Clerkship in Psychiatry - Class of 2015
Syllabus - CE 9185
- General Description
- The Clerkship in Psychiatry is a course (CE 9185) in the undergraduate medical curriculum that culminates in the D.O. degree. As part of the core clerkship program, this rotation is offered during the third year of study. It is directed by the Department of Behavioral Sciences. Successful completion of this course is required for graduation.
- This rotation is a four-week experience in which the student, under supervision, may extend his/her knowledge of clinical psychiatry and develop psychiatric skills. Students advance their knowledge base in pursuit of answers to questions that arise during patient care, through assigned reading and interactions with faculty. Skill development occurs as students apply this knowledge and information from pre-clinical course work to clinical problems encountered in clerkship activities.
- The majority of the course is conducted in clinical sites including JCAHO-certified hospitals or College-affiliated psychiatric facilities.
- The course is taught by OSU-COM clinical faculty. The Course Coordinators (see section 15, below) are responsible for the overall organization and conduct of the course. A Preceptor (see section 14, below) at each training site is responsible for the organization of that site’s training activities and often conducts direct supervision of the students activities. AnAttending Physician(s) at each site (see section 14, below) may conduct direct supervision of the student’s activities. Attending physicians may be Residents in Psychiatry. The roles of Preceptor and Attending Physician may be carried out by the same or by different individuals who may be referred to as Site Faculty. All clinical activities of each student will be supervised by such physicians who will be in attendance for training purposes while the student is in the facility.
- This syllabus is effective for the class of 2015. That is, it applies to those third-year students who take this Clerkship during the 2013-2014 academic year.
The first four semesters of the required OSU-COM curriculum must be successfully completed prior to starting clerkship rotations. This coursework contains exposure to basic behavioral science and psychiatric knowledge and skills.
The purpose of this clerkship is to develop students’ knowledge base and clinical skills in psychiatry to the level expected of medical school graduates. Further information about these expectations may be obtained from “Clinical Learning Objectives Guide for Psychiatry Education of Medical Students” published by the Association of Directors of Medical Student Education in Psychiatry [ADMSEP] (available at www.admsep.org).
- Course Objectives
Certain knowledge and skills are fundamental to the diagnosis and management of mental health problems. Development of this core knowledge and these skills in clinical psychiatry is emphasized in this clerkship.
- Clinical psychiatry is based on a distinctive fund of information. Development of a knowledge base that will enable primary care physicians to recognize and prescribe first-line treatment for patients with common psychiatric disorders is an integral part of this clerkship. The assigned readings and Psychiatric Clerkship Didactic Day instruction are designed to assist students with accumulation and application of this information.
- Certain clinical psychiatric skills are fundamental to the diagnosis and management of mental health problems. Development of these skills is emphasized in this clerkship. This rotation is oriented toward helping the student increase his/her readiness to perform the following basic skills:
- Conducting diagnostic interviews, including activities such as:
- Responding to patients’ concerns in an empathic manner,
- Obtaining relevant psychosocial and medical histories, and
- Performing a Mental Status Exam.
- Formulating and clarifying diagnostic findings and treatment recommendations involving, for example:
- Summarizing medical and psychosocial histories,
- Describing physical exam and lab results
- Organizing interview data and treatment recommendations into comprehensive, integrated, cogent case presentations, and
- Explaining findings to the patient, family, and/or other health care professionals.
- Collaborating with various disciplines in the treatment team by:
- Researching medical tests and diagnostic procedures,
- Searching for information about medications and other somatic treatments
- Conducting diagnostic and/or treatment interviews, as directed by the attending physician.
- Documenting evaluation and treatment procedures, involving duties such as recording results of diagnostic interviews, lab studies, and/or treatment plans in a timely way according to the medical records protocols of the rotation site, and
- Sharing information and developing intervention plans with other members of the treatment team, including the patient and family.
- Curriculum The instructional program consists of the following:
- Observing clinical interviews conducted by Site Faculty,
- Performing clinical activities under direct supervision,
- Participating in mini-lectures or directed discussions (i.e., one-on-one instruction) with Site Faculty about selected clinical topics,
- Attending 12-step meetings (e.g., Open Meetings of Alcoholics Anonymous, Narcotics Anonymous, Overeaters Anonymous, Al-Anon, etc.). Each student is required to attend a 12-step meeting; for example, an AA (Alcoholics Anonymous) or NA (Narcotics Anonymous) Open Meeting. Each student should discuss experiences in this meeting with his/her attending clinical faculty. Attendance at such a meeting is part of the attendance requirement. Information regarding meeting times and locations can be obtained from the site Preceptor or from:
- Reading assigned material,
- Attending didactic presentations both at the rotation site (as per the rotation preceptor) and the Psychiatric Clerkship Didactic Day,
- Writing case studies that emphasize clinical psychopharmacologic issues, and
- Performing other assigned duties that are designed to assist the student in learning to perform core psychiatric skills with increased proficiency.
- Required Reading
The following book is required reading for this course. The questions on the written exam for this course are based on the text and questions in this book.
- Supplemental Resources
The following are highly recommended resources for increasing depth and breadth of knowledge as well as effectiveness of skills:
- Stevens VM, Redwood SK, Neel JL, Bost RH, Van Winkle NW, and Pollak MH. (2007). Rapid Review Behavioral Science, 2nd ed.Philadelphia: Mosby/Elsevier. [This familiar reference offers concise yet comprehensive coverage of essential behavioral science and psychiatric knowledge.]
- Sadock, BJ, Sadock, VA, & Ruiz, P. (eds). (2009). Kaplan and Sadock’s Comprehensive Textbook of Psychiatry. Washington, D.C.: American Psychiatric Association. [This two-volume reference offers comprehensive and in-depth coverage of psychiatric knowledge. Also available on-line through OSU-CHS Medical Library.]
- Carlat, D.J. (2005). The Psychiatric Interview (2nd ed.) Philadelphia: Lippincott, Williams, & Wilkins. [This is a concise compendium of interview questions designed to identify psychiatric disorders quickly and accurately.]
- Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition, (DSM- 5). (2013). Washington, D.C.: American Psychiatric Association. [The DSM-5 can be accessed as an ebook by going to the PsychiatryOnline database or by going directly to theDSM-5 ebook.]
- Hahn RK, Reist C, Alberrs LJ. (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.]
- Pharmacology Case Studies
- Students are to write two case studies. Each study should focus on the psychopharmacological management involved in the patient’s treatment.
- The purpose of these studies is to enhance students’ clinical psychopharmacology knowledge base, case presentation skills, and familiarity with relevant resources regarding the management of psychotropic medications, especially in the presence of complicating medical conditions.
- 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); for example, liver disease or cardiac disorder.
- Ideally these studies will be based on cases that are seen at the clerkship site. If such cases are not available during the rotation month, they should be based on appropriate cases with which the Preceptor or Attending Physician is familiar.
- These 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 Site Faculty about case selection and the clinical reasoning involved in each case. Either the student or Site Faculty may suggest appropriate cases to study. The student should take the initiative in developing each case study, and then refine it in consultation with Site Faculty. The Site Faculty 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 HIPAA standards, these studies must not contain any personally identifying information (HPI).
- At least three published resources used in developing the case must be cited.
- Each student should consult his/her Site Faculty as the case study progresses. Then, upon completion of each case study, students are to present the study to the Site Faculty for final review. Preceptors will evaluate each study on a “pass-fail” basis according to whether or not the student has displayed knowledge and reasoning skills expected of medical school graduates.
- Upon final approval, students are then responsible for transmitting each case study electronically to the Department of Behavioral Sciences at email@example.com. 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 sections 11.3 and 12.4, below).
- Psychiatry COMAT Preparation Day The Day is a case-based structured review of psychiatric knowledge that is designed to help students prepare for the COMAT in Psychiatry and the COMLEX, part 2. The Day will be led by psychologist and psychiatrist faculty. It will be held on the OSU-CHS campus, room 237, from 8:00 AM till 5:00 PM on the 3rd Friday of each 4-week rotation. Attendance is required. Readings, if any, for this training experience will be announced early in the rotation.
- 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.
- Each student must be prepared to present the results of his/her OSBI background check and immunization record to the Preceptor or designated administrative official at the training site.
In addition to this general requirement, however, some sites have specific requirements, as follows:
- Veterans Affairs Medical Center.
- Students who are to complete this clerkship at the Veterans Affairs Medical Center in Tulsa/Muskogee must complete required fingerprinting and VA background checks. Students will normally receive an e-mail to start this process about 60 days before beginning the rotation, but must take responsibility for initiating this process if this e-mail is not received as expected.
- If students have questions or concerns about this, they should feel free to contact Ms. Stacie Williams directly (see section 14.6 for contact information).
- Laureate Psychiatric Clinic and Hospital (St Francis Health System).
- Students who are to complete this clerkship at this site must complete and submit a packet of information. This packet is to contain two completed forms: (1) the Medical Student Check-in Form 2013-14, and (2) the Confidentiality Agreement form. The packet is also to contain a letter of good standing, malpractice insurance verification, a photo ID, and a current TB skin test. Debbie Evans in the OSU-COM Clinical Education Office can supply to students a letter of good standing that includes insurance verification (firstname.lastname@example.org). In addition, please read the Medical Student Information Sheet and the Employee Parking Garage documents for helpful information.
- Students must submit the packet at least two weeks prior to beginning this clerkship so that computer and security access can be arranged by the starting date. This packet should be submitted to Bonnie Fuqua at email@example.com.
- On or before the first day of the rotation (before is desirable), students are to report to the Medical Staff Office to get their ID badge before reporting to a clinical area. Students may not be on a clinical floor without this badge. Students are to be in the company of an attending physician or a resident when in a clinical area. Students may wish to consult the attached map for directions to specified locations in the St. Francis/Laureate site.
- Griffin Memorial Hospital.
- Students who are to complete this clerkship at this site must complete and submit a packet of information. Students should contact Ms. Pam Melton at least a month before the clerkship is to begin. She may be reached by email at firstname.lastname@example.org, or see section 14 below for additional contact information.
Toy, E.C. & Klamen, D. (2009). Case Files: Psychiatry (3rd ed.). New York: McGraw Hill. [This text contains case presentations with Q&As designed to develop clerkship-level clinical reasoning and knowledge in psychiatry.]
Additional reading will be assigned in preparation for the Didactic Day. Specific readings will be announced.
11. Course Evaluations
If a student does not pass the COMAT Exam, he/she must enter a formal remediation process as described by each course coordinator including entering into a mentorship with a designated faculty member in the department. The designated faculty member will direct the student to review specific topics of weakness as identified by their personalized COMAT Exam score sheet. After remediation, the student will be eligible to retake the COMAT Exam. If the student fails the same COMAT Exam a second time, a letter grade of "I" for incomplete will be assigned and the student will be referred to the Academic Standards Committee for a plan of corrective action.
The faculty for this clerkship are as follows:
17. Students with Disabilities