Department of Psychiatry

Course Description

INPATIENT CLINICAL WORK

Patients admitted to the inpatient unit assigned to a medical student will have a complete history and physical and on going psychiatric care participation by that student. The number of patients followed by each student will depend on the patient flow and number of students on the rotation. Assignments will be made by the inpatient director/residents.

When you are evaluating a new admission you should make an effort to obtain as much information as possible from the patient and any other information sources, such as relatives or old records. As complete as possible a history of present illness, past medical history, review of systems, mental status examination, and physical examination should be performs.

The history of present illness and mental status examination should be recorded on the student progress notes. Medical history and physical evaluation should be recorded. A differential diagnosis and plan of evaluation and treatment should also be recorded. An outline of the psychiatric database is included as Appendix 1. This outline is to be followed in a narrative form for oral and written case presentation. When signing your name, please designate your academic status. Practice admitting orders should be written, to be gone over with the resident or attending.

The student should be attentive to the implementation of and modification of the treatment plan (including medications). The medical work-up of each patient should be evaluated and action should be taken as indicated (with the assistance of the patient’s attending). A progress note should be entered every time the patient is seen, generally once every day.

With the assistance of the patient’s attending physician, resident and social worker, the student should participate, when possible, in planning for discharge and follow-up care. A student discharge note should be entered in the chart once the attending has communicated in the record that the patient is being discharged.

The discharge note should outline the diagnosis, problems treated, the outcome, and the need for any appropriate modalities of follow-up care. On the inpatient unit patients may not be taken out of community meetings or group therapy. Please check with ward staff for the specific times of these activities. You have the opportunity to participate in these activities after discussion with ward staff. It is expected that most new cases will be seen by the student on-call for the day. The hours of on-call responsibility are from 5:00pm to 10:00pm weekdays and from 8:00am until 12:00 noon or completion of rounds on Saturday and Sunday.

CONSULTATION/LIAISON ROTATION

The students spend thee weeks (half time) on the C/L service. The student rotation consists of:

Performing consults on C/L under the supervision of the resident and the attending C/L psychiatrist. The student does a history, mental status exam, differential diagnosis, and treatment recommendation. The students learn about depression and anxiety in the medically ill, somatoform disorders, substance abuse, delirium and dementia, trauma victims and the family’s interaction with the above problems. The student present during daily rounds.
Observation of interviewing technique. The student is observed and given feedback on interviewing patients in the medical setting. The ability to gather data and be empathic is emphasized. Also, the student learns about the emotional impact of disease. This is done at rounds and informal sit down sessions.
The student learns about the consultative process. The student speaks with the physician who asks for the consult, the nurse on the floor and becomes an integral part of the C/L team. The link between psychiatry and medicine/surgery is learned at interdisciplinary rounds with the trauma service. Consults are done on special units such as ICU, TICU and CCU.
The student follows-up with patients. The student sees the patient over time and records observations and assessments. The student reports the finding to the resident and attending at meetings prior to bedside rounds. Treatment approaches involving psychotherapy and medication are discussed. Students are “quizzed” during rounds.

OUTPATIENT CLINICAL WORK

During their C/L rotation, student will spend half their time (usually afternoons) in the Outpatient Clinic in 3 Cooper Plaza. They will interview outpatients who come in for an initial visit, then follow these patients for several weeks. Supervision will be provided by faculty members and residents.

For more information, contact Viktoria Rile, Clerkship Coord. at 856-757-7853