PSYCHIATRYCLERKSHIPREVIEW

REVIEWERS PrimaryReviewers

Birmingham TerrenceShaneyfelt,M.D. Huntsville DanielAvery,M.D. Tuscaloosa KevinLeon,M.D.

SecondaryReviewers J.MichaelWells,M.D DwightHooper,M.D. HarrisReynoldsMSIV KevinGreenMSIV

ClerkshipDirectors Birmingham AndreeStoves,M.D. Huntsville Anupama Yedla,M.D Tuscaloosa LloydaWilliamson,M.D.

BirminghamPsychiatry Studentsassignedtooneclinicalservice

5 AdultInpatient,1AdultOutpatient,1Geriatric,1Adolescent,1consult

Spend8hoursadayonclinicalservices

21hoursoncallinPsychiatryER/consult

4hoursvisitingpatientsintheirhomeswiththeCommunityMentalHealthService

4hoursinOutpatientClinic

5hoursinStateMentalHospital

Didactics13hoursdaily

5smallgroupdiscussionsessions providedwithrecentjournalarticlesandacase

HuntsvillePsychiatry Studentrotations

Inpatientrounds Inpatientconsultations OutpatientclinicsatUABandMadisonCountyMentalHealthCenter

Duringinpatientrotations Studentsarerequiredtofollowatleast3patientsdaily

Opportunitytoworkwithchildpsychiatrist

TuscaloosaPsychiatry IntegratedwiththeNeurologyclerkshipover8weeks

2.5daysofPsychiatryperweek 2.5daysofNeurologyperweek

Studentrotations inpatientVAMCandthenoutpatientVAMC/orWOW(WorkingOnWomanhood)JuvenileDetentionProgram

inpatientBryceandVAMCOutpatient Added4.5hoursoncallatTuscaloosaCo.Jail

Didacticsweekly eight2.5hoursessions 6PBLsessions(2.5hoursinduration)

Studentshaveassignmentsforthepresentationsthattheyresearchandpresenttotheotherstudentsontheclerkship

CONTENTANDMETHODSOFINSTRUCTION(StrengthsoftheClerkship)

VarietyofLearningExperiences Birmingham

Patienthomevisits,outpatientclinic,StateMentalHealthhospital OnemorningobservingECT Weeklycaseconference livepatientinterviewfollowedbydiscussion

Huntsville Inpatientandoutpatientclinics AddedERtotherotation Addedanothersiterotation Grouphomeforboys

Tuscaloosa Allstudentsdooutpatientandoutpatient clinics Collegiaterecoveryprogram1hourperrotation AddedWOW(WorkingOnWomanhood)Education&TreatmentProgram

withmultidisciplinarymeeting Allstudentshavechildpsychiatryexperience

InstructioninCommunicationSkills(TeachingandCounseling) Birmingham

Allstudentsarerequiredtoparticipateinatleastonefamilymeeting signedoffbyattending

Huntsville Outpatientsetting workcloselywithattending.Feedbackisprovidedinstantlyaftereachencounter

Takepartintreatmentteamandgrouptherapysessions Takepartinfamilymeetings

Tuscaloosa Studentswork1:1withattendings andgetimmediatefeedback

Instructionintotalmedicalneedsofpatientsincludingsocialandculturalaspectsofcare WorkaspartofaninterdisciplinaryteamincludingM.D.s,CRNPs,R.N.s,socialworkers,occupationaltherapy,andpsychologists

Studentwriteupsincludeaculturalformulationsection

CONTENTANDMETHODSOFINSTRUCTION(AreaforImprovement)

PatientEncounters Acrossall3campuses,studentscareforpatientswithawidevarietyofpsychiatricdisorders.Thefollowingaredisordersnotcommonlyseenbystudentsonallcampuses. Sexualandidentitydisorders Factitiousdisorders Eatingdisorders Dissociativedisorders

METHODSOFASSESSMENT

SupervisionofStudents Birmingham

RequiredtoperformatleastonefullHistoryandPhysicalunderdirectsupervisionoftheresidentorattending

Huntsville Work1:1withattending

Tuscaloosa Work1:1withattendingphysician

PatientWriteUps Birmingham

Requiredtohave2writeupsreviewedbytheirsupervisor

Tuscaloosa Patientwriteups(2) aregradedbythesameattendingforallstudents

Independentstudyintegratedpapers(1) ( gradedbythesameattending

FormativeandSummativeFeedback Birmingham

UASOMMidClerkshipfeedbackform

Huntsville Feedbackisprovidedbyattendingimmediatelyaftereachpatient

visit Feedbackisprovidedaftertheoralexam

Tuscaloosa Eachstudentreceiveswrittenmidrotationfeedbackfrom2

attendingphysicians Feedbackisprovidedaftertheoralexam

VarietyofMethodsofAssessment NBMEshelfexam

Oralexam

Patientlogs(BirminghamandTuscaloosa)

ClinicalPerformanceratingsbypreceptors

Performanceingroupdiscussion(Birmingham)

STUDENTOUTCOMES

PsychiatryClerkshipScoresAcrossCampuses

(Averagefrom20112013)

Birmingham Huntsville Tuscaloosa

ClinicalPerformance

92.6 90.9 91.8

NBME 76.9 78.3 76.9

OralExam 92.8 91.7 91.2

RawScore 90 89.6 89.5

HonorsCriteria ClinicalHonors

Birmingham 100%Honorsboxescheckedbyfacultyandoralexam90orhigher

Huntsville andTuscaloosa committeedecision

NBMEHonors 50th percentileorhigher/rawscoreof76orhigher

SeniorOSCEscoresbycampus GeriatricDepression

Birmingham 88 Huntsville 87 Tuscaloosa 88

NBMEexam8/1/10to7/31/11 Meansinindividualareasbelowthenationalaverageinmostareasexcept: Mechanismsofdisease Tuscaloosa childpsychiatry

StudentEvaluationsBirmingham Huntsville Tuscaloosa

Organization 7.27.8 7.58.3 6.37.6

Content 5.77.5 7.38.0 6.37.0

Overallimpactofclerkship

6.57.3 7.68.3 6.77.2

Overall 6.47.0 7.77.8 6.56.9

Note:Huntsville nostudentevaluationdataavailablefromJanuarytoApril

StudentEvaluations Gradingandexaminations

Highlysatisfactory

FacultyandResidents Viewedasexcellentatall3campuses

StudentComments Acrossallcampuses,scoredlowonHowwelldidfirsttwoyearsprepareyoufortheclerkship? Birmingham 5.5 Huntsville 5.8 Tuscaloosa 5.4

SpecificStudentRecommendationsforImprovement Birmingham Concern:Studentsareassignedtoasingleclinicalservicefortheirentire rotation Studentswouldlikemoreoutpatientexposure

(suggestedtwo2weekblocks)

Tuscaloosa Concern: SwitchingbackandforthbetweenNeurologyandPsychiatry

2.5daysofpsychiatryperweek 2.5daysofNeurologyperweek NBMEexam duringthe8th week

Neurology Tuesday Psychiatry Friday

Dr.Williamsonsresponse studentsareabletoseediversepatientpopulationsatvarioussitesandseepsychiatristsfunctioninvariousroles;noneofthesites,(universityorcommunity)canmaintainstudentsallday,for5daysoftheweek

WhatWeCanLearnFromEachOther

TuscaloosaClerkship Themedicalstudentlog:

Notesactivitieswithplaceforattendingtoinitialanddatewhencompleted

Eachactivityislinkedtothecorrespondingclerkshipobjectivethattheactivityaddresses

HuntsvilleClerkship Standardizationoftheoralexam:

Examinersaskidenticalquestionsofthestudents

Theanswersareassignedpointvalues

Theyhavedoneinterraterreliabilitybytwoexaminerssittingintogetherandcheckingtheirscoresandgivingfeedbacktoeachother

BirminghamClerkship PatientExposure:

Studentsareregularlyqueriedabouttheirpatientexposures.Anystudentwhoishavingdifficultyinteractingwithpatientsofacertaindemographicareaskedtothenotifytheclerkshipdirector,whothenarrangesforthestudenttomakeroundsfor13dayswithadifferentclinicalteam.