Psychiatry Clerkship Review
MEC subcommittee: 11/1/13
Members Present: John Dick MD – Chair; Paul Hannissian MD –OBGYN; Cathy Morrow, MD – FM;
Adam Weinstein, MD – Peds; Alison Holmes, MD – Peds; Nicole Beudoin, M.Ed; Chris Bolka; Matt
Duncan, MD – Psych; Julia Frew, MD - Psych
Framework for Review:
Geisel Competencies -> Course Learning Objectives -> Assessment of Learning -> Learning Activities
Course Description:
This is a 3rd year required clerkship. It consists of a 6-week block with 5 weeks of clinical time. They run
a one day orientation. The student rotates on one inpatient service and has weekly outpatient exposure.
Four sites used including DH, NHH, VA and CPMC.
Course Objectives (19)
Course Objective
Geisel Competency
How Assessed
Learning Activity
Demonstrate and
conduct a complete
psychiatric history with
emphasis on the mental
status examination.
2b, 2c
Attending and resident
observation and feedback
Clinical workflow – multiple
opportunities eg. Call,
inpatient rounds and outpt
clinic; orientation demo
Identify psychopathology
and formulate a
differential diagnosis and
a treatment plan.
2e
General clinical feedback
according to the RIME
framework and Geisel
competencies. Critical
Thinking seminar grade;
Write-ups (2)
Clinical workflow – multiple
opportunities eg. Call,
inpatient rounds and outpt
clinic; Critical Thinking
Discuss the biological,
social, intrapsychic and
behavioral aspects of
illness whether its
etiology and
development be medical,
1f, 4e, 4j, 4k
General clinical feedback
according to the RIME
framework and Geisel
competencies. Critical
Thinking seminar grade;
Clinical workflow – multiple
opportunities eg. Call,
inpatient rounds and outpt
clinic
emotional, or, as in most
cases, both
Demonstrate effective
and active listening to
patients
2a,2b,3b,4a,4c,4e,4j
General clinical feedback
according to the RIME
framework and Geisel
competencies.
Clinical workflow – multiple
opportunities eg. Call,
inpatient rounds and outpt
clinic
Develop effective and
therapeutic doctor
patient relationships.
2a,3a,3b,3c,3d,4a,4b
,4c,4d,4e,4f,4g,4j
General clinical feedback
according to the RIME
framework and Geisel
competencies.
Clinical workflow – multiple
opportunities eg. Call,
inpatient rounds and outpt
clinic
Recognize and list
different modalities of
psychiatric treatment
including cost,
availability, and
accessibility to patients.
1c,1d,1e,1f,6a,6b,6c,
6e,6g
Healthcare Systems
Reflection assignment
Clinical workflow – multiple
opportunities eg. Call,
inpatient rounds and outpt
clinic
Compare and contrast
the
appropriate/inappropriate
use of psychotropic
medication.
1d,3d,4c,6c,6h
General clinical feedback
according to the RIME
framework and Geisel
competencies. Health
care Systems Reflection
assignment
Critical Thinking, Rounds, and
Healthcare Systems group
discussion.
Communicate and work
effectively on an
interdisciplinary team.
3d,3e,3g,4k,6b
General clinical feedback
according to the RIME
framework and Geisel
competencies.
Clinical workflow – multiple
opportunities eg. Call,
inpatient rounds and outpt
clinic
Discuss the ?unique?
principles of ethical
conduct with psychiatric
patients.
3a,3d,4c,4d,4g,4k
Group discussion
and General clinical
feedback according to the
RIME framework and
Geisel competencies.
Lecture on capacity and
competency evaluations.
Healthcare Systems and
Resiliency group sessions
Acknowledge the
problem of stigmatization
1e,1f,4a,4c,4e,4g,4j,
4k
General clinical feedback
according to the RIME
framework and Geisel
Clinical workflow – multiple
opportunities eg. Call,
inpatient rounds and outpt
Also Healthcare Systems
Reflection assignment
of the mentally ill.
competencies. Health
care Systems and
Resilience Reflection
assignments.
clinic
Explain the relationship
between psychosocial
factors and behaviors
leading to ill health and
disability.
1f
General clinical feedback
according to the RIME
framework and Geisel
competencies. Health
care Systems and
Resilience Reflection
assignments.
Lecture on capacity and
competency evaluations.
Healthcare Systems and
Resiliency group sessions,
critical thinking and the
healthcare systems and
resiliency reflection
discussions.
Explain "the what, when,
and how" of appropriate
referrals.
3d, 3g
Clinical evaluation.
Clinical workflow – multiple
opportunities eg. Call,
inpatient rounds and outpt
clinic
1e, 1f, 3d
General clinical feedback
according to the RIME
framework and Geisel
competencies. Health
care Systems and
Resilience Reflection
assignments.
Clinical workflow – multiple
opportunities eg. Call,
inpatient rounds, groups and
outpt clinic.
General clinical feedback
according to the RIME
framework and Geisel
competencies. Health
care Systems and
Resilience Reflection
assignments.
Attend the IOP program.
Describe the different
kinds of treatment
services outside of the
medical center, such as
New Hampshire
Hospital, Alcoholics
Anonymous, day
hospital, community
outreach programs, and
so forth.
6a,6e,6f,6g,6j
Critical Thinking Seminars.
Clinical workflow – multiple
opportunities eg. Call,
inpatient rounds, groups and
outpt clinic.
Critical Thinking Seminars.
Discuss the impact of
family dynamics in health
and illness.
3c
General clinical feedback
according to the RIME
framework and Geisel
competencies. Health
care Systems and
Resilience Reflection
assignments.
Attend the IOP program.
Clinical workflow – multiple
opportunities eg. Call,
inpatient rounds, groups and
outpt clinic.
Critical Thinking Seminars.
Compare and contrast
the, techniques and
delivery of different
psychotherapies.
1d, 1e, 1f
General clinical feedback
according to the RIME
framework and Geisel
competencies.
Critical thinking seminar,
inpatient unit groups and
rounds, outpt clinic.
Critical Thinking Seminars.
Compare and contrast
the theoretical basis,
techniques and delivery
of different biomedical
treatment modalities.
1d, 1e, 1f
General clinical feedback
according to the RIME
framework and Geisel
competencies.
Lectures.
Critical Thinking.
General clinical work.
Observe ECT.
Critical Thinking Seminars.
Relate the difference
between competency
and capacity to make
medical decisions and
describe the process of
evaluation of capacity.
1e
.
3h
General clinical feedback
according to the RIME
framework and Geisel
competencies.
Critical Thinking Seminars.
Healthcare systems reflection.
1 hour lecture in this topic and
1 week on the C/L service
where this is a common issue
Ilios is missing info on specific goals of:
2) To become sophisticated in eliciting histories of alcohol and other drug use,
as well as developing intervention and management skills
3) To become comfortable and effective in taking histories of traumatic
experiences and become familiar with the variety of symptoms in which the
patient may present.
Essential Skills/Conditions
Year 3: PSYCHIATRY CLERKSHIP
ESSENTIAL CLINICAL
CONDITION (10)
Depression
Bipolar affective disorder
Mania, Hypomania
Schizophrenia
Psychosis, other
Post-Traumatic Stress Disorder
Anxiety Disorder
Personality disorder, borderline
Suicide attempt or ideation
Substance abuse, alcohol
Substance abuse, other
Delirium
LEVEL OF
STUDENT
RESPONSIBILITY
Manage with
supervision
Manage
Manage
Manage
Manage
Manage
Manage
Manage
Manage
Manage
Manage
Manage
CLINICAL
SETTING
Inpatient / Outpatient
% Students seeing at
least 1
100
Inpatient / Outpatient
Inpatient / Outpatient
Inpatient / Outpatient
Inpatient / Outpatient
Inpatient / Outpatient
Inpatient / Outpatient
Inpatient / Outpatient
Inpatient / Outpatient
Inpatient / Outpatient
Inpatient / Outpatient
Inpatient / Outpatient
100
99
99
100
100
100
100
100
100
100
92%
Perform
Perform
Perform
Perform
Perform
Perform
Perform
Inpatient / Outpatient
Inpatient / Outpatient
Inpatient / Outpatient
Inpatient / Outpatient
Inpatient / Outpatient
Inpatient / Outpatient
Inpatient / Outpatient
Perform
Inpatient / Outpatient
100
100
100
100
100
100
100
99
Perform
Inpatient / Outpatient
ESSENTIAL CLINICAL SKILL (10)
Perform HPI relevant to this clerkship
Mental status exam
Counsel Alcohol use and abuse
Counsel Depression/suicide
Counsel Life stressors
Counsel Substance abuse
Counsel Safety
Oral presentation of inpatient
admission
Written inpatient admission note
99
Written inpatient progress note
Perform
Inpatient / Outpatient
100
Learning Assessment Tools:
1) DMEDS – Assess progress on meeting essential skills and conditions
2) Essential Skills Competency Form – Students assessed as meeting level of skill expected of 3rd
year
3) Clinical Performance Evaluation Form – Competency based assessment, RIME metric, completed
by housestaff and faculty
4) NBME subject matter exam
5) 2 Clinical write ups
6) Resiliency Reflection
7) Health Care System Reflection
8) Critical Thinking Seminar – One write up
9) Mid-clerkship feedback form
Feedback:
The student’s receive mid-rotation feedback at with their designated attending faculty member.
Learning Environments / Activities
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Orientation – 1 full day
Ward and Clinic experience
o 4 weeks on on inpt service
o 1 week on consult/liaison service
o ½ day in clinic each week with paired attending (just DHMC)
Friday Didactic Sessions:
o 2 hours of didactics led by various faculty
o Resilience Module
 Readings, Reflection piece, discussion
o Health Care Systems Module
 student interviews patient/family prior and presents findings to group for
discussion
Thursday Critical Thinking Sessions:
o 1 hour per week
ECT AM – observation at DH x 1
Intensive Outpatient Program – Buck Road, Evening session x 1
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3 Call Exposures - DH
Self Study
o Textbook recommended
Friday Didactic Schedule
10/31 – 12/17
11/1/13
Bipolar Disorder - Dr. Duncan
11/8/13
Capacity Evaluations – Dr. Thakur
Psychopharmacology Review – Dr. Dahle
11/15/13
Depression – Dr. Holtzheimer
Schizophrenia – Dr. Noordsy
11/22/13
Women’s Mental Health – Dr. Frew
Substance Abuse – Dr. West
12/6/13
Resiliency Reflection
Child Psychiatry – Dr. Swartz & Dr. Savage
Health Care System Reflection
Sessions (Copied from Ilios)
1 Cognitive Behavioral Therapy - Case Based Discussion
5 Anxiety Disorders - Case Based Discussion
7 Depression - Case Based Discussion
8 Bipolar Disorder - Case Based Discussion
9 Capacity Evaluations - Lecture/Small Group
10 Psychopharmacolgy - Lecture/Small Group
11 Child Psychiatry - Case Based Discussion
12 Interviewing Course - Small Group
13 Ethics and Stigma Lecture
14 Diagnosis and Formulation Lecture- With Live Patient Interview - Small Group
15 ECT Lecture
16 Spirituality Lecture
17 Personality Disorders Case Based Discussion
18 Substance Abuse - Lecture/Small Group
19 Critical Thinking - Small Group Interactive Weekly Case Discussion Seminar
20 Active Learning and Reflecting, Including DMEDS and Setting Personal Learning
Goals
21 Direct patient care - Ambulatory and Inpatient - Clerkship
22 ED/Call - Clerkship
23 CRASH - Outpatient/Small Group
Site Comparability – See attached comparability grid
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Concerns / Actions
o
Course Planning
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Educational Team Structure
o One director, one assistant director
o One Clerkship Coordinator
Self –Review/ Planning Methods
o Weekly group
Method and Frequency of Coordination with Non-DH sites
o Yearly visit; email by block
Faculty Preparation
o Faculty training during visit
Resident Preparation
o CPMC resident prep – email; check with Winston
Clerkship Outcomes
NBME Shelf Scores
Avg NBME Raw Score
2010-11
2011-12
2012-13
Geisel: 84.6
Nat: 79.9
Geisel: 84.5
Nat: 80.2
Geisel: 82.78
AAMC GS 2013 Questionnaire
Student Feedback – See Attached Report
Recommendations for Ongoing Improvement
See attached report