The Clinical Psychiatry Clerkship builds on your second and third year course in Psychology, your second year course in Neuroanatomy and Neurophysiology and your third year course in Neuropharmacology and Neuropathology. Students should be engaged as far as possible in self directed, independent learning which is Problem Based and in accordance with overall objectives of the Faculty. The clerkship emphasizes clinical teaching, centring about specific cases which illustrated the variety of psychiatric disorders and their response to treatment interventions. This core clinical experience will be critical to your medical education as your basic exposure to approaching disorders of mental life. Since a substantial portion of patients seen in non-psychiatric treatment settings will have psychiatric problems, the Clerkship is a basic pillar of your clinical training. In addition, virtually every medical disorder has significant potential for psychiatric complications.

The purpose of all branches of medicine is to allow people to live their lives as freely as possible from burdens of physical and mental incapacity. Psychiatry does not offer patients a formula for living life and should never pretend to know general answers to the eternal dilemmas and travails of human existence. Psychiatry can attempt to remove some of the barriers to human freedom imposed by emergence of identifiable psychiatric syndromes, by central nervous system disease, by vulnerabilities in personality, by acquired abnormalities in thinking or behaviour, and by reactions to stresses including medical illnesses.

In the Clerkship we will emphasise a scientific, methodologic and rational basis for psychiatric clinical thinking and practice, drawing on empirical studies and striving to avoid bias deriving from theory-bound approaches to psychological life. We will work simultaneously to approach our patients compassionately, intending to dilute the loneliness, mental anguish and daily struggles of individuals with symptoms of any illness, particularly of individuals suffering in the personal, internal world of their mental life. We will strive to remove the stigma associated with mental illness.

Aim of the course

The main aim of the course is to produce a medical practitioner who is capable to deal with common emotional and psychiatric problems of patients at the primary care level.

Goals

The overall focus of the clerkship is to achieve in five domains :

1. Attitudinal change

When students come to the psychiatry block for the first time, they are not sure of what psychiatry is. They come with the well established negative attitude to psychiatry. Our first focus is to change the student’s attitude towards psychiatry and remove the stigma associated with the mental illness.

2. Function as a Physician

Demonstrated degree of responsibility, initiative, thoroughness, rapport with patients, and ability to work as part of a team, applicable to all specialities.

3. Knowledge of human behavioural sciences and psychiatry

Mastery of the basis facts of HBS and psychiatry disorders aetiology, pathogenesis, psychopathology, diagnostic points and major treatments.

4. Skills

Demonstrated ability to obtain a psychiatric history, execute and communicate the mental status examination, formulate a case, give a differential diagnosis and management plan.

5. Ability to reason psychiatrically

Capacity to approach mental life from a variety of perspectives of analysis, aware of sources of theory-bound, bias, recognizing and prioritizing the issues in patients’ lives for which psychiatric intervention is appropriate and potentially beneficial.

The course is balanced between learning clinical psychiatry on inpatient and outpatient services, and applying psychiatry in the context of general hospital medicine as well as in the Emergency Room setting. At completion of the course, students should be able to identify common primary psychiatric aspects of general medical/surgical illness and initiate appropriate intervention.

Outline of the curriculum

MBChB IV

There is no clinical block. Psychiatry will be taught in the form of lectures.

MBChB V

The student will have during the year a six weeks clinical block. During this time they will be introduced to clinical psychiatry; will be involved in ward clerking, case presentations and discussions in the form of tutorials and seminars. Emphasis will be placed on history taking, the ability to grasp and present the clinical problem, common psychiatric problems and general functioning in the ward. The students should be present at ward rounds. They should be involved in ward programme, should have seen patients other than those allocated for case reports, for instance, they should clerk patients at the Family Medicine, OPD, Surgical, Medical, Paediatric and O and G departments.

They should discuss with the Consultants and show genuine concern for patients and their welfare.

Emphasis will be placed on general hospital psychiatry; the ability to grasp and present the clinical problem; correlate and synthesise clinical information; psychodynamic formulation and prioritizing the differential diagnosis according to DSM – IV Multiaxial Classification. They will be expected to manage the patient along the Bio-Psycho-Social lines.

Year mark, Examinations, DP requirements

4th Year

• Year Mark: Calculated as follows: First assessment 20% of mark, Second assessment 20% of mark, Final assessment 60% of mark
• DP requirement – 80% attendance at lectures.
• Promotion to 5th year depends on obtaining a 50% average of the above three assessments. Supplementary examination will be a theory paper.

5th Year

• Year Mark: Calculated as follows: Written cases 10%, Clinical Case Presentation 30%, Viva 30%, Case Vignette 30%.
• DP requirement – 80% block attendance.

Examinations

• Final Mark: Year Mark (Clinical assessments) 100%, Theory Examination 100%
• A pass requires a minimum 50% mark in the theory examination and a minimum of 50% in clinical assessments.
• Failing the clinical component requires the student to do a supplementary block. A failed theory mark requires the student to do a written supplementary examination. A supplementary block and written examination will have to be done if the student fails both the clinical assessments and written examination.

Objectives for Students

Medical students at the end of their 5th year should be able to:

General Objectives

1. Practice primary care psychiatry within the Southern African context.
2. Maintain the highest ethical standards.
3. Put the interests of patients first.
4. Know their own limitations.
5. Study independently and continue to do so.
6. Have sufficient basic knowledge for further study.
7. Work effectively in a team.

Specific Objectives

1. Take, record and present a case history.
2. Elicit, record and present the clinical signs.
3. Request and interpret necessary special investigations.
4. Make a working diagnosis.
5. Solve common clinical problems.
6. Diagnose and treat common psychiatric conditions.
7. Diagnose and treat psychiatric emergencies.
8. Understand and manage bio-psychosocial factors in psychiatry.
9. Understand and implement the methods of preventive psychiatry.
10. Know and utilise the resources of the community.
11. Treat, but where possible, prevent latrogenic disease.
12. Have a working knowledge of the laws relevant to their practice.