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Psychiatry

Students participate in 4 workshops during their Psychiatry Clerkship. The workshops will reinforce Core Communication Skills as well as introduce several specific communication challenges encountered in the psychiatric field. Each Workshop is structured as follows:

10 minutes Didactic session
70 minutes Practice-the students are divided into smaller groups where they practice
2 scenarios using standardized patients.
10 minutes Debrief-groups will come together and discuss take home points.

The specific topics are written below.


The Interview and Psychiatry
Goals:
· Learn to use the interview effectively to elicit a useful history and clarify complex medical-
psychiatric problems.
· Learn how medical and psychiatric problems can coexist and inter-relate.

Objectives:
Knowledge
· Learn about the various ways that psychiatric and medical problems can overlap.
· Know the three functions of the interview, and data gathering and rapport building skills.
· Learn conceptual framework of mind-body unity (vs. dichotomy).

Skills
· Utilize appropriate and effective information gathering techniques to elicit a useful and
meaningful HPI.
· Use effective techniques to elicit psychosocial data that are: integrated with medical information gatheringand non-threatening.
· Employ appropriate relationship building skills.
· Give patient information regarding an emotional diagnosis.
· Conceptualize illness as occurring on various levels; cognitive, emotional, somatic, behavioral.

Attitudes
· Acknowledge role of psychological factors in physical health and illness.
· Becoming non-judgmental towards patients who manifest emotional problems physically.

Resources:
Faculty Notes-teaching points each case, see Appendix 14 for example.
Standardized patients and scenarios
Case 1 Young male with Major Depression vs. Hypothyroidism
Case 2 Middle aged female with symptoms consistent with panic disorder as well as peri-menopause.
Student instructions and checklist.

Interviewing a Hostile or Violent Patient
Goal:
Students will be able to interview and evaluate hostile and violent patients while maintaining personal safety.

Objectives:
Identify and diagnose any causes of hostility.
Know the common predictors of violent behavior.
Identify feelings and behaviors that put the interviewer at more risk.
Create a physically safe interviewing environment.
Defuse hostility and violence when possible.
Establish rapport when possible.
Identify normal counter-transference reactions and use them appropriately.
Negotiate when possible.

Resources:
Faculty Notes-teaching points each case
Standardized patients and scenarios
Case 1 Situational anger- recent breakup with partner causing uncharacteristic trouble at work. .
Case 2 Paranoid personality.
Student instructions and checklist.


Interviewing a Depressed or Suicidal Patient
Goal:
Students will be able to recognize and assess patients at risk for suicide and depression.

Objectives:
Students will know:
Symptoms of Major Depressive Disorder.
Risk factors for and natural history of suicide.
Potential barriers to suicide detection.
Treatment options for patients at risk.
Indications to hospitalize patients who are at risk.


Students will be able to :
Recognize signs and symptoms of Major Depressive Disorder and other risk factors for suicide.
Screen for Major Depressive Disorder.
If patient is at risk, ask detailed questions about suicidal ideation, plan, means and deterrents.
Convey understanding and acceptance of the patient's feelings.


Students will display:
Willingness to directly inquire about and discuss Major Depression and suicide ideation, intent, means and motives.
Willingness to ask for help with and refer patients at risk of suicide.

Resources:
Faculty Notes-teaching points about each case
Standardized patients and scenarios
Case 1-Borderline patient, in ER after cutting wrists.
Case 2-Elderly male, severely Depressed and Actively Suicidal.
Student instructions and checklist.


Working with a Psychotic Patient

Goals:
Learn how to communicate with psychotic patients.

Specific Objectives:
Knowledge:
Define the core symptoms of psychosis.
Understand the different presentations/syndromes and underlying disorders of psychotic patients.
Skills:
Overcome barriers to communicating with psychotic patients.
Evaluate core psychotic symptoms.
Elicit essential information (current problems, past history, danger risk, current functioning, medication, support).
Elicit patient's experience.
Establish therapeutic alliance if possible.
Attitudes:
Willingness to understand the patient's experience.
Tolerating interacting with patients who are having delusions, hallucinations or thought disorganization.
Recognize your own reaction to psychotic patients.

Resources:
Faculty Notes-teaching points about each case
Standardized patients and scenarios
Case 1-Patient in ER, actively psychotic (chronic schizophrenia)
Case 2-Middle aged female in outpatient clinic with Delusions.
Student instructions and checklist.

 



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