University of Toronto Undergraduate Medical Education

Brain and Behaviour - BRB 111Y

Course Directors: Dr. David K. Chan and Dr. Dee Ballyk

COURSE DESCRIPTION

Brain and Behaviour is a ten-week course from the end of March until the end of May.  Brain and Behaviour aims to provide a solid foundation in neuroanatomy and, neurophysiology, as well as an introduction to the clinical neurosciences.  There is also a two-week segment on pharmacology at the end of the Brain and Behaviour time period.  The course is organized around several blocks: I) neuroanatomy and molecular neurobiology; II) the motor system; III) the somatosensory system and pain; IV) vision; V) consciousness and higher cortical functions; and VI) behaviour and personality.  There is a central theme each week.  The core material is outlined in the learning objectives provided for each section of the course.  Students will attain these objectives through attendance at lectures and labs, participation in problem-based learning (PBL) tutorials, and through self-directed learning.  A "case of the week" is used to stimulate learning around the core topics for that week and to allow consolidation of new learning through small group sessions facilitated by a PBL tutor.  Two tutorials, each of two hours in length, are scheduled each week.

Wednesday afternoons and Friday mornings are occupied by the longitudinal courses (ASCM-1 and DOCH-1).  The didactic component of the Brain and Behaviour occurs on the other days of the week.  On these days, there are generally two lectures followed by a lab or seminar.  For the majority of weeks during the course, two half-days are designated as “self-study” time with no scheduled formal instruction, with one of these being always available between the two weekly PBL sessions.  This allows ample time for self-directed learning including preparation for the PBL tutorials.

Laboratories are used to teach anatomy and physiology by providing prepared specimens, models, human brains for dissection, and a variety of medical images.  Neuroanatomy is a critical component of the course and is emphasized in each of the weeks.  However, there is a concentration of lectures and labs at the beginning of course to quickly familiarize the students with the anatomy of the human nervous system.  Seminars have been included to further illustrate the clinical applications of basic science material by providing the opportunity to work through short clinical cases, with the help of an expert tutor in a small-group setting.

The two-week segment on pharmacology takes place at the end of the Brain and Behaviour period.  It consists of a mixture of large- and small-group teaching to provide students with an opportunity to consolidate various aspects of pharmacology learned earlier in the first-year program, to develop greater competence in aspects of pharmacokinetics, pharmacodynamics, toxicology and adverse drug reactions, and to begin to develop an understanding of the practical use of medications.
 
COURSE THEMES
I.    Introduction to the Neurosciences
    A.    Neuroanatomy and Molecular Neurobiology
    B.    The Neurological Examination

II.    Motor System
    A.    Motor Unit and Corticospinal System
    B.    Cerebellum and Basal Ganglia

III.    Somatosensory System and Pain

IV.    Vision

V.    Consciousness and Higher Cortical Functions

VI.    Behaviour and Personality

VII.    Pharmacology

 
COURSE OBJECTIVES

The principal learning objectives of Brain and Behaviour are for the students to: 

•    Acquire knowledge of the nervous system including the locations, anatomical relations, functions and blood supply of major structures.  Students should be able to apply this knowledge to determine the symptoms and signs resulting from different lesions of the central and peripheral nervous systems.  Conversely, using a patient's symptoms and signs, students should be able to localize the responsible anatomical lesion(s).

•    Identify anatomical structures and common disease processes from normal radiological images utilizing axial, coronal, and sagittal planes. 

•    Describe how nerves communicate with their target structures, i.e., muscles, glands, and other nerves.

•    Integrate the anatomy, physiology, and pharmacology of the motor, somatosensory (including pain), and special sensory (visual, auditory, vestibular) systems.

•    List the major neurotransmitter systems, describe their anatomical distributions, and describe how they can be affected by disease and pharmacological agents. 

•    Describe the anatomy and determinants of consciousness and sleep.

•    Discuss cortical specialization and higher cognitive functions including language, memory, learning, praxis, behaviour, and emotion.

•    Briefly outline the current theories about the pathophysiological mechanisms underlying depression, psychosis, anxiety, and personality disorders.  Discuss the mechanisms of action of drugs used in their treatment.

•    Identify key learning objectives (including neuroanatomy, neurophysiology, neuropharmacology, clinical aspects, and psychosocial issues) when provided with a clinical scenario and learn about the various sources of information to find information related to the learning objectives (problem-based learning).

•    Further develop professional skills through interaction with peers and the tutor during small group learning sessions and patients during the Discovery Laboratories and large group sessions. These include altruism, reliability and responsibility, self improvement and adaptability, respect for others, and honour and integrity in upholding a professional code of conduct.

Learning Objectives for the Pharmacology Component:

Students will be able to describe:

•    Major principles of pharmacokinetics

•    Major principles of pharmacodynamics

•    Adverse drug reactions

•    Use of medications in specific practical settings

 
EVALUATION

The final grade for the neuroscience portion of the course will be determined as follows: a mid-term examination worth 40% and a final examination worth 60%.  The mid-term examination is scheduled at the beginning of the fifth week of the course and consists of: (1) a "bell ringer" practical anatomy examination (50% of mid-term exam mark), (2) 45 single-answer multiple choice questions (40% of mid-term exam mark), and (3) short-answer questions based on a new PBL case (10% of mid-term exam mark).  The final examination consists of 60 single-answer multiple choice questions (80% of final exam mark) and short-answer questions based on another new PBL case (20% of final exam mark).  Part one of the new PBL cases is handed out one week prior to each exam, and part two will be provided at the time of the exam.  Professionalism is assessed mainly during PBL sessions.  As in other preclerkship courses, students must pass the professionalism component in order to receive credit for the course.

Both the mid-term and final examinations test knowledge of the core material outlined in the weekly learning objectives found in the course syllabus.  The PBL material is tested based on the learning objectives of the summary lecture following each case. 
Students must achieve a mark of 70% or higher on each examination in order to pass the course.  A student who scores between 60% and 70% on either examination, but otherwise achieves an overall course grade of 70% or higher, will be required to undertake and succeed in extra work to address their areas of weakness.

Students who score below 60% on any component of the course and students who achieve an overall course grade below 70% will be discussed by the Board of Examiners.  The Board of Examiners may on occasion require these students to repeat the Course in the following academic year.  More commonly, however, they will be required to undertake a program of remediation with examination over the summer months.  Students who pass this re-examination will be allowed to enter Year 2 of the undergraduate medical program subject to the approval of the Board of Examiners.

Students must successfully complete the required extra work and/or remediation/re-examination prior to the beginning of Year 2.  Where remedial work is recommended by two or more of the first-year Course Directors, the Board of Examiners may require the student to repeat the year.

Grades will be recorded and transcripted by the Faculty Registrar as Credit or No Credit.

In addition, there will be a written examination at the end of the pharmacology block that addresses the pharmacology objectives.  Students will need to achieve a passing grade of at least 65% on this assessment to be promoted to Year 2.  If students fail to achieve this standard, they will be required to do extra work and be re-examined.  Failure to achieve a satisfactory standard on this extra work will normally be reported to the Board of Examiners and may lead to the need to do formal remediation in this subject. 
 
RECOMMENDED TEXTBOOKS

Neuroanatomy Textbooks: 

Blumenfeld H.  Neuroanatomy through Clinical Cases.  Sinauer Associates, 2002.

Young PA, Young PH, Tolbert DL.  Basic Clinical Neuroscience.  2nd Edition.  Lippincott Williams & Wilkins, 2007. 

Fitzgerald MJT, Gruener G, Mtui E.  Clinical Neuroanatomy and Neuroscience.  5th Edition.  Saunders, 2007.  (QM451 .F5 2002)
http://search1.library.utoronto.ca/UTL/index?N=0&Nr=p_catalog_code:4738101&showDetail=first  

Nolte J.  The Human Brain:  An Introduction to its Functional Anatomy.  6th Edition.  Mosby, 2008.  (QM451 .N644 2000)
http://search2.library.utoronto.ca/UTL/index?N=0&Nr=p_catalog_code:4721876&showDetail=first

Kiernan JA.  Barr’s The Human Nervous System: An Anatomical Viewpoint.  8th Edition.  Lippincott Williams & Wilkins, 2004.  (STL: QM451 .B37 1998X)
http://search2.library.utoronto.ca/UTL/index?N=0&Nr=p_catalog_code:1870261&showDetail=first

Afifi AK, Bergman RA.  Functional Neuroanatomy: Text and Atlas.  2nd Edition.  McGraw-Hill, 2005.  (QM451 .A35 1998)
http://search2.library.utoronto.ca/UTL/index?N=0&Nr=p_catalog_code:1738426&showDetail=first

Martin JH.  Neuroanatomy: Text and Atlas.  3rd Edition.  McGraw-Hill, 2003.  (QM451 .M27 2003X)
http://search2.library.utoronto.ca/UTL/index?N=0&Nr=p_catalog_code:5014962&showDetail=first

Wilson-Pauwels L, Akesson EJ, Stewart PA, Spacey SD.  Cranial Nerves in Health and Disease.  2nd Edition.  B.C. Decker, 2002.  (QM471 .W55 1988)
http://search2.library.utoronto.ca/UTL/index?N=0&Nr=p_catalog_code:2817245&showDetail=first

Goldberg S.  Clinical Neuroanatomy Made Ridiculously Simple (Book & CD-ROM).  3rd Edition.  MedMaster, 2007.  (STL: QM451 .G63 1992)
http://search2.library.utoronto.ca/UTL/index?N=0&Nr=p_catalog_code:2714700&showDetail=first

Crossman AR, Neary D.  Neuroanatomy: An Illustrated Colour Text.  3rd Edition.  Churchill Livingstone, 2006.  (STL: QM451 .C76 2000)
http://search2.library.utoronto.ca/UTL/index?N=0&Nr=p_catalog_code:5500298&showDetail=first

Waxman SG.  Clinical Neuroanatomy. 25th Edition. McGraw Hill, 2003.

Snell RS.  Clinical Neuroanatomy.  7th Edition.  Lippincott Williams & Wilkins, 2009.


Neuroanatomy Atlases:

Haines DE.  Neuroanatomy: An Atlas of Structures, Sections, and Systems.  7th Edition.  Lippincott Williams & Wilkins, 2008.  (STL: QM451 .H18 2004X) 
http://search2.library.utoronto.ca/UTL/index?N=0&Nr=p_catalog_code:5157398&showDetail=first

England MA, Wakeley J.  Color Atlas of the Brain and Spinal Cord.  2nd Edition.  Mosby, 2005.  (QM451 .E55 2006)
http://search2.library.utoronto.ca/UTL/index?N=0&Nr=p_catalog_code:5806436&showDetail=first

Hendelman WJ.  Atlas of Functional Neuroanatomy.  2nd Edition.  CRC Press, 2005.  (STL: QM451 .H347 2006X)
http://search2.library.utoronto.ca/UTL/index?N=0&Nr=p_catalog_code:5656450&showDetail=first

Woolsey TA, Hanaway J, Gado MH.  The Brain Atlas: A Visual Guide to the Human Central Nervous System.  3rd  Edition.  Wiley, 2008.

Kahle W, Frotscher M.  Color Atlas and Textbook of Anatomy, Vol. 3: Nervous System and Sensory Organs.  5th Edition.  Thieme, 2003.

Greenstein B, Greenstein A.  Color Atlas of Neuroscience: Neuroanatomy and Neurophysiology.  Thieme, 2000.  (available online through U of T Library)
http://search1.library.utoronto.ca/UTL/index?N=0&Nr=p_catalog_code:6041030&showDetail=first


Neurophysiology:

Kandel ER, Schwartz JH, Jessell TM.  Principles of Neural Science, 4th Edition, McGraw-Hill, 2000.  (STL: QP355.2 .P76 2000X)
http://search2.library.utoronto.ca/UTL/index?N=0&Nr=p_catalog_code:3618259&showDetail=first

Haines DE.  Fundamental Neuroscience for Basic and Clinical Applications, 3rd Edition.  Churchill Livingstone, 2005.  (QP355.2 .F86 1997X)
http://search2.library.utoronto.ca/UTL/index?N=0&Nr=p_catalog_code:762523&showDetail=first

Purves D, Augustine GJ, Fitzpatrick D, Hall WC, LaMantia AS, McNamara JO, White LE.  Neuroscience.  4th Edition.  Sinauer Associates, 2008.

Conn PM.  Neuroscience in Medicine. 2nd Edition.  Humana Press, 2003.  (STL: QP355.2 .N53 2003X)
http://search2.library.utoronto.ca/UTL/index?N=0&Nr=p_catalog_code:5019439&showDetail=first

Bear MF, Connors B, Paradiso M.  Neuroscience: Exploring the Brain.  3rd Edition.  Lippincott Williams & Wilkins, 2006.  (QP355.2  .B425 1996X) 
http://search2.library.utoronto.ca/UTL/index?N=0&Nr=p_catalog_code:1561055&showDetail=first


Neuropharmacology:

Golan DE, Tashjian Jr. AH, Armstrong EJ, Armstrong AW.  Principles of Pharmacology: The Pathophysiological Basis of Drug Therapy.  2nd Edition.  Lippincott Williams & Wilkins, 2008.

Kalant H, Grant D, Mitchell J.  Principles of Medical Pharmacology.  7th Edition.  Saunders, 2006.  (STL: RM103 .S33 2006)
http://search2.library.utoronto.ca/UTL/index?N=0&Nr=p_catalog_code:5920076&showDetail=first

Siegel GJ, Albers RW, Brady S, Price D.  Basic Neurochemistry: Molecular, Cellular, and Medical Aspects.  7th Edition.  Academic Press, 2005.  (QP356.3 .B27 2006)
http://search2.library.utoronto.ca/UTL/index?N=0&Nr=p_catalog_code:5838032&showDetail=first


Clinical Neurology and Neurosurgery: 
The clinical texts will be more important after first-year medicine; purchasing one of the following may be helpful for working through the problem-based learning cases.

Lindsay KW, Bone I.  Neurology and Neurosurgery Illustrated.  4th Edition, Churchill Livingstone, 2004.  (STL: RD593 .L56 1997X) 
http://search2.library.utoronto.ca/UTL/index?N=0&Nr=p_catalog_code:1352314&showDetail=first
•    Well organized, many sketches and diagrams that simplify material, information outlined in “point form” but still comprehensive, good section on neurological investigations.

Aids to the Examination of the Peripheral Nervous System.  4th Edition.  W.B. Saunders Company 2000.  (RC409 .M44 1986)
http://search2.library.utoronto.ca/UTL/index?N=0&Nr=p_catalog_code:3554726&showDetail=first
•    A detailed guide to examination of muscles supplied by individual peripheral nerves.


Other References:

Ropper AH, Brown RH.  Adams and Victor’s Principles of Neurology.  8th Edition.  McGraw-Hill Professional, 2005.  (STL: RC346 .A3 1997X; also available at various hospital libraries)
http://search2.library.utoronto.ca/UTL/index?N=0&Nr=p_catalog_code:869241&showDetail=first

Rowland LP (editor).  Merritt’s Neurology.  11th Edition.  Lippincott Williams & Wilkins, 2005.  (RC346 .M4 1995)
http://search2.library.utoronto.ca/UTL/index?N=0&Nr=p_catalog_code:971185&showDetail=first
Online access to the 11th edition at: http://www.myilibrary.com.myaccess.library.utoronto.ca/browse/open.asp?ID=73077

Posner JB, Saper CB, Schiff ND, Plum F. Plum and Posner’s Diagnosis of Stupor and Coma.  4th Edition. Oxford University Press, 2007.  (RB150 .C6 P55 2007)
http://search2.library.utoronto.ca/UTL/index?N=0&Nr=p_catalog_code:6199972&showDetail=first

Strubb RL, Black FW. The Mental Status Examination in Neurology.  4th Edition, F.A. Davis, 2000.  (RC386.6 .M44 S87 2000X)
http://search2.library.utoronto.ca/UTL/index?N=0&Nr=p_catalog_code:3250033&showDetail=first

Feinberg TE, Farah MJ.  Behavioral Neurology and Neuropsychology.  2nd Edition.  McGraw-Hill Professional, 2003.  (RC341 .B424 2003)
http://search2.library.utoronto.ca/UTL/index?N=0&Nr=p_catalog_code:5005939&showDetail=first

Grossman RI, Yousem DM.  Neuroradiology: The Requisites.  2nd Edition.  Mosby, 2003.  (RC349 .R3 G76 2003X)
http://search2.library.utoronto.ca/UTL/index?N=0&Nr=p_catalog_code:5019191&showDetail=first

Bradford CA.  Basic Ophthalmology for Medical Students and Primary Care Residents.  8th Edition.  American Academy of Ophthalmology, 2004.  (RE46 .O65 1993X)
http://search2.library.utoronto.ca/UTL/index?N=0&Nr=p_catalog_code:1188060&showDetail=first