Psychiatry Clerkship Review
MEC subcommittee: 11/1/13
Members Present: John Dick MD – Chair; Paul Hannissian MD –OBGYN; Cathy Morrow, MD – FM; Adam Weinstein, MD – Peds; Alison Holmes, MD – Peds; Nicole Beudoin, M.Ed; Chris Bolka; Matt Duncan, MD – Psych; Julia Frew, MD - Psych
Framework for Review:
Geisel Competencies -> Course Learning Objectives -> Assessment of Learning -> Learning Activities
Course Description:
This is a 3rd year required clerkship. It consists of a 6-week block with 5 weeks of clinical time. They run a one day orientation. The student rotates on one inpatient service and has weekly outpatient exposure. Four sites used including DH, NHH, VA and CPMC.
Course Objectives (19)
Course Objective / Geisel Competency / How Assessed / Learning ActivityDemonstrate and conduct a complete psychiatric history with emphasis on the mental status examination. / 2b, 2c / Attending and resident observation and feedback / Clinical workflow – multiple opportunities eg. Call, inpatient rounds and outpt clinic; orientation demo
Identify psychopathology and formulate a differential diagnosis and a treatment plan. / 2e / General clinical feedback according to the RIME framework and Geisel competencies. Critical Thinking seminar grade; Write-ups (2) / Clinical workflow – multiple opportunities eg. Call, inpatient rounds and outpt clinic; Critical Thinking
Discuss the biological, social, intrapsychic and behavioral aspects of ALL illness whether its etiology and development be medical, emotional, or, as in most cases, both / 1f, 4e, 4j, 4k / General clinical feedback according to the RIME framework and Geisel competencies. Critical Thinking seminar grade; / Clinical workflow – multiple opportunities eg. Call, inpatient rounds and outpt clinic
Demonstrate effective and active listening to patients / 2a,2b,3b,4a,4c,4e,4j / General clinical feedback according to the RIME framework and Geisel competencies. / Clinical workflow – multiple opportunities eg. Call, inpatient rounds and outpt clinic
Develop effective and therapeutic doctor patient relationships. / 2a,3a,3b,3c,3d,4a,4b,4c,4d,4e,4f,4g,4j / General clinical feedback according to the RIME framework and Geisel competencies. / Clinical workflow – multiple opportunities eg. Call, inpatient rounds and outpt clinic
Recognize and list different modalities of psychiatric treatment including cost, availability, and accessibility to patients. / 1c,1d,1e,1f,6a,6b,6c,6e,6g / Healthcare Systems Reflection assignment / Clinical workflow – multiple opportunities eg. Call, inpatient rounds and outpt clinic
Also Healthcare Systems Reflection assignment
Compare and contrast the appropriate/inappropriate use of psychotropic medication. / 1d,3d,4c,6c,6h / General clinical feedback according to the RIME framework and Geisel competencies. Health care Systems Reflection assignment / Critical Thinking, Rounds, and Healthcare Systems group discussion.
Communicate and work effectively on an interdisciplinary team. / 3d,3e,3g,4k,6b / General clinical feedback according to the RIME framework and Geisel competencies. / Clinical workflow – multiple opportunities eg. Call, inpatient rounds and outpt clinic
Discuss the ?unique? principles of ethical conduct with psychiatric patients. / 3a,3d,4c,4d,4g,4k / Group discussion and General clinical feedback according to the RIME framework and Geisel competencies. / Lecture on capacity and competency evaluations. Healthcare Systems and Resiliency group sessions
Acknowledge the problem of stigmatization of the mentally ill. / 1e,1f,4a,4c,4e,4g,4j,4k / General clinical feedback according to the RIME framework and Geisel competencies. Health care Systems and Resilience Reflection assignments. / Clinical workflow – multiple opportunities eg. Call, inpatient rounds and outpt clinic
Explain the relationship between psychosocial factors and behaviors leading to ill health and disability. / 1f / General clinical feedback according to the RIME framework and Geisel competencies. Health care Systems and Resilience Reflection assignments. / Lecture on capacity and competency evaluations. Healthcare Systems and Resiliency group sessions, critical thinking and the healthcare systems and resiliency reflection discussions.
Explain "the what, when, and how" of appropriate referrals. / 3d, 3g / Clinical evaluation. / Clinical workflow – multiple opportunities eg. Call, inpatient rounds and outpt clinic
Describe and/ or interpret auxilliary aids in psychiatry, such as neuropsychiatric testing, psychological testing, social services, or special programs (i.e. activities therapy, behavioral medicine, etc.). / 1e, 1f, 3d / General clinical feedback according to the RIME framework and Geisel competencies. Health care Systems and Resilience Reflection assignments. / Clinical workflow – multiple opportunities eg. Call, inpatient rounds, groups and outpt clinic.
Critical Thinking Seminars.
Describe the different kinds of treatment services outside of the medical center, such as New Hampshire Hospital, Alcoholics Anonymous, day hospital, community outreach programs, and so forth. / 6a,6e,6f,6g,6j / General clinical feedback according to the RIME framework and Geisel competencies. Health care Systems and Resilience Reflection assignments. / Attend the IOP program.
Clinical workflow – multiple opportunities eg. Call, inpatient rounds, groups and outpt clinic.
Critical Thinking Seminars.
Discuss the impact of family dynamics in health and illness. / 3c / General clinical feedback according to the RIME framework and Geisel competencies. Health care Systems and Resilience Reflection assignments. / Attend the IOP program.
Clinical workflow – multiple opportunities eg. Call, inpatient rounds, groups and outpt clinic.
Critical Thinking Seminars.
Compare and contrast the theoretical basis, techniques and delivery of different psychotherapies. / 1d, 1e, 1f / General clinical feedback according to the RIME framework and Geisel competencies.
Critical Thinking Seminars. / Critical thinking seminar, inpatient unit groups and rounds, outpt clinic.
Compare and contrast the theoretical basis, techniques and delivery of different biomedical treatment modalities. / 1d, 1e, 1f / General clinical feedback according to the RIME framework and Geisel competencies.
Critical Thinking Seminars. / Lectures.
Critical Thinking.
General clinical work.
Observe ECT.
Healthcare systems reflection.
Relate the difference between competency and capacity to make medical decisions and describe the process of evaluation of capacity. / 1e / General clinical feedback according to the RIME framework and Geisel competencies.
Critical Thinking Seminars. / 1 hour lecture in this topic and 1 week on the C/L service where this is a common issue
Utilize DMEDS as a way of practicing electronic medical record keeping. / 3h / Review of DMEDS at the midpoint and end.
Ilios is missing info on specific goals of:
2) To become sophisticated in eliciting histories of alcohol and other drug use, as well as developing intervention and management skills
3) To become comfortable and effective in taking histories of traumatic experiences and become familiar with the variety of symptoms in which the patient may present.
Essential Skills/Conditions
Year 3: PSYCHIATRY CLERKSHIPESSENTIAL CLINICAL CONDITION (10) / LEVEL OF STUDENT RESPONSIBILITY / CLINICAL SETTING / % Students seeing at least 1
Depression / Manage with supervision / Inpatient / Outpatient / 100
Bipolar affective disorder / Manage / Inpatient / Outpatient / 100
Mania, Hypomania / Manage / Inpatient / Outpatient / 99
Schizophrenia / Manage / Inpatient / Outpatient / 99
Psychosis, other / Manage / Inpatient / Outpatient / 100
Post-Traumatic Stress Disorder / Manage / Inpatient / Outpatient / 100
Anxiety Disorder / Manage / Inpatient / Outpatient / 100
Personality disorder, borderline / Manage / Inpatient / Outpatient / 100
Suicide attempt or ideation / Manage / Inpatient / Outpatient / 100
Substance abuse, alcohol / Manage / Inpatient / Outpatient / 100
Substance abuse, other / Manage / Inpatient / Outpatient / 100
Delirium / Manage / Inpatient / Outpatient / 92%
ESSENTIAL CLINICAL SKILL (10)
Perform HPI relevant to this clerkship / Perform / Inpatient / Outpatient / 100
Mental status exam / Perform / Inpatient / Outpatient / 100
Counsel Alcohol use and abuse / Perform / Inpatient / Outpatient / 100
Counsel Depression/suicide / Perform / Inpatient / Outpatient / 100
Counsel Life stressors / Perform / Inpatient / Outpatient / 100
Counsel Substance abuse / Perform / Inpatient / Outpatient / 100
Counsel Safety / Perform / Inpatient / Outpatient / 100
Oral presentation of inpatient admission / Perform / Inpatient / Outpatient / 99
Written inpatient admission note / Perform / Inpatient / Outpatient / 99
Written inpatient progress note / Perform / Inpatient / Outpatient / 100
Learning Assessment Tools:
1) DMEDS – Assess progress on meeting essential skills and conditions
2) Essential Skills Competency Form – Students assessed as meeting level of skill expected of 3rd year
3) Clinical Performance Evaluation Form – Competency based assessment, RIME metric, completed by housestaff and faculty
4) NBME subject matter exam
5) 2 Clinical write ups
6) Resiliency Reflection
7) Health Care System Reflection
8) Critical Thinking Seminar – One write up
9) Mid-clerkship feedback form
Feedback:
The student’s receive mid-rotation feedback at with their designated attending faculty member.
Learning Environments / Activities
· Orientation – 1 full day
· Ward and Clinic experience
o 4 weeks on on inpt service
o 1 week on consult/liaison service
o ½ day in clinic each week with paired attending (just DHMC)
· Friday Didactic Sessions:
o 2 hours of didactics led by various faculty
o Resilience Module
§ Readings, Reflection piece, discussion
o Health Care Systems Module
§ student interviews patient/family prior and presents findings to group for discussion
· Thursday Critical Thinking Sessions:
o 1 hour per week
· ECT AM – observation at DH x 1
· Intensive Outpatient Program – Buck Road, Evening session x 1
· 3 Call Exposures - DH
· Self Study
o Textbook recommended
Friday Didactic Schedule
10/31 – 12/17
11/1/13 Bipolar Disorder - Dr. Duncan
11/8/13 Capacity Evaluations – Dr. Thakur
Psychopharmacology Review – Dr. Dahle
11/15/13 Depression – Dr. Holtzheimer
Schizophrenia – Dr. Noordsy
11/22/13 Women’s Mental Health – Dr. Frew
Substance Abuse – Dr. West
12/6/13 Resiliency Reflection
Child Psychiatry – Dr. Swartz & Dr. Savage
Health Care System Reflection
Sessions (Copied from Ilios)
1 Cognitive Behavioral Therapy - Case Based Discussion
2 Eating Disorders - Case Based Discussion
3 Delirium & Dementia - Part I: Delirium - Case Based Discussion
4 Delirium & Dementia - Part II: Dementia - Case Based Discussion
5 Anxiety Disorders - Case Based Discussion
6 Sleep Medicine - Case Based Discussion
7 Depression - Case Based Discussion
8 Bipolar Disorder - Case Based Discussion
9 Capacity Evaluations - Lecture/Small Group
10 Psychopharmacolgy - Lecture/Small Group
11 Child Psychiatry - Case Based Discussion
12 Interviewing Course - Small Group
13 Ethics and Stigma Lecture
14 Diagnosis and Formulation Lecture- With Live Patient Interview - Small Group
15 ECT Lecture
16 Spirituality Lecture
17 Personality Disorders Case Based Discussion
18 Substance Abuse - Lecture/Small Group
19 Critical Thinking - Small Group Interactive Weekly Case Discussion Seminar
20 Active Learning and Reflecting, Including DMEDS and Setting Personal Learning Goals
21 Direct patient care - Ambulatory and Inpatient - Clerkship
22 ED/Call - Clerkship
23 CRASH - Outpatient/Small Group
Site Comparability – See attached comparability grid
· Concerns / Actions
o
Course Planning
· Educational Team Structure
o One director, one assistant director
o One Clerkship Coordinator
· Self –Review/ Planning Methods
o Weekly group
· Method and Frequency of Coordination with Non-DH sites
o Yearly visit; email by block
· Faculty Preparation
o Faculty training during visit
· Resident Preparation
o CPMC resident prep – email; check with Winston
Clerkship Outcomes
NBME Shelf Scores
Avg NBME Raw Score2010-11 / 2011-12 / 2012-13
Geisel: 84.6
Nat: 79.9 / Geisel: 84.5
Nat: 80.2 / Geisel: 82.78
AAMC GS 2013 Questionnaire
Student Feedback – See Attached Report
Recommendations for Ongoing Improvement
See attached report