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Service Based Teaching in Consultation-Liaison Psychiatry: Development and Results of a Novel Curriculum Kristen Brooks, MD; J. Jewel Shim, MD University of California San Francisco Departments of Psychiatry DISSEMINATION ORIGINAL CURRICULUM CONTENT BACKGROUND AND OBJECTIVE

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Service Based Teaching in Consultation-Liaison Psychiatry:

Development and Results of a Novel Curriculum

Kristen Brooks, MD; J. Jewel Shim, MD

University of California San Francisco Departments of Psychiatry

DISSEMINATION

ORIGINAL CURRICULUM CONTENT

BACKGROUND AND OBJECTIVE

  • Initial 12 week course:

  • Introduction to Consult-Liaison Psychiatry, PGY-2 Guided learning objectives

  • How to take and complete a consult – effectively working with consulting services, gathering data, evaluating the patient, and providing recommendations

  • Delirium: identification, differential, management, follow up

  • Capacity evaluations: basic principles and concepts

  • “My Patient Seems Sad”: Etiologies and Management of Depression in the Hospital Setting

  • “My Patient is Acting Weird”: Etiologies and Management of Psychosis and Mania in the Hospital Setting

  • Common Psychiatric Sequelae of Neurologic Illness

  • Cancer: The Psychiatric Ramifications of Diagnosis, Disease, and Treatment

  • Somatoform Disorders: Identification and Management in the Inpatient Setting

  • Personality Disorders on the Hospital Unit: Patient and Team Management

  • Brief Therapy in the Hospital Setting

  • Feedback

  • Dissemination is planned in 3 ways:

  • Service: Ensure sustainability

  • Department: Application of teaching principles and structure; collaboration within our multi-site system

  • National: Poster presentation in the academic psychiatry and CLP communities; publish the curriculum with both objective and subjective data

Historically, teaching on the Consultation-Liaison Psychiatry (CLP) Service was case-based. As a result, second year residents (R2s) were not systematically exposed to core CLP topics. With this project we developed and implemented a formalized didactic curriculum for R2s rotating on the CLP Service.

METHODS

  • Content derived from multiple sources:

    • Literature on service-based curricula in CLP

    • ACGME and RRC requirements in CLP

    • Residency Training Program core requirements

    • Academy of Psychosomatic Medicine training guidelines

    • Faculty input

  • Structured to facilitate learning:

    • Thirty minute didactic sessions facilitate high-yield, focused learning on a busy clinical service

    • Content begins with the most urgent topics, and moves through diagnostic categories, covering diagnosis and management issues

  • Teaching techniques vary to best cover a topic:

    • Didactics

    • Case-based learning

    • Evidence Based Medicine

WHERE WE ARE NOW, AND THE FUTURE:

  • Based on positive feedback, we have implemented the following expansions:

  • 28 lectures on core topics in CLP following a similar developmental plan

  • 5 Evidence Based Medicine literature reviews on key topics in CLP

  • Feedback on the current curriculum structure is overwhelmingly positive and this rotation is amongst the most highly ranked by residents in terms of education and learning

  • Ongoing research: Obtain quantitative data on the curriculum’s effectiveness, including early and end of rotation evaluation of:

    • Resident self-evaluation of knowledge and competency in core CLP topics

    • Attending evaluation of residents using 2 standardized cases with a systematic scoring system.  Residents will be evaluated on their ability to demonstrate:

      • Application of DSM IV criteria in the medically ill

      • Recognition of common medication issues

      • Consideration of medical co-morbidities

      • Identification of systems issues

      • Appropriate use of collateral

EVALUATION STRATEGIES

Anonymous,

end of rotation

summative feedback

Feedback incorporated

rotation to rotation

  • Results:

  • Content adjusted

  • Sequence streamlined

  • Curriculum expanded

Feedback incorporated

week to week

Ongoing verbal

feedback

FEEDBACK FROM RESIDENTS:

  • “Weekly didactics are well-organized and thought-out, great quality. The teaching is

  • thorough, engaging, up to date, and diverse”

  • “Teaching is outstanding, including the organization of teaching, with the time for teaching at generally the same time each morning”

  • “Excellent teaching! Rotation takes advantage of uneven flow with ample didactics and ad hoc teaching”

  • “I developed increased confidence in my clinical decision-making skills on this rotation more than any other rotation”

  • “Definitely one of the best educational experiences as a resident I have had thus far”

  • “Teaching sessions were frequent and useful”

  • 100% of residents agree (18%) or strongly agree (82%) that “the teaching is of high quality” and that the rotation is “an excellent overall educational experience”

REFERENCES

1.ACGME Program Requirements for Graduate Medical Education

in Psychiatry;Revised Common Program Requirements Effective: July 1, 2007

2. Recommended Guidelines for Consultation-Liaison Psychiatry Training in Psychiatry Residency Programs: A Report from the APM Task Force on Psychiatric Resident Training in Consultation-Liaison Psychiatry. Gitlin,et al.

Supported by: UCSF Psychiatry Faculty Fellowship in Educational Scholarship


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