PSYU-4038 - Acting Internship in a Psychiatric Inpatient Service

PSYU-4038 - Acting Internship in a Psychiatric Inpatient Service

Elective Type: clinical
    
Title
Acting Internship in a Psychiatric Inpatient Service
Course Number
PSYU-4038
Duration/Weeks
4
Prerequisites: Successful completion of Year 2 
      Additional Requirements:
Successful completion of Psych & IM Clerkships or successful completion of Psych Clerkship & approval of course director based on previous experience in Psych. Send to Courtney Silberisen (clsilber@utmb.edu).
Responsible Faculty Director:
Michael Stone, M.D.
Other Faculty:
Location to Report on First Day
St. Joseph Medical Center.
Periods Offered
1-13
including holiday period 8
Maximum Enrollment
2

Goals
1. To develop clinical and assessment skills on a variety of psychiatric patients, who are acutely ill and require in-patient treatment.
2. To develop an understanding of the appropriate treatment of all major psychiatric disorders and have an opportunity to follow the course of illness and response to treatment.

Objectives
Students will participate in the role of the First Year Resident on the in-patient treatment team in the Department of Psychiatry and Behavioral Sciences and will be the primary individual responsible for the assessment and treatment of patients and answer directly to their attending psychiatrist, Dr. Stone.

Description of course activities
Students will receive individualized clinical experience under the supervision of an attending psychiatrist. They will have the responsibility of their patients from assessment through the treatment process. They will work as part of a multidisciplinary team. This clinical service emphasizes care of patients with acute and severe psychopathology.
For credentialing purposes, this class may not be added less than one month before the start date.

Type of students who would benefit from the course
Students interested in neurology, psychiatry, internal medicine, or family medicine as a career.

Weekly Schedule
  Clinical Activities (estimated schedule)
  Day of Week AM PM
  Monday 8:00 5:00
  Tuesday 8:00 5:00
  Wednesday 8:00 5:00
  Thursday 8:00 5:00
  Friday 8:00 5:00
  Saturday
  Sunday
   Average number of patients seen per week: 20-30  
   Call Schedule:   n/a  

Research Activities (estimated schedule)
Activity Hours per Week
Faculty Contact-Time 30
Self-Directed Study 10
Data-Collection/Analysis
Other

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?
    Daily - students are expected to attend and participate in daily rounds.
  C. Format - What method(s) are used to document the student's clinical performance?
    Daily oral feedback   End of period oral feedback   Written feedback
Other

2.  Oral Presentation
  A. Audience - To whom does the student present?
    Faculty and/or Resident
  B. Frequency / Duration of Presentation(s)?
    Based on complexity of patients
  C. Format - What guidelines are set for the student's presentation?
   
  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)?
    Based on number of patients seen
  B. Format - What guidelines are set for the student's written work?
    Complete H&Ps & Mental Status exams. Daily Progress notes.
  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.?
    Related to cases
  F. Audience - Who assesses the student’s written performance?
    Peer Assessment     Faculty Assessment     Other

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

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)?
    Students will be expected to participate in the role of the first-year resident on the inpatient unit. He or She will be the primary individual responsible for the assessment and treatment of patients.

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".
    None

7.  Other Modes of Evaluation
  Please explain below.
    Students interviewing, diagnostic planning, and treatment implementation skills will be directly assessed by their attending physician and course director, Dr. Stone.

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.
    Daily supervision of student with feedback on presentations, treatment plans.
 
B.

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.
    Advanced mental status examination skills
Formulation of more extensive treatment plans
Advanced diagnosis of complex mental illnesses
Interacting with mental health support services
Take on more of a leadership role in treatment team
 
C.

How specifically will this AI build on developing skills from the clerkship year to prepare students for internship?
    Management of drug/alcohol withdrawal
Management of eating disorders
Providing supportive psychotherapy
 
D.

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)?
    AI will follow patients, seeing them daily and taking the lead on assessing their condition and recommending treatments.

AI will NOT actually be responsible for writing orders, dictating reports, nor writing progress notes.
 
E.

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?
    Expose the student to management of mental illness, formulation of treatment plan, interacting with mental health support services. Also expose student to leading a treatment team, working with nurses, therapists, and others.
 
F.

How is the student demonstrating drawing clinical conclusions and/or developing a management plan and documentation as an intern would do?
    Face to face meeting at midpoint of rotation. Constructive instruction to address deficiencies/weaknesses identified.
 
G.

How and by whom will midpoint feedback be provided to the student? How will you remediate deficiencies identified at midpoint?
    Close interaction with one or two faculty members on daily M-F basis. Close interaction with residents as well.
 
H.

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.
    The AI will generally work with one faculty member. There is a close, direct daily supervision and communication with the faculty and the AI. There will also be daily interaction with the residents. Feedback will come from both faculty and residents, and evaluation will be done by the faculty with input from the residents.