Psychiatry Clerkship Research Articles

The Efficacy of the Psychiatry Clerkship in Developing Students' Comprehensive Clinical Skills.

This study investigates the impact of the psychiatry rotation in developing students' clinical skills that are applicable across various medical specialties. Medical students at Saint Louis University completed the same survey before and after completing a 3½-week psychiatry rotation. Students rated 18 statements on a Likert scale. Statements were grouped into six categories to assess students' confidence in (1) managing medical issues of psychiatric patients, (2) addressing injurious behaviors, (3) gathering a clinical history, (4) de-escalating crises, (5) self-regulating emotions, and (6) empathizing with patients. Students' pre- and post-survey numerical responses were added within the six categories and compared using paired t-tests. Forty-three students completed both the pre-clerkship and post-clerkship surveys. For all six clinical skills categories, post-survey composite scores significantly increased. Managing medical complaints had a 7-point median score increase. Addressing injurious behavior had a 3-point median increase. Gathering a clinical history had a 4-point median increase. De-escalating crises had a 4-point median increase. Emotional self-regulation had a 2-point median increase. Empathizing with patients had a 2-point median increase. All six paired t-tests between pre- and post-surveys showed p-values < 0.001, indicating subjective improvement in students' performance for each clinical competency. The psychiatry rotation effectively increased medical students' perceived acquisition of essential clinical skills. These competencies, including gathering a history, emotionally self-regulating, and de-escalating crises, apply to nearly all medical specialties. Further research is needed to investigate which specific opportunities helped students develop these skills and the broader strengths of the psychiatry clerkship.

The Psychiatry Information Card: a pocket resource to assist students’ transition into psychiatry clerkship

Implication Statement The Psychiatry Information Card (PIC) offers a practical, structured concise resource to enhance medical students' confidence, knowledge, and self-reflection during psychiatry rotations. Its utility lies in providing targeted support for students navigating the transition from classroom learning to clinical practice, and addressing specific challenges encountered during this critical phase of medical education. By offering accessible and relevant information aligned with rotation objectives, the PIC increased knowledge pre and post rotation, and enhanced the learning experience. The PIC's acceptability is demonstrated by the high recommendation rate (90%) among participants, who endorsed its integration into the rotations. Additionally, the low cost and ease of distribution make the PIC a cost-effective resource, further supporting its feasibility for widespread implementation. Therefore, we recommend formal integration into the curriculum.

Stigmatising Attitudes Towards Mental Health Conditions Among Medical Students In Five South-Eastern European Countries.

Stigmatising attitudes towards mentally ill people are present among healthcare professionals. The aim of the study was to evaluate medical students' attitudes in five medical schools from Albania, Bulgaria, Moldova, Romania and Serbia and to determine if psychiatry clerkship improves these attitudes. In the first stage, the study included students from the first and final years of medical school; in the second stage, only final-year students were included; The Mental Illness Clinicians' Attitude Scale (MICA-2) and the Attribution Questionnaire (AQ-9) were used in this study. The total sample comprised 1,526 medical students in the first stage and 614 in the second stage. The analysis of the average AQ-9 and MICA-2 scores between countries revealed significant differences (p<0.05). Multivariable analysis showed that female students were 30% more likely to have elevated AQ-9 scores than male students (p=0.029). Final-year students had a significantly lower chance of having a higher MICA-2 score compared to first-year students (OR=0.7; p<0.05). Psychiatry clerkship contributes to a decrease in the level of stigmatising attitudes among medical students. Further research is required to assess the curricula to achieve better results in reducing stigma among future doctors.

Changing Medical Student Perceptions of Mental Illness Through a Psychiatry Clinical Clerkship: A Longitudinal Qualitative Study

Abstract Objective This study sought to understand whether perceptions of mental illness change during the course of students’ psychiatry clerkships, and what facilitates such change. Methods Using a longitudinal qualitative study design, the authors followed up 14 medical students, interviewing them before, during, and after their psychiatric clerkship. Results Prior to clerkships, students perceived psychiatric patients to be dangerous, fragile, hard to treat, and to exert a disproportionate emotional toll on clinicians. Stigma was reinforced by safety measures including the provision of alarms, but this improved following “real life” engagement with patients. Students experienced little emotional distress from clinical contacts, particularly those where they led the consultation. Pre-existing beliefs about mental illness being hard to “fix” showed less change over time. Although uncommon, when staff referred to patients using pejorative language, students emulated these negative attitudes. Conclusions Among medical students, direct patient contact plays an important role in counteracting pre-existing negative attitudes towards mental illness. This can be facilitated by supportive supervisors, clinical teams allocating students a clear practical role, involving patients in teaching, and roleplay to alleviate potential concerns about seeing patients.

A Psychiatry Clerkship Orientation Based on Bite-Sized Teaching and Chalk Talks.

Chalk talks are a subtype of bite-sized teaching with potential benefits over conventional teaching methods, including their use of visuals, adaptability, and potential to be more engaging. The objective of this study was to develop and evaluate the effectiveness of an orientation curriculum for medical students during the psychiatry clerkship based on bite-sized teaching and chalk talks. A series of brief (10min) lectures were developed covering fundamental skills in psychiatry, including psychiatric interview, mental status exam, and differential diagnosis. Talks were presented to medical students by the study author on the first day of their psychiatry clerkship in 60-min group educational sessions with 10-15 students per group. Data was gathered in pre- and post-session surveys that measured response to 4 knowledge-based questions on mental status exam terminology, 3 questions assessing confidence in completing skills associated with the talks, and 3 questions assessing beliefs regarding these skills. Fifty-six medical students participated in the educational sessions and completed pre- and post-session surveys. Students showed significant improvement from pre- to post-session in answering knowledge questions and perceived confidence in all skills, and indicated significant change in their beliefs regarding these topics. Although this is a small study without a control group, the results provide initial evidence that approaches to teaching foundational psychiatry topics based on bite-sized teaching and chalk talks may be an acceptable and more time-efficient alternative to a traditional lecture-based curriculum, and can produce significant changes in knowledge and attitudes.

Effect of the COVID-19 Pandemic on Medical Student Performance and Evaluation Scores.

In March 2020, the University of Hawaii John A. Burns School of Medicine suspended in person clinical teaching due to the SARS-CoV-2 (COVID) pandemic. During this period, virtual cases, telehealth participation, and online cases were incorporated into medical education. We have examined the effects of educational outcomes of third and fourth year students throughout clerkship performance, national standardized test scores, and our local fourth year OSCE examination. We found that USMLE step 2 scores were higher in the COVID-affected group. Patient logs in the COVID-affected group were lower for internal medicine, family medicine, OBGYN, and psychiatry clerkships. Clerkship performance grades in the COVID-affected group were lower for OBGYN and higher for surgery and psychiatry, but not different in other clerkships. USNBME subject specific examination scores in the COVID-affected group were higher for internal medicine, surgery, family medicine and psychiatry, but not different in all other specialties. For the fourth year OSCE, students in the COVID-affected group performed better on note taking and worse on physical examination. Future investigations will be needed to explore how our COVID-affected medical students perform in residency and beyond.

Reimagining the Psychiatry Clerkship: The Washington University School of Medicine Story.

Reimagining the Psychiatry Clerkship: The Washington University School of Medicine Story.

Interprofessional collaborative practice requirement embedded in a psychiatry clerkship for medical students

Embedding interprofessional education (IPE) into medical student curricula in clinically-relevant contexts can be challenging. The goal of this educational activity was to facilitate progression of interprofessional competencies in medical students as they completed a clinical clerkship in psychiatry. Third year medical students were provided with a menu of 18 patient-care activities that they could complete in conjunction with a non-physician member of the healthcare team (e.g. therapist, nurse, social worker, etc.) to advance collaborative practice knowledge and skills. Students were required to complete a minimum of two activities from the menu. Learning objectives focused on demonstrating respect for those with whom they worked (patients and staff); recognizing one's own limitations; engaging with other professionals to collaborate and integrate clinical care; using respectful language, and performing effectively as a team member. To assess the extent to which these objectives were attained, a rubric was developed for students to quantitatively and qualitatively self-reflect on the extent and manner in which they achieved the competencies. All students (n = 144) completed the clerkship assignment, and 82 students opted to allow their data to be used for research (57%). This cohort of students rated themselves highly (≥4.4 out of 5) on all competency statements. Written reflections detailed examples of ways the students demonstrated interprofessional competencies and what they learned from working alongside colleagues from other professions - including gaining new insights from collaboration with the health professionals, the importance of establishing trusting relationships, and the value that non-physician team members provide when caring for psychiatry patients. Clerkships are ideal opportunities for students to engage in interprofessional collaborative practice. Intentional practice experiences provide students with opportunities to execute IPE skills with colleagues while learning new knowledge, practicing new behaviors/skills, and gaining new insights about other professionals.

Medical Student Attitudes Toward Patients With Substance Use Disorder After Experiential Learning on an Addiction Psychiatry Consultation-Liaison Service: A Pilot Study.

Stigma surrounding substance use disorder (SUD) is highly prevalent in health care. Negative attitudes toward patients with SUD have been shown to negatively impact patient care. Addressing SUD stigma in medical students is a promising approach, however, few curricula include experiential learning on addiction psychiatry clinical services. We describe a medical student rotation on an addiction psychiatry clinical service and examine its effect on attitudes toward patients with SUD. Medical students were integrated onto an addiction psychiatry consultation-liaison service serving medically/surgically hospitalized patients with co-occurring SUD and other psychiatric disorders. Students learned and practiced in-person assessment of patients and received instruction on basic principles of psychiatry and evaluation and management of SUD. A targeted anti-stigma curriculum was included. Attitudes toward patients with SUD were measured with the Medical Condition Regard Scale (MCRS) before and after the experience. Each item of the MCRS and an overall composite attitude score were analyzed. Of the 36 students on the clinical rotation, 33 completed the survey. Attitudes showed widespread improvement toward patients with SUD. Mann-Whitney U tests showed significant improvement in most items of the MCRS. Further analysis of composite scores showed an improvement in overall attitudes toward patients with SUD. Inclusion of medical students on an addiction psychiatry consult service as part of the core psychiatry clerkship may hold promise for helping improve student attitudes and decrease stigma toward patients with SUD. Controlled study is needed to compare other clinical experiences and determine specific causative effects.

A Verbal De-escalation Standardized Patient Workshop for Third- and Fourth-Year Medical Students.

Verbal de-escalation is an essential skill for physicians across specialties and is the first-line intervention for patients who present with agitation. Training in verbal de-escalation for medical students is less robust compared to other health care disciplines. We describe the creation and evaluation of a novel verbal de-escalation curriculum for third- and fourth-year medical students on their psychiatry clerkship rotation. We developed a simulation using standardized patient (SP) methodology and a dedicated reflection session, implementing it in the third-year psychiatry clerkship. Participants in the scenario received targeted feedback from their peers and SPs. The sessions were video recorded, and a random sample was selected and reviewed to identify key observations and themes from student performance. A total of 139 students participated in the encounter. One hundred twenty-two of 125 students (82%) stated the activity met the learning objectives, with 108 (86%) assigning the letter grade A to the activity. Written feedback indicated that the majority of students believed the activity to be realistic, instructive, and helpful but felt the SPs de-escalated too quickly. Video review of the encounters found that while the students effectively used the skills, many jumped to a quick fix, and some offered inappropriate choices to end the encounter. This SP activity was effective in allowing students to practice skills in a safe setting and was valued by students. In the future, adding another workshop in the fourth year could facilitate higher retention and practice of skills.

&amp;#8220;It&amp;#8217;s Like Starting All Over&amp;#8221;: 5th-Year Medical Students Approach Psychiatry Clerkships as Absolute Beginners

&amp;#8220;It&amp;#8217;s Like Starting All Over&amp;#8221;: 5th-Year Medical Students Approach Psychiatry Clerkships as Absolute Beginners

Impact of Psychiatry Clerkship Rotation in Attitudes Towards Mental Illness and Psychiatry as a Career Among Medical Students.

Stigma associated with mental illness (MI) permeates many professions, including healthcare. Recognizing and correcting bias is critical in delivering impartial and beneficial healthcare for all patients. Early educational interventions providing exposure to individuals with MI have shown to be effective at reducing MI stigma. The primary aim of our study was to assess the impact of a psychiatry clerkship on attitudes to MI. A secondary aim was to determine if the psychiatry clerkship influenced medical students' perceptions of psychiatry as a career. A cohort of third-year medical students in Florida was invited to complete an online survey before and after participating in their first 4-week-long psychiatry clerkship during the 2021-2022 academic year. The voluntary, anonymous survey consisted of the Attitudes to Mental Illness Questionnaire (AMIQ) and a 3-item questionnaire on interest and knowledge in psychiatry. The Wilcoxon Sign-Rank test was used to determine statistical significance (P < .05) for pre- and post-clerkship values. Among 39 invited students, 22 participated before (56.4%), and 23 participated after their psychiatry rotation (59.0%). Overall, there was a statistically significant increase in the perceived level of general interest in psychiatry (P = .027), psychiatry knowledge (P < .001), and career interest in psychiatry (P = .040). There was also a significant decrease in the stigmatized attitude score for depression and self-harm after their psychiatry rotation (P = .042). Finally, the participants initially showed the highest stigmatized attitude score for intravenous drug abuse among the 4 mental illnesses presented, which also included depression and suicidal ideation, alcohol use disorder, and schizophrenia. The findings suggest that a psychiatry clerkship provided a positive exposure to the field, enhanced medical students' overall interest in psychiatry, and positively impacted medical students' attitudes towards MI.

Resident Teaching of the Cultural Formulation Interview to Psychiatry Clerkship Students.

Resident Teaching of the Cultural Formulation Interview to Psychiatry Clerkship Students.

Predictors of Excellent Urology Residents at the Time of the Urology Match

ObjectiveTo update our experience and report on features predictive of high quality urology residents at the time of the urology match, because data predicting which medical students will mature into excellent urology residents are sparse. MethodsWe reviewed our experience with 84 urology residents who graduated from 2006 to 2023. Residents were independently scored 1-10 based on overall quality by the current and former Program Director. Discrepant scoring by >2 was resolved by an independent review. Associations of features from the medical student application with an excellent score (defined as 8-10) were evaluated with logistic regression. ResultsDiscrepant scoring >2 was noted in only 5 (6%) residents. Among the 84 residents, the median overall score was 7 (range 1-10) and 36 (43%) residents had an excellent score of 8-10. Univariably, higher USMLE step II score (p=0.03), election to AOA (p=0.004), no negative interview comments (p=0.002), honors in OB/Gyn (p=0.048) and psychiatry clerkships (p=0.04), and honors in all core clinical clerkships (p<0.001) were significantly associated with an excellent score. In a multivariable model, no negative interview comments (p=0.003) and honors in all core clinical clerkships (p=0.001) were independently associated with an excellent score (c-index 0.76). There were several notable features (sex, letters of recommendation, USMLE step I, externship at our institution, surgery clerkship grade, and rank list) that were not significantly associated with excellent residents. ConclusionsWe demonstrate features associated with excellent urology residents, most notably no negative interview comments and an honors grade in all core clinical clerkships.

Interprofessional Education in a Psychiatry Clerkship.

The purpose of this initiative was to encourage medical students to develop collaborative relationships with healthcare team members during a required psychiatry clerkship and reflect upon their demonstration of interprofessional competencies. During the clerkship, third year medical students were required to complete two interprofessional activities (from a menu of 18 potential options) in conjunction with nurses, therapists, care coordinators, behavioral health specialists, peer specialists, unit secretaries, or unit managers during care of mutual patients. After completing these activities, students completed a reflection in which they self-reported how they had accomplished specific interprofessional competencies (quantitative and qualitative); the healthcare team members with whom the students collaborated also completed a corresponding reflection (quantitative) of students' interprofessional competence, based upon their interactions. Quantitative feedback from students and staff was paired to look for correlations. Paired responses produced a dataset that included 67 students' self-reflections and 110 feedback submissions from staff. Overall, there was much similarity between students' self-assessment ratings and ratings provided by staff members. Qualitative analysis of students' written feedback indicated they took initiative to take on new roles to support the care team and intentionally sought out healthcare teammates to learn about their roles and to better care for patients. Reflections highlight examples of student advocacy and empathy for patients they served. Results demonstrate that clerkship-based interprofessional education initiatives, designed with intentionality, promote interprofessional collaborative practices and prepare medical students for achieving residency milestones related to interprofessional collaboration.

Acceptance and commitment training for reducing burnout in medical students during a clinical clerkship in psychiatry and palliative care: A pilot study

Physicians are likely to experience burnout early in their medical education, and it only accelerates as their clinical and academic responsibilities expand and they begin clinical practice. However, effective burnout interventions for clinical-year medical students are lacking. Avoidance of unpleasant internal experiences and decreased engagement in value-based behaviors are associated with burnout. This study, an open-label pilot research with a single-center, before-and-after comparative study design and without a control group, aimed to examine the feasibility and effectiveness of brief acceptance and commitment training (ACT) in reducing burnout during psychiatric clinical clerkships at a medical school. The feasibility proved to be good, with all the participants (n = 56) completing the training. There were no significant differences in the emotional exhaustion (EE) and depersonalization (DP) scores of burnout as measured by the Maslach Burnout Inventory (MBI) at the end of the ACT and two months following the intervention. A comparison was made with scores recorded before the intervention, and significant differences were observed. A subsample of medical students with moderate or greater burnout at T0 manifested significant burnout score reductions. The same subsample revealed a significant increase in psychological flexibility as indicated by the progress factor score on the Valuing Questionnaire (VQ) at T1 compared to T0 and a significant reduction in reaction latency to negative words as indicated by the DIRAP score of the Implicit Relational Assessment Procedure (IRAP) for anxiety. We argue that short-term ACT during clinical clerkships of medical students in psychiatry and palliative care is feasible and potentially effective, and a multi-site comparative study using more direct behavioral measures is warranted to further investigate its effectiveness.

Crafting a dynamic learning environment during psychiatry clerkships

Crafting a dynamic learning environment during psychiatry clerkships

Training medical students in motivational interviewing using a blended learning approach: a proof-of-concept study.

Difficulties in implementing behavior change in patients with chronic diseases are common in clinical practice. Motivational interviewing (MI) helps clinicians to support patients in overcoming ambivalence while maintaining self-determination. The inclusion of MI in German medical training curricula is still rare. Furthermore, the effects of systematic teaching of MI, especially via blended learning, have hardly been investigated. Medical students participated in three curricular events related to MI, consisting of instructional videos and theoretical and practical components in a blended learning format. The aim of the study was to investigate the effect of teaching MI in students' medical education. A controlled, non-randomized study was conducted with an intervention group and a control group. Both groups completed questionnaires on their experience and knowledge related to MI, completed a knowledge test and rated their satisfaction with the course. MI was taught in the 6th semester of medical coursework as part of a psychosomatic course, in the 8th semester during a psychiatry course and in the 9th semester during a weekly psychiatry clerkship. Data from the intervention group (n = 35) and control group (n = 14) were analyzed, with 65.7% of students participating in all three parts of the curriculum. Overall interest in learning MI was high, with M = 2.92 (SD = 1.00). The results indicate a greater increase in knowledge over time in the intervention group. The majority (62.86%) stated that the curriculum was relevant to their future career. Free-form text responses indicated a high level of satisfaction with practical relevance. This study demonstrates the usefulness of an MI curriculum for medical students. The integration of MI into medical curricula is a promising curricular addition to improve doctor-patient communication. Future research should address patient perceptions of MI competencies and the persistence of acquired competencies.

Introduction of a Novel Ethics Curriculum to the Third-Year Psychiatry Clerkship Experience.

The purpose of this study was to determine if a brief ethics curriculum embedded in a third-year required clerkship differentially impacted students' self-rated confidence versus competence (determined by a written examination) regarding ethical principles related to psychiatry. Using a naturalistic design, 270 medical students at the University of Washington were assigned to one of three groups during their third-year psychiatry clerkship: a control group with no additional ethics content, a group with access to a pre-recorded video ethics curriculum, or a group with live didactic sessions in addition to the video curriculum. All students took a pre- and post-test that assessed their confidence and competence in ethical theory and behavioral health ethics. Confidence and competence were not statistically different across the three groups prior to completing the curriculum (p > 0.1). Post-test scores on confidence in behavioral health ethics were not significantly different between the three groups (p > 0.05). Post-test scores on confidence in ethical theory were significantly higher in the video-only and video + discussion group as compared to the control group (3.74 ± 0.55 and 4.00 ± 0.44 vs. 3.19 ± 0.59 respectively; p < 0.0001). Both the video-only and video + discussion group showed greater improvement in competence in ethical theory and application than the control group (0.68 ± 0.30 and 0.76 ± 0.23 vs. 0.31 ± 0.33, respectively; p < 0.0001) and behavioral health ethics (0.79 ± 0.14 and 0.85 ± 0.14 vs. 0.59 ± 0.15, respectively; p < 0.002). With the addition of this ethics curriculum, students showed both increased confidence and competence in their ability to analyze ethical situations as well as increased competence regarding behavioral health ethics.

Neuroscience-based nomenclature as a teaching tool, introduction and pilot study.

Neuroscience-based nomenclature (NbN) is a pharmacologically-driven nomenclature aiming to replace the current disease-based nomenclature of psychotropics, focusing on pharmacology and mode-of-action to encourage scientifically-minded prescribing. NbN might also be used as a teaching tool as it presents the depth and richness of the neuroscience of psychotropics. This study examines the effect of using NbN in student curriculum. Fifty-six medical students during clerkship in psychiatry, divided into a control group ( n = 20), taught standard psychopharmacology, and an intervention group ( n = 36) introduced with NbN. Both groups filled out identical questionnaires at the beginning and end of the clerkship, including questions of knowledge on psychopharmacology, views on current terminology and interest in psychiatric residency. Comparing the average change in scorings (delta post-pre) for each item in intervention vs. control questionnaires, the intervention group showed a significantly larger positive delta in 6 out of 10 items than the control group. Mean scores did not differ significantly between the two groups in the pre-questionnaires, while significantly higher scores were shown for the intervention group in within- and between-group comparisons. Introduction of NbN was associated with a better educational experience, a deeper understanding of psychotropics and increased interest in psychiatric residency.