OMSE Newsletter

							    Office of Medical Student Education (OMSE)
                     Newsletter
                                     August 2007
                                          Vol 1, No 2

CONTENTS
      CNC Update: what’s going on in the Clinical Neurosciences Clerkship for MS3s [Pg2]
      Introduction to Psychiatry: planning and evaluation of the MS1 psychiatry course [Pg3]
      AOC News: What’s going on with the Area of Concentration in Neuroscience [Pg3]
      Recruitment: convincing students to choose psychiatry as a specialty [Pg4]
      Data Corner: statistics and trends from OMSE [Pg4]
      Educational Scholarship: what’s out there in the literature—research on education [Pg5]
      Teaching Tips: a short burst of “how-to” advice or strategies to help your teaching [Pg6]
      Teachers Who Excel: student feedback on particularly exceptional teachers at WPIC [Pg7]
      Upcoming Events: what’s coming up in medical student education [Pg7]
      Help Wanted: activities we really need faculty/resident teaching help with [Pg7]


OMSE Mission Statement:
   Providing all medical students with psychiatric knowledge and skills
   to incorporate into their future practice/research, inspiring them to
   consider psychiatry as a specialty, and advising/supporting them as
   they embark on their medical careers.



OMSE Staff:
Jason Rosenstock, MD
Director, Medical Student Education

Angela Labuda
Education Coordinator
MS1-2 Issues, AOC, Detre/Schizophrenia Awards, Visiting Students, Recruitment

Kesha Fincher
Education Coordinator
MS3-4 Issues, CNC/Electives




8/07                                           1                                        Vol.1(2)
CNC Update
The goals for MS3s/MS4s in the Clinical Neuroscience Clerkship include specific
disorders that we expect students to encounter. But there’s more to it than that. We also
hope and expect that they develop basic competencies and a few key skill areas essential
for all physicians:

      Assessing patients for dangerousness, and making management recommendations
      Assessing decision-making capacity
      Assessing and managing patients presenting with substance withdrawal
      Performing and documenting a mental status examination

We also have laid out specific abilities that we hope students develop in terms of using
psychosocial and biological treatments. For psychosocial treatments, we hope they learn:

      Assessing and managing non-adherence
      Providing basic psychoeducation
      Conducting basic behavioral therapy (e.g., sleep hygiene)
      Performing supportive psychotherapy

For biological treatments, we expose them to ECT and hope that they develop a positive
attitude towards that treatment. But we expect a higher level of competency for
pharmacotherapies: all students should understand how to use and have experience in
prescribing medication from four psychotropic classes:

      Antidepressants
      Antipsychotics
      Anxiolytics
      Acetylcholinesterase inhibitors

Remember, this represents the basic minimum we hope students come away with. Surely
most medical students will also learn about mood stabilizers and lithium. But the classes
represented above, determined by our course design group (faculty, residents, students),
are either very important, very commonly used, or likely to be taught to students only on
psychiatry.

For all these learning objectives, we encourage you to talk to the students about their
comfort level with these. Highlight these issues as they come up with patients. Observe
students performing these competencies and give them feedback about how they do. And
emphasize how important these skills are for all physicians to develop—remember, that’s
our overall clerkship goal: what does the non-psychiatrist need to know about
psychiatry? If you think PCPs or ER docs will need a particular skill, then tell the
students that.




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Especially powerful is linking up a skill with what the student’s planned specialty
actually is. For instance, if a student is planning to go into pediatrics, you can talk about
how common ADHD is, and how often they’re going to end up seeing kids on stimulants.
Or, for the student going in to surgery, describing how often decision-making capacity
issues come up in daily practice.

For more information, check out the clerkship website, which has a link to our learning
objectives:

http://navigator.medschool.pitt.edu/34_viewFolder.asp?folderID=614121038



Intro to Psych
As we prepare for the 2008 Introduction to Psychiatry course, we’re constantly looking to
revise, freshen, update, and improve our teaching material and formats. If you’re
interested in getting involved, please let me know. We’ll have a formal course design
group getting together in winter.

One part of the course we definitely want to revise is our depression small group. In the
past (see link below), we’ve used a written case that prompts students to talk about
depression phenomenologically, the differential diagnosis, interviewing strategies, etc.

http://navigator.medschool.pitt.edu/34_viewPage.asp?pageID=1659537967

But it may be too broad, and we also want to add a bit more on bereavement to the
preclinical curriculum—this small group activity seems like a perfect place.

We may want to add small groups on psychopharmacology—previously, we’ve had two
hours of lecture time, but it might make more sense to add time and do it in a small group
or PBL format.

If you’re interested in working on either of these two small groups, let me know.


AOC News
Our AOC students have been quite productive and successful, with three publications last year as
well as conference presentations, posters, and awards. For example, Christopher Keary ’09 did a
poster and oral presentation at the Science 2006 meeting here in Pittsburgh, entitled “Volumetric
Analysis of Corpus Collosum Size in Patients with Autism.” Mentored by Drs. Antonio Hardan
and Nancy Minshew, Chris succeeded in winning the Merskey Prize for the best clinical research
project conducted during the summer of 2006, given by the University of Pittsburgh School of
Medicine.




8/07                                            3                                       Vol.1(2)
Recruitment
WPIC continues to encourage interest among visiting medical students by offering a
$1000 travel grant program (the Thomas Detre Award) that partially funds “away”
electives for highly accomplished medical students. Four Detre awardees have been
announced, they will be coming to WPIC over the next few months, and you may have
contact with them. These students are visiting us from all around the country and are
outstanding, selected for their references, their personal statements, their interests and
backgrounds. And each one should be a recruitment target for our residency program.

Here are the students coming in 2007-08, along with their home schools:

Rebekah Hughey         University of North Carolina           Community Psych (7/07)
Ronald Lee             University of Maryland                 Merck (8/07)
Ashley Zucker          University of Vermont                  Triple Board AI (9/07)
Stacey Carloni         Mercer School of Medicine              Community Psych (12/07)


Data Corner
This simple but visually pleasing table shows how many medical students come to our
Psychiatry Specialty Night, held annually in May. We had a great turnout this past one,
and we hope to do even better this coming spring.
                                   Students


       35
       30
       25
       20
                                                   31               Students
       15
                                       23
       10                  19

       5       5
       0
            2005        2005         2006         2007




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Educational Scholarship
       Martin VL, Bennett DS, and Pitale M. (2007) Medical students’ interest in child
       psychiatry: a clerkship intervention. Acad Psych 31:225-227.

What will help convince students to consider child psychiatry as a specialty? A lot of
programs try the basic intervention of giving MS3s a presentation about how great child
psychiatry is. But does this affect attitudes at all? These Drexel faculty members tried to
assess this practice by comparing attitudes towards the subspecialty before and after such
a presentation, and comparing that to the attitudes of those who did not attend the
promotional talk. About 220 students were assessed; about half attended the
presentation. About half (not all the same people) rotated on a child and adolescent
inpatient unit as part of their clerkship. The authors found that students who attended the
presentation had better knowledge about child psychiatry (e.g., mean salaries, physician
shortage, etc.) but presentation attendance was unrelated to students’ respect for and
interest in child psychiatry as a career choice.

What did make a difference? Having personal contact with child psychiatrists was the
biggest factor. Also, rotating on a child psychiatry service prevented a decline in interest
seen among those students who worked on an adult service.

The study is limited by its non-random design, the fact that the promotional presentation
was a brief, one-shot experience, and the variety of other possible confounding factors in
the MS3 psychiatry experience. But the authors conclude that better recruitment
strategies for child psychiatry would include:

      Weekly child/adolescent patient interviewing with attending discussion
      Clinical exposure to child psychiatry in the MS1-2 years
      Mentorship by child psychiatrists
      More teaching by child psychiatrists in basic/preclinical med school courses
      Increasing the rigor of child psychiatry experiences
      Having child psychiatry participate in career day activities
      Requiring that all students have a child psychiatry experience

PROCAP and AACAP have prioritized recruitment to the field, and if any of you are
interested in working more on this, please let me know.




8/07                                         5                                      Vol.1(2)
Teaching Tips
You may have heard about or be using the “Five Microskills” approach to clinical
teaching. It’s widely promoted and may be a useful way to think about how you interact
with medical students. See chart below:




To start, you make a diagnosis of the patient, then “diagnose” the learner by asking them
for a commitment about what THEY think the diagnosis of the patient is (or some other
clinical issue related to the patient). Try to get them to come down on something and use
that for the subsequent discussion. Ask them (#2) what makes them say “bipolar
disorder” or whatever, then use the discussion phase for your more active teaching.

Teach general rules (#3): “Yes, I agree, and you’re right to focus on the decreased sleep
need, euphoric mood, and mood-congruent psychotic features as core signs of bipolar
disorder, along with the time course that’s consistent.”

Provide positive feedback (#4): “You did a great job getting that history, and cuing in on
the temporal association of symptoms—that was crucial to making the diagnosis.

Correct errors (#5): “Don’t forget to ask about substance use—we didn’t really explore
that, but if he’s using a lot of cocaine or something, that could a consideration in our
diagnostic formulation.”

So remember the microskills: commitment with reasoning, general rules, positive and
and corrective feedback.




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Teachers Who Excel
At the Pitt graduation in May, senior graduating medical students gave faculty
appreciation awards to teachers who best fulfilled the educational mission of our school.
The Department of Psychiatry boasted two winners were Drs. Antoine Douaihy and
Mukesh Sah. Congratulations to you both!

I also want to recognize our small group facilitators from the Introduction to Psychiatry
course in May. All our facilitators were well-received, but three in particular earned
perfect scores (ratings of 5, with 5=outstanding) from this group of first-year medical
students: Julie Kmiec, Ed MacPhee, and Natalie Veasquez.

As an example, let me share some of the comments made by students in Natalie’s small
group:

      Natalie was an excellent facilitator. She was always available to answer any
       questions and provide feedback.

      Dr. Velasquez was a great facilitator- a great teacher and relaxed person at the same
       time. She was great to discuss psychiatry with, as her passion for the field was
       always evident. She really seemed to care about her PBL group and was always
       helping us out as best as she could, which was greatly appreciated.

      Very helpful. Gave us important imformation and really appreciated her feedback.

Congratulations, to all!


Upcoming Events
August 3       CNC Group 1 students finish psychiatry (grades due)
August 10      CNC Group 2 students need completed midcourse evaluations
August 13      Ethical/Legal Issues in Clinical Neuroscience (Noon-1p, Scaife 1105)
August 24      CNC ends—all grades/forms submitted
September 10   Hot Topics: Integrated Health Care [Jamie Tew]
September 27   PGY-I Resident As Teacher Training                 1p-5p
October 18     PGY-II Resident As Teacher Training                1p-3p


Help Wanted
Residents/Fellows:
If you are interested in serving as a mentor for AOC-N students who might be
interested in a career in psychiatry, please let me know. You rarely get contacted, but
students like having names of people they could call for advice about programs,
applications, and the field in general.



8/07                                         7                                        Vol.1(2)
Faculty:
We’re always looking for good ambulatory psychiatry sites, and faculty preceptors to
supervise MS3s on their psychiatry rotation. As part of the Clinical Neurosciences
Clerkship, we include an ambulatory psychiatry experience: a four-week, one afternoon
per week, required part of their clerkship. The student role would be to help out in any
way the preceptor saw fit, but ideally they would do some interviewing, help with
documentation or collateral contact, review the chart, do weights/vitals, write scripts,
whatever. Especially in the beginning, there’s shadowing involved as they learn what to
do, but we want the experience to be as active as possible for them, so that even on the
first day they would be doing more than just observing. Faculty would evaluate them by
writing a sentence or two about how they did on a form they’d give you on the final day.
That’s pretty much it. We’re flexible in terms of scheduling—morning, afternoon,
whatever—as long as you could assure us of four scheduled clinics per student. We
could do this on a regular basis (one student per month) or on an intermittent basis
(asking you periodically if you could help out). Let me know if you think you might be
interested to have students come to your outpatient site!




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