GOALS FOR THE PSCYHIATRY CLERKSHIP

GOALS FOR THE PSCYHIATRY CLERKSHIP GOALS - The aim of the core psychiatry clerkship is to expose students to patients with mental illness and to prepare them to provide psychiatric care at a basic level. By the end of the rotation, students should be proficient at taking a psychiatric history and doing a mental status exam. They should also be able to formulate a biopsychosocial assessment, differential diagnosis, and treatment plan. The clerkship places an emphasis on learning interviewing skills, team collaboration, and respect for psychiatric patients and their disorders. PSYCHIATRY CLERKSHIP OBJECTIVES Psychiatric History and Mental Status Exam By the end of the clerkship, the student will demonstrate the ability to obtain a complete psychiatric history, recognize relevant physical findings, and perform a complete mental status examination. Elicit and clearly record a complete psychiatric history, including the identifying data, chief complaint, history of present illness, past psychiatric history, general medical history, medications (psychiatric and non-psychiatric), substance abuse history, family history, and social history. [PCMC-1] Elicit, describe, and precisely record the components of the mental status examination, including general appearance and behavior, motor activity, speech, mood, affect, thought process, thought content, cognition, judgment, and insight. [PCMC-2] Interviewing Skills By the end of the clerkship, the student will conduct an interview in a manner that facilitates information gathering and formation of a therapeutic alliance. Demonstrate respect, empathy, responsiveness, and concern regardless of the patient's problems or personal characteristics. [ECIS-1] Identify verbal and nonverbal expressions of affect in a patient's responses, and apply this information in assessing and treating the patient. [ECIS-1] Identify strengths and weaknesses in his or her interviewing skills. [CLQI-1] Page 1 of 9

Clinical Reasoning By the end of the clerkship, the student will be able to identify clinical psychiatric symptoms and syndromes, formulate accurate differential and working diagnoses, and develop appropriate assessment and treatment plans for psychiatric patients. Using his or her knowledge of psychopathology, diagnostic criteria, and epidemiology, the student will: Use the five axes of the DSM-IV in evaluating patients. [PCMC-3] Formulate a differential diagnosis for major presenting problems. [PCMC-3] Formulate a biopsychosocial assessment. [PCMC-3] Formulate a treatment plan for major presenting problems. [PCMC-3] Interprofessional Communication By the end of the clerkship, the student will be able to deliver a complete oral presentation about a patient and write both initial and follow-up notes. Deliver oral presentations that are accurate, organized, well-reasoned, and appropriately thorough. [ECIS-3, PCMC-3] Write chart entries that are timely, accurate, organized, well-reasoned, and appropriately thorough. [ECIS-2,PCMC-3] Page 2 of 9

KNOWLEDGE OBJECTIVES KNOWLEDGE OBJECTIVES -At the completion of the 4-week clerkship, the student should be have studied the following material at least ONCE via clinical encounter, didactic sessions, OR through self study from recommended texts. Specific enabling objectives for this area are found later in this document. These objectives are assessed on the Clinical Performance Appraisals, in Seminar, on the Midterm and National Board of Medical Examiners Subject Examination. Psychiatric Emergencies By the end of the clerkship, the student will assess and begin emergency management and referral of a person with psychiatric symptoms. Identify the clinical and demographic factors associated with a statistically increased risk of suicide. [MKS-1f MKS 1d] Conduct a clinical assessment and recommend management for a patient exhibiting suicidal thoughts or behavior. [PCMC-2, MKS 3b) Discuss classes, indications, and associated risks of medications used for management of acutely psychotic, agitated, and combative patients. [MKS- 1e] Conduct an evaluation of decision-making capacity in a medical patient. [PCMC-1] Discuss the indications for psychiatric hospitalization (both voluntary and involuntary). [MKS-3b] Delirium and Dementia By the end of the clerkship, the student will recognize the psychiatric manifestations of delirium and dementia and will describe the evaluation and initial management of these disorders. Discuss the epidemiology, clinical features, differential diagnosis, and evaluation of delirium. [MKS-1f, MKS1d) Discuss the behavioral and pharmacologic treatments of delirious patients. [MKS-1e, MKS-3b] Discuss the epidemiology, clinical features, differential diagnosis, and evaluation of a patient with dementia. [MKS-1f, MKS-1d] Page 3 of 9

Substance-Related Disorders By the end of the clerkship, the student will identify the physical and mental sequelae of substance abuse and dependence, and will describe the evaluation and initial management of these disorders. Obtain and record a thorough history of a patient's substance use through empathic, nonjudgmental, and systematic interviewing. [PCMC-1, ECIS-1] Compare the characteristic clinical features of substance abuse and dependence. [MKS-1d] List the psychiatric and psychosocial complications of alcoholism. [MKS- 1c] Identify the clinical features of intoxication with, and withdrawal from: cocaine, amphetamines, hallucinogens, cannabis, phencyclidine, barbiturates, opiates, caffeine, nicotine, benzodiazepines, and alcohol. [MKS-1e] Describe psychosocial treatments for substance use disorders (e.g. alcoholics anonymous). [MKS-3b] Schizophrenia and other Psychotic Disorders By the end of the clerkship, the student will be familiar with the diagnosis and initial management of the psychotic disorders. Develop and record a differential diagnosis for a person presenting with psychosis. [MKS-1a] Summarize the epidemiology, clinical features, course, and complications of schizophrenia. [MKS-1f, MKS-3a; MKS-3b] Outline the pharmacologic and psychosocial treatments of schizophrenia. [MKS-1e; MKS-3b; MKS-1c] List the features that differentiate delusional disorder, schizophreniform disorder, schizoaffective disorder, and brief psychotic disorder from each other and from schizophrenia. [MKS-3a] Page 4 of 9

Mood Disorders By the end of the clerkship, the student will be familiar with the diagnosis and initial management of major mood disorders. Develop a differential diagnosis for a person presenting with depression. [MKS-3a] Summarize the epidemiology, clinical features, course, and complications of major depressive disorder, dysthymia, bipolar disorder type I, bipolar disorder type II, and cyclothymia. [MKS-1f, MKS-1d] Outline the recommended acute and maintenance treatments for major depressive disorder, bipolar disorders, dysthymia, and cyclothymia. [MKS-1e, MKS-3b] Anxiety Disorders By the end of the clerkship, the student will be familiar with the diagnosis and initial management of the anxiety disorders. Summarize the epidemiology, clinical features, course, and psychiatric comorbidity of panic disorder, social phobia, generalized anxiety disorder, posttraumatic stress disorder, and obsessive-compulsive disorder. [MKS-1f, MKS-1d) List the common general medical and substance-induced causes of anxiety, and assess for these causes in evaluating a person with an anxiety disorder. [MKS-1d, PCMC-1) List the psychotherapeutic and pharmacologic treatments for the major anxiety disorders. [MKS-1e, MKS-3b] Somatoform and Factitious Disorders By the end of the clerkship, the student will be familiar with the diagnosis and initial management of somatoform and factitious disorders. List the clinical characteristics of somatization disorder, conversion disorder, and hypochondriasis. [MKS-1d ] List the characteristic features of factitious disorder and malingering, and compare these with the somatoform disorders. [MKS-1d] Discuss the frequency and importance of physical symptoms as manifestations of psychological distress. [MKS-1d] Discuss difficulties physicians may have in treating patients with these diagnoses. [PASC-1] Page 5 of 9

Personality Disorders By the end of the clerkship, the student will recognize maladaptive traits and interpersonal patterns that typify personality disorders, and discuss strategies for caring for patients with personality disorders. Explain how the DSM-IV defines personality traits and disorders, and identify features common to all personality disorders. [MKS-1d] List the three descriptive groupings (clusters) of personality disorders in the DSM-IV and describe the typical traits of each personality disorder. [MKS-1d] Discuss the management of patients with personality disorders in the general medical setting. [MKS 1e, MKS-3b] Psychopharmacology By the end of the clerkship, the student will be able to select and initiate treatment with common psychotropic medications. Summarize the indications, basic mechanisms of action, common side effects, drug interactions, and toxicities of the following classes of psychotropic medications: antidepressants (including SSRIs, SNRIs, atypical antidepressants, TCAs, MAO-Is); mood stabilizers (including lithium, depakote, carbamezapine, lamotrigine); antipsychotics (first and second generation); benzodiazepines. [MKS-1e] Recognize and explain the typical signs and symptoms of common psychopharmacologic emergencies (e.g., lithium toxicity, neuroleptic malignant syndrome, anticholinergic delirium, monoamine oxidase inhibitor-related hypertensive crisis) and discuss treatment strategies. [MKS-1e, MKS-3b] Electroconvulsive Therapy By the end of the clerkship, the student will be familiar with the current uses of electroconvulsive therapy (ECT). List the indications and contraindications for ECT, as well as the clinical situations in which it may be a treatment of choice. [MKS-1e, MKS-3b] Page 6 of 9

Psychotherapies By the end of the clerkship, the student will understand the principles and techniques of the psychosocial therapies in order to explain psychotherapy to a patient and to make a referral when indicated. State the principles of and common indications for the major forms of psychotherapy (including psychodynamic psychotherapy, supportive psychotherapy, cognitive therapy, group therapy, and couples and family therapy). [MKS-1e, MKS-3b] Define and begin to recognize transference and countertransference. [PASC-1] Child & Adolescent Psychiatry By the end of the clerkship, the student will summarize the unique factors essential to the evaluation of children and adolescents, and will be able to diagnose the common child psychiatric disorders. Compare and contrast the process of psychiatric evaluation of children and adolescents at varying developmental stages with that of adults. [PCMC-1] Generate a differential diagnosis of cognitive and school-related problems in children, including learning disabilities, mental retardation, autism, and the range of pervasive developmental disorders. [MKS-1b, MKS 3a] Summarize the epidemiology, clinical features, co-morbidity, course of illness, and treatment of attention-deficit hyperactivity disorder, oppositional defiant disorder and conduct disorder. [MKS-1c, MKS 1d, MKS 1-f MKS 1-e, MKS-3b] Generate a differential diagnosis of anxiety symptoms in youth. [MKS-3a] Compare and contrast the clinical features of mood disorders in children with that of adults. [MKS-1d] Describe basic clinical features of tic disorders and common comorbidities. [MKS-1d] Describe the basic clinical features of eating disorders in youth. [MKS-1d] Discuss the epidemiology and clinical features of suicide risk in youth. [MKS-1f] Identify the empirically supported treatments for the major psychiatric disorders in youth (e.g. ADHD, mood disorders and anxiety disorders). [MKS-1e] Describe the process for mandated reporting of abuse and/or neglect of youth. [MKS-3b] List the short- and long-term psychiatric sequelae of childhood sexual abuse. [MKS-1c] Page 7 of 9

Critical Appraisal By the end of the clerkship, the student will gather and apply evidence-based literature to improve patient-care and self-learning. Use peer-reviewed literature sources to answer clinical questions pertaining to his or her patients. [CLIQ-3] Ethics By the end of the clerkship, the student will identify and analyze appropriate ethical and legal choices in the treatment of individual patients and their families, as well as in the healthcare system in which the student works. Describe ethical dilemmas encountered on the clerkship, and discuss ways of resolving these dilemmas. [PBMR-1,2] Collaboration By the end of the clerkship, the student will work effectively with other health professionals. Participate as a member of a multidisciplinary patient care team. [SATBC-2a] Demonstrate respect for, and appreciation of, the contributions of others participating in patient care. [SATBC-2b] Page 8 of 9

Professional Behavior By the end of the clerkship, the student will demonstrate maturation in clinical and personal development. Behave with honesty, integrity, dependability, accountability, respect and compassion toward all patients, families, colleagues, and supervisors. [PBMR-3] Behave with accountability and dependability, and maintain a professional appearance. [PBMR-5] Demonstrate comfort, concern, and responsibility in the care of psychiatrically ill persons. [PBMR-3] Respect the privacy and maintain the confidentiality of patients and families. [PBMR-6] Solicit, utilize, and provide constructive criticism. [CLQI-1] Take steps to maintain his/her own mental health, seeking appropriate assistance as needed. [PASC-2] COMMON RESOURCES DIDACTIC LECTURE SERIES KAPLAN AND SADOCK SYNOPSIS OF PSYCHIATRY AVAILABLE VIA THE GALTER LIBRARY PRECEPTOR GROUP SESSIONS PRIMARY CLINICAL TEAMS Page 9 of 9