Psychiatry Clerkship Research Articles

Independent or Integrated? The Impact on Subject Examination Scores of Changing a Neuropsychiatry Clerkship to Independent Clerkships in Psychiatry and Neurology.

This study was undertaken to assess any impact on National Board of Medical Examiners (NBME) neurology and psychiatry subject examination scores of changing from an integrated neuropsychiatry clerkship to independent neurology and psychiatry clerkships. NBME psychiatry and neurology subject examinations scores were compared for all 625 students completing the required neuropsychiatry clerkship in academic years 2005-2006 through 2008-2009 with all 650 students completing the independent neurology and psychiatry clerkships in academic years 2009-2010 through 2012-2013. Statistical adjustments were made to ensure comparability across groups and over time. A significant improvement in subject examination scores was associated with the independent clerkships. The independent clerkship model was associated with a modest improvement in NBME subject examination scores. This finding may be attributable to many causes or combination of causes other than curricular design. Curricular planners need to pay attention to the potential impact of course integration on specialty-specific NBME subject examination performance.

Disruptive Behavior Disorders and ADHD: A Problem-Based Learning Activity for Psychiatry Clerkship Students.

Clinicians are challenged when differentiating the symptoms of attention deficit hyperactivity disorder from those of disruptive behavior disorders such as oppositional defiant disorder and conduct disorder, as many of the core symptoms overlap. Without a correct diagnosis, it is difficult to create an effective treatment plan. This progressive disclosure case was developed with the intention of helping medical students learn the process of clinical evaluation. The purpose of this resource is to provide a lesson plan to teach intermediate/advanced learners how to systematically approach a case with symptoms of disruptive behavior and attention and focus problems in order to improve their ability to establish the correct diagnosis. Students were assigned readings, including relevant sections of the Diagnostic and Statistical Manual of Mental Disorders (fifth edition) and a textbook chapter. During a 1-hour class, a child psychiatrist facilitated students in the progressive disclosure case. The learning process included a pre- and posttest. Students positively perceived the emphasis of important points and showed increased motivation to learn more. Participant evaluations overall were positive, although some students still preferred learning from straight lectures. Feedback led to modifications of the pre- and posttests to reflect a greater emphasis on factual material. Progressive disclosure cases can be used to facilitate structured exposure to clinical topics in child and adolescent psychiatry.

Research Reveals Profile of Students Inclined Toward Choosing Psychiatry

Research Reveals Profile of Students Inclined Toward Choosing Psychiatry

Observing Electroconvulsive Therapy Changes Students' Attitudes: A Survey of Croatian Medical Students.

To assess the impact of education and direct observation of electroconvulsive therapy (ECT) on medical students' attitudes toward ECT in particular and psychiatric treatment in general in Croatia. Two self-administered questionnaires were completed by year 4 medical students twice, at the beginning and the end of the psychiatry clerkship. Students were divided into 2 groups: those who observed an ECT session (47.9%) and those who did not (52.1%). The survey was completed by 190 students yielding a response rate of 79.8%. Students' attitudes toward ECT and other methods of psychiatric treatment and psychiatry in general changed in positive direction after the clerkship in both groups. However, the attitudes toward ECT of students who observed a live ECT session became more positive than those who did not. Likewise, students who observed ECT were more likely to agree to receive ECT and had better knowledge about ECT compared with the other group. Having watched a live ECT session had a positive effect on students' attitudes toward ECT and other types of psychiatric treatment. Watching live ECT sessions should be mandatory during the psychiatric clerkship.

Reducing Mental Illness Stigma through Unconscious Bias-Informed Education

This article was migrated. The article was not marked as recommended. Mental illness stigma can have disastrous consequences for patients, families and healthcare organizations. Unconscious bias informed education seeks a systematic approach to addressing implicit biases in healthcare providers by promoting awareness and understanding in order to promote compassion and empathy. After a 1 hour intervention, third year medical students who were enrolled in the third year psychiatry clerkship rotation completed a demographic form, (pre/post) a shortened mental illness implicit association test (IAT) and the Brief Mental Illness Attitudes Scale (BMIAS). For the IAT, the majority (51.4%) of participants demonstrated a bias that mental illness was associated with dangerousness. A paired samples t test of BMIAS scores found no significant change in pre and post scores on Responsibility subscale. There was a statistically significant improvement in the in the Traits subscale from pre (n=87, m=5.15, sd=0.87) and post (n=87, m=5.62, sd=0.71), t(86)=5.16 p<0.001. Our brief seminar had a statistically significant impact on student attitudes towards patients with traits of individuals with psychiatric illness. These findings indicate that mental illness stigma is an important issue in medical education and that unconscious bias-informed education may provide an effective method to reduce stigma.

Addressing Mental Illness Biases Should Start Early in Training

Addressing Mental Illness Biases Should Start Early in Training

The Effect of Clinical Exposure to Patients on Medical Students' Attitude Towards Mental Illness.

BackgroundStigma of mental disorders causes a reduction in seeking help from the health care professionals and is evident across the world.ObjectivesThe current study aimed to compare medical students’ attitude towards mental illness after two different psychiatry clerkships in terms of the level of clinical exposure to patients with mental illness.Patients and MethodsThrough a quasi-experimental study, all of the 4th-year medical students were invited to enroll this study conducted in Tehran University of Medical Sciences (TUMS). They were non-randomly assigned into two different psychiatry clerkships from January 2009 to January 2010. One group was enrolled in the traditional lecture-based course (low-exposure) while the second group participated in a novel method with increased hours of patient exposure (high-exposure). Attitude towards mental illness (AMI) was measured by a 22-item questionnaire before and after the clerkship and data were compared between the two groups in terms of changing attitude towards mental illness in five different categories.ResultsA total of 211 participants were enrolled in the study (115 female) of which 115 students (54.5%) were in low-exposure group and 96 students (45.5%) in the high-exposure group. Generally, AMI scores did not differ between the two groups and did not show any significant changes before and after the psychiatry clerkship. The only exceptions to this were AMI4 category (the concept of etiology of the mental illness), which significantly improved after the clerkship in the low-exposure (P = 0.011) and the high-exposure groups (P = 0.024), respectively.ConclusionsExposure of medical students to patients with mental illness did not improve attitude towards mental illness and psychiatric conditions.

Spaced learning using emails to integrate psychiatry into general medical curriculum: Keep psychiatry in mind

Objectives: Traditionally, medical students on clinical rotations receive instruction on principles of mental health only during the psychiatry clerkship. We used emails to insert teaching of psychiatric concepts beyond the psychiatry clerkship into other rotations using the method of spaced learning, the delivery of brief morsels of information repeated over time intervals. We predicted that the intervention would improve attitudes and confidence towards the integration of psychiatry and knowledge retention.Methods: We developed and distributed a series of emails relating key psychiatric concepts targeted to the other core clerkships.Results: In a cluster-randomized trial over one academic year (intervention group n = 71, control group n = 61), scores on the Attitudes and Confidence in the Integration of Psychiatry scale and on the knowledge quiz did not differ significantly. Students who actively engaged with the emails demonstrated significantly higher scores on the knowledge test. Email users valued the timing, format of delivery and application of psychiatric principles outside the psychiatric setting. Participants recommended simplifying the format and previewing the benefits of spaced learning to increase utilization.Conclusion: Delivering spaced learning through emails, within a curriculum designed to foster engagement, may provide an efficient means of addressing the widely-recognized but elusive goal of integrating teaching across medical disciplines.

The relationship between assessment methods and self-directed learning readiness in medical education.

Objectives This research explored the assessment of self-directed learning readiness within the comprehensive evaluation of medical students’ knowledge and skills and the extent to which several variables predicted participants’ self-directed learning readiness prior to their graduation. Methods Five metrics for evaluating medical students were considered in a multiple regression analysis. Fourth-year medical students at a competitive US medical school received an informed consent and an online survey. Participants voluntarily completed a self-directed learning readiness scale that assessed four subsets of self-directed learning readiness and consented to the release of their academic records. Results The assortment of metrics considered in this study only vaguely captured students’ self-directedness. The strongest predictors were faculty evaluations of students’ performance on clerkship rotations. Specific clerkship grades were mildly predictive of three subscales. The Pediatrics clerkship modestly predicted critical self-evaluation (r=-.30, p=.01) and the Psychiatry clerkship mildly predicted learning self-efficacy (r =-.30, p=.01), while the Junior Surgery clerkship nominally correlated with participants’ effective organization for learning (r=.21, p=.05). Other metrics examined did not contribute to predicting participants’ readiness for self-directed learning. Conclusions Given individual differences among participants for the variables considered, no combination of students’ grades and/or test scores overwhelmingly predicted their aptitude for self-directed learning. Considering the importance of fostering medical students’ self-directed learning skills, schools need a reliable and pragmatic approach to measure them. This data analysis, however, offered no clear-cut way of documenting students’ self-directed learning readiness based on the evaluation metrics included.

Attitudes of Students at a US Medical School Toward Mental Illness and Its Causes

Stigma among health care providers toward people with mental illness is a worldwide problem. This study at a large US university examined medical student attitudes toward mental illness and its causes, and whether student attitudes change as they progress in their education. An electronic questionnaire focusing on attitudes toward people with mental illness, causes of mental illness, and treatment efficacy was used to survey medical students at all levels of training. Exploratory factor analysis was used to establish attitudinal factors, and analysis of variance was used to identify differences in student attitudes among these factors. Independent-samples t tests were used to assess attitudes toward efficacy of treatments for six common psychiatric and medical conditions. The study response rate was 42.6% (n = 289). Exploratory factor analysis identified three factors reflecting social acceptance of mental illness, belief in supernatural causes, and belief in biopsychosocial causes. Stages of student education did not differ across these factors. Students who had completed the psychiatry clerkship were more likely to believe that anxiety disorders and diabetes could be treated effectively. Students reporting personal experiences with mental illness showed significantly more social acceptance, and people born outside the USA were more likely to endorse supernatural causes of mental illness. Sociocultural influences and personal experience with mental illness have a greater effect than medical education on attitudes toward people with mental illness. Psychiatric education appears to have a small but significant effect on student attitudes regarding treatment efficacy.

Understanding the Role of Psychiatric Principles in Patient Care: An Important Goal of the Medical Student Clerkship in Psychiatry.

Understanding the Role of Psychiatric Principles in Patient Care: An Important Goal of the Medical Student Clerkship in Psychiatry.

The impact of reflective practices on medical students' attitudes towards mental illness

Objective: This study aimed to examine the impact of reflective practices on the attitudes of the medical students towards mental illnesses and to determine the impact of some variables on the attitude change. Methods: A quasi-experimental study was carried out in two medical schools in Turkey. Educational intervention, included written and verbal reflection practices for student experience in interview with patients during psychiatry clerkship, was applied in intervention groups. The impact was evaluated by collecting data at before and after psychiatry clerkship using Beliefs towards Mental Illness Inventory (BMI) in intervention and control groups. Results: Total 190 students were included in the intervention (51.6%) and (48.4%) control groups. Mean score of total BMI was found to be significantly lower after intervention in both groups, however, no statistical difference was observed between the two groups. The impact of two subscales of the empathy and basic personal traits of the students and self-experience of mental illness on attitude change were found to be statistically significant. After correction was done for these variables, time affect (psychiatry training) could not be found statistically significant. Verbal reflective practice was found to be more beneficial than written one. Discussion: Psychiatry clerkship training created a small and meaningful impact, but reflective practices did not show a significant impact on attitude change of students towards mental illness. Empathy, basic personal traits and self-experience of mental illnesses can be taken into consideration as factors related with stigma in improving attitudes of students.

Impact of a structured review session on medical student psychiatry subject examination performance.

Introduction: The National Board of Medical Examiners (NBME) subject examinations are used as a standardized metric for performance in required clerkships for third-year medical students. While several medical schools have implemented a review session to help consolidate knowledge acquired during the clerkship, the effects of such an intervention are not yet well-established. An improvement in NBME psychiatry examination scores has previously been reported with a single end-of-clerkship review session, but this was limited by a small sample size and the fact that attendance at the review session was optional, leading to likely selection bias. Methods: A 1.5-hour structured review session was conducted for medical students in the last week of each 4-week psychiatry clerkship between September 2014 and July 2015. Students were required to attend unless excused due to scheduling conflicts. Scores on the NBME psychiatry subject exam were compared with those of students taking the examination in the corresponding time period in each of the previous two academic years. Results: 83 students took the exam during the experimental period, while 176 took the exam during the control period. Statistically significant improvements were found in mean score (p=0.03), mean for the two lowest scores in each group (p<0.0007), and percentage of students scoring 70 or less (p=0.03).Percentage of students achieving the maximum possible score (99) was higher in the experimental group, but did not reach significance (p=0.06). Conclusions: An end-of-clerkship review session led to increased mean scores on the NBME psychiatry subject examination, particularly for students at the lower end of the score range. Future research should investigate the impact of such an intervention in other specialties and other institutions.

Impact of a structured review session on medical student psychiatry subject examination performance

Introduction: The National Board of Medical Examiners (NBME) subject examinations are used as a standardized metric for performance in required clerkships for third-year medical students. While several medical schools have implemented a review session to help consolidate knowledge acquired during the clerkship, the effects of such an intervention are not yet well-established. An improvement in NBME psychiatry examination scores has previously been reported with a single end-of-clerkship review session, but this was limited by a small sample size and the fact that attendance at the review session was optional, leading to likely selection bias. Methods: A 1.5-hour structured review session was conducted for medical students in the last week of each 4-week psychiatry clerkship between September 2014 and July 2015. Students were required to attend unless excused due to scheduling conflicts. Scores on the NBME psychiatry subject exam were compared with those of students taking the examination in the corresponding time period in each of the previous two academic years. Results: 83 students took the exam during the experimental period, while 176 took the exam during the control period. Statistically significant improvements were found in mean score (p=0.03), mean for the two lowest scores in each group (p<0.0007), and percentage of students scoring 70 or less (p=0.03). Percentage of students achieving the maximum possible score (99) was higher in the experimental group, but did not reach significance (p=0.06). Conclusions: An end-of-clerkship review session led to increased mean scores on the NBME psychiatry subject examination, particularly for students at the lower end of the score range. Future research should investigate the impact of such an intervention in other specialties and other institutions.

Impact of a structured review session on medical student psychiatry subject examination performance

Introduction: The National Board of Medical Examiners (NBME) subject examinations are used as a standardized metric for performance in required clerkships for third-year medical students. While several medical schools have implemented a review session to help consolidate knowledge acquired during the clerkship, the effects of such an intervention are not yet well-established. One prior study reported an improvement in NBME psychiatry examination scores with a 1.5-hour review session, but this study was limited by a small sample size and the fact that attendance at the review session was optional, leading to likely selection bias.Methods: A 1.5-hour structured review session was conducted for medical students in the last week of each 4-week psychiatry clerkship between September 2014 and July 2015. Students were required to attend unless excused due to scheduling conflicts. Scores on the NBME psychiatry subject exam were compared with those of students taking the examination in the corresponding time period in each of the previous two academic years.Results: 83 students took the exam during the experimental period, while 176 took the exam during the control period. Statistically significant improvements were found in mean score (p=0.03), mean for the two lowest scores in each group (p&lt;0.0007), and percentage of students scoring 70 or less (p=0.03). Percentage of students achieving the maximum possible score (99) was higher in the experimental group, but did not reach significance (p=0.06).Conclusions: An end-of-clerkship review session led to increased mean scores on the NBME psychiatry subject examination, particularly for students at the lower end of the score range. Future research should investigate the impact of such an intervention in other specialties and other institutions.

In Reply to "'I Started to Feel Like a "Real Doctor"': Medical Students' Reflections on Their Psychiatry Clerkship".

To the Editor: I read with interest the excellent report by Schatte et al. [1] on the reflective writing of medical students during the psychiatry clerkship experience. I strongly agree that narrative reflection can greatly help students process complex and challenging experiences during training, and I think it is particularly useful for us educators to understand and respond to the most important themes that emerge from such reflection. At our institution, we have required students to write a 500word reflective essay at some point during their clerkship, with the general prompt of picking a patient they worked with that stood out for them, writing about what made them stand out. This essay counts for 10 % of their final grade, with student papers assessed for empathy, ability to reflect on meaning, and presentation of broader issues beyond the case. An informal look at the past year of essays shows very similar themes to the ones reported by Schatte et al. Out of 159 essays, 18 % emphasized themes of context (that patients do not exist in a vacuum, that family and social forces matter, etc.). Another 17 % addressed the struggle of patients with mental illness, particularly recognizing the severity of illness and functional effects. The third most common theme (16 %) related to challenges in the doctor-patient relationship, particularly countertransference, provider limitations, and resistance. To our surprise, only 5 % of essays addressed issues of patient autonomy or paternalism (e.g., coercion, capacity, etc.). We were particularly interested in examining if there were any differences in themes between essays written at the very start of the students’ clerkship year, compared to the writing of students at the very end. Although the combined sample is small (n=38), it does appear that students just starting clerkships were more likely than their veteran peers to write about issues of context and the doctor-patient relationship (50 vs. 25 % for both) and less likely to address issues of autonomy, severity, or patient-centered care. When we sit down with students to discuss the clerkship experience, these are the issues we now highlight, both at the outset and during the clerkship, in an effort to help students more productively and safely grow into their professional identity and role. Using reflective writing as a prompt for group discussion can further deepen the value of such writing [2]. Finally, it also seems important that such a process takes place throughout the medical curriculum, not just on psychiatry. Although the psychiatry clerkship certainly raises unique and powerful issues related to patient care, the most common themes raised by students certainly occur in many clinical contexts, and students are likely to benefit from reflection on all clerkships. At our institution, we have successfully encouraged other clerkships to add a writing component to the requirements, and other medical schools do reflective writing throughout the curriculum, which seems to be a particularly useful way to help students with their professional development.

A Qualitative Analysis of Medical Students' Reflection on Attending an Alcoholics Anonymous Meeting: Insights for Future Addiction Curricula.

This paper describes medical students' views of alcoholism and their response to attending an Alcoholics Anonymous (AA) meeting during their psychiatry clerkship. This may assist other educators in planning their addiction curricula. Medical students were required to attend an AA meeting during their psychiatry clerkship and then to write a reflection piece on this experience. We selected a random sample of 40 pieces and performed a qualitative analysis to identify the prominent ideas and themes in this sample. Medical students found their experience attending an AA meeting to be educationally valuable. They reported their familiarity with AA prior to this experience was largely limited to popular media depictions. Students reported understanding alcoholism as a disease with both biological and psychosocial components. They were often concerned with the presence of religiosity and spirituality at the meetings. Following the experience, students felt more comfortable referring patients to AA and identified empathy, honesty, and openness as crucial contributors to the efficacy of AA. Students felt that attending an AA meeting during their psychiatry clerkship was an educationally valuable experience. Medical students' familiarity with addiction treatment is limited, and attending an AA meeting may be helpful in increasing their comfort with treating addicted patients in the future. In addition, educators may want to explicitly address the spirituality issue related to some treatment programs to increase the likelihood that future physicians feel comfortable referring their patients to recovery programs.

Changing undergraduate attitudes to mental illness.

Promoting positive experiences of patient contact during psychiatry clerkships may be important in influencing medical students' attitudes to people with mental illness. Here we report findings from a focus group study that explored the impact on undergraduate attitudes of participation in a novel social interaction programme for people with mental illness and their carers, provided by a non-governmental organisation (NGO). An audio-taped focus group interview was undertaken with 14 medical students using a semi-structured interview guide. The recorded discussion was transcribed verbatim andthematic analysis was performed. Initial apprehension about interacting with patients lessened as the students engaged in shared activities. Students described their increased awareness of the normality and competence of psychiatric patients. As future doctors, they reported a greater understanding of the benefits of social inclusion for patients and carers alike. Promoting positive experiences of patient contact … may be important in influencing medical students' attitudes to people with mental illness Medical students' joint participation in a group activity programme for people with mental illness in non-hospital settings may have advantages in promoting positive attitudinal change. Clinical teachers could usefully incorporate this type of experience into the undergraduate psychiatry curriculum.

Assisting Undergraduate Physician Assistant Training in Psychiatry: The Role of Academic Psychiatry Departments.

Physician assistants (PAs) are medical professionals who practice medicine with the supervision of a physician through delegated autonomy. PA school accreditation standards provide limited guidance for training PAs in psychiatry. As a result, PA students may receive inconsistent and possibly inadequate exposure to psychiatry. Providing broad and in-depth exposure to the field of psychiatry is important to attract PA students to pursue careers in psychiatry and provide a possible solution to the shortage of psychiatrists nationwide. Additionally, this level of exposure will prepare PA students who pursue careers in other fields of medicine to recognize and address their patient's psychiatric symptoms in an appropriate manner. This training can be provided by an academic department of psychiatry invested in the education of PA students. We describe a training model implemented at our university that emphasizes psychiatrist involvement in the preclinical year of PA school and full integration of PA students into the medical student psychiatry clerkship during the clinical years. The benefits and challenges to implementing this model are discussed as well.

What Do Medical Students Perceive as Meaningful in the Psychiatry Clerkship Learning Environment? A Content Analysis of Critical Incident Narratives.

In order to better understand the professional development of medical students during their psychiatry clerkship, this study identifies common themes and characteristics of students' critical incident narratives which are designed to capture a recount of clerkship experiences they perceived as meaningful. A total of 205 narratives submitted by psychiatry clerkship students in 2010-2011 were subjected to a thematic analysis using a methodological approach and adaptation of categories derived from prior similar research. Descriptive content analysis was also carried out to assess the valence of the narrative content, characters involved, and whether there was evidence that the experience changed students' perspectives in some way. Narratives contained a variety of positive (19%) and negative content (24%) and many contained a hybrid of both (57%). The most common theme (29%) concerned issues of respect and disrespect in patient, clinical, and coworker interactions. In general, the majority (68%) of students' meaningful experience narratives reflected a change in their perspective (e.g., I learned that...). Narratives containing positive and hybrid content were associated with a change in students' perspective (χ(2) = 10.61, df = 2, p < 0.005). Medical students are keenly aware of the learning environment. Positive and hybrid critical incident narratives were associated with a stated change in their beliefs, attitudes, or behaviors due to the experience. Understanding the events that are meaningful to students can also provide rich feedback to medical educators regarding the ways in which students perceive clinical learning environments and how to best foster their professional development.