This elective is designed to provide advanced
training in the psychiatric care of seriously ill patients in a large
metropolitan general hospital. The elective is a valuable adjunct to the
CORE requirements for those students interested in, or curious about,
pursuing a career in psychiatry. The rotation is also appropriate for
those students who are interested in pursuing alternate fields, but who desire
advanced training in the diagnosis and management of emotional and
behavioral problems in the general medical setting.
Purpose:
The student will learn medical aspects of psychiatry,
including diagnosis of psychiatric and neurologic syndromes,
behavioral neurology, psychopharmacology, and dealing with
difficult patients. Common problems addressed include depression,
anxiety, delirium, dementia, palliation in terminal illness, physical and
drug-induced psychiatric states, functional psychiatric states in the
medical setting, competence to engage in treatment decisions, and refusal
of treatment. Patients are seen on all services, but most prominently on
the general medical and surgical, oncology, ICU, organ transplantation,
cardiology, trauma, and HIV services.
Format:
The student is responsible, under the
supervision of the consultation/liaison attending group, for the care of
patients referred to the Consultation/Liaison Psychiatry Service at
Hartford Hospital. The responsibilities of the student include the
initial psychiatric diagnostic evaluation, assessment of the needs and
interrelationships of members of the multidisciplinary treatment team,
pharmacologic management, individual/family short-term psychotherapy when
indicated, and daily progress notes and communication with members of the
patient’s treatment team. The student carries 5-10 patients in
consultation at any one time. Night call is not required but remains an
elective adjunct to this rotation.
Goals:
To learn biological psychiatry in patients
with medical/psychiatric illness.
To develop a basic knowledge of
psychopharmacology in the medical setting.
To develop a framework for thinking
about behavioral neurology.
To enhance one’s capacity to listen
to patients.
To develop a framework for
deciphering the complexity of the patient-family-medical team interface.
Teaching:
The student functions as an integral part of the
Consultation/Liaison Psychiatry Service. Teaching is clinically based and
socratic in nature. It consists of daily rounds and daily educational
walk rounds with the attending and other members of the consultation
team. Weekly individual supervision is provided by the fellow and a
senior attending psychiatrist. More structured educational experiences
include weekly Psychiatry Grand Rounds, weekly Emergency Psychiatry
Conferences, monthly Psychosomatic Medicine and Neuropsychology Conferences,
bimonthly Psychopharmacology and Neuroscience Rounds, and regular
case-based medical/psychiatric literature reviews.
Patient Population:
Hartford Hospital is the city’s largest general
hospital, with a capacity of 850 beds. The patient population ranges in age from 18 to
80 and beyond, and patients hail from a wide variety of socioeconomic, ethnic,
and cultural backgrounds. The length of stay on the consultation service
ranges from one to 90 days, with the average being seven days. Fifteen hundred consultations are
provided each year to the Hartford Hospital medical population.
Evaluation Process:
Evaluation information is solicited
from all supervising attendings and residents on the service. The primary
supervisor provides the student with feedback on his/her progress at
midpoint and with a final verbal and written evaluation at conclusion of
the rotation.
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