MEDD 421 Clinical Skills 2019-2020 Psychiatry Student Guide Table of Contents Introduction ............................................................................................................................................ 2 Organization ........................................................................................................................................... 2 Preparation ............................................................................................................................................. 3 Required Readings / Review ........................................................................................................... 3 Required Viewings .......................................................................................................................... 3 Suggested Resources (including other texts, websites, course material, etc.) .............................. 3 Objectives ............................................................................................................................................... 4 Equipment .............................................................................................................................................. 4 Assessment & Evaluation (when required) ............................................................................................. 4 Student Assessment ....................................................................................................................... 4 Tutor Evaluation ............................................................................................................................. 4 Technique ............................................................................................................................................... 5 1. Introduction ........................................................................................................................................ 5 2. Chief Complaint .................................................................................................................................. 6 3. History of Present Illness .................................................................................................................... 6 4. Medications ...................................................................................................................................... 15 5. Past Medical History ......................................................................................................................... 15 6. Review of Systems ............................................................................................................................ 15 7. Substance Use .................................................................................................................................. 15 8. Forensic History ................................................................................................................................ 15 9. Past Psychiatric History .................................................................................................................... 16 10. Family Psychiatric History ............................................................................................................... 16 11. Personal History.............................................................................................................................. 16 12. Mental Status Exam ........................................................................................................................ 17 13. Biopsychosocial Formulation and Treatment Plan ......................................................................... 18 Appendix 1-Sample Case report ........................................................................................................... 20 Appendix 2-Biopsychological Formulation Grid ................................................................................... 24 Appendix 3-Empathy Checklist ............................................................................................................. 25 ACKNOWLEDGEMENTS We are grateful to Dr. Michael Cooper, Dr. Clare Beasley, Dr. Marilyn Champage, Dr. Randall White Dr. Elton Ngan, Dr. Jon Fleming, Dr. Bill Maurice and their colleagues in the UBC Dept.of Psychiatry MEDD 421 Clinical Skills Psychiatry Student Guide 2019-2020 INTRODUCTION The psychiatric interview is very complex and takes many years to master. This guide will focus on beginning learners and the basic building blocks of the interview. Second year medical students will have an opportunity to practice these skills with standardized and volunteer patients. Students will progress to a more advanced psychiatric interview in third year when doing the clinical clerkship in psychiatry. Some patients and situations will always present great difficulties. The most important thing is to maintain an attitude of respectful attentiveness and concern. Using empathic comments appropriately, even when patients are angry and challenging, will always be the best approach. The skills you learn doing the psychiatric interview will benefit your history taking in all of your medical and surgical rotations and will provide a foundation for professionalism for the rest of your career. The most important learning point is using the structure of mood, thoughts, and behaviour to guide the interview process. Almost all psychiatric disorders can be described by these 3 categories. Using a logical structure instead of a mnemonic (e.g. SIG E CAPS) will ensure a more effective interview. ORGANIZATION Each student will participate in three Psychiatric Clinical Skills sessions as part of MEDD 421. For the most part, tutors will be psychiatrists, but some sessions may be taught by other clinicians (psychologists, mental health workers, psychiatric registered nurses). Efforts will be made to ensure group/tutor continuity across sessions. Before the start of the interview, the interviewing student will be paired with another student who will take notes. The note-taker will present the history after the interview and will be responsible for writing up a full case report. The case report must be emailed or given to the supervisor the following week. The interviewer will present the mental status exam. The other students will be assigned to either doing a biopsychosocial formulation or doing an empathy checklist. For students doing the biopsychosocial formulation, please see the blank grid in appendix 2. Be sure to bring a printed form to the session. You only need to make very brief notes in the appropriate boxes as the interview proceeds. You might have additional notes to add when the case presentation is being done. The formulation will be discussed as a group. For students doing the empathy checklist, please bring a printed copy of the form in appendix 3. Listen carefully to the interview and make a brief note in the appropriate boxes when the interviewing student makes an empathic comment or behaviour. The empathy checklist will be discussed as a group. Session 1: Students will practice/observe psychiatric interviewing using Standardized Patients. Cases have been developed to facilitate interviewing and conducting a mental status examination. Session 2 & 3: Students will practice /observe psychiatric interviewing and mental status examination on appropriate psychiatric in/outpatients. Each group should have the opportunity to observe an interview with a patient who demonstrates Major Depressive Disorder (MDD) and a patient who demonstrates a psychotic disorder. In addition, if time permits, it is hoped that there will be opportunities to observe interviews of patients with other DSM-5 disorders. All students are expected to have at least one opportunity to participate in a (supervised) psychiatric interview on a patient, and to present the history and mental status examination. This comprehensive guide contains information on how to perform a psychiatric interview. Each student will be required to submit a written Case Report. 2 MEDD 421 Clinical Skills Psychiatry Student Guide 2019-2020 Case Report: Over the 3 weeks, each student will be required to submit 1 case write up to their tutor. The case report for these introductory sessions should be a brief 2- to 3-page summary that follows the headings in this guide. Psychiatric reports follow a narrative style for the identifying data, history of presenting problem, and mental status examination. Point form may be used for the other sections. Please see appendix 1 for a sample case report. The case report concludes with three additional sections: • Diagnostic classification based on DSM5—this includes the working diagnosis and relevant differential diagnoses • Biopsychosocial formulation • Treatment plan PLEASE NOTE: For all Case Write Ups, students are NOT to use any patient names, identifiers, birth date or address. For confidentiality purposes, please refer to patient as ‘patient A’ (or pick any letter) in all write ups. ***Write ups will need to be encrypted, password protected and emailed to your tutor. Passwords should NOT be emailed. Please confirm password with your preceptor during the session. Encryption guidelines can be found at: https://cio.ubc.ca/sites/cio.ubc.ca/files/documents/resources/How%20to%20Encrypt%20Files%20using%20C ommon%20Applications%20Guideline.pdf PREPARATION Required Readings / Review ● Bates’ Guide to Physical Examination & History Taking, latest edition. Chapter 5: Behaviour