Plenary
Friday, June 13
8:00 – 9:00 a.m.
Explorers’ Room
SPECIAL ADDRESS
Laura
Weiss Roberts, M.D.
University
of New Mexico
Editor-in-Chief
of Academic Psychiatry
Educational goals: This plenary presentation will provide
an introduction to the process of getting published in the psychiatric
education literature, giving guidance on how to approach the writing process,
on what makes a good paper, and on emerging ethical standards in the medical
education literature
Method: Participants will
be introduced to the process of getting a paper published in the psychiatric
education literature, including manuscript preparation, submission, editorial
review, peer-review, revision and resubmission, editorial decision-making, and
publication production. Information
will be provided on specialized format papers, such as annotated
bibliographies, review papers, brief reports.
Specific strategies for assessing one’s strengths and motivations as a
writer and collaborator, for choosing the “right“ target journal for a paper,
for selecting the “right” presentation of the content, for responding to
reviewers’ concerns, and for working with editors will be addressed. We will also cover important but seldom
discussed considerations related to collaboration with co-authors, authorship
“ethics”, and scientific integrity issues. Essential skills for medical
educators regarding ethical and regulatory issues in educational research will
be outlined. Relevant federal
regulations for educational research will be outlined.
Results: This presentation
is aimed at enhancing the understanding and skills of early and middle career
academic psychiatrists with an interest in writing manuscripts for publication
in the field of psychiatric education.
It will also be valuable for more senior faculty who serve as mentors,
senior authors, and guest editors.
Conclusions:
This plenary session will help enhance confidence and competence of
members of the audience in approaching the process of getting published in the
psychiatric education literature.
Workshop
Friday, June 13
9:00 – 10:15 a.m.
Wapiti 1
Aurora J. Bennett, M.D.
Lowell Tong, M.D.
University of California, San Francisco
Kemal Sagduyu, M.D.
University of Missouri, Kansas City
On-line schedules and evaluations were introduced into the clerkships
at our various institutions during the past two years. The on-line programs utilized by our
departments range from large commercial programs to small clerkship-specific
designs. Students and faculty complete
evaluations on-line and the data are organized in a manner that facilitates the
tracking of various sites and preceptors.
Reports are readily generated that provide faculty with their individual
scores and comments, from students, along with the numerical averages at
comparable sites. The development and
implementation of these programs has been challenging, but the rewards far
exceed the difficulties. Examples of
the various systems will be viewed as a means of promoting discussion about the
pros and cons of the varying designs.
Workshop
Friday, June 13
9:00 – 10:15 a.m.
Moose 2
Using
Guided Role-plays to Prepare
Students
for Standardized Patient Experiences
Julia
Frank, M.D.
George
Washington University
Educational goals: Participants
in this workshop will learn how to
use semistructured role playing exercises to teach interviewing skills
and the skills of psychiatric assessment in primary care settings.
Description: For the last five
years, clerks at the George Washington University
School of Medicine have learned outpatient psychiatric assessment skills
in part through participating in a series of semistructured role plays.
These exercises, which build on the problem based methods used in
preclinical courses, may be self or faculty led in groups ranging from
four to thirty people. Students are assigned in advance to be a primary
care doctor, an unfamiliar patient or a psychiatric consultant. The
latter two receive specific information and research their tasks ahead
of time. During the exercise, the naive primary care doctor interviews
the patient, observers join in, and finally the consultant reviews the
diagnosis and treatment options for the group as a whole.
This method, which has generally been well received by
students,
resembles the standardized patient experiences that will soon be part of
national boards. The interviews are longer than typical SP experiences,
but the format allows for direct observation of interviewing technique
and feedback, with particular emphasis on simultaneous
behavioral-psychiatric and medical assessment.
Workshop participants will be invited to participate in a sample
exercise and to review the available feedback. They will then have time
to offer their reactions and suggestions for improving this experience.
A complete copy of the current curriculum will be available for
participants to take and adapt to their own institutions.
Workshop
Friday, June 13
9:00 – 10:15 a.m.
Wapiti 2
(Down-to-earth)
Writers’ Workshop:
Writing
Manuscripts for Publication
Laura
Weiss Roberts, M.D
University
of New Mexico
John Coverdale, M.D.
Alan Louie, M.D.
University
of California, San Francisco
Academic Psychiatry
Educational goals: This workshop is a down-to-earth,
hands-on introduction to the essential skills of writing manuscripts for
publication in peer-reviewed academic medical journals.
Method: In helping
participants to build their writing skills, the course will involve
presentation of valuable and detailed information on the framework of empirical
and conceptual manuscripts and of specialized format papers, such as annotated
bibliographies, review papers, brief reports.
Participants will be introduced to the process of getting a paper
published, including manuscript preparation, submission, editorial review, peer-review,
revision and resubmission, editorial decision-making, and publication
production. This process will be
discussed in a step-by-step fashion, giving insights from the perspective of
writers, reviewers, and editors.
Specific strategies for assessing one’s strengths and motivations as a
writer and collaborator, for choosing the “right“ target journal for a paper,
for selecting the “right” presentation of the content, for responding to
reviewers’ concerns, and for working with editors will be addressed. We will also cover important but seldom
discussed considerations related to collaboration with co-authors, authorship
“ethics”, and scientific integrity issues. This workshop will involve
interactive learning and Q and A formats, and it will have a tone of warmth and
collegiality. Up-to-date resource
materials will be provided to all participants.
Results: This workshop is
aimed at enhancing the skills of early and middle career academic psychiatrists
with respect to writing manuscripts for publication in peer-reviewed
journals. It will also be valuable for
more senior faculty who serve as mentors, senior authors, and guest editors.
Conclusions:
Psychiatric educators may receive benefit from activities which enhance
and expand their skill set and prepare them for the tasks of careers in
academic psychiatry.
Poster
Friday, June 13
10:15 – 10:45 a.m.
Explorers’ Room
Psychiatrists
Compared to Other Specialists on Performance Before, During and After Medical
School: Over Three Decades of Data from the Jefferson Longitudinal Study
Frederick S. Sierles, M.D.
Finch
University of Health Sciences/The Chicago Medical School
Michael J. Vergare, M.D.
Mohammadreza Hojat, Ph.D.
Joseph
S. Gonnella, M.D.
Thomas
Jefferson University
Educational goals:
Participants will compare longitudinal academic performance of
psychiatrists compared to other specialists, and discuss the implications of
this for career counseling and curriculum development for third and early
fourth year
medical students and first year psychiatry residents, and
for recruitment of medical students into psychiatry.
Objectives:
This study was designed to compare psychiatrists with other physicians
on measures of academic performance before, during and after medical school.
Method: More than three
decades of data for graduates of Jefferson Medical College (n=5,701) were analyzed. Those who pursued psychiatry were compared
to physicians in seven other specialties on 21 performance measures. Using analysis of covariance controlled
gender effect.
Results: Psychiatrists
performed better on measures of verbal ability and general information before
medical school, and in evaluations of knowledge and skills in behavioral
sciences during medical school, but not on the examinations of general medical
sciences. Also, in their first year of
residency training, psychiatrists were rated high on the clinical competence
area of socioeconomic aspects of patient care, but not in the areas of
knowledge and data gathering, interpersonal skills and attitudes. The latter finding is counterintuitive but
readily explainable.
Conclusions: The results have implications for
career counseling of third year and early-fourth-year medical students, for
program planning and career counseling for first year psychiatry residents, and
for recruitment of medical students into psychiatry. More attention should be paid to the general medical education of
psychiatrists and other non-generalist specialists.
Poster
Friday, June 13
10:15 – 10:45 a.m.
Explorers’ Room
Julia Frank, M.D.
George Washington University
Educational goals:
1.
Increase students’
self-awareness in their interactions with psychiatric patients.
2.
Increase students’
tolerance for patients’ distress.
3.
Improve residents’
ability to use non-directive teaching methods with medical students.
Description: Since July, 2002,
students on their third year psychiatry
clerkship at George Washington University School of Medicine have
participated in a modified group exercise based on the work of Michael
and Enid Balint. This method, used extensively with primary care
practitioners in England and in some US residency programs, involves
small group sessions in which one member is instructed to present a
patient from the point of view of the doctor patient relationship. The
presenter is encouraged to reflect on his/her reactions to the
patient, for the purpose of understanding more about the patient, based upon
the countertransference he/she elicits. Others in the group then comment
on the dyad presented.
Groups of 8 students meet three times during the clerkship for an hour
fifteen minutes. Advanced residents lead the groups, under the
supervision of a resident who has received special training in
Balint’s methods.
Conclusions: Based on anonymous feedback, students have
found these
groups helpful in buffering the emotional stress of dealing with very
ill psychiatric patients, especially children. The residents leading
the groups have also expressed high levels of satisfaction with the
experience, which leads to an open discussion of issues rarely
addressed during formal clerkship didactics. By June, there will be
enough feedback available to comment on whether this experience
increases or stifles students’ self declared interest in working with
the mentally ill.
Poster
Friday, June 13
10:15 – 10:45 a.m.
Ruth
M. Lamdan, M.D.
Temple
University
Educational goals: At the conclusion of
this poster, participants will gain an understanding of the group process as a
tool for faculty development and assurance of uniformity amongst clerkship
training sites as mandated by the LCME.
Introduction: Temple
University School of Medicine Department of Psychiatry faculty has more than
doubled in size over the past year with the hiring of our new graduates. This paucity of teaching experience in our
new faculty and the “end of school” medical student survey from the AAMC
alerted us to educational needs of our students.
Method: At the
recommendation of our Chair and Chief of Service we created a “Supervising the
Supervisors” group to address these training goals. This forum has been used for the purpose of improving resident
supervision in psychiatry residency training programs. Our review of the
literature failed to uncover its utility or description. Our monthly group for all faculty and our
chief residents is ongoing. We are
addressing both the content and process of the clinical clerkship curriculum,
the evaluation process and the critical clinical skills which we require to
pass the rotation.
Findings/Results:
We will report on the beginning development of this group: the growth of our faculty identity and
cohesiveness, specific training directives, evaluation standards, specific
curriculum and course content: to establish our unique educational
culture. Future goals include the
development of qualitative measures of our faculty process. We will also disseminate the new standards
and techniques for improving the supervision of medical students to our
off-site faculty to assure uniformity amongst training sites and enhance their
supervisory skills.
Poster
Friday, June 13
10:15 – 10:45 a.m.
Simon Kung, M.D.
Maria I. Lapid, M.D.
Lois E. Krahn, M.D.
Mayo Clinic
We designed a simple and
user-friendly computer program to allow students to self-test their knowledge
of Psychiatry. The program presents a
series of multiple-choice questions drawn from a databank of questions geared
towards content found on standardized, national Psychiatry examinations. Students are familiar with this method of
testing because of the computerized USMLE examinations. The program runs on any Microsoft Windows
computer that has Microsoft Access, a widely-available database program.
In the spirit of academic
collaboration and to decrease barriers to access, we plan to share this
program, free of charge, with anyone who is interested. Because we are writing these assessment
questions ourselves, we also welcome contributions to our databank of
questions. Future plans include
producing a similar program for the wildly popular Palm-style computers.
Poster
Friday, June 13
10:15 – 10:45 a.m.
Dimensions
of First Year Medical Student
Religiosity
and Correlation with Attitude
Towards
Psychiatry and the Behavioral Sciences
Mercer University School of Medicine
Macon, Georgia
Introduction:
Despite a growing interest in addressing religious and spiritual issues
in the undergraduate medical curriculum relatively little is known about
medical student religiosity, how it is affected by medical education, and how
it correlates with medical students’ attitudes towards psychiatry and the
behavioral sciences. This poster
presents initial, pilot data from a longitudinal project, which will follow
medical students over the course of their medical education and assess these
things.
1.
To quantify key
dimensions of medical student religiosity, specifically organizational
religious practice, non-organizational religious practice, intrinsic
religiosity, and religious coping.
2.
To assess medical
students’ views of the role of religion
and spirituality in the medical school curriculum
3.
To assess medical
students’ views of the role of religion
and spirituality in the practice of medicine
4.
To assess first year medical
students’ attitudes towards psychiatry and the behavioral sciences
5.
To see if key
dimensions of medical student religiosity correlate with students’ views of the
role of religion and spirituality in
the medical school curriculum
6.
To see if key dimensions
of medical student religiosity correlate with attitudes towards psychiatry and
the behavioral sciences.
Description:
First year medical students at Mercer University School of Medicine were
surveyed using the Duke University Religion Index, R-COPE (religious coping),
Intrinsic Religious Motivation Scale, Attitudes Towards Religion in Medicine
Scale, ATP-30 (attitudes towards psychiatry), and Behavioral Medicine
Questionnaire (attitudes towards behavioral science.) The results of each survey will be quantified and the data will
be analyzed for correlation between the various instruments. Associations with age, sex, and choice of
medical specialty will also be analyzed.
This group of medical students will be re-surveyed at the end of their
second and fourth years of medical school to assess for change over the course
of medical education.
Conclusion:
Relatively little is known about medical student religiosity and
attitudes towards addressing religion and spirituality in the medical school
curriculum. This poster will present
pilot results of an assessment of several dimensions of medical student
religiosity and associations with attitudes towards psychiatry and the
behavioral sciences.
Poster
Friday, June 13
10:15 – 10:45 a.m.
Pre-Clinical
Medical School Education:
The Patient
Perspective
Lois E. Krahn, M.D.
Mayo Clinic
Educational
goals:
1.
Participants will be
aware of the degree of satisfaction and willingness to return that patients
interviewed in a pre-clinical medical student course expressed.
2.
Participants will be
aware of the multiple reasons that patients provided for participating in the
medical student course, many of which revealed an altruistic desire to help
students and health care institutions.
3.
Participants will be
able to consider identifying a group of psychiatric outpatients willing to be
involved with small group sessions in pre-clinical courses.
Purpose: The purpose of
this project is to understand why patients are willing to come in for
appointments arranged purely for the sake of medical education. By
understanding the patient perspective, we hope to better understand the nature
of the experience for our students as well as develop means to recruit more
patients as participants.
Introduction: For over eight
years Mayo Medical School has had a patient-oriented preclinical course called
"Introduction to Psychopathology." The course includes 18 hours of
lectures. The course was designed to incorporate active adult learning
techniques and use a case method teaching style. Each day after an introductory
lecture, the students break up into groups of 6-7 students where they interview
patients. Each small group has the opportunity to interview 15 patients. The
patients are recruited from the inpatient units as well as outpatient practice.
In the past we have tried using standardized patients. However we found that
when available, actual patients had several advantages over standardized patients'. Recruiting appropriate patients is a
potential challenge. Outpatient participants are suggested to the education
secretary by their psychiatrist or psychologist. The secretary contacts them
and asks them if they would be willing to participate. The patients participate
in two interviews an afternoon. The interviews are 30 minutes in length and
followed by a 30-minute break during which time the small groups discuss the
patient's interview. The patient is not present for the students' discussion.
Patients are paid for their participation.
Method: A six-question
survey was mailed to all participating outpatients after the course. This study
was approved by the Mayo IRB.
Results: Surveys were sent
to the 15 patients who participated in the 2002 course. The mean age was 50 years (range 27-70) and
73% were women. Eleven patients responded (73%). The mean duration of
participation was 3.5 years (range 1-8 years). Patients were highly satisfied
with their experience (mean 4.7 on a 5-point scale with 5 highly satisfied,
range 3-5). Their reasons for participating are listed in Table I. All would be
willing to participate again.
TABLE I
|
MOTIVATION FOR
PARTICIPATING |
|
|
Desire
to help students |
100% |
|
Opportunity
to teach about their illness |
91% |
|
Wish
to satisfy their psychiatrist |
18% |
|
Opportunity
to meet students/teachers |
73% |
|
Enjoyable |
64% |
|
Financial
Compensation |
65% |
|
Desire
to support the institution |
91% |
Conclusions: Patients who
returned the survey expressed a high degree of satisfaction and a willingness
to return next year. They provided multiple reasons for participating, many of
which revealed an altruistic desire to help students and health care
institutions. More medical schools could consider identifying a group of
psychiatric outpatients willing to be involved with small group sessions in
pre-clinical courses.
Reference: Krahn LE, Bostwick JM, Sutor, B, Olsen MW.
"The Challenge of Empathy: A Pilot Study Using Standardized Patients to
Teach Introductory Psychopathology to Medical Students." Academic
Psychiatry. 2002,26:26-30.
Poster
Friday, June 13
10:15 – 10:45 a.m.
Patient
Acceptance and Comfort Level Regarding
Medical
Students in Psychiatric Outpatient Clinic
University of Alabama
Educational goals:
To help participants to better prepare medical students for patient
interaction by being aware of patient comfort and confidence about seeing
medical students in an academic psychiatric outpatient clinic.
Method: The authors
developed a self-administered questionnaire that was distributed to patients
waiting for an office visit with the psychiatrists who served as faculty for
third year medical students in an academic institution. The questionnaire asked patients about their
comfort levels with having medical students present during their visits and
their confidence in the abilities of medical students.
Results: Ninety-nine
patients completed the survey. The
majority was female (76%) and Caucasian (84%).
Twelve respondents were excluded due to missing data. A majority of patients accepted students as
student doctors in training; 36% of patients preferred to see physician only;
and 41% preferred to see the physician only during first visit. Patients were uncomfortable discussing
sexual issues (49%), marital problems (30%), substance abuse issues (27%), and
financial and legal issues (28%) with medical students. Some patients felt that they had to repeat
their stories. Greater than 95% of
patients rated students favorably in their skills and professionalism.
Conclusions:
Although generalizations to all patients are limited by the sampling
design of the study, the majority of patients are accepting of medical students
in the academic psychiatry clinic.
Despite patient confidence in medical students’ abilities, a sizeable
minority prefers to see the physician only.
This may be due in part to having to repeat their histories to multiple
professionals. Academic psychiatric
physicians should prepare medical students for some patient discomfort in
talking with them and particularly as regards more sensitive issues.
Plenary
Friday, June 13
10:45 a.m. – 12:00 p.m.
Explorers’ Room
ASSESSMENT, PART I: MEASURING
ATTITUDES AND PERFORMANCE
Amy
Brodkey, M.D., Chair
University
of Pennsylvania
School-by-School
Trends in Medical Student
Career
Choice of Psychiatry, 1999-2001
Frederick S. Sierles, M.D.
Stephen H. Dinwiddie, M.D.
Delia Patroi, M.D.
Nutan Atre-Vaidya, M.D.
Michael J. Schrift, D.O.
John Woodard, M.D.
Finch University of Health Sciences/The Chicago Medical
School
Educational goals:
Participants will be able to summarize the factors that influence
school-by-school trends in medical student career choice of psychiatry.
Introduction: The proportion of students matching
into psychiatry (PMP) at each medical school results from a complex interplay
between national and regional trends (extrinsic variables) and characteristics
of each school, including the quality of its psychiatric education
(intrinsic). The authors ascertained
which extrinsic factors are associated with school-by-school differences in PMP
from 1999-01.
Methods: The authors obtained the PMP for each U.S. school (data
for individual schools is confidential and will not be mentioned) from student
affairs deans and the National Residency Matching Program (NRMP). They obtained data about the independent
variables from the AMA, the AAMC, the APA and Harvard’s HealthSystem
Consortium. Data were analyzed using
SPSS 11.
Results: The best
predictor of a school’s PMP is its PMP from the prior year. There were no significant associations
between PMP and the school’s funding, tuition, clerkship length, having a
psychiatrist dean, ethnic composition of the student body, admissions
preference for students from rural areas or underserved minority populations or
preferring primary care. Findings about
the association between PMP and local managed care penetration were surprising
and initially counterintuitive. There
was a significant, low-magnitude inverse correlation between PMP and
proportions of IMGs in the psychiatry residency. PMP for geographic region has changed notably since 1991-92.
Conclusions:
Though national trends are currently conducive to medical students
choosing psychiatry, individual departments cannot expect to be beneficiaries
of good fortune in their students choosing psychiatry based on regional or
school related “extrinsic” factors such as Southern location or public
funding. It is reasonable to infer,
therefore, that departments wishing to improve their PMP must provide the resources
in personnel and time to produce the best possible education programs.
Plenary
Friday, June 13
10:45 a.m. – 12:00 p.m.
Explorers’ Room
George W. Christison, M.D.
Loma Linda University
Educational goals: Upon completion of
this presentation, those present should be able to:
1.
Summarize the main
findings of the literature on the effects of medical curricula on attitudes
toward persons with psychiatric conditions
2.
List questions that
remain insufficiently answered regarding this area
3.
Describe useful
methodologies for researching this area further
Plenary
Friday, June 13
10:45 a.m. – 12:00 p.m.
Explorers’ Room
Dennis P. McNeilly, Psy.D.
Steven P. Wengel, M.D.
Educational goals:
1. To increase awareness of the advantages and
disadvantages resulting to medical students from their placement on a
particular clinical psychiatry clerkship rotation.
2. To increase knowledge of those factors that
may increase student performance on the psychiatry SHELF exam for medical
students and psychiatry clerkship directors.
Purpose: To examine and
compare medical student performance on the National Board of Medical Examiners
Subject Examination in Psychiatry (the “SHELF” exam) with student exposure to
psychiatry patients on four psychiatry clinical services.
Methods: The SHELF exam
scores of 365 third-year medical students who undertook a six-week psychiatry
clerkship from 1999-2002 were compared with five independent variables
inclusive of the clinical psychiatry clerkship experience. Analysis of the data compared student SHELF performance with student and attending
gender, student’s age, type of patient exposure during clinical rotation (child and adolescent, adult, geriatrics,
and consultation and liaison), number of patients seen during the clerkship
rotation, and the attending faculty rank on the student’s clinical rotation
(junior and senior).
Results: Student
performance on the psychiatry SHELF exam was found to be significantly
correlated with student gender, type of patient exposure, faculty rank. Number of patients seen by the student,
student age, number of students on service and attending gender were not found
to be predictive of student performance on the psychiatry SHELF exam.
Conclusions: The results of the study highlighted the
differences among student performance on the SHELF exam following exposure to
five different populations of psychiatry patients. The implications of this study suggest that student gender and
age are important factors predictive of student performance on the SHELF
exam. This study may also serve
departments of psychiatry and clerkship directors dispel the belief that
exposure to a particular psychiatry patient populations are more beneficial
than exposure to other psychiatry patient populations.
Plenary
Friday, June 13
10:45 a.m. – 12:00 p.m.
Explorers’ Room
Evaluation
of Attitudinal Changes Regarding
Mental
Disorders Among Third-Year Medical
Students
Following the Psychiatry Clerkship
Chrissoula
Stavrakaki, M.D., Ph.D.
Clare
Gray, M.D.
Alison
Freeland, M.D.
Cathy
Braidek, M.D.
Rene
Ducharme, M.D.
Ginette
Goulard, M.D.
Patricia
C. Emery, B.A.
One hundred and ten medical students will be asked to
anonymously complete the questionnaire before and after the psychiatric
clerkship. The data will be analyzed to identify and evaluate any attitudinal
changes occurring as a result of the clerkship experience.
Plenary
Friday, June 13
10:45 a.m. – 12:00 p.m.
Explorers’ Room
Evaluation
of Change in Attitudes Before and After a Sophomore Clinical Neuroscience and
Third Year Psychiatry Clerkship
1. To determine if the medical condition regard
scale will be able to measure attitude change towards a disorder after
clinical/educational exposure to that disorder.
2. To assess if greatest degree of change in
attitude will occur after the clinical clerkship or after didactic exposure in
the preclinical year.
Reference: Christison GW,
Haviland MG: How do you tell if your
curriculum is altering attitude towards patients. Presented at the Annual Meeting of the Association of Directors
of Medical Student Education in Psychiatry, Key Biscayne, Florida, 2002.
Plenary
Friday, June 13
1:00 – 2:15 p.m.
Explorers’ Room
APPROACHES TO TEACHING
PSYCHOTHERAPY
Nutan Atre-Vaidya, M.D.
G. Scott Waterman, M.D.
University of Vermont
Educational goals: To describe and discuss reasons why
learning psychotherapy should not be an explicit aim of psychiatric clerkships.
Description:
Psychiatry is a broad and complex discipline. Psychiatric clerkships are brief. Those facts make inevitable the necessity of determining which
aspects of our field are fundamental and necessary for all medical students to
assimilate, and which are not.
Psychiatrists are experts in the evaluation, diagnosis,
classification, etiopathogenesis, natural history, complications, epidemiology,
differential diagnosis, and therapy of a group of diseases characterized by
abnormalities of emotion, cognition, and/or behavior. Thus, despite the peculiar tradition of defining psychiatrists
according to the type(s) of treatment they typically offer, therapy is but one
facet of our specialty, and psychotherapy is a subset of that. Moreover, in medical education and training,
learning about therapies generally comes last, as knowledge of several of the
other above-named areas is prerequisite to understanding treatment, which is
thus more reasonably the emphasis of senior-year clinical experiences and
residency training.
If psychotherapy should be taught in psychiatric
clerkships, what specifically is it that we should be teaching? There is now a wide variety of
psychotherapies, each with its own theoretical underpinnings, purported
indications, techniques, and outcome data.
There remains a tendency in some quarters to treat
psychoanalytic/psychodynamic theory and therapy as central to psychiatric
thinking and practice, despite its weak evidential foundations and moribund
status as psychological theory. While
psychodynamic theory and therapy are of legitimate historical and philosophical
interest, the time allotted to psychiatric clerkships is grossly insufficient
for the sophisticated treatment the topic would deserve, were it to be part of
the curriculum.
Finally, it is important to discuss what this argument is not about. The efficacy of at least some psychotherapies for at least some
illnesses is undeniable, and all medical students (and physicians) need to know
that. More broadly, the importance of
effective communication, empathy, and understanding of the physician-patient
relationship cannot be overemphasized.
But those latter capacities are not synonymous with psychotherapy, nor
is learning psychotherapy a necessary or sufficient prerequisite to learning
those vital doctoring skills.
Conclusions:
There is a great deal of psychiatric knowledge and skill that students
must assimilate in order to become effective physicians. Although psychotherapies are important modalities
in the management of psychiatric and other disorders, learning to conduct them
is best left to later stages of education and training for those students and
physicians who plan to make such treatments part of their clinical work.
Plenary
Friday, June 13
1:00 – 2:15 p.m.
Explorers’ Room
Ted Feldmann, M.D.
University of Louisville
1.
Present a rationale
for training medical students in the theories and techniques of psychotherapy
2.
Familiarize
psychiatric educators with the components of a psychotherapy curriculum for
medical students
3.
Discuss the
development of outcome measures to evaluate the effectiveness of the training
program
Description:
Psychotherapy training has traditionally been an important component of
psychiatry residency programs. Medical
student training in psychotherapy has been more variable in nature. Time constraints, emphasis on diagnostic
issues, and advances in psychopharmacology have limited psychiatric educators
in their ability to address psychotherapy training.
A basic assumption for this presentation is that
familiarity with the theories and techniques of psychotherapy is essential for
medical students. All types of patient
encounters, from basic history taking to extended outpatient care, may be
viewed as forms of psychotherapy.
Techniques of psychotherapy are utilized not only in psychiatry but in
all physician-patient interactions.
Thus, familiarity with basic concepts of psychotherapy (e.g., the unconscious,
transference, countertransference, and resistance) are essential for medical
students.
This presentation outlines a three-year psychotherapy
curriculum for medical students. Basic
material on theory and technique of psychotherapy are integrated into the
preclinical behavioral science and doctor-patient relationship curriculum. This material is then built upon during the
psychiatry clerkship in the form of a course requirement for completion of
psychotherapy with a patient under faculty supervision. Outcome measures including a case write-up
and standardized patient exercise focusing on developing a therapeutic alliance
and treatment plan are utilized to measure effectiveness.
Plenary
Friday, June 13
1:00 – 2:15 p.m.
Explorers’ Room
Teaching Psychotherapy in
the
Clerkship Doesn’t Work
Myrl Manley, M.D.
New York University
Educational goals: To consider
whether psychotherapy should be taught in the psychiatry clerkship, and if so
in what manner.
Description: The tradition of teaching both diseases and
therapeutics in medical school is reviewed, and the distinction between
knowledge and skills is discussed.
Adequate acquisition of skills requires repeated application over time
in a variety of settings. The
psychotherapies are complex sets of skills that cannot meaningfully be mastered
in a six to eight week clerkship. To
pretend that students can do psychotherapy devalues the process.
Conclusions:
It is not possible to teach the skills of psychotherapy to medical
students, but knowledge of psychotherapies should be part of a general medical
education. A model curriculum on
differential therapeutics is offered which includes: 1) recognition of different modalities of therapy, 2) information about basic techniques and
theoretical assumptions underlying different modalities, 3)
indications and contraindications for common modalities. The value and significance of psychotherapy
outcome studies is emphasized.
Difficulty in conducting outcome studies—particularly compared to
pharmacological studies—is discussed.
Plenary
Friday, June 13
1:00 – 2:15 p.m.
Explorers’ Room
Psychodynamics/Psychotherapy
in
General
Medical Education—
A
Thorn in the Side or a Rose in Mufti?
Julia
Frank, M.D.
George
Washington University
Educational goals: To clarify the relationship between
psychodynamics and patient centered medicine and suggest methods of
incorporating psychodynamic and psychotherapeutic concepts into current medical
school curricula
Description: Medical education currently strives to
balance evidence based and patient centered approaches to clinical
practice. Evidence based methods may
teach students descriptive psychiatry, including the evaluation of treatment
outcome, but they provide an insufficient foundation for interacting with patients
in the real world. By contrast, patient centered approaches prepare students
for dealing with the human dimensions of patient care. They expropriate many of
the principles of psychodynamics, without necessarily acknowledging their
source. Psychiatrists can enhance methods of patient centered teaching, and in
the process carve out space for psychodynamic concepts in the general
curriculum.
At GWUSM, psychiatrists have woven the old behavioral
science curriculum into problem based learning exercises across years I and II.
These cases introduce students to normal child and adult development,
principles of stress and coping in adults (understanding the role of cognitions
and defenses), cultural variation in dealing with disease and illness, family
process, and the nuances of the doctor patient relationship. Every case provides an example of a core
psychodynamic concept needed for effective clinical practice. These concepts
include the way that a patient’s prior experiences might shape current behavior
or beliefs, the unique meanings that particular illnesses may have for a
patient, the unconscious roots of predictable irrational or non compliant
behavior (habits, intentions, defenses,
intrapsychic and interpersonal conflicts), and why doctor patient communication
goes well or goes wrong (transference/ counter-transference).
This effort occurs in parallel with students’ clinical
skills curriculum, which emphasizes non-directive, patient- centered
interviewing and considerable experience with real patients. During the
psychiatry clerkship, students learn to take a
biopsychosocial developmental history along with a symptom focussed one.
They are encouraged to formulate their cases as well as diagnose them. Once
students begin to recognize the psychodynamic aspects of patient’s
presentations—their underlying concerns, developmental stressors, and
behavioral problems—the role of psychotherapy becomes comprehensible. A series
of case based exercises during the clerkship requires students to learn the
assumptions and procedures of brief dynamic therapy, interpersonal therapy, and
cognitive therapy as they relate to the cases covered, along with information
about outcome, duration and costs of psychotherapy. Students are expected to
present a psychotherapy treatment plan to a standardized patient, which
requires the student to understand basic psychotherapeutic concepts well enough
to explain them to someone else.
Students have been taught about the importance of empathy,
but this has often been denied them in their own education. The clerkship
includes experience with expressive groups, in which students’ own reactions to
patients are the topic of discussion. This gives them a small amount of direct
experience with the power of putting emotionally charged experience into words
in a supportive context (in other words, psychotherapy).
Conclusion:
By shaping the patient centered exercises offered to students in pre
clinical and clinical settings, psychiatrists can keep the fundamental
principles of psychodynamic understanding in the general curriculum. Explicit
instruction in patient centered medicine allows students to develop an
adequately complex understanding of human behavior and to appreciate the value
of psychotherapy as a core modality of treatment. Only a few of our students
would be able to describe psychosexual stages, or transference, or the
functions of id, ego and superego. But many have learned to map patients’
current stress and coping onto their prior personal experience, to analyze
problems of compliance from a relational perspective, and to value various
forms of counseling as essential in patient care.
Plenary
Friday, June 13
1:00 – 2:15 p.m.
Explorers’ Room
Psychodynamic Psychotherapy
Seminar in the
Clerkship: A Success Story
Janis L. Cutler, M.D.
Columbia University
Educational
goals: The participant will be aware of a model for
exposing medical students to psychodynamic psychotherapy during the psychiatry
clerkship. The participant will be
aware of some of the potential advantages of exposing medical students to
psychodynamic psychotherapy during the psychiatry clerkship.
Description: A
psychodynamic psychotherapy seminar is presented to medical students as part of
a required core of seminars during their psychiatry clerkship. A psychoanalytically trained psychiatrist
reviews basic psychodynamic concepts and presents patients, including detailed
session material. The students are
actively involved in discussions that include such topics as defense
mechanisms, resistance, transference, and countertransference. The applicability of these concepts and
issues to non-psychiatric medical practice is discussed. The seminar has been extremely well received
by the students.
Conclusions: Third
year medical students can be receptive to and enthusiastic about exposure to
psychodynamic psychotherapy, and such exposure can contribute to their better
understanding of the psychology of their patients and to more sophisticated
interpersonal skills, irrespective of their specialty choice.
Plenary
Saturday, June 14
7:45 – 8:30 a.m.
Explorers’ Room
SPECIAL ADDRESS
Chair:
Myrl Manley, M.D.
New York University
Impact
of Managed Care on Psychiatric
Practice,
Or, How I Learned to
Love
and Profit From the 15 Minute Interview
Irwin
Hassenfeld, M.D.
Albany
Medical College
Educational goals:
To make the audience aware of some of the hazards and pitfalls of
contemporary psychiatric practice in the managed care era. As a result of this presentation the
audience will be able to:
1. Identify 3 significant changes in the practice of psychiatry and their
potentially deleterious effects on professional values.
2. Identify 3 ways to mitigate these effects.
Description: Since 1998 I’ve
been working full-time in a community hospital mental health clinic. For the
decade prior to 1998 I had done little direct clinical service except for a
small selective private practice and periodic emergency back-up. Therefore, it
came as quite a shock to experience, first-hand, the profound changes in
psychiatric practice under managed care. I felt like the character in Woody
Allen’s “Sleeper” who woke up some time in the 21st century, only to
discover that everything that used to be bad for you was now good.
I had been taught, and passed it on to medical students and
residents whom I taught, the value of the open-ended question in starting an
interview. Unlike the close-ended question, it gave patients an opportunity to
tell the doctor, right off the bat, about all of the health problems that worry
them the most, as well as, anything else that concerned or troubled them. The
idea was that this approach would, in the end, save time as the clinician would
not have to play “20 questions”. Alas, in the 15 minutes allotted the doctor
for each patient, open-ended questions are out of the question. One such
question could blow the whole 15 minutes.
Making eye contact with patients was another article of
faith. The argument went something as follows: In order for a bond to be
established between patient and doctor, sometimes referred to as the
therapeutic alliance, empathy must be communicated. An important element in
empathic communication is face to face and eye to eye contact. But, seeing
patients every 15 minutes back to back makes it necessary to write the progress
note during the interview. Eye contact under these conditions is episodic at
best and sporadic at worst, unless the doctor is able to write without looking
at what is being written, a skill that I have not been able to master. Other
cherished practices which had to be jettisoned and which I will discuss
include: integrated treatment which has given way to split treatment; the
prohibition against poly-pharmacy which is now the norm; and the prohibition
against dealing with proprietary hospitals and clinics which are now a
prominent part of the health care system. I will also discuss the impact of
these developments on medical education.
A relatively new feature of hospital and clinic practice,
which is troublesome and potentially corrupting, is the “productivity model” in
which salaries are supplemented, depending upon the number of patients seen
beyond a predetermined quota. I will report on a small study which I did
comparing my own practice profile before and after the institution of a
productivity model in the clinic.
Saturday, June 14
8:30 – 9:45 a.m.
Explorers’ Room
ASSESSMENT, PART II:
SYSTEMS OF ASSESSMENT
Martin
Leamon, M.D.
University
of California, Davis
Clerkship Length: Assessment and
Academic Issues
Renate
Rosenthal, Ph.D.
University
of Tennessee Health Science Center, Memphis
Introduction:
Psychiatry Core Clerkships in LCME accredited medical schools vary in
length. This study, part of a larger
survey, aimed at assessing how clerkship length affects student evaluation
procedures, and how satisfied clerkship directors are with the amount of time
allotted to them.
Educational goals:
1.
To learn how
clerkships of varying lengths handle student evaluations
2.
To learn about
various clerkship structures across LCME schools
Description:
Questionnaires were sent to all Psychiatry clerkship directors of LCME
approved medical schools. 109 questionnaires were returned. 19% of clerkships
were four weeks, 50% were six weeks, 19% lasted eight weeks, and 11% described
their time as “other.” Only 6% of the six-week clerkships were combined with
other disciplines, while 24% of both the four-week and eight-week clerkships
were combined with other programs in some manner. Only 15% of clerkships had a
block of two full months devoted only to Psychiatry.
All directors of the eight-week group felt the clerkship
length was adequate. 96% of the six-week and 86% of the four-week group also
felt they had enough time.
The majority felt their evaluations reflected the learning
objectives. Most programs used the NBME exam (77% of 4 four-week programs, 74%
of six-week programs, and 83% of eight-week programs). OSCEs were used by 14%
of four-week and eight-week programs, and by 20% of the six-week programs. The
latter group also relied more on direct observation as an assessment tool, (29%),
as compared to 14% of the four-week and 10% of the eight-week groups. Only one
(5%) of the four-week programs had oral exams, as compared to 24% of the
six-week, and 42% of the eight-week programs. 14% of the four-week, 18% of the
six-week, and 29% of the eight-week programs used logbooks.
These results indicate that, although the freestanding
eight-week clerkship has become a distinct minority, most clerkship directors
seem to perceive the length of their clerkships as fairly adequate. The
majority used the NBME exam as one of the assessment tools.
According to recently published norms by the NBME*,
students with four-week and six-week clerkships perform at least as well as
students with longer clerkships on that exam. This raises the question whether students
with short clerkships have a more intense and organized didactic experience,
whether they study harder, or whether they learn (and retain) significant
additional Psychiatry content outside of the clerkship, perhaps in the first
two years of medical school. These questions will require further study.
Saturday, June 14
8:30 – 9:45 a.m.
Explorers’ Room
Combined Clerkships
Kathleen
Clegg, M.D.
University
Hospitals of Cleveland
.
Educational goals:
1.
Participants
will be aware of the degree of educational benefit reported by clerkship
directors regarding combined clerkships as opposed to the traditional free
standing clerkship.
2.
Participants
will be aware of the administrative difficulties that clerkship directors felt
interfered with the effectiveness of the combined clerkship as an educational
experience.
3.
Factors
affecting the decision to pursue and maintain combined clerkships will be
discussed.
Regarding attitudes, 9.9% of all responders (both combined
and free standing) agreed or strongly agreed that “the combination clerkship
provides an educational benefit compared to the traditional psychiatry
clerkship.” 57.2% of all responders
disagreed or strongly disagreed with this statement, while 33% were
neutral. Among responders with combined
clerkships, 68.4 % either strongly disagreed, disagreed or were neutral
about whether there is an educational
benefit to the combined clerkship.
57.9% of responders with a combined clerkship agreed or strongly agreed
with the belief that “the combination clerkship creates administrative
difficulties that interfere with it’s effectiveness as an educational
experience.” Positive and negative narrative comments about the combined
clerkships will be discussed in this session.
The survey did not separate out evaluation strategies or
remediation strategies specific to combined clerkships. This would most certainly be an area for
further research.
Given this widely perceived lack of educational benefit and
excessive administrative burden, factors affecting the decision to pursue and
maintain combined clerkships will be discussed.
Saturday, June 14
8:30 – 9:45 a.m.
Explorers’ Room
1.
Be knowledgeable
about the extent of usage of the NBME examination in psychiatric clerkships.
2.
Understand the ways
that different clerkships use the NBME examination in determining their overall
clerkship grade.
3.
Be aware of the
various methods utilized by clerkships to remediate failure of the NBME
examination.
Background:
In recent years an increasing number of clerkships have been including
the National Board of Medical Examiners Subject Examination in Psychiatry as a
tool for assessing students. There are no “established” standards or
guidelines regarding proper usage of
the examination. To determine the extent to which the examination is used,
reasons for its usage, and methods for converting it into a grade, a number of
questions regarding the NBME examination were included on a survey that was
sent to Clerkship directors throughout the U.S. and Canada.
Method: A comprehensive questionnaire surveying methods of
evaluation and remediation was sent to 150 clerkship directors in the United
States and Canada. The survey was anonymous, and self-addressed stamped
envelopes were included for return. Two mailings were distributed, and
clerkship directors were contacted by phone to encourage compliance.
Results: 111 questionnaires were returned. 65% of respondents
reporting using the NBME exam. Of these, all but 4 schools incorporate the exam
into their overall grade. The majority of schools use it to count for between
20% and 50% of the overall grade, with the largest number (23%) having it count
25%. There is no predominant mode of converting the score into a grade-- 38% of users convert the subject score; 42%
of users convert the percentile score; and 20% of users use another method. There is a wide range of what is considered a “passing” score. Among those who use the
subject score, passing ranges from 50 to 75 with a mean passing score of 58.3
and a median passing score of 58. Among those who use the percentile score, the
mean passing score was the 12th percentile and the median was the 11th
percentile. The majority of respondents who use the exam (75%) remediate
failures by having students retake the exam. Other methods for remediation
include taking an alternative exam, or redoing all or part of the clerkship. A
number of different reasons for using the NMBE examination were acknowledged,
the most common of which was “it is a good way of comparing students.” 90.7% of respondents believed the exam was a
good measure of knowledge base. Clerkship directors were split regarding
whether or not it was a good measure of clinical skills, and most clerkship
directors disagreed with the statement “the NBME exam is a good measure of
professional attitude.”
Discussion: The majority of clerkships in the U.S.
and Canada use the NMBE examination as an assessment tool. Most clerkship
directors believe the exam is a good measure of knowledge base, and a good way
to compare students. There is no predominant method for converting the score
into a grade. There is also considerable disparity in terms of the weight that
the examination is given when determining
the overall clerkship grade.
Most students who fail the exam are required to retake the exam as part
of remediation.
Saturday, June 14
8:30 – 9:45 a.m.
Explorers’ Room
Clerkship Evaluation and
Remediation
David
L. Carlson, M.D.
University
of North Dakota
Background:
Constructing clerkship evaluation systems that are fair and reliable is
a challenge. Knowledge of how other
schools structure their systems can help stimulate new ideas as well as support
current efforts.
This study attempted to determine current student
assessment patterns within psychiatry clerkships by looking at the evaluation
tools being utilized and how these fit into an overall evaluation process. Further we were interested in determining
how students who fail current evaluation tools are required to remediate such
failures and what behaviors or deficits can lead to clerkship failure. We hope to provide information that will
help guide clerkship directors as they reassess and structure their evaluation
and remediation systems.
1.
Be knowledgeable
about how students are assessed in psychiatry clerkships.
2.
Be familiar with
clerkship director views on how well various assessment modes measure expected
clinical knowledge, expected clinical skills, and expected professional
attitude development.
3.
Be aware of the types
of remediation utilized when students fail assessments.
4.
Be familiar with
behaviors and deficiencies that can lead to clerkship failure.
Method: Anonymous
questionnaires were mailed to psychiatry clerkship programs at all accredited
U.S. (125) and Canadian (16) allopathic medical schools. A first mailing was sent in November, 2001,
and second mailing was sent in February, 2002.
Results: 111
questionnaires were returned. 20% of
respondents were from four week programs, 50% were from six week programs, 19%
were from eight week programs, and 11% described their time as “other”. 18% were combined with another discipline,
and 88% of combined programs noted neurology as the other discipline.
The three most frequently used evaluation components
were: evaluation by attendings (90%),
NBME exam (75%), and department exams (37%).
The average (mean) contributions to the overall clerkship grade by these
evaluations were: clinical evaluations
– 54% (median 50%, range 10-100%); NBME exam – 31% (median 25%, range 0-100%);
department exam – 22% (median 20%, range 0-50).
Average (mean) passing score on the NBME for schools utilizing
the subject (raw) score was 59 (median 58, range 50-75). Average (mean) passing for those utilizing a
percentile score was the 12th percentile (median 11th
percentile, range 2nd-25th). Most schools use the subject score (2.5 times those using the percentile
number).
The most highly rated measures of expected clinical
knowledge were the department exam (51% “strongly” endorse), NBME exam (41%
“strongly” endorse), and oral exams (34% “strongly” endorse). When combining “strongly agree” with “agree”
these three evaluation components were nearly equal at 90% for department exam
and 91% for both NBME exam and oral exams.
The most highly rated measures of expected clinical skills
were direct observation (53% “strongly” endorse, 98% endorse), clinical evaluations
(39% “strongly” endorse, 93% endorse), and OSCE exams (46% “strongly” endorse,
90% endorse.
The most highly rated measures of expected professional
attitude development were clinical evaluations (44% “strongly” endorse, 94%
endorse), direct observation (42% “strongly” endorse, 92% endorse), and oral
exams (20% “strongly” endorse, 73% endorse).
Overall 45% of programs tailored remediation depending upon
circumstances of failure, 41% had a standard method of remediation but would
occasionally tailor based upon circumstances, and 14% of programs always used
the same methods of remediation.
The clinical evaluation by attending, the most frequently
used and scored evaluation component, was the component most likely to require
a repeat of the entire clerkship if failed (41%). Another 40% would require redoing a portion of the
clerkship. The NBME exam, the next most
used and scored evaluation component, rarely required a repeat of the clerkship
if failed (4%). Another 7% would
require redoing a portion of the clerkship.
78% would require retaking another NBME exam. The department exam, a
distant third in usage and scoring, would lead to retaking the entire clerkship
by only 3% of programs using this exam.
Another 9% would require redoing a portion of a clerkship. 66% would require retaking another
department exam or similar evaluation.
Most programs related that a breach of ethical or expected
professional behavior could lead to immediate clerkship failure.
Conclusions:
The attending clinical evaluation is still the assessment method of
choice for measuring clinical skills and professional attitude
development. It is used more frequently
(90% of clerkships) and given more weight (around 50% of grade) than any other
assessment tool. Failing this
evaluation had the highest likelihood of requiring a repeat of the
clerkship. Further studies are needed,
however, to assess the frequency and nature of failure on clinical evaluations
as well as how such assessments go about measuring clinical skills and
professional attitude.
The NBME and department exams complement the overall
process by providing better data on clinical knowledge, though the NBME exam is
favored over and generally weighted higher than department exams. Both received significant negative ratings
as measures of professional attitude development; and the NBME exam was rated
negatively for measuring clinical skills while opinion was divided for
department exams on this. Failure on
these evaluations was more likely to require a retake of a similar exam.
OSCE evaluations are still emerging, and ratings and usage
patterns will need to be reassessed in a couple years’ time.
Overall a significant majority (82%) of directors report
their particular system of evaluation of clerks reflects the learning
objectives of the clerkship.
Saturday, June 14
8:30 – 9:45 a.m.
Explorers’ Room
Performance
Based Assessment in a Psychiatry Clerkship
James Springer, Ed.D.
Christopher Colenda, M.D., M.P.H.
Robert Strung, M.D.
David Dunstone, M.D.
Educational
goals:
1.
Attendees will learn
about the experiences of one Department of Psychiatry in creating a Performance
Based Assessment for clerkship students
2.
Participants will
examine the standardized rating scale for the PBA
3.
Attendees will
examine data that indicates the PBA tests different domains of performance than
do other standard measures
Description: Formative and
summative evaluation of student performance in psychiatry clerkships typically
involves the use of structured, objective examinations, preceptor or supervisor
evaluations of clinical performance, and some type of written paper, case
study, or comprehensive patient evaluation.
While these methods measure knowledge of psychopathology, generalized
treatment approaches, psychopharmacology, epidemiology, and performance in
clinics or on psychiatric units, they do not assess elements of the diagnostic
interview of establishment of an effective patient/physician relationship. This
paper describes Michigan State University’s College of Human Medicine’s
Department of Psychiatry’s efforts to create formative evaluations of clinical
interviewing, case presentations, and clinical problem solving that are
accomplished across its community campuses.
After
several revisions, the final approach to the Performance Based Assessment (PBA)
mirrored, to some extent, the oral board examination for psychiatric
certification. It consisted of
face-to-face interviews with “real” patients chosen by the Community Clerkship
Director. The evaluation included a
30-minute interview followed by a case presentation and treatment
planning. A faculty evaluator provided
feedback immediately. A standardized
instrument was developed to measure critical components of the examination and
presentation.
Results:
Table 1.
Performance Based Assessment (PBA) and Other Measures of Performance
|
|
Correlation
|
|
PBA Total – NBME
Exam Score |
0.065 |
|
PBA Total Score –
Honors in Clerkship |
0.061 |
|
PBA Total
Score—Community |
0.019 |
|
|
Correlation
|
|
Communication –
Data Collection Skills |
0.271 |
|
Communication –
Presentation Skills |
0.468 |
|
Data Collection –
Presentation Skills |
0.375 |
To date 275 College of Human Medicine students have taken
the Department of Psychiatry’s Performance Based Assessment. While data is still being collected,
preliminary findings indicate that students from each of the community campuses
do well on the PBA. This is in spite of
having differing clinical placement sites, variable lecture topics, and
exposure to different patient populations.
Pass rates have been consistently high across the campuses with no one
community showing outliers for higher rates of students receiving failing
ratings.
Conclusions:
Student performance on the PBA is not strongly correlated with other
student evaluation measures, suggesting that the PBA is successful in measuring
different and distinct elements of student performance. As we were concerned that there would be
confounding among the different evaluation methods for students (e.g., good
students would score well on all evaluation measures), these data indicate that
we are testing different domains of clinical performance.
While it was anticipated that there might be some
difficulty in finding patient volunteers for this experience, this has not been
an issue. Student acceptance has been
high, possibly because College of Human Medicine students are familiar with
observed and videotaped interviews, having completed several during the pre-clinical
curriculum. Students have commented
favorably on the opportunity for professional interaction with a faculty member
with whom they had not previously worked.
Feedback from faculty indicate that in addition to being able to
formulate an impression of interviewing skills, psychiatric knowledge, case
presentation skills, and clinical decision-making abilities, the PBA is able to
provide some assessment of professional behavior as well.
Workshop
Saturday, June 14
10:00 – 11:15 a.m.
Wapiti 1
1. Participants will view a case-based multimedia presentation
and consider the possibility of using such tools as adjuncts to traditional
textbooks.
2. Participants will learn how to develop these presentations
using widely available software such as Microsoft PowerPoint and Adobe Acrobat.
Description:
As teachers in the twenty-first century, we have progressed considerably
from the time when lectures were the sole form of teaching. The use of transparencies and blackboards
has for many of us given way to the use of PowerPoint slides.
Textbooks have evolved from simple typewritten documents to include sophisticated graphics and color photographs. We now have available to us another medium
to help us teach medicine to our students – the World Wide Web. Recent advances in technology make it
simpler for us to publish our lectures and presentations on the Web.
Here at the University of Vermont
we have for the past several years been developing a new medical
curriculum. Among its features is an
emphasis on using case material to demonstrate examples of common or otherwise
important disease entities and clinical situations. There is also a premium placed on self-learning and
professionalism. In an effort to
combine these two aspects of the Vermont Integrated Curriculum, we are
developing cases for use in small group discussion settings, which will also be
available to students on the Web to re-read and study after the discussion
group meetings. Also on the Web will be
a series of questions and answers associated with the cases that will
communicate the knowledge associated with the cases whose mastery is expected. In addition to questions and answers related
to the cases, there will also be videos and images whose purpose is to
supplement the verbal information imparted.
These learning modules will communicate information that could be found
in textbooks and seen on videos, and they will do so in an interactive fashion
that will make them enjoyable, readily available, easy to search, and more effective.
In this presentation we will help teachers develop these
types of multimedia, interactive tutorials that can be available to students at
all times. We will discuss and
demonstrate how to use simple, familiar, widely available, easy-to-learn
software such as Microsoft PowerPoint and Adobe Acrobat to produce teaching
modules that can easily be published on the Web for students to use whenever
and however often they wish. We will
show how to use the more advanced features of Microsoft PowerPoint and easy
ways to incorporate audio clips, pictures and videos. We will show how to make presentations more interactive, and we
will demonstrate the use of Adobe Acrobat to publish them on the Web such that
a non-authorized user cannot modify them.
Workshop
Saturday, June 14
10:00 – 11:15 a.m.
Moose 2
Cultural
Assessment in Clinical Psychiatry:
A Method to
Teach Cultural Competence
Francis G. Lu,
M.D.
University of
California, San Francisco
Educational goals:
1) To understand the 2 LCME standards on cultural competence.
2) To understand how the DSM-IV Outline for Cultural
Formulation can be useful to teach cultural competence.
Description:
Medical school curricula must now meet June 2002 LCME requirements “to
document objectives relating to the development of skills in cultural
competence.” These standards are: 1) The faculty and students must demonstrate
an understanding of the manner in which people of diverse cultures and belief
systems perceive health and illness and respond to various symptoms, diseases,
and treatments; 2) Medical students must learn to recognize and appropriately
address gender and cultural biases in themselves and others, and in the process
of health care delivery.
The DSM-IV Outline for Cultural Formulation (pages
843-844) provides a concise clinical tool for cultural assessment. It consists of 5 sections: 1) Cultural Identity, 2) Cultural Expressions
and Explanations of Illness, 3) Cultural Stressors and Supports, 4) Cultural
Elements of the Clinician-Patient Relationship, 5) Overall Cultural Assessment
for Differential Diagnosis and Treatment Planning.
Two sections of “The Culture of Emotions” videotape that
relate to the 2 LCME standards will be shown;they are the “cultural expressions
and explanations of illness” and “cultural elements of the clinician-patient
relationship.” (The tape is an
introductory overview of the Outline.
After a short prologue, the five sections are described; after each
section, there are short commentaries from 23 multicultural experts.)
References:
Group for the Advancement of Psychiatry. Cultural
Assessment in Clinical Psychiatry. Washington, DC; American Psychiatric
Publishing, 2002.
Koskoff, H. The Culture of Emotions. Boston, MA. Fanlight Productions, 2002.
Workshop
Saturday, June 14
10:00 – 11:15 a.m.
Wapiti 2
(Down-to-earth)
Reviewers’ Workshop:
Reviewing
Manuscripts for Publication
Laura
Weiss Roberts, M.D.
University
of New Mexico
John
Coverdale, M.D.
Baylor
School of Medicine
Alan
Louie, M.D.
University
of California, San Francisco
Academic Psychiatry
Educational goals:
This workshop is a down-to-earth, hands-on introduction to the essential
skills of reviewing manuscripts for publication in peer-reviewed academic
medical journals.
Methods: The workshop leaders will provide an overview of the
“anatomy” of a helpful peer review. In
helping participants to build their reviewing skills, the importance of
peer-review as a generative, collegial activity of importance to colleagues and
the profession will be discussed. Special advanced topics such as serving as a
guest editor will be introduced. This
workshop will involve interactive learning and Q and A formats, and it will
have a tone of warmth and collegiality.
Up-to-date resource materials will be provided to all participants.
Results: This workshop is
aimed at enhancing the skills of early and middle career academic psychiatrists
who serve as peer reviewers for journals.
It will also be valuable for more senior faculty who serve as mentors,
senior authors, and guest editors.
Conclusions:
Psychiatric educators may receive benefit from activities which enhance
and expand their skill set and prepare them for the tasks of careers in academic
psychiatry.
Workshop
Saturday, June 14
10:00 – 11:15 a.m.
Antelope 2
Be Your Own Spielberg: The Nuts and
Bolts of Home Digital Video Production
Robert Boland, M.D.
Brown University
Educational objectives: at the end of this workshop, the participant
will be able to:
1)
convert movie from
videotape to computer (digital) video
2)
edit that video into
a polished product
3)
output the computer
video to a variety of presentation formats, including videotape, CD-Rom,
web-based formats and DVD
Description:
Teachers are increasing using such digital video as a teaching
tool. Presentations of various uses for
such video are becoming common. Such
presentations generally focus on the implementation of video. As these presentations demonstrate, there
are advantages to the use of digital video over older formats.
However, educators without technical expertise (or an A-V
department at their disposal) are left to marvel at these end results, feeling
that such techniques are beyond reach. This is unfortunate, as the increasing
power and storage capacity of computers has made inexpensive digital home video
production a reality for anyone.
This presentation will show how digital videos are
made. This will be a hands-on
interactive presentation. In the time
allowed, we will be able to follow video production from start to finish. We will (1) create a short film on
videotape, (2) convert it to computer video, (3) edit the video into a polished
production, using transitions, titling, and superimposed overlays, and (4)
convert this computer video to a variety of formats that could be used in the
classroom: videotape, CD-ROM, a format suited for web-based delivery, and a
DVD-compatible format. The benefits and
limitations of each format (resolution, screen size, compression and file size,
etc.) will be discussed.
All this will be done using commonly available equipment:
primarily a home video camera and a laptop computer that has a CD burner. The software programs that will be used will
all be consumer-level software, many of which are shareware, freeware, or have
trial or “lite” versions that are affordable for all, and information on and/or
samples of such software will be made available.
Plenary
Saturday, June 14
11:15 a.m. – 12:30 p.m.
Explorers’ Room
NEW DIRECTIONS AND NEW ROLES
Darlene
Shaw, Ph.D., Chair
Medical
University of South Carolina
Psychiatric
Medical Student Education within the
University
of Rochester Double Helix Curriculum
Linda
Ryan, M.D.
Jeffrey
M. Lyness, M.D.
Ralph
Jozefowicz, M.D.
Kerry
O’Bannion, Ph.D.
Elaine
Dannefer, Ph.D.
University
of Rochester
1.
Describe the
Psychiatry Clerkship within the University of Rochester’s (U of R’s) fully
integrated clinical and basic science Double Helix Curriculum (DHC).
2.
Compare third year
medical student NBME exam performance based on completion of the traditional
clerkship versus the DHC block.
3.
Explore the
differences in student feedback regarding the clerkship experience.
To facilitate psychiatry/neurology interdisciplinary
themes, several didactic activities are held jointly with the entire MBBII
student cohort. For example, Joint Neurology/Psychiatry case conferences take
place twice per block and allow for in-depth discussion of a case from both
psychiatric and neurological perspectives.
An end of life/palliative care conference affords an opportunity to
explore ethical issues in a case-based format.
An 8-week didactic series of core neurology and psychiatry seminars also
brings the full group of students together one afternoon per week. Lastly, the
fully integrated Advanced Basic Science portion explores clinical neuroscience
via PBL sessions, case conferences, lectures and laboratory sessions.
The class of 2003 completed the first cycle of the
third-year DHC during the 2001-2002 academic year. Ninety students from this class took the NBME subject exam in
psychiatry. Exam scores were compared
to the previous “traditional” class. Additionally, all students completed an
evaluation of the clerkship experience.
The overall clerkship quality score derives from a feedback
questionnaire that uses a 1 – 5 scale (1 = needs much improvement, 5 =
excellent). Students rated these areas:
academic and clinical experience, clerkship organization, and communication of
course goals and objectives. Overall
class of 2003 psychiatry clerkship ratings
were compared to the previous year. Results are shown as mean (SD). The NBME shelf exam national mean for
2001-2002 and the neurology and basic science student ratings are also
included.
Plenary
Saturday, June 14
11:15 a.m. – 12:30 p.m.
Explorers’ Room
Anthony
L. Rostain, M.D.
University
of Pennsylvania
1. To describe the involvement of one psychiatry educator in
addressing his university’s efforts to promote mental health.
2. To stimulate discussion among ADMSEP members about getting
involved in campus mental health promotion activities
Participants will be able to:
1. Identify steps for getting involved with university mental
health promotion activities
2. Discuss strategies for making resources available to teach
about mental health and mental illness in the university setting, and to foster
greater awareness of and sensitivity to mental health issues affecting college
and university students
Plenary
Saturday, June 14
11:15 a.m. – 12:30 p.m.
Explorers’ Room
Renate
Rosenthal, Ph.D.
Sandra
Kaplan, B.A.
University
of Tennessee Health Science Center, Memphis
Educational goals:
1.
To learn about the
creation of an innovative student support service, including recruitment and
selection of volunteers
2.
To learn about the
role of the Director of Medical Student Education in creating this service
(boundaries, potential conflicts, potential benefits)
3.
To learn about the
process of mentoring this kind of service, step-by-step, from its inception to
the third year of its existence
4.
To learn about strategies
for triage of acutely ill students, or students who need professional, rather
than volunteer assistance
5.
To learn about
confidentiality issues, and how they are being handled
6.
To stimulate
discussion about the role of counseling/psychotherapy in medical education
Description:
Like most schools, the College of Medicine at the University of
Tennessee has a professional Student Mental Health service, readily available
and free of charge to the student, via heavily discounted fees. It is still,
however, a Psychiatric Service. Students are fearful that this type of contact
will go on their record and follow them around. Consequently, medical students are reluctant to use this service
for issues they consider “minor.” They often seek professional help only when
their personal or academic situation has deteriorated significantly.
In January of 2000, a “second-career” medical student, a
former Nurse-Practitioner, needed to design and execute a Community Project to
satisfy the requirements of a class. She felt there was a need for a
confidential student support service, run by peers. She wanted to fulfill this need as her community project. She
asked the Psychiatry Clerkship Director to help her design such a service, and
to serve as the faculty sponsor and mentor of the organization.
This was the beginning of “Audience of One.” In 2001/02,
AOO logged more than 60 counseling contacts. The vast majority did not require
referral for professional help.
The consensus among volunteers and counselees is that this has
been an extremely positive experience all around. It now is under the umbrella
of the Office of Student Affairs.
For more information, including volunteer profiles, please
visit the AOO website at http://www.utmem.edu/AOO/AudienceOfOne.html
Plenary
Saturday, June 14
11:15 a.m. – 12:30 p.m.
Explorers’ Room
Educational goals:
1. To provide a model for outpatient clerkship
development, with accompanying preliminary results from the first year.
2. To highlight the important role of student
choice in actual clinical assignments at a community mental health center.
Description:
At the University of Michigan in April 2001, we piloted our first all
ambulatory 3rd year clerkship at our affiliated Community Mental
Health Center (CMH). Our goal was to
develop community psychiatry rotation that allowed students to gain experience
in a variety of clinical settings and to see a broad spectrum of patients. An implied objective was to ensure that
students completing this rotation will approach patients with severe and
persistent mental illness with less anxiety.
This required clerkship is unique among all other at the
University of Michigan, in that each student chooses from “core clinical sites”
and “optional clinical sites,” to form their own individualized clerkship
template. This choice component has been
widely praised by almost every student, as it appears to actively engage them
in the learning process. Some of the
clinical requirements are listed as follows:
1. One half-day block per week in the psychiatric emergency
room.
2. Three half-day “core” experiences per week
3. (choosing from
8 core offerings).
4. Three or more half-day “optional” experiences over the 4
weeks
5. (choosing from
5 offerings).
Conclusions:
Performance data, such as shelf examination scores comparing CMH
students with students at other sites, has been collected. The mean shelf score of the CMH students is
approximately 1.5 points higher than the mean from other sites. Data analysis will be calculated looking for
statistical significance.