Download Psychiatry - Central Michigan University

Central Michigan University - Physician Assistant Program
COURSE OBJECTIVES for CLINICAL CLERKSHIP in
PSYCHIATRY
The mission of the Central Michigan University Physician Assistant (PA) Program is to
produce well-educated and highly-skilled Physician Assistants who provide evidence-based
medical services within the interdisciplinary primary care environment, with an emphasis
on diversity and service to medically underserved populations in rural or urban
communities.
PROGRAM GOALS
1. Medical Skills & Competence: PA students will know and explain the differences between
good health and states of illness, and in collaboration with their supervising physicians be
able to screen for and diagnose, formulate care plans, and treat the common health problems
of individuals across the lifespan, and their families and communities.
2. Evidence-Based Learning: Students will demonstrate their understanding of the importance
of medical research as it relates to clinical practice, in order to utilize evidence based medical
literature to formulate patient management plans.
3. Systems-Based Learning and Interprofessional Education: PA students will understand
how patient care relates to the healthcare system as a whole. Graduates will be prepared to
work effectively in interprofessional healthcare teams to improve patient care outcomes.
CLINICAL CLERKSHIP COURSE DESCRIPTION: This clinical clerkship is designed to
Students will develop the skills necessary to evaluate and manage patients with a variety of
psychiatric problems. The clerkship will provide students the opportunity to develop an
understanding of the role of psychiatrists, psychologists, social workers and nurses in the care of
the psychiatric patient. Students will learn the appropriate use of selected psychoactive
pharmaceuticals. There will be ample opportunity for the student to practice the skills necessary
to perform a psychiatric interview and mental status examination and make referrals for
specialized psychiatric treatment.
COURSE FORMAT: The methods of learning will come from observation, participation in
direct inpatient and outpatient care, demonstration, case presentations and interaction with the
team of health care professionals on staff in the clinic. The student is responsible for the material
in the required texts as well as readings assigned by the preceptor.
COURSE GOALS: Upon completion of this clerkship students will have the skills necessary
to; evaluate and manage patients with a variety of psychiatric problems. The student will be
familiar with the indications, contraindications, side effects and dosing guidelines for the
medications commonly used in Psychiatric practice and be able to use selected psychoactive
pharmaceuticals appropriately. Additionally, students are expected to perform a psychiatric
interviews and mental status examinations. The student will learn and understand the role of
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Psychiatric Medicine Clinical Rotation
psychiatrists, psychologists, social workers and nurses in the care of the psychiatric patient and
learn when to make referrals for specialized psychiatric care to the appropriate specialists.
DSM-5 PUBLICATION
As a result of the 2013 publication of the Diagnostic and Statistical Manual of Mental Disorders,
Fifth Edition (DSM-5) criteria, the PAEA End-of-Rotation examination effective September
2014 and the NCCPA (http://www.nccpa.net/ExamsContentBlueprint) will "adapt its content
blueprints, disease and disorder lists, and test questions to conform to DSM-5 classifications and
diagnostic criteria for all of our examinations beginning in 2015, according to the following
timeline" •
PANCE and PANRE administered in 2015: In these examinations, test questions will
include the DSM-5 terminology followed by the DSM-4-TR terminology in parentheses.
Example: illness anxiety disorder (hypochondriasis)
•
PANCE and PANRE administered in 2016 and beyond: In these examinations, only the
DSM-5 terminology will be provided. Example: illness anxiety disorder
PSYCHIATRY CLERKSHIP GOALS
The aim of the core or embedded psychiatry clerkship* is to:
a. Achieve a level of competency in psychiatry to be able safely carry out the duties of a PA
in any domain of medicine.
b. Promulgate respect and understanding of psychiatry as a medical discipline and its
importance to other medical specialties.
c. Dispel attitudes which result in stigmatization of patients with psychiatric disorders.
*The CMU PA Program’s core and embedded clinical rotations provide comparable experiences over the course
of the program. Each clinical site has different resources, culture, philopsphy, and patient casemix; these factors
coupled with the service setting (whether in-patient or outpatient), patient throughput processes and the types of
communities served, all impact patient access to care, patient volume, and the types of patients seen on a weekly
basis. As a result, the program assesses student exposure to the various domains of medical education for each
clinical rotation and over the course of the clinical year through student data management in our clinical tracking
database and extensive monitoring by faculty of student outcomes performance including patient casemix,
interventions and procedures, case presentations, formative reviews, and formal summative assessment.
REQUIRED READINGS (coursework textbooks from first year studies)
•
Introductory Textbook of Psychiatry (6TH edition) by D. W. Black and N. C. Andreasen.
Publisher: American Psychiatric Publishing, 2014 (ISBN-13: 978-1585624690) The sixth edition of the Introductory Textbook of Psychiatry has been reorganized and
rewritten to reflect the reformulated DSM-5® diagnostic classes, rendering all other texts
obsolete. No other introductory psychiatry text incorporates up-to-date information on all of
the major disorders, arranged by DSM-5® diagnostic class, along with current treatment
information.
•
A Comprehensive Review For the Certification and Recertification Examinations for
Physician Assistants, by C.B. O'Connell, S. F. Zarbock. Publisher: Wolters Kluwer.
•
Step-Up to Medicine, by S. Agabegi & E. Agabegi. Publisher: Wolters Kluwer.
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ADDITIONAL REQUIRED READINGS (Physician Assistant Education Association, 2012)
• The Psychiatric Medicine topic list, as referenced in Appendix A and available at
http://endofrotation.org/exams/blueprints-and-topic-lists/psychiatry-topic-list.pdf, outlines
the medical conditions students need to understand in order to prepare for their
end-of-rotation (EoR) case presentations and examinations;
• The Psychiatric Medicine Skills Competency Blueprint List - In order to build
competence in addressing various medical conditions, students are to understand and gain the
following clinical skills (as referenced in Appendix B and available at
http://www.paeaonline.org/index.php?ht=a/GetDocumentAction/i/140865).
• PAEA Learning Supplement to the skills competency blueprint,
http://www.paeaonline.org/index.php?ht=a/GetDocumentAction/i/153610 detailing the
learning objectives pertaining to:
o History Taking and Physical
o Health Maintenance
Examination Skills
o Clinical Intervention
o Diagnostic Studies
o Clinical Therapeutics
o Diagnosis
o Scientific Concepts
SUPPLEMENTAL RECOMMENDED READING (optional)
• Examination Content Blueprint, http://www.nccpa.net/Upload/PDFs/Content%20Blueprint.pdf
• First Aid Clinical Clerkship Series, http://www.usbmis.com/faid/
• Dynamed, http://catalog.lib.cmich.edu/record=b2506547
OBJECTIVES
GENERAL PSYCHIATRIC OBJECTIVES
Student learning outcomes have been developed for general psychiatric skills and for selected
presentations/diagnoses. By the end of the psychiatry clerkship it is expected that the student will
be able to:
• Obtain, document, and present an age and gender-appropriate problem-oriented
psychiatric history and physical examination, assessment and plan.
• Perform and document a complete psychiatric history and mental status examination with
identification of normal and abnormal findings.
• Identify suicidal and homicidal ideation, across the lifespan.
• Demonstrate differential diagnosis skills using specific history and physical exam
findings.
• Identify appropriate diagnostic and laboratory tests and interpret results.
o Describe the indications for the use of the following neuroimaging procedures in
psychiatry: MRI, C-T, SPECT, and PET scanning
• Distinguish the co-morbidities of other chronic illnesses that often accommodate the most
common mental disorders (depression, anxiety, and substance abuse) and their impact
course, severity, and clinical outcome.
• Demonstrate effective communication skills with patients and families using sensitive,
• non-judgmental language, and recognize the emotional impact of illness on patients and
families.
• Construct an appropriate treatment plan (medication and/or therapy) and, if
necessary, refer to specialty care.
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State the indications, contraindications, major side-effects/adverse reactions and
correct dosing schedules for medications commonly used in psychiatry, including
(but not limited to): Antidepressants, Anxiolytics, Antipsychotics, Sedatives
o State the indications, contraindications, major side-effects/adverse reactions and
correct dosing schedules for medications commonly used in emergency
psychiatry, including (but not limited to):
Oxygen, Dextrose, Naloxone, Thiamine, Flumazil, Haldol, Cogentin, and
Diphenhydramine
o Demonstrate familiarity with the utilization of traditional community resources
available for patients with psychiatric disorders and psychosocial problems.
Develop skills for enhancing treatment adherence.
Identify the legal requirements of civil commitment and competency evaluations.
o
•
•
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SPECIFIC LEARNING OUTCOMES
Learning outcomes have been developed for selected diagnoses and clinical settings.
Depression:
1. Acknowledge the high prevalence of depression in medical patients.
2. Identify various presentations of depression across the life span.
3. Select and monitor appropriate psychiatric medications used in treating depression.
4. Determine an individual patient's potential risk for subsequent depression.
5. Determine 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.
6. Discern a patient's risk for suicide.
7. Determine the impact of depression upon the patient's level of function.
8. Ascertain that depression may be a potentially life-threatening illness; however,
uncomplicated depression can be diagnosed and treated by non-psychiatrists.
9. Demonstrate that treatment of depression is interdisciplinary.
Anxiety Disorders:
1. State of the etiology, pathophysiology and epidemiology of generalized anxiety disorder,
panic disorder, social phobia, agoraphobia and other specific phobias
2. Identify elicit psychiatric symptoms and signs of a patient with an anxiety disorder or
obsessive compulsive disorder
3. Discern when and how to use anxiolytic drugs and know their side effects
4. Identify the treatment, both pharmacological and psychotherapeutic, for each of the
anxiety disorders
5. Describe the diagnosis and management of panic disorder, agoraphobia, social phobia
and specific phobias
6. Differentiate between fear and anxiety and the importance of this distinction
Substance Abuse & dependence:
1. Describe the impact of alcohol and drug misuse and dependence on the family and
society
2. Describe the psychological effects of the misuse of alcohol and other illicit drugs
3. Identify the range of individuals and services that are available to help the problem
drinker and drug user and how to match the individual with the most appropriate service
4. Identify the community resources required for the optimum rehabilitation and
management of substance misuse and dependence
5. Recognize the investigations undertaken in cases of alcohol and substance misuse
6. List the social and behavioral associations of alcohol and drug misuse and dependence
7. Describe the pharmacological and metabolic effects of alcohol and other drugs of misuse.
8. Demonstrate a non-judgmental attitude towards patients with substance misuse problems
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Psychotic disorders: Schizophrenia
1. Name the features that distinguish schizophrenia from a mood disorder with psychotic
features
2. Summarize the current knowledge concerning aetiology, pathogenesis and epidemiology
of schizophrenia
3. Describe an appropriate course of treatment for a patient with schizophrenia including
pharmacotherapy and psychosocial support
4. Summarize the clinical features and course of schizophrenia
Personality Disorders:
1. Elicit psychiatric symptoms and signs of a patient with a personality disorder
2. Explain the basics of how personality traits and disorders are defined and classified
3. Identify the community resources required for the optimum rehabilitation and
management of severe personality disorders
4. Outline the clinical features common to all personality disorders and the features which
distinguish them
5. Defend the moral difficulties posed by serious personality disorder for the care of those
so affected
Mood disorders:
1. Define the classification of mood disorders and distinguish between unipolar depression
and bipolar disorder
2. Describe the signs and symptoms, differential diagnosis, course of illness, co-morbidity,
prognosis and complications of mood disorders
3. Identify the features that distinguish schizophrenia from a mood disorder with psychotic
features
4. Screen for depressive symptoms
5. Screen for suicidality and to identify and manage suicide risk in a general medical setting
6. Discern when and how to use antidepressants and know their side effects
7. Screen for manic and hypomanic symptoms
8. Report the treatment for major depression and bipolar disorder (manic and depressive
phases) for acute episodes and longer term maintenance
9. Discern when and how to use antimanic agents and know their side effects
10. Differentiate between depressive symptoms and depressive disorders and why the
distinction is important
11. Differentiate between sadness and grief associated with life events and depressive
disorders
Bi-polar Disorder
1. Classify mood disorders and distinguish between unipolar depression and bipolar
disorder
2. Screen for manic and hypomanic symptoms
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In addition,
1. Relative to care provided by the physician assistant, counsel patient/patient’s family on
issues dealing with:
Read
Observe
Perform
Discuss
Read
Chronically ill patients
Parenting skills
Crisis intervention
Stress reduction techniques
Death and dying
Observe
Perform
Discuss
Perform
Discuss
Legal issues and notification
This may be used as a study guide for the student
2. Relative to care provided by the physician assistant, manage selected psychiatric
emergencies, including:
Read
Observe
Perform
Discuss
Read
Acute psychotic disorder
Suicidal/homicidal risk
Hypermania
Violent behavior
Observe
This may be used as a study guide for the student
3. Define the basic concepts & considerations for use of the following nonpharmacologic
therapeutic interventions.
Read
Observe
Perform
Discuss
Read
Behavioral Therapy
Neurosurgery
Electroconvulsive Shock
Therapy
Psychoanalysis
Hypnotherapy
Psychotherapy
Observe
Perform
Discuss
Inpatient vs Outpatient
treatment
This may be used as a study guide for the student
4. Relative to the care provided by the physician assistant, identify and refer patients with the
personality disorders below.
Read
Observe
Perform
Discuss
Read
Antisocial
Narcissistic
Avoidant
Obsessive-Compulsive
Borderline
Paranoid
Dependent
Schizoid
Histrionic
Schizotypal
Observe
Perform
Discuss
This may be used as a study guide for the student
5. Understand and know indications and interpretation of results for the following testing tools.
Read
Observe
Perform
Discuss
Read
Beck Depression Scale
MMPI
Bender Gestalt
Rorschach
Denver Developmental
Screening Test
Thematic apperception Test
DSM IV
Wechlser Adult
Intelligence scale
Manic State Scale
Geriatric depression scale
Observe
Perform
Discuss
This may be used as a study guide for the student
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Psychiatric Medicine Clinical Rotation
6. Identify the emotional impact of sexual abuse/rape, spouse abuse, child abuse, trauma,
disasters and war on immediate victims, family and caregivers.
7. For patients presenting with the conditions listed below:
A. Perform a psychiatric interview and physical examination when indicated and
communicate the results in written and oral form
B. List related differential diagnoses
C. Determine a tentative diagnosis
D. Direct a primary care diagnostic evaluation
E. Determine the impact of existing medical illness on diagnosis
F. Order a primary care-level clinical treatment plan, which includes:
• Pharmacologic and non-pharmacologic interventions (side-effects of major
psychotropic medications), management of acute psychosis
• Patient education
• Further diagnostic studies
• Appropriate referrals or consultation; and
• Follow up
Read
Observe
Perform
Discuss
Read
Adjustment disorder
Memory loss
Anxiety
Mood swings
Delirium
Neglect of a child
Delusions
Panic attacks
Dementia
Physical abuse
Depression (major and minor)
Psychological factors affecting
medical conditions
Difficulty concentrating
Schizophrenia
Eating disorders
Sexual abuse
Excessive sleep
Factitious disorders
Sexual dysfunction and
disorders
Somatiform disorder
Fatigue
Spouse abuse
Hyperactivity
Stress disorder (PTSD)
Hypermania
Suicidal/violent behavior risk
Insomnia
Substance abuse disorder;
Recognition of withdrawal
symptoms of common drugs of
abuse, opiates, ETOH, ect.;
Observe
Perform
Discuss
Pain management in a drug
dependent patient
Loss of appetite
Tourette’s disorder
This may be used as a study guide for the student.
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Appendices
A – Physician Assistant Education Assocation (PAEA) Clerkship Topic List, retrieved Aug. 21,
2014 from http://endofrotation.org/exams/blueprints-and-topic-lists/psychiatry-topic-list.pdf
B – PAEA Skills Competency List Blueprint, retrieved Aug. 21, 2014 from
http://www.paeaonline.org/index.php?ht=a/GetDocumentAction/i/140865
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