particular medium and then meet regularly with other students, outline and complete writing or other media projects, provide updates to their mentor, and meet the ongoing requirements throughout the four years of medical school.

For the students selected to participate in the Physician as Communicator Scholarly Concentration, there will be continuing assistance offered for their self-focused goals of improving their own journalistic skills of communication and completion of presentations and projects. From the lay press and mass media to the professional medical literature and giving grand rounds – the student can explore many ways to examine and expand the ability to communicate within and on behalf of their profession and themselves.

This concentration not only provides a foundation of helpful information and support but will also give the student a greater understanding of the world of medical journalism – from developing a critical eye when reading published work to being interviewed by the press themselves and eventually navigating the editing and submission processes as a professional physician writer or a physician broadcaster.

The Physician as Communicator Concentration can easily overlap or help facilitate and encompass ideas and topics from virtually any of the other eleven Scholarly Concentrations including Bioethics, Advocacy and Activism, Aging, Medical Education, Global Health, etc. Any student who wants to focus on one of the other areas of concentration specifically could also benefit from involvement in Physician as Communicator to help collect, write and present their work.  

Curriculum

The student who selects this concentration will be responsible for:

  1. Elective Course: Attendance and participation in the current medical student writing elective course. This elective meets once or twice per month with a faculty member during the academic year (and often times during the summer as well) and will include other medical students who are not officially part of the concentration. This ongoing elective provides a core support group and excellent resource for any medical student interested in writing. Visiting speakers as well as information about book readings, writing contests, publication/submission requests, and lectures will be offered. The regular two-hour sessions provide an opportunity for students to meet with each other, present their writing or broadcast work and receive feedback, and assistance in having their work edited and submitted for publication.  The medical students who participate in this course provide administrative help with the course including planning events of interest to the writing class.
  2. Scholarly Project: This scholarly concentration will require completion of a major communications project such as an in-depth article (6,000 words plus), a book (including initial outline and all or most chapters completed), or documentary (fully edited and ready for submission or broadcast) or series of written articles on a particular subject of interest to the student.
  3. Regular Updates: The student will be required to have regular contact with a mentor who is overseeing their scholarly project and provide regular updates and receive feedback on their progress from the mentor and or concentration leader.
  4. Reading List: Completion of selected articles and books from a master reading list that will include medical literature, medical journalism, medical narrative, medical mystery, medical nonfiction and grammar and will be distributed to the students and updated regularly.
  5. Presentations: The student will be responsible for presenting their final work in front of the medical students writing elective course and possibly a larger audience including other medical students and faculty.

Timeline

The student applying to the Physician as Communicator Scholarly Concentration should have a particular writing or communications project (book, series of articles, documentary, website, podcasts, etc.) in mind that will act as the basis for a summer experience, as well as for a potential final scholarly product.  The student must outline this project in detail in their application.

During the summer between Year I and Year II, the student will spend 8-10 weeks working on their communications project.  The student’s work might include the completion of certain written products (the quantity of which to be agreed upon by the student and faculty mentor ahead of time), the collection of information and research including literature searches, interviews, etc., or some combination thereof.  This work will form the basis of the student’s final scholarly project. If the student has secured an internship/externship in the medical communications field for the summer between Year I and Year II, the student will still be responsible for collecting and researching the bulk of information needed for their final scholarly writing project. The student will meet with the concentration leader and/or their mentor before the summer and make a commitment to present their research and data at the beginning of Year II.

Major activities for students in Years II –IV involve participating in the Physician as Communicator elective, conducting any further research or interviews necessary, and completing the final scholarly product.

Concentration Related Electives

Pre-clinical:
BIOL 3710 I: Physician as Communicator

Learning Objectives

  • To find one’s voice and ultimately improve one’s ability to write and critique others' writing.
  • To become familiar with all genres of “medical writing” both past and present and analyze the various styles, mediums, and function of the profession. 
  • To improve one’s ability to think like a writer -- and then to learn concrete ways to research a topic and direct one's writing for the desired audience.
  • To master the ability to select a project and then provide an outline, conduct interviews, literature reviews, and to bring the project to fruition – all the while learning more about the entire process of writing for publication from query to submission.
  • To improve one’s ability to speak and give presentations on medical subjects before others and to listen critically to others' presentations.
  • To provide the student with a forum to capture and express in words or pictures the experiences and lessons during an extraordinary time of medical training – the first four years of graduate medical education.

Project Examples

The student’s scholarly project could include a first-person narrative of clinical work abroad in  book form, or an in-depth exploration of a particular area of interest in clinical medicine in an article or series of articles, a paper on biological sciences or bioethics, an audio or video documentary on a controversial topic in medicine, or an autobiographical sketch of an individual in medical history --- as well as any other topic the student and mentor determine acceptable to meet the requirements for a scholarly concentration project in medical writing or communications.

2010 Accepted Students & Scholarly Concentration Projects:

Student Project Title Mentor
Yang, Angela Beyond pain and meds: stories of chronic pain patients on long-term opiods/narcotics Dr. Jeffrey Borkan

Maximum Number of Students

This concentration will be able to accommodate 2-4 students to start. 

Faculty Mentors

There will be approximately 4 to 5 faculty to mentor students.

Funding Opportunities
(alternatives to Summer Assistantships)

There is a possibility of securing short-term internship or externship opportunities with medical journals, newspapers, publishing companies, or broadcast outlets for the medical student who wants to actually spend part of their time working directly in an area of medical communications or writing.

Concentration in Caring for Underserved Communities
Concentration in Caring for Underserved Communities

Concentration Directors

Fadya El Rayess, MD, MPH
Department of Family Medicine, Alpert Medical School
Email: Fadya_El_Rayess@brown.edu
111 Brewster St
Pawtucket, RI 02860
Ph: (401)523-2439

Joseph Diaz, MD, MPH, FAC
Department of General Internal Medicine, Alpert Medical School
Email: Joseph_Diaz@brown.edu
111 Brewster St
Pawtucket, RI 02860
Ph: (401) 729-2761

Arthur Frazzano, MD, MMS
Department of Family Medicine, Alpert Medical School
AHEC of RI
Email: Arthur_Frazzano@brown.edu
70 Ship St, Box GA-4
Providence, RI 02903
Ph: (401) 863-3598

OVERVIEW

The link between access to primary care and improvement in health and health care has clearly been demonstrated. However the United States is facing a shortage of primary care physicians. This co-insides with a decline in primary care graduates that is likely due to a combination of forces including: decreased reimbursement for primary care services, increasing student debt, problematic structure of primary care practices, perceived prestige and lifestyle preferences.  With recent proposed changes to the health insurance structure in the United States and the planned reliance on community health centers as a primary way to give care to underinsured and uninsured patients, there is a critical need to train physicians with the skills they need to thrive and remain in these settings.

The concentration in Caring for Underserved Communities strives to give students early positive clinical experience with community health centers from their first year of medical school through graduation. We have developed partnerships with such community health centers as East Bay,Thundermist, Crossroads, SSTAR, Clinica Esperanza and the RI Free Clinic, the VA’s homeless clinic and the Department of Corrections, with the goal of having students engage with the same community health setting throughout their 4 years of med school. Students choose a site that reflects their own interests and goals. Many health centers have several sites and faculty mentors practicing Family Medicine, Pediatrics, Internal Medicine and OB/GYN. As a result, a student could have more than one mentor and schedule rotations in more than one discipline at a particular health center. Students will be encouraged to remain within the local network of health centers if possible to facilitate a long term (3-4 year) relationship with a specific underserved community.

In addition to their clinical work concentrators will participate in the health center’s team based care and learn about population management and system based practice from experienced health center directors.The experience will begin with a summer placement between first and second year of medical school and continue with the scholar completing his or her community health and family medicine clerkship at the same site. Based on his/her clinical experiences the student will be mentored to develop a Scholarly Development Project that addresses a need of particular interest to the student and the community he/she is interacting with. The student’s scholarly concentration work will be supported by a curriculum taught by the concentration directors aimed at developing the knowledge and skills needed to provide care, leadership and advocacy for underserved communities.

The student will have the opportunity to carry out some of his/her scholarly project during his/her community health and/or family medicine clerkship. At the end of the concentration, the student will have produced a project consistent with the requirements of the scholarly concentration program. S/he will also have had a longitudinal experience in a community health center or site serving an underserved community with community based preceptors/mentors and the community they serve.

CURRICULUM

Learning Objectives

Learners will;

  • have a longitudinal experience with a specific community health center, health center physician mentor(s), and the patients and community they serve
  • design, implement, evaluate and present at least one scholarly project in response to an identified community need that will benefit the health center and the community it serves
  • be able to describe the organization of community health centers, free clinics and agencies serving underserved communities, including financing, administration, recruitment and retention of providers
  • develop the non-clinical skills needed to practice in underserved communities including population management, leadership and advocacy skills
  •  be able to recognize and discuss the impact of health disparities, access, culture, language and poverty on health status
  •  

    Timeline of Activities

    Year I

    •  Students will choose a mentor and develop a proposal for a summer project in the fall/early spring. Concentration directors will facilitate a series of meetings between the student and his/her community site mentor to develop a summer project proposal by the February deadline for concentration proposals. Possible projects include quality improvement, needs assessment and program development in response to a community/clinical need identified by the student and/or mentor. 

    Summer between Years I & II:

    • The summer project will serve as foundation for scholarly product. The student will receive support and mentoring from the concentration directors to develop the skills needed to complete this summer project. 
    • Students will deliver a power point presentation of their summer work in the fall and a poster presentation in December of their second year.

    Year II:

    During the second year concentrators will continue to implement their projects building on their summer experience.

    • Concentrators will attend monthly concentration seminars held at Clinica Esperanza covering such topics as: impact of social stressors including poverty, racism, environment and sexism on health outcomes; the health care ‘safety net’: community medical and mental health centers, public housing, programs for the homeless, free clinics, correctional system and Department of Children & Friends. Students will develop such specific skills as population/practice management tools, design and implementation of quality improvement projects, - working with medical interpreters, motivational interviewing and the setting of self-management goals. Joint seminars will be held with the scholarly concentration on Advocacy and Activism and Women’s Reproductive Health.
    • Students will also complete one to -two reflective writing assignments to be shared during the monthly meetings.

    Year III and IV:

    • One of the innovative strategies of this scholarly concentration is that students have a built in way to continue their work in the concentration in the setting of some of their required clinical rotations. Towards this end, students will be encouraged to spend one of their core third-year clerkships (such as family medicine , peds or IM) at their ‘matched’ health center/underserved site. While their primary focus will be on meeting the requirements of the clinical rotation, they will also have the opportunity to continue to work on their scholarly project.
    • Third-year students will meet/correspond every 6 months with concentration directors to ensure that they are making progress towards meeting their scholarly goals.
    • Fourth-year students will meet/correspond twice with concentration directors.
    • They will also be included in concentration-related meetings/events as well as invited to participate in any of the ongoing second year curriculum.
    • The majority of the work on the scholarly product will be completed by the end of the 2nd year with time during a 3rd or 4th year elective to complete the analysis and write up of the project.
    • Scholars will also be expected to submit an abstract to a state, regional or national conference and/or journal manuscript for publication in the fall of their 4th year.

    Concentration Related Electives

    Pre-Clinical
    BIOL 6504: Health Care in America
    BIOL 6653: Refugee Health and Advocacy
    BIOL 6650: Medical Students Outreach to MotherS-to-be (MOMS)
    BIOL 6655: Health Care of Underserved 

    Clinical
    Family Medicine Clerkship - integrate scholarly concentration work into project requirements
    Community Health Clerkship - integrate scholarly concentration work into the field experience or project requirement of the Community Health Clerkship.
    Scholarly Elective - Scholars can use this rotation to complete their project.
    Advanced Clinical Mentorship (ACM) - it may be possible to design an ACM that also allows work towards the scholarly product.

    Evaluation

    1. First year: students will be evaluated on their summer project presentations.
    2. Second year: students will be required to attend and actively participate in monthly seminars. They will be evaluated on their participation, their reflective writing, and their application of lessons learned as they develop their concentration project.
    3. Third year students will be required to meet once each semester with concentration directors.
    4. Fourth year students will be required to complete bimonthly progress reports and attend bimonthly meetings with concentration directors.
    5. Students will submit an abstract to a state, regional or national conference and/or journal manuscript for publication in the fall of their 4th year.
    6. Students will submit a written report and give a powerpoint and poster presentation of their final product that will be evaluated using the scholarly concentration product rubric. 

    Maximum Number of Students

    4 per class.

    Faculty Mentors

    • Jennifer Clarke, MD, PhD (IM-MHRI, Prison
      Health)
    • Anne DeGroot, MD, (IM-ID, Director of Clinica
      Esperanza)
    •  Sarah Fessler, MD, (FM, Director of East Bay
      Community Health Center)
    •  Beata Nelkin, MD (Peds, Thundermist Health
      Center)
    •  Thomas O’Toole, MD, MPH (IM, Director of
      National Homeless Veterans PACT Program)
    •  Joe Rabatin, MD (IM, MHRI, RI Free Clinic)
    •  Kimberly Zeller, MD (FM, East Bay CHC) refugee,
      global and HIV medicine

    Funding Opportunities 

    Students can apply for summer assistantship funding.