Learning Objectives | Psychiatry | Michigan Medicine

Course Description

The Psychiatry rotation is a required four-week clinical rotation for clinical trunk students at the University of Michigan. Students learn to recognize and treat psychiatric disorders. They spend a significant amount of time interviewing patients, allowing them to refine their communication skills that are important for becoming effective physicians. We emphasize neuroscience and teaching specific communication skills in the Psychiatry rotation. The basic science content includes a two-hour session Basic Science Correlation at the beginning of the rotation on Neurotransmission and Psychopharmacology. The communication skills sessions will focus on communication challenges in the healthcare environment, particularly agitation and verbal de-escalation.

Institutional Objectives

Learning outcomes have been developed for general psychiatric skills and for selected diagnoses and clinical settings. By the end of the psychiatry clerkship the student will be expected to be able to:

General Psychiatric Skills:

Obtain, document, and present an age and gender-appropriate psychiatric history.
Do a complete mental status examination.
Assess suicidal and homicidal ideation, across the lifespan.
Apply differential diagnosis skills using specific history and physical exam findings.
Select appropriate diagnostic and laboratory tests and interpret results.
Effectively communicate with patients and families using sensitive, non-judgmental language, and recognize the emotional impact of illness on patients and families.
Select appropriate treatment (medication and/or therapy) and, if necessary, refer to specialty care.
Develop skills for enhancing treatment adherence.
Understand that the most common mental disorders (depression, anxiety, and substance abuse) are often co-morbid with other chronic diseases and impact course, severity, and clinical outcome.
Understand the confidentiality requirements of psychiatric diagnoses.
Understand legal requirements of civil commitment and competency evaluations.

Learning Outcomes:

Learning outcomes have been developed for selected diagnoses and clinical settings. By the end of the psychiatry clerkship the student will be expected to be able to:

Mood Disorders:

Recognize the high prevalence of depression in medical patients.
Identify various presentations and the natural history, onset, and prognostic features of depression across the life span.
Select and monitor appropriate psychiatric medications used in treating depression.
Assess an individual patient’s potential risk for subsequent depression.
Recognize the signs and symptoms of major depression, bipolar illness, and dysthymia so that given a patient description you can recognize these syndromes.
Assess the presence or absence of possible co-morbidities including dementia, anxiety disorder, adverse drug effect, substance abuse, and grief in any patient suspected of having depression.
Assess a patient’s risk for suicide and be able to appropriately respond to high risk patients.
Assess the impact of depression upon the patient’s level of function.
Recognize that depression may be a potentially life-threatening illness.
Recognize that uncomplicated depression can be diagnosed and treated by non-psychiatrists.
Recognize that treatment of depression is interdisciplinary.

Anxiety Disorders:

Differentiate between normal anxiety and specific anxiety disorders.
Describe major clinical, etiological, and epidemiological characteristics of panic disorder, agoraphobia, generalized anxiety disorder, social phobia, specific phobia, obsessive-compulsive disorder (OCD) and post-traumatic stress disorder (PTSD).
Recognize the ways in which anxiety disorders may present in primary care and other medical settings.
Recognize the general medical conditions and substances commonly associated with anxiety symptoms.
Describe anxiety disorder symptom presentations as they vary across the life span (e.g. child andelderly).
Describe major characteristics of anxiety disorders unique to childhood, including separation anxiety disorder and overanxious disorder of childhood.
Recognize the precipitating factors and functional impact (e.g. work, school, family relationships) of anxiety disorders.
Identify major classes of psychiatric medications used in treating anxiety disorders and discuss potential side effects of each.
Select and monitor appropriate psychiatric medications used in treating anxiety disorders.
Identify the primary psychosocial therapies used to treat anxiety disorders.

Substance Abuse:

Understand the major models of substance dependence and implications for treatment.
Differentiate between substance abuse and substance dependence (addiction).
Know how to screen for alcohol and drug problems in general medical practice.
Have working knowledge and an approach to the differential diagnosis of substance dependent patients with co-morbid psychiatric disorders.
Know the signs, symptoms, clinical course, and treatment of withdrawal (outpatient detoxification) for the various drugs of abuse.
Understand the difference between addiction to prescription drugs and taking medications due to legitimate medical need.
Differentiate between abstinence and sobriety.
Have a working knowledge of self-help groups such as Alcoholics Anonymous and Alanon and understand basic concepts in recovery.
Know the indications, contraindications, and efficacies of pharmacotherapy to treat substance abuse.
Become knowledgeable of community resources for treatment of addiction.

Psychosis:

State the definition of psychosis and describe how to recognize and diagnose psychotic conditions.
Perform an initial diagnostic evaluation of a patient with psychotic symptoms, including history and mental status examination.
Give a medical and psychiatric differential diagnosis for psychosis.
Summarize the epidemiology, diagnostic criteria, clinical features, course and complications of schizophrenia.
Recognize current theories of the etiology and pathophysiology of schizophrenia.
Recognize the common substances associated with psychosis during intoxication or withdrawal.
Recognize the other major primary psychotic disorders including mood disorders, schizoaffective disorder, brief psychotic disorder, and delusional disorder.
Describe common and serious side effects of frequently used antipsychotic medications.
Recognize the pharmacologic and psychosocial treatments of schizophrenia and other psychotic disorders.
Describe the initial and maintenance treatment of a manic episode.

Personality Disorders:

State the definitions of personality trait and personality disorder.
Describe each personality disorder cluster and name its component disorders.
Describe the basic characteristics of each personality disorder.
Describe the clinical features, epidemiology, diagnostic criteria, comorbidities, and treatments of borderline personality disorder.
Demonstrate a working knowledge of Dialectical Behavior Therapy (DBT).
Recognize the treatments for other personality disorders.
Describe the implications for the doctor-patient relationship of each personality disorder.
Conduct a suicide assessment that differentiates between acute and chronic suicidal ideation.

Child/Adolescent Component:

Describe major characteristics of disorders first presenting in childhood or adolescence including ADHD, Pervasive Developmental Disorders, Learning Disorders, and Mental Retardation.
Describe symptoms of mood, anxiety, and psychotic disorders presenting in children.
Recognize the ways in which a specific psychiatric disorder may present differently in childhood/adolescence.
Conduct and interpret a child/adolescent mental status exam with a child and conduct a parent interview.
Identify major classes of psychiatric medications and their pharmacokinetic principles, used in treating child and adolescent disorders and discuss potential side effects of each.
Recognize the potential biological, psychological, and social impact of child abuse/neglect on development in children, and describe the legal requirements and procedure for reporting suspected child abuse/neglect in children and adolescents.

Consultation Liaison / Emergency Services Component:

Recognize medical symptoms of psychiatric disorders.
Recognize psychiatric symptoms of medical disorders.
Recognize, assess and manage the delirious patient.
Conduct and interpret a Mini-Mental Status Exam or MOCA to assess cognitive function.
Review commitment laws for involuntary treatment, and evaluate a patient’s capacity to give informed consent.
Recognize psychiatric symptoms that are side effects of medications.
Recognize the following somatoform disorders: somatization disorder, conversion disorder, hypochondriasis, pain disorder, body dysmorphic disorder.
Discuss the management of somatoform disorders.

Geriatric Psychiatry Component:

Demonstrate proficiency in taking a past/family psychiatric history from older adults.
Recognize the importance of obtaining information from collateral informants. The student will develop an awareness that cognition may interfere with reliability of the patient’s report.
Recognize how geriatric psychiatry conditions impact functionality, Activities of Daily Living (ADL), and Instrumental Activities of Daily Living (IADL), should be assessed and followed in every patient.
Perform standardized cognitive screening tools (e.g. MMSE and MOCA).
Define dementia and dementia subtypes, recognize symptoms of Dementia of the Alzheimer’s type (DAT), describe the typical progression for dementia, and recognize treatments for dementia.
Articulate that depression is not a normal part of aging and that depression may have an atypical presentation compared to younger adults.
Use the Geriatric Depression Scale (GDS) as a standardized screening tool for depression in older adults, identify treatments for geriatric depression including the use of ECT, recognize that geriatric depression may be associated with reversible cognitive decline (i.e., pseudodementia) and recognize that late life depression may be precursor to dementia.
Recognize the complexity of the geropsychiatric patient and the interactions between medical, neurological, and psychiatric illnesses.
Demonstrate understanding of how physiological changes with aging and medical comorbidities affect psychotropic prescribing.
Recognize, assess, and treat delirium.
Categorize the differential diagnosis of late onset psychosis.

How students will be evaluated to ensure that each objective is met:

Students will be given opportunities to participate in direct patient care under attending and resident

supervision. This will include individual interviews with patients, written initial evaluations and progress notes, review of diagnostic test results, contact with families and outside care providers, presentation of cases to attendings and other staff, and participation in patient-related meetings and discussions.

Last updated: 1/22/2016