PSYU-4071 - Psychiatric Diagnosis

PSYU-4071 - Psychiatric Diagnosis

Elective Type: clinical
    
Title
Psychiatric Diagnosis
Course Number
PSYU-4071
Duration/Weeks
4
Prerequisites: Successful completion of Year 2 
      Additional Requirements:
Successful completion of the Psychiatry Clerkship. Contact Courtney Silberisen (clsilber@utmb.edu).
Responsible Faculty Director:
Kimberly Grayson, MD
Other Faculty:
Location to Report on First Day
7.106 Rebecca Sealy
Periods Offered
1-13
including holiday period 8
Maximum Enrollment
3

Goals
1) Recognize and accurately diagnose mental illness. 2) Be aware of and consider the significance of the history of a psychiatric diagnosis: its development, past treatments, and past theories behind the illness. 3) Appreciate the past and present social views of a mental illness, and note its implications (e.g. stigma) on the patients personal experience as well as medical care. 4) Integrate these insights into the biopsychosocial formulation of the patient during medical decision-making. 5) Empathize with the patients experience. 3) Appreciate the past and present social views of a mental illness, and note its implications (e.g. stigma) on the patients personal experience as well as medical care.
4)Integrate these insights into the biopsychosocial formulation of the patient during medical decision-making.
5)Empathize with the patients experience.

Objectives
1) Obtain an extensive history from the patient and establish rapport. 2) Formulate an accurate psychiatric diagnosis and defend the rationale. 3) Relate the history of the diagnosis itself: specifically, creation of the diagnostic criteria and its changes in terminology; past and current views of etiology and treatment; and past social views of the diagnosis (e.g. stigma) 4)
Describe the implications of the diagnosis on the patient, both personally and socially (e.g. stigma) 5) Describe the implications of the diagnosis on the patients medical care, in medical and financial terms 6) Both versions of course: write and submit a case study of the patient exploring these concepts, both for review and feedback as well as to submit to the UTMB history of psychiatry annual writing contest 7) 4-week version only: give a case conference to peers and residents on these concepts 8) 4-week version only: prepare the case report for submission to an appropriate scholarly journal

Description of course activities
Students will actively participate at a minimum of two locations during this rotation: Community Clubhouse (St. Joseph House in mid-town Houston and Dona Marie Clubhouse in South Houston), Sunshine Center (developmental disabilities on Galveston island), The Harris Center peer groups (formerly MHMRA), and/or Our Daily Bread (Galveston Island). The total hours per week are 32-40, including supervision, face-to-face interactions with patients, reading and research, writing and editing a case study, and presenting a case conference. In clinic or on the consult service, students will obtain in-depth, comprehensive histories of their patients, from the patient and/or the family. Students will use this gathered history and clinical exam to form and defend a diagnosis. To promote clinical decision making as well as empathy, students will then formulate a biopsychosocial assessment of the diagnosis, using the patients personal experience. Students will then research the history of this diagnosis or some aspect of the patients case relating to the diagnosis and prepare a written case study presenting the patients history, clinical presentation, biopsychosocial assessment, and personal/social implications and significance based on their historical research and the patients personal experience. Students will give a professional, oral case presentation to peers. Students will work with the attending to find a scholarly journal in a relevant field (e.g. therapy, cultural issues, history of medicine, etc.), edit their case presentation and submit the article for review for publication. During this elective, required reading materials will be referenced, as well as suggested ones, however the student should explore and locate appropriate, relevant research materials to cite and defend in their case study.

Type of students who would benefit from the course
1)Any student interested in psychiatry or will be dealing with mental illness frequently in their practice. 2)Any student interested in the history of psychiatry and medicine. 3)Any student interested in improving their interview skills and diagnosis formulation. 4)Any student interested in exploring professional activities such as case presentations or article submissions.

Weekly Schedule
  Clinical Activities (estimated schedule)
  Day of Week AM PM
  Monday 8:00 Week 1 only 5:00 Week 1 only
  Tuesday 8:00 Week 1 only 5:00 Week 1 only
  Wednesday 8:00 Week 1 only 5:00 Week 1 only
  Thursday 8:00 Week 1 only 5:00 Week 1 only
  Friday 8:00 Week 1 only 5:00 Week 1 only
  Saturday
  Sunday
   Average number of patients seen per week: 20 (first week only)  
   Call Schedule:   None  

Research Activities (estimated schedule)
Activity Hours per Week
Faculty Contact-Time
Self-Directed Study
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 the 1st week, with regular subsequent check-ins & daily workday available from faculty for feedback with preparing case study & presentation
  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, Residents, & other Students (primarily students)
  B. Frequency / Duration of Presentation(s)?
    once during elective
  C. Format - What guidelines are set for the student's presentation?
    Well researched, clarity of presentation, & completeness of the history/interview obtained
  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)?
    1 case study for elective, modified history of psychiatry contest & for journal submission
  B. Format - What guidelines are set for the student's written work?
    Well researched, clarity of presentation, completeness of the history/interview obtained, & formatting, sources, & word count based on contest & journal specifications
  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 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)?
    Required reading: Diagnostic and statistical manual of mental disorders: DSM-5, American Psychiatric Association DSM-5 Clinical Cases, ed. John Barnhill Essentials of psychiatric diagnosis : responding to the challenge of DSM-5, Allen Frances. Suggested supplemental text readings (students should also find their own through research): A Brief History of Madness, Roy Porter Shrinks, Jeffrey Lieberman Saving Normal, Allen Frances

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.
    None

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.
   
 
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.
   
 
C.

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

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

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