UVA Clinical Requirements
Students will spend two weeks on the inpatient psychiatric unit. You should expect rounds to begin around 8:00 AM and you should come in about ½ hour prior to pre-round on your patients and find out about new admissions. The ward routine and schedules for groups, hearings, family meetings, etc. will be further explained on the unit.
Students should follow 4 patients at a time and should be involved with the initial assessment of as many patients as possible during the 2 weeks on the inpatient service. It is preferable that the student “pick up” the patients for whom the student has performed the admission/initial assessment. Students should review the charts and nursing notes of their patients, and be ready to present on rounds. Students may write daily medical student progress notes that are to be reviewed by the attending physician or an upper level resident.
Ward duties are Monday through Friday plus one Saturday or Sunday for weekend rounds and share in the morning work. Weekend duty generally ends by early afternoon.
CONSULT / ER SERVICE:
Two weeks will be spent on the Consult/ER service. Report to the Consult Room in the West Complex, 3rd Floor, Psychiatric Offices, at 8:00 AM each day to meet the Consult/ER resident, receive a sign-out on any patients still in ER, then plan and discuss current consults. Your exact daily duties will be determined by the team you work with, and will depend on the number of patients in the ER and the number of consults. In general, students should participate with as many consults and ER evaluations as possible under the supervision of an attending or resident physician. Students are not responsible for writing consult or progress notes for the patient charts but may write-up initial assessments/consults for the purpose of meeting the passport/ED-2 requirements. Students should follow-up and see their patients as needed and report to the team on their progress. The on-call team will come on-duty at 5:30 PM and students may then go home (unless you are on call that night). Students have their weekends free while on the consult service.
Keys to the units and consult office will be available from Rebecca Hensley. You will need to sign the key out. Keys must be returned before grades will be released.
Students are expected to observe ECT (electroconvulsive therapy) at least once during their psychiatric clerkship. Generally, the best time to do this is during the Consult/ER rotation. ECT is done three times a week (Mondays, Wednesdays, and Fridays) at the Short Stay Unit on the 2nd Floor of the Main Hospital. Dr. Cohen is the attednign physician covering the ECT service. ECT starts at 8:30 AM on Mondays and Fridays and at 9:00 AM on Wednesdays.
WEEKDAY ER CALL:
ER Call is on weeknights only, excluding a recognized holiday or the night prior to the SHELF exam. Each student group will devise its own call schedule on the first day of rotation, and give or fax a copy of the schedule to Rebecca Hensley(fax: 924-5149) who will then distribute it around the department. The student on-call should meet the on-call intern/resident team in the consult office at 5:30 PM and should plan to stay until approximately 10:00 PM. Students will work with the on-call residents to evaluate/treat/refer nighttime consults in the ER or from other services. Direct admissions from outside referral sources will also be seen. It is the student’s duty to arrange coverage by another student in the event that he/she cannot make an assigned call. Any such changes or trades in the schedule should be communicated to Rebecca Hensley(982-4113). A missed call is considered as an incomplete for grading purposes.
The requirement checlist is a clerkship document that identifies the clinical skills relevant to the particular clerkship that each student must perform, demonstrating competency. The clinical skills are to be performed under the supervision of an attending physician or an upper level resident. If the skills is performed at a satisfactory level, the supervising physician will then sign off on the checklist skill (in real time). It is the student's responsibility to make sure that his/her checklist is completed at the end of the clerkship. Successful completion of the checklist is required to satifactorily complete a clerkship.
During the psychiatric medicine clinical clerkship, each student is required to see two of each of the following types of patients: patient with affective disturbance, patient with anxiety, patient with suicidal ideation, patient with psychotic features, patient with mental status changes/cognitive impairment, and patient with behavioral disorder (which may be addictive, impulsive, compulsive, or aggressive). The patients may be seen in a variety of clinical venues including the inpatient units, the outpatient clinic, a partial hospitalization program or the ED/Consultation-Liaison service. For each of the patients seen, the student must perform all elements listed in the checklist i.e. the student must perform a focused diagnostic interview, present the case (written or verbal) with a complete mental status exam, and participate in the formulation of the differential diagnosis and initial treatment plan for patient care. The checklist will serve as a written documentation of minimal competency (as verified by the supervising attending physician or upper level resident).
If the student is having any difficulty finding the appropriate patients to see to satisfy the checklist reiquirments please notify your supervising attending ASAP and/or the clerkship director.
MEDICAL STUDENT DUTY HOURS:
As per the medical school policy, students will be limited to an 80-hour work week. The typical workday during the psychiatric medicine clerkship is approximately 10 hours (7:30 AM to 5:30 PM) with on-call duties adding an additional 5 hours (5:30 PM to 10:30 PM). If the medical student believes that he/she is scheduled to work more than 80 hours in a particular week, the student should notify the clerkship director to reschedule the student for fewer hours.
Students are expected to act and work in a fashion that is consistent with the core values established by the University of Virginia Department of Psychiatric Medicine. The student is expected to act with integrity and respect, in a collaborative effort with others in scholarly pursuits and the use of best clinical practice.
BOUNDARY and CONFIDENTIALITY ISSUES:
Maintaining professionalism and the integrity of the doctor-patient relationship is important in all specialties of medicine. In psychiatry, it is particularly essential that the mental health provider is mindful of boundary issues as a patient’s mental state or disorder may compromise his/her level of impulse control or affect judgment. Students should keep interactions with patients purely professional and approach patients in a respectful manner. There should be no fraternization between students and patients on the unit, nor after the patient is discharged from the unit. Physical examinations necessary to provide appropriate patient care should not be done without appropriate supervision. If a student is not certain how to handle an uncomfortable situation with a patient, the student should excuse himself/herself from the patient and seek out supervision from a senior team member. Students are discouraged from sharing personal data with their patients. Likewise, students should respect the confidentiality of patient information. Students should not discuss their patients in areas where people other than the treatment team may overhear the conversation. Write-ups, notes, etc. that contain patient information should not be removed from the premises and ideally should stay in the office or designated work area on the unit.