4a. Psychiatry Curriculum

 

PSYCHIATRY

 

Course title	Psychiatry
Course type	Core rotation
Duration	6 weeks
Major hospital sites	Mercy Medical Center, Rockville Centre, NY Jackson Park Hospital, Chicago, IL
Clinical chair Assistant chair	Dr. Ronald Brenner Dr. Sumeet Singh

TABLE OF CONTENTS

 

1. Course Overview 
2. Course Description 
3. Course Objectives
4. Clinical skills training – Guidelines by AAMC 
5. Linkage with XUSOM educational objectives
6. Overall curriculum
7. Learning resources

 

CLINICAL CHAIR: DR. RONALD BRENNER
ASSISTANT CLINICAL CHAIR: DR. SUMEET SINGH

1. COURSE OVERVIEW:

COURSE	Psychiatry Core Rotation
LENGTH	6 weeks
METHODS OF EVALUATION	Attendance Attitude, professional behavior, Patient evaluation, case presentation and summaries [written and oral] Knowledge of differential diagnosis, initial and ongoing therapies Technical skills, where required Oral and written quizzes NBME Clinical clerkship examination Mid-course [three week] formal feedback session [not part of final grade]
GRADING	75% - Preceptor Evaluation 10% - Logs 10% - Final Examination [NBME] 5% - Attendance Notes: A minimum passing grade on each area listed above is required to receive a final grade. No grade will be given until complete clinical logs and multimedia assignments have been completed and submitted
On-call	No more than two times per week

Note: See the XUSOM Academic Policies and Procedures Manual for students for information on overall academic and financial policies governing all rotations.

2. COURSE DESCRIPTION:

The clerkship in Psychiatry familiarizes the student with the psychological aspects of human behavior in health and disease, and the diagnosis and management of psychiatric interviews and on performing mental status examinations. The student observes interviews and conducts psychiatric examinations under supervision.

During the clinical rotations, students spend a period of time on an inpatient psychiatric service where they apply the training received under supervision of house staff and clinical faculty. In most instances students also receive experience with outpatient psychiatry, child psychiatry, and substance rehabilitation programs.

This course will be taught through a series of lectures, group discussions, observation, Grand Rounds, clinical/hospital interaction, assignments, and case studies under the direction of the doctors and/or senior residents at the hospital, clinic, or private office. Students will further demonstrate knowledge of the core through completion of case studies and assignments as determined by the doctors and/or senior residents.

3. COURSE OBJECTIVES:

Upon successful completion of this course the student will be able to:

• Conduct an adequate psychiatric examination that is compassionate, appropriate, and effective in children, adolescents and adults including the geriatric population;
• Understand the diagnostic requirements for the common psychotic and affective disorders, in order to be able to provide a reasonable differential diagnosis for each patient [DSM-5];
• Identify common psychiatric emergencies and reasons for involuntary commitment;
• Describe the standard treatment for the common psychiatric disorders, in order to be able to develop an initial treatment plan;
• Identify and describe the common side effects of frequently used drugs and other treatment modalities in psychiatry;
• Understand the association between psychiatric and other illnesses;
• Understand the relationship of psychiatry to medical practice;
• Realize the importance of a professional and compassionate doctor/patient/family relationship and to develop the necessary skills for this.

 

4. OBJECTIVES OF CLINICAL SKILLS TRAINING (MODIFIED AND ADOPTED FROM ASSOCIATION OF AMERICAN MEDICAL COLLEGE (AAMC) GUIDELINES FOR UNDERGRADUATE MEDICAL EDUCATION (UME):

1. The ability to understand the nature of, and demonstrate professional and ethical behavior in, the act of medical care. This includes respect, responsibility and accountability, excellence and scholarship, honor and integrity, altruism, leadership, cultural competency, caring and compassion, and confidentiality.
2. The ability to engage and communicate with a patient, develops a student-patient relationship, and communicate with others in the professional setting, using interpersonal skills to build relationships
3. For the purpose of information gathering, guidance, education, support and collaboration.
4. The ability to apply scientific knowledge and method to clinical problem solving.
5. The ability to take a clinical history, both focused and comprehensive.
6. The ability to perform a mental and physical examination;
7. The ability to select, justify and interpret selected clinical tests and imaging;
8. The ability to understand and perform a variety of basic clinical procedures;
9. The ability to record, present, research, critique and manage clinical information.
10. The ability to diagnose and explain clinical problems in terms of pathogenesis, to develop basic differential diagnosis, and to learn and demonstrate clinical reasoning and problem identification;
11. The ability to understand and select clinical interventions in the natural history of disease, including basic preventive, curative and palliative strategies
12. The ability to understand and to formulate a prognosis about the future events of an individual’s health and illness based upon an understanding of the patient, the natural history of disease, and upon known intervention alternatives.
     

5. LINKAGE WITH THE EDUCATIONAL OBJECTIVES OF XUSOM:

XUSOM Educational objective	Course objectives	Learning methods	Assessment methods
The Science and Practice Of Medicine Apply scientific principles and a multidisciplinary body of scientific knowledge to the diagnosis, management, and prevention of clinical, epidemiologic, social and behavioral problems in patient care and related disciplines. Understand the variation in the expression of health and disease through critical evaluation of both patients and the scientific literature. Apply knowledge of study design and statistical methods to the appraisal of clinical studies and other information on diagnostic and therapeutic effectiveness	Understand the diagnostic requirements for the common psychotic and affective disorders, in order to be able to provide a reasonable differential diagnosis for each patient [DSM-5] Identify and describe the common side effects of frequently used drugs and other treatment modalities in psychiatry	Lectures Group discussions Observation Grand rounds Clinical/hospital interaction, Assignments Case studies	Preceptor Evaluation Log books Multimedia assignments On-call evaluation
Clinical Competence Obtain a sufficient level of medical knowledge to understand the basic facts, concepts, and principles essential to competent medical practice. Exhibit the highest level of effective and efficient performance in data gathering, organization, interpretation and clinical decision making in the prevention, diagnosis, and management of disease. Communicate effectively using caring and respectful behaviors when interacting with patients, families and members of the health care team. Perform all technical procedures accurately and completely, to the extent considered essential for the area of practice and level of education Understand and appropriately use medically related information technology Effectively use the resources of the entire health care team in treating disease, preventing future health problems and maintaining the health of individuals	Conduct an adequate psychiatric examination that is compassionate, appropriate, and effective in children, adolescents and adults including the geriatric population	Lectures Group discussions Observation Grand rounds Clinical/hospital interaction, Assignments Case studies	Preceptor Evaluation Log books Multimedia assignments On-call evaluation
The Social Context Of Medicine Understand and respond to factors that influence the social, behavioral, and economical factors in health, disease and medical care working to be able to provide care that is of optimal value. Advocate for quality patient care and assist patients in dealing with system complexities Begin to understand the complexities of the entire health care practice and delivery system, managers, payers, providers, organizations and bureaucracy in defining access, cost, value and outcomes	Identify common psychiatric emergencies and reasons for involuntary commitment	Lectures Group discussions Observation Grand rounds Clinical/hospital interaction, Assignments Case studies	Preceptor Evaluation Log books Multimedia assignments On-call evaluation
Communication Demonstrate effective and compassionate interpersonal communication skills toward patients and families necessary to form and sustain effective medical care. Present information and ideas in an organized and clear manner to educate or inform patients, families, colleagues and community. Understand the complexity of communication including non-verbal, explanatory, questioning and writing in a culturally appropriate context	Describe the standard treatment for the common psychiatric disorders, in order to be able to develop an initial treatment plan;	Lectures Group discussions Observation Grand rounds Clinical/hospital interaction, Assignments Case studies	Preceptor Evaluation Log books Multimedia assignments On-call evaluation
Professionalism Display the personal attributes of compassion, honesty and integrity in relationship with patients, families, and the medical community. Adhere to the highest ethical standards of judgment, conduct and accountability as each applies to the health care milieu. Demonstrate a critical self-appraisal in his/her knowledge and practice of medicine, as well as received and give constructive appraisal to/from patients, families, colleagues and other healthcare professionals. Demonstrate a commitment to ethical principles pertaining to provision or withholding of clinical care, confidentiality of patient information, informed consent, and business practices Demonstrate sensitivity and responsiveness to patients’ culture, age, gender and disabilities	Realize the importance of a professional and compassionate doctor/patient/family relationship and to develop the necessary skills for this	Lectures Group discussions Observation Grand rounds Clinical/hospital interaction, Assignments Case studies	Preceptor Evaluation Log books Multimedia assignments On-call evaluation
Lifelong Learning Understand the limits of personal knowledge and experience and demonstrate the intellectual curiosity to actively pursue the acquisition of new scientific and clinical knowledge and skills necessary to refine and improve his/her medical practice, assure excellent care of patients, or to contribute to the scientific body of medical knowledge throughout a career. Understand the concepts of analyzing practice experience and perform practice-based improvement activities using a systematic methodology Understand methods to obtain and use information about their own population of patients and the larger population from which their patients are drawn	Understand the association between psychiatric and other illnesses;  Understand the relationship of psychiatry to medical practice	Lectures Group discussions Observation Grand rounds Clinical/hospital interaction, Assignments Case studies	Preceptor Evaluation Log books Multimedia assignments On-call evaluation

 

6. OVERALL CURRICULUM:

Note to the student:

• This is a suggested weekly curriculum undertaking a minimum of two modules or topics per week.
• By the end of the rotation, the student should have covered all topics listed.
• The individual preceptor, based on scheduling, patient population and other factors may alter the order of the topics or assignments.
• In addition, the student should complete all Skills Modules
• At the end of week 3, the student should request a formal feedback session from the preceptor on their progress.
• At the end of week 4, or beginning of week 5, the student should ensure that Comprehensive Examination has been scheduled.

Week 1:

• An introduction to Psychiatry.
• Principles of Diagnosis.
• Emergency and Acute care.
• Suicidal Ideation.
• Homicidal Ideation.
• Neuroleptic Malignant Syndrome.
• Mood Disorders.
• Major Depressive Disorders.
• Major Depressive Episode.
• Dysthymic Disorder.
• Seasonal Affective Disorder.
• Manic Episode. Bipolar Disorder.
• Mood Disorder Due to a Medical Condition.

Week 1 Assignments

Waldinger – Chapters 1, 2, 3, 4, 6, 15, 16
Access Medicine Psychiatry Case Files - #21, #9, #10, #12, #13, #15, #7, #14

Week 2: 

• Anxiety Disorders.
• Panic Attacks.
• Panic Disorder.
• Specific Phobia.
• Social Phobia.
• Acute Stress Disorder.
• Posttraumatic Stress Disorder.
• Generalized Anxiety Disorder.
• Obsessive-Compulsive Disorder.
• Anxiety Due to a General Medical Condition.
• Eating Disorders

Week 2 Assignments

Waldinger – Chapters 8, 12, 17, 18
Access Medicine Psychiatry Case Files - #25, #20, #28, #22, #23, #18, #19, #17, #16

Week 3:

• Schizophrenia and Other Psychotic Disorders.
• Schizophrenia.
• Schizophreniform Disorder.
• Schizoaffective Disorder.
• Delusional Disorder.
• Brief Psychotic Disorder.
• Shared Psychotic Disorder (Folie a Deux) Medical Condition.
• Personality Disorders.
• Cluster A Personality Disorders.
• Cluster B Personality Disorders.
• Cluster C Personality Disorder

Week 3 Assignments

Waldinger – Chapters 5, 7
Kaplan and Saddock – Chapter 23
Access Medicine Psychiatry Case Files - #49, #50, #57, #53, #52, #55, #51, #56, #5, #48, #6, #54, #31, #32

Week 4: 

• Substance-related Disorders.
• Substance Intoxication.
• Substance Abuse.
• Substance Dependence.
• Substance Withdrawal.
• Alcohol-related Disorders.
• Caffeine-related Disorders.
• Cannabis-related Disorders.
• Nicotine-related Disorders.
• Cocaine -related Disorders.
• Amphetamine Related Disorders.
• Opioid-related Disorders.

Week 4 Assignments

Waldinger – Chapters 11, 14, Appendix B, D, E
Access Medicine Psychiatry Case Files – #38, #43, #45, #44, #59, #40, #39, #11, #41, #42

Week 5:

• Sleep Disorders.
• Stages of Sleep.
• Insomnia.
• Sleep Apnea Syndrome.
• Narcolepsy.
• Circadian Rhythm Sleep Disorder.
• Parasomnias.
• Somatoform and Factitious Disorders,
• Somatization Disorder.
• Conversion Disorder.
• Hypochondriasis.
• Factitious Disorder.

Week 5 Assignments

Waldinger – Chapter 8
Access Medicine Psychiatry Case Files - #27, #33, #30, #34, #60, #35, #29

Week 6: 

• Sexual and Gender Identity Disorders.
• Sexual Dysfunctions.
• Paraphilias.
• Gender Identity Disorders.
• Other Common Psychiatric
• Disorders.
• Adjustment Disorder.
• Dissociative Disorder.
• Delirium. Dementia.
• Child Psychiatry.
• Mental Retardation.

Week 6 Assignments

Waldinger – Chapters 9, 10, 12, 13
Access Medicine Psychiatry Case Files –#24, #3, #2, #8, #37, #26, #46, #58, #36, #47, #1, #18, #4

 

 

7. LEARNING RESOURCES:

REQUIRED READING

 

Psychiatry for Medical Students, Third Edition, Robert J. Waldinger.
URL to purchase book - http://www.amazon.com/Psychiatry-Medical-Students-Robert- Waldinger/dp/0880487895/ref=sr_1_1?ie=UTF8&qid=1456851820&sr=8- 1&keywords=Psychiatry+for+Medical+Students+waldinger OR Free PDF link (without chapter numbers) - http://brain101.info/Psychiatry.pdf

2. Synopsis of Psychiatry, Tenth Edition, Kaplan & Saddock
URL to purchase book - http://www.amazon.com/Kaplan-Sadocks-Synopsis-Psychiatry- Behavioral/dp/078177327X

SUPPLEMENTAL OR ALTERNATIVE READING

 

3. American Journal of Psychiatry

4. Archives of General Psychiatry

5. European Psychiatry

6. Journal of Clinical Psychiatry

7. Journal of Psychiatry

8. Diagnostic and Statistical Manual of Mental Disorders, 5th Edition Washington D.C. American Psychiatric Association