How The Psychiatry Clerkship Works
Summary: Again, welcome. Please ask questions when in doubt. Here's an outline of key features of the rotation.
Oh, and before we start: please email Drs. Lindsey and Phelps with the best
way to reach you quickly during this rotation: cell or text, number?
Email to llindsey and jphelps at samhealth.org, please. Thank you!
We expect that about two thirds of your day should be involved in some sort of patient care: either providing it yourself, or watching someone else do so from whom you can learn. The remaining one third of the day is available to you for reading and pursuing any learning issues that you've identified (a burning question sparked by your work with and observations of patients) or projects you've gotten involved in. As you'll discover, there's a lot to read and consider. You're expected to do some of this work outside of clinic hours.
Unless other arrangements have been made, start each morning by checking in with your supervisor (Health Psychologist or Attending Psychiatrist) regarding the day's schedule. You will:
Maps and Direction
As you see patients with a given diagnosis, put a check-mark alongside that diagnosis on your Map. Similarly, when you see a patient being prescribed a new medication you've not encountered before, look it up and compare the PAR you hear the doctor give to the Up-to-Date presentation, or other similar reference (e.g. warnings, contraindications, common side effects, starting dosage and titration), then put a check-mark alongside that one on your Medication Map. Thus you'll have an ongoing quick reference for what you've seen and what you've not seen yet. One of your colleagues made a table of dosing/side effects/warnings-considerations for each major class and filled that in for specific medications as she went along; consider that.
Primary Care and Specialty Clinics
You will be given a schedule for the first two weeks as you begin the rotation, indicating the clinic where you'll be expected, on what day, and who your supervisor will be for those days. If in doubt, look for the Health Psychologist at the Primary Care Clinic or the Attending Psychiatrist at Samaritan Mental Health.
On Tuesday and Friday mornings you'll go instead to a psychiatric setting which will be noted in our first emails to you. These include Child, Inpatient Consult/Liason, Outpatient Consult/Liason and follow-up, Linn County Mental Health, and Samaritan's psychiatric inpatient unit.
Nevertheless, our hope is to provide you with multiple opportunities to interview patients and apply some of what you're learning about basic psychotherapies. We will help you expand your ability to connect to patients as you gather information; and do so using good reflective listening skills and "good GEW": genuineness, empathy and warmth. Ask for feedback from your supervisors (including residents) about your skills so that you may improve them as you go.
Observing Real-Time Psychotherapy
Use Aptius to watch therapy sessions at Samaritan Mental Health (SMH). Call SMH (541 768 5235) and ask to be connected to the Attending who is supervising residents. She or he will put you on a speakerphone while you both listen to a session so that you may ask questions as the therapy proceeds. At the end of this rotation you'll be tested for your grasp of 4 different kinds of psychotherapy, which you'll learn to recognize by observing these sessions; more on that evaluation below.
Having taught yourself some of these basics (and maybe not so basics), now create a 1-page summary of what you learned. This is for you, not for us. This is to help you pass your Boards. This is to drive this material far enough into your hippocampus that some of it will still be there a year from now. This is to allow you to be creative and follow your nose in terms of what you want to learn. Hopefully the patient whom you saw will make you want to know some or a lot of these things. Use that.
Depending on how busy things are, you and your supervisor may go over some of your 1-pagers but remember, this is for you, not for your evaluation. (Yes, of course it will have an impact on your overall evaluation if you don't follow through on this. But DO NOT go hog-wild here trying to impress. This exercise is for you. Use whatever you think will help make it stick (pictures, diagrams, comparison tables, stars, arrows -- or text). Have some fun and think of that patient.
After you finish your one-pager, circle that diagnosis. We're aiming for circles around all the diagnoses that appear in Bold on your Map; at least a few more circles beyond that.
These seminars will give you an opportunity to talk with your MS3 colleagues who are flung about in other clinics.
How You're Evaluated
Maps: the idea is to see what you've learned. There is no grade attached nor penalties for having uncircled diagnoses or un-checked medications! But your evaluator will ask you about conditions you've circled, randomly, so don't fudge it. They'll ask you for basics about that condition, the kind of stuff you'd have on your 1-pager. Our expectation, as noted above, is that you'll have circles around the Bold diagnoses, and at least a few more. More is better, obviously. But don't fudge and embarrass yourself, not good.
One-pagers: your supervisor will look at your collection and pick out 2-3 for review, also random, and based on her/his interests. Bring 'em all.
Projects: if you were involved in any particular Clinic projects, please write a brief (like one page) summary of what you did. This includes passing along any instructions or guides for your MS3 colleagues who follow behind you. You can get a fine grade without doing a large project. But it is a way to feel like you're making a contribution to the Clinics.
Videotape analysis: at the end of the rotation you'll be asked to watch a videotape of a therapy session and note whether you see examples therein of 4 kinds of psychotherapy. The response form will look like this:
In the recording you observe, there may be not be an example of every one of these therapies. But this exercise is designed to help you really watch closely for these therapies, and ask your supervisors about them, as you're watching therapy sessions (which can seem rather boring at times, but not if you're watching closely for them to appear, and asking your supervisor for help in doing so).
Use the Resources on the Medical Students Home page for further information.