Ascension Providence Hospital Psychiatry Sub-Internship
Faculty Contact: Paul Lessem, MD
Rotation Location: Ascension Providence Hospital, Southfield Campus
Duration of the Rotation: 4 weeks
Students Per Month: 2
Work Hours: Weekdays; 8am-5pm; no call
Prerequisites: 2 years of medical school; 3rd year completion of Psychiatry clerkship
MSUCHM Course #: PSC 609
The senior elective in psychiatry at Ascension Providence Hospital introduces students to the presence and management of psychiatric issues in medical patients. This elective stresses the implications of recent neuroscience discoveries on the mental functioning of patients a primary care specialist may encounter in their practice. This rotation is meant to open the student’s mind to taking a more synthetic view of the interplay between the brain and mental functioning and the body by focusing on patients who are generally functional but may not be severely mentally ill but are suffering from psychological effects of severe medical problems. The clinical focus will be providing consultation on medically ill and hospice patients whose normal mental processing does not preclude day-to-day functioning, but who currently may be working against optimal adjustment to and treatment of their illnesses.
CLINICAL ACTIVITY, GOALS AND OBJECTIVES
Student time is split between evaluating and providing support for patients of several services throughout the hospital, including the academic internal medicine inpatient practice, the palliative care service, the high-risk pregnancy service and the hospice service. Students will go on post-call rounds with resident teams of the internal medicine department, attend team meetings where appropriate, go on resident preceptor rounds, and select and follow patients and families as appropriate on any of the services mentioned. Students will interview and follow appropriate patients in any of these services and present and review their findings in daily rounds with the elective preceptor; students will also attend weekly grand rounds and consultation rounds where they will present cases and meet weekly with the course director to discuss their patients and their readings.
Students will evaluate and help patients manage poor health behaviors including social inhibition, medication noncompliance, denial, concreteness, substance abuse and affective disorders. They will practice interviewing skills and the approach to medical patients with psychiatric illness or psychiatric reactions to medical illness. They will explore techniques of thinking medically and reflecting, using their own mental mechanisms as references to better understand patients and facilitate their understanding of patterns of health and illness. Students will follow up with patients and families as appropriate.
At the end of the rotation, the student will present a log of clinical activity to the preceptor and a write up of one treatment case. The Rotation Director will collect data from the supervising physician and other medical team members and complete a written evaluation of the student that is reflective of the student’s academic competence, procedural proficiency and professional attributes. The standard medical school form from the student’s medical school will be used. If the school requires a log, the student may keep the clinical case log in the format required by the school and give the Rotation Director a duplicate copy.
1. Incognito, David Eagleman, Vintage Books, Random House, 2012
2. How Doctors Think, Jerome Groopman, Houghton Mifflin, 2008
3. Basic Freud, Michael Kahn, Basic Books, 2002
4. The Psychiatric Interview in Clinical Practice, 3rd Edition, Roger A. McKinnon, Amer Psychiatric Pub, 2015
1. Ten Principles of Good Interdisciplinary Team Work, published online 2013 May 10, Biomed Central
2. Principles supporting Dynamic Clinical Care Teams, ACP position paper 2013
3. Redefining the Role of Psychiatry in Medicine, Leiberman and Rush, Am J. Psychiatry 153:11, Nov 1996
4. Polyvagal theory, Porges Online lecture
5. Selected readings in standard psychiatry texts regarding somatic disorder and physical conditions with psychological factors