Clerkship in Psychiatry-Clinical Neuroscience 1

The psychiatry clerkship is a 6-week rotation designed to give the student a brief yet in-depth experience in a particular aspect of psychiatry.  What aspect of psychiatry that is largely depends on the primary site that the student chooses, but can include:  general adult psychiatry, child psychiatry, outpatient psychiatry or psychiatry in the medical/surgical setting. Students spend most of their time immersed in their primary site, however this is partly balanced by additional experiences including an optional outpatient experience, and an experience in two psychiatry emergency departments.

Mission Statement

This clerkship is meant to be an introduction to psychiatry in the clinical setting, combined with a chance to learn one or more aspects of psychiatry in some detail.  Although we do not feel it feasible (or desirable) to attempt to teach all of the important aspects of psychiatry in six weeks, we do believe the that clerkship should give at least some exposure (either practical or didactic) to our major themes, including common types of psychiatric disease, treatment, and the psychiatric interview and mental status examination.

Educational Goals

By the end of the 6 week rotation the student should be able to:

1. Conduct an interview in a manner that promotes information gathering and a therapeutic alliance.

2. Develop a sense of comfort with disturbed patients and patients with chronic psychiatric illnesses, with an awareness of your reactions to these patients.

3. Demonstrate the ability to obtain a complete psychiatric history, perform a complete mental status exam, and recognize significant physical findings.

4. Identify the major psychiatric disorders, e.g., mood and anxiety disorders, psychoses, personality disorders, substance disorders, and disorders involving cognitive impairment (delirium, dementia).

5. Acquire a basic fund of knowledge about these disorders.

6. Formulate differential diagnoses.

7. Develop a plan of further assessment and treatment that addresses medical, psychiatric, and psychosocial problems.

8. Be familiar with the major classes of psychotropic medications, including pretreatment work-up, indications and contraindications, starting and adequate maintenance dose ranges, common drug interactions, and common side effects.

9. Assess and begin emergency management and referral of a patient with psychiatric symptoms.

10. Develop a familiarity with basic psychotherapy concepts.

Textbooks

We don't require a textbook. However, it is highly recommended to have some source of info while on the clerkship. Some recommendations follow:

Traditional Books

Handbook: Bauer, Mark S., Field Guide to Psychiatric Assessment and Treatment, 1st Edition. Philadelphia, PA, Lippincott Williams & Wilkins, 2003. --See it at Amazon.com--a good guide to have with your on service, concise, with lots of good reference tables and lists.

Textbooks

Roberts LW, Hoop, JG, Heinrich TW.  Clinical Psychiatry Essentials.  Lippincott, Williams & Wilkins, 2009.

Andreasen Nancy, Black, Donald, Introductory Textbook of Psychiatry, 3rd Edition. Washington D.C., American Psychiatric Publishing, INC., 2001.

Online Resources

From Medscape

Moore & Jefferson: Handbook of Medical Psychiatry, 2nd ed. , 2004 Mosby, Inc. A very well organized textbook, arranged by disease, and using what should be a familar medically oriented approach to describing each psychiatric disease.

Jacobson: Psychiatric Secrets, 2nd ed. 2001 Hanley and Belfus. A good, concise handbook style text, arranged in question-and-answer format.

Books @ Ovid

Kaplan and Sadock's Comprehensive Textbook of Psychiatry, 9th edition by Sadock and Sadock. This is probably the most popular textbook of psychiatry, but very large and probably too comprehensive for a clerkship. Still, if you want the fullest possible information available in a textbook, this is a good place to look.

Child & Adolescent Psychiatry: A Comprehensive Textbook, 3rd edition, by Melvin Lewis. Like the title says, this is a big book concentrating on child psychiatry.

Wikipedia:  is getting better every day (esp. as they added some editorial oversight to the psychiatry entries)

Resources on this Site

In addition to the above, a number of readings and references are provided on the clerkship site (available through MyCourses).  One can find a variety of resources including readings and videos on this site. Just go to the didactics section for this course Web CT site.

      *     Required projects - e.g. Social and Community Context of Care oral presentation on final day of rotation

In addition to the above rotations and clinical experiences, the student is required to conduct an observed clinical interview which will be rated by an attending. 

      *     Clerkship site(s)

- these could be links to the respective web sites - clicking on Miriam Hospital takes you to the Lifespan Miriam page.

Butler Hospital

Butler Hospital is a freestanding psychiatric facility with a broad range of treatment settings on and off the Butler Campus.  Students generally rotate through the general treatment unit, or the partial hospital unit.  
The general treatment floor (GT4) admits patients needing acute care (ie, patients needing immediate medication adjustment or who pose safety concerns).  The partial hospital (aka Day Hospital) sees patients who need daylong supervision and daily psychotherapy but are safe enough to return home at night.

In addition, Butler Hospital offers one child rotation, in which a student can rotate on a unit specially designed for child and adolescent psychiatry.

The VMAC Hospital

The student's main role at the VA is to assume a subinternship role on the inpatient unit, following an average of 3-5 patients on the team.  The Veteran’s Hospital is a general medical hospital serving a wide variety of medical problems among veterans.  On the inpatient unit, a variety of problems will be observed, running the gamut of psychiatric illness.  However, the doctors there have particular expertise in special problems common in veterans, including PTSD and substance abuse. 

Rhode Island Hospital

RIH has three main areas for students to choose to work in:

The inpatient unit (Jane Brown 5-South and 4-South) population covers the spectrum of psychiatric illnesses, including exposure to pharmacotherapy, family meetings, and group psychotherapy. Students working on the inpatient floor stay mainly on the unit, and typically work directly with an attending psychiatrist and resident.

The consult service with Dr. Harrington treats the various medical patients throughout RIH that have psychiatric issues (delirium, psychosis, etc.). Students evaluate and chart patients individually during the morning hours and then round with the team during the afternoon. Dr. Harrington is a great teacher (he was awarded the Senior Citation Award in 2003), but be aware that the service often runs late hours. Also be aware this rotation is a popular elective for fourth year medical students. As such, typically only one student may choose the consult service.

The Partial Program with Drs. Villalba and Elliot is an intensive day program. The focus is on group therapy, and students participate in both individual assessments as well as group therapy. There is less resident contact than on the other services, and at times (depending on the partial population) less cross-sectional exposure to a wide variety of psychiatric illness. Due to the size of the program, typically only one student may choose the partial program. 4 th year students are better suited for this experience.

Bradley Hospital

Bradley Hospital is a unique hospital specializing in child psychiatry, one of the few in the country.  This affords a unique experience for those students wanting to concentrate on the treatment of children and adolescents.  Be warned that this will be the bulk of the experience for students choosing this rotation; the outpatient and other sites will be chosen with an eye to partially rounding out this experience. 

The Miriam Hospital

Miriam Hospital is a medical surgical hospital only (i.e., no psychiatry unit).  Thus, the psychiatrists there have a particular interest in psychiatry in the medical and surgical setting.  The clinical rotation in Psychiatry at TMH is performed in the general hospital on the Psychiatry Consultation/Liaison Service. The hospital population ranges in age, and patients seen by the C/L Service include those with depression, bipolar disorder, anxiety disorders, delirium, dementia, schizophrenia, substance abuse, and somatoform disorders. In addition, medical/psychiatric conditions such as serotonin syndrome, neuroleptic malignant syndrome, catatonia, pain disorders, and acute overdose are seen. The service has a particular interest in neuropsychiatric disorders, and regularly sees patients for dementia evaluation and assessment of movement abnormalities.

More information on each site, the responsibilities, and contact information can be found on the MyCourses site for the psychiatry clerkship.

Contact Information

Robert Boland, MD
Clerkship Director
Butler hospital
Phone: 455-6417
Pager: 350-7467
Robert_boland_1@brown.edu

Tracey Guthrie, MD
Associate Clerkship Director
tguthrie@butler.org

Donna Golomboski
Clerkship Coordinator
Phone: 455-6417
Donna.Golomboski@va.gov