Curriculum

Psychiatry Clerkship

Director: Bethany Harper, M.D., Director, Medical Student Education and Assistant Professor, Psychiatry

Clerkship Description: The Psychiatry Clerkship serves the primary purpose of providing the training and education to enable students to acquire basic skills for dealing with psychiatric aspects of primary care medicine.  Secondarily, an understanding of the theoretical basis of handling psychiatric problems in clinical practice is a prerequisite.  Finally, professional attitudes and behaviors are sine qua non requirements of acceptable clinical practice.

Boonshoft SOM Educational Objectives/Competencies

Code

What competencies / milestones will this unit address?  

Foundational Knowledge – Medical Knowledge: Master fundamental biomedical concepts, terms, processes, and system interactions

1.1A

Apply knowledge of the expected changes in organ function as well as normal physiologic changes across the lifespan into the care of patients with core medical problems

1.1B

Describe how the altered structure and function of the body and its major organ systems are manifest through major diseases and conditions

1.1C

Describe the scientific basis for the diagnostic tests used in medicine

Foundational Knowledge – Medical Knowledge: Describe the determinants of health

1.2A

Using available data, compare and describe the health status of the U.S. to the health status of other countries for key health indicators

1.2B

Identify determinants of health, risk factors and protective factors that influence the diagnosis of a specific patient with a health condition

Foundational Knowledge – Medical Knowledge: Utilize evidence in making clinical decisions

1.3A 

Develop a clinical question, identify relevant research findings, critically evaluate the validity and reliability of that research, and apply the findings to the care of patients

1.3B

Incorporate pertinent biomedical information and research findings into clinical decision making and identify barriers to implementation

1.3C

Apply basic statistical approaches to clinical situations

Application – Patient Care (Clinical Skills): Conduct patient interviews and physical examinations

2.1A

Independently conduct an organized, comprehensive history and physical and recognize common abnormal findings

2.1B

Independently conduct a focused, prioritized history and physical

Application – Patient Care (Clinical Skills): Diagnose patient health problems

2.2A

Prioritize a differential diagnosis by applying knowledge of the basic sciences and pathophysiology

2.2B

Propose appropriate ancillary diagnostics and summarize diagnostic results

Application – Patient Care (Clinical Skills): Propose evidence-based health maintenance and therapeutic treatments

2.3A

Develop a cost-effective plan of care under supervision

2.3B

Identify and select relevant, evidence-based health promotion and education tools, as well as materials for common acute and chronic conditions encountered in the clinical setting

2.3C

Demonstrate the ability, under supervision, to perform basic medical procedures 

Integration – System-Based Practice: Connect knowledge of patient populations and health delivery processes in making diagnoses and therapeutic recommendations

3.1A

Describe the reporting process for disease surveillance

3.1B

Describe the epidemiologic investigation process

3.1C

Identify available community resources to improve the health of individuals and populations

Integration – System-Based Practice: Advocate for the humane, just, safe and prudent care of persons

3.2A

Demonstrate behavior that conveys caring, honesty, genuine interest and tolerance when interacting with a diverse population of patients and families

3.2B

Recognize the impact of contextual factors on patient care

3.2C

Recognize the importance of effective communication in the prevention of medical errors

Integration – System-Based Practice: Adapt to the complex economic and social structure of health care delivery

3.3A

Recognize how the health care delivery system in which one works affects patient care

3.3B

Recognize the improvements in systems can enhance quality of care and identify strategies to improve systems of care

Human Dimension – Personal and Interpersonal Professional Development Goals: Reflect upon one’s personal strengths and weaknesses to make changes in one’s behavior

4.1A

Seek and integrate feedback from patients, peers and faculty to better understand one’s development as a physician and as a member of the health care team

Human Dimension – Personal and Interpersonal Professional Development Goals: Find one’s own meaning in medicine

4.2A

Develop the skill of self-reflection and apply the insights to one’s professional 

Human Dimension – Personal and Interpersonal Professional Development Goals: Take care of oneself

4.3B

Engage in formal and informal self-awareness practices

4.3C

Demonstrate flexibility within the dynamic medical environment

Human Dimension – Personal and Interpersonal Professional Development Goals: Deliver effective patient presentations and document accurately in the medical record

4.4A

Present patient encounters accurately and succinctly

4.4B

Document patient encounters accurately in a timely, focused, and prioritized way

4.4C

Document supervised procedures accurately and succinctly in the medical record

Human Dimension – Personal and Interpersonal Professional Development Goals: Communicate and work effectively with others

4.5A

Seek feedback on one’s communication skills

4.5B

Effectively assimilate into the appropriate role and contribute to the health care team

4.5C

Communicate with patients and families in a timely, clear, empathetic, and humble manner

Human Dimension – Personal and Interpersonal Professional Development Goals: Demonstrate leadership skills in a variety of settings

4.6A

Meaningfully contribute to the clinical team

Caring/Valuing – Professionalism Goals: Value and behave in a manner consistent with the highest ethical standards of the profession

5.3A

Demonstrate the highest standards of individual and team-based ethical behavior that is patient centered, culturally sensitive, and socially just

5.3B

Apply knowledge of medical ethics to clinical situations

Learning How to Learn – Practice-Based Learning:Appropriately utilize evidence-based resources to address uncertainty in medicine and gaps in knowledge/skills

6.3A

Identify appropriate resources to address uncertainty in medicine and gaps in knowledge/skills

Clerkship-Level Objectives

Code

What are the clerkship-level objectives for this course?  

Boonshoft SOM Objectives

LO1

Frame a patient encounter in an organized fashion, reinforcing etiology, pathophysiology, clinical manifestations, diagnostic strategies and therapeutic interventions.

1.1abc, 2.1a

LO2

Explain disease specific treatment strategies and associated prognosis and complications.

1.1abc, 2.1b

LO3

Evaluate patients’ presenting clinical problems, including: Major Depressive Disorder, Bipolar Disorder, Persistent Depressive Disorder, Panic Disorder, Generalized Anxiety Disorder, PTSD, OCD, Schizophrenia, Schizoaffective Disorder, Personality Disorders, Substance Use Disorders, Neurocognitive Disorders, Somatic Symptoms and Related Disorders, ADHD.

1.1ab, 2.1a

LO4

Diagnose and manage patients with acute and chronic conditions including: list Major Depressive Disorder, Bipolar Disorder, Persistent Depressive Disorder, Panic Disorder, Generalized Anxiety Disorder, PTSD, OCD, Schizophrenia, Schizoaffective Disorder, Personality Disorders, Substance Use Disorders, Neurocognitive Disorders, Somatic Symptoms and Related Disorders, ADHD.

1.1ab, 2.1ab, 2.2ab, 2.3c

LO5

Demonstrate the ability to recognize psychiatric emergencies among general medical patients, including: suicidal thinking, homicidal thinking, signs of mental decompensation, impulsivity, dangerously poor judgment, lethal side effects to medications (neuroleptic malignant syndrome, neurotoxic or cardiotoxic responses, overdose).

2.1ab, 2.2a

LO6

Demonstrate knowledge about medical and medical-legal interventions (psychiatric referrals, involuntary commitment, judgments of medical capacity and competence) and recognize potential risks in general medical patients who have psychiatric disorder.

1.1ab, 2.3b, 3.1c, 3.2b

LO7

Apply the fundamentals of adult care to coordinate the care of healthy adults.

1.1ab

LO8

Demonstrate the ability to conduct a psychiatric interview, including: establish rapport with patients by properly introducing self and defining the role the interview will have in patients' care, be empathic with patients, showing genuine concern for patients' moods, dilemmas, viewpoints, and conflicts through tone of voice, style of speaking, facial expressions and gestures, facilitate interviews with helpful blends of open and closed questions, supportive remarks, uses of silences, and therapeutic interruptions, use language that is neutral to gender, age, race, sexual orientation, culture, and religion, and conclude interviews with proper timing and respect

2.1ab, 4.4a

LO9

Demonstrate the ability to perform a physical exam as well as a psychiatric examination, including: general appearance and activity, levels of consciousness, speech characteristics, orientation, concentration, memory, fund of knowledge, mood and affect, perceptual abilities/disturbances, hallucinations/illusions, depersonalization/derealization, thought processes, obsessions/compulsions, delusions, suicidal and homicidal thoughts, thoughts of self-harm, abstract thinking, judgment, insight, reality

2.1ab, 4.4a

LO10

Demonstrate appropriate interpretation of labs and testing, as well as perform common screening exams for common psychiatric disorders (CAGE, MMSE).

2.2b

LO11

Recognize the indications for lab data, and demonstrate the ability to: determine which laboratory tests are medically indicated based upon patients' psychiatric presentations, recognize when psychiatric laboratory data are pathological, determine when laboratory tests are indicated to check patients' compliance and responses to psychiatric medications, inform patients of risks and benefits of obtaining psychiatric laboratory tests.

2.2b

LO12

Begin to formulate diagnostic reasoning, and justify therapeutic decision-making.

1.3abc, 2.2ab, 2.3ab

LO13

Demonstrate clear and concise oral presentations and written documentation reflecting a systematic approach to adult patients. Demonstrate the ability to develop psychiatric formulation and present plausible theories about the etiologies and courses of patients' psychiatric illnesses in regard to: biological factors, psychological factors, social factors, spiritual factors, patients' strengths, and patients' weaknesses.

2.1ab, 4.4abc

LO14

Identify the social determinants of health for a specific patient, and develop a plan to coordinate care to include community resources to try to improve the health of the individual.

1.2ab, 31.abc, 3.2abc

LO15

Consider patient, physician, and system barriers to successfully negotiate treatment plans and patient adherence; and identify strategies that may be used to overcome these barriers.

1.2b, 3.1bc, 3.2abc

LO16

Identify the role of each team member to the care of the patient, and call on interdisciplinary resources to provide optimal and comprehensive care.

3.3ab, 4.5bc, 4.6a

LO17

Demonstrate effective skills in collaborating with family members, other health care providers, and professionals to identify the socio-cultural, familial, psychological, economic, environmental, legal, and political factors impacting the health care of the individual and the health care delivery system.

3.3ab, 4.5bc, 4.6a

LO18

Establish professional relationships and effectively communicate with patients, their families, instructors, colleagues and staff.

4.1a, 4.3c, 4.5abc, 4.6a

LO19

Work effectively with the broad, interdisciplinary team in patient care and appropriately incorporate their unique care skills.

4.1a, 4.3c, 4.5b, 4.6a

LO20

Demonstrate the ability to act with honesty/integrity while maintaining ethical duties to patients and others.

5.3ab

LO21

Demonstrate the ability to act in a manner that is dependable, dedicated and punctual.

5.3a

LO22

Demonstrate the ability to act with patience, altruism and equanimity.

5.1a, 4.1a, 4.6c

LO23

Demonstrate the ability to share advancement of knowledge with peers and other members of the health care team. Additionally, show a commitment to leadership, whether it be by taking initiative when working with families, or by taking on more challenges as the explicit leader in working with peers and in the community.

4.5bc, 4.6a

LO24

Recognize when additional information is needed to care for the patient and demonstrate ongoing commitment to self-directed learning.

6.3a

LO25

Demonstrate effective skills in navigating the medical literature to answer clinical care questions.

6.3a

LO26

Demonstrate the ability to acquire and soundly manage knowledge, identify knowledge deficiencies and create a plan for knowledge gains

4.2a, 6.3a

LO27

Demonstrate the ability to seek out and listen to feedback on performance, accept it positively, and respond to it constructively by improving performance.

4.5a, 4.3bc, 4.1a

To review all Boonshoft SOM Educational Milestones please visit the Educational Milestones page.

Required Clinical Experiences

Clerkship/Clinical discipline

Patient type/Clinical condition

Clinical setting

Level of student responsibility

Psychiatry

Neurocognitive Disorders

Ambulatory/inpatient

Observation

Psychiatry

Psychiatric Condition

Ambulatory/inpatient

Full

Psychiatry

Substance Abuse

Ambulatory/inpatient

Moderate

Psychiatry

Anxiety Disorders and OCD

Ambulatory/inpatient

Moderate

Psychiatry

Mood Disorders

Ambulatory/inpatient

Full

Psychiatry

Personality Disorders

Ambulatory/inpatient

Moderate

Psychiatry

Schizophrenia and Other Psychotic Disorders

Ambulatory/inpatient

Moderate

Psychiatry

Suicide

Ambulatory/inpatient

Full

Psychiatry

Trauma and Stressor-Related Disorders

Ambulatory/inpatient

Moderate

Psychiatry

History of Abuse

Ambulatory/inpatient

Moderate

Psychiatry

Adverse Effect of Psychiatric Medication

Ambulatory/inpatient

Observation

Observation: Student is observing encounter

Moderate Participation: Student completes the History and Physical (either complete or focused) and participates in the differential diagnosis. (*Student directly interacts with the patient)

Full Participation: Student completes History and Physical (either complete or focused), participates in the differential diagnosis, and then completes a therapeutic treatment plan, which can include documentation.

For Procedures:

            Observation

            Assisted in the procedure

            Fully performed the procedure

 

Last edited on 07/12/2018.