Curricular Resources for Child Psychiatry Training in Medical Student
Education
Steve Schlozman, M.D.
I. Formal Child Psychiatry Lecture and Tutorial Experience
A. Mandatory as part of the general psychiatry course that occurs in second
year of medical school
B. Second year course in general psychiatry has multiple functions
1. To teach students about specific psychiatric presentations
2. To introduce students to what we can comfortably surmise about
the pathophsyiology of the illnesses we treat.
3. To introduce students to the role of the psychiatrist in the world of
medicine.
4. To make students more comfortable with interviewing designated
psychiatric patients
5. To make students aware of the prevalence of psychiatric illness in
patients who are seeing their physicians in all clinical settings
C. These multi-faceted goals allow us to devote one of the 7 formal lectures
and one of the 7 formal tutorials that comprise the general psychiatry course
entirely to child and adolescent psychiatry
D. We therefore introduce the topic of child and adolescent psychiatry after
we have covered many of the formal psychiatric disorders that they are likely
to encounter and that have their onset in adolescence (mood disorders,
anxiety disorders)
E. Format – we show a videotaped session of an actual and consented-forteaching interview of an adolescent patient who has been hospitalized but is
currently in outpatient psychotherapy and treatment. We use this video as
the scaffolding of the lecture. The clinician who conducts the interview on
video is present and can tell the students how the patient is doing currently
and what changes have been made to her treatment. This allows us as well to
stress the importance of inpatient, outpatient, psychotherapy, and
psychopharmacological treatments in child patients
1. Patients suffers from Mood Disorder NOS, ADHD, and significant
psychosocial stressors. Each of these issues are dealt with both as
separate but intertwined issues
2. These diagnoses and the patient’s description of her symptoms
allow a three-pronged lecture approach:
1 . We interrupt the video at pre-determined times.
i. after first break of video, we discuss normal
development (here, a review from their earlier
development class) and then places where the patient’s
development may been theoretically derailed
a. ATTACHMENT
b. IMPORTANCE OF DEVELOPMENTAL
TRAJECTORY
c. DEVELOPMENTAL PSYCHOPATHOLOGY
d. HOW ONE MIGHT ELICIT THESE ISSUES IN A
PATIENT INTERVIEW
ii. after second break, we cover content
a. DEFINE ADHD
b. DEFINE PEDIATRIC MOOD DISORDERS
c. DISCUSS PEDIATRIC SUICIDALITY
d. DISCUSS TREATMENTS
e. PRESENT EVIDENCE FOR THESE
TREATMENTS
f. DISCUSS PATHOPHSYIOLOGY AS IT RELATES
TO THE RAPIDLY DEVELOPING BRAIN
iii. after third break
a. note that regression towards earlier
developmental crises is common in medicine
b. present a very concrete toolbox for how one
might take issues that are germane to child
psychiatry and apply them to all patient
encounters regardless of age or reason for
seeing the doctor
E. On tutorial, students then go to three to five different settings and interview at
least two patients per three students. This means three students will elect one of
the three to conduct the interview with faculty supervision
F. Assessment
1. Patient write up in the form of a mental status exam, a developmental
assessment and a formulation with proposed treatments
2. Specific questions on the final exam that are directly related to the material
presented in class
G. CAVEAT: our students just don’t read that much. They study very closely what we
show them, but they tend to gloss over the assigned reading. WE THEREFORE TEST
THEM PRIMARILY ON WHAT WE CAN SHOW THEM IN CLASS
H. CAVEAT: we tell our students that we can’t possibly cover all of child psychiatry
in one lecture, and we make ourselves actively available for further shadowing
opportunities or research opportunities.
J. CAVEAT: we have learned that very few students and indeed very few nonpsychiatrists know what one does to become a child psychiatrist, or know the
breadth of what child psychiatrists do. We make this material very concretely
available at the beginning of the lecture.
II. Formal Electives
A. We offer a number of formal and structured 4th year experiences
B. These involve inpatient, outpatient, research, emergency, school and C/L
settings; most are 4 weeks in duration. Some are two weeks
C. We also allow a formal independent project to be designed with faculty
mentorship in child psychiatry
III. Clerkship Experiences
A. We have a 4-week clerkship in psychiatry. To date, we have not been
successful in extending that time
B. That time is split between C/L and inpatient mostly, with students who
want to having the opportunity to shadow faculty in clinic. Some students
will ask specifically to shadow a child psychiatrist in clinic or on C/L
rounds, and we can virtually meet that request
C. There is one formal lecture during the clerkship that attempts to
summarize child psychiatry as it relates primarily to the kids they see
when they take call in the EW
IV. Student Interest Group Topics
A. The psychiatry student interest group is active and often has its largest
draw (as many as 40 to 60 students, well fed on the lunch that we provide
as a bold faced incentive to show-up) when the topics involve child
psychiatry. Successful topics have included:
1. Child Psychotherapy
2. Controversies in Psychopharmacology
3. Eating Disorders
4. Child Forensic Issues
5. Advocacy
B. When possible, we team up with other student interest groups. For
example, there was a very successful forum on substance abuse among
youth that involved different approaches from pediatrics, adolescent
medicine, and child psychiatry
V. Final Thoughts
A. Every medical school class has former teachers and/or guidance
counselors or something similar. Many of them are looking for ways to
continue something akin to the work they were doing but as physicians. We
actively seek those students and simply offer to talk with them.
B. We very actively tell the students how much fun, and how hard we work,
as child psychiatrists. The message we’re aiming for is the experience we all
have that the hard work is made possible by the fun and the reward. This is
of course no different from the rest of medicine, but the barriers to
embracing psychiatry, and perhaps especially child psychiatry, are nuanced
and tricky. This approach seems to help with those barriers
C. REMEMBER: this is one of the few topics that many of the students will
have had some experience already as patients or siblings/friends etc as
patients. Some of those experiences will have been great and some not so
great. Encouraging discussion around these issues and acknowledging
these realities has proved helpful in fostering discussion.