Objectives

Students have all of medicine to choose from for their careers, and not all of them choose psychiatry! The purpose of the psychiatric clerkship is to provide clerks with a range of experiences and opportunities to enable them to recognize and begin to manage psychiatric problems they are likely to encounter in the diverse medical settings they will enter as residents. 

A. Skills clerks should acquire:

Interviewing: Building on the techniques acquired during earlier units, especially units 1 and 4, clerks should be able to:

• take a psychiatric history in such a way that they are able to assess the importance of psychological, medical and social factors
• make  a short assessment of a patient's characteristic coping style and personality
• perform a mental state examination of a patient with psychiatric illness
• adapt their interview techniques to deal with common sorts of "special" patients: e.g., children, the elderly, those who don't speak English, those with communication problems
• adapt their interview techniques to deal with common sorts of "difficult" patients: e.g., silent, over-talkative, angry, seductive, suspicious, passive, dependent, defensive, evasive patients, or those who deny they need help
• assess risk of suicide, violence and self-neglect

Diagnosis: The multi-axial approach of the DSM-IV exemplifies the biopsychosocial model. At the conclusion of the rotation, clerks should be able to:

• recognize the major clinical disorders (Axis I)
• reach reasonable hypotheses about a patient's pre-morbid personality and its link to the present predicament (Axis II)
• specify relevant medical considerations, including substance and medication misuse (Axis III)
• recognize relevant environmental and social stresses (Axis IV)
• describe the level of everyday functioning (Axis V) and realistic goals for improvement

Management: At the end of the rotation, clerks should be ready to begin dealing with the following:

Crises

• management of acute psychosis
• management of violent behaviour in hospital
• emergency procedures under the Mental Health Act

Psychotherapy

problem-solving therapy: helping patients to specify the components of the predicament in which they find themselves; to identify potential solutions to their problems; and to implement a means to tackle them

supportive psychotherapy: helping patients to deal with bad news or overwhelming situations, eg., bereavement, their own serious illnesses or dying

Biological Treatment

• fundamentals of drugs: practical principles of selection and monitoring
• indications for electroconvulsive therapy

Social Interventions

• finding and working with social agencies
• when to refer to psychiatry

Knowledge clerks should acquire:

Clinical features, epidemiology, aetiology, diagnosis, and treatment of: Common and important psychiatric disorders, of relevance to the practice of medicine in general (as justified in the World Health Organisation's Diagnostic and Management Guidelines for Mental Disorders in Primary Care (ICD 10-PHC) http://www.rsm.ac.uk/pub/bkwhopdf.htm:

Acute psychotic disorders (including acute schizophrenia-like psychosis, acute delusional psychosis, and other acute and transient psychotic disorders)

• Adjustment disorder (including acute stress reaction)
• Alcohol misuse
• Bereavement
• Bipolar disorder
• Chronic fatigue and chronic fatigue syndrome
• Chronic mixed anxiety and depression
• Chronic psychotic disorders
• (including schizophrenia, delusional disorders, and other nonorganic psychotic disorders)
• Delirium
• Dementia
• Depression
• Dissociative (conversion) disorder
• Drug use disorders
• Eating disorders
  
• Generalized anxiety
• Panic disorder
• Phobic disorders  (including agoraphobia and social phobia)
• Post-traumatic stress disorder
• Sexual disorders
• Sleep problems (insomnia)
• Unexplained somatic complaints
• Learning disabilities

B. CLINICAL EXPERIENCE

Each clerk will be assigned primarily to the supervision of a member of the faculty of the Department of Psychiatry and Behavioural Neurosciences, and will be expected to spend most of her or his time learning and practicing clinical psychiatry in that supervisor’s clinical team. The supervisor will be responsible for the supervision, assignment and evaluation of clinical work. For rotations taking place after April 2002, clerks will have an opportunity to state their preferences for particular psychiatric subspecialties: where possible and appropriate, we will try to accommodate such preferences.

Emergency Psychiatry: About four times during Hamilton and Guelph rotations, each clerk will be expected to take night (1700-0800) and/or weekend/holiday (0900 - 0900) call with the Emergency Psychiatry Team (EPT) at St. Joseph's Hospital, Hamilton. A duty schedule will be published at the start of each rotation: clerks must sign in with the senior residents on call at the start of the shift; be available to see patients under supervision of the residents and staff on call; and attend hand-over rounds following the shift. Call is mandatory, and clerks must remain in the hospital for the entire shift. There is a call room at St. Joseph's Hospital for the clerk on call. Clerks are permitted to leave call at 12 midnight if they are post call on the academic day.

Crisis Outreach and Support Team (COAST): In addition to the EPT shifts, a limited number of students may choose to spend an evening with the COAST team, participating in the assessment and management of psychiatric crises in the community. The team consists of specially trained police officers and mental health professionals. Students wishing to take advantage of this opportunity must inform the Psychiatry Education Office at 905-522-1155 ext. 2206 of their interest in advance of the rotation so that the necessary arrangements can be made for scheduling and clearance.

C. ACADEMIC EXPERIENCE

Attendance at the following activities is expected. We will make every effort to consolidate these activities into one day, usually Wednesdays.

Tutorials

In groups of 7 or 8 students, clerks will attend weekly tutorials on topics drawn from their own clinical experience. Students will be expected to take turns to present a case which exemplifies one of the diagnoses in the ICD-10 PHC; the group will identify problems and learning objectives based on the case presentation, and by the next session, the group should be prepared to discuss their conclusions based upon their review of the relevant literature.

Teaching sessions

There will be weekly interactive sessions for the whole group featuring demonstrations and discussions of a range of clinical and therapeutic problems, intended to ensure exposure for all students to a balanced range of psychiatric issues, no matter which setting they are primarily assigned to.

Grand Rounds

Clerks should attend Psychiatric Grand Rounds from 0900 to 1000 each Wednesday morning. These are sometimes followed by workshops with the presenter of the Grand Rounds. The schedule can be found on the Grand Rounds section of the website.

Chief Resident Seminars

Each week for an hour, the clerks will meet with a Chief Resident for a seminar on a topic of mutual psychiatric interest.

D. EVALUATION

Evaluation, at the half-way mark and at the end of the rotation, is the joint responsibility of the tutor and the clinical supervisor. The following will be evaluated:

• Interviewing skills
• Knowledge of psychiatry
• Clinical performance on wards, in clinics and in the emergency department
• Participation in tutorials
• Professional behaviour

The evaluations are to be informed by the scores on the encounter cards and on the end-unit test. Each clerk must return 12 encounter cards during the rotation, each one reflecting a complete psychiatric history and examination. The ratings on these cards will be taken into account in the student's overall evaluation. At the end of each rotation, students are required to take a multiple choice test in Psychiatry.

Back to Education