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A Psychopharmacology Clinic For Medical Students

David H. Taylor, M.D.

Langley Porter Psychiatric Institute

University of California – San Francisco

At UCSF/Langley Porter Psychiatry Institute, we have developed an innovative program for third year medical students rotating in our outpatient clinics:  The Continuing Care Clinic (CCC).  The CCC is a psychopharmacology clinic which provides a unique opportunity for medical students to work one on one with psychiatric outpatients and learn about psychopharmacology.

 This clinic has allowed our department to respond to a changing emphasis in education.  Continuity placements are now required, and we have adapted this service to work for clerkship as well as continuity requirements.

 Ø      Students learn how to evaluate and treat outpatients in general, work with families and therapists, and learn how to work in a managed care environment.

Ø      Students evaluate the patient alone and then present to an attending.  They are integral to the delivery of care and are involved in actual clinical practice.  They are encouraged to follow the same patients throughout their rotation.

Ø      This 2½ hour clinic, which is held four days a week, is staffed by attending psychiatrists, resident psychiatrists, medicine residents, a clinical pharmacist, and a nurse.

Ø      This clinic model has become an integral part of a new six-month continuity ambulatory placement program.  Students can develop meaningful relationships with patients, take responsibility for their care, and observe long term change.

Ø      In addition, the clinic permits students from other disciplines, including nursing and pharmacy, to be trained simultaneously.

 Ø      The clinic features:

1.                  Centralized consulting and chart review

2.                  Direct real time supervision with attendings

3.                  Rounds in which students present their patients for discussion

4.                  The opportunity to learn about a wide range of other cases from their peers

The Corrections Clerkship:

Medical Students in Jail

Martin Leamon, M.D.

Paul D. Cox, M.D.

University of California Davis Medical Center

Sacramento, California 

Educational Objectives:

By the end of the workshop, the participant should be able to: 

1.         Describe recent societal trends in the United States that make correctional settings potentially valuable training sites for medical student clerks in psychiatry; 

2.         Describe the overall conclusions from the experience of the University of California Davis in training medical student clerks in the local county jail system; 

3.         Identify educational advantages and disadvantages of correctional settings as psychiatric clerkship sites.

Summary:

With correctional systems in the United States housing increasing numbers of prisoners with mental illness, such settings become increasingly viable training sites for medical students in psychiatry.  This presentation will describe required medical student clerkships in outpatient psychiatry in the local county jail system at the University of California, Davis.  Student evaluation of clerkship learning/teaching and student academic performance measures will be presented, for the academic years of 1997 and 1998.  Results for students at correctional sites will be compared with those for students at more traditional, non-correctional sites.  The educational opportunities and restrictions afforded by psychiatric clerkships in correctional settings and their implications for the education of the generalist physician will be discussed.

Do Clerkship Placements Affect Exam Scores?

Renate Rosenthal, Ph.D.

University of Tennessee, Memphis

Memphis, Tennessee

Educational Goals:

1.                  To see how placement on different clinical services may affect USMLE shelf exam scores.

2.                  To stimulate discussion about ways to enhance students’ exam performance

3.                  To stimulate discussion about student placements outside of the traditional inpatient setting

Narrative Description:

The Clerkship at UT Memphis is a two-month rotation, for approximately 170 students per year.  It consists of one month of acute care inpatient Psychiatry and a second month where the student rotates through one of the following services: Alcohol and Drug Treatment, Child and Adolescent Psychiatry, Consultation-Liaison, Neuropsychiatry, VA Outpatient Clinic, or Psychiatric Emergency Room.  All these placements are full-time one-month rotations, each with its own merits and shortcomings.  Regardless of placement, the ADMSEP goals and objectives for Psychiatry Clerkships are used as the basic framework for content of lectures and presentation. 

All students sit for the USMLE Shelf exam at the end of the Clerkship.

 This study compares the final exam scores as they relate to the different placements in two successive years of medical students. 

Findings suggest that students’ mean exam scores at the end of the clerkship are comparable, regardless of placement.  There is variability of performance on all services.  Basic content of a Core Clerkship can be successfully taught in a wide variety of settings, as long as there is a coherent plan of goals and objectives.

Substance Abuse Education: 

A Systematic Approach to Curriculum Change

Lisa Fore Arcand, Ed.D.

Eastern Virginia Medical School

Norfolk, Virginia

Kathleen Stack, M.D.

Eastern Virginia Medical School and

Staff Psychiatrist Veterans Affairs Medical Center

Hampton, Virginia

Educational Goals and Objectives

At the completion of this lecture participants will:

1.                  Describe one way of assessing medical students’ application of their substance abuse knowledge.

2.                  Evaluate medical students’ ability or willingness to ask questions about substance abuse in simulated clinical situations.

3.         Recognize how incentives may motivate medical students to ask substance use questions in this type of testing situation.

 The Eastern Virginia Medical School substance abuse rotation was a one-week requirement in the fourth year. This location in the curriculum did not facilitate inclusion of substance abuse information as part of the students’ standard history taking practice. Revision of the substance abuse curriculum was undertaken to provide a more integrated experience for the students and to increase their application of this knowledge in clinical practice.

The first step in the revisions to the substance abuse rotation was to assess the substance abuse knowledge of the rising fourth year students as tested by interviews of simulated patients and related probe questions.  The goal was to determine what information the students had and applied in clinical situations on the subject of substance abuse prior to making curriculum changes. This information was obtained and used as a base line.  The next class of rising fourth-year students were provided additional written information on the subject matter.  Also, emphasis was placed on obtaining substance abuse histories on all patients.  There was an incentive placed on doing this successfully in the testing situation.  Third, there was a change in the curriculum and the assessment process will be repeated in July of 2000.  This will clarify the relationship between the curriculum changes and any effect on the students’ performance on the examination.  The results of the completed first and second step will be presented.

Identifying Mind-Body Dualistic Fallacies Among Medical Students: 

Implications for Psychiatric Education

G. Scott Waterman, M.D.

Robert J. Schwartz, Ph.D.

University of Vermont College of Medicine

Burlington, Vermont

It is ironic that at this time of an unprecedented rate of expansion of our understanding of the prevalences, etiopathogeneses, natural histories, and therapies of psychiatric illnesses, our profession faces unprecedented danger from forces that threaten the future of psychiatry as a medical specialty.  It is our contention that one component of ensuring the future of psychiatry involves the identification and correction of medical students’ fallacious beliefs about the nature of our specialty and of the illnesses that we study and treat. 

The way that the rest of medicine and society at large view the nature of the “mental” and its relation to the “physical” is of great import to our field.   Specifically, we believe that the stigma associated with those who have, and with those who study and treat, mental illness is traceable in no small measure to widely held mind-body dualistic fallacies.  Further, we assert that those fallacies present impediments to rational and useful conceptualization, classification, diagnosis, and treatment of psychiatric illnesses.  Since one would expect medical students’ beliefs to mirror those of their family members, friends, and teachers – many of whom harbor these important and harmful misconceptions – determining students’ understanding of this topic and seeking to shape it appear to be important tasks for medical educators in psychiatry.

 On the first day of the Introduction to Psychopathology course for second-year medical students, we administered a ten-item questionnaire designed to assess students’ positions on the mind-body problem and its implications for psychiatry and the rest of medicine.  As expected, dualism appears to be the predominant mind-body philosophy of our students.  We will discuss this finding, its relevance and implications, and possible strategies for addressing it.

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