PSYU-4073 - Acting Internship in Psychiatry at Tyler: Audition Rotation

PSYU-4073 - Acting Internship in Psychiatry at Tyler: Audition Rotation

Elective Title: Acting Internship in Psychiatry at Tyler: Audition Rotation
Course Number: PSYU-4073
Elective Type: clinical Duration/Weeks: 4 Max Enrollment: 1
Prerequisites: Successful completion of Year 3
Additional Requirements: C Form required to register, send to Tyler Coordinator, Megan Pazos, megan.pazos@uthct.edu
Responsible Faculty Director: Andrew Mellon, M.D. Periods Offered: 1, 3-9, 11-13 including holiday period 8 
Coordinator: Jessica Prescott Other Faculty:
Location to Report on First Day:
UTHSCT, 11937 US Hwy. 271, Tyler, TX 75708, Megan Pazos, Medical Education Coordinator, will email students 1 week prior to start date the exact location, time and other information needed to start this elective.

Goals
Improve awareness of inpatient adult psychiatry units for state funded patients

Objectives
1. To enhance clinical and communication skills with general adult psychiatry inpatient population.
2. Understand the need for better access to mental health care in suburban and rural areas of Northeast Texas.

Description of course activities
Daily round on inpatient acute psychiatry unit with multi-disciplinary treatment team. Consults service on inpatient medicine. Newly created Psychiatric ER with 24/7 coverage (residency curriculum now includes one month of night float in Psychiatric ER). There is also usually limited but good exposure to management of outpatients in behavioral health clinic (both child adolescent and adult with upper-level residents and attendings). Exposure will vary based on the faculty and residents on service. Students will receive daily schedule with assignments once on service.

Type of students who would benefit from the course
Any student interested in psychiatry, particularly involving underserved, indigent patient populations.

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: 15-20 depending on unit vs clinic
 Call Schedule: no, unless students want too

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 by residents and teaching faculty
  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?
    Resident and teaching faculty
  B. Frequency / Duration of Presentation(s)?
    1-2 times per week
  C. Format - What guidelines are set for the student's presentation?
    Oral presentation on daily notes or work-ups as applicable
  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
  B. Format - What guidelines are set for the student's written work?
    Oral presentation on daily notes or work-ups as applicable
  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.?
    student can select or a topic will be given for current 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)?
    1. Didactic attendance, any Grand Rounds pertinent, daily questions with residents and program director. 2. letters of recommendation are available if attendings have adequate time with student.

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.
    The program would like feedback from the medical student on his/her residents and faculty. These evaluations will be available through New Innovations.

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.
    At midpoint of the rotation, the student will fill out the Acting Internship Selective feedback form to self-assess their performance and then discuss this with the attending or residents with whom the student works. Feeback will be on all aspects of clinical work and should include feedback on entering and discussing orders/prescriptions, giving or receiving patient handover to transition care responsibility, recognizing a patient requiring urgent or emergent care and initiating management, and obtaining informed consent for tests and procedures.
 
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.
    In this rotation, students will be able to work with underserved populations and describe access to and barriers to care in Northeast Texas and rural settings.
 
C.
How specifically will this AI build on developing skills from the clerkship year to prepare students for internship?
    As this is an audition rotation and acting internship, students will be given advanced responsibility compared to the clerkship year student and will formulate a plan, write notes, and obtain informed consent for treatment under direct supervision of the teaching faculty.
 
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)?
    Yes
 
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?
    This course will allow the student to practice skills needed for internship, and the student will be provided feedback and additional learning opportunities to allow the student to develop those skills.
 
F.
How is the student demonstrating drawing clinical conclusions and/or developing a management plan and documentation as an intern would do?
    At midpoint of the rotation, the student will fill out the Acting Internship Selective feedback form to self-assess their performance and then discuss this with the attending or residents with whom the student worked with. If a student is not meeting expectations at that point, the faculty or residents with whom the student is working with will delineate what skills are lacking and how to improve performance.
 
G.
How and by whom will midpoint feedback be provided to the student? How will you remediate deficiencies identified at midpoint?
    At midpoint of the rotation, the student will fill out the Letters of recommendation are available if attendings have adequate time with student.
 
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.