PSYU-4077 - Outpatient Child Psychiatry

PSYU-4077 - Outpatient Child Psychiatry

Elective Title: Outpatient Child Psychiatry
Course Number: PSYU-4077
Elective Type: clinical Duration/Weeks: 4 Max Enrollment: 1
Prerequisites: Successful completion of Year 2
Additional Requirements: N/A
Responsible Faculty Director: Denise Baughn, MD Periods Offered: 3-7, 9-13 excluding holiday period 8 
Coordinator: Jessica Prescott Other Faculty:
Location to Report on First Day:
UTMB Health Psychiatry - Webster 400 N. Texas Ave., Webster, TX 77598

1. To gain knowledge and skills in the assessment and management of mental health disorders in children and adolescents
2. To develop an understanding of the unique developmental and cultural factors that impact mental health in young people
3. To become familiar with common treatment modalities available for child and adolescent mental health conditions, including pharmacotherapy and psychotherapy
4. To improve clinical reasoning and decision-making skills in the context of child and adolescent psychiatry
5. To learn effective communication strategies with young patients and their families
6. To develop an understanding of the legal and ethical considerations involved in the care of children and adolescents with mental health conditions
7. To appreciate the importance of interdisciplinary collaboration in the care of children and adolescents with mental health concerns

1. To conduct comprehensive psychiatric assessments of children and adolescents, including obtaining a detailed history, performing a mental status examination, and assessing for comorbid conditions
2. To formulate a differential diagnosis and develop a treatment plan based on the assessment findings
3. To develop effective communication strategies with young patients and their families, including the ability to explain diagnoses and treatment options in a clear and empathetic manner
4. To gain experience in the use of psychotherapeutic techniques, such as cognitive-behavioral therapy and family therapy, in the treatment of child and adolescent mental health conditions
5. To develop an understanding of the role of pharmacotherapy in the treatment of child and adolescent mental health conditions, including knowledge of medication options, dosing, and side effects
6. To participate in interdisciplinary team meetings and collaborate with other healthcare professionals involved in the care of children and adolescents with mental health concerns.

Description of course activities
The student will work directly with attendings and child psychiatry fellows in the outpatient clinics to evaluate and treat patients. He/she will also observe child psychiatry telemedicine practice provided through the school systems in Texas through the Texas Children's Health Access Through Telemedicine (TCHATT) program. The student will also complete 1 case presentation prior to completion of the elective.

Type of students who would benefit from the course
Students interested in psychiatry who are interested in the combined child/adolescent psychiatry match or interested in further exploring a career in child psychiatry. Students interested in pediatrics who want more experience working with children with behavioral or mental health concerns.

Weekly Schedule
  Clinical Activities (estimated schedule)  
Day of Week   AM   PM
Monday 8-12 (Webster Outpatient) 1-5 (TCHATT)
Tuesday 8-12 (Didactics with Child Fellow Outpatient) 1-5 (Child Fellow Clinic Webster/PCP)
Wednesday 8-12 (TCHATT) 1-5 (Webster Child Fellow Outpatient)
Thursday 8-12 (Child Fellow Clinic/PCP) 1-5 (Child Fellow Clinic/PCP)
Friday 8-12 (Development Disorders Clinic) 1-5 (Fellow Mtg./case presentations)

 Average number of patients seen per week: 45
 Call Schedule: No

Research Activities (estimated schedule)
Activity Hours per Week
Faculty Contact-Time
Self-Directed Study

Method of Student Evaluation
1.  Clinical Observation
  A. Where are students observed on this elective?
    Inpatient Service   Ambulatory   Surgery   Standardized patients
Patients simulators   Other
  B. Frequency - How often are students observed clinically?
  C. Format - What method(s) are used to document the student's clinical performance?
    Daily oral feedback   End of period oral feedback   Written feedback

2.  Oral Presentation
  A. Audience - To whom does the student present?
    Faculty & Fellows
  B. Frequency / Duration of Presentation(s)?
    Max 1 hour
  C. Format - What guidelines are set for the student's presentation?
    The student will present an interesting or challenging case, then present related literature (1-2 articles) to help guide treatment decisions/recommendations.
  D. Assessment - Who assesses the student's presentation performance?
    Self-assessment   Peer assessment   Faculty assessment
  E. Method of content selection
    Current cases  Student-selected topic   Assigned topic

3.  Written Assignment (H&P's, notes, papers, abstracts, etc.)
  A. Frequency of written assignment(s)?
  B. Format - What guidelines are set for the student's written work?
    Students will complete written H&Ps and/or Progress notes appropriate for clinical encounters. They will receive feedback regarding this documentation from their supervisor.
  C. Length of written assignment(s)?
    Abstract   Annotated bibliography   1 - 2 page paper   3+ page paper
  D. Are recent references required?   No    If yes, how are they selected?
  E. Method of content selection - e.g. student-selected, relate to cases, etc.?
    Clinical Cases
  F. Audience - Who assesses the student's written performance?
    Peer Assessment     Faculty Assessment     Other

4.  Examination
    Oral   Written multiple choice   Written essay / short answer   OSCE

5.  Extra Course Activities
  What expectations do you have for the student to demonstrate participation in the elective (e.g. small group activities, seminars, thoughtful questions, providing resources, journal club, resident lecture attendance)?
    Resident lecture attendance and department of psychiatry grand rounds attendance is required. The student will participate in resident discussions and case conferences and should ask thoughtful questions as appropriate throughout the rotation.

6.  Additional Costs
  Please list any additional costs and/or purchases (books, materials, movies to watch, etc.) that are required for this course. Include an estimated total cost. If there are no additional costs, please enter "None".

7.  Other Modes of Evaluation
  Please explain below.
    The patient will be directly observed clinically by supervising attendings and fellows. Written clinical work will be evaluated with appropriate feedback given.

8.  If this course is an Acting Internship, please complete the following:
  A. Objectives for the AI should relate directly to the Entrustable Professional Activities (EPAs). Each AI should describe how the four key Year-4 EPAs that our school has identified as being Year-4 skills are assessed. The Year-4 objectives are:
1. Entering and discussing orders/prescriptions.
2. Give or receive patient handover to transition care responsibility.
3. Recognizing a patient requiring urgent or emergent care and initiating management.
4. Obtaining informed consent for tests and procedures.
Specify how the student will be given formative feedback on their clinical skills.

Year-4 students should demonstrate mastery of EPAs they developed in the clerkship year, including recommending and interpreting common diagnostic and screening tests, and performing general procedures of a physician. They should be able to demonstrate masterfully and independently skills they mastered in Years 2-3, including efficiently performing comprehensive admission-notes and succinct daily progress notes and perform accurate, concise, and hypothesis-driven clinical presentations, form clinical questions and retrieve evidence to advance patient care. They should be able to demonstrate basic understanding of and beginning mastery of collaborate as a member of the interprofessional team and identify system failures and contribute to a culture of safety improvement.

List advanced clinical skills that a student will be assured an opportunity to practice.

How specifically will this AI build on developing skills from the clerkship year to prepare students for internship?

What opportunities will typically be available to all students who take this AI (procedures, required presentations, etc.)? What opportunities may be available based on patient load/presentation or student initiative (ie. Writing a case report)?

An AI should have expectation of a minimum of 32 hours per week of clinical responsibilities. Duty hours should be capped at ACGME limits for an intern, thus up to 24 hours followed by 4 hours of activities related to patient safety, education, and handoff. Students cannot work more than 80 hours per week averaged over 4 weeks. They can only have 1 day off in a 7-day work week with 8 hours off between shifts.

Clinical responsibilities will vary depending on specialty, but how is the student functioning with work commensurate to a PGY1 with an appropriate level of training?

How is the student demonstrating drawing clinical conclusions and/or developing a management plan and documentation as an intern would do?

How and by whom will midpoint feedback be provided to the student? How will you remediate deficiencies identified at midpoint?

Acting Internship students often seek letters of recommendation following their experience. How many different Faculty will work directly with the student and have knowledge of the student's abilities to detail in a written evaluation? Describe the degree of supervision and interaction with faculty vs. residents or other providers and how feedback will be obtained if more direct work is with residents or other providers.