At the conclusion of the clerkship students will:
- Recognize the tremendous importance of social and psychological factors in health and disease: physicians treat whole people, and whole people have problems which extend far beyond the organ system which brings them to attention.
- Appreciate that missing the mental health component of general-medical problems is a critical error; and that identifying the mental health component leads to better outcomes.
- Be capable of identifying and initiating appropriate medical/psychiatric interventions for mental illnesses that present in primary care
- Have advanced their skills of interviewing (competence is a life-long endeavor...)
- Be able to construct an appropriate psychiatric differential diagnosis for presentations of psychosis, mood disorder, and anxiety disorders
Patient Care (Problem Solving and Clinical Skills)
Students are expected to provide patient care that is compassionate, appropriate, and effective for the treatment of health problems and the promotion of health.
- Conduct an adequate interview, including recognition of behavioral phenomena as described in the psychiatric mental status examination
- Engage a patient and establish rapport
- Introduce and discuss sensitive material
- Understand some means of handling behavioral or emotional difficulties commonly encountered in the psychiatric interview
- Perform a psychiatric diagnostic workup, to include:
- Acquiring and organizing the psychiatric history
- Including appropriate components of a mental status exam in their interview and report
- Making decisions regarding further diagnostic studies
- Diagnose a patient based on clinical history and other information
- Present a patient with an assessment that includes psychological and social factors in the explanation of the patient's difficulties
Students are expected to demonstrate knowledge of established and evolving biomedical, clinical and social sciences.
- Describe the major psychiatric diagnoses as defined in the DSM (in transition, in 2013, from 4th to 5th edition)
- Explain the range of psychiatric interventional therapeutics,
- Indications for and possible side effects and complications of psychotherapies including fundamentals of behavioral and cognitive approaches; and some grasp of psychodynamic principles
- Indications for and possible side effects and complications of psychopharmacologic treatments
- Indications and appropriate selection for psychosocial interventions in primary care, including case management, crisis intervention, social work, occupational therapy and vocational counseling; and psychiatric hospitalization where needed.
- Identify a psychiatric emergency in the clinical setting, and describe the appropriate interventions in the primary care setting for immediate management or referral of the patient
- List the indications for a psychiatric referral or psychiatric consultation, and derive an understanding of the concept of a psychiatric liaison
Practice-Based Learning and Improvement
Students are expected to investigate and evaluate their patient care practices by appraisal and assimilation of scientific evidence.
- Formulate skills in assembling and integrating information relevant to patient care from multiple sources, including specialty information databases used in searches on psychiatric and psychological issues
- Recognize how these skills are a base for lifelong learning
Students are expected to demonstrate an awareness of the larger context and system of health care and effectively call on system resources to provide optimal care.
- Demonstrate respect for, and integrate the care of patients in the outpatient setting with all team members, including primary care or other physicians, psychotherapists, social workers, case management team members, and psychiatrists involved in the patient's care
- Understand the concept of a medical home and of the importance of delivering mental health services in that context
- Recognize the contributions of the various team members and understand how psychologists and psychiatrists fit into that team.
Interpersonal and Communication Skills
Students are expected to effectively communicate and collaborate with patients, their families and health professionals.
- Exhibit the ability to engage a patient in a respectful and empathetic fashion (long live Carl Rogers)
- Roll with resistance; and to some degree utilize other motivational interviewing skills such as developing discrepancy and eliciting change talk
- Recognize and manage personal reactions and responses to the patient that may detract from an appropriate professional relationship that may include excessive sympathy, anger, rejection, fear, or emphasis on interpersonal control
Students are expected to demonstrate a commitment to carrying out professional responsibilities, and to be responsive and compassionate.
- Describe the details and reasons for care of medical confidentiality in the mental health matters; and release-of-information procedure, including responding to family queries when no release of information has been signed
- Demonstrate appropriate professional interpersonal boundaries in the context of the intense relationship issues which arise in interviewing patients with mental health problems