Department of Behavioral Medicine and Psychiatry

Clerkships-Third Year

Neuropsychiatry

The Neuropsychiatry rotation is an eight-week clinical rotation for third-year medical students. Students will rotate two weeks in Neurology and six weeks in Psychiatry. The Psychiatry portion will consist of the following five mini-rotations:

• Two weeks on the adult dual diagnosis unit (substance abuse with other psychiatric diagnoses)
• One week on the adult unit (adult patients who require hospitalization but who can function at a level of participating in adult groups)
• One week on the psychiatric intensive care unit (adult patients who require hospitalization and require more intensive care than the adult unit)
• One week on the acute care adolescent unit
• One week on the consult-liaison service in Ruby Memorial Hospital

Students are assessed by:

• Demonstrating competence to their individually assigned mentors in these measures:
  • Two psychiatric patient interviews including mental status examinations
  • One oral case report
  • One journal article presentation
  • Discussion of knowledge of the patients in their patient log books
  • Discusion of their overall experiences in psychiatry
• Demonstrating competence in each of the required five mini-rotations
• Demonstrating professionalism:
  • attend required events
  • be punctual
  • complete patient notes in a timely fashion with legible writing
  • maintain professional demeanor
  • maintain proper professional boundaries (physical, sexual, financial, emotional, and confidentiality) with patients
  • be truthful about medical data
  • display enthusiasm for patient care
  • display enthusiasm for learning
  • complete required reading assignments
  • be courteous to patients, patients' families, staff, colleagues, and other health professionals
• Scoring the tenth percentile or above on the national shelf board in psychiatry
• Attending all required lectures and seminars

Competencies which will be assessed during the clinical rotation:

Conducting psychiatric interviews(Clinician, Communicator)

The student will demonstrate the ability to:

• establish rapport with patients by properly introducing self and defining the role the interview will have in patients' care
• be empathic with patients, showing genuine concern for patients' moods, dilemmas, viewpoints, and conflicts through tone of voice, style of speaking, facial expressions and gestures
• facilitate interviews with helpful blends of open and closed questions, supportive remarks, uses of silences, and therapeutic interruptions
• use language neutral to gender, age, race, sexual orientation, culture and religion
• speak with clarity of speech
• speak with words proper to patients' levels of education
• set up interview environments with proper placements of interviewers and patients, arrangements of furniture, placement and quality of lighting, and safety measures
• conclude interviews with proper timing and respect

Eliciting data for psychiatric histories(Clinician, Communicator)

The student will demonstrate the ability to:

• elicit chief complaints in patients' own words
• elicit details for thorough histories of present psychiatric illness:
  • onset of symptoms
  • duration of symptoms
  • time lines of exacerbations and decreases of symptoms
  • actions patients have taken to cope with symptoms
  • impacts of symptoms upon patients
  • patients' thoughts about causes for and meanings of symptoms
  • patients' expectations for prognosis
• elicit details for past general medical histories
• elicit details for psychiatric reviews of systems
• elicit details for family and social histories
• elicit details for developmental histories

Performing mental status examinations (Clinician, Communicator)

The student will demonstrate the ability to ask questions to test patients' levels of functioning in the areas of:

• general appearance and activity
• levels of consciousness
• speech characteristics
• orientation
• concentration
• memory
• fund of information
• mood and affect
• perceptual abilities / disturbances
  • hallucinations/illusions
  • depersonalization/derealization
• thought processes
  • obsessions/compulsions
  • delusions
  • suicidal and homicidal thoughts
  • self mutilation thoughts
• abstract thinking
• judgment
• insight
• reliability

Performing neurological examinations in psychiatry (Clinician, Communicator)

Students will demonstrate the ability to:

• perform acceptable general medical physical examinations
• perform concentrated neuro-psychiatric aspects of physical examinations
  • the 12 individual cranial nerves
  • touch and pain sensation, proprioception, vibratory sensation, discrimination, extinction
  • motor strength
  • normal reflexes
  • pathological reflexes

Recognizing indications for laboratory data (Clinician, Scholar)

The student will demonstrate the ability to:

• determine which laboratory tests are medically indicated based upon patients' psychiatric presentations
• recognize when psychiatric laboratory data are pathological
• determine when laboratory tests are indicated to check patients' compliance and responses to psychiatric medications
• inform patients of risks and benefits of obtaining psychiatric laboratory tests

Recognizing major categories of mental illness (Clinician, Scholar)

The student will demonstrate the ability to:

• organize clinical data from psychiatric interviews and mental status exams to hypothesize reasonable psychiatric diagnoses on all five axes
• develop thorough psychiatric differential diagnoses based upon patients' data

Developing psychiatric formulations (Clinician, Collaborator)

The student will demonstrate the ability to:

• present plausible theories about the etiologies and courses of patients' psychiatric illnesses in regard to:
  • biological factors
  • psychological factors
  • social factors
  • spiritual factors
  • patients' strengths
  • patients' weaknesses

Developing psychiatric treatment plans (Clinician, Collaborator, Advocate)

The student will demonstrate the ability to:

• recognize indications for treatments for patients with psychiatric disorders
  • types of psychotherapies
    • individual: psychodynamic, cognitive, behavioral, supportive, other
    • marital and/or family
    • groups: support, theme, psychodrama, other
  • medications
  • somatic therapies
  • social interventions
  • economic interventions
  • legal interventions
• recognize contraindications for specific psychiatric treatments in specific patients
• inform patients about risks and benefits of psychiatric treatments
• collect data about compliance with treatments

Presenting psychiatric cases (Communicator)

The student will demonstrate the ability to present coherent, thoughtful presentations in both oral and written forms:

• patients' psychiatric histories
• mental status examinations data
• physical examination data
• lab data
• five axes of diagnoses
• differential diagnoses
• psychiatric formulations
• treatment plans

Recognizing psychiatric emergencies(Clinician, Collaborator, Advocate)

The student will demonstrate the ability to:

• recognize psychiatric emergencies among general medical patients
  • suicidal thinking
  • homicidal thinking
  • signs of mental decompensation
  • impulsivity
  • dangerously poor judgment
  • lethal side effects to medications
    • Neuro-Malignant Syndrome
    • Neuro or cardiotoxic responses
    • Over dosage
• demonstrate knowledge about medical and medical-legal interventions
  • psychiatric referrals
  • involuntary commitment
  • judgments of medical incompetence
• recognize potential risks in general medical patients who have psychiatric disorders