CHICAGO MEDICAL SCHOOL Psychiatry Clerkship MPSY700 SYLLABUS 2016-17 ACADEMIC YEAR Education Director: David Garfield, M.D. david.garfield@rosalindfranklin.edu Clerkship Coordinator: Sue Shaw susan.shaw@rosalindfranklin.edu 847-578-8722 CLERKSHIP DESCRIPTION The psychiatry clerkship is a required 6 week rotation in the third year of medical school. Students rotate at a variety of medical sites including the Federal Health Care Center, Illinois Masonic Hospital, Elgin State Mental Hospital, Centegra, RFUHS Clinic and Lutheran General Hospital. Medical students are supervised by both psychiatry residents and attendings. They are assigned to inpatient acute psych wards, consultation psychiatry service, and outpatient mental health clinics. Students have assigned readings, required patient interview exercises, required quizzes and exams in addition to a full day of didactic teaching at RFU during the 3rd week of the rotation. At most sites the students will take two evenings on call with a resident. During this rotation the majority of students will also observe Electroconvulsive Therapy being administered to psychiatric patient at the Federal Health Care Center. Students who are interested in child psychiatry will attend child psych clinics at Vernon Hills clinic and Federal Health Care Center. CLERKSHIP OBJECTIVES LINKED TO CMS COMPETENCIES AND OBJECTIVES (see next page)
Psychiatry Clerkship Competency Map 2016-2017 I. Medical and Scientific Knowledge: Demonstrate knowledge about established and evolving biomedical, clinical, epidemiological, and social-behavioral sciences and apply this knowledge in caring for ill and healthy patients of all ages. Specifically, the student must demonstrate: CMS Objective Course Objective(s) Learning Activity/ Content Assessment Method(s) 1.1 Describe the normal structure and function of the body. Describe the normal structure and function of the brain and behavior as it relates to the following content domains in psychiatric cases/ management: - Major Depression, Bipolar Disorder, Anxiety Disorder, Alcohol and/or Substance, Cognitive Assessment Required lecture topics/ presentations attended during clerkship. Performance on NBME Psychiatry Shelf Examination. Performance on USMLE Step 2CK/ CS as appropriate to psychiatric domains. 1.2 Distinguish the causes and underlying mechanisms of disease. Distinguish the causes and underlying mechanisms of disease as it relates to the following content domains in psychiatric cases/management: - Major Depression, Bipolar Disorder, Anxiety Disorder, Alcohol and/or Substance, Neurocognitive Disorder/ Dementia, Violence Risk Or Assessment, Suicide Risk or Assessment, Cognitive Assessment Demonstrate expected knowledge of psychiatric illnesses and secondary causes. defined by the Psychiatric Required Required lecture topics/ presentations attended during clerkship. Performance on NBME Psychiatry Shelf Examination. Performance on USMLE Step 2CK/ CS as appropriate to psychiatric domains. Psychiatry Clerkship Competency Map 2016-2017 Page 1
Demonstrate knowledge of psychopharmacology (includes mechanisms, side effects, drug-drug interactions of commonly used psychotropics). 1.3 Identify the epidemiology of common illnesses. Student will know the epidemiology of mood disorders, psychotic disorder, and anxiety disorder. Participation in the care of patients with these disorders. Shelf Examination Direct observation and discussion by faculty. 1.4 Describe the principles and methods of diagnostic decision-making (to include clinical, laboratory, pathologic and imaging studies). Describe the principles and methods of diagnostic decision-making in psychiatric cases (to include clinical, laboratory, pathologic and imaging studies). - Major Depression, Bipolar Disorder, Anxiety Disorder, Alcohol and/or Substance, Neurocognitive Disorder/ Dementia, Violence Risk Or Assessment, Suicide Risk or Assessment, Cognitive Assessment Demonstrate the ability to interpret laboratory data as well as indications for appropriate lab tests (including imaging). defined by the Psychiatric Required Required lecture topics/ presentations attended during clerkship. Performance on NBME Psychiatry Shelf Examination. Performance on USMLE Step 2CK/ CS as appropriate to psychiatric domains. 1.5 Describe the principles of therapeutic decisionmaking. Describe the principles of therapeutic decisionmaking in psychiatric cases. defined by the Psychiatric Required Required lecture topics/ presentations attended during clerkship. Performance on NBME Psychiatry Shelf Examination. Performance on USMLE Step 2CK/ CS as appropriate to psychiatric domains. Psychiatry Clerkship Competency Map 2016-2017 Page 2
II. Patient Care and Prevention: Demonstrate patient centered care that is compassionate, appropriate and effective for the promotion of health, quality of life, prevention of illness, treatment of disease, and the end of life. Specifically, students must: CMS Objective Course Objective(s) Learning Activity/ Content Assessment Method(s) 2.1 Identify factors that place individuals at risk for disease or injury and use strategies to prevent or slow the disease process. Identify risk factors and preventive strategies for psychiatric patients presenting with conditions related to the following - Major Depression, Bipolar Disorder, Anxiety Disorder, Alcohol and/or Substance, Neurocognitive Disorder/ Dementia, Violence Risk Or Assessment, Suicide Risk or Assessment, Cognitive Assessment Required lecture topics/ presentations attended during clerkship. Performance on NBME Psychiatry Shelf Examination. Performance on USMLE Step 2CK/ CS as appropriate to psychiatric domains. 2.2 Perform reliable (comprehensive and problem focused) history and physical examinations. Participate in the performance of a reliable history and physical exam for psychiatric patients with conditions applicable to: - Major Depression, Bipolar Disorder, Anxiety Disorder, Alcohol and/or Substance, Neurocognitive Disorder/ Dementia, Violence Risk Or Assessment, Suicide Risk or Assessment, Cognitive Assessment Obtain a pertinent history, establish a rapport and be able to give a differential and working diagnosis (Interview Exercise Assessment). Completion of Interview Exercise Assessment. Completion of all required minimum encounters. Interview Exercise Assessment observed by an attending psychiatrist. Psychiatry Clerkship Competency Map 2016-2017 Page 3
2.3 Order and appropriately interpret the results of commonly used diagnostic procedures. Order and appropriately interpret the results of commonly used diagnostic procedures in psychiatric rotations. Violence Assessment, Suicide Assessment, Cognitive Assessment Demonstrate the ability to screen: Completion of Screening exercises. Completion of all required minimum encounters. - Suicide risk, violence risk, major depression, alcohol and other substance abuse/dependence, cognitive impairment 2.4 Perform routine technical procedures. N/A N/A N/A 2.5 Construct appropriate diagnostic and therapeutic strategies for patients with common acute and chronic conditions. Construct appropriate diagnostic and therapeutic strategies for patients with common acute and chronic conditions in psychiatric medicine. - Major Depression, Bipolar Disorder, Anxiety Disorder, Alcohol and/or Substance, Neurocognitive Disorder/ Dementia, Violence Risk Or Assessment, Suicide Risk or Assessment, Cognitive Assessment Completion of history, mental status exam, multi-axial differential diagnosis and initial assessment and management plan. Completion of all required minimum encounters. Write an initial patient evaluation including a complete history, mental status exam, multi-axial differential diagnosis and initial assessment and management plan. Formulate a differential diagnosis after a patient examination. Psychiatry Clerkship Competency Map 2016-2017 Page 4
2.6 Provide effective education to patients and their families. Provide educational materials and discuss the appropriate diagnosis and treatment plan with patients and their families. Students will review medications and their side effects with patients. Psychiatry Clerkship Competency Map 2016-2017 Page 5
III. Professionalism and self-awareness: Demonstrate a commitment to professional services, adherence to ethical principles, and awareness of one s own interests and vulnerabilities. Specifically, students must: CMS Objective Course Objective(s) Learning Activity/ Content Assessment Method(s) 3.1 Apply the theories and principles that govern ethical decision-making in medicine. Describe the ethical principles surrounding involuntary and voluntary treatment. Ethical issues involving enhancement of normal function and genetic testing. Clinical vignette discussion on didactic day, discussion of individual cases during clerkship. 3.2 Demonstrate respect, dignity, compassion and integrity when engaging patients, their families, peers, the university community and other healthcare providers. Demonstrate respect, dignity, compassion and integrity when engaging patients, their families, peers, the university community and other healthcare providers in the psychiatry rotations. Demonstrate dedication to psychiatric patient care. Demonstrate compassion with patients and caretakers. Discussion of cases with faculty on the appropriate role of a medical student, resident, attending physician, as well as other members of the healthcare team. Integration of professionalism into practice habits and clinical performance. Demonstrates awareness and sensitivity for patient confidentiality. 3.3 Recognize how one s own limitations, personal biases and vulnerabilities may impact patient care and interactions with other healthcare providers. Recognize one s own limitations, biases, and vulnerabilities may impact care of the psychiatric patient and interactions with other providers on the psychiatric team. Recognizes limitations of psychiatric knowledge and skills and seeks appropriate assistance when necessary. Discussion of cases with faculty on the appropriate role of a medical student, resident, attending physician, as well as other members of the healthcare team. Psychiatry Clerkship Competency Map 2016-2017 Page 6
3.4 Seek and respond appropriately to performance feedback. Seek and respond appropriately to performance feedback during psychiatry rotations. Seek punctuality to rounds, clinics and seminars. Complete all mid-term and end of clerkship logging requirements. Meet with clerkship/site director or designated faculty for mid-clerkship and end of clerkship evaluation. Integration of feedback into practice habits and clinical performance. Psychiatry Clerkship Competency Map 2016-2017 Page 7
IV. Practice-Based, Life-Long Learning: Demonstrate the ability to appraise and assimilate scientific evidence to evaluate and improve patient care practices. Specifically, students must: CMS Objective Course Objective(s) Learning Activity/ Content Assessment Method(s) 4.1 Search for, evaluate, and apply evidence-based medicine for solving clinical problems. Search for, evaluate, and apply evidence in the care of psychiatric patients. Apply psychiatric information to patient care. Analyze psychiatric research appropriate to patient care. Discussion of cases with faculty with particular emphasis on current best practices for managing common psychiatric conditions and presentations. 4.2 Apply current technology to access, manage, and use biomedical information in the context of patient care. Read and present on clinical questions that arise during patient encounters. Assess evidence based literature and apply it to clinical problems/situations: - Major Depression, Bipolar Disorder, Anxiety Disorder, Alcohol and/or Substance Clerkship lectures address evidencebased diagnostic. Perform at least one research presentation during psychiatry rotation. Observation by preceptor and final comments. 4.3 Develop the ability to self-assess and demonstrate a willingness to engage in reflective practice. Develop the ability to self-assess and demonstrate a willingness to engage in reflective practice during psychiatry rotations. Demonstrates willingness to self-assess and learn from errors. Reviews own progress mid-way through clerkship in the midclerkship evaluation. Completion of forms and discussion with faculty. Psychiatry Clerkship Competency Map 2016-2017 Page 8
4.4 Provide constructive feedback to peers/ colleagues aimed at fostering professional growth and improving patient care. Students present cases to each other in presence of faculty. Fellow students give feedback to peers during presentation. Final. Psychiatry Clerkship Competency Map 2016-2017 Page 9
V. Systems-based, Interprofessional Practice: Demonstrate and awareness of and responsiveness to the larger context of health care and be able to call on system resources and other health care professionals to provide optimal care. Specifically, students must: CMS Objective Course Objective(s) Learning Activity/ Content Assessment Method(s) 5.1 Identify one s own role on the healthcare team and how it is complementary to other health professionals in the delivery of patient care. Identify one s own role on the psychiatric team and how it relates to other members of the healthcare team. Identify the professional role of the MD and the role of other providers specific to the management of psychiatric cases. In care meetings, (i.e., intake rounds or discharge planning), discuss Psychiatric cases with an emphasis on one s own professional role, identity, and the role of other providers specific to the management of psychiatric care cases being discussed. Submit self-assessment to Preceptor indicating what the student has learned about their own professional roles and the roles of other healthcare professionals regarding the Psychiatric care cases being discussed. Receive immediate feedback. 5.2 Recognize when and how to initiate the assistance of other healthcare providers in the context of patient care. Recognize when and how to initiate the assistance of other providers in the context of caring for the psychiatric patient to provide high quality interprofessional care. Discussion of cases with faculty with specific emphasis on interprofessional collaboration. 5.3 Describe various healthcare practice types, delivery systems, and identify interprofessional members of these practices and how they work together to meet the needs of the community. Describe health care settings in psychiatric practice and interprofessional members of these practices and how they are used to meet community needs: - Military and Veterans psychiatry, State hospital based treatment, Community hospital, Telepsychiatry, Patient centered homes. Each student will experience psychiatric patient encounters at various types of healthcare settings. Direct observation, evaluation and immediate feedback to each student by preceptor regarding their description of various healthcare practice types, delivery systems, and identify interprofessional members of these practices and how they are used to Psychiatry Clerkship Competency Map 2016-2017 Page 10
meet the needs of the community. 5.4 Identify systematic interprofessional practices that improve patient safety, minimize error, and contribute to continuous quality improvement. N/A N/A N/A Psychiatry Clerkship Competency Map 2016-2017 Page 11
VI. Interpersonal and Communication Skills: Demonstrate effective understanding, information exchange, and teamwork with patients, their families, peers and other health professionals. Specifically, students must: CMS Objective Course Objective(s) Learning Activity/ Content Assessment Method(s) 6.1 Demonstrate the ability to initiate and sustain professional relationships with patients, their families, and other members of the healthcare team. Interact effectively with patients and their families. Interact effectively with other members of the psychiatric teams. Participate in patient rounds and discussions. Discussion of cases with faculty with particular emphasis on interpersonal relationships between providers, patients and their families. 6.2 Use effective listening, questioning, verbal, nonverbal, and writing skills when communicating with patients and their families. Demonstrate effective communications skills when interacting with psychiatric patients and their families. Communicate effectively with other members of the healthcare team. Provide educational materials and discuss the appropriate diagnosis and treatment plan with patients and their families. Discussion of cases with faculty with particular emphasis on interpersonal relationships between providers, patients and their families. Demonstrate the ability to interview a patient and collect data through the Interview Exercise Assessment. Communicate respectfully and clearly (with limited medical jargon) with patients, families and caregivers. Psychiatry Clerkship Competency Map 2016-2017 Page 12
6.3 Prepare and organize comprehensive, timely, and legible medical records. Write comprehensive history and mental status evaluation. Write concise but informative progress notes. Perform at least 2 comprehensive psychiatric evaluations. Daily progress notes on assigned patients. Review of the final evaluation and notes by faculty. 6.4 Use effective verbal presentation and written skills when communicating with colleagues, superiors, and other members of the healthcare team. Use effective verbal presentation and written skills when communicating with colleagues, superiors, and other members of the psychiatric team. Present well researched and organized psychiatric topics. Write comprehensive histories and SOAP notes. Discussion of cases with faculty with particular emphasis on interpersonal relationships between providers, patients and their families. Psychiatry Clerkship Competency Map 2016-2017 Page 13
EVALUATION, EXAMINATION, AND REMEDIATION POLICIES See D2L for CMS Clerkship Grading Policy See D2L for Clinical Evaluation Standards See D2L for Teacher-Learner Expectations CMS Clerkship Remediation Guidelines Reference the Required Patient Encounters document for specific patient type/clinical condition remediation guidelines. [Posted in D2L] Reference the CMS Clerkship Exam Failure Policy document for specific make-up/retake examination guidelines. [Posted in D2L] Reference the CMS Excused Absence Policy document for examination and other clinical experience remediation guidelines. [Posted in D2L] In general, Clerkship Directors will determine how the student will make up patient encounters, clinical activities or other clerkship requirements. Clerkship Directors will determine if and when the student will be required to repeat the clerkship. Clerkship Directors will use case-by- case evaluation and coordinate with the Office of Student Affairs & Education. ATTENDANCE POLICY See D2L for Excused Absence Policy. Holiday Schedule: You must follow the holiday schedule for your site, not Chicago Medical School's schedule. Weather Emergencies: If the University is closed due to extreme weather, check with your clinical site regarding its status. Unless otherwise directed by your Site Director, you should go to your clinical site. CLERKSHIP-SPECIFIC PERFORMANCES, PROJECTS, REQUIREMENTS: Psychopharmacology quiz (available week one only) Interview Exercise (submitted via D2L drop box on final day of clerkship) History and physical write up (submitted via D2L drop box on final day of clerkship) Oral presentation form is submitted via D2L drop box after it is signed by attending. This form is due in drop box on final day of clerkship. 11 questions Mid-clerkship evaluation form (submitted via D2L drop box during 3 rd week of rotation). one45 patient log (submitted via D2L drop box on final day of clerkship) Medical Ethics Self-Reflection (submitted via D2L drop box on final day of clerkship) Interprofessional Activity Self-Reflection (submitted via D2L drop box on final day of clerkship)
OTHER CLERKSHIP INFORMATION The D2L website has important information and must be reviewed prior to the beginning of this clerkship. This includes schedules, objectives, requirements, policies as well as a lot of good information about psychiatry This includes: required readings, power point lectures, journal articles, information about interviewing skills, cognitive testing, child psychiatry, psychopharmacology REQUIRED PATIENT ENCOUNTERS AND ALTERNATIVE LEARNING (see next page)
Minimum Required Patient Encounters PSYCHIATRY CLERKSHIP Type of Patient/ Clinical Condition Major Depression (3) Bipolar Disorder (2) Anxiety Disorder (2) Alcohol and/or Substance (2) Neurocognitive Disorders /Dementia (2) Clinical Setting Level of Student Responsibility Benchmark/Explanation I, O FP Student will participate in the evaluation of patient under the supervision or resident or attending physician. First, student will observe patient interview. Then, student will obtain history, conduct mental status examination and participate in developing therapeutic plan with attending and resident physician. I, O FP Student will participate in the evaluation of patient under the supervision or resident or attending physician. First, student will observe patient interview. Then, student will obtain history, conduct mental status examination and participate in developing therapeutic plan with attending and resident physician. O FP Student will participate in the evaluation of patient under the supervision or resident or attending physician. First, student will observe patient interview. Then, student will obtain history, conduct mental status examination and participate in developing therapeutic plan with attending and resident physician. I, O PP Student will participate in the evaluation of patient under the supervision or resident or attending physician. First, student will observe patient interview. Then, student will obtain history, conduct mental status examination and participate in developing therapeutic plan with attending and resident physician. I, O PP Student will participate in the evaluation of patient under the supervision or resident or attending physician. First, student will observe patient interview. Then, student will obtain history, conduct mental status examination and Alternative If a student has not had the opportunity to complete a FP Major Depression clinical encounter by the mid-clerkship evaluation, the student should notify the Attending/Director. The Site Director will arrange for the student to see either a video or a patient with Major Depression under the supervision of an attending. If a student has not had the opportunity to achieve the minimum number of FP Bipolar Disorder clinical encounters by the midclerkship evaluation, the student should notify the Attending/Director. Students will then see videotapes of patients with Bipolar Disorder and discuss the videos with a resident. If a student has not had the opportunity to complete a FP Anxiety Disorder clinical encounter by the mid-clerkship evaluation, the student should notify the Attending/Director. Student may go to another site or observe a videotape of a patient with Anxiety Disorder under the supervision of a resident. If a student has not completed a PP Alcohol and/or Substance clinical encounter at the time of the mid-clerkship evaluation, the student should notify the A ttending/ Director, who will arrange for the student to perform an Alcohol and Substance Abuse Assessment under their supervision. If a student has not had the opportunity to complete a PP Neurocognitive/Dementia patient encounter by the mid-clerkship evaluation, the student should
Minimum Required Patient Encounters PSYCHIATRY CLERKSHIP Violence Risk Or Assessment (2) Suicide Risk or Assessment (2) Cognitive Assessment (2) participate in developing therapeutic plan with attending and resident physician. I, O PP Student will participate in the evaluation of patient under the supervision or resident or attending physician. First, student will observe patient interview. Then, student will obtain history, conduct mental status examination and participate in developing therapeutic plan with attending and resident physician. I, O PP Student will participate in the evaluation of patient under the supervision or resident or attending physician. First, student will observe patient interview. Then, student will obtain history, conduct mental status examination and participate in developing therapeutic plan with attending and resident physician. I, O FP Student will perform screening cognitive assessment and discuss with attending. notify the Attending/Director for alternative options. Student may go to another site or observe a videotape on Cognitive Impairment/Dementia and discuss the video with a resident. If a student has not completed a PP Violence Risk or Assessment for two patients, the student should notify the Attending/Director for alternative. Student will go to another site and complete a Violence Risk or Assessment clinical encounter under faculty supervision. If a student has not completed a PP Suicide Risk or Assessment by mid-clerkship, the student should notify the Attending/Director for alternative means. Student will observe a videotape of a Suicide Risk or Assessment and discuss the video with a resident. If a student has not had the opportunity to do a FP Cognitive Assessment at the time of the didactic day, the student should notify the Attending/Director for alternative options. Student may go to FHCC to do a cognitive assessment under the supervision of a resident.
Faculty and Staff Faculty and Staff Contact Information Psychiatry Clerkship Students (Updated 6/24/16) Site Name & Address Advocate IL Masonic Medical Center 836 W. Wellington Avenue Chicago, IL 60057 Primary Contact Ms. Gertrude Lobo Phone: (773) 296-8977 Fax: (773) 296-8978 E-mail: Gertrude.Lobo@advocatehealth.com Site Director: Rebecca Goedken, MD Advocate Lutheran General Hospital Medical Student Office, 6 South 1775 Dempster Street Park Ridge, IL 60068 Ms. Marisol Hernandez-Martinez E-mail: marisol.hernandez-martinez@advocatehealth.com Phone: (847) 723-6464 Fax: (847) 723-6029 Site Director: Maya Ramic, MD James A. Lovell Federal Health Care Center 3001 Green Bay Road Building 131, Room 110 North Chicago, IL 60064 Ms. Tashekia Ramsey Phone: (224) 610-5719 Fax: (224) 601-3885 E-mail: tashekia.ramsey@va.gov Site Director: Lori Moss, MD Elgin Mental Health C enter 750 S. State Street Elgin, IL 60120 Ms. Heather Johnson Phone: (847) 742-1040,ext. 2072 Fax: (847) 429-4811 E-Mail: heather.johnson@illinois.gov Site Director: Malini Patel, MD RFU Behavioral Health Center 830 West End Court, Suite 400 Vernon Hills, IL 60061 Ms. Kristen Serdar Phone: (847) 578-8728 E-Mail: kristen.serdar@rosalindfranklin.edu Site Director: Lin Lu, MD Centegra Hospital McHenry 4201 Medical Center Drive McHenry, IL 60050 Contact Information Psychiatry Sites 6/2016 Ms. Edie Best Phone: (815) 759-8151 E-Mail: ebest@centegra.com Site Director: Paul Berkowitz, MD