PREREQUISITES AND PLACEMENT IN THE CURRICULUM: Open to students who have completed the Psychiatry Core Clerkship.
PURPOSE: The purpose of the rotation is to gain proficiency in the diagnosis, risk assessment, treatment, and disposition of acute mental illness and associated behaviors in the emergency and acute medical/surgical hospital setting and to learn how to work with consulting physicians and social workers in order to properly triage patients with such a condition. To that end, this rotation will focus work on consultations from medical, surgical, and emergency department services. The medical student will have a clear understanding of what constitutes a psychiatric emergency in these contexts and how to not only treat the immediate symptomology, but also how to treat the patient in the context of complex social, psychological and biological factors.
- Demonstrate the ability to perform a sufficiently full interview in the acute medical, surgical, and emergency department setting.
- Demonstrate the ability to rank an appropriate differential diagnosis for acute psychiatric and behavioral presentations.
- Demonstrate appropriate actions to ensure immediate safety of patients and staff.
- Demonstrate the ability to effectively communicate with consulting medical, surgical, and emergency department teams including social workers regarding case evaluations and dispositions.
INSTRUCTIONAL FEATURES: Learning activities in addition to inpatient care include weekly case conference, morning reports from inpatient unit, and grand rounds. Student will also present on case as a formal case presentation towards the end of the rotation. Students will interact with both general adult and pediatric patients. Independent evaluations should constitute the majority of patient interaction, however all cases will be supervised by either a resident or attending. Supervision will depend on the nature of the case at hand, with admissions to 8E being supervised by the admitting resident and discharges from the emergency department needing supervision by the on-call attending.
- Patient Care
- As a consult service, the student in consultation and emergency psychiatry will directly evaluate patients in the medical, surgical, and emergency departments; such evaluations will necessarily include both an extensive interview and physical exam. In addition, the student will work with the patient, people close with the patient, as well as relevant staff to help determine the appropriate next steps and disposition of the patient. Indeed, data gathering will tend to surpass conventional sources of information, even as these sources, such as medical records, are thoroughly assessed by the student. In most cases, the maximum rate of success can be expected when the student develops a good rapport with the patient, and so rapport building will be practiced. However it will often be necessary to seek collateral sources of information.
- Medical Knowledge
- The student will demonstrate advances in knowledge of both the differential diagnosis regarding acute behavioral concerns as well as proper medication treatments and their proper monitoring and administration in the acute setting. Social factors as they pertain to emergency psychiatry will be emphasized. Legal and ethical dimensions of the care of these patients will also be indispensable to the proper assessment and plan of care that the student will be expected to master.
- Practice Based Learning and Improvement
- As consultation and emergency psychiatry is a rapid and fluid field, the student will –out of necessity—develop a reliance on continuous learning. Both resident, social worker, and attending feedback will help the student to evaluate their own progress and identify areas for improvement. Direct supervision of cases can help the student evaluate self-limitations in real time.
- Interpersonal and Communication Skills
- Patient interviewing skills will be at the heart of this rotation; however the student will practice and improve general communication skills in the context of reporting cases with supervisors, discussing cases with interdisciplinary teams, and in discussing cases with appropriate collateral sources. The student will also be expected to practice written communication in writing formal psychiatric assessments.
- Professionalism is expected to be demonstrated via the expectations outlined above. In particular, the student will have expanding responsibility to assess and manage key areas of their patient’s care, including initial assessment and follow up with proper sign out to the next level of care, when appropriate.
- Systems-based Practice
- The student will be immersed not only in the hospital level of the system, but in the broader network of mental health providers and appropriate legal norms.
ASSESSMENT: The student will be evaluated at appropriate intervals, several times per week or more as needed. Formal midterm feedback will be scheduled with the attending for some time in the second week.
Program Number: ELEC 346
Location: UI Health
Program Directors: Aneet Ahluwalia, MD
Coordinator: Graciela Bernal
Duration: 4 weeks
Night Call: Yes
Students Accepted: Min – 1; Max – 1
Housestaff Used as Faculty: Yes
Total Hours /Week: 42