Clerkship Objectives

Key Objectives for the Unit

1.       Conduct a comprehensive psychiatric evaluation that includes relevant collateral history, while demonstrating the capacity to build a therapeutic relationship with the patient and obtain complete and relevant information. (2.1, 2.2, 2.6)

2.       Conduct and interpret a complete mental status examination, including the assessment of risk to self or others and cognition, as appropriate to the presentation of the patient. (2.1, 2.2)

3.       Discuss the importance of co-morbidity of psychiatric and medical illness and evaluate and manage this with appropriate use of targeted physical examination, investigation and consultation. (2.3, 2.4, 2.9)

4.       Integrate information obtained in the assessment to develop a working and differential diagnosis, using the DSM-5. Students should begin to describe the etiology of the diagnosis within a bio-psych-social framework relevant to the patient. (2.3, 2.6)

5.       Develop and carry out (under supervision) a bio-psycho-social management plan that considers immediate, short term and long term treatment goals. (2.1, 2.2, 2.3, 2.6)

6.       Discuss pharmacologic and non-pharmacologic strategies as potential treatment options for patients presenting with psychiatric illness including consideration of risk / benefit, indications, contraindications, common and serious side effects and interactions. (2.3, 2.6, 2.5, 2.8)

7.       Communicate effectively, both orally and in writing, including documentation in patient charts, case presentations, writing orders and prescriptions, sending referrals and in providing education and negotiating a management plan with patients and their families. (2.1, 2.2, 2.3, 2.4, 2.5, 2.6, 2.7, 2.8)

8.       Work collaboratively within a multidisciplinary team, including accessing community resources and agencies to optimize the care of patients presenting with psychiatric illness and their families. (2.3, 2.4, 2.6, 2.8, 2.9)

9.       Discuss the common clinical, ethical and legal issues in practice with specific emphasis on patient autonomy, confidentiality, involuntary admission and competency. (2.1, 2.2, 2.3, 2.5, 2.6, 2.7)

10.   Demonstrate the attitudes and behaviours necessary to optimize the care of the patient presenting with psychiatric symptoms. Emphasis should be placed on recognition of the components of a therapeutic relationship and professional boundaries and on skills used by physicians to cope with stress and balancing personal and professional lives. (2.1, 2.2, 2.3, 2.4, 2.5, 2.6, 2.7)

11.   Discuss the role of the social stigma of mental illness as a potential barrier to access to care and explore and manage their own preconceptions or reactions to patients with psychiatric symptoms. (2.4, 2.5, 2.6, 2.7, 2.8)

12.   Demonstrate competence and commitment to lifelong learning that would include development of self-assessment skills and the use of evidence based resources to direct patient care. (2.3, 2.7, 2.8)

Seminar: Psychiatry Orientation

By the end of the seminar, the medical student will be able to:

1. Discuss roles and expectations during the Psychiatry rotation, including on-call.
2. Describe the objectives of the Psychiatry clerkship
3. Describe where to seek help, including if a critical incident occurs, and how to access relevant information required during the rotation

Module: Approach to and Management of Agitated Patients in the Psychiatric Emergency Setting

By the end of the module, the medical student will be able to:

1. Identify signs of early and escalating agitation
2. Apply different techniques to redirect the course of an interaction before the patient becomes acutely agitated
3. Apply a theoretical approach to managing acute agitation from non-pharmacological and pharmacological perspectives
4. Identify the roles of interprofessional collaboration in management of the acutely agitated patient

Seminar: Anxiety

By the end of the seminar, the medical student will be able to:

1. Describe the six most common anxiety disorders
2. Understand the concept of ‘psychiatric comorbidity’
3. Identify physical manifestations of anxiety
4. Choose medications to treat anxiety disorders
5. Describe non-pharmacological means of dealing with anxiety
6. Discuss how to differentiate between normal and pathological anxiety

Modules & Seminars: Child & Adolescent

By the end of the modules/seminars, the medical student will be able to:

1. To identify differences in childhood disorders and childhood onset disorders from adult disorders
2. To describe common features of and common treatments for:
       a. ADHD and Disruptive Behaviour Disorders
       b. Autism Spectrum Disorders
       c. Anxiety Disorders and Obsessive Compulsive Disorder

Module & Seminar: Eating Disorders

By the end of the module/seminar, the medical student will be able to:

1. Describe the DSM-5 criteria for anorexia nervosa and bulimia nervosa
2. Recognize clinical presentations and common co-morbidities of eating disorders
3. Understand basic treatment approaches (non-pharmacological and medications)

Module & Seminar: Electroconvulsive Therapy (ECT)

By the end of the module/seminar, the medical student will be able to:

1. Discuss the history of Electroconvulsive Therapy (ECT)
   
2. Describe the proposed mechanism of action for ECT
3. List the indications and contraindications for ECT
4. Describe the process of receiving an ECT Treatment
5. List treatment side effects of ECT
6. Reflect on stigma and ECT

Module & Seminar: Emergency Psychiatry

By the end of the module/seminar, the medical student will be able to:

1. Discuss an approach to the assessment of a psychiatric emergency
2. Describe the concept of medical clearance and its importance in emergency psychiatry
3. Demonstrate an approach to the assessment and initial management of a patient with agitation / aggression
4. Demonstrate an approach to the assessment and initial management of a patient with suicidal ideation, including identification of risk factors for completed suicide
5. Describe the clinical presentation and initial management of neuroleptic malignant syndrome and serotonin syndrome

Seminar: Jeopardy

By the end of the seminar, the medical student will be able to:

1. Through use of a game, apply the knowledge learned over the course of the psychiatry rotation to questions representative of the rotation objectives
2. Self-assess areas of relative strength or deficiency in their knowledge base, as it relates to the objectives of the Psychiatry clerkship

Video: Mental Health Law

By the end of the seminar, the medical student will be able to:

1. To reflect on the legal rights & values informing mental health laws in the maritime provinces
2. To become familiar with the criteria for involuntary hospitalization and treatment in the three provinces
3. To assess the different ways the maritime provinces seek to advance or balance fundamental values in their mental health laws

Seminar: Mood Disorders Case Vignettes

By the end of the seminar, the medical student will be able to:

1. List the DSM- V criteria for bipolar and depressive disorders (mood disorders)
   
2. Recognize clinical presentations of mood disorders
   
3. List common co-morbidities of mood disorders
4. Appreciate treatment issues in various presentations of mood disorders

Module & Seminar: Neuropsychiatric Disorders & Dementia

By the end of the module, the medical student will be able to:

1. Describe a brief overview of clinical neuroanatomy
2. Discuss the concepts of cortical and subcortical dysfunction
3. Describe the pathological and clinical features of common neuropsychiatric syndromes and representative disorders

At the end of the case students will be able to:

1. Apply their knowledge of neuropsychiatric disorders to a clinical case of cognitive impairment
2. Choose appropriate cognitive tests for a patient presenting with cognitive impairment and interpret the results
3. Discuss common challenges in the diagnosis of cognitive impairment

Seminar: Optimizing Care for People with Serious Mental Illness

By the end of the seminar, the medical student will be able to:

1. Define recovery as it relates to severe and persistent mental illness
2. Identify relevant biopsychosocial factors for people living with severe and persistent mental illness that influence their recovery trajectory and quality of life
3. Begin to develop a biopsychosocial management plan for an individual with severe and persistent mental illness that aligns with a recovery model
4. Apply knowledge of recovery and integration to cases representing persons with severe and persistent mental illness

Seminar: Personality Disorders

By the end of the seminar, the medical student will be able to:

1. Define what a personality disorder is according to DSM-5
2. Describe and contrast the three clusters of personality disorders
3. Integrate personality disorder into the differential diagnoses where appropriate
4. Discuss and describe theoretical factors (from a bio/psycho/social perspective) that contribute to the development of a personality disorder
5. Detect transference and countertransference in the context of a patient with a personality disorder or strong personality traits
6. Identify risk factors for attempted and completed suicide in patients with personality disorders
7. Recognize common comorbidities associated with personality disorders
8. Assess safety in a patient with a personality disorder
9. Apply the information obtained in lecture to clinical interactions with a patient with a personality disorder
10. Name evidence-based treatment for borderline personality disorder

Seminar: Psychiatric Assessment

By the end of the seminar, the medical student will be able to:

1. Describe an approach to the psychiatric assessment
2. Discuss common challenges in obtaining a psychiatric history
3. Discuss the components of the mental status examination, including examples
4. Describe the elements of a bio-psycho-social formulation

Seminar: Psychopharmacology

By the end of the seminar, the medical student will be able to:

1. To apply the principles of psychopharmacotherapy using clerk-identified case scenarios
2. To discuss the wide range of psychopharmacotherapeutic considerations when using psychotropic medications in the care of patients with mental health and addictions problems;
3. To develop a framework for learning about and developing skills toward the optimal use of psychotropic medications in the care of patients with mental health and addictions problems

Module: Psychopharmacology (Antidepressants)

Following completion of the whiteboard animation/module, the medical student will be able to:

1. Interpret a clinical scenario to determine indications for anti-depressant initiation
2. Apply knowledge of anti-depressant mechanisms of action to determine common and serious side effects across the lifespan
3. Determine how to appropriately monitor patients on anti-depressants
4. Describe the symptoms and initial management of serotonin syndrome

Module: Psychopharmacology (Antipsychotics)

Following completion of the whiteboard animation/module, the medical student will be able to:

1. Interpret a clinical scenario to determine indications for antipsychotic initiation
2. Apply knowledge of anti-psychotic mechanisms of action to determine common and serious side effects across the lifespan
3. Determine how to appropriately monitor patients on antipsychotics
4. Describe how to identify and treat extrapyramidal side effects

Module: Psychopharmacology (Benzodiazepines)

Following completion of the whiteboard animation/module, the medical student will be able to:

1. Interpret a clinical scenario to determine indications for benzodiazepine initiation
2. Apply knowledge of benzodiazepine mechanisms of action to determine common and serious side effects across the lifespan
3. Determine how to appropriately monitor patients on benzodiazepines
4. Apply knowledge of benzodiazepine pharmacology to the management of alcohol withdrawal

Seminar: Psychosis Case Vignettes

By the end of the seminar, the medical student will be able to:

1. Discuss the assessment process for a patient presenting with psychosis
2. Recognize the common clinical presentations of psychosis
3. Using the DSM-5 criteria be able to develop a reasonable differential diagnosis for a patient presenting with psychosis
4. Begin to develop a management plan for patients presenting with psychosis that considers pharmacological and non-pharmacological strategies

Seminar: Psychotherapy

By the end of the seminar, the medical student will be able to:

1. Describe indications and general techniques of the following therapies:
       a. Cognitive Behavioural Therapy
       b. Interpersonal Therapy
       c. Dialectical Behavioural Therapy
       d. Psychodynamic Psychotherapy
       e. Motivational Interviewing
2. Describe the Stages of change model

Video: Somatoform

By the end of the seminar, the medical student will be able to:

1. Describe the health system burden of functional disorders and unexplained symptoms
2. Describe observational and interview based approaches to detect emotion dysregulation
3. Describe typical somatic experiences of anger, guilt and grief
4. Describe the general relationship between unacceptable emotions, anxiety about these emotions and defense mechanisms
5. Describe four categories of physical effects of blocked emotions
6. Describe the main categories of DSM 5 somatoform disorders

Seminar: Stigma

By the end of the seminar, the medical student will be able to:

1. Recognize the importance of increased awareness of stigma in mental health
2. Describe a framework for understanding stigma, including historical elements
3. Discuss important topics within the area of stigma, including the impact on patients and families and the role of the media
4. Discuss current concepts in the management and prevention of stigma

Seminar: Stress and Trauma

By the end of the seminar, the medical student will be able to:

1. Discuss the concept of stress, including the stress response curve, and the range of potential impacts stress may have on people, including on their mental health.
2. List defining characteristics of trauma and stressor related disorders of adults, especially of post-traumatic stress disorder (PTSD), and identify their common comorbidities.
3. Describe biopsychosocial (pharmacological and non-pharmacological) evidence-based interventions for PTSD.
4. Demonstrate trauma-informed clinical communication.

Seminar: Substance Use Case Vignettes

By the end of the seminar, the medical student will be able to:

1. Describe the various substance use and related disorders that are listed in DSM-5
2. Demonstrate knowledge of appropriate history and physical examination for intoxication/withdrawal states
3. Recognize Intoxication states for various substances
4. Recognize withdrawal states for various substances
5. Outline treatment approaches of intoxication/withdrawal states

Transgender Module & Case Session

By the end of the module/seminar, the medical student will be able to:

1. Describe the concept of “the gender spectrum”
2. Define relevant terminology including; Trans*, transgender, transman, transwoman, natal male, natal female
3. Discuss the epidemiology of the transgender population
4. Access and use the World Professional Association for Transgender Healthcare, Standards of Care
5. Describe the evidenced based treatment options for Transgender individuals
6. Recognize the importance of and apply effective communication strategies in clinical scenarios with transgender individuals