University of Illinois

LCME

Liaison Committee on Medical Education

Goals and Objectives

Core Clerkship Goals and Objectives
Psychiatry

COURSE NAME
       
        Psychiatry


GOALS/OBJECTIVES
        Fundamental to mastery of psychiatric work is the development of an effective interview technique that is the major source of clinical information in the discipline.  The student should demonstrate:

I.  Clinical Interviewing: Data Gathering Skills

A student should be able to conduct a basic psychiatric interview using:

  1. an open-ended approach;
  2. a style that facilitates the patient providing information;
  3. specific questions of information to cover all content areas  relevant to making a DSM diagnosis;
  4. silence or facilitating comments as appropriate;
  5. confrontation and other techniques which may facilitate the gathering of information;      
  6. child, parent and family interviews.

A student should be able to:

  1. identify verbal and non-verbal presentations of information.
  2. organize interview data;
  3. gather data from all relevant sources (e.g., patient interview, patient observation, family members, medical records, and other therapists
II. Interactions With Patients

Students are expected to:

  1. demonstrate a capacity for empathy;
  2. establish rapport with a wide variety of patients:
  3. listen carefully, and
  4. communicate clearly.
III. Mental Status Evaluation

A student is expected to:

  1. conduct a comprehensive and accurate mental status examination, and
  2. present the findings orally and in writing without reference to any written material
IV.  Presentation of Clinical Material

Students are expected to:

  1. write complete and accurate psychiatric evaluation/admission notes, using electronic medical records, where appropriate
  2. write succinct progress notes with all key information, and
  3. present organized case summaries orally.         
V. Diagnostic and Conceptual Skills

A student is expected to:

  1. identify major problem areas, including primary and co-morbid conditions;
  2. identify predisposing, precipitating and maintaining factors;
  3. Identify biological, psychological, family and sociocultural influences on symptoms and their contribution to the etiology, pathogenesis, epidemiology and treatment of the presenting illness(es);
  4. identify relevant past history;
  5. identify general medical or substance related contributors to the presenting illness;
  6. evaluate the emergency aspects of the problem;
  7. formulate the accurate and comprehensive differential diagnosis using the current Diagnostic and Statistical Manual;
  8. formulate a beginning treatment plan considering somatic and psychosocial interventions;
  9. identify deviations from normal development.

VI. Responsibility and Professionalism

A student is expected to:

  1. be punctual and available;
  2. reliably complete tasks and assignments;
  3. ask for help when needed;
  4. terminate and transfer cases appropriately.
  5. A student’s appearance, demeanor, behavior and relationship with staff should be consistent with their role.
VII. Educational Initiative

Students are expected to:

  1. Ask questions,
  2. do relevant reading,
  3. volunteer for presentations,
  4. actively seek clinical experiences. 
VIII. Feedback

Students are expected to:

  1. Actively seek feedback from supervisors.
  2. Be receptive to suggestions and change behavior in response to suggestions from supervisors, staff, and patients.
IX. Management Skills

A student should be able to:

  1. demonstrate basic skills to promote a therapeutic relationship;
  2. assess violence risk towards self and others;
  3. utilize psychotropic medication with knowledge of its mechanism of action, indications, contraindications, adverse effects, monitoring requirements and drug interactions.
  4. Demonstrate a working knowledge of the functioning of a psychiatric healthcare delivery system.
  5. A student should be able to make referrals to appropriate community agencies, clinics and private psychiatrists,
  6. communicate (in verbal and written form) psychiatric findings to other medical and agency professionals.
  7. work within a team frame-work.
X. Knowledge
  1. Students should have a basic knowledge of the normal developmental stages of childhood, adolescence and adulthood.  The student should be able to identify, describe and discuss the major pathological syndromes and developmental deviations associated with these developmental stages.
  2. Students should be able to identify and describe the major psychiatric disorders described in the current Diagnostic and Statistical Manual.
  3. Students should be able to achieve a minimum score of 60 for the end-of-clerkship examination.  The student will be required to pass both the non-cognitive (clinical rotation) and cognitive (exam) portions of the clerkship to pass the clerkship.
  4. Students should acquire an elementary understanding of various theoretical models for conceptualizing mental illness and its treatment.
  5. Students should be familiar with modalities of psychiatric treatment including commonly used approaches in biopsychosocial areas.  They should have a basic knowledge of different types of treatment (e.g., cognitive therapy, 12-step, behavior therapies, psychodynamic therapies, pharmacotherapy, etc.); formats of treatment (individual, family, marital, group); and phases of treatment (acute, maintenance, rehabilitation).
  6. Students should understand indications for various levels of care, e.g. prevention, inpatient, partial hospitalization, intensive outpatient, residential, outpatient.
  7. Students should be familiar with medico-legal concepts relevant to psychiatric practice, e.g. HIPAA rules, confidentiality, reporting duties, involuntary hospitalization, etc.
  8. Students should be familiar with commonly used evaluation tools e.g. imaging studies, psychometric scales, psychological and neuropsychological testing instruments etc.
  9. demonstrate evidence-based medicine skills in psychiatric practice.

 

VIII. Competencies
  1. Perform and articulate a comprehensive mental status examination, including psychiatric and neuropsychiatric elements.
  2. Conduct psychiatric interviews with a wide variety of patients, demonstrating the ability to establish rapport and obtain information pertinent to diagnosis.
  3. Identify and collect other clinical data needed to diagnose behavioral disturbances, including relevant laboratory studies and psychological testing.
  4. Formulate a comprehensive and accurate differential diagnosis for psychiatric symptoms, using standard diagnostic nomenclature.
  5. Use a biopsychosocial framework to describe biological, intrapsychic, familial, cultural, and social influences on patient’s presenting complaints.
  6. Understand the implications for, and basic principles of, commonly used psychiatric treatments, including psychodynamic psychotherapy, cognitive psychotherapy, behavior therapy, family therapy, group therapy, pharmacotherapy, and electroconvulsive therapy.
  7. Recognize psychiatric emergencies and perform basic emergency intervention.
  8. Function as a member of the health care team in a professional and ethical manner.

 

VIIII. Activities to Facilitate Achievement of Competencies

  1. Students should spend the majority of clerkship time in clinical activities related to care of patients and/or their families whether in an inpatient or outpatient setting. Opportunities will be provided to work with patients manifesting a broad range of psychopathology.
  2. Students will be given responsibility for clinical management of patients within the limits of the student’s ability and the requirements of the institution.
  3. Clinical work will be closely supervised and directly observed.
  4. Psychiatric evaluations and progress notes will be written according to the format used in the clinical setting and reviewed by the preceptor.
  5. Students will spend one half-day each week in didactic instruction.
  6. The Clerkship Director will work with students on their clinical skills and any areas that are problematic.

 

X.  Assessment and Evaluation

  1. Students should receive regular feedback from their preceptors in their supervisory sessions.  Please let the clerkship director know as soon as possible if there is a problem with your preceptor. 
  2. Students receive feedback informally on a daily basis in this rotation, and should feel free to ask for feedback at any time. However, a formal feedback session should occur at the mid point of each block of the rotation.  Purple feedback cards, listing the categories of feedback, will be given out during orientation.  Students should give the feedback card to their preceptor during the second week of the Block.  The preceptor and student will discuss strengths as well as areas for improvement.  After the preceptor signs the card, the student should return it to the psychiatry secretary.  The student should recognize that feedback is different from evaluation (grading).  Feedback is for the purpose of learning; while a grade assesses learning and performance.
  3. The preceptor will complete a written evaluation assessing each student. The evaluation includes assessment of achievement of the previously described objectives and is based on direct observation of the student’s work in the clinical setting; the student’s participation in supervisory sessions; written psychiatric evaluations and progress notes; and the professionalism and ethical standards of the student.
  4. The National Board of Medical Examiners Subject Examination will be used to formally assess the student’s knowledge. The examination will be taken on the last Wednesday of the rotation.
  5. The student’s final grade will be determined according to the approved formula with approximately two-thirds derived from clinical performance and one-third from the NBME Subject Examination. The Clerkship Director will utilize all data to determine the final grade.

In order to pass the clerkship, the student must pass the NBME Subject Examination and do satisfactory clinical work.

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