1. to Apply the Medical Content and Principles of Behavioral Medicine to the Care of Patients

Department of Physician Assistant Studies Learning. Caring. Serving. Leading.

PAS 642 Behavioral Medicine 1.5 Semester Hours

Course Description: The Behavioral Medicine rotation is designed to give students practical experience in the diagnosis and management of psychiatric patients in the clinical setting. Students will work to hone their ability to recognize psychiatric diagnoses in both the outpatient and inpatient settings with the goal of applying their knowledge and skills to the many other disciplines of medicine and clinical practice. Course Goals: 1. To apply the medical content and principles of behavioral medicine to the care of patients. 2. To provide opportunities for each student to develop the core PA competencies in a supervised behavioral health setting. 3. To expose each student to an experienced and competent medical provider role model for the care of psychiatric patients.

Course Director: Office Phone E-mail Diane Duffy, MD FC 336-278- [email protected] 205 6848 Tracey Tonsor, PA-C FC 336-278- [email protected] 207 6852 Learning Outcomes: Upon completion of this course the clinical phase PA students will: 1. Obtain and document an appropriate history relevant to the behavioral health, utilizing all available information sources, e.g. patient, family, community. (MK, IC, PC; B1.02, B1.03, B2.04, B2.05, B2.06) 2. Perform and document appropriate physical examinations for the behavioral medicine patients. (MK, PC; B1.03, B2.07, B2.08) 3. List and describe the common diagnoses in behavioral medicine. Demonstrate understanding of epidemiology, pathophysiology, and management including cognitive therapies/counseling strategies in addition to pharmacotherapeutics. (MK, IC; B1.03, B1.07, B2.04, B2.05, B2.07, B2.08, B2.09, B2.10) 4. Interpret diagnostic tests, including screening questionnaires, laboratory results and imaging studies. (MK; B1.02, B1.03, B1.07, B2.05, B2.07, B2.08) 5. Generate and implement an appropriate management plan, including treatment, follow-up plans, patient education and counseling. (MK, IC, PC; B1.07, B2.04, B2.05, B2.09) 6. Discuss the appropriate use of medication related to such issues as: dosage, indications, contraindications, interactions, complications, metabolism, excretion, and mutagenicity. (MK, PC; B1.03, B1.07)

1 1/15/16 7. Properly perform/assist and document any procedures under the supervision of the preceptor. (IC, PC; B1.02, B1.03, B2.04, B2.05, B2.07)

Teaching Methodologies: The content of this module will be presented through a variety of methods that include observation and participation at the clinical site, independent reading and participation in online activities developed to guide experiential learning. Accommodations: Students requiring academic accommodations must follow the “Academic Support” policy in the Elon University DPAS Student Handbook.

Academic Honesty: All Elon PA students acknowledged their commitment to abide by the Elon Honor Code by signing the Honor Pledge during orientation.

Required Textbooks: 1. All first year required textbooks 2. Specific additional textbooks and resources to be determined through collaboration between the student and course directors based on elective discipline. 3. Ebert, Michael, Loosen, Peter, Nurcombe, Barry, Leckman, James. Current Diagnosis & Treatment Psychiatry (current edition). McGraw-Hill/Lange Other Resources: 1. *Moodle: Please check the course site frequently for new announcements, updated schedules, assignments and other course communication. 2. Practicing physician assistants, physicians, allied health care providers and laboratory teaching aids.

Assessment Activities: Multiple Choice Behavioral Medicine Exam (30%), Preceptor Evaluation (60%), Professionalism (10%). Grade Scale and Grade Points: Percentage Letter Grade Grade points 89.50-100 A 4.0 85.50-89.49 B+ 3.3 79.50-85.49 B 3.0 75.50-79.49 C+ 2.3 69.50-75.49 C 2.0 Below 69.50 U 0 There is no rounding of grades. Note: For further information regarding academic standing in the Department of Physician Assistant Studies, please see the Student Handbook. Grading Criteria: 1. Demonstrate acquisition of a strong medical science knowledge base as demonstrated on the End of Rotation exam. 2. Demonstrate satisfactory self-directed learning skills, clinical reasoning skills, interpersonal communication, a commitment to patient-centered care,

2 professionalism and practice-based learning as evidenced by satisfactory performance on the preceptor evaluation. 3. Demonstrate a commitment to learning and professionalism by actively participating in all clinical activities and exceeding the professional behavior standards and minimum requirements for clinical rotations available in the Elon PA Student Handbook.

Instructional Objectives: Behavioral Medicine Objectives: 1. History a. Elicit a history and medical review of symptoms that may present as psychiatric disease b. Develop a risk factors profile c. Develop skills that will enable recognition of normal and deviation from normal d. Evaluate suicidal risk 2. Perform and interpret the results of a complete mental status examination including: a. Appearance and behavior b. Thought process and perceptions b.i. Coherency and relevance b.ii. Thought content b.iii. Perception c. Cognitive factors c.i. Orientation c.i.1. Attention and concentration c.i.2. Memory c.i.3. Information and vocabulary c.i.4. Abstract reasoning c.i.5. Judgment c.i.6. Perception and coordination 3. Perform problem-focused physical examination, recognizing and interpreting pertinent physical examination findings. 4. Determine a differential diagnosis based upon historical information, physical examination findings, and laboratory and diagnostic study findings. 5. Interview an adolescent patient, using the HEADSS method, to ask sensitive questions about lifestyle choices that affect health and safety (e.g. sexuality, drug, tobacco and alcohol use) and give appropriate counseling. 6. Describe and discuss the assessment and management of psychiatric emergencies (e.g. suicide, acute psychosis, drug overdose, violent behavior). 7. Discuss conflicting ethical principles related to the care of the psychiatric/geriatric patient. 8. Discuss the legal process and implications of committing a patient to a psychiatric hospital/long-term care facility. 9. Describe and discuss public health issues related to psychiatry/geriatrics, such as:

3 1/15/16 a. Epidemiology of mental health problems b. Mental health problems of the homeless c. Access to care d. Rural vs. urban location e. Cultural influences f. Socioeconomic environment g. Risk-taking behaviors (e.g. substance abuse) h. Spouse/child/elder abuse i. Epidemiology of adolescent suicide j. Geriatric considerations and aging of the population 10.Discuss the appropriate use of medications in the psychiatric/geriatric patient related to such issues as dosage, indications, contraindications, interactions, complications, metabolism and excretion. 11.Select a clinical intervention plan that is consistent with the working diagnosis. Identify appropriate monitoring for patients after interventions, including checking for compliance, adverse events, and effectiveness. Select a plan that considers the cost, efficacy, possible adverse reactions, contraindications, and drug interactions for medications selected. 12.Recognize appropriate counseling and patient and family education related to clinical interventions. 13.Identify proper referral strategies for patients to other services for clinical intervention as appropriate. 14.Select non-pharmacologic modalities, such as counseling, to integrate into patient management plans. 15.Describe the following common psychiatric/geriatric problems, including pathophysiology, diagnosis, treatment and follow-up:

TOPIC LIST Mood Disorders Schizophrenia and Substance Abuse Related Major depressive Psychotic Disorders Disorders disorder Bipolar disorder Schizophrenia Alcohol Abuse/dependence Cyclothymia/dysthymia Delusional disorder Drug abuse/dependence Adjustment disorder Schizoaffective disorder Tobacco Abuse/Dependence Anxiety Disorders Schizophreniform disorder Attention Deficit Disorder and Generalized anxiety Schizotypal Disruptive disorder Behavior Panic disorder Paraphilias and Sexual Disorders Dysfunction Post-traumatic stress Hypoactive sexual desire Attention deficit disorder hyperactivity Disorder Sexual aversion disorder Disorder

4 Phobic disorders Exhibitionism Conduct disorder Personality Disorders Fetishism Oppositional defiant disorder Antisocial Pedophilia Somatoform/Fictitious Avoidant Sexual masochism Disorders Borderline Voyeurism Somatization disorder Dependent Eating Disorders Hypochondriasis Histrionic/Narcissistic Anorexia nervosa Body dysmorphic disorder Obsessive compulsive Bulimia nervosa Factitious disorder Paranoid Malingering Schizoid Behavioral Medicine Successful completion of the Behavioral Medicine rotation will be evidenced by: 1. Completion of the 3 week Behavioral Medicine rotation. 2. Documentation in the Typhon database of a minimum of 25 patient encounters over the course of the rotation. 3. Evaluation and treatment or self-study of the diagnoses listed in the Topic List of the Behavioral Medicine syllabus. 4. Completion of appropriate deliverable for Clinical Year Seminar (may include admit history and physical, discharge summary or SOAP note). 5. Have achieved a passing grade (69.5% or greater) for the course from the following assessments: a. End of Rotation exam b. Preceptor Evaluation c. Professional Assessment Tool 6. Contacting Clinical Education Team at any point in rotation to discuss concerns regarding the ability to achieve the above.

5 1/15/16