This elective is designed to provide
advanced training in the psychiatric care of seriously ill patients in the
acute inpatient unit of a large metropolitan psychiatric hospital. The
student will acquire an appreciation for the complexity of the diagnosis
and treatment of acutely ill patients who also often have chronic
psychiatric disorders.
Purpose:
Students will refine their fund of
knowledge and their interviewing, diagnostic, psychopharmacologic,
psychotherapeutic and management skills in the care of complex and acutely
ill psychiatric inpatients. They will function as subinterns and
as members of the teaching service, managing their patients with greater
autonomy under the direct supervision of the attending. Common problems
include decompensated psychotic disorders, mood disorders, anxiety
disorders, substance use disorders, and personality disorders.
Format:
Under the supervision of an experienced
attending psychiatrist, the student is responsible for the evaluation,
diagnosis, treatment planning, and management of patients referred to the
inpatient psychiatric service of The Institute of Living/Hartford
Hospital. The responsibilities of the student
include the initial psychiatric evaluation, confirmation of all diagnoses,
pharmacologic and behavioral management, focused individual/family
psychotherapy, and participation in disposition planning. The student is
responsible for a caseload of up to three patients, and he/she will begin to
acquire the skills needed to assume the leadership role of a psychiatrist on an
interdisciplinary inpatient mental health team. The student will have the
opportunity to follow one or two patients referred at discharge to the
extensive day treatment program facilities on grounds. Night call is not
required but is an elective adjunct to this rotation. (University
requirements for subinternship objectives mandate call.)
Goals:
To refine the subtlety and complexity of
one’s psychiatric evaluations.
To extend the range and complexity of
psychiatric diagnoses with which the student is familiar.
To refine the capacity to prioritize
and defend one’s comprehensive differential diagnosis.
To extend the student’s knowledge
and utilization of psychotropic medications and their associated
complications.
To gain some experience in the
conduct of group and short-term supportive psychotherapy and in the
co-leading of family interventions.
To understand the role of inpatient hospitalization in the continuum of care of psychiatric
patients and the importance of disposition planning in maintaining this
connection.
Teaching:
Under the leadership of the attending
psychiatrist, the student functions in the role of
the primary psychiatrist on a multidisciplinary treatment team that
includes 3rd year medical students, PG I’s or II’s, social
workers, and nurses.
The team attending psychiatrist provides supervision in the care of each
patient seen by the students daily in work rounds and teaching rounds. In
addition, the attending meets with the student one hour per week in
individual supervision. Each student is provided with an additional hour
of individual psychotherapy supervision. More structured educational
experiences include weekly Inpatient Case Conferences, Psychiatry Grand
Rounds, weekly Emergency Psychiatry Conferences, and bimonthly
Psychopharmacology and Neuroscience Rounds.
Patient Population:
The Institute of Living is the area’s
largest psychiatric hospital, with extensive resources across the continuum
of psychiatric care. There are 130 inpatient beds at this facility. The
patients on the adult units range in age from 18 (including
first break psychotic and mood disorders) to 65. The average length of stay is seven days. Patients come from a wide range of socioeconomic,
ethnic, and cultural backgrounds.
Evaluation Process:
The student is evaluated directly by
the supervising attending psychiatrist, who provides midpoint feedback on progress
and a final verbal and written evaluation upon conclusion of the rotation.
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