PSYCHIATRIC MEDICINE STUDENT CLERKSHIP

OVERVIEW

CLERKSHIP OBJECTIVES: 

The student will develop proficiency in performing a diagnostic psychiatric interview and mental status exam.

The student will understand the risk factors associated with suicide and self-injury and be able to evaluate for dangerous to self or others.

The student will have a basic understanding of neurobiological functioning, and psychological developmental theories as they relate to the precipitation, development, and perpetuation of mental illness. 

The student will be able to generate an appropriate differential diagnosis, identify target symptoms, and begin to develop an appropriate plan for further evaluation and treatment utilizing a multidisciplinary approach to implement the treatment plan.

The student will be able to recognize when inpatient vs. outpatient treatment is appropriate and know how to make appropriate referrals.

Students will become familiar with the legal aspects of psychiatric practice.   Students will learn the criteria required in Virginia  for involuntary hospitalization and will be able to make an assessment of a patient’s capacity to consent to treatment.

The student will demonstrate appropriate interpersonal and communication skills including the ability to develop patient rapport and show mindfulness of boundary issues.

The student will be able to effectively organize and present clinical data orally and/or in written format.

The student will become familiar with the DSM diagnostic criteria for major psychiatric disorders including:   psychotic disorders, affective disorders, anxiety disorders, delirium and dementia and disorders of cognition, and substance related disorders.  The student should be familiar with the clinical features, pathology and etiology of each and approaches to treatment. 

The student will develop a general familiarity with the following disorders:   Personality disorders, Somatoform disorders, Eating disorders, Sleep disorders, and Mental disorders secondary to general medical conditions.

The student will have an understanding of the neuro-imaging and laboratory studies used in evaluating patients with psychiatric illnesses. 

The student will become familiar with the fundamentals of psychological testing of intelligence and personality and neuropsychological assessment of adults.

The student will gain an appreciation of the basic principles of the analytic process and types of psychotherapy including the indications and uses for psychotherapy.

Students will be familiar with psychotropic drugs by their category (i.e. anti-psychotics, mood stabilizers, antidepressants, anxiolytics, sedative/hypnotics) and be familiar with the uses of each of these categories of psychotropic drugs.   For individual drugs, the student should be aware of the uses and the potential side-effects.

Each student will understand the indications for electroconvulsive therapy (ECT), the relative contraindications for ECT, and the potential risks of ECT.   Students should have a familiarity with how the procedure is performed.

PRE-REQUISITES: 

Prior to beginning the Psychiatric Medicine clerkship, all students are required to complete the following computer-based learing modules: Human Rights, Abuse and Neglect, Boundaries, and Falls Prevention.  

ATTENDING and RESIDENT ROLES:

Each student will be working with a team that will include an attending physician and various levels of resident physicians.  Attending physicians and residents are expected to involve the student as much as possible and encourage active participation of the student as a member of the treatment team.  The clerkship objectives should be used as the guidelines for teaching and evaluation.  Much of the clinical teaching on service occurs during rounds.  Students should be encouraged to practice their interviewing skills and present clinical data during rounds.  Supervision by an upper level resident or an attending is required for the meeting of the passport requirements (see below).  Following rounds, students can expect to spend most of the workday with the intern and resident physicians and should be actively engaged in the day to day duties of patient care.  Attending or resident physicians may suggest readings or topics for exploration that supplement the recommeded readings.  If time permits, they may also choose to give talks that are supplemental to the scheduled didactics.  Attending physicians are expected to give midroation feedback to students after 2 weeks.  Towards the end of the rotation, attending and resident physicians will be solicited via OASIS for a more comprehensive performance evaluation which should be completed in a timely fashion.

REQUIRED TEXT:

All students should have either the  Synopsis of Psychiatry, Behavioral Sciences, Clinical Psychiatry (9th edition) by Harold I. Kaplan, M.D. and Benjamin J. Sadock, M.D. or  Theory and Practice of Psychiatry  by Bruce Cohen, M.D.  It is expected that students will read chapters dealing with the diagnosis of their patients.  (e.g.  if you are following someone with schizophrenia and substance abuse, those chapters should be read).  In addition, students should refer to the Psychiatric Medicine Clerkship Curriculum:  Recommended Readings for more specifics on topics to study/read about.

LECTURES:

Didactic teachings are scheduled at each site:   UVA, WSH, Roanoke, and Salem.  Attendance is required.

CLINICAL DUTIES:

Clinical duties, including call may vary to some degree depending on the clinical site: UVA, WSH, Roanoke or Salem.  Please refer to the site specific webpages for a review of the clinical duties/expectations at that site.

PASSPORTS:

The clinical passport is a clerkship specific document that identifies the clinical skills relevant to the particular clerkship that each student must perform, demonstrating competency.  The clinical skills are to be performed under the supervision of an attending physician or an upper level resident.  If the skill is performed at a satisfactory level, the supervising physician will then sign off on the passport skill (in real time).  It is the student’s responsibility to make sure that his/her passport is completed and turned in at the end of the clerkship.  Successful completion of the passport is required to satisfactorily complete a clerkship.  The psychiatric medicine passports are directly linked to the LCME ED-2 requirement (see below).

LCME ED-2 REQUIREMENT:

During the psychiatric medicine clinical clerkship, each student is required to see two of each of the following types of patients:  patient with affective disturbance, patient with anxiety, patient with suicidal ideation, patient with psychotic features, patient with mental status changes/cognitive impairment, and patient with behavioral disorder (which may be addictive, impulsive, compulsive, or aggressive).  The patients may be seen in a variety of clinical venues including the inpatient units, the outpatient clinic, a partial hospitalization program or the ED/Consultation-Liaison service.  For each of the patients seen, the student must perform all elements listed in the clinical passport i.e. the student must perform a focused diagnostic interview, present the case (written or verbal) with a complete mental status exam, and participate in the formulation of the differential diagnosis and initial treatment plan for patient care.  The passport will serve as a written documentation of minimal competency (as verified by the supervising attending physician or upper level resident).  Additionally, the student is required to enter the ED data into the ED-2 Patient Log at:

                           www.med-ed.virginia.edu/patientlogs/PatientLog.cfm

If the student is having any difficulty finding the appropriate patients to see to satisfy the ED-2 requirements or the requirements for the clinical passports, please notify your supervising attending ASAP and/or the clerkship director. 

ATTENDANCE:

Students are expected to be present during their assigned clerkship period.  If a special circumstance or emergency necessitates that a student be absent from his/her clinical duties, the student must notify the supervising attending and/or the site director.  A student cannot be absent for more than two days without permission/clearance from the office of student affairs, and make-up days will then need to be arranged. 

MEDICAL STUDENT DUTY HOURS:

As per the medical school policy, students will be limited to an 80-hour work week.  The typical workday during the psychiatric medicine clerkship is approximately 10 hours (7:30 AM to 5:30 PM) with on-call duties adding an additional 5 hours (5:30 PM to 10:30 PM).  If the medical student believes that he/she is scheduled to work more than 80 hours in a particular week, the student should notify the clerkship director to reschedule the student for fewer hours. 

GENERAL CONDUCT:

Students are expected to act and work in a fashion that is consistent with the core values established by the University of Virginia Department of Psychiatric Medicine.  The student is expected to act with integrity and respect, in a collaborative effort with others in scholarly pursuits and the use of best clinical practice.

BOUNDARY and CONFIDENTIALITY ISSUES:

Maintaining professionalism and the integrity of the doctor-patient relationship is important in all specialties of medicine.  In psychiatry, it is particularly essential that the mental health provider is mindful of boundary issues as a patient’s mental state or disorder may compromise his/her level of impulse control or affect judgment.  Students should keep interactions with patients purely professional and approach patients in a respectful manner.  There should be no fraternization between students and patients on the unit, nor after the patient is discharged from the unit.  Physical examinations necessary to provide appropriate patient care should not be done without appropriate supervision.  If a student is not certain how to handle an uncomfortable situation with a patient, the student should excuse himself/herself from the patient and seek out supervision from a senior team member.  Students are discouraged from sharing personal data with their patients.  Likewise, students should respect the confidentiality of patient information.  Students should not discuss their patients in areas where people other than the treatment team may overhear the conversation.  Write-ups, notes, etc. that contain patient information should not be removed from the premises and ideally should stay in the office or designated work area on the unit.

GRADES:

Clinical work:(50%) This grade is determined by evaluations submitted by the attendings and residents with whom you worked.  Your clinical knowledge, skills, and judgment will be assessed as well as your professionalism, attitude towards work, and interpersonal skills.

Psychiatric Medicine SHELF Exam: (50%)  This is a standardized national exam that will be given on the last day of the clerkship. 

Failing any above section prevents passing the course, and that section must be retaken as deemed appropriate by the promotions committee. 

Grades should be available within 4 weeks from the end of rotation.

STUEDENT FEEDBACK:

We invite and depend on student feedback on the clerkship and we do try to use this feedback to improve the clerkship experience.  We hope that this feedback will occur spontaneously and continuously, but in addition we depend on the Uniform Clerkship Evaluation Form developed by the Student Medical Education Committee.  In order to insure reliable and valid feedback, we require that all students complete this form (along with our appended departmental evaluation form) on the last day of the rotation. 

If a student has any particular questions or needs during the course of the clerkship the clerkship director and clerkship coordinator are available to assist.

The Psychiatric Medicine Clerkship Web-Site:

www.healthsystem.virginia.edu/internet/psych-clerkship/

Revised August 2007