Psychiatry Junior Clerkship
Student Objectives

The clinical clerkship is designed to enable each student to develop clinical skill and to master sufficient knowledge of the discipline of psychiatry in order to prepare them for residency training for careers as generalist physicians, or to continue training in a specialty area.

This clerkship utilizes a wide variety of clinical settings. In both outpatient and inpatient settings, students will perform diagnostic evaluations and provide treatment under the supervision of physicians who assume responsibility for the patients' care. Additional assignments (instead of or in addition to inpatient units) may  include child psychiatry clinics and groups, emergency call, consultation-liaison service, addiction treatment programs, day hospital, or neuropsychiatric services.

Fundamental to mastery of psychiatric work is the development of an effective interview technique that is the major source of clinical information in the discipline. The student should demonstrate:

I. Clinical Interviewing: Data Gathering Skills

1) an open-ended approach;
2) a style that facilitates the patient providing information;
3) specific questions of information to cover all content areas relevant to making a  DSM diagnosis;
4) silence or facilitating comments as appropriate;
5) confrontation and other techniques which may facilitate the gathering of information;
6) child, parent, and family interviews.

A student should be able to:

1) identify verbal and non-verbal presentations of information;
2) organize interview data;
3) gather data from all relevant sources (e.g., patient interview, patient observation, family members, medical records and other therapists.

II. Interactions with Patients:

Students are expected to:

1) demonstrate a capacity for empathy;
2) establish rapport with a wide variety of patients;
3) listen carefully;
4) communicate clearly.

III. Mental Status Examination:

1) conduct a comprehensive and accurate mental status examination;
2) present the findings orally and in writing without reference to any written material.

IV. Presentation of Clinical Material:

Students are expected to:

1) write complete and accurate psychiatric evaluation/admission notes, using electronic medical records, where appropriate;
2) write succinct progress notes with all key information;
3) present organized case summaries orally.

V. Diagnostic and Conceptual Skills:

A student is expected to:

1) identify major problem areas, including primary and co-morbid conditions;
2) identify predisposing, precipitating, and maintaining factors;
3) identify biological, psychological, family and socio-cultural influences on symptoms; and their contribution to the etiology, pathogenesis, epidemiology and treatment of the presenting illness (es);
4) identify relevant past history;
5) identify general medical and substance related contributors to the presenting illness;
6) evaluate the emergency aspects of the problem;
7) formulate an accurate and comprehensive differential diagnosis using the current Diagnostic and Statistical Manual;
8) formulate a beginning treatment plan considering somatic and psychosocial interventions;
9) identify deviations from normal development.

V. Responsibility and Professionalism:

A student is expected to:

1) be punctual and available;
2) reliably complete tasks and assignments;
3) ask for help when needed;
4) terminate and transfer cases appropriately;
5) A student=s appearance, demeanor, behavior and relationship with staff should be consistent with their role.

VI. Educational Initiative:

Students are expected to:

1) ask questions;
2) do relevant reading;
3) volunteer for presentations;
4) actively seek clinical experiences.

VII. Feedback:

Students are expected to:

1) actively seek feedback from supervisors;
2) be receptive to suggestions and change behavior in             response to suggestions from supervisors, staff, and patients.

A student should be able to:

1) demonstrate basic skills to promote a therapeutic relationship;
2) assess violence risk towards self and others;
3) utilize psychotropic medication with knowledge of its mechanism of action, indications, contraindications, adverse effects, monitoring requirements, and drug interactions;
4) demonstrate a working knowledge of the functioning of a psychiatric healthcare delivery system;
5) make referrals to appropriate community agencies, clinics and private psychiatrists;
6) communicate (in verbal and written form) psychiatric findings to other medical and agency professionals;
7) work within a team frame-work.

1) Students should have a basic knowledge of the normal developmental stages of childhood, adolescence, and adulthood. The student should be able to identify, describe, and discuss the major pathological syndromes and developmental deviations associated with these developmental stages.

2) Students should be able to identify and describe the major adult psychiatric disorders described in the current Diagnostic and Statistical Manual.

3) Students should be able to achieve a minimum score of 60 for the end-of-clerkship examination. The student will be required to pass both the clinical rotation (including standardized patient exam) and shelf exam portions of the clerkship in order to pass the entire clerkship.

4) Students should acquire an elementary understanding of various theoretical models for conceptualizing mental illness and its treatment.

5) Students should be familiar with modalities of psychiatric treatment  including commonly used approaches in the biopsychosocial areas.  They should have a basic knowledge of different types of treatment (e.g., cognitive therapy, 12-step, behavior therapies, psychodynamic therapies, pharmacotherapy, etc.); formats of treatment (individual, family, marital, group); and phases of treatment (acute, maintenance, rehabilitation).

6) Students should understand indications for various levels of care, e.g. prevention, inpatient, partial hospitalization, intensive outpatient, residential, outpatient.

7) Students should be familiar with medico-legal concepts relevant to psychiatric practice, e.g. HIPAA rules, confidentiality, reporting duties, involuntary hospitalization, etc.

8) Students should be familiar with commonly used evaluation tools e.g. imaging studies, psychometric scales, psychological and neuropsychological testing instruments, etc...

9) Students should be able to demonstrate evidence-based medicine skills in psychiatric practice.

The final grade is independently derived from a clinical and shelf exam score as is assigned by the Clerkship Director. Both the clinical and shelf exam  aspects of the clerkship must be passed independently in order for a final passing grade to be assigned.

1.  CLINICAL PORTION  (2/3 of grade) This is  made up of two components:

a)   A Standardized Patient Exam

A Standardized patient examination will be administered to all students completing the M-3 Psychiatry clerkship. This examination will be given usually on the Monday or Tuesday preceding the written NBME shelf examination (see below). This examination will consist of 3 standardized patient evaluations. Students will be expected to interview each patient for30 minutes, and document a mental status examination and differential diagnosis on each patient seen. This examination will last 2 and 2 hours, and be graded on a needs remediation/proficient/advanced/outstanding basis. The grade achieved will be factored in to the clinical grade from the site to determine the final clinical grade. A failing grade on the standardized patient exam will preclude an outstanding grade in the clerkship.

The standardized patient exam will be factored with the clinical site grade to provide the final clinical grade (worth 2/3 of the overall clerkship grade) in the following manner:

Standardized patient exam +Clinical site grade = Final Clinical grade

Outstanding                               Outstanding                             Outstanding

Outstanding                               Advanced                                Advanced

Outstanding                               Proficient                                 Advanced

  Advanced                                Outstanding                              Outstanding

 Advanced                                  Advanced                                 Advanced

 Advanced                                   Proficient                                  Proficient

  Proficient                                    Outstanding                               Advanced

  Proficient                                    Advanced                                   Advanced

  Proficient                                    Proficient                                     Proficient

Assignment of the overall clinical site grade is the responsibility of the clerkship director based upon the written evaluations by the faculty and house staff for each assigned service. The current grading form is included in this packet and identifies the core skills, or principle components being evaluated.   These include: EDUCATIONAL INITIATIVE, RESPONSIBILITY AND PROFESSIONALISM, RESPONSE TO FEEDBACK, MENTAL STATUS EXAM, CLINICAL INTERVIEWING: DATA GATHERING, INTERACTIONS WITH PATIENTS, PRESENTATION OF CLINICAL MATERIAL, DIAGNOSTIC AND CONCEPTUAL SKILLS. Each item is evaluated as Outstanding,Advanced, Proficient, or Needs Remediation. These individual grading sheets are submitted to the Clerkship Director who summarizes them. Assignment of the overall clinical site grade is then calculated by a formula, i.e., students who receive five or more outstanding grades will be rated AOutstanding@ for the non-cognitive score. Students receiving at least 3 "Outstanding" and no ANeeds Remediation@ score will be rated an  AAdvanced."  All others with no ANeeds Remediation@ will receive a AProficient" score. Students given ANeeds Remediation@ for any of the principle components of the clerkship will receive an incomplete until specific remediation is successfully accomplished, either during the clerkship, or later. Thereafter the Clinical site grade will be converted to AProficient.@

Five or more AOutstanding@ ---"Outstanding" (typically 7-10% of students)  10
Three outstanding and no ANeeds Remediation@ --Advanced                      08
All others with no ANeeds Remediation@ -- Proficient                                 06
Any "Needs Remediation@                                                                      00

Remediation will be at the discretion and advice of the faculty member, Site Coordinator, Clerkship Director, and the Department Head. If necessary, it may consist of repeating a part of or the entire Clerkship. Students failing two attempts at remediation will be referred to the Dean=s Office and thereafter to the Student Promotions Committee for further action.

Students who want to discuss the Clinical grade received must do so with the Site Coordinator. Only under rare circumstances will the Clerkship  Director  overrule the Site Coordinator.

The final examination consisting of an NBME Shelf Examination is considered part of the Clerkship and counts for one-third of the final grade. A minimum pass level of 59 is required. Students receiving a score of less than 59 will be given an AIncomplete@ for the course and will be required to retake and pass the examination. A Second Failure will require a third attempt after a structured learning period. If the MPL is not reached after a third attempt, the student will receive an AIncomplete@ for the course and will be referred to the Dean=s Office and thereafter, to the Student Promotions Committee for further action.

SCORE                                                                  POINTS

83 or above                                                                  05

77-82                                                                           04

72-76                                                                           03

60-71                                                                           02

0-59                                                                             00

   3.   SUMMARY

If a student passes the CLINICAL component and fails the examination, that student will be required to retake the examination in the sequence described above. Students passing the exam but receiving ANeeds Remediation,@ for the Clinical part of the clerkship will be offered the opportunity to complete the clinical remediation requirements and pass. Students who fail both components of the clerkship evaluation must repeat the Entire clerkship.

Regardless of the outcome, a grade of AOutstanding@ will not be awarded, if, during any phase of the evaluation, the student has had to remediate or retake the entire or any part of the clerkship or the end-of-clerkship examination. 

This is the composite of the points awarded for the Clinical component and the Shelf Exam component.

CATEGORY                                                        POINTS

Outstanding__________________________________ 13-15

Advanced____________________________________ 11-12

Proficient____________________________________  08-10

Need Remediation ____________________________  06-07

A 2 POINT PENALTY OFF THE FINAL GRADE FOR EACH DAY MISSED.