PSYU-4062 - Acting Internship: Consultation & Liaison Psychiatry

PSYU-4062 - Acting Internship: Consultation & Liaison Psychiatry

Elective Title: Acting Internship: Consultation & Liaison Psychiatry
Course Number: PSYU-4062
Elective Type: clinical Duration/Weeks: 4 Max Enrollment: 2
Prerequisites: Successful completion of Year 2
Additional Requirements: Successful completion of Psychiatry & IM Clerkships or approval from the course director based on previous experience in psychiatry; Contact Jessica Prescott (
Responsible Faculty Director: Michael Miller, M.D. Periods Offered: 1-13 including holiday period 8 
Coordinator: Jessica Prescott Other Faculty:
Location to Report on First Day:
Rebecca Sealy 7.408 @ 8:00 am

Diagnosis, treatment and management of patients on medical, obstetric-gynecological, and surgical wards and in the emergency room.

By the conclusion of this acting internship, the student will be able to: 1. Recognize, diagnose and manage delirium and dementia syndromes. 2. Determine mental capacity and distinguish this from competence. 3. Recognize, diagnose and treat depression, anxiety and stress syndromes. 4. List contributions to psychiatric disorder made by drugs used for psychiatric conditions. 5. Outline the mechanisms of action of drugs used for psychiatric conditions. 6. Note the distinctive illness profile seen in AIDS patients. 7. Describe the issues aroused by fatal and terminal illnesses for patients, family and staff.

Description of course activities
Present patients evaluated to faculty. Working directly with faculty this A/I will assume resident like clinical responsibilities to include directly examining patients, formulating a diagnostic impression and treatment plan and presenting that plan to faculty and other team members. Fourth year student will typically evaluate one new consultation per day with directed study to provide more in depth understanding of psychiatric diagnosis and treatment. The experience can be tailored to focus on specific area(s) of interest, especially if the student plans to enter a field of medicine other than psychiatry.

Type of students who would benefit from the course
Students going into primary care and psychiatry (though psychiatric issues arise in all specialties of medicine).

    Weekly Schedule
          Estimated Course Activities (Start-Time/Finish-Time):
Day of Week   AM   PM
Monday 8 5
Tuesday 8 5
Wednesday 8 5
Thursday 8 5
Friday 8 5

 Average number of patients seen per week: 5-7
 Call Schedule: N/A

Research / Other Course 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 and residents/Treatment Team
  B. Frequency / Duration of Presentation(s)?
  C. Format - What guidelines are set for the student's presentation?
    Standard Psychiatric Evaluation
  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)?
    Daily Cases
  B. Format - What guidelines are set for the student's written work?
    Students may complete sections of H&Ps that are permissible such as demographic information, past history, ROS, vital signs, and lab results. Students may be asked to leave notes in progress section of chart under direction of psychiatry faculty and residents.
  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.?
    Relate to 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)?

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.

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.
    verbal from faculty and resident at halfway and end of rotation.

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.
    Interview skills, formulation

How specifically will this AI build on developing skills from the clerkship year to prepare students for internship?
    Treating acute psychosis, Post Traumatic Stress Disorder

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)?
    Will perform initial intake interviews and report directly to staff or supervising resident

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?
    Broad exposure to complex psychiatric conditions in a medical environment.

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?
    They will encounter one faculty on a daily basis. Close supervision.

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.
    On the psych C/L A/I, students will work with three attendings, second and fourth residents, and other third and fourth year medical students. The A/I will work the most with the residents directly, with the attending supervising overall activity. The residents will observe interviews, review student documentation, guide the student in obtaining collateral and contacting treatment teams, and offer feedback for these skills areas. The attendings will also supervise the A/I directly without residents at times in the same skills areas. Feedback may be given verbally or in writing (e.g. e-mail or documentation revision), and may be given by encounter or periodically at the evaluators discretion, or at the request of the A/I.