Clinical Skills Examination

Psychiatry Clerkship: Reno

  1. Observed Interview (45 minutes)
    1. The duration of the observed interview will be 45 minutes.
    2. During the observed portion of the interview, the student will focus on obtaining the chief complaint, history of present illness, psychiatric review of systems, past medical history, past psychiatric history and mental status examination. There should be time to ask other questions about social, developmental, or substance use history as the student feels is appropriate. Note, it is not the expectation that a complete interview will be able to be obtained during this time. When obtaining patients for interview, patients suffering primarily with a substance use disorder should be avoided.
    3. During the observed portion of the interview, the faculty examiner should focus mostly on the interpersonal aspects of interviewing and the conduct of the interview - establishing rapport, expressing empathy, use of appropriate open and closed-ended questions, organization, etc.
  2. Case Presentation & Discussion (30 minutes)
    1. After the 45 minute observed interview, the patient is dismissed and the student presents the case to the examiner. In this phase of the exam (30 minutes), the student should offer at least a preliminary biopsychosocial formulation as well as a treatment plan.
    2. During the presentation/discussion phase, a preliminary differential diagnosis may be discussed. Since their database will likely be incomplete, a discussion about what other information they would like to obtain and how they would go about doing it could be worthwhile. In addition, the student may be questioned on whatever material comes up in the course of the observed interview and case presentation. For instance, if the patient is on fluoxetine and olanzapine, the depth of the student's knowledge of these drugs may be probed. Or if the patient presents with flight of ideas and pressured speech, the significance of these findings may be queried and discussed. Also, if certain psychological themes are noted to emerge during the observed interview, the student may certainly be questioned about them.
    3. A discussion of preliminary treatment ideas is encouraged but the student is not expected to present a comprehensive treatment plan.
    4. The examiner gives feedback to the student at the conclusion of the discussion.

Examination Form

Standardized Grading For Clerkship: Clinical Examination

  1. Honors: The honors student obtained a complete history of present illness, psychiatric review of systems and past psychiatric history. The student was also able to prioritize other areas to explore with the patient (i.e. social/developmental history, substance use history, medical history). The interview was logical and organized. The student formed good rapport and demonstrated superior empathic skills. The presentation and discussion were well-organized and showed good understanding of the material. In the discussion, the honor student considered all relevant DSM diagnoses in his or her differential and potential comorbid diagnoses. Multiple biological, psychological, social and spiritual factors were discussed in the formulation. The treatment plan was comprehensive and included "work-up" as well as specific medications and non-biologic treatments appropriate to the patient.
  2. High Pass: The high pass student obtained a nearly complete history of present illness, psychiatric review of systems and past psychiatric history. The student was able to ask some questions about social/developmental history, substance use history, medical history. The interview was mostly logical and organized. The student formed adequate rapport and demonstrated adequate empathic skills. The presentation and discussion were sufficiently organized and showed a reasonably good understanding of the material. In the discussion, the high pass student considered most relevant DSM diagnoses and potential comorbid diagnoses. Multiple biological, psychological, social and spiritual factors were integrated reasonably well in the formulation. The treatment plan was ample and included "work-up" as well as specific medications and non-biologic treatments appropriate to the patient.
  3. Pass: The pass student obtained a nearly complete history of present illness, psychiatric review of systems and past psychiatric history. The student was able to ask some questions about social/developmental history, substance use history, medical history. The interview was somewhat disorganized. The student formed some rapport and demonstrated some empathic skills. The presentation and discussion was somewhat disorganized and showed an adequate understanding of the material. In discussion, the pass student considered one or two relevant DSM diagnoses and potential comorbid diagnoses. One or two biological, psychological, social and spiritual factors were integrated reasonably well in the formulation. The treatment plan was adequate and included "work-up" as well as specific medications and non-biologic treatments appropriate to the patient.
  4. Marginal Pass: The marginal pass student obtained a history of present illness, psychiatric review of systems and past psychiatric history that was deficient in one or more areas. The student had some difficulty prioritizing questions about social/developmental history, substance use history, medical history. The interview was disorganized. The student did not form adequate rapport and/or did not demonstrate adequate empathic skills. The presentation and discussion were disorganized and/or showed a less than adequate understanding of the material. In the discussion, the marginal pass student did not consider major relevant DSM diagnoses and potential comorbid diagnoses. Biological, psychological, social and spiritual factors were not integrated reasonably well in the formulation. The treatment plan had one or two significant inadequacies and/or failed to include "work-up" as well as specific medications and non-biologic treatments appropriate to the patient.
  5. Fail (Any of the following): The failing student failed to obtain relevant information in one or more key areas of the data base (i.e. History of Present Illness or Mental Status Examination). The student failed to attempt to create a positive relationship with the patient. The interview was very disorganized. The presentation and discussion were very disorganized and/or showed a very superficial understanding of the material. In the discussion, the failing student did not provide a DSM diagnosis. The student did not provide a biopsychosocial formulation. The treatment plan had multiple major inadequacies.

Professionalism Expectations

In addition to the expectations found in the core competencies, students are expected to adhere to professionalism standards set by their rotation sites.

Feedback and Clinical Performance

Students are consistently receiving feedback from supervisors on an informal/clinical basis. Formal feedback should be given by supervisors and/or the clerkship coordinator at the midway point in the rotation.

Case presentations - Oral and Written

Two written workups are evaluated by the faculty tutor. Case presentation is done on a day to day basis at the clinical sites. Part of the final grade is an oral examination consisting of a patient interview and case presentation.

Other Modes of Evaluation

A 12-Step presentation is evaluated by Dr. Chen and students receive feedback from participating AA representatives.