Medical Student Education

Third Year Clerkships - Psychiatry

The 4 week Psychiatry clerkship is based at the University of Tennessee Medical Center in Knoxville, TN. The majority of the clinical experience will be with the Behavioral Health Consultation Service as well as an outpatient clinic staffed by the clerkship director Dr. Paul Warrick Miller. When in the clinic students will have the opportunity to work with Dr. Miller on a 1:1 basis. This allows for an extensive amount of individual instruction pertaining to typical behavioral health disorders presenting in an outpatient setting. This is mostly an observational learning experience with some opportunities for direct patient care. Time on the consultation service will be more of a team-based learning experience that allows for more direct patient care. Observed history and physicals, independent assessments, and the ability to follow one’s own patients are part of this experience. The patient population is extensively varied and a mix of both acute and chronic behavioral health problems. Acuity can be very high and there are frequent opportunities to see unusual or uncommon mental health disorder presentations. This experience will also be led by Dr. Miller who trained in both Internal Medicine and Psychiatry. This allows for an emphasis on providing behavioral health care to medically complex patients as well as the overlap that often exists between behavioral health disorders and medical illness.

In addition to these clinical experiences students will spend one week at the Knoxville Center for Behavioral Medicine (KCBM). This is a 64 bed inpatient facility with separate units devoted to Adult Psychiatry, Geriatric Psychiatry, and Co-Occurring Substance Abuse. Dr. Brent Coyle serves as the Medical Director and will be the clinician guiding the students through their experience at KCBM. Dr. Coyle has a wealth of experience in medical education and takes a unique approach to patient care that properly balances a pharmacologic approach with behavioral interventions, most notably Cognitive Behavioral Therapy. The time spent at KCBM will help to round out and enrich the student learning experience and expose them to a 3rd main area of behavioral health delivery (inpatient, outpatient, and consultation).

Students will have additional learning opportunities spending one 1/2 day with Dr. Dovile Paulauskas at The McNabb Center observing Child and Adolescent Psychiatry in an outpatient setting.

The structure of this clerkship provides a desirable case mix with regards to types of psychiatric disorders thereby ensuring student exposure to the full range of behavioral health pathologies required to meet the learning objectives. Students will also have formal didactic activities originating from the Memphis campus that are available to all clerkship sites across the state. Dr. Miller also does a separate series of 7 didactic sessions covering topics relevant to the NBME shelf exam taken at the end of the rotation.

Learning Objectives

Following this four-week clerkship students will be able to do the following:
1. Demonstrate basic skills related to psychiatry in the following:

• History taking and medical interviewing
• Physical examination/assessment
• Documentation and communication
• Clinical reasoning and differential diagnosis
• Assessment of psychiatric emergencies

2. Recognize the most common psychiatric disorders and psychopathology including but not limited to the following:

• Cognitive disorders
• Substance use disorders
• Psychotic, mood and anxiety disorders
• Eating, sexual and sleep disorders
• Personality disorders
• Adjustment disorders
• Behavioral health problems in special populations (children/adolescents and geriatrics)

3. Describe strategies for prevention, therapeutic intervention and management of psychiatric disorders such as but not limited to the following:

• Pharmacological therapies
• Biological therapies
• Psychotherapies/Behavioral therapies
• Multidisciplinary and collaborative management
• Complementary and alternative modalities

4. Describe basic issues in psychiatric disorders related to professionalism, ethics and the law.
5. Describe commitment criteria for acute psychiatric disorders and develop an understanding of issues related to involuntary hospitalization.
6. Demonstrate competitive or greater performance on the NBME shelf exam.
7. Acquire a heightened awareness of the role of behavioral health disorders in altered health and chronic illness

Call
There is no call experience for this clerkship rotation.

Evaluation & Exam
Exams will be given on the last day of the clerkship. The student's clinical performance will be evaluated by the same criteria as the Memphis rotation using the same format and evaluation instruments and performance on the NBME psychiatry shelf exam.

Clerkship Faculty
Paul Warrick Miller, MD, Clinical Assistant Professor, Clerkship Director
Brent Coyle, MD, Clinical Assistant Professor