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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