7. Pharmacology Case Studies

1. The purpose of these studies is to enhance students’ clinical psychopharmacology knowledge base, case formulation skills, and familiarity with relevant resources regarding the management of psychotropic medications, especially in the presence of complicating medical conditions.
2. Students are to write two case studies.  These studies are to focus on psychopharmacological management of each case.  One of these cases should involve the use of first-line psychotropics in an otherwise healthy patient, and the other should involve a patient with a complicating general medical condition(s) (e.g., liver disease, cardiac disorder).  Ideally these studies will be based on cases that are seen at the clerkship site.  They may be based on cases with which the attending psychiatrist is familiar if appropriate cases are not available at the time of the rotation.  The case studies should present the clinical rationale for selecting the psychotropic medications that were chosen, for dealing with drug interactions or other medical complications, and for describing the resources to which the student referred when developing the study (see attached case study example. 
   • Students should consult with their attending psychiatrist about case selection and the clinical reasoning involved in each case.  Either the student or the preceptor may suggest appropriate cases to study.  A student should take the initiative in developing each case study, and then refine it in consultation with the preceptor.  The preceptor will give feedback and offer suggestions so that the student will have the opportunity to refine the study using information and clinical reasoning that’s as accurate and complete as possible.
   • These studies are to be brief.  Each one should be about two pages in length.  Use of a bulleted style rather than a prose style is encouraged.
   • Patient confidentiality must be protected.  In keeping with HIPPA standards, these studies must not contain any personally identifying information (HPI). 
   • At least three published resources used in developing the case must be cited. 
   • Upon completion of each case study, students are to present the study to the preceptor for final review.  Preceptors will evaluate each case study on a “pass-fail” basis according to whether or not the student has displayed knowledge and reasoning skills expected of third-year students of primary care medicine.
   • Upon final approval, the student is then responsible for transmitting each case study electronically to the Department of Behavioral Sciences at karen.mull@okstate.edu.  Students are encouraged to submit studies as each has been successfully prepared and approved.  However, all studies are due by 5:00 p.m. on the last day of the rotation.  These studies will contribute to the course grade (see section X.F., below).

8. Supplemental Resources
    Highly recommended supplemental resources include:

• DSM-IV-TR (Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, Text Revision (DSM-IV-TR). American Psychiatric Association: Washington, D.C. 2000.)
• Hahn, Rhoda K., Reist, Christopher Reist, and Alberrs, Lawrence J. (2002). Current Clinical Strategies: Psychiatry. Laguna Hills, CA: Current Clinical Strategies Publishing. [This inexpensive pocket-sized reference outlines key information for diagnosis and management of psychiatric disorders. For example: summaries of admitting orders, progress notes, and discharge summaries are concisely presented. Key clinical features of major disorders and guidelines for prescribing psychiatric medications are clearly and succinctly presented. Also available as software for PDAs.]

9. Student Responsibilities

• Student responsibilities that apply to all rotations are explained in the Clerkship Handbook. Students should refer to this document to review these responsibilities.
• The student is responsible for completing a Site Evaluation.  The student must also assure that a Clinical Performance Evaluation (titled “Clerkship Evaluation”) has been completed, signed by the Site Faculty, and reviewed with the student (as documented by the student's signature).  The student is responsible for the delivery of these two documents to the Department of Behavioral Sciences.
• Students must be prepared to present the results of their OSBI background check to the Preceptor or designated administrative official at the training site.  At Shadow Mountain Behavioral Health, the OSBI background check is sufficient for students who have never lived outside Oklahoma; however, the Kroll background check is required for any student who has ever lived outside of Oklahoma.
• Students who are to complete this rotation at the Shadow Mountain Behavioral Health site must contact Ms. Alena Barnett at Shadow Mountain to start orientation at least two weeks before the rotation is to begin. She may be reached at 918-493-3205 or abarnett@psysolutions.com
• Students who are to complete this rotation with Dr. Lester must submit additional information to Muskogee Regional Medical Center.  In addition to the OSBI background check and record of current immunizations, students must fill out and submit the Mandatory And Required Knowledge (MARK) packet.  This packet is available in the Department of Behavioral Sciences.  All of this material must be submitted to Shemena Escoe no later than two weeks before the rotation is to begin via mail (300 Rockefeller Drive, Muskogee, OK 74401) or fax (918-684-3334).
• Sites for the core Clerkship in Psychiatry are in the Tulsa and Oklahoma City metropolitan areas.  In keeping with the Clerkship Handbook, students who must travel an extended distance from one of these areas to their next rotation will take travel time from the distant rotation, not from the Psychiatry Clerkship.

10. Course Evaluations

• Performance evaluation.  The performance of each student at the training site will be evaluated by his/her site faculty. 

Midway through the rotation, the Preceptor and/or Attending Physician should give informal, verbal feedback to the student about his/her performance to date. The physician is encouraged to use the Clinical Performance Evaluation form (titled “Clerkship Evaluation”) as a format for this feedback. This information should offer the student an opportunity to verify strengths and deficits in his/her performance, and to improve performance weaknesses prior to the final evaluation.
At the completion of the rotation, a formal evaluation of the student's overall performance will be conducted by the Preceptor and/or Attending Physician. An OSU-COM Clinical Performance Evaluation form is to be filled out by the Attending Physician, and verified by the Preceptor. The ratings on this form and the comments provided by the Site Faculty will reflect a careful assessment of the student’s performance. The results of this evaluation, as expressed by the ratings on this form, will constitute 50% of each student’s final Clerkship grade.
Site Faculty will describe the quality of the accomplishments of each student according to the 10 performance criteria on the Clinical Performance Evaluation form.  These qualitative descriptions will be expressed on a continuum from "Exceptional" to "Inadequate".  Faculty will fill in a circle for each of these criteria.  Numerical values will not be assigned to these criteria.
Almost all of these descriptions will be in the "Excellent", "Good", or "Adequate" categories. "Exceptional" and "Inadequate" descriptions will be rare.  An "Inadequate" description on any of the 10 performance criteria will normally result in requiring the student to repeat the rotation.
Site faculty will use these descriptions as the basis for assigning an Overall Clinical Performance rating.  This rating, similar to the performance criteria descriptions, will be on a continuum from "Exceptional" to "Inadequate”.

• Written exam.  The student must take a written exam covering the assigned readings at the end of the rotation. Exam questions will be based on the items in Tests 1 and 2 in the Stevens, et al (2007) text and the associated Online Study and Testing Tool (see inside front cover of the book).  The results of this exam will constitute 30% of the final grade for the rotation.

The written exam will be administered at 3:00 p.m. on the last business day of the calendar month, with the exception of November and December, as noted below. The exam will be given at the Department of Behavioral Sciences at the main campus of OSU-COM in Tulsa. Students at a rotation site in the Oklahoma City metro area may take the exam at the same time at Griffin Memorial Hospital. Students who choose to take it at this site must contact Ms. Nancy Snodgrass, by phone at (405) 321-4880 or by e-mail at nsnodgra@odmhsas.org at least one week before the exam to confirm your reservation.

The exam dates for the 2008-09 academic year are:
Thursday, July 31, 2008
Friday, August 29, 2008
Tuesday, September 30, 2008
Friday, October 31, 2008
Friday, November 21, 2008
Thursday, December 18, 2008

Friday, January 30, 2009
Friday, February 27, 2009
Tuesday, March 31, 2009
Thursday, April 30, 2009
Friday, May 29, 2009
Tuesday, June 30, 2009
The exam for the November and December rotations will be given earlier than usual because of the holidays. Please note that this exam date does not mark the completion of the attendance obligations for this month (see page 5 in the Clerkship Handbook).

• Case studies.  The case studies are graded on a “pass-fail” basis.  Each of the case studies contributes five points each to the final course grade.  Any missing or failing case study will receive no points; no partial credit will be awarded.  Successful completion of both of these studies constitutes 10% of the course grade.
• Site evaluation.  Students are required to formally evaluate their rotation experience. This evaluation must be completed by filling out the Site Evaluation form.  Site Evaluations are due within 7 days of the completion of the rotation. Grades are normally computed and submitted to the Dean soon after this date; if this material is not turned in to the Course Coordinator by this time, grade computation will include a “0” for this portion of the grade. This requirement constitutes 5% of the course grade.
• Attendance.  The student must be in attendance at all assigned rotation activities. If absences occur, students must make arrangements with the Preceptor or Attending Physician to complete equivalent activities to those missed during the absence.

Successful completion of this requirement will constitute 5% of the final grade for the rotation. Failure to complete this requirement will result in a “0” for this portion of the grade. Completion of this requirement is reported on the evaluation of the student’s performance that is completed by the Site Faculty.

11. Grading Procedures

• Grade computation will utilize the following procedures:
• Evaluation by Site Faculty: The ratings on the Clinical Performance Evaluation will be utilized in course grade computation as follows:

The Course Coordinator will assign a numerical value to the Overall Clinical Performance rating. These values, in descending order, will be:

• Exceptional = 10 points
• Excellent = 9.5 and 9.0
• Good = 8.5, 8.0, and 7.5
• Adequate = 7.0 and 6.0
• Inadequate = 3.0 and 2.0

The numerical value reflected in the Overall Clinical Performance rating will be multiplied by 5. This value will constitute 50% of the student’s course grade.

• Written Exam: The raw score for the written exam is the total number of correct responses out of 50 questions. This Exam Raw Score will be converted to an Exam Total Score by multiplying the raw score by the conversion factor of 0.6. The purpose of this conversion is to adjust this raw score to a number that represents 30% of the final grade.
• Site Evaluation – Five points will be credited for completing the Site Evaluation. No points will be credited if the Site Evaluation is not completed and turned in.
• Case Studies – Five points will be credited for each of the case studies that have been successfully completed and turned in as described above (see section VII.A.). 
• Attendance – Five points will be credited for meeting the attendance requirements, as reported by Site Faculty. No points will be credited if all attendance requirements (including attendance at AA/NA meeting) are not met.
• The Total Course Points will be derived by adding the Clinical Total Score, the Exam Total Score and the points earned for completing the Site Evaluation and Attendance requirements. Total Course Points ending in .50 - .99 will be rounded up to the next whole number; course points ending in .49 or less will be rounded down to the next whole number. Letter grades will be assigned according to procedures outlined in the Student Handbook.
• Both letter grades and Total Course Points are reported to the Dean and to the College Registrar.
• The course coordinator determines and issues a grade for each student.

12. Elective Rotations

Many students choose to pursue additional psychiatric clerkship training beyond the required core rotation. Interested students should refer to the "Clerkship Elective" section of the applicable Clerkship Handbook for information on requirements for these rotations.

Letter grades are not issued for elective clerkships. "Pass/Fail" grades instead are given for each elective psychiatry rotation.

13. Faculty
     The following psychiatrists are Site Coordinators:

Lori Hake, D.O.
Griffin Memorial Hospital
900 East Main St.
P.O. Box 151
Norman, OK  73070
Contact: Ms. Nancy Snodgrass 
405-573-6602 / 405-573-6684 fax

Madhu Koduri, M.D., Emmanuel Román, M.D., and Katherine Klaasen, M.D.
Clinical Assistant Professors of Psychiatry
Behavioral Medicine Services
Veterans Administration Medical Center
1011 Honor Heights Blvd.
Muskogee, OK  74401
    --and--
VA Outpatient Clinic
Behavioral Medicine Services
9322 E. 41st St.
Tulsa, OK  74135
Contact:  Ms. Jane Swan  918-680-3699
Note: Students typically spend 4 days/week at Outpatient Clinic in Tulsa.

Charles A. “Chuck” Lester, M.D.
Clinical Assistant Professor of Psychiatry
The Pavilion, Muskogee Regional Hospital
300 Rockefeller Drive
Muskogee, OK 74401
   --or--
(Office of Private Practice)
Charles Lester, M.D.
201 S. 36th Street
Muskogee, OK 74401
918-687-9227 / 918-680-6981 fax

Dean Martin, M.D.
Clinical Assistant Professor of Psychiatry
Shadow Mountain Behavioral Health
6262 S. Sheridan
Tulsa, OK 74135
918-492-8200
abarnett@psysolutions.com

Jimmie D. McAdams, D.O.
Clinical Assistant Professor of Psychiatry
Laureate Psychiatric Clinic and Hospital
6655 S. Yale
Tulsa, OK 74136
918-491-5645

Lonnie Morris, M.D.
Clinical Assistant Professor of Psychiatry
OSU Medical Center
744 West 9th
Tulsa, OK 74107
918-599-5880

Roderick Purdie, M.D.
Clinical Assistant Professor of Psychiatry
Hillcrest Medical Center
Behavioral Service
1120 S. Utica, 3rd Floor
Tulsa, OK  74104
918-579-1190
rodpurdie@yahoo.com

David Shadid, D.O. and Michelle Hubner, M.D.
Clinical Assistant Professor of Psychiatry
4520 S. Harvard Ave., Suite 250
Tulsa, OK  74135
918-747-5565 / 918-747-5568 fax

14. Course Coordinator



Richard H. Bost, Ph.D., ABPP
Diplomate Rehabilitation Psychology
Professor of Behavioral Sciences
Department of Behavioral Sciences
1111 W. 17th Street
Tulsa, Oklahoma 74127
918-561-8474 / 918-561-8428 fax
richard.bost@okstate.edu

Requests for general information:
Karen Mull
Administrative Assistant
Department of Behavioral Sciences
1111 W. 17th Street
Tulsa, Oklahoma 74127
918-561-8474 / 918-561-8428 fax
karen.mull@okstate.edu

15. Grievance Authority


Questions about a Clinical Performance Evaluation should be directed to the Site Coordinator during the formal evaluation (see section IX B). If a grievance cannot be satisfactorily resolved in this manner, the assistance of the Course Coordinator may be requested.

16. Students with Disabilities


If any student taking this course feels that he/she has a disability that requires special accommodations to enable full participation in the course, the Course Coordinator will work with that student and the Office of Student Services to provide reasonable accommodations to ensure that that student has a fair opportunity to perform in this class. Students wishing to arrange for such accommodations should advise the Course Coordinator of this need at some point before, during, or immediately after the first of the month in which the course is to be taken.