A Direct Observation Form for Evaluation of the Psychiatric Interview: Pilot Testing During the Psychiatry Clerkship.

OBJECTIVES: The authors evaluated the validity of a structured direct observation form (DOF) to assess medical student performance on psychiatric interviews for use in the psychiatry clerkship. METHODS: One hundred and forty-eight third-year medical students were evaluated by two DOFs completed by a supervising resident, fellow, attending, or another team member. One DOF was completed early (time 1) and the other late (time 2) during a 4-week psychiatry clerkship. RESULTS: The DOF showed good internal consistency (Cronbach's alpha = 0.88-0.89). DOFs submitted at time 2 were positively associated with end-of-course clinical grades (p < 0.001); this association remained significant while controlling for time of academic year the course was completed, rater rank, complexity of the case, and difficulty of the interview (time 2 p < 0.001). Mean scores from the DOF were associated with the time of year students took the course with students assessed early in the academic year having lower average scores (p-values = 0.01 at time 1, 0.002 at time 2). Scores on time 1 DOFs were positively associated with rater rank (p = 0.005; residents gave higher scores than faculty). DOFs also correlated with an Entrustable Professional Activity (EPA) assessment of the interview (time 1 r = 0.76, p < 0.001; time 2 r = 0.79, p < 0.001), but not with shelf exam scores (time 1 r = 0.10, p = 0.24; time 2 r = 0.11, p = 0.21). CONCLUSIONS: A brief structured form evaluating medical student performance on psychiatric interviews provided valid information about performance by third-year medical students during the psychiatry clerkship.

Adapting a first- and second-year medical student psychiatric interview course for virtual learning.

Background: In response to the COVID-19 pandemic, a first- and second-year psychiatric interviewing course was converted to a virtual platform with interviews performed via video conferencing. Telepsychiatry has been shown to be an effective modality for patient care, but little is known about the effectiveness of using this modality to teach the psychiatric interview. We sought to examine how switching to remote learning would affect the quality of the course. Methods: We compared student course evaluations from 2019 (in-person) with evaluations from the 2020 (virtual). Using Likert scales, students were asked to rate their comfort in interviewing patients, discussing emotional and psychological topics, and documenting the encounter. Student responses were supplemented with qualitative feedback and input from faculty facilitators. Results: We found no significant difference in student reports of their overall experience with the course, comfort with interviewing patients or with discussing emotional and psychological issues. The course reduced student self-reported stigma toward mental illness. Conclusions: The virtual delivery of this course offers learners a very similar experience to an in-person course. Looking beyond the pandemic, this model could have applications in other institutions where geographic or other logistical considerations would impede the implementation of such a course in-person.

Telepsychiatric Evaluation and Consultation in Emergency Care Settings.

Telepsychiatric care in the emergency setting is a viable and accessible modality that helps address the needs of patients, families, and communities. An expanding literature base for telepsychiatry in multiple clinical settings has shown benefits, including increased access to care, equal efficacy to face-to-face encounters, cost efficiency, decreased wait-times, decreased unnecessary psychiatric hospitalizations, and high levels of patient satisfaction. The evidence base for emergency telepsychiatry is growing for pediatric populations. Increased use of the modality is part of the solution to address high demand for pediatric psychiatric expertise in emergency rooms and to help bridge service gaps in parts of the country.