Kathleen Clegg, MD
Psychiatry, UHC
email Dr. Clegg
phone: 844-5061

Abstract

My project proposal for the Scholars Collaboration in Teaching and Learning involves the development of a 'virtual' ambulatory psychiatry clinic for third year medical students. Currently, most CWRU medical students do not see ambulatory patients during their psychiatry clerkship. At the same time, on those occasions when patients with psychiatric conditions are encountered in the family medicine and ambulatory internal medicine clerkships, there is no access to supervision or preceptorship by Psychiatry faculty. This contributes to under-recognition and under-treatment of psychiatric conditions in the primary care setting.

In the "Virtual Clinic," students will be required to work through computer cases of patients presenting in a primary care office setting with ambulatory psychiatric problems such as depression, anxiety, personality disorders and somatoform disorders. Students will log on to the 'virtual clinic' once per week over the 8 weeks they are doing the ambulatory medicine/family medicine clerkship. The cases will approximate the presentation of actual patients in a primary care setting.

Project Description

My project proposal for the Scholars Collaboration in Teaching and Learning involves the development of a 'virtual' ambulatory psychiatry clinic for third year medical students. Currently, most CWRU medical students do not see ambulatory patients during their psychiatry clerkship. At the same time, on those occasions when patients with psychiatric conditions are encountered in the family medicine and ambulatory internal medicine clerkships, there is no access to supervision or preceptorship by Psychiatry faculty. This contributes to under-recognition and under-treatment of psychiatric conditions in the primary care setting.

In the "Virtual Clinic," students will be required to work through computer cases of patients presenting in a primary care office setting with ambulatory psychiatric problems such as depression, anxiety, personality disorders and somatoform disorders. Students will log on to the 'virtual clinic' once per week over the 8 weeks they are doing the ambulatory medicine/family medicine clerkship. The cases will approximate the presentation of actual patients in a primary care setting.

In these simulations, students will first gather the patient's history. Teaching points here will focus on what questions to ask and how to ask them. Physical exam and mental status exam findings as well as pertinent laboratory studies will be made available, if requested, as with a case in the problem-based learning format. Taking into consideration biopsychosocial factors, the student will generate a differential diagnoses, make a working diagnosis and formulate a treatment plan (all from among alternatives in the computer simulation). Patient and family education regarding diagnoses and treatment options will also be addressed.

Subsequent 'visits' to the virtual clinic will include encounters which approximate patient presentations at follow-up visits as well as encounters with new patients. In the case of follow-up visits, a student will need to evaluate the patient's progress (or lack there of) and make appropriate adjustments to the original treatment plan, as needed. Again, patient and family education regarding expectations, prognosis and treatment recommendations will be addressed.

The exposure of medical students to patients with ambulatory psychiatric problems is clearly an unmet need in the current CWRU School of Medicine curriculum. Students have not received adequate education about the diagnosis and management of common out patient psychiatric problems in the psychiatry clerkship.

The need for this type of instruction is pressing. It is a necessity for every physician, regardless of medical specialty, to be able to recognize, diagnose and treat common psychiatric diagnoses. Not only is the prevalence of disorders such as depression and anxiety high and climbing, but the presence of these disorders affects a patient's ability to recover from almost any other medical illness. The virtual clinic would ensure that each student is exposed to the major types of ambulatory psychiatric problems and their clinical management in an out patient setting.

This model clearly advances the CWRU School of Medicine's mission of educating the biopsychosocial physician. This model also advances the successful collaboration between Internal Medicine, Family Medicine and Psychiatry that has already begun within the clinical and didactic portions of the third year clerkships.

Development of these simulations will involve Family Medicine and Internal Medicine faculty as consultants. This should lead to greater interdepartmental collaboration than has yet taken place on the level of substantive diagnostic and treatment issues.

This will add yet another supplemental computer assisted instruction resource to current efforts to develop computer assisted instruction for our medical students, such as the primary care and sexuality modules now being developed under the leadership of Dr. Linda Lewin and Dr. Sheryl Kingsberg, respectively. These resources, when developed, will contribute significantly to the School of Medicine's goal of making substantial portions of the undergraduate curriculum available at any time, anywhere.