Course Objectives

By the completion of the Clerkship, the student will be expected to master the following objectives, developed internally:

Please see education program objectives (competency statement) for the FSUCOM with 6 competency domains.

Skills

1. Based on the observations of clerkship director and/or the clerkship faculty, the student will demonstrate the ability to:
   1. Perform a complete psychiatric examination that will include identifying data, history of present illness, a psychosocial history, past psychiatric history, past medical history, current medical problems, alcohol/substance abuse history and a mental status exam, summation and differential diagnosis. This will be a 1-5 page paper. Each student must:
      1. Send a copy via email to Dr. Lee
      2. Provide a copy to the Clerkship Director
      3. Place a copy in the student's e-portfolio
      4. Complete and turn in before or on Wednesday of week 6
   2. Perform a problem - focused exam.
   3. Perform a "mini - mental status" exam.
   4. Do a risk assessment for suicide or potential to do harm to others and discuss an intervention plan.
   5. Verbally present a case. The presentation will include identifying data, history of present illness, a psychosocial history, past psychiatric history, past medical history, current medical problems, alcohol/substance abuse history and a mental status exam, summation, differential diagnosis and a treatment plan.
2. Based on review of the clerkship director and clerkship faculty, the student will demonstrate the ability to:
   1. Dictate or write a case in a form satisfactory for a medical record.
   2. Use technology to locate evidence based psychiatric information.
3. Based on the observations of clerkship director and / or the clerkship faculty, and with some weight given to the surveys completed by 10 patients on each student, the student will demonstrate the ability to:
   1. Keep boundaries, recognize transference issues and set limits with patients.
   2. Verbally communicate in a manner understood by the patient and effective for gathering history.
4. Using technology to access current Evidence-Based Medical Information (e.g. PDA), the student will demonstrate the ability to research relevant psychiatric topics. Such information will be appropriately utilized for patient evaluation and diagnosis, in treatment plan formulation, or while preparing reports or presentations on psychiatric topics. Mastery of this skill may be demonstrated by using a PDA to determine the potential interactions between psychotropic and other medications.

Students will demonstrate an assessment for polypharmacology, and an ability to discriminate appropriately between depression, delirium, and dementia while using communication skills as outlined in the Reynolds grant. Discussion of this will take place during one of the six weekly sessions with the clerkship director.

Knowledge

1. Based on the observations of clerkship director and / or the clerkship faculty during patient rounds, case presentations, small group discussions, and independent required readings the student will demonstrate knowledge in the following core areas:
   1. Mental illnesses to include major depression, dysthymic disorder, bipolar disorder, adjustment disorders, generalized anxiety disorder, panic disorder, social phobia, obsessive-compulsive disorder, substance and alcohol abuse, Personality disorder, schizophrenia/psychoses, dementia and deliriums, somatoform disorders, factitious disorders, malingering and sleep disorders.
   2. Demonstrate an understanding of the use of The Diagnostic and Statistical Manual of Mental Disorders 4th Edition (DSM-IV).
   3. Psychopharmacology to include the usage of anxiolytics, antidepressants (and ECT), antipsychotics, mood stabilizing agents, anticholinergics, acetyl cholinesterase inhibitors, psychostimulants, and beta blockers in appropriate treatment of the mentally ill.
2. During discussions with the faculty regarding the comprehensive evaluation and management of a psychiatric patient, the student will demonstrate an understanding of the following:
   1. The co-morbidity of mental, neurological and medical illnesses.
   2. The use of laboratory tests and various types of scans (CT, PET, MRI, etc.) to evaluate for mental illness or for the ongoing monitoring of medications. (Lithium level, etc.)
3. The student will construct and present to faculty an organized treatment plan addressing the findings of the evaluation. In addition to recommending medications using the principles of psychopharmacology, this presentation will demonstrate to the faculty:
   1. Recognition of the signs, symptoms and risk factors for suicide, homicide and withdrawal from drugs and alcohol.
   2. The ability to assess for the need for inpatient hospitalization.
   3. The ability to apply the basic concepts of various psychotherapies and propose ways to incorporate them into a treatment plan. (Psychotherapies include but are not limited to psychoanalysis, cognitive behavioral therapy, behavioral therapy, supportive psychotherapy, and brief/time limited psychotherapy.)
4. For diagnostic clarification or treatment planning, the student will demonstrate to faculty:
   1. A conceptual understanding of the indications for psychological testing.
5. From the patient evaluation, the student will demonstrate to faculty:
   1. Recognition of the signs of abuse in all ages.
   2. The differing presentations of mental illness over the life span. (e.g. children, adolescents, adults, and the elderly).

Attitudes and Behaviors

1. With patient write-ups and during case presentations and discussions with the clerkship director and faculty, the student must demonstrate the ability to remain objective and non-judgmental toward a patient, regardless of lifestyle and life choices.
2. Regardless of setting (e.g. inpatient ward, ambulatory care centers, hallways, and waiting rooms) the student will demonstrate and appreciate the importance of confidentiality of psychiatric information. This will be based on faculty observation.
3. During discussions with faculty, the student will be able to discuss the basic ethical issues in psychiatry (e.g. involuntary treatment, duty to warn, reporting abuse and boundaries with patients).
4. The student must demonstrate to faculty the ability to recognize circumstances that require a psychiatric referral, particularly in the primary care setting, and acknowledge professional limitations. During case presentation and conferences, the student will be able to discuss when such a referral is appropriate.
5. During case discussions with faculty or participation in multidisciplinary treatment team meetings, the student will demonstrate an appreciation of the following in aftercare planning and community mental health:
   1. The biases against the mentally ill in society and patient advocacy when appropriate.
   2. The barriers to treatment for the mentally ill (e.g. medical systems, third party payers, and the patient themselves).
6. The community resources available for different demographic groups and the appropriate organizations to contact in if assistance in needed (e.g. Social Services, or Council on Aging, etc.)