NeuroPsychiatry Clerkship

Expected outcomes

The medical student will learn the basic principles of evaluation, diagnosis and treatment of common psychiatry and neurology disease entities.

Competencies

• Obtaining a psychiatric history and documenting

• Perform mini-mental status exam• Documentation of mental status • Perform suicide risk assessment• Understand, perform and document

neurologic exam• Perform lumber puncture (mannequin)• Education to patient/family on disease

state or treatment

Competency Attainment

• Mastery of basic clinical skill– Focused observation and evaluation by

faculty during interviews, MMSE, suicide risk assessment, patient education, history and physical examination

– Faculty review of documentation (H+P, clinic notes, etc)

– Standardized patients OSCE

Independent learning

• Case discussion during weekly didactics

• Student presentations on a topic

• Consider some online material to supplement didactics or case discussions

• AA meeting

• ? PDA use to track experiences

Major Diagnoses for clerkship• *Psychosis

– Schizophrenia – Substance induced – In context of delirium

• *Mood disorders – Depression – Bipolar disorder

• Anxiety • *Substance abuse and dependence • *Delirium • *Dementia• Neurosurgery

– Head and spinal cord injury– Radiculopathy and myelopathy– Brief survey of neuro-oncology

 •

• Pain • *Stroke

– SAH – Hemorrhage – Ischemic

• *Headache • *Movement Disorders

– Parkinson’s ,Essential tremor, Huntington’s

• Neuromuscular – Myasthenia & ALS

• *Dementia • *Epilepsy • Multiple Sclerosis• Pediatric

– Well child neurology examination– Static and progressive

encephalopathies– Pediatric epilepsy

Didactic Topics• Emergency psychiatry• Schizophrenia• Mood Disorders• Psychopharmacology• Confusion or memory problems

(Dementia and delirium)• Child psychiatry• Personality development• Substance dependence (alcohol

and others)• Neuroscience review• Eating disorders• Personality disorders• Psychotherapy• Anxiety disorders• Systems of practice in psychiatry

• Weakness –Neuromuscular problems

• Numbness – sensory changes• Neurological exam and what it

means• Pediatric neurology exam• Loss of consciousness differential

(seizure, syncope, coma)• Epilepsy- Adult and pediatric• Sleep disorders• Pain and headache• Stroke• Shaking-Movement disorders• Disorders of intracranial pressure• Head and spinal cord injury• Neuro-oncology

Integrated Longitudinal Curriculum

• Disease prevention and health promotion – issues related to stroke and prevention and health

• EBM – stroke prevention, endarterectomy, migraine headache treatment, dementia

• End of life care – mgmt after stroke, ALS, Huntington’s, and neuro-diagnoses diagonses for quality of life

• Ethics – cases on informed consent• Nutrition- childhood developmental disorders• Pain mgmt-Headache, back pain, neuropathy and neuropathic pain• Path and lab -?• Patient safety – head injury, topics of suicide risk prevention,

involuntary commitments, informed consent, drug interactions, driving and epilepsy

• Professional communication – working as a consultant and roles• Radiology – neuroradiology, interventional neurology• System based practice-systems of care in psychiatry

Clerkship structure

• 4 weeks psychiatry consultation– Half day psychiatry clinic

• 2 weeks psychiatry inpatient• 2 weeks neurology outpatient- variety of clinics

at USF, VA, TGH 30th street, Haborside Tower

• Full day of didactics• Call experiences- TGH/VA psychiatry, TGH/VA

neurology

Pedagogical Issues

• Integrate basic and clinical sciences- have basic science faculty participate in case discussions.

• Interdisciplinary teaching- combined case discussions with neurology and psychiatry faculty

• Less formal lecturing/more active learning- common recurrent lectures on web with faculty/student discussion time.

• Promotion of independent study/life-long learning/computer and information skills-– software for tracking encounters/diagnoses. – Promote self picked topic presentations– Online topic reviews with live discussion

sessions.

Pedagogical Issues Continued

• Promote professionalism and humanism• Develop critical judgement- each discipline

will cover major evidence based treatments.

• Develop student principles and skills in solving health and disease problems- case seminars to be symptom focused to stimulate clinical thinking and problem solving skills.

Pedagogical Issues Continued

Outcome measures

• Neurology OSCE stations rotation end

• Lumbar puncture lab

• Written rotation end exam

• Faculty evaluations

• ? Weekly quizzes

• Psychiatry NBME (?combo exam)

Methods of Student Evaluation

• Faculty will complete skill based assessments of students they work with including areas such as knowledge, history taking, physical exam skills, ability to form a differential, clinical decision making, professionalism and educational attitude.

Methods of Program Evaluation

• Faculty evaluation- teaching faculty will provide feedback to course directors each 6 months.

• Students- Standard OCME course evaluation and standard anonymous questionaires

Resources

• Co-course directors and course coordinators from neurology and psychiatry

• 8 neurology faculty

• 8 psychiatry faculty

• Standardized patients and training for OSCE

• Maintain lumbar puncture lab