Elements of an Excellent Psychiatry Clerkship Experience: A Survey Study of Graduating Medical Students.

OBJECTIVE: One possible factor associated with choosing psychiatry as a career is students rating their psychiatry clerkship as excellent. Although this suggests that an excellent clerkship may improve recruitment into psychiatry, to our knowledge there has never been a multi-site survey study of graduating medical students that identify what factors lead to an excellent clerkship rating. The purpose of this study was to determine factors that medical student find important for an excellent psychiatry clerkship experience. METHODS: A total of 1457 graduating medical students at eight institutions were sent a 22-item Likert-type survey about what clinical and administrative factors they considered when rating their psychiatry clerkship via email in the fall of their last year. 357 (24.5%) responded and Z-test, t-tests, and multiple regression analyses were carried out. RESULTS: The factors which students rated higher than the mean included planned application to psychiatry residency, clear expectations, a transparent grading process, feeling part of a team, timely feedback by faculty, and a competent clerkship coordinator and director. Lectures, active learning, and self-study were rated as less pertinent, and the overall clerkship rating did differ between students going into psychiatry versus other specialties. CONCLUSIONS: Although the low response undermines the validity of findings, by improving the administration of the clerkship with clear expectations, grading, feedback, and by encouraging clinical teams to fully integrate students clerkship ratings might improve which could potentially improve recruitment. Future research could further quantify and qualify these parameters and compare psychiatric clerkships to other clerkships.

A Psychiatric-Specific Entrustable Professional Activity for the Evaluation of Prospective Psychiatric Residents: Towards a National Standard.

INTRODUCTION: Entrustable professional activities (EPAs) were developed as a way to ensure adequate skills of the medical school graduate. While the 12 EPAs apply to all medical specialties, EPA 1, "Gather a history and perform a physical examination," applies most explicitly to psychiatry through the performance of a mental status exam. Although proficiency in performing a psychiatric interview and mental status exam evolves throughout a psychiatrist's professional life, basic proficiency is essential in order to function as a psychiatry intern. We developed a tool for assessing the mental status exams conducted by future psychiatry residents. METHODS: Our tool contains both a video of a psychiatrist interviewing a patient and a mental status exam rating sheet that can be used when students present a mental status exam orally or in writing. We incorporated feedback from psychiatry educators at an annual meeting of the Association for Medical Student Educators in Psychiatry, followed by the reiteration of the video and the rubric. Subsequently, the rubric was verified on the performance of a cohort of 13 third- and fourth-year medical students from three institutions. RESULTS: In their mental status exam presentations, students covered all the items measured by the rubric. There was a significant difference between the third- and fourth-year medical students in describing the cognitive exam. DISCUSSION: Overall, our tool offers an opportunity to standardize mental status presentations by senior medical students who wish to specialize in psychiatry.

Panic as a harbinger of pancreatic cancer.

BACKGROUND: Previous literature has discussed the diagnosis of cancer with psychiatric symptoms. There are noted associations made between pancreatic cancer and depression and anxiety symptoms both in literature and textbooks. METHOD: The authors discuss the case of a patient who presented with anxiety and panic attacks before his diagnosis of pancreatic cancer. CONCLUSION: There has been a previous association noted between depression and anxiety and pancreatic cancer; however, this work and another report have noted panic episodes preceding diagnosis, as well. These symptoms could prove to be an important marker for early detection.

Etomidate and unpredicted seizures during electroconvulsive therapy.

Electroconvulsive therapy has been a novel treatment for about half a century, effective for severe psychiatric conditions. Over the years, the treatment has been refined with the addition of anesthesia. Different inducing agents have been used in clinical practice over the last few decades including propofol, methohexital, and etomidate. Previous literature rarely mentions seizures soon after induction with etomidate and typically only in anesthesia literature. We describe 2 cases with different demographics, diagnosis, and treatment that had seizures with the use of etomidate as an inducing agent.

Language and cultural barriers in the assessment of enemy prisoners of war and other foreign nationals.

The authors describe difficulties encountered in the assessment and treatment of enemy prisoners of war and foreign civilians during Operation Enduring Freedom and Operation Iraqi Freedom. Of prime concern was the complexity of evaluating and working with patients through translators. Secondary concerns included self-protective behaviors of and fears experienced by patients, which complicated the patient-provider relationship. Future difficulties could be reduced by training translators in medical interviewing, training providers in the skills used by translators, informing providers of command and political policy, and producing concrete, portable information in written or other forms for enemy prisoners to reduce inherent mistrust.