Psychiatry

Objectives Readings/Assignments Policies Clerkship Sites Evaluations/Assessments Objectives With Competencies
Patient Log Self-Study Topics Clinical Examinatuons Additional Resources Psychiatric Assessment and CAT Guidelines Careers in Psychiatry

Psychiatry - Handbook (PDF)


 

Objectives

I. Knowledge and Life-Long Learning

By the end of the psychiatry clerkship, the student will demonstrate the ability to:

  • organize clinical data from psychiatric interviews and mental status exams to hypothesize reasonable psychiatric diagnoses on all fives axes, with attention to gender and cultural differences
  • develop thorough psychiatric differential diagnoses based upon patients' data
  • recognize these psychiatric illnesses:
    -Major Depression
    -Bipolar Disorder
    -Dysthymia
    -Panic Disorder
    -Generalized Anxiety Disorder
    -PTSD
    -OCD
    -Schizophrenia
    -Schizoaffective Disorder
    -Personality Disorders
    -Substance Use Disorders
    -Cognitive Disorders
    -Somatoform Disorders
    -ADHD
  • describe first line medication treatments and psychotherapy treatments for each of the above disorders
    By the end of psychiatry clerkship, the student will demonstrate understanding of the mechanisms of action, common side effects, potentially catastrophic side effects, and contra-indications for the following psychotropic classes of medication:
  • antidepressants
  • mood stabilizers
  • anxiolytics
  • antipsychotics
  • sleep agents
  • cognitive enhancers
  • stimulants

By the end of psychiatry clerkship, the student will be able to describe both intoxication and withdrawal syndromes for the following categories if substances of abuse:

  • alcohol and other central nervous system depressants
  • opioids
  • sympathomimetics
  • cannabinoids
  • psychadelics
  • dissociate anesthetics
  • steroids
  • nicotine
  • miscellaneous prescription medications

By tho general appearance and activity


-levels of consciousness
-speech characteristics
-orientation
-concentration
-memory
-fund of information
-mood and affect
-perceptual abilities/disturbances
-hallucinations/illusions
-depersonalization/derealization
-thought processes
-obsessions/compulsions
-delusions
-suicidal and homicidal thoughts
-self mutilation thoughts
-abstract thinking
-judgment
-insight
-reality

  • perform acceptable general medical physical examinations
  • perform common screening exams for common psychiatric disorders, i.e., CAGE, MMSE

By the end of the psychiatry clerkship, the student will recognize the indications for lab data, and will 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 test are indicated to check patients' compliance and responses to psychiatric medications
  • inform patients of risks and benefits of obtaining psychiatric laboratory tests.

By the end of the psychiatry clerkship, the student will 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
  • cultural factors
  • spiritual factors
  • patients' strengths
  • patients' weaknesses

By the end of the psychiatry clerkship, the student will 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
  • overdosage
  • demonstrate knowledge about medical and medical-legal interventions
    -psychiatric referrals
    -involuntary commitment
    -judgments of medical incompetence
  • recognize potential risks in general medical patients who have psychiatric disorders

II. Interpersonal and Communication

By the end of the psychiatry clerkship, the student will 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 neutral to gender, age, race, sexual orientation, culture and religion
  • conclude interviews with proper timing and respect

By the end of the psychiatry clerkship, the student will demonstrate the ability to elicit data for a complete psychiatric history, including:

  • chief complaints in patients' own words
  • details for thorough histories of present psychiatric illness:
    -onset of symptoms
    -duration of symptoms
    -time lines of exacerbations and decreases of symptoms
    -actions patients have taken to cope with symptoms
    -impacts of symptoms on patients
    -patients' thoughts about causes for and meanings of symptoms
    -patients' expectations for prognosis
  • details for past general medical histories and psychiatric histories
  • details for psychiatric reviews of systems
  • details for family and social histories
  • details for developmental histories
  • details for substance use histories

By the end of the psychiatry clerkship, the student will demonstrate the ability to develop psychiatric treatment plan with attention to cultural and gender influences, including:

  • indications for treatments for patients with psychiatric disorders
    -types of psychotherapies
    -- individual: psychodynamic, cognitive, behavioral, supportive, interpersonal
    --marital, family, groups
    -medications
    -somatic therapies
    -social interventions
    -economic interventions
    -legal interventions
    --recognize contraindications for specific psychiatric treatments in specific patients
    --inform patients about risks and benefits of psychiatric treatments
    --collect data about compliance with treatments

By the end of the psychiatry clerkship, the student will demonstrate the ability to present coherent, thoughtful presentations of psychiatric patients in both oral and written forms:

  • patients' psychiatric histories
  • mental status examinations data
  • physical examination data
  • lab data
  • five axes of diagnoses
  • differential diagnoses
  • psychiatric formulations
  • treatment plans
    By the end of the psychiatry clerkship, the student will demonstrate the capacity to respond appropriately to constructive feedback given throughout the rotation and, specifically, at mid-rotation evaluations and in the observed interviews.

III. Professionalism

The student will demonstrate professionalism through the ability to:

  • be punctual and attend required events
  • complete patient notes in a timely fashion with legible writing
  • maintain professional boundaries (physical, sexual, financial, and emotional) with patients
  • be truthful about medical data
  • be courteous to patients, patients' families, staff, colleagues, and other health professionals
  • maintain confidentiality regarding patient care
  • demonstrate respect, empathy, responsiveness, and concern regardless of the patient's problems, personal characteristics, or cultural background
  • demonstrate sensitivity to medical student-patient similarities and differences in gender, ethnic background, sexual orientation, socioeconomic status, educational level, political views, and
  • personality traits.
  • demonstrate integrity, responsibility and accountability in the care of assigned patients
  • demonstrate scholarship in the form of contributing to a positive learning environment, collaborating with colleagues, and performing self-assessment and self-directed learning
  • to assess one's strengths, weaknesses and health (physical and emotional), and be willing to seek and accept supervision and constructive feedback

www.psychiatryonline.com/dsmLibrary.aspx
www.psychiatryonline.com/resourceTOC.aspx?resourceID=4
www.psychiatryonline.com/resourceToc.aspx?resourceID=5


 

Policies

Evaluation Policy

This Clinical Clerkship builds upon your education in Biennium I which included courses in human development and psychopathology.

The Clinical Clerkship in Psychiatry 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. Evaluation of clinical skills is by demonstration in working with patients. Acquisition of knowledge is demonstrated by written tests. Both knowledge and skills are demonstrated in program activities and interactions with faculty. The priorities are reflected in the weighting of the grading structure:

Grading Guidelines

 

Clinical:

Inpatient Attending

25%

 

Outpatient Attending

5%

 

Psychiatric Assessment

10%

 

Observed Interview

10%

 

Total

50%

 

 
 

Clinical Exams:

Written Exam

10%

 

Oral Exam

10%

 

Total

20%

 

 
 

Objective Exams:

NBME Subject Exam

25%

 

IRATS

2.5%

 

GRATS

2.50%

 

Total

30%

Scale to be utilized for evaluations with the following percentages assigned:

5-Exceptional

4-Above Average

3-Average

2-Marginal

1-Unacceptable

100%

90%

80%

70%

50% - F

Attending Evaluations

Final evaluations tallied on above 5 point scale, with the percentages assigned as above. Residents also have input into your attending evaluation grades.

Additionally, each student will meet with site attending at the mid-rotation point to discuss progress at the time. Although this is a formative evaluation and not graded, it is required to be turned into the medical student education coordinator. Each student will also meet with the Director of Medical Student Education or her designee at the mid rotation point to discuss progress, personal objectives and any concerns.


 

Clerkship Sites

Good Samaritan Hospital

Important phone numbers
Main Hospital - 278-2612
Mental health unit extension - 4301
Living Room - 4368
Resident office - 4378
Resident pager - 636-0441
Lab - 8320

Attendings
J.J. Schulte, M.D.
C. Michael Hendricks, M.D.

Daily duties
There are three different Psych units on this floor, the PICU, Crisis and the geriatric unit.  Crisis is used for non-acute patients, basically meaning the non-psychotic or non-aggressive.  This leaves the psychotic patients to be placed in the PICU.  There is also the Lifewell program which is an intensive outpatient program used if patients need intensive f/u but do not meet criteria for inpatient status. You may have some patients discharged to this program. Mornings typically start at 7 am or earlier, but you need to arrive with enough time to complete pre-rounding by 8:30 am.  Assign one person in the group to print off the patient list for each day to have available for all members of the team. Pre-rounding consists of reading nursing notes and talking to staff about the overnight activities, checking for medication compliance, and evaluating old patients.  You will also need to complete the work-up for new patients who arrived overnight.  Rounds start at 8:30 am and typically last through the morning. During group rounds, you will first describe how the patient is doing, if they are med compliant and any new issues.  The resident will then add any additional info they think would be helpful.  Make sure to include prn’s given, status of admission symptoms, and SI. Lastly, make sure you know the patient’s diagnosis and medications prior to rounds. Write an admit note on the patients you will be following (1-2 pages front/back max) as they come in. Daily progress notes on all your patients. Write the orders on your patients as they are needed. Your resident or attending will need to cosign. Write any consults that are needed for your patients. Co-signature required as above. Work is completed during the morning and afternoon, and the attendings give lectures, usually on Mondays and Thursdays.  Typically Mondays are very busy and are likely to be longer days.  Remember that all this work is done before lectures start on Tuesdays, so you need to be prepared to work fast and complete before didactics. You are to stay in house until 4:00 P.M. at the earliest.

 

  • Chief Complaint
  • History of Presenting Illnessà more on this below
  • Psychiatric ROS
  • Substance Use Hx
  • Past Psych Hx
  • Family Psych Hx
  • Past Medical Hx
  • Family Medical Hx
  • Medical ROS
  • Physical Examination (all systems must be covered)
  • Mental Status Examination (include any special cognitive testing at the end of this exam)
  • Laboratory and Diagnostic Studies
  • Assessment
  • Diagnoses (all five Axes)
  • Plan

 

The HPI is often the most important part of the presentation. This section needs to contain all relevant information to why the patient is now being admitted. In this section, you may include information that would usually be in other parts of the H&P if it is relevant to why the patient is NOW being admitted. For example, you will typically start with the biographical information along with any past psych diagnoses and admitting symptoms. Ex. This is 25 year old man with a prior history of Schizophrenia admitted with complaints of worsening auditory hallucinations and suicidal ideation. After this, you will document the circumstances and symptoms in detail that brought the patient to the hospital. Include the patient’s prior history, if any, of these admitting symptoms including if these symptoms have led to past hospitalities or suicidal ideation. Also include any prior successful/unsuccessful treatments for these symptoms. Next, include any active substance issues, pertinent lab work or pertinent medical problems that can contribute to their admission. Often the last part of the HPI in the current status of suicidal ideation, homicidal ideation and psychotic symptoms (typically auditory or visual hallucinations). 

 

  • Date of admission
  • Date of discharge
  • Discharge to __________
  • Discharge condition ___________
  • Discharge diagnoses (all five Axes)
  • Discharge medications (include names of meds, number of samples given, number provided for on prescription)

Discharge plans (follow-up plans, instructions “Patient instructed to abstain from nicotine, alcohol, and all illicit substance; to take all medication as prescribed, to stop taking _____________, and to keep all follow-up appointments.”

 


Miami Valley Hospital

Miami Valley Phone Directory

Main Line 208-8000
Psych Floor 208-2031(N), 208-2032(S)
Psych outpatient 208-2732

Attendings:
Douglas Songer, M.D.
Jamie Chu, M.D.

General Info

The Psychiatry floor is entered using the tower elevators.  It is on the seventh floor.  There are three different Psych units on this floor, 7South, 7North and the geriatric unit.  7 North is used for non-acute patients, basically meaning the non-psychotic or non-aggressive.  This leaves the psychotic patients to be placed on 7 South. Follow-up appt are made by the care coordinator and patients can not be discharged without them.   If your patient needs a follow-up appointment for something other than psych, tell the care coordinator what physician they need an appointment with, when and why as soon as you can. There will usually be a second year consult service resident. They will perform almost all consults (except on the weekends) and work with the intensive outpatient program and dual diagnosis group. The intensive outpatient program is used if patients need intensive f/u but do not meet criteria for inpatient status. The dual diagnosis program is for patients with a primary psych diagnosis and a substance abuse disease.  Both programs are located at Elizabeth Place on the first floor of the East Medical Plaza.  The groups run from 9-12 three times per week.  Every patient that is admitted by one of our attendings (Dr. Chu or Dr. Songer) must to be seen by a resident every day.  This will most likely be the consult resident.
The resident on call is in charge of rounding on the weekends.  Have all patients seen by the time the attending arrives (this excludes any new admissions from over night).  New admissions can be seen after rounds.  The resident will need to call and staff each of these patients with the attending.  Residents are also in charge of seeing all new and old consults on the weekends. 

Rotation Rules

  1. *NEVER arrive late for rounds-they start at 8AM*, in the large group room on the south side. Pre-round on your patients before group rounds. The attending will physically round on patients the day of admission, discharge and if you have a concern.  Dr. Chu and Dr. Songer switch as inpatient attending roughly every two weeks.

  2. During group rounds, you will first describe how the patient is doing, if they are med compliant and any new issues.  The resident will then add any additional info they think would be helpful.  Make sure to include prn’s given, status of admission symptoms, and SI. Lastly, make sure you know the patient’s diagnosis and medications prior to rounds.

  3. Write an admit note on the patients you will be following (1-2 pages front/back max) as they come in. Daily progress notes on all your patients. Write the orders on your patients as they are needed. Your resident or attending will need to cosign. Write any consults that are needed for your patients. Co-signature required as above.

  4. Try to attend all your patient’s family meetings.  The social worker will run them.  Make sure a social worker/resident is available before scheduling a meeting.

  5. Patient’s arriving to the unit by 4:00 PM need to be seen that day.  The exceptions are: Tuesdays the cut off is 11:00 AM and weekends the cut off is 11:00 AM.

  6. If there are patient’s transferring to the psych unit, it is often helpful to complete the work up before they get to the psych unit

  7. Duty day ends at 4:00, but only if all work is completedDo not leave before then

To do for new admissions prior to presenting the patient:

  • Read/Obtain the pink slip prior to presentation if there is one (so you know why the patient was brought in)
  • Read/Obtain information on social work sheet if there is one utilized at your site
  • Read/Obtain information about the patients behavior in the ED including any medication used, statements they made or if they had to be restrained
  • Read/Obtain information about the patient’s behavior once they were on the unit including any medication used, statements they made or if they had to be restrained
  • Gather collateral information about the patient from relevant sources (discuss this with your resident) after obtaining consent.
  • Present the above to your resident

 

Admit Note Format-(1-2 pages front/back max)

  • Chief Complaint
  • History of Presenting Illnessà more on this below
  • Psychiatric ROS
  • Substance Use Hx
  • Past Psych Hx
  • Family Psych Hx
  • Past Medical Hx
  • Family Medical Hx
  • Medical ROS
  • Physical Examination (all systems must be covered)
  • Mental Status Examination (include any special cognitive testing at the end of this exam)
  • Laboratory and Diagnostic Studies
  • Assessment
  • Diagnoses (all five Axes)
  • Plan

Writing the HPI:

The HPI is often the most important part of the presentation. This section needs to contain all relevant information to why the patient is now being admitted. In this section, you may include information that would usually be in other parts of the H&P if it is relevant to why the patient is NOW being admitted. For example, you will typically start with the biographical information along with any past psych diagnoses and admitting symptoms. Ex. This is 25 year old man with a prior history of Schizophrenia admitted with complaints of worsening auditory hallucinations and suicidal ideation. After this, you will document the circumstances and symptoms in detail that brought the patient to the hospital. Include the patient’s prior history, if any, of these admitting symptoms including if these symptoms have led to past hospitalities or suicidal ideation. Also include any prior successful/unsuccessful treatments for these symptoms. Next, include any active substance issues, pertinent lab work or pertinent medical problems that can contribute to their admission. Often the last part of the HPI in the current status of suicidal ideation, homicidal ideation and psychotic symptoms (typically auditory or visual hallucinations). 

 

  • Date of admission
  • Date of discharge
  • Discharge to __________
  • Discharge condition ___________
  • Discharge diagnoses (all five Axes)
  • Discharge medications (include names of meds, number of samples given, number provided for on prescription)

Discharge plans (follow-up plans, instructions “Patient instructed to abstain from nicotine, alcohol, and all illicit substance; to take all medication as prescribed, to stop taking _____________, and to keep all follow-up appointments.”


DAYTON VA MEDICAL CENTER

Important phone numbers
Main Hospital – 268-6511
Inpatient Psychiatry Unit – 3748, 3730
Administrative support office - 2167
Resident offices – 2678, 2008

Attendings
R. D. Sanders, M.D.
P. R. Schwartz, M.D.

Daily duties
DVA operates a 26‑bed acute inpatient psychiatry unit (7S) that offers a program of therapeutic activities by a multidisciplinary team. Inpatient psychiatry comprises most of the clinical experience in this rotation.
Students are assigned to one of two attending psychiatrists, each with one assigned psychiatry resident. In addition to treating inpatients, students may participate in emergency department consults or geriatric psychiatric consults. One afternoon per week is spent in an outpatient psychiatric clinic with another attending psychiatrist. Students will have occasional follow-up visits with their patients after discharge, in an outpatient or residential treatment setting.
Arrive by 8:00 am. You will be provided a list of patients on your team. Morning report starts at 8:15 am, and lasts to around 9:00. Didactics and/or discussions are from 9:00 to 9:30. The rest of the day is primarily clinical. Clinical rounds start at 9:30 am and last most of the day. At noon on Thursdays and many Wednesdays are educational programs at the VA. You will be assigned up to 6 patients. Your primary jobs will be to know each patient well, to meet with each daily, to write clinical notes on each daily. Daily notes should include any changes in symptoms (with particular attention to potentially life-threatening symptoms), any unscheduled (PRN) medications given, any actual or contemplated changes in treatment plan, in addition to diagnoses and medications. You will write admit notes on your patients on your first day of contact. Stay aware of afternoon activities (didactics on Tuesdays and outpatient clinic one other day), so that you can have your work done in time. Stay in house until at least 4:30 each day, excepting Tuesdays or with permission of your attending.

Format for written or reported case histories

 

 2008-2009 PSYCHIATRY RESIDENTS PAGER NUMBERS

R-1 RESIDENTS

 

    • Chief Complaint
    • History of Presenting Illness (why now?)
    • Psychiatric ROS
    • Substance Use Hx
    • Past Psych Hx (inc past suicidal/violent behavior, past treatments and impact)
    • Past Medical Hx (focus on hx of potential psychiatric relevance)
    • Family Hx (focus on neuropsychiatric)
    • Medical ROS
    • Physical Examination  (focus on neurologic)
    • Mental Status Examination (include any cognitive testing)
    • Laboratory and Diagnostic Studies
    • Assessment (what is the problem now?)
    • Diagnoses (what diagnoses apply? -all five Axes)
    • Plan (don’t be afraid to think independently)
    • ALBRECHT, BENJAMIN, D.O. - 463-6787
    • ANKLESARIA, ARIZ, D.O. - 463-6952
    • BAULA, MARVIN, M.D. - 463-7506
    • BELEN, THERESA, M.D. - 463-7507
    • *JOO, HYON, M.D. - 463-7508
    • KOOL, RITESH, M.D. - 463-7509
    • *JAMES, TRENTON, M.D. - 463-7851
    • *SLUSHER, CORINNE, M.D. - 463-8236
    • *ZEOLA, MICHAEL, M.D. - 463-9280

      R-2 RESIDENTS
    • BALASKO, BRIDGETTE, M.D. - 341-0003
    • COLLISON, JASON, M.D. - 341-0004
    • GAINER, DANIELLE, M.D. - 341-0536
    • *LEASURE, WILLIAM, M.D. - 341-1118
    • *MANETTA, CHRISTOPHER, D.O. - 341-1119
    • MAST, RYAN, D.O. - 341-1127
    • *McKINLAY, MICHELLE, D.O. - 341-1129
    • SCHMITT, LIZ, M.D. - 341-1132
    • *SHIDELER, MARK, M.D. 341-1133
    • *STRINGER, SARAH, M.D. - 341-1134

      R-3 RESIDENTS
    • *COLES, JOSEPH, M.D. - 463-6041
    • COWAN, ALLISON, M.D. - 463-6069
    • *FOLEY, GRETCHEN, M.D. - 463-6071
    • IGNATOWSKI, MICHAEL, D.O. - 463-6084
    • JACOBS, LIESL, M.D. - 463-6113
    • *JENSEN, JEREMY, M.D. - 463-6118
    • *JOHNSON, ASHLEY, D.O. - 463-6119
    • LAWVER, TIMOTHY, D.O. - 463-6121
    • RATLIFF, CARL, D.O. - 463-6122
    • SMITH, ANDREW, M.D. - 463-6123
       
      R-4 RESIDENTS
    • *BLACK, ERIC, M.D. - 463-6009
    • * BRODERICK, PAMELA, M.D. - 463-6046
    • *GOODWYN, ERIK, M.D. - 463-6082
    • *REES, ANDREW, M.D. - 463-6085                           
    • SARANGA, VINAY, M.D. - 463-6086                                   
    • SOMUSETTY, PAVAN, M.B.B.S. - 463-6089           
    • THOMAS, JERRY, M.D. - 463-6096
       
      CHILD FELLOW –R-4
    • *FIERROS, MELINDA, M.D. - 463-6076
    • HART, DAVID, M.D. - 341-1120
    • KHAVARI, REZA, M.D. - 341-1143
       
      CHILD FELLOW – R-5
    • BLANKENSHIP, KELLY, D.O. - 341-1201
    • HUD-ALEEM, RAUSHANAH, D.O. - 341-1190


      (*  = MILITARY RESIDENTS) ON-CALL PAGER: 341-1138
      CRISIS CARE: 224-4646

 

Evaluations/Assessments

From

Evaluation Name

File Download

 

Observed Interview Assessment Eval

PDF

 

Mid Rotation Eval

PDF

 

Oral Exam (OSCE)

PDF

 

Written Exam

PDF

Professional Attitudes and Behavior

If there are any breeches of professional conduct in patient care, professional boundaries, attendance problems or major problems in team rapport, failure in the clerkship may be a possibility.  If passing grades are not obtained in the category of professionalism, a failure will be issued for the clerkship.

NBME Psychiatry Subject Exam

 

A grade of the equivalent of 66.56% (Raw Subject Test score of 62) must be received on the NBME Psychiatry Subject Exam in order to receive a passing grade for the course.  This equates to the 5th percentile nationally for all medical students.

If a failing grade is received, the student will receive an incomplete for the clerkship.  One retake of the NBME subject exam will be allowed, to be made up in one of the next 3 offerings during the psychiatry clerkship preferably, and certainly no later than the end of the academic year in accordance with School of Medicine policy.

Upon passing the exam, the grade will be computed based upon all of the components, with an averaging of the two NBME subject exam scores for the final NBME grade.  If a 2nd failure of the NBME occurs, a failing grade will be issued for the clerkship.

Course Grade

Final passing grade for the course must be 70% or better, and MUST include passing grade in clinical performance and professionalism, as well as passing written/oral final exams and the NBME subject exam.

Grading will follow SOM policy, with a pass or fail and the final percentage grade.

Appeal of a Course Grade and/or Written Evaluation
Appeal to the Course/Clerkship Director
The first level of appeal of a course grade and/or written evaluation is to the clerkship director. The appeal must be submitted and received within 60 days of the grade distribution. If the course/clerkship director determines that there is reason to change the grade or written evaluation, he/she will inform the Office of Student Affairs of the change. If the course/clerkship director does not believe there is sufficient reason to change the grade/written evaluation, he/she will inform the student in writing that the grade/written evaluation stands. In the Psychiatry clerkship, student appeals may be considered by the clerkship committee.

Student Clerk Assessment      

At the end of the clerkship, each student will evaluate the overall experience, the attending and residents on the RMS website.


 

Objectives With Competencies

Boonshoft School of Medicine Psychiatry Clerkship Objectives

Adapted from the Association of Directors of Medical Student Education in Psychiatry
July 11, 2007

The objectives listed are comprehensive, yet achievable during the psychiatry rotation.

Following each objective is the expectation for level of competence or achievement, using the following descriptions:
Knows – K (can state)
Shows – S (discuss application)
Shows How – SH (application under simulation)
Does – D (perform under actual conditions)
Adapted from MillerGE (Acad Med 1990; 65:S63-7) for the Clinical Curriculum Resource Guide for Psychiatry Education
The instructional methods utilized to achieve these stated goals include extensive clinical teaching and clinical experiences.  Additionally, performance feedback, departmental conferences, lectures, discussions and team-based learning sessions are utilized.  Individual projects may also be assigned.

After each competence level expected are numbers corresponding to the assessment methodsutilized corresponding to the ACGME glossary of assessment methods found at the end of these objectives.

Clinical Skills

History-Taking, Examination and Medical Interviewing

Rationale:  To evaluate and care for any patient, the clinician must be skillful with developmentally and culturally appropriate communication methods in obtaining relevant historical information and performing a complete examination.  Although the comprehensiveness of an examination may vary based on the situation, physicians should be able to perform a mental status exam and accurately describe the findings.For effective history taking and patient evaluation, a clinician must have an understanding, ability, and self-awareness to flexibly use a range of empathic interviewing techniques with patients a) across the lifespan including children, adolescents, adults, and the elderly; b) across cultures; and c) with persons afflicted with mental illness or experiencing considerable distress.

By completion of the clerkship the student will be able to:

  1. Elicit and accurately document a complete psychiatric history, including the identifying data, chief complaint, and history of the present illness, past psychiatric history, medications (psychotropic and non-psychotropic), general medical history, review of systems, substance use history, family history, and personal and social history. D—1,2

  2. Perform an appropriate physical exam on patients with presumed psychiatric disorders and:   a)  Recognize and discuss bodily signs and symptoms that accompany classic psychiatric disorders (e.g., tachycardia and hyperventilation in panic disorder); b) Discuss the extent to which a general medical illness may contribute to the signs and symptoms of a psychiatric disorder; c) Recognize and discuss the possible manifestations of psychotropic drugs e.g., medications and drugs of abuse) in the physical exam. D—1,2

  3. Recognize the importance of, and be able to obtain and interpret, historical data from multiple sources including family members, community mental health resources, primary care providers, family clergy, old records, child’s teachers, primary care physician, etc. D—1,2

  4. Perform and accurately describe the components of the comprehensive Mental Status Examination (e.g., including general appearance and behavior, motor activity, speech, affect, mood, thought processes, thought content, perception, sensorium and cognition, abstraction, intellect, judgment, and insight.  Describe variations in presentation according to age, stage of development and cultural background.  D—1,2, 12

  5. Describe common abnormalities, and their causes, for each component of the Mental Status Exam.  D—1,2

  6. Perform common screening exams for common psychiatric disorders (e.g., CAGE, MMSE, etc.).  D—1,2

  7. Discuss and use basic strategies for engaging and putting patients at ease in challenging interviews (e.g., with patients who are disorganized, cognitively impaired, hostile/resistant, mistrustful, circumstantial/hyperverbal, unspontaneous/hypoverbal, potentially assaultive; when being assisted by an interpreter).  Describe different interviewing techniques for different ages.  D—1,2

  8. Demonstrate an effective repertoire of interviewing skills including: appropriate initiation of the interview; establishing rapport; the appropriate use of open-ended and closed questions; techniques for asking "difficult" questions; the appropriate use of facilitation, empathy, clarification, confrontation, reassurance, silence, summary statements; soliciting and acknowledging expression of the patient's ideas, concerns, questions, and feelings about their illness and its treatment; communicating information to patients in a clear fashion; appropriate closure of the interview; and be able to perform these basic interviewing skills in performing a family assessment.  D—1,2

  9. Discuss and avoid the common pitfalls in interviewing technique including: interrupting the patient unnecessarily; asking long, complex questions; using jargon; asking questions in a manner suggesting the desired answer; asking questions in an interrogatory manner; ignoring patient verbal or nonverbal cues; making sudden inappropriate changes in topic; indicating patronizing or judgmental attitudes by verbal or nonverbal cues.  D—1,2

  10. Identify strengths and weaknesses in personal interviewing skills and discuss with a        colleague or supervisor.  D—1,2

Documentation and Communication
Rationale:  Regardless of the clinical specialty, a physician must be able to properly document clinical findings, diagnostic impressions, and clinical reasoning.  The physician must be able to communicate clearly and concisely to other professionals and to patients and their families, in both written and oral formats.  These skills are particularly important for communicating about psychiatric disorders where obvious laboratory or physical findings may not be present.

By completion of the clerkship the student will be able to:

  1. Accurately document a complete psychiatric history and appropriate examination and accurately record and communicate the components of a comprehensive mental status examination.  D—1,2, 12, 18

  2. Accurately document the daily or periodic progress of patients’ psychiatric disorders recording mental status changes and diagnostic impressions.  D—1,2, 18

  3. Provide a clear and concise oral presentation of a) a complete psychiatric evaluation including relevant history, mental status findings and diagnostic impressions, and b) the daily or periodic progress of patients being treated for psychiatric disorders.  D—1,2, 12

  4. Communicate clinical impressions, treatment recommendations including risks and benefits, and other relevant education to assigned patients and their families.  D—1,2

  5. Document assessment of patient’s degree of risk to self and others D—1,2, 18

Clinical Reasoning and Differential Diagnosis

Rationale:  Accurately identifying a patient’s problems and the relevant signs and symptoms is basic to establishing a diagnosis in any field of medicine.  In psychiatry patients may lack insight to the problems they are having and insist that nothing is wrong.  Hence, to be skillful at discerning signs and symptoms of psychiatric disorders the physician must have a heightened level of suspicion, be knowledgeable about symptom clusters that are suggestive of specific disorders, and be able to formulate reasonable diagnostic hypotheses with plans for further evaluation.  To be successful, the physician must also be able to incorporate knowledge about the range of normal behaviors at various ages and stages of development.

By the end of the clerkship students will be able to:

  1. Use the DSM-IV to identify signs and symptoms that comprise specific syndromes or disorders and construct diagnoses using the five axes system.  D—1,2,  12, 18

  2. Formulate a differential diagnosis and plan for assessment of common presenting signs and symptoms of psychiatric disorders (e.g., insomnia, behavioral dyscontrol, confusion, hallucinations, delusions, etc.)  D—1,2, 12, 18

  3. Discuss the indications for, how to order, and the limitations of common medical tests for evaluating patients with psychiatric symptoms (e.g., laboratory, imaging, projective and objective psychological tests, etc.)  D—1

  4. Interpret basic test results and consultant reports relevant to working through a differential diagnosis of designated patients.  D—1

  5. Assess, record and interpret mental status changes of designated patients, and alter diagnostic hypotheses and management recommendations in response to these changes. D—1, 18

Assessment of Psychiatric Emergencies

Rationale:  Psychiatric emergencies may occur in any clinical or non-clinical setting and are life threatening.  An effective physician must be able to recognize potential psychiatric emergencies and initiate an intervention.  Although suicide is the most common psychiatric emergency the list of emergent conditions is lengthy and diverse ranging from suicidality and homicidality, to catatonia, intoxication, delirium, and severe drug reactions.  It is important for physicians to be able to perform risk assessments, evaluate patients with altered mental status or behavioral dyscontrol, and recognize signs of potential assaultive behavior.

By completion of the clerkship the student will be able to:

  1. Identify and discuss risk factors for suicide across the lifespan.  K—1, 13, 14

  2. Conduct diagnostic and risk assessments of a patient with suicidal thoughts or behavior and make recommendations for further evaluation and management.  D—1,2

  3. Identify and discuss risk factors for violence and assaultive behavior.   S—1,2, 13, 14

  4. Discuss signs of escalating violence and review the appropriate safety precautions and interventions.  K—1

  5. Discuss the differential diagnosis and conduct of a clinical assessment of a patient with potential or active violent behavior and make recommendations for further evaluation and management.  K—1

  6. Discuss the clinical assessment and differential diagnosis of a patient presenting with psychotic symptoms such as perceptual disturbance, bizarre ideation and thought disorder, and make recommendations for further evaluation and management.  D—1,2

  7. Discuss the clinical assessment and differential diagnosis of a patient with impaired attention, altered consciousness and/or other cognitive abnormalities and make recommendations for further evaluation and management.  K—1

  8. Analyze risk factors and make recommendations for psychiatric hospitalization versus an ambulatory disposition in the management of designated patients. S—1,2

Psychopathology and Psychiatric Disorders
The typical signs and symptoms of common psychiatric disorders as outlined below should be learned and understood at each phase of the life cycle (i.e., children, adolescent, adult, and geriatric populations).  The clerkship learning experiences should build on an established understanding of basic principles of neurobiology and psychopathology derived from the pre-clerkship curriculum.

Cognitive Disorders
Rationale:  Cognitive impairment is a presenting sign or symptom for many medical conditions.  Regardless of medical specialty, a physician should be able to make an initial assessment of cognition with attention to possible emergent underlying conditions, be familiar with the common causes of cognitive impairment, and proceed with or refer patients for further evaluation and management.

By completion of the clerkship the student will be able to:

  1. Differentiate and discuss the cognitive, emotional and behavioral manifestations of common Cognitive Disorders including Delirium and Dementia syndromes. K—1,2, 13, 14

  1. Perform cognitive assessments to evaluate new patients and monitor patients with identified cognitive impairment, and discuss challenges to assessment related to the patient’s cultural background and developmental level.  D—1,2

  2. Recognize the prevalence of Delirium in various clinical settings and across the lifespan, and discuss the clinical features and differential diagnosis of the delirious patient with recommendations for evaluation and management.  K—1, 13

  3. Differentiate the clinical features and course of the common types of Dementia including Alzheimer’s, Vascular, Lewy Body and those syndromes caused by other neurodegenerative and infectious diseases (e.g., Parkinson’s, HIV infection, Huntington’s, Pick’s, Creutzfeldt-Jakob, etc.)  K--13

Substance Use Disorders
Rationale:  Substance use disorders are prevalent among patients in all clinical settings.  There is a particularly high co-morbidity between substance use disorders and other psychiatric disorders and medical conditions, which has a negative affect on clinical course and prognosis.  Regardless of medical specialty the clinician should be able to recognize signs and symptoms of possible Substance Use Disorders, make initial assessment with attention to possible underlying emergent conditions (e.g., withdrawal delirium), and proceed with or refer the patient for further evaluation and management.

By completion of the clerkship the student will be able to:

  1. Obtain a thorough substance use history through the use of empathic, nonjudgmental interviewing techniques and established screening instruments (e.g., CAGE), accounting for the patient’s developmental stage and cultural background, and obtain information from collateral sources.  D—1,2, 12

  2. Compare and contrast diagnostic criteria for substance abuse versus dependence. S—1,2, 13, 14

  1. Know the clinical features of intoxication with cocaine, amphetamines, hallucinogens, cannabis, phencyclidine, barbiturates, opiates, caffeine, nicotine, benzodiazepines, alcohol and anabolic steroids.  K—1, 13, 14

  2. Recognize the clinical signs and recommend management strategies for substance withdrawal from sedative hypnotics including alcohol, benzodiazepines and barbiturates. S—1, 13, 14

  3. Discuss the epidemiology, course of illness, and the medical and psychosocial complications of common substance use disorders.  K—1, 13

  4. Discuss management strategies for substance abuse and dependence including 12-step programs, support groups (AA, NA, Alanon), pharmacotherapy, rehabilitation programs, and family support.  SH—1

Psychotic Disorders

Rationale:  Patients with symptoms of psychosis can present in any clinical setting.  By their very nature the signs and symptoms of psychosis are often associated with impaired insight, considerable distress for the patient and their families, and the potential to evolve into an emergent, life-threatening situation.  Regardless of medical specialty, clinicians should be able to recognize the signs and symptoms of possible Psychotic Disorders, make initial assessment with attention to possible emergent underlying conditions, and proceed with or refer for further evaluation and management.

By completion of the clerkship the student will be able to:

  1. Define the term psychosis and be able to discuss the clinical manifestations and presentation of patients with psychotic symptoms.  D—1, 13, 14

  2. Recognize that psychosis is a syndrome and discuss the broad differential diagnosis, including both primary psychiatric as well as other types of medical conditions, which necessitates a thorough medical evaluation for all patients presenting with signs and symptoms of psychosis.  D—1

  3. Develop a differential diagnosis and plan for further evaluation of patients presenting with signs and symptoms of psychosis.  D—1,2

  4. Compare and contrast the clinical presentation of psychotic disorders in children and adolescents, adults, the elderly, patients in a general medical practice setting, the developmentally disabled, and accounting for cultural diversity.  K—1

  5. Compare and contrast the clinical features and course of common psychiatric disorders that present with associated psychotic features.  K—1

  6. Discuss epidemiology, clinical course, prodromal stages, subtypes, and the positive, negative and cognitive symptoms of Schizophrenia.  K—1, 13, 14

  7. Recommend management of patients with Schizophrenia and other psychotic disorders including all relevant interventions.  D—1, 18

  8. Discuss the theories of etiology and pathophysiology of Schizophrenia and other psychotic disorders.  SH—2, 13, 14

Mood Disorders
Rationale:  Mood Disorders are prevalent, serious and highly treatable conditions encountered in all clinical settings.  Although sometimes difficult to diagnose, unrecognized and untreated mood disorders are associated with considerable morbidity and mortality.  A physician should be able to recognize signs and symptoms of possible Mood Disorders, make initial assessment with attention to possible emergent underlying conditions and risk of suicidal and/or homicidal behavior, and proceed with or refer for further evaluation and management.

By completion of the clerkship the student will be able to:

 

  1. Discuss the epidemiology of mood disorders with special emphasis on the prevalence of depression in the general population and in non-psychiatric clinical settings among patients with other medical-surgical illness (e.g., cardiovascular disease, cancer, neurological conditions) and the impact of depression on the morbidity and mortality of other medical-surgical illness.  K—1, 13, 14

  2. Compare and contrast the features of unipolar and bipolar mood disorders with regard to clinical course, comorbidity, family history, prognosis and associated complications (e.g., suicide).  K—1,2

  3. Discuss the differential diagnosis for patients presenting with signs and symptoms of mood disturbance, including primary mood disorders (e.g., Bereavement, Major Depressive Disorder, Adjustment Disorder, etc.) and mood disorders secondary to other conditions (e.g., substance use, underlying  medical-surgical illness) with regard to clinical course, comorbidity, family history, prognosis, associated complications (e.g., suicide), and plan for further evaluation.  D—1,2, 12

  4. Discuss the subtypes of primary mood disorders including melancholic versus atypical features, with psychotic features, seasonal pattern, and postpartum onset.  K—13, 14

  5. Compare and contrast the clinical presentation of mood disorders in children and adolescents, adults, the elderly, patients in a general medical practice setting, the developmentally disabled, and across cultures.  K—13, 14

  6. Discuss the high risk of suicide in patients with mood disorders, risk assessment and management strategies.  D—1, 2

  7. Recommend management of patients with primary or secondary mood disorders including all relevant interventions.  D—1,2, 12, 18

  8. Discuss the theories of etiology and pathophysiology of mood disorders.  SH—13, 14

Anxiety Disorders
Rationale:  Anxiety Disorders are considered one of the most prevalent classes of psychiatric disorders and as such are likely to be encountered in all clinical settings. It is important for clinicians not only to recognize signs and symptoms of anxiety but also to be familiar with the diagnostic criteria for various anxiety disorders, be able to make an initial assessment with some precision and with attention to possible emergent underlying conditions, and proceed with or refer the patient for further evaluation and management.

By completion of the clerkship the student will be able to:

  1. Discuss the epidemiology of anxiety disorders with special emphasis on the prevalence of anxiety in the general population and in non-psychiatric clinical settings and effect on total health care expenditures in the U.S.  K—13. 14

  2. Discuss the differential diagnosis for patients presenting with anxiety, including primary anxiety disorders (e.g., Phobias, Panic Disorder, Adjustment Disorder, etc.) and anxiety disorders secondary to other conditions (e.g., substance use, underlying medical-surgical illness) with regard to developmental stage, developmental disability, cultural diversity, medical practice setting, clinical course, comorbidity, family history, prognosis, associated complications, and plan for further evaluation.  K—13. 14

  3. Discuss the epidemiology and distinguish the clinical course, co-morbidity, family history and prognosis of Obsessive Compulsive Disorder relative to other anxiety disorders.  K—13. 14

  4. Discuss the epidemiology and distinguish the clinical course, co-morbidity, family history and prognosis of Acute and Post-traumatic Stress Disorders relative to other anxiety disorders.  K—1, 13, 14

  5. Recommend management of patients with primary or secondary anxiety disorders including all relevant interventions (e.g., relaxation, exposure-response prevention and other psychotherapies; psychopharmacology, etc.  D—1,2, 18

  6. Discuss the theories of etiology and pathophysiology of anxiety disorders.  K—13, 14

Somatoform Disorders, Factitious Disorder and Malingering

Rationale:  By their very nature, Somatoform Disorders frequently present in non-psychiatric settings.  If the physician does not have an understanding of Somatoform Disorders, patients with these conditions are likely to be misdiagnosed, receive unnecessary treatments or become a focus of hostility.  All physicians should be able to recognize signs and symptoms of possible Somatoform Disorders, Factitious Disorder and Malingering, make initial assessment with attention to actual underlying pathology, and proceed with or refer patients for further evaluation and management.

By completion of the clerkship the student will be able to:

  1. Compare and contrast the signs, symptoms, clinical characteristics and course, and prognosis of specific Somatoform Disorders including Somatization Disorder,  Conversion Disorder, Pain Disorder, Body Dysmorphic Disorder, and Hypochondriasis. K—13, 14

  2. Compare and contrast the characteristic features of Factitious Disorder and Malingering and distinguish these conditions from the Somatoform Disorders.  K—13, 14

  3. Discuss the principles and challenges to physicians of ongoing evaluation and management of patients with Somatoform Disorders, Factitious Disorder and Malingering.  K—1

Dissociative and Amnestic Disorders

Rationale:  Persons who experience trauma and patients with personality disorders may suffer dissociative symptoms.  These persons may present in any clinical setting.  Despite the disability associated with dissociative disorders they may go undetected and untreated.  All physicians should be able to recognize signs and symptoms suggestive of a dissociative disorder and refer patients for further evaluation and treatment.

By completion of the clerkship the student will be able to:

  1. Define “dissociation”.  K—13

  2. Discuss the hypothesized role of psychological trauma in the development of disorders characterized by dissociation and altered memory (e.g., Acute Stress Disorder, PTSD, Borderline Personality, Dissociative Identity Disorder).  K—1

Eating Disorders
Rationale:  Eating Disorders are potentially life-threatening conditions.  These conditions occur across the life span and despite their prevalence may go undetected and unaddressed.  Patients with eating disorders may present in any clinical setting.  Hence, all physicians should be able to recognize the signs and symptoms suggestive of an eating disorder and refer patients for further evaluation and treatment.

By completion of the clerkship the student will be able to:

  1. Discuss the clinical features, course, complications including mortality, and prognosis of common Eating Disorders (e.g., Anorexia Nervosa, Bulimia, and Obesity).  K—13, 14

  2. Propose plans for further evaluation, referral, and management, including discussion of clinical features suggesting the need for hospitalization of patients with possible Eating Disorders. K—13, 14

Sexual Disorders
Rationale:  Sexual Disorders are diverse and prevalent.  Patients with sexual disorders may present in any clinical setting.  Despite the considerable morbidity associated with sexual disorders, they may go undetected because of their sensitive nature.  All physicians should be able to obtain an accurate sexual history, recognize signs and symptoms suggestive of sexual disorders, and refer patients for further evaluation and treatment.

By completion of the clerkship the student will be able to:

  1. Obtain and document a sexual history and interpret findings to formulate a differential diagnosis accounting for patient age, developmental stage, and cultural background.  D--2

Sleep Disorders

Rationale:  Sleep Disorders are prevalent, treatable conditions associated with considerable morbidity.  Persons with sleep disorders may present in any clinical setting.  Hence all physicians should be able to obtain an accurate sleep history, recognize signs of sleep disorders, and recommend management or referral for further evaluation and management.

By completion of the clerkship the student will be able to:

  1. Discuss the signs and symptoms of common sleep disturbances that accompany psychiatric disorders and substance use including dyssomnias and parasomnias.  K--13

  2. Review the effects of common psychotropic medications on sleep and discuss basic recommendations for sleep hygiene.  D--1

Personality Disorders

Rationale:  Personality Disorders are highly prevalent, chronic conditions.  Patients with personality disorders present in all clinical settings and by virtue of their personality disorders are often particularly challenging and frustrating for the treating physician.  Unrecognized or unaddressed personality disorders can complicate the course of any medical condition and lead to unsatisfactory outcomes.  Hence all physicians should be able to recognize signs and symptoms suggestive of personality disorders, be alert to how these disorders may complicate treatment efforts, and be able to refer patients for further evaluation and treatment.

By completion of the clerkship the student will be able to:

  1. Discuss the concepts and relevance of personality traits and disorders in providing patient care.  K—1. 2. 12

  2. Discuss the three cluster conceptualization of personality disorders as outlined in the DSM-IV-TR and describe typical features of each disorder.  K—1, 13, 14  

  3. Recognize and discuss common clinical features and maladaptive behaviors suggestive of a personality disorder and make recommendations for further evaluation, referral, and management.  D—1, 18

  4. Summarize the principles of management of patients with personality disorders in any clinical setting, particularly those with the most challenging behaviors (i.e., Borderline and Antisocial), including self-awareness of one’s own response to the patient, the benefit of outside consultations, the use of both support and non-punitive limit setting, and the indications for various forms of psychotherapy.  K--1

Disorders in Childhood and Adolescence
 Many psychiatric disorders are first manifested or diagnosed in infancy, childhood or adolescence.  These disorders are diverse ranging from mental retardation and behavioral disturbances to mood disorders and psychosis.  Children and adolescents manifesting signs and symptoms of these disorders often present in a primary care setting.  Hence all physicians should be knowledgeable about child development and be able to obtain an accurate developmental history and perform an age-appropriate mental status exam as part of a thorough medical assessment.  Clinicians should be able to recognize signs and symptoms suggestive of a psychiatric disorder and manage or refer patients for further evaluation and management.

By completion of the clerkship the student will be able to:

  1. Recognize and distinguish the difference between behavior that is developmentally normal (e.g., stranger anxiety) from behavior that suggests psychopathology (e.g., Panic Disorder).  K—13, 14

  2. Discuss the clinical assessment and differential diagnosis for children and adolescents  presenting with disruptive behavior and make recommendations for further evaluation, referral, and management.  K—13, 14

  3. Discuss the epidemiology, clinical course, family history and prognosis of common psychiatric disorders in childhood and adolescence including Attention Deficit and Disruptive Behavioral Disorders, Learning Disability, Autistic Spectrum Disorders, Mood and Anxiety Disorders, Eating Disorders, and Substance Use Disorders.
           K—13, 14

  4. Discuss the physician’s role in diagnosing, managing and reporting suspected abuse of children and adolescents.  K--1

Geriatric Psychiatry
Rationale:  The percentage of the US population over 65 years old is increasing dramatically.  There are many predisposing risk factors for psychiatric illness associated with aging.  As such, mental disorders in the elderly, ranging from cognitive to mood disorders are prevalent and the risk for suicide is particularly high in this age group.  Geriatric patients with psychiatric disorders may present in any clinical setting.  Hence all physicians should be able to assess mental status in elderly patients and recognize the signs and symptoms suggestive of mental disorders.  Physicians should incorporate knowledge of the physiological and psychosocial changes accompanying aging into treatment planning and be able to refer patients for further evaluation and treatment.

By completion of the clerkship the student will be able to:

  1. Describe issues unique to the psychiatric evaluation of the elderly (e.g., changing sensory perception).  K--1

  2. Compare and contrast the clinical presentation of psychiatric disorders in the elderly versus other adults (e.g., somatic focus in depression).  K--1

  3. Discuss and assess the heightened risk of suicide in elderly patients.  K--13

  4. Discuss the physiology of aging relevant to the prescribing of psychotropic medications.  K

  5. Discuss the physician’s role in diagnosing, managing and reporting suspected elder abuse.  K--1

Adjustment Disorders
Rationale:  Adjustment Disorders are clinically significant reactions to stress.  Patients with adjustment disorders may present in any clinical setting in crisis with diverse symptomatology.  All physicians should be able to recognize signs and symptoms suggestive of an adjustment disorder, provide support, and be able to provide or refer patients for further evaluation and crisis intervention.

By completion of the clerkship the student will be able to:

  1. Describe the essential features and course of Adjustment Disorders.  K—1, 13

  2. Compare and contrast Adjustment Disorders with major Mood, Anxiety and Conduct Disorders and normal Bereavement.  K--13

  3. Recommend plans for further evaluation and management of patients diagnosed with Adjustment Disorders.  D--1

Disease Prevention, Therapeutics, and Management

Prevention
Rationale:  Prevention is fundamental to medical practice.  Physicians must keep in mind the goals of decreasing the occurrence of illness, reducing illness duration, and minimizing the associated disability of medical conditions.  Preventive medicine is a particular challenge in psychiatry where the etiology and pathophysiology of many disorders is as yet unknown and patients may lack insight into their illness.

By completion of the clerkship the student will be able to:

  1. Assess the effects of socioeconomic factors (e.g., culture, family stability, divorce, finances, lifestyle, etc.) on the course of psychiatric illness and adherence to treatment and counsel assigned patients and their families.  K--1

  2. Describe the genetic and environmental risk factors for psychiatric illness including emotional, physical and sexual abuse, domestic violence, and co-morbid substance abuse.  SH--1

  3. Discuss the risks of untreated psychiatric illness and the importance of early identification of major psychiatric disorders in at-risk youth.  K

  1. Discuss factors that suggest need for psychiatric hospitalization and inpatient care. D—1,2

  1. Provide education about psychiatric illness and treatment options to designated patients.  D--1

Pharmacological Therapies
Rationale:  Knowledge of psychopharmacology is critical to the practice of all medical specialties.  The field of psychopharmacology is best characterized as dynamic and the product of ongoing research and new drug development.  Students must be knowledgeable about indications, contraindications, presumed mechanism of action, pharmacodynamics, pharmacokinetics, and common and serious adverse effects of psychotropic drugs.  Students must also be knowledgeable about factors that will impact the use of psychotropic medications including drug-drug interactions, drug-disease interactions, and important considerations for drug use in special populations across the lifespan (e.g., children, pregnancy and lactation, the elderly).  During the psychiatry clerkship, students should review, prioritize and update the important principles first learned in the pre-clinical pharmacology, physiology and pathology curriculum.  Students should also become competent at accessing relevant information (e.g., results of large population based clinical trials, consensus algorithms, etc.) and maintaining an up-to-date knowledge base in the area of psychotropic pharmacotherapy.

By completion of the clerkship the student will be able to:

  1. Discuss the common, currently available psychotropic medications with regard to clinical indications and contraindications, presumed mechanism of action and relevant pharmacodynamics, common and serious adverse effects, pharmacokinetics, evidence for efficacy, cost, risk of drug-drug interactions and drug-disease interactions, and issues relevant to use in special populations (e.g., pregnancy and lactation, childhood and adolescence, the elderly).  K—1,2, 13, 14

  2. Propose selected psychotropic pharmacotherapy for designated patients and provide clinical reasoning that includes discussion of factors influencing treatment selection (e.g., patient-specific and drug-specific variables, scientific evidence).  D—1,2, 18

  3. Discuss the factors relevant to implementing, monitoring and discontinuing psychotropic pharmacotherapy including drug dosing, treatment duration, and compliance, and make management recommendations for dealing with an unsuccessful treatment trial (e.g., lack of efficacy, intolerability).  D--1

  4. Counsel patients about psychotropic pharmacotherapy including risks and benefits of recommended treatment, treatment alternatives, and no treatment.  D--1

  5. Discuss special issues and concerns related to specific psychotropic drug classes:

a) Antidepressant Agents:  Be able to discuss the risk, early detection, relevance and interventions for Hyperserotonergic Syndrome, Hypertensive Crisis, suicidality and cardiac arrhythmias; b)Antipsychotic Agents:  Be able to discuss the risk, early detection, relevance and interventions for acute Extrapyramidal Side Effects (EPS), Tardive Dyskinesia, Neuroleptic Malignant Syndrome, metabolic derangements, cardiac arrhythmias, and anticholinergic toxicity; c) Mood Stabilizing Agents:  Be able to discuss the risk, early detection, relevance and interventions for lithium and anticonvulsant toxicity including plasma level monitoring; d) Anxiolytics and Sedative-Hypnotic Agents:  Be able to discuss the risk, early detection, relevance and interventions for toxicity, dependence and consequences of abrupt discontinuation; e)Stimulant Agents:  Be able to discuss the risk, early detection, relevance and interventions for toxicity and abuse;  f)Cognitive Enhancers:  Be able to discuss the clinical use, drug interactions and potential adverse effects.  SH—1, 2, 13, 14, 18

Brain Stimulation Therapies
Rationale:  Electroconvulsive therapy (ECT) remains one of the most effective treatments for mood disorders.  It is used widely and in many cases is considered to offer the most favorable risk: benefit ratio among available antidepressant interventions.  A variety of alternative brain stimulation therapies are either being approved for general use to treat psychiatric disorders or are in various stages of development.  Since patients with mood disorders may present in any clinical setting, all physicians should be able to refer patients for further evaluation for ECT. 

By completion of the clerkship the student will be able to:

  1. Discuss electroconvulsive therapy (ECT) with regard to clinical indications and contraindications, presumed mechanism of action, common and serious adverse effects, evidence for efficacy, cost, and issues relevant to use in special populations (e.g., pregnancy, childhood and adolescence, the elderly).  K—13, 14

Psychotherapies
Rationale:  Evidence-based interventions for many disorders encountered in medical practice include psychotherapy.  Although a psychiatry clerkship does not provide adequate time for a student to learn to conduct psychotherapy, it does present an opportunity for students to gain familiarity with and develop and understanding of psychotherapy.  At the most essential level, psychotherapy is the process of helping people overcome problems by talking about them.  There are many types of psychotherapy, each with a theoretical construct that aims to help us understand human behavior and treat disturbances of emotion and behavior.  Regardless of medical specialty, an effective practitioner should have a basic understanding of psychotherapy, recognize the relevance of psychotherapy principles to the doctor-patient relationship, be aware of those psychotherapies with evidence-based efficacy for particular disorders, and be able to refer patients for psychotherapy.

By completion of the clerkship the student will be able to:

  1. Discuss general features of common psychotherapies and recommend specific psychotherapy for designated patients in conjunction with or instead of other forms of treatment and provide clinical reasoning that includes discussion of factors influencing treatment selection (e.g., patient-specific and treatment-specific variables, scientific evidence).  SH--1

  2. Counsel patients, provide education about psychotherapy, and promote the use of healthy coping strategies.  D--1

  3. Identify and discuss the relevance of potential levels of verbal and non-verbal communication occurring in the uniquely intimate relationship between doctor and patient that occurs regardless of the medical setting or type of medical care being provided including therapeutic boundaries, therapeutic stance, therapeutic alliance, transference and countertransference.  K--1

Multidisciplinary Treatment Planning and Collaborative Management
Rationale:  Regardless of medical specialty, because of the complexity of our healthcare system, the complexity of peoples’ lives, and the impact of psychosocial variables on health and illness, it is critical that a physician be able to collaborate effectively with other physicians in different specialties and with other healthcare workers in different disciplines.  The effective collaborations necessary to bring about an optimal clinical outcome require an understanding and appreciation of what each discipline contributes to patient care.  An effective physician recognizes the importance of collaboration with the patient’s family and others in their life to increase the likelihood of a successful treatment outcome.

By completion of the clerkship the student will be able to:

  1. Discuss the roles of different physician specialties and non-physician healthcare disciplines (e.g., case managers, addiction counselors, etc), demonstrate respect for these colleagues, and work collaboratively in the care of patients and their families.  D--1

  2. Discuss the importance of working successfully with patient’s families and other agencies in the patient’s life (e.g., schools, employers, etc) accounting for cultural diversity, to bring about an optimal clinical outcome.  K--1

  3. Discuss and propose appropriate community resources as part of a comprehensive treatment plan for assigned patients (e.g., support groups, residential facilities, vocational rehabilitation, etc).  SH—1,2, 18

Professionalism, Ethics and the Law

Professionalism
Rationale:  Professionalism is a broadly defined, critical component of medical practice and should be fundamentally present in all clerkship curriculums and throughout undergraduate medical education.  Elements of professionalism include integrity, honesty, responsibility, dedication to the best interests of the patient, and sensitivity to the diversity of patients and their disabilities.  Physician effectiveness, patient safety, and quality health care require a high level of professionalism.

By completion of the clerkship the student will be able to:

 

  1. Demonstrate respect, empathy, responsiveness, and concern regardless of the patient's problems, personal characteristics, or cultural background.  D—1,2

  2. Demonstrate sensitivity to medical student-patient similarities and differences in gender, ethnic background, sexual orientation, socioeconomic status, educational level, political views, and personality traits.  D—1,2

  3. Discuss the prevalence and barriers to recognition of psychiatric illnesses in general medical settings and recognition of general medical conditions in patients with known psychiatric illness.  K--1

  4. Discuss the concept of boundaries in the doctor-patient relationship and boundary violations.  S—1

  5. Demonstrate integrity, responsibility and accountability in the care of assigned patients.  D—1

  6. Demonstrate scholarship in the form of contributing to a positive learning environment, collaborating with colleagues, and performing self-assessment and self-directed learning.  D—1

  7. Be able to assess one’s strengths, weaknesses and health (physical and emotional), and be willing to seek and accept supervision and constructive feedback.  D—2

Medical Ethics
Rationale:  All physicians confront ethical issues in medical practice.  In caring for patients with altered mental status, physicians must deal with the conflict between beneficence and autonomy, psychological development and personal history in the lives of patients.  In caring for patients with significant emotional disturbance, a physician must refrain from rejecting a patient or getting over involved. A thorough understanding of the ethical issues of confidentiality, informed consent, caring for special populations and the right to refuse treatment is critical to appropriate clinical practice.  For clinical excellence, a physician must be able to identify ethical features in a patient’s care, utilize self-observation and self-scrutiny, and implement focused strategies for approaching ethical issues.

By completion of the clerkship the student will be able to:

  1. Identify and discuss issues of ethical concern in the care of assigned patients (e.g., autonomy versus beneficence and interpersonal boundaries).  D—1, 22

  2. Identify and discuss ethically risky and problematic situations encountered in healthcare (e.g., duty to warn, reporting child abuse).  D—13, 14

 

Medical-Legal Issues in Psychiatry
Rationale:  All physicians must be knowledgeable about the legal obligations associated with medical practice.  Important legal obligations for physicians include duty to report, duty to warn, and least restrictive alternative treatments.  Particularly relevant in psychiatry are the issues of involuntary commitment, assessment of competency, seclusion and restraints, and criminal responsibility.

By completion of the clerkship the student will be able to:

 

  1. Discuss the risk factors, screening methods and reporting requirements for suspected abuse, neglect and domestic violence in vulnerable populations including children, adults, and the elderly.  S—13

  2. Discuss the physician’s role in screening for, diagnosing, reporting and managing victims of abuse.  K--1

  3. Discuss the elements of informed consent and evaluation of decision-making capacity (i.e., the right to refuse treatment, assent versus consent in children and adolescents).  K—13

  4. Discuss the principles and process of the physicians “duty to warn” obligation.K—13, 22

ACGME Glossary of Assessment Methods for Clinical Education (ACGME 2000) - Adapted for the Clinical Curriculum Resource Guide for Psychiatry Education

  1. Clinical Performance Ratings – Weekly, monthly, end-of-rotation ratings of student overall performance

  2. Direct Observation and Evaluation - Supervisor/attending observation of individual student-patient encounters, operations, specimen preparation, etc., and concurrent (same day) evaluation

  3. 360 Assessments - Evaluation by MDs (supervisors, residents, medical students) and non-MDs (nurses, technicians, social workers, PAs ) using the same or similar evaluation forms

  4. Evaluation Committee - Evaluation of student performance in a small group discussion format, e.g., Evaluation Committee

  5. Structured Case Discussions - An informal structured mini-oral exam consisting of a small set of pre-determined questions; the exam occurs during a student's case presentation to his/her supervisor

  6. Stimulated Chart Recall - Uses a student’s patient records in an oral exam-like format to explore decisions made and patient management; is conducted "after the fact" using patient charts to stimulate memory of the case

  7. Standardized Patient - The student provides care to an SP as if (s)he were a real patient and is evaluated concurrently by the SP or another trained observer; the SP is a well person or actual patient trained to present a case in a standardized way

  8. OSCE - A multi-station exam of simulated clinical tasks, which might include SPs, anatomical models, X-ray interpretation, lab test interpretation, etc.; a student performs the tasks and is evaluated concurrently by a trained observer

  9. High Tech Simulators/Simulations - Students' performance of procedures on a high-tech simulator (e.g., Harvey) is evaluated; this may involve built-in evaluation by the simulator or observation and concurrent evaluation.

  1. Anatomic or Animal Models - Students' performance of procedures on non-computerized, 3-dimensional models that replicate the properties of human anatomical structures is observed and evaluated concurrently

  2. Role-play or Simulations - Students are evaluated based on their performance on assigned responsibilities in a staged replica of a potentially real situation, e.g., mobilization of medical team in a multi-victim accident, confrontation of an "impaired" colleague, negotiation with administration regarding facilities and equipment upgrade

  3. Formal Oral Exam - "Mock" oral exam in which an examiner asks students questions about what to do in a clinical scenario presented verbally or role played by the examiner

  4. In-training Exams - A multiple-choice exam developed by an external vendor

  5. In-house Written Exams - A multiple choice exam developed by program faculty

  6. Multimedia Exam - A computer based multiple choice or branching question exam in which authentic visual and auditory patient information is presented as question information

  7. Practice/Billing Audit - Educational equivalent of physician profiling; this data-based process benchmarks individual student billing data against peers in the office, hospital, or managed care setting

  8. Review of Case or Procedure Log - Review of number of cases or procedures performed and comparison against minimum numbers required

  9. Review of Patient Chart/Record - Involves abstraction of information from patient records, such as tests ordered, and comparison of findings against accepted patient care standards

  10. Review of Patient Outcomes - Aggregation of outcomes of patients cared for by a student and compared against a standard

  11. Review of Drug Prescribing - Systematic review of drug prescribing for selected conditions to determine adherence to protocol

  12. Student Project Report (Portfolio) - Evaluation of student work products, such as examples of clinical documentation including progress notes and History and Physical Exams, reports of research studies, practice improvement, or systems-based improvement

  13. Student Experience Narrative (Portfolio) - Evaluation of performance based on students’ narratives of critical incidences or other experiences, usually accompanied by reflection on the event, e.g., what happened, why, what could have been done differently

Other Portfolio - Evaluation of student performance based on other work/performance products not included above, e.g., audiotapes, slide presentations


 

Patient Log

Residency Management Suite Link
http://new-innov.com/

 

Instructions on how to log onto the system and Log

page 1

page 2

Page 3

Page 4

page 5

Page 6

page 7

page 8


 

Self-Study Topics

Required Topics
Week
Topic Name
Download Format
1
Motivational Interviewing
3 (IRAT#2)
Depression in the Elderly

 

Self-Study Topics
From
Topic Name
Download Format
IRAT#1
Delirium and Dementia
IRAT#1
Neuroscience Pearls
IRAT#1
Substance Abuse Pearls
IRAT#1
Alcohol and Substance Abuse Team Based Learning (TBL)
IRAT#2
Personality Disorders
IRAT#3
Psychosi
IRAT#3
Psychotherapy Pearls
IRAT#4
Child Development Pearls
 

  

Self-Study Topics
From
Topic Name
Download Format
Victor R. Knapp, M.D.
Brenda Roman, M.D.
Biopsychosocial Model
Justin Trevino, M.D.
Post Stroke Syndromes
Douglas S. Lehrer, M.D.
Neuroscience Applications
RD Sanders, M.D.
Neuropsychiatry
 
Principles of Addiction Medicine Second Edition
Brenda Roman
Therapeutics

 

Self-Study Topics
From
Topic Name
Download Format
Jennifer Shoenfelt M.D.
Child Depression
Suzie C. Nelson, M.D.
Eating Disorders
Brenda Roman, M.D.
Psychiatric Interviewing and Assessment
PPT | PDF
Terry Correll, M.D.
Substance Abuse
Brenda Roman, M.D.
Boundaries in Clinical Practice
Adrienne McCray, M.D
Child & Adolescent
Mary White, Ph.D.
Ehtics - "Duty to Warn"

   

Additional Topics
From
Topic Name
Download Format
-
The Mind Psychiatry Resources
Psychiatry Topics
-
Mental Statis Exam

 


 

Clinical Examinatuons

Clinical Examinations

The clinical examinations are variations of standardized patient exams.  As with any exam, no books or written materials may be used.  You can take blank sheets of paper on which you can take notes during the videotapes.

Two exams will be scheduled for you:

1)     Written exam - you will view a 30 minute videotape of a psychiatric patient.  You will then
         have 60 minutes to write out the following on an examination outline that will be given to you:
a) mental status exam
b) differential diagnosis
c) your “working diagnosis” with rationale for that diagnosis
d) Axis I–V diagnoses
e) treatment plan based on your working diagnosis
f) biological theories

  • prognosis

 

The Clerkship Director will grade each of these written examinations, utilizing a 5 point scale, as set forth above.

2) Oral Exam - you will view a 30 minute videotape of a psychiatric patient.  You will then present a 5-7 minute synopsis (i.e., HPI, Past psychiatric history, MSE and other pertinent information) of the patient interview to an examiner (psychiatry faculty).  The examiner will then request that you share your differential diagnosis with supporting data for your working diagnosis.  The examiner will ask you questions regarding a treatment plan.  The treatment plan will include medications, so be familiar with indications and side effects.  This will last approximately 30 minutes.

A 5 point scale will be utilized for grading purposes, as set forth above.  A copy of the evaluation form for your review is included and available on the clerkship website Http://www.MedU.wright.edu.

  • If the combined grade for the clinical examination is a failing grade (less than 70%), it will result in an incomplete, with the requirement to retake both the written and oral examinations.  If another failing grade is received, failure of the clerkship will result.

 


 

Additional Resources

Additional Resources

 


 

Psychiatric Assessment and CAT Guidelines

Psychiatry Critically Appraised Topic (CAT)
(Adapted from W. Scott Richardson, MD)

A CAT (Critically Appraised Topic) is a structured, 1 page summary of the results of an evidence-based learning effort, in which a patient’s illness stimulates a learner’s question, for which the learner finds evidence, appraises the evidence critically, and decides whether and how to use that evidence in the care of the patient. A CAT summarizes the work of busy clinicians, using the best available evidence found in “real time” searching, and therefore is not simply a systematic review. By writing down the question, the clinical “bottom line” answer, and the evidence that supports the answer, we are summarizing the key lesson(s) from an episode of evidence-based learning. Utilizing CATs can help us refine our abilities to ask answerable questions, search for evidence, critically appraise evidence, and integrate evidence with our clinical expertise and patient preferences.

The CAT, in one page, should include the following:

Title: Write a declarative sentence that states concisely the clinical bottom line

Appraiser: Include your name and email so others can contact you about the CAT

Date CAT was born: So you will know when to look again and when to search from

Clinical Question: Include the 4 components of the foreground question you asked

Search Strategy: Include bulleted points of resources, methods, and terms used

Clinical Bottom Line: The concise, best answer(s) to your clinical question:

First: Explain qualitatively what main result of evidence means. Second: Summarize whether, when, how, and in whom to use the evidence in clinical decisions, e.g. balance of benefits and harms suggest offering Rx to most patients
(Bottom line should differ from study results and from authors’ conclusions.)

Evidence summary: Concise description of what was done and what was found First: describe methods concisely, e.g. “randomized trial of 2000 patients with ...” Second: summarize main results that address your clinical question, in a table Include absolute and relative measures of effect size with confidence intervals. (Don’t include other results that don’t address your question.)

Comments: Concise summary of how well it was done and how to use it

First: summarize your critical appraisal of validity, importance, and applicability

Second: any additional concerns you have about potential use in decisions

Third: how to estimate an individual patient’s expected risk or responsiveness

Fourth: address feasibility of using evidence in your health care setting

Citation(s): Full citation to evidence appraised; may include other resources, as needed

You may use software to help: Oxford’s Centre for Evidence-Based Medicine provides CATMaker software, as free download from website www.cebm.net/


 

Careers in Psychiatry

Information for Students Interested in Psychiatry as a Career
July 1, 2009

The field of psychiatry is rich with possibilities, and many rewards for a fulfilling career. General adult psychiatry residency is four years long; with an internship that includes a minimum of 3 months in internal medicine and 2 months in neurology. Subspecialization options for psychiatry include: child and adolescent psychiatry, forensic psychiatry, geriatric psychiatry, addiction psychiatry, and consultation/liaison psychiatry. Psychiatrists have practice opportunities ranging from inpatient psychiatry to private practice psychiatry with a focus on psychotherapy to community psychiatry to a focus on patients with mental illness and developmental disabilities. Other psychiatrists may focus on an academic career, whether in undergraduate medical education or residency education or research. Research opportunities include both basic science research and clinical research. More specific information about sub-specialties follows at the end of this document.

The Department of Psychiatry Boonshoft School of Medicine is willing to assist you in any way possible regarding your interest in psychiatry, whether you plan to remain in the area or look at programs elsewhere. As you plan for a career in psychiatry, here are some tips and other resources as you explore psychiatry.

Medical School

Brenda Roman, MD
Professor and Director of Medical Student Education in Psychiatry

While it is important to do as well as possible on your clinical rotation in psychiatry as well as the other core rotations, it is not essential to receive the top grades. Work hard, read the literature, ask to spend time with residents and faculty, and remain professional in all of your interactions. If you are interested in academic opportunities such as writing an article to be considered for publication or to do some research, please contact Dr. Roman for further information.

If you are certain about pursuing psychiatry as a career, taking 4th year electives in the field of psychiatry is not needed. Round out your clinical rotations with as many nonpsychiatry electives as possible, as you will not have the opportunity to ever do such rotations again! If you are uncertain about your interest, or want to see a side of psychiatry that you did not see during your clerkship, like child and adolescent psychiatry, by all means sign up for an elective. You will likely want to do your elective rather early in your 4th year to solidify your career choice, and possibly to secure a letter of recommendation. Unless you are planning to pursue a very competitive residency program, “audition” electives are not necessary in psychiatry. You will find it helpful to schedule a meeting at the beginning of your 4th year with Dr. Bienenfeld and Dr. Kay to discuss your career interests, as both can share their knowledge of other programs across the country. The national psychiatry interest group, PsychSIGN, also has resources available on their website: http://www.psychsign.org/

You should also join the American Psychiatric Association, which is free to medical students, and has information about careers in psychiatry and applying to residency programs. See: http://psych.org/MainMenu/EducationCareerDevelopment/MedicalStudents.aspx

Applying to Residency

David Bienenfeld, MD
Professor and Director of Residency Training

Once you have decided, with the help of your faculty and academic advisors, which training programs are most likely to be a good fit for you, application out of the senior year of medical school is through the Electronic Residency Application Service (ERAS) http://www.aamc.org/students/eras/. In filling out the application, emphasize your accomplishments and activities, including extracurricular involvement. Note any research or publications, of course.

It is best to request at least one of your recommendation letters from a psychiatrist, better to have two. While the application is fairly straightforward, the Personal Statement is truly a blank slate. Use it to define yourself around some standard that makes you stand out from the crowd. It need not be exhaustive; leave the reader wanting to invite you for an interview and discuss your ideas further.

The interview is the centerpiece of the application for psychiatric residency. Be prepared to demonstrate that you have thought clearly about your career decision, and about selecting the programs to which you are applying. Come with questions about the characteristics that define the program, such as its philosophies about teaching and learning and about psychiatric practice. You will have the opportunity to find out from residents and program coordinators about call schedules and other logistical dimensions of the program; save your questions of faculty for the meaty stuff. A good reference article is: Bak et al. "Applying to Psychiatry Residency Programs." Acad Psychiatry. 2006; 30: 239-247.

Comments from a Chair regarding the application process

Jerald Kay, MD
Professor and Chair

The application process is undoubtedly anxiety provoking for many. In some ways this process is more critical than application to medical school. Undergraduate medical education, with rare exceptions, is a rather uniform experience for students throughout the country since much of what is taught and how it is taught is mandated by accreditation regulations. What makes the psychiatry residencies unique is often reflected in a program’s philosophical approach to the patient, psychotherapy, teaching commitment, and breadth of clinical experiences. I feel passionately that this is the most exciting time ever to be entering psychiatric training. Scientific advances have brought us increasingly closer to the integration of the neurobiological with the psychosocial and our treatments are exceptionally effective. The exciting aspect of interviewing is the opportunity to meet new faculty and residents from other institutions. These encounters provide you with differing institutional and personal views about American psychiatry which are critical for you to ascertain because they form the ethos and value system of a particular training program. Since coming to Wright State in 1990, I have met with every student considering a career choice in psychiatry and you too, should sit down and talk with me. My experiences, such as being the immediate past chair of the ACGME Psychiatry Residency Review Committee (the group responsible for accrediting all psychiatry programs) have provided me with a snap shot of all residencies in the country. I am also one of the longest standing chairs nationally which means that if you are around long enough, you develop professional relationships with many faculty throughout the country as well as having the opportunity to be a consultant to many training programs. Career counseling is something I enjoy a great deal and it also allows me to get to know you beyond the traditional relationship I have had as a lecturer in the preclinical years.

Comments from a selection committee member

Terry Correll, DO
Assistant Professor

We are looking for individuals who are well rounded in all areas of their life. We like to see determination, focus and an ability to clear all hurdles as they are presented in achieving your academic and career goals. You don't need the highest scores or grades, but it is encouraging for us to see that you can do well enough in the “book work” to take the next step in applying that knowledge in real life clinical scenarios.

In order to maintain an optimal training environment, we seek people who “work and play well” with others knowing that a significant amount of your learning will come from your colleagues. Of course, people skills, empathy, compassion, and a desire to help others are essential.

Comments from a resident

David Hart, MD
Child Fellow

Deciding where to do residency can be a daunting task. Having an idea of what type of program you are looking and where you want to live can be helpful prior to searching. For example, knowing if you are looking for a program strong in psychotherapy, psychopharmacology, research, fellowship opportunities, etc. will be helpful in guiding your decision. One good resource to get started with is FREIDA Online at http://www.ama-assn.org/ama/pub/education-careers/graduate-medical-education/freidaonline.shtml

This website will allow you to search for programs based on residency and fellowship types as well as their location. In addition, there are usually links provided for each program directing you to their homepage. Other information contained on this site includes salary, benefits, vacation and contact information for each program to help answer any questions you may have.

Most programs are decent enough programs when looking but a few things may be helpful. I want to reiterate the above information about choosing a residency program. The thing that helped me decide where to go was first figuring out what I wanted to do, as far as type of program. Once I decided on that, I was able to search for programs and compile a list of prospective places. Speaking with current faculty is very helpful as they know people at many of the programs and can give you a good idea of what programs will have what you are looking for.

Interviewing can be rough both emotionally and financially. Go to those places you really are interested in. Most people wear down after a while and end up not going to all available interviews. Much debate exists whether to schedule first, middle or last the places you are most interested in. I recommend somewhere in the middle, so you can compare the programs to those before and after.

On the interview day, it is important to meet residents. A red flag should go up if you only get to meet one or two. Attend any possible events/activities that residents are involved with during your interview day/s as this is the best way to see how they interact with each other and with you. The questions below are good to ask. Have an idea of what you want to know about a program before the interview day. My one big piece of advice here would be to ask a well balanced amount of questions. Don’t overly focus on salary or time off, at this will be what you are remembered by when you leave. Lastly, never rank a program you wouldn’t want to go to because you just might end up there.

Interested in Child and Adolescent Psychiatry?

William Klykylo, MD
Professor and Director of the Division of Child and Adolescent Psychiatry

Child and Adolescent Psychiatry (CAP) is the most underserved specialty in medicine as well as one of the most rewarding. CAPs are involved in a wide range of clinical activities with children and families, as well as consultation and administration. To be a CAP means that you have an almost unlimited choice of practice patterns, locations, and lifestyles. The scientific basis of CAP is growing as fast as any area in medicine, informed by molecular biology, imaging, pharmacology, medical epidemiology, outcome research, and advances in psychotherapy. But the most important part is the chance to make a difference in the development of children, adolescents, and their families.

To become a Child and Adolescent Psychiatrist, you would complete a two-year residency (often called a fellowship), usually after three or four years of residency in General Psychiatry. Most residents take begin their training after three years, combining the first year of CAP and the last year of General Psychiatry into a five-year residency; but other arrangements are possible. A CAP residency prepares a psychiatrist for the totality of somatic, psychological, and social interventions required in direct clinical work, as well training psychiatrists to serve as consultants to schools, social agencies, the justice system, and other programs. There are also “Triple Board” programs, which prepare you to be a general psychiatrist, CAP, and pediatrician after five busy years. In any case, all CAPs presently must be board-eligible in general psychiatry. Applicants to general residencies will usually express their interest in CAP when they apply, and apply formally to a CAP program after two years. A fourth-year elective in CAP is certainly not required but may help you to discern and focus your interests. Students interested in CAP should join the American Academy of Child and Adolescent Psychiatry (www.aacap.org) and receive our highly-cited journal, JAACAP.

Interested in Forensic Psychiatry?

David Bienenfeld, MD
Professor and Director of Residency Training

Forensic psychiatry is a specialty which encompasses many pursuits. Forensic psychiatrists may focus on criminal determinations such as innocence by reason of insanity, on tort (or liability) cases, on civil determinations such as competency, on issues of child custody, on care of imprisoned offenders, or any of a number of different areas in which the law and psychiatry overlap. Forensic psychiatry appeals to those who are comfortable making stark determinations and testifying to them in public settings. To be eligible for ABPN certification, one must complete a one-year fellowship. There are about forty certified fellowship in the US. Neither fellowship training nor board certification is required for practice, but in any setting involving competing experts, the trained and certified specialist is at an advantage.

Interested in Geriatric Psychiatry?

David Bienenfeld, MD
Professor and Director of Residency Training

Demographic patterns guarantee that the elderly will need ever more psychiatric care for the foreseeable future. Advances in the study of dementias and mood disorders of late life make geriatric psychiatry an exciting pursuit. There are about sixty accredited fellowship programs in geriatric psychiatry. Fellowship training is intended for those aiming for academic careers in geriatric psychiatry, and is required for eligibility for ABPN certification in the specialty. Most practitioners who treat the elderly, however, are not fellowship trained and have derived their expertise form special focus in residency and in their practices. Excellent information about careers in geriatric psychiatry is available form the American Association for Geriatric Psychiatry at: http://www.aagpgpa.org/prof/careers_gerpsych.asp

Interested in Consultation/Liaison Psychiatry?

Jerome Schulte, MD
Associate Professor

Consultation-Liaison Psychiatry/ Psychosomatic Medicine is an exciting subspecialty of psychiatry where the psychiatrist combines knowledge of psychiatry, internal medicine and the other specialties taught in medical school to evaluate complicated patients with psychiatric symptoms in the general hospital setting. “Consults” are often seen on an emergency basis at the request of the treating physician, and are usually seen on inpatient medical and surgical wards, in the emergency room, or in outpatient medical or surgical clinics. Typically the reason for evaluation is suicidality or suicide attempt, depression, confusion, or capacity for medical decision making. Also, psychiatric consultation is performed in specialty clinics or for a special “situations.” For example, a psychiatric evaluation is usually required prior to organ transplantation or flying in outer space. Specialty areas of consultation include hematology/oncology, burn units, as well as, working for the CIA, FBI, NASA or a branch of the military such as flight evaluation for the Air Force, evaluation for submarine duty for the Navy, as well as evaluating candidates for Special Forces. Consultation psychiatrists are usually employed at major medical centers, University teaching programs, or by the government, but may also have a “private practice,” working with multiple medical groups on an outpatient basis.

To become board certified in consultation psychiatry one must successfully complete one year of ACGME-accredited fellowship training in psychosomatic medicine . A useful website for more information on Consultation-Liaison Psychiatry/ Psychosomatic Medicine is the Academy of Psychosomatic Medicine at http://www.apm.org.

Interested in Addiction Psychiatry and Co-occurring addictions/mental illness?

David Hart, MD

Through any career path, be it child or adult, you will see patients with addictions. Knowing how to recognize and manage addictions will be a valuable part of your training. As a part of the general psychiatry residency, you will be exposed to addiction psychiatry as a rotation generally within the first two years. Should you desire further training you can complete a fellowship in addiction psychiatry which is a board certified subspecialty you can complete after your adult psychiatry training. It is a one year program, and there are currently forty three programs nationwide, with two being in Ohio. Addiction psychiatrists work in many settings and can see a wide variety of patients.

A nice resource for more information can be found at http://www.aaap.org/home.htm. This is the website for the American Academy of Addiction Psychiatry (AAAP). This website contains a wealth of knowledge including knowledge specific to medical students and residents. There are national meetings and other educational opportunities available as well.

Interested in Community Psychiatry?

Ann Morrison, MD
Associate Professor

Imagine being able to help people survive a life-threatening illness which strikes them just as they are becoming independent young adults, shaping their own their lives. People living with schizophrenia and other severe mental illnesses in our communities face daily challenges both in periods of crises and stability. Psychiatrists with an in depth understanding of these diseases and willingness to work with individuals with severe mental disorders and their families can help make the difference between hope and demoralization.

The life-long nature of many of these illnesses provides an opportunity to work with patients and families for years and sometimes decades. The challenge of being able to use all of ones skills including the therapeutic alliance, pharmacologic knowledge, community resources and even common sense make Community Psychiatry rewarding. Additionally, the complex nature of these illnesses and the individuals’ needs to be able to successfully live in their homes involves many other professionals. This allows the psychiatrist the bonus of being able to work with a team, to not feel isolated or unduly burdened with all of the problems that can arise. While the work day may be busy and full it is virtually never dull. In short, Community Psychiatry, changes lives—yours and your patients and their families!

Interested in developmental disorders/mental illness?

Julie Gentile, MD
Associate Professor

Individuals with intellectual and developmental disabilities (DD) comprise ~1-3 % of the U.S. population, and so patients with co-occurring mental illness and developmental disabilities will be integrated into nearly every mental health care delivery system. Patients with dual diagnosis (mental illness/intellectual disabilities) often present with communication difficulties and behavioral issues; this specialized patient population also commonly has undiagnosed and untreated medical conditions which can be screened for by psychiatrists. The psychiatrist plays a vital role in the medical care of dual diagnosis patients since they will frequently be referred for mental health assessment for these behavioral presentations of medical issues. The Wright State University Department of Psychiatry offers a Dual Diagnosis curriculum including didactics and clinical practice sites where residents in training can gain exposure to this patient population. There are only a handful of residency training programs in the U.S. who can offer this experience, and it continues to grow and be a popular site for resident training.

Interested in a research career?

Douglas Lehrer, M.D.
Associate Professor

The National Institutes of Health (NIH) spent over $30 Billion during the last fiscal year with almost 10% of those funds going to psychiatric, psychological, and addiction-related research through the National Institute(s) of Mental Health (NIMH), Drug Abuse (NIDA), and Alcohol Abuse and Alcoholism (NIAAA). Additional funding from the states, National Science Foundation (NSF), American Psychiatric Association and other professional societies, private foundations, and other sources add millions of dollars each year to the struggle to solve the dilemma and tragedy of mental suffering. A substantial proportion of these funds (for example, ~10% of the NIMH budget) directly supports training -- including research career development.

Several WSU Department of Psychiatry faculty are involved in clinical psychiatry research and welcome interested trainees. Time and scope of participation is generally flexible depending on the trainee’s interests and career goals. For residents with an interest in making research an integral part of a career, we have had success in obtaining external funding to help the individual get started. Each resident’s chosen mentor can help the resident focus interests, design a small pilot study (or get involved in a larger existing project), achieve the study objectives and move the results to a publication and/or meeting presentation. Such opportunities during training can help the resident decide whether they want to make research part of their future, either as a principle career direction or as a gratifying addition to a clinical career.

Interested in college mental health?

Terry Correll, DO
Assistant Professor

College mental health offers outstanding opportunities to help students during one of the most pivotal times in their lives. Today's college students are increasingly diverse and presenting with a myriad of needs to include multicultural and gender issues, career and developmental issues, life transitions, stress, substance abuse, suicidal behavior, violence, and serious psychological problems. Clearly, there is a shift towards more severe presentations in college mental health centers than ever before. Many students are coming to college with an extensive prior psychiatric history and already taking psychiatric medications. This makes for an exciting place to practice psychiatry with students who are motivated to learn and grow in all aspects of life.

Free public information about mental health issues for college students and others is available on APA's consumer Web site at http://www.healthyminds.org.

Interested in advanced psychotherapy training/psychoanalysis?

Nancy Smith, DO
Assistant Professor

In addition to the biological and pharmacological understanding and treatment of the patient, WSU Department of Psychiatry has a rich tradition of training residents in the practice of psychotherapy. Psychotherapy helps to address patients' concerns about problematic areas of their lives. These might include interpersonal conflicts, personal unhappiness, conflicts at work, difficulty in relationships, loss issues, or traumatic experiences. With treatment, patients are able to work through problems and gain a better understanding of themselves and their interactions with others in their lives. Through the Psychotherapy Clinic, residents receive training in individual, group, family and child psychotherapy. Sigmund Freud was the founder of Psychoanalysis which has evolved over time. Today there are many schools of psychotherapy theory and practice. For those who are seeking a longer and deeper experience, psychoanalysis remains a viable choice. Many of the Psychoanalytic Institutes across the country offer fully psychoanalytic training and shorter programs for certificates in advanced psychotherapy.

Learning and practicing psychotherapy is a valuable undertaking. It is a uniquely rewarding experience in which we see patients change and grow in their efforts to overcome psychological obstacles. WSU residents meet weekly with experienced psychotherapy supervisors in addition to receiving classroom didactics which emphasize history, theory and practice. Empathic listening and understanding of our patients enhance skills not only used in psychotherapy but in all areas of medicine.

Interested in rural and underserved populations in psychiatry?

Paulette Gillig, MD, PhD
Professor of Psychiatry

A few Psychiatry residencies, including Wright State, offer opportunities to work with patients who live in rural areas, or who are otherwise "underserved" (e.g. inner city populations, working-poor families, Native American persons etc.). We have trained residents in Champaign and Logan Counties for 14 years, and last year we expanded the program to the Middletown central city area in Butler County. These sites have become quite popular with our residents during the Community Psychiatry rotation and for electives, because the residents enjoy exposure to people from other cultural backgrounds (Mennonite, Appalachian, Amish, Hispanic), and also because the patients deeply appreciate the care they obtain from the residents. In addition, I think you can learn the most about providing evidence-based treatment when you work in an environment where resources are scarce, because you have to think very hard about what you are going to spend your money on, and in what order. There is a broad differential diagnosis (including organic causes for mental status changes) for any given patient you will see, in part because often no one else has examined the patient and figured out what is going on and also because most of these patients have many concurrent physical ailments. These facts immediately impose upon you the responsibility to order the appropriate laboratory studies and not order inappropriate studies, weigh risks and benefits of any treatment carefully, determine patient acuity at every appointment, and become aware of the training and competence of all of the other members of the treatment team. These team members will seek out and act on your advice about differential diagnosis, the interface with primary care providers, medication side effects, prognosis, and case formulations.

If you decide to work in a rural or underserved area after graduation, you will become a respected and trusted professional in that community, and you will never be forgotten by the people there (for better or worse). You sometimes can obtain student-loan repayment if you work in such an area after you finish residency, with some up to about $100,000. Please see the AAMC data base for more details: www.aamc.org/stloan

Boonshoft School of Medicine Faculty Available for mentoring

Brenda Roman, MD (general psychiatry) brenda.roman@wright.edu
Christina Weston, MD (child and adolescent psychiatry) christina.weston@wright.edu
William Klykylo, MD (child and adolescent psychiatry) william.klykylo@wright.edu
Terry Correll, DO (general psychiatry) terry.correll@wright.edu

 

Suggested Application Timeline* from Bak et al. "Applying to Psychiatry Residency Programs." Acad. Psychiatry. 2006; 30: 239-247

April–May

  • Plan fourth-year schedules with faculty advisors (assuming fourth year electives start in July; some schools start earlier, requiring earlier planning)
  • If considering externships at outside institutions, request applications Start reviewing FREIDA and program websites
  • Residencies: Update program’s website and brochures

June–July

  • Obtain application photograph
  • ERAS website opens; applicants may begin working on applications (around July 1)
  • Residencies: Graduation and welcome new PGY1 residents; review externship applications

August–September

  • Request letters of recommendation not obtained during the third year clerkships
  • Begin writing and editing personal statements
  • Registration opens for NRMP (around August)
  • ACGME accredited programs on ERAS begin accepting applications (around September)
  • Residencies: Prepare for NRMP and ERAS; review externship applications

October

  • Begin scheduling interviews
  • Complete fourth-year psychiatry electives by November, if possible
  • Residencies: Download applications from ERAS and invite a few applicants to interview; others will only be invited after the MSPE is reviewed.

November–December

  • MSPEs are released (around November 1)
  • Check that all application documents are available on ERAS
  • Continue the interview process and maintain communication with programs of interest
  • Applicant registration deadline for NRMP (around December 1) (late registration fee after deadline)
  • Residencies: Review MSPEs and put applications into categories (invite for interview, wait list for invitation, and reject). Send out bulk of invitations and schedule interviews as applicants respond. Some programs will start preliminary ranking and give feedback to applicants at some interval after the interview.

January

  • Complete last interviews; send thank you notes to training directors and others (optional)
  • Consider a ‘‘second-look’’ at top residency choices
  • Consider sending follow-up communications to training directors of top interest programs
  • Applicants and programs may begin entering rank list on NRMP website (around mid-January)
  • Residencies: Invite back some applicants if it is felt that the applicant or the program needs more information (these are not necessarily the top applicants). Some programs will invite top applicants for a dinner to ‘‘wine and dine’’, but many programs do not subscribe to this.

February–March

  • NRMP late registration deadline and deadline for applicants to certify their rank order lists (around mid-February) (NRMP staff will be available to answer questions during the final deadline hours)
  • Status of applicant as matched or unmatched is released (around mid-March, 3 days before Match Day)
  • Scramble for unfilled positions if applicant failed to match (around mid-March, 2 days before Match Day)
  • NRMP match results are available (Match Day, around mid-March)
  • Residencies: Formulate and submit rank list. Program(s) may or may not choose to let some applicants know how they anticipate ranking them.

*The activities of the residencies have been added alongside the student timeline for a contrasting perspective.

Sample Questions

Sample questions asked of applicants

  • Describe your strengths and weaknesses.
  • When, why, and how did you decide on going into psychiatry?
  • Describe your experience during your psychiatry rotations. If you did not receive the top grade, why not?
  • Describe an interesting case you have seen. What did you learn from this case?
  • Describe your educational history. Are there any gaps in your education? Were there any disruptions due to sickness, family illness, academic problems, disciplinary actions, or the like?
  • Explain any unusual information in your application, personal statement, Medical Student Performance Evaluation, recommendations, transcript, and test scores.
  • Why did you choose the college and medical school you attended?
  • What are the best methods by which you learn?
  • What are the important factors you are considering in psychiatry training, and why do you think our program would be a good fit?
  • How did you first learn about our program?
  • Are you interested in pursuing fellowship training after residency? Do you want to leave after PGY3 for a child and adolescent psychiatry fellowship?
  • What career plans do you currently envision?
  • Which geographic areas are you considering?
  • What questions do you have regarding our program?

Sample questions applicants ask of faculty or training directors

  • What do you see as the program’s strengths and weaknesses?
  • What are the qualities of the residents who thrive in this program?
  • How do the residents perform on the PRITE exam and psychiatry board exams?
  • What do your residents do after graduation? What percentages pursue fellowships, academics, and private practice?
  • What is the evaluation process for the residents and the program?
  • What is the balance between psychopharmacology and psychotherapy training?
  • How many hours per week of psychotherapy supervision do residents receive, and how is this organized?
  • What are the research and teaching activities for residents? Are they required?
  • What is the diagnostic, socioeconomic, and ethnic mix of the patient population?
  • What are the affiliated hospitals in which residents work, and how close are they?
  • What is the variety of clinical settings in which residents will be exposed? How much time is spent doing inpatient versus outpatient work?
  • May I have a list of the didactic seminars and elective rotations?
  • Which medical schools and colleges did your residents attend?
  • Do residents get an allowance for buying books and attending conferences?
  • Are modifications of the program likely; will there be changes in the psychiatry department or medical center that will impact the program?

Sample questions applicants ask of residents

  • What do you think are the program’s strengths and weaknesses?
  • Which other programs did you seriously consider?; Why and how did you rank this program?
  • Do you have any misgivings about your matching here?
  • What is the culture among the residents, and what is their relationship amongst themselves and with the faculty?
  • Have residents left the program? What do residents do after they graduate?
  • How much autonomy and oversight do residents have when making clinical decisions?
  • What are the on-call requirements, and what is that experience like?
  • How do you feel about the case conferences? Grand rounds? Elective rotations? Didactics? Is didactic time protected from clinical duties?
  • Do you have a resident process or support group? When is it and is this time protected?
  • How diverse is your clinical work and patient mix?
  • What type and how much psychotherapy exposure and supervision do you get?
  • Have adjustments been made in response to residents’ complaints regarding didactics or rotations?
  • Do residents engage in moonlighting jobs?
  • Where do residents live, and what are typical housing costs?
  • How are the accommodations (library, cafeteria, and sleeping rooms)?
  • Do residents have enough free time to continue doing the things they enjoy?

Characteristics to Consider in Evaluating Training Programs

  • Location
  • Balance of training in psychotherapy, psychopharmacology, and social psychiatry
  • Training in various clinical settings (e.g., forensic, student mental health, community) and health delivery systems (e.g., public sector, private hospital, academic, managed care)
  • Quality of psychotherapy training and supervision
  • Research opportunities
  • Administrative and teaching opportunities
  • Patient population • Program size
  • Teaching faculty quality and diversity
  • Residents’ quality, diversity, and background
  • Residents’ post-graduate career paths
  • Residency culture, morale, and quality of life
  • Residency director’s commitment to education
  • Salary and other benefits
  • On-call schedule
  • Moonlighting opportunities