Psychiatry Component

Biopsychosocial Approach to the Patient (BAH) is a 12-week integrated clerkship block comprised of Psychiatry and Primary Care. Integration of training in Primary Care and Psychiatry occurs in two areas. First, in didactics, all students assemble together to complete “Top Ten” workshops on topics spanning both disciplines, e.g., assessment of competency, treatment of chronic pain, motivational interviewing, diagnosis and treatment of somatic symptoms, addressing social determinants of health. Additionally, students participate in three individual workshops a) introduction and rationale for the biopsychosocial approach with readings (e.g., George Engel, Barbara Starfield), b) clinical approach to the biopsychosocial model and c) how patients access community health and psychiatric resources. In the clinical realm, many sites have embedded psychiatric services, e.g., West Haven VA Medical Center, the New Haven Health Consortium, Cornell Scott Hill Federally Qualified Health Center, and Yale Internal Medicine Associates. Course Directors (CDs) communicate with preceptors at all sites before students arrive, emphasizing the clerkship’s goal to teach a holistic approach to patient care. Additionally, to promote exchange of ideas across Primary Care and Psychiatry faculty, CDs prepare and host regular evening faculty development events focusing on topics of interest to both Primary Care and Psychiatry faculty.

Psychiatry is a 6-week component during which students care for patients with a breadth of psychiatric diagnoses across the lifespan. Students spend 3 weeks on 2 different clinical services--one of several inpatient psychiatric settings, consult-liaison or emergency psychiatry services or intensive outpatient programs. The clinical sites include Yale New Haven Hospital (including Yale Psychiatry Hospital and Saint Raphael’s campus), Connecticut Mental Health Care Center, West Haven VA, and Middlesex Hospital. In addition, each student spends a half-day a week at an outpatient psychiatric subspecialty clinic (including addiction, young adult psychiatry, etc.).

Students spend every Thursday afternoon attending themed-didactics sessions: psychotic disorders, mood disorders, anxiety and traumatic-based disorders, personality disorders, and medicine-psychiatry interface. To supplement these sessions, students complete high-quality online modules on eating disorder, geriatric depression, personality disorder, and insomnia. At the end of the 12-week BAH block, students apply skills with standardized patients and simulated manikin in a half-day Postcede session at the simulation center. Additional sessions are incorporated into the psychiatry component allowing for reflection and discussions of the students’ experiences.

Student assessments occur throughout the component.

• Students are evaluated on their level of independence in gathering a history, presenting a mental status exam, prioritizing differential diagnoses, presenting a clinical case, and writing a clinical note using Entrustable Professional Activity (EPA)-based assessments. The students are directly supervised and given real time actionable feedback.
• During the tutoring sessions, students are assessed on their oral and written presentation with feedback.
• Mid-rotation feedback is obtained during each of the 3-week core rotations.
• Students are given immediate feedback after their interactions with standardized patients and simulated manikin.
• At the end of the rotation, the students complete a 66-item knowledge-based assessment and receive immediate feedback.
• Core clerkship attendings and residents, outpatient clinic supervisor, and tutor provide summative feedback via MedHub evaluations.

The Psychiatry component learning objectives span knowledge, skills and attitudes including professionalism, interview skills, and clinical reasoning. The learning objectives are distributed to the students via Box.

• Learn the clinical knowledge and apply basic science concepts to evaluate and treat common presentations and diagnoses in psychiatry.
• Identify the most common mental health disorders.
• Describe and apply the biopsychosocial model in the care of patients including an appreciation of the changing needs of persons across a lifespan.
• Use clinical reasoning to synthesize data into a prioritized differential diagnosis and plan.
• Demonstrate behaviors consistent with the highest standards of professionalism and medical ethics in all patient encounters and interactions with colleagues.
• Improve therapeutic alliances with patients via self-reflection
• Identify deficiencies and limits in knowledge and expertise to guide self-directed study during the clerkship.
• Demonstrate respectful attitudes and professional behaviors toward patients with psychiatric disorders and their families. Display the ability to connect with their underlying humanity.
• Demonstrate effective communication with patients, families, and all members of the healthcare team.
• Utilize patient-centered interview techniques by incorporating patient’s point of view and values.
• Effectively deliver evidence-based brief behavioral intervention.
• Obtain an accurate and appropriately detailed medical history in a logical and organized manner for a given clinical setting.
• Complete an appropriate and accurate hypothesis-driven physical with particular emphasis on the mental status examination.
• Deliver an effective oral and written presentation, appropriately tailored for a given clinical setting.
• Recognize whether to obtain and how to interpret common diagnostic studies in psychiatry.
• Develop, describe, and implement appropriate therapeutic plans.
• Demonstrate skills for coordination of care and communication with colleagues.
• Demonstrate sensitivity and responsiveness to diverse patient populations.
• Appreciate how patient health care needs are impacted by social and structural determinants of health.
• Identify key economic, statistical, and clinical factors (e.g., physical risk) that may affect choice among management decisions.
• Explain the importance of understanding family, community, and societal roles in providing care to patients with psychiatric conditions.
• Utilize effective methods of acquiring and applying evidence-based practices to guide diagnosis and treatment decisions.
• Appreciate the overlapping skills, knowledge, and approach to patient care in psychiatry and primary care through shared learning activities.