Frequently asked questions (FAQ’s) about the “Brain and Behavior Clinical Skills Preceptorship”
Prepared by Anthony Guerrero, M.D., Director of Medical Student Education in Psychiatry, and the Medical Student Education Committee, Department of Psychiatry, UH-JABSOM
What exactly is the “clinical skills preceptorship?”
The Clinical Skills Preceptorship (CSP) is a required experience for first and second-year UH-JABSOM medical students, in which they learn basic components of the physical examination. The CSP occurs during different, organ- or life cycle-specific units and sub-units throughout the first two years of medical school. The CSP unit that our department is involved with is the Brain and Behavior Subunit CSP, which occurs during the month of November for second-year medical students in the Unit 4 problem-based learning (PBL) block. Unit 4 is divided into three (#3) month-long subunits: locomotor/musculoskeletal, neurologic, and brain and behavior.
MS1 / Unit 1: Health and Illness / Unit 2: Cardio, Respiratory, Renal / Unit 3: Endocrine, GI, HemeMS2 / Primary Care / Unit 4: Locomotor, Neurologic, Brain and Behavior / Unit 5: Life Cycle / USMLE Review
MS3 / Unit 6 Clinical Clerkships: Medicine, Pediatrics, Family Practice, OB/GYN, Psychiatry, Surgery, Elective
MS4 / Unit 7: 4th-year Electives
Do I really have to do this? Is this really required?
If you are an academic faculty member, 50% or greater FTE, who is not assigned to be a PBL tutor (e.g., Unit 1, Unit 4, or the Unit 6 clerkship), you are required to be a clinical skills preceptor every year, as per UH-DOP policy on medical student teaching by faculty.
What is the time commitment involved?
One (#1) half-day (3 hours) per week, for 4 weeks. For this year (2006-2007), the 4 weeks are November 6 – December 1, 2006. This is a total of only 12 hours for the whole year.
How does 12 hours compare to the other teaching activities that faculty participate in?
Tutoring a major PBL unit (e.g., Unit 1, Unit 4) is a roughly 3 hour/session x 2 session/wk x 14 wk/yr + orientation session time + triple-jump time + evaluation time = 100 hour/yr commitment. Tutoring in the Unit 6 clerkship is a roughly 2 hour/session x 2 session/wk x 5.5 week/block = 22 hour commitment. 12 hours per year is a very small commitment, relative to what other faculty in this department are doing for the PBL program and relative to what other department require their faculty to do.
I haven’t yet been trained as a PBL tutor. Am I still eligible to participate in the CSP?
Yes. The CSP experience is separate from the PBL tutorial, and you will not be required to use any PBL tutoring skills per se.
What if I’m out-of-town during some of the weeks?
You are still responsible for insuring the integrity of the CSP experience, either by: finding teaching coverage for yourself (e.g., NOT by placing responsibility on the course coordinators) or “doubling up” sessions during the weeks that you will be in-town between November 6 – December 1, 2006.
What are the goals of the Brain and Behavior CSP?
The basic goal is to introduce students to the mental status examination (MSE) as a sort of “branch sequence” of the basic physical examination. Because it is often students’ first experience with psychiatric patients, it is an excellent opportunity to dispel myths about psychiatry and patients with psychiatric conditions, cultivate professional attitudes towards caring for patients with psychiatric conditions, and increase comfort in interviewing patients with psychiatric conditions.
Whom am I teaching, and what can I expect they have already learned?
You will be teaching small groups (5-6) of second-year medical students at UH-JABSOM. By that point, they will have gone through Units 1, 2, 3, and most of 4 (topics noted above), and should have learned most of the basic physical examination sequence, including the neurologic exam, but excluding the detailed mental status examination. While most of them will not have had any specific experience with psychiatric patients, they should be familiar with approaching patients comprehensively and recognizing the “4 perspectives of PBL”: biological, clinical, behavioral, and populational.
Where does the teaching take place? Do I need to leave my clinical site?
Teaching ideally takes place wherever it is that you provide care for patients – e.g., QMC, HSH, Kahi Mohala, etc. There should be reasonably easy access to patients who are willing to be interviewed by medical students (so that if one declines or is not otherwise available, others may be available). For this reason, inpatient sites may be more convenient; however, outpatient sites have been used successfully in the past.
What sort of patients should I choose?
Very ideally, the patients you choose should provide clinical correlation with the paper cases that they study in their PBL tutorial groups (which is a separate class). You will be provided with copies of these PBL cases (5 total), with the understanding that you are not responsible for necessarily reviewing these paper cases in a tutorial-style format. Very ideally, you should try to find patients with psychosis, mood disturbances, substance use, and cognitive disturbances; as these are the types of cases studied as paper cases in the tutorial groups. You could also consider finding a child and adolescent patient with a disruptive behavior disorder; however, this would be optional. The bottom line is that students should have a chance to learn the mental status examination through seeing patients with psychiatric conditions.
How do I find patients?
You may ask any of the inpatient attendings and/or chief residents for help in finding an appropriate patient who may be willing to speak with medical students.
How is the time usually spent, and what does a typical teaching protocol look like?
You should introduce students to the basic psychiatric history and mental status examination; structure clinical experiences so that each student gets to have some practice interviewing a patient, whom they can do a write-up on; and provide opportunities for questions and feedback. The pace should generally be very relaxed.
A schedule that I’ve tended to use (since I started doing this in 1999) is shown as follows:
Session 11 hour: review the psychiatric history and physical examination (MSE) and compare with the basic H and P, emphasizing similarities more than differences
1 hour: see a patient as a group, having 2 students (who will eventually do a write-up on this patient) take the lead
1 hour: discuss findings, especially the MSE, and give feedback.
Session 20.25 hour: discuss feedback/comments from the last session
1 hour: see a patient as a group, having 2 students (who will eventually do a write-up on this patient) take the lead
1 hour: see a patient as a group, having 2 students (who will eventually do a write-up on this patient) take the lead
0.75 hour: discuss findings, especially the MSE, and give feedback. Remind students to work on their write-ups.
Session 30.5 hour: discuss feedback/comments from the last session, insure write-ups are progressing
1 hour: see a patient as a group, allowing for further practice/make-up
1 hour: any other supplemental clinical experiences
0.5 hour: discuss findings, answer additional questions
Session 41 hour: review write-ups and discuss any other questions
1 hour: give and solicit feedback
Obviously, the size of the student groups interviewing a patient will be influenced by the comfort level of the patient, etc.
What should I expect their write-ups to look like? What things should I expect they would learn later on (e.g., in the third-year clerkship) and wouldn’t need to worry about teaching them?
A sample write-up format is provided, that you should feel free to share with your students. We wouldn’t necessarily expect them to learn how to do detailed discussions of bio-psycho-social formulation or DSM-4 minutia.
What else do the medical students do? What does the rest of their week look like when I’m not teaching them?
The medical students’ typical work week includes one (#1) half-day for CSP, two (#2) half-days for PBL tutorial (where the majority of learning occurs), supplemental lectures to cover basic science topics and to broaden the perspectives of the PBL cases, and one (#1) half-day for community medicine. Students in the PBL program are accustomed to self-directed, patient-based learning.
Will my being a CSP count for anything?
Medical student teaching in the UH-JABSOM curriculum is a very important factor considered in any applications for academic promotion. You can list your participation in this class, called Biomedical Science (BIOM) 574 Clinical Skills (Brain and Behavior Subunit,) equal to roughly 1 credit in the UH-Manoa system. Also, the office of medical education tries to send all preceptors copies of students’ ratings of the CSP; make sure to keep your copy so that you can include it in your application for promotion.
Is there any other significance to the teaching that I do?
Many educators strongly believe that students’ experiences in psychiatry early on in their training can be very influential in shaping career choices as well as attitudes towards patients with psychiatric conditions. At UH-JABSOM, we boast one of the highest recruitment rates into psychiatry in the country (our 15-year average is about 7.5%, which is more than double the national average). We believe that our faculty’s and residents’ involvement in medical student teaching is an important factor in inspiring our students to choose careers in psychiatry.
On behalf of the Department of Psychiatry, thank you very much for your teaching of our students!
1