Psychiatry Curriculum – Students will have to learn and be tested on the following information laid out in the curriculum*. All information can be accessed in the resources and lecture videos listed below the curriculum.
I. LEARNING OBJECTIVES
1. Students should develop respectful attitudes toward patients with psychiatric disorders, and be able to connect with their underlying humanity.
2. Students should demonstrate effective communication strategies and professional behaviors with patients, families, and other members of the team caring for the patient.
3. Students should understand the importance of self-reflection. Students should understand how to identify and manage their internal feelings (countertransference) while retaining a therapeutic stance towards their patients.
4. Students should understand the importance of self-reflection with patients at the end-of-life.
5. Students should pay attention to and be able to discuss issues of professional boundary management in the context of the doctor-patient relationship.
Skills
1. Students should evaluate a variety of patients with core psychiatric disorders in a variety of intensive care and medical settings. Students should have exposure to patients with less severe presentations of mental illness and the opportunity to see patients living successfully despite having a mental illness.
2. Students should be able to conduct a psychiatric screening interview including chief complaint, history of present illness, past medical history, past psychiatric history, family history, social and developmental history and mental status examination.
3. Students should develop comfort in being able to interview a patient at the end-of-life and interact with the patient’s family and the patient’s caregivers.
4. Students should be able to demonstrate mastery of the format of the mental status examination and be able to present individual patient findings from the mental status examination in that format.
5. Students should be able to present pertinent initial history, physical examination, and mental status examination in morning work rounds and be able to present pertinent changes in their patient’s during subsequent work rounds.
6. Students should be able to write patient data and review pertinent laboratory and other diagnostic findings in the usual medical format.
7. Students should be able to write a bio-psycho- social formulation and a broad multi-axial differential diagnosis.
8. Students should be able to write a treatment plan for the patient, including plans for further evaluation to test various diagnostic possibilities.
9. Students should be able to write progress notes reflecting pertinent changes in their patient in the patient’s chart.
10. Students should be aware of the scientific literature in psychiatry and be able to apply it in the care of their patients.
11. Medical students should have the skill of motivational interviewing to aid in counseling their patients.
Knowledge
1. Students should know the major DSM-IV signs and symptoms for the following disorders and be able to apply these major criteria in diagnostic interviews. Students should be able to apply the full DSM-IV criteria for the following disorders when developing a differential diagnosis for their patient write-ups:
A. ADHD/Learning Disability
B. Adjustment Disorder
C. Autism/Pervasive Developmental
Disorders
D. Bereavement/Complicated Bereavement E. Bipolar Disorder
F. Borderline Personality Disorder
G. Delirium
H. Dementia
I. Dysthymic Disorder
J. Generalized Anxiety Disorder
K. Major Depressive Disorder
L. Obsessive Compulsive Disorder
M. Panic Disorder
N. Post-Traumatic Stress Disorder
O. Schizophrenia
P. Somatization Disorder
Q. Substance Abuse & Dependence
R. Substance Intoxication & Withdrawal
2. Students should recognize which common medical disorders and medications may contribute to the onset or worsen the course of the above disorders, and include these in their presentations and patient write-ups.
3. Students should be able to state the indications, mechanism of action (where known), and major side effects of the following somatic treatments:
- Antipsychotics (both typical agents and atypical agents)
- Antidepressants (selective serotonin reuptake inhibitors, tricyclicantidepressants, and monoamine oxidase
inhibitors)
- Benzodiazepines
- Mood stabilizers (Lithium, valproate, carbamazepine)
- Medications for Substance Abuse (Antabuse, Clonidine, Methadone)
- Electroconvulsive Therapy
4. Students should be aware of the evidence-base for the efficacy of CBT. Students should understand psychodynamic approaches to treatment. Students should be aware of other complementary modalities like hypnotherapy.
5. Students should have supervised experience in the evaluation and treatment of patients in crisis, often with suicidal ideation.
6. Students recognize medico-legal implications of involuntary hospitalizations, obtaining informed consent in a patient with a psychiatric disorder, and confidentiality issues.
II. IMPLEMENTATION
The objectives of the clerkship in psychiatry will be met in the following manner:
1. Patient Evaluation
Patient evaluation and work with treatment team is the central experience of the clerkship in Psychiatry. During both the “Patients in Crisis” and “Interface with Medicine” components, students should evaluate and follow at least 2-4 patients each week.
Each work-up should include:
- INTERVIEW OF THE P A TIENT
Students should progress from observing interviews to eventually performing interviews independently. Initial interviews may be conducted in collaboration with an experienced faculty member or resident acting as tutor or clinical preceptor in the same room with the student. Students should continue to seek direct supervision if they or faculty deem this appropriate or if the patient’s state suggests direct supervision is indicated. - MENTAL STATUS EVALUATION
The mental status evaluation should assess mood, affect, psychotic ideation, thought disorder, suicidal and homicidal ideation, insight/judgment and a full cognitive exam. - PHYSICAL EXAMINATION
The initial physical examination, including neurological examination, should be supervised by a physician who is able to bear medical responsibility for the patient. The write-up of findings should be checked and reviewed with the student by an experienced resident or faculty member. The student should be aware that conducting a physical exam may have unintended meaning for patients and always have another person present for a full physical examination. If parts of the PE are deleted the student should understand the rationale for not carrying out the examination. - COLLATERAL INTERVIEW
A collateral interview with family or significant others is conducted whenever possible to corroborate findings and to aid in treatment planning. Other team members will usually also participate in collateral interviews. - WRITTEN PRESENTATION
Students should collaborate with attendings and residents to complete initial and follow-up progress notes on patients they are following.
Each student should work with at least one patient from each of the following diagnostic groups:
1. Cognitive Disorder
2. Mood Disorder
3. Personality Disorder
4. Psychotic Disorder
5. Substance Use Disorder
*Psychiatry Curriculum – This curriculum is a curriculum formed by the Yale School of Medicine.