Psychiatry Inpatient Rotation
Psychotic Disorders Unit
Medical Student Objectives, Competencies, and
Expectations
Welcome to the Psychotic Disorders Unit. We use an interdisciplinary team to
address acute psychiatric problems that typically are psychotic disorders. You’ll
see that each member of the treatment team has an area of expertise, so feel
free to ask anyone any questions that you have.
Objectives
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To become familiar with the psychiatric disorders experienced by adults
with prominent psychotic symptoms (schizophrenia, bipolar disorder, etc)
To understand and participate in the medical workup for psychotic
disorders
To learn how to interact with psychiatric patients and to perform the
mental status exam
To appreciate the multidisciplinary approach to treating psychiatric
disorders in an acute psychiatric hospital
To appreciate the pharmacotherapies, psychotherapies, occupational
therapy, recreational therapy, and social/environmental interventions we
use
To appreciate the importance of the family/support system in the
discharge planning for patients who have been hospitalized
Competency Building
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Skills in interviewing patients about sensitive topics such as psychosis,
substance use, physical/sexual abuse
Mental status exam skills in interviewing and in presentation
Obtaining collateral histories from family and other clinicians
Education of patients about diagnoses and medications
Communication skills in dealing with interpersonal conflicts
Further development of organizational skills in patient care, including
interview techniques, presentations and progress notes
Perform a basic safety evaluation of a patient and be familiar with
demographic and dynamic factors into this evaluation
Psychotic Disorders Inpatient Rotation, Medical Student Orientation
Kenan Penaskovic, MD 2011
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Expectations
Arrive 30 minutes before scheduled rounds
 Check in with you resident(s)
 Obtain vital sign graph, sleep log, and review daily labs
 Review your patients chart and note any prn medications administered
 Compile and update master patient list on the computer
Participate in Team Rounds
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Begin interview with your patients, focusing on their progress related to
chief complaint and discharge planning.
Ask about contact with family.
Attend Treatment Team
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Briefly present each of your patients
Facilitate input from treatment team members
Summarize the treatment plan for the day
After Team
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Clarify questions from team with resident/attending, staff, social work.
Work with residents on writing orders (use CPOE), following up on tests,
labwork, making contacts, etc.
Update the master patient list on the computer with new medications, labs,
and medical conditions
Participate in scheduled family meetings involving your patients.
See your patients to work on rapport building, supportive work, goal work,
safety plan, and history gathering.
Other Expectations
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We expect you to know your assigned patients well (current medications,
medical conditions, allergies, and family issues)
Document progress notes in WebCIS; have resident review for feedback.
Use time in the afternoons not spent with patients, groups, and families to
look up information on clinical topics of interest. You’re encouraged to
make a presentation to the team.
Psychotic Disorders Inpatient Rotation, Medical Student Orientation
Kenan Penaskovic, MD 2011
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Working with your patients
One of the biggest challenges in working with psychiatric patients is the
maintenance of careful boundaries. A few pointers:
 While empathy is important, avoid sharing your own personal experiences
with your patients.
 Meet with your patients where others can see you.
 Physical exams should be done in the treatment room with a chaperone of
the same gender of the patient.
 If you feel uncomfortable or confused about an interaction with a patient,
don’t hesitate to seek guidance from your resident or attending.
Student Safety
Most patients with mental illness are not randomly violent and in fact patients
with schizophrenia alone are not inherently more violent than the general
population. However, hospitalization and involuntary treatment can be a trigger
for some patients to feel threatened. On the unit student safety is our highest
priority. To that end students are not expected to play any role other than getting
to a safe environment if a patient does become agitated or aggressive. Please
allow the staff, trained to deal with these situations, to intervene. As prevention
is the first step in avoiding incidents we ask the students to follow some practical
suggestions.
Every one of us has a “spider sense” that alerts us when we feel uncomfortable
or threatened. We do ask students to listen to their “spider sense” when it comes
to dealing with patients and stop interviews if they feel the patient is becoming
agitated. Additionally, all physicals and interviews are to be completed with
another peer, staff member, or the resident present. We also recommend all
initial interviews be held in visible locations (interview rooms) as opposed to
individual patient rooms.
Forced Treatment:
One of the common themes prevalent on the psychotic unit is a lack of patient
insight or awareness of having a mental illness. If a patient becomes imminently
dangerous the situation becomes an emergency and one physician may order
forced medications. Some patients will just refuse treatment but never escalate
to an emergency. Non-emergent forced medications are used when it appears
the patient’s illness will not improve without medical intervention. When this
situation arises the treatment team will evaluate whether the patient has the
capacity to refuse treatment. If the team feels the patient lacks capacity, the
team will legally petition to have the patient placed in an involuntary status. The
staff will involve the patient’s next of kin in decisions and in getting two attending
physician signatures recommending non-emergent treatment be forced.
Psychotic Disorders Inpatient Rotation, Medical Student Orientation
Kenan Penaskovic, MD 2011
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Make use of these resources for your patients
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Safety Plans: summaries of their plans to manage new crises. The
patient can take these plans home as a reminder of what they have
learned during hospitalization.
Packets: Self harm, Anger management, Stress and anxiety,
Schizophrenia, etc. that the patient can read and fill out. They often
include worksheets that many patients find helpful. The National Institute
of Mental Health (NIMH) has great education packets for patients and
families.
Final Thoughts
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Your education is the priority while you rotate with us. Please be on time
to all scheduled educational activities and remind your resident if you need
to be excused to attend an event. This is expected!
Psychotic Disorders are by definition serious mental illnesses. They cut
across every social-economic class and greatly impact patients and
families. While you will rotate with very ill patients on the unit, not every
patient with a psychotic illness requires hospitalization or is in acute crisis.
Most of what our patients will tell us will be confidential and private.
Please respect the identifying information of your patients and do not
share with others unless the patient gives us written permission. The
important exceptions are issues that involve harm to self and/or others.
Psychotic Disorders Inpatient Rotation, Medical Student Orientation
Kenan Penaskovic, MD 2011
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