Key Diagnoses, Learning Goals and Milestones for Psychiatry in Undergraduate Medical Education

Task Force Members

  • Brenda Roman, M.D., Co-Chair
  • Dawnelle Schatte, M.D., Co-Chair
  • Mary Blazek, M.D.
  • Michael Brand, Ph.D.
  • Thomas Brouette, M.D.
  • David Carlson, M.D.
  • Julia Frank, M.D.
  • Catherine Lewis, M.D.4
  • Dilip Ramchandani, M.D.
  • Mary Kay Smith, M.D.
  • Brenda Talley, M.D.
Key Diagnoses for Medical Students

“Key diagnoses” are the major psychiatric diagnoses that medical students should know by the time they graduate from medical school. Ideally, all students would have had clinical exposure or other intensive exposure through a learning experience to at least one of the diagnoses under each diagnostic category. These have been determined by the Association of Directors of Medical Student Education in Psychiatry as being important for graduating medical students to know. They were selected because they are common and/or critical in the care of patients, without specification to an age group. Directors of psychiatric education for medical students can use this document as a guideline, realizing that each school has unique circumstances, patient populations and missions that will need to be taken into consideration in determining what is best for an institution and its’ students.

Neurodevelopmental Disorders

  • Intellectual Disability (Intellectual Developmental Disorder)
  • Autism Spectrum Disorder
  • Attention-Deficit/Hyperactivity Disorder
  • Tourette's Disorder

Schizophrenia Spectrum and Other Psychotic Disorders

  • Schizotypal Personality Disorder
  • Delusional Disorder
  • Brief Psychotic Disorder
  • Schizophreniform Disorder
  • Schizophrenia
  • Schizoaffective Disorder

Bipolar and Related Disorders

  • Bipolar I Disorder
  • Bipolar II Disorder
  • Cyclothymic Disorder

Depressive Disorders

  • Disruptive Mood Dysregulation Disorder
  • Major Depressive Disorder, Single and Recurrent Episodes
  • Persistent Depressive Disorder (Dysthymia)
  • Premenstrual Dysphoric Disorder

Anxiety Disorders

  • Separation Anxiety Disorder
  • Specific Phobia
  • Social Anxiety Disorder (Social Phobia)
  • Panic Disorder
  • Agoraphobia

Trauma and Stressor-Related Disorders

  • Reactive Attachment Disorder
  • Disinhibited Social Engagement Disorder
  • Posttraumatic Stress Disorder
  • Acute Stress Disorder
  • Adjustment Disorder

Feeding and Eating Disorders

  • Anorexia Nervosa
  • Bulimia Nervosa
  • Binge Eating Disorder

Somatic Symptom and Related Disorders

  • Somatic Symptom Disorder
  • Illness Anxiety Disorder
  • Conversion Disorder (Functional Neurological Symptom Disorder)
  • Factitious Disorder

Substance-Related and Addictive Disorders

  • Substance Use Disorders
  • Substance-Induced Disorders
  • Substance Intoxication
  • Substance Withdrawal
  • For the following substances:
    • Alcohol
    • Caffeine
    • Cannabis
    • Hallucinogens
    • Inhalants
    • Opioid
    • Sedative, hypnotic, anxiolytics
    • Stimulants
    • Tobacco

Neurocognitive Disorders

  • Delirium
  • Major or Mild Neurocognitive Disorder:
    • Due to Alzheimer’s Disease
    • Frontotemporal Neurocognitive Disorder
    • With Lewy Bodies
    • Vascular Neurocognitive Disorder
    • Due to Traumatic Brain Injury
    • Substance/Medication-Induced Neurocognitive Disorder
    • Due to HIV Infection
    • Due to Prion Disease
    • Due to Parkinson’s Disease
    • Due to Huntington’s Disease

Personality Disorders

  • Paranoid Personality Disorder
  • Schizoid Personality Disorder
  • Schizotypal Personality Disorder
  • Antisocial Personality Disorder
  • Borderline Personality Disorder
  • Histrionic Personality Disorder
  • Narcissistic Personality Disorder
  • Avoidant Personality Disorder
  • Dependent Personality Disorder
  • Obsessive-Compulsive Personality Disorder

Medication-Induced Movement Disorders and Other Adverse Effects of Medication
Learning Goals and Milestones

The Learning Goals in Psychiatry are intended for all medical students in which they should be able to demonstrate competence in these domains, as aligned with the ACGME core competencies, for the care of patients. These are meant to be broad enough so that if an individual school wishes to include more specific objectives that can be readily done within this framework. Additionally, the milestones (knowledge, skills, attitudes or other attributes) have been described in a developmental framework from less advanced to more advanced in order to ultimately reach the overall learning goals.

Learning Goal 1: Medical Knowledge
1.1 Describe the normal psychological development across the lifespan
a. Describe psychological development and social development across the lifespan, as well as the major issues and common reactions to normative crises with attention to cultural, economic and gender influences a. Apply knowledge of the expected changes across the lifespan in the care of patients with psychiatric disorders and medical conditions
1.2 Describe the psychobiological-behavioral theories for psychiatric disorders and substance use disorders

a. Describe and compare the diagnostic criteria for the major psychiatric disorders

b. Describe the neurobiological basis of the substance use disorders, and indicate both intoxication and withdrawal syndromes

c. Describe the psychobiological-behavioral models for the major psychiatric disorders

a. Apply knowledge of the major psychiatric disorders in the care of patients

b. Apply knowledge of the substance use disorders in the care of patients

c. Describe the scientific basis for the diagnostic tests used in psychiatry

1.3 Describe the psychopharmacological treatments and psychotherapies for psychiatric disorders

a. Demonstrate understanding of the mechanisms of action, common side effects, potentially catastrophic side effects, and contra-indications for the common classes of psychotropic medication

b. Describe the essential features of motivational interviewing, supportive psychotherapy, cognitive behavioral psychotherapy and psychodynamic psychotherapy

a. Apply knowledge of psychopharmacology in developing treatment plans for patients with psychiatric disorders

b. Demonstrate the basic features of motivational interviewing and supportive psychotherapy

1.4 Demonstrate knowledge of psychiatric concepts, components of the psychiatric mental status exam and cognitive screening

a. Describe the components of a mental status examination

b. Describe the components of a cognitive screening tool

a. Demonstrate ability to complete a mental status examination

b. Demonstrate ability to perform a cognitive screening examination

Learning Goal 2: Patient Care (clinical skills)
2.1 Conduct patient interviews skillfully

a. Conduct an organized, comprehensive diagnostic and narrative history

b. Conduct a mental status examination

a. Independently conduct an organized, comprehensive history, including a thorough psychiatric and narrative history

b. Demonstrate the ability to engage challenging patients

2.2 Diagnose psychiatric disorders in patients

a. Generate a differential diagnosis by applying knowledge of psychopathology and medical illnesses

b. Describe the elements of a biopsychosocial formulation

a. Prioritize a differential diagnosis by applying knowledge of psychopathology and medical illnesses

b. Understand the relevance of a biopsychosocial formulation in developing treatment plans

2.3 Propose evidence based therapeutic options

a. Identify the treatments for common psychiatric and behavioral disorders

b. Identify the components of informed consent

a. Apply knowledge of indications, contraindications and potential adverse reactions, and likely outcomes for a given therapeutic intervention, with attention to cost and quality

b. Provide patient education regarding prevention, diagnosis, treatment plan and health promotion, including obtaining informed consent

2.4 Assess risk factors for suicidality and dangerousness in patients

a. Identify the risk factors for suicide

b. Identify the risk factors for violence

c. Describe the laws for reporting of abuse

a. Apply knowledge of the risk factors for suicide when making treatment plans and understand the limits of confidentiality

b. Apply knowledge of the risk factors for violence when making treatment plans and an understanding when to alert others, including potential targets

c. Apply knowledge of potential signs/symptoms of abuse when developing treatment plans, including when to report suspected abuse

Learning Goal 3: Systems-Based Practice
3.1 Apply the bio-psycho-social model in psychiatric assessments

a. Identify contextual factors that may affect the health status of an individual patient or population

a. Incorporate contextual factors into plans for patient

3.2 Advocate for the humane, just, safe and prudent care of patients with psychiatric disorders

a. Explain the conceptual foundations of ethical patient care

a. Demonstrate behavior that conveys caring, honesty, genuine interest and tolerance when interacting with a diverse population of patients and families

3.3 Describe the basic framework for mental health care in our country

a. Describe the basic structure and range of resources of the mental healthcare system in our country

a. Recognize how the mental health care delivery system in which one works affects patient care, being able to identify the resources available to assist patients with psychiatric disorders

Learning Goal 4: Interpersonal Skills and Communication
4.1 Deliver effective patient presentations, including a psychiatric examination

a. Present patient psychiatric history findings in an organized format

a. Present patient encounters accurately and succinctly both verbally and in written communication

4.2 Document accurately in the medical record, including a mental status examination

a. Document patient history findings in an organized format

a. Document patient encounters accurately in a timely, focused, and prioritized way

4.3 Communicate and work effectively with others with attention to appropriate boundaries

a. Identify roles within teams

b. Provide and receive effective feedback

c. Communicate clearly in both written and verbal venues

a. Seek and respond to feedback on one’s communication skills

b. Communicate with patients and families in a timely, clear, and empathetic manner

c. Communicate effectively with all members of the patient’s treatment team, including those from other professions and disciplines

d. Participate effectively in hand-off communications with other providers

Learning Goal 5: Caring/Valuing – Professionalism
5.1 Demonstrate respect, empathy and concern for all patients, regardless of the patient’s problems, personal characteristics or cultural background

a. Demonstrate awareness of how cultural beliefs and practices can influence professional relationships and medical decision making

a. Demonstrate respect for all patients and families in clinical encounters

b. Demonstrate ability to self-reflect on one’s cultural sensitivity and interactions with patients and families

5.2 Be courteous to patients, families, staff, colleagues and other health professionals

a. Demonstrate respect for all patients, peers, and staff

a. Demonstrate punctuality, reliability, preparedness, initiative, and follow-through

5.3 Value and behave in a manner consistent with the highest ethical standards of the profession, including confidentiality and honesty

a. Identify the basic principles of medical ethics, with particular attention to those impacting the practice of psychiatry

b. Recognize the humanistic core of professional values

c. Explain the relationship between professional behavior and licensure

a. Demonstrate the highest standards of individual and team-behavior that is patient-centered, culturally sensitive, and socially just

b. Apply knowledge of medical ethics to clinical situations. Self-identify limitations and strengths in one’s abilities to work autonomously and request supervision when needed

Learning Goal 6: Practice-Based Learning
6.1 Advance knowledge through intellectual curiosity

a. Critically reflect on one’s own performance, identifying strengths and challenges, as well as one’s learning improvement goals

a. Incorporate critical reflection and feedback received to identify strengths and weaknesses, set individual learning goals, and engage in learning activities to meet those goals

b. Demonstrate curiosity, objectivity, and the use of scientific reasoning in patient care

6.2 Appropriately utilize evidence-based resources to address uncertainty in medicine and gaps in knowledge/skills

a. Recognize that gaps of knowledge and ambiguity exist in medicine

b. Define clinical question in the context of patient care and access resources to answer the question

a. Identify appropriate resources to address uncertainty in medicine and gaps in knowledge/skills

b. Identify clinical questions as they emerge in patient care activities; identify, appraise, and apply relevant evidence to answer those questions

6.3 Accept, reflect on, and implement feedback on one’s own performance

a. Use feedback from self-reflection, faculty, and peers to assess one’s individual level of knowledge and expertise

a. Accept and process feedback from self-reflection, faculty, patients and peers to improve clinical performance