The Biopsychosocial Approach to the Patient (BAH) is a 12-week integrated clerkship block comprised of Psychology 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 clerkship 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 clerkship, 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 clerkship allowing for reflection and discussions of the students’ experiences.
Student assessments occur throughout the clerkship.
- 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-clerkship feedbacks are 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 clerkship, 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 Clerkship learning objectives span knowledge, skills and attitudes including professionalism, interview skills, and clinical reasoning. The learning objectives are distributed to the students via Box.
- Demonstrate behaviors consistent with the highest standards of professionalism and medical ethics in all patient encounters.
- Incorporate core concepts for psychiatry during the care of patients.
- Obtain an accurate and appropriately focused psychiatric history for a specific setting and amount of time.
- Complete a mental status examination for an adult or child patient.
- Formulate and describe the differential diagnosis and a diagnostic plan for children and adults presenting with various complaints in psychiatry.
- Deliver an effective oral presentation and write a note based on the findings from an interview and examination of an adult or child in psychiatry.
- Ascertain and interpret the results of common tests.
- Develop, describe, and implement appropriate therapeutic plans.
- Demonstrate the learning skills and ability to identify and meet emerging information needs for diagnosis, prognosis and treatment of patients cared for in psychiatry.
- Demonstrate skills for coordination of care and communication with colleagues.
- Demonstrate the knowledge required to provide care for patients presenting with the most important and common needs in psychiatry.
- Recognize and diagnose selected emergencies in psychiatry and describe the initial approach to management of each.
- Recognize the various ways in which primary care and psychiatry in the United States are practiced and the mechanisms/forces which have shaped psychiatry.
- Describe benefits of providing mental health within primary care practice.
|Students must do the following checklist items||Minimum no. of times||Type of patient|
|Evaluate and document in the medical record a patient with a mood disorder||1||real|
|Evaluate and document in the medical record a patient with a psychotic disorder||1||real|
|Evaluate and document in the medical record a patient with a substance use disorder||1||real|
|Evaluate and document in the medical record a patient with a personality disorder||1||real|
|Evaluate and document in the medical record a patient with a cognitive disorder||1||real|
|Complete geriatric depression learning activity||1||online module|
|Complete eating disorder learning activity||1||online module|
|Complete personality disorder learning activity||1||online module|
|Complete insomnia learning activity||1||online module|
|Observe electroconvulsive therapy session||1||real|
|Complete EPA 1a (Gather a History) with preceptor||1||real|
|Complete EPA 1b (Perform and Present a Mental Status Exam) with preceptor||1||real|
|Complete EPA 2 (Prioritize a differential diagnosis following a clinical encounter) with preceptor||1||real|
|Complete EPA 5 (Document a clinical encounter) with preceptor||1||real|
|Complete EPA 6 (Provide an oral presentation of a clinical encounter) with preceptor||1||real|
|Evaluate a patient with alcohol use disorder||1||SP*|
*SP = standardized patient