Objectives of the Psychiatry Clerkship

The primary objective of the clerkship in psychiatry is to become skilled in evaluating patients primarily identified as having psychiatric symptomatology. These are patients under the clinical care of psychiatrists. A secondary, but parallel objective is to be able to integrate this knowledge when evaluating any patient, integrating the mental status examination in your general framework of clinical care.
   
 

EDUCATIONAL GOALS:

1. To learn patient interviewing technique to elicit a thorough history appropriate to "psychiatric" chief complaints and conditions; addressing both pertinent "positives" and "negatives."

2. To learn in interviewing techniques to include a "mental status exam" component. In actual practice the "mental status exam" is a portion of the presentation of a case and combines both observed and formally elicited elements that have taken place during a patient interview.

3. To learn in your patient interviews (and presentations) to be mindful of the many critical "medical" and "neurologic" conditions that present with "psychiatric" symptomatology. For example, you must learn to distinguish deliria and dementias from the classically distinct psychiatric disorders, such as the schizophrenias and bipolar disorders -- the latter disorders, unlike the deliria and dementias -- are solely in the domain of psychiatry rather than considered medical or neurological conditions.

4. To learn in your patient interviews (and presentations) to be conspicuously mindful of and elicit a history appropriate to the issues of suicide, homicide, substance abuse, violence, and child abuse and neglect.

5. To learn in your patient interviews (and presentations) to be informed by a working knowledge of the psychopharmacologic principles and "first-line" psychotropic agents applicable to the treatment of the schizophrenias and related psychotic disorders, the mood disorders, and the anxiety disorders (as a minimum list), including the side effects and toxic effects of these agents.

6. To be able to integrate your historical material, interview material, observations, and review of past medical records into a readable and comprehensive write-up. This would include some literature references to answer some question you pose for your particular patient.

  
   
 

EVALUATION OF OBJECTIVES:

• Your knowledge base learning in the clerkship experience and in your reading will be tested in an exam purchased and graded by the National Board of Medical Examiners, which is given on the last day of the clerkship. These tests have consisted of 100 multiple choice or matching questions (2 hours 10 min allotted) and span the full gamut (as per the Board) of "psychiatry" information. The Board has been less than forthcoming in providing summary information as to the content of these exams. There are a number of study guides listed in the Readings section.

• A departmentally designed essay examination (45min allotted) will be administered the same morning as the NBME exam.

• The Preceptor of the clerkship at your assigned site will, in addition to his or her own impressions of your skills, knowledge, and attitudes, solicit evaluations from your clinical supervisors and co-workers. These input, especially those from your "primary" clinical assignment, will weigh greatly in the assessment of your attainment of the above goals and the criteria listed on the standard clerkship evaluation form.

• Another method for evaluating the achievement of the above objectives will be a formal, faculty- observed clinical interview of a patient which will be conducted towards the close of the clerkship. Your performance on this exam will be included in your final narrative evaluation from the clerkship. The observed clinical encounter will contribute to your overall clerkship grade.

• One write-up of those that you are asked to do at your site will be an exercise in evidence based practice in psychiatry. A question is to be asked by you, of some clinical aspect of the patient. You are to answer this question in a 2-page addendum to your write-up using 2-3 references from the literature. This particular write-up may also be eligible to be entered in The Maurice Greenhill Memorial Award competition at the end of the 3rd year.

MID-CLERKSHIP FEEDBACK :
A mid-clerkship feedback session is conducted to review your experience during the Psychiatry Clerkship. A form is signed by faculty member and student.