Medical Student Education

 

• Program Objectives: UTHSC COM
• Learning Objectives: Psychiatry Clerkship

PSY-1. Conduct an organized, comprehensive history, including a thorough psychiatric and narrative history and demonstrate the ability to engage challenging patients.

PSY-2. Diagnose psychiatric disorders in patients, generate a differential diagnosis by applying knowledge of psychopathology and medical illnesses and understand the relevance of a biopsychosocial formulation in developing treatment plans.

PSY-3. Apply knowledge of the major psychiatric disorders and substance use disorders in the care of patients, and describe the scientific basis for the diagnostic tests used in psychiatry.

PSY-4. Describe and apply knowledge of the psychopharmacological treatments and psychotherapies for psychiatric disorders.

PSY-5. Demonstrate knowledge of psychiatric concepts, and ability to perform, present and document psychiatric mental status exam and cognitive screening.

PSY-6. Apply knowledge of indications, contraindications and potential adverse reactions, and likely outcomes for a given therapeutic intervention, with attention to cost and quality and provide patient education regarding prevention, diagnosis, treatment plan and health promotion.

PSY-7. Assess the risk factors for suicidality and dangerousness in patients. Apply knowledge of the risk factors when making treatment plans and understand the limits of confidentiality. Understand when reporting to a relevant authority is expected to protect the safety of the patient or others.

PSY-P-1. Demonstrate a commitment to life-long learning and continuous improvement of knowledge, skills, and attitudes. Make use of self-evaluation and feedback from others to manage uncertainty, adapt to change, and develop habits of continuous improvement.

PSY-P-2. Demonstrate accountability to all patients and a commitment to carrying out professional responsibilities with integrity and compassion.

Structure

Chattanooga: Each Student will be assigned a unit at Moccasin Bend as primary site.  Students will be active participants in treatment team including interview, presenting, and documenting.  Each student will be assigned to one day of outpatient child/adolescent clinic.  

Knoxville: Each student will work with Dr. Miller both rounding as a team for hospital consults on the medical and surgical floors of UTMC as well as individually in an outpatient clinic setting.  In the context of consults, students will be expected to be able to operate semi-independently and be responsible for their own cadre of patients.  Students will also have ½ day each of an ECT and Child Psychiatry experience.

Memphis:  Each student will be assigned to one site for the 4 weeks of their rotation. This will be their primary site. Here students are expected to be a part of the treatment team, have patients assigned to them whom they will complete daily rounds on, and will be responsible for presenting and documenting. In addition to being on service at their primary site, students will also be engaging in outpatient clinic. Each student will have one half day of child outpatient clinic and 2 half days of adult outpatient clinic. Each student will be on short call one evening per block.

Recommended Text

Andreasen and Black: Introductory Textbook of Psychiatry, Seventh edition
ADMSEP e modules
DSM 5

Key Diagnoses, Learning Goals and Milestones for Psychiatry in Undergraduate Medical Education

Inpatient:

Student may be assigned to either inpatient psychiatric unit or on a consultation liaison service. Daily responsibilities include attending morning report, pre-rounding on patients, writing H&Ps on the patients you did an initial assessment on, writing daily progress notes on each patient, attending daily rounds and presenting your patients, following up on lab tests, diagnostic studies, consultations, seeing patients again in the afternoon as needed.

H&Ps:

Each student needs to complete 4 H and P cards during their 4 week block. One of this has to be a complete H and P. 3 of these can be a focused mental status exam.

Progress Notes:

Progress notes on the inpatient wards and consult services follow the Interim History, Objective, Mental Status Exam, Assessment, Problem list/Plan format. 

Call Shifts:

In Memphis, each student will be on call one weekday evening/block from 5-10 pm with a resident. Call covers coverage at the VAMC and ROH

Outpatient:

The outpatient portion of the clerkship is designed to provide students with a broad view of the outpatient assessment of adult and pediatric patients. Each student will be doing 2 half days in adult outpatient clinic and 1 half day in the child outpatient clinic. To get the most out of this experience, students should be proactive in trying to see patients on their own when permitted.

Computer Access:

• Chattanooga:
• Knoxville: For students who are rotating at UTMC for the first time they will have a tutorial session scheduled for the second day of the rotation during which they will be given sign-in information.
• Memphis:

ROH: T Helpdesk- 901.545.7480
VA: Valerie Tunstall- Ernest- 901.523.8990 Ext. 2376
Lakeside: paper charts
MMHI: ^{Chandra Wilbourn, 901-577-1807 /Cheryl Stevens Manning, 901.577.1825}
LeBonheur: For Powerchart (Cerner) access, call 901.516.0000 #2.

Distribution of points

• Clinical evaluation 60%
• Shelf exam 40%

Grading Scale (A, B, C, F)

• The following scale will be used to assign final grades for the clerkship. Grades will not be rounded.
• A: 89.5-100
  B: 78.5-89.49
  C: 67.5-78.49
  F: 67.49 or lower

Inpatient Rotation Evaluation

This evaluation is completed by your inpatient attending/resident on eMedley based on patient interviews, daily progress notes, participation in rounds, and presentations. It will be based on EPAs (Entrustable Professional Activities) and accounts for 50% of the final clerkship grade. 

Inpatient Mid-Rotation Feedback: 

To give you an idea of how you are performing, your attending physician/resident will provide written mid-month feedback halfway through your inpatient rotation. If the faculty fails to provide this feedback, the student is expected to ask the attending for the current evaluation. This form should be ready at the end of the second week of clerkship to be presented to the clerkship director for mid month meeting. Mid month Feedback Form

Shelf Exam:

At the end of the clerkship, students will take the National Board of Medical Examiners (NBME) Pediatric Shelf Exam as the written exam. This score accounts for 40% of the final clerkship grade. The minimum passing score is the 5th percentile adjusted for the quarter of the year. The minimum score to be eligible to receive an “A” for the clerkship is the 50th percentile adjusted for the quarter of the year. You can view a table of these. Grading policy for Psychiatry Clerkship

Re-examination must occur as follows: if failed during Block 5-10 you must retake the exam in January of Block 1 of your M3 year; if failed after Block 11 of M3 year, you must retake the Shelf exam by the end of Block 8 of your M4 year.  Under special circumstances, a student may be able to retake the Shelf exam other than at the regularly scheduled time, and if so, 4 weeks’ notice must be given.

Failure to be re-examined will result in a failing grade for the rotation. The original test score will be averaged into the final overall grade. Failure of the re-exam or failure of any portion of the clerkship requires that the entire rotation be repeated.

Important Notes on Grading

The Clerkship Director retains the right to discuss with the attending physicians any serious infraction, professionalism issues, extenuating circumstances, or positive behavior not previously known to the attendings and may advise the attendings to alter the student’s grade accordingly.

All portions of the psychiatry clerkship including clinics and exams must be completed and passed within one (1) year of starting the psychiatry clerkship or by September of the senior year, whichever comes first. Failure of the first shelf exam, or any segment of the clerkship, negates the ability to receive an “A” as a final grade no matter in what the ultimate grade average results.

When grades are finalized, you will receive an email notifying you that your evaluations and grading composite are available to review.

Students are required to turn in all assignments and documentation with appropriate signatures (clinic logs, observed H&P card, clinical skills rubrics, time logs and case logs) by the last day of the rotation. Students failing to complete assignments by the last day of the rotation will be notified in email of the missing assignments. If assignments (including time logs and case logs) are not completed by 4 weeks after the end of the clerkship, this will result in a drop of 1 letter grade for the final clerkship grade due to professionalism. Additionally, the Dean of Student Affairs will be notified. If all assignments are not completed by 8 weeks after the end of the clerkship, this will result in a failing grade for the clerkship and the full clerkship must be repeated

Course Evaluations:

Each student is strongly encouraged to complete a course evaluation at the conclusion of the clerkship (link will be emailed).

SASSI Accommodations:   

Any student who feels he/she may need an accommodation based on the impact of a disability should contact Student Academic Support Services and Inclusion (SASSI) to self-disclose and officially request accommodations. All requests for accommodations must be submitted with supporting documentation and the SASSI Self-Disclosure and Accommodation Request Forms. Although students may register for services at any time, please attempt to make arrangements within the first week of the clerkship as it does take time to process the request and review documentation. For additional information, contact the SASSI Disability Coordinator at lbrook15@uthsc.edu or (901) 448-1452.

Any special testing accommodations need to be arranged at the beginning of the rotation, otherwise it may not be possible to honor requests (i.e. testing in the SASSI office, etc.)

In contrast to the first two years of medical school where much of a student’s grade is based on objective criteria obtained through written testing, the second two years base much of the grade on subjective clinical evaluation. Perusal of the evaluation form reveals that a portion of the grade is based on evaluation of professional and personal attributes. Physicians-in-training must possess certain necessary attitudes and interpersonal skills. Some of these are inherent, but much can be cultivated particularly in an environment filled with the appropriate role models. The administration of the University of Tennessee feels strongly about this and has published guidelines for Professional Behavior and Conduct reproduced here:

• General Guidelines for Professional Behavior and Conduct in Psychiatry

Computer Use

It has become standard that all large corporations monitor the computer use in their businesses. Students can be identified surfing inappropriate websites, which will result in dismissal from medical school.

Serious infraction of any of the above professional behaviors will result in automatic failure of the rotation no matter what the subjective evaluation or written final grades.

• TBL sessions: all campuses: Thursdays of week 1-3 between 1pm- 3pm.These are topic specific sessions led by faculty. Pre study needs to be completed prior to attendance.
  • Chattanooga

-Grand rounds: Every Thursday 12 noon – 1pm in Memphis (virtually)

- First Tuesday of the block – Introduction to MSE immediately following treatment team

-informal lecture/topic discussion twice weekly immediately following treatment team (example topics: substance use disorders, Personality D/o, Child and Adolescent Psychiatry, Psychosis and antipsychotics)

-ZOOM lectures with Memphis

• Knoxville: Resident lecture first Monday of the month at 12:20 in the Medicine Conference Room. Didactic sessions with Dr. Miller every Wednesday and Friday of the rotation at 1:00 in the Small Conference Room on the second floor of the GSM Building.

            - ZOOM lecture with Memphis weekly

• Memphis:

- Grand rounds: Every Thursday 12 noon- 1 pm (attendance mandatory)

- First Monday of the block- Introduction to MSE- 1pm-2 pm (attendance mandatory)

- Last Tuesday or Wednesday of block: SHELF review. Resident led. (Attendance mandatory)

Clinical Skills Assessments

Students will complete clinical skills rubrics for the following psychiatric skills: 1) Mental Status Exam and 2) Bio-psycho-social-spiritual assessment. You must be directly observed by a faculty member or supervising resident for each skill. It is the student’s responsibility to alert the attending or supervising resident to the need for this assessment, and to ensure that both skills assessments are completed prior to the end of the clerkship.

Observed History and Physical

You are required to have a resident or attending observe your history taking and mental status exam skills and sign the appropriate card. If you do not perform the skill adequately, you and the resident/attending should discuss ways to improve then they should observe you again for competence. This observed H&P form should be turned into the clerkship coordinator by the end of the clerkship.

Case Logs and Time Logs

In order to ensure that you are seeing a breadth of patients, we require documentation of 14 competencies (Case Logs) located on eMedley. You should be a participant in the patient’s care, not an observer. If you do not see a patient with a particular diagnosis, you should complete the appropriate ADMSEP module to fulfill this requirement. If you use an ADMSEP module, please mark this as a “simulated patient.

Log your hours (Time Logs) on eMedley. These will be checked multiple times throughout the clerkship by the coordinator and you will be emailed if you are behind. All hours must be logged by the end of the day on the last day of the rotation (shelf exam day).

1. Chattanooga
   1. Parking – students may park in any front lot with car tag to be provided on the first day of the rotation
   2. Clinical Services Lounge – available for storing belongings if needed (obtain key on first day)
2. Knoxville: For all students including those who are rotating at UTMC for the first time an orientation will be scheduled with Brittany Bracco at 0800 on the first day of the rotation.
3. Memphis:
   1. Parking: UT garage that has been designated. Lakeside parking available on hospital grounds.

Psychiatry clerkship is 4 weeks long and passes along quickly. Most of you, regardless of the residency you choose, will continue to require many of the skills you learn in this rotation in future.