Jabatan Psikiatri Fakulti Perubatan

 Universiti Kebangsaan Malaysia

PRASISWAZAH

PSYCHIATRY (FFFF4118)

Dear Students,

Welcome to the fourth year undergraduate psychiatry posting. In this 7-week course, you will be exposed to clinical settings in psychiatry and various other teaching and learning activities.

Unlike other disciplines in medicine, the majority of diagnoses in psychiatry are based on phenomenology. A psychiatrist will interview the patient or family members to elicit the symptoms that he or she experiences. A diagnosis is then made based on the type and number of symptoms and the impact it has on the patient. This is contrary to other disciplines where diagnoses can be confirmed through blood investigations, imaging, etc. Hence, it is very important for you to gain good interview skills while you are going through your psychiatry posting.

Our main reference for diagnosis is the Diagnostic and Statistical Manual of Mental Disorders (DSM). In July 2013, DSM-5 was released. Your learning and assessments will be based on DSM-5. A lecture on diagnosis and classification will be given to you during the first week of psychiatry posting.

In this posting, we will be carrying out some of our teaching and learning activities online.  We will inform you which platform we will be using as our learning management system (LMS). For the best learning experience, please make sure you have enough data plan during these 7 weeks.

We hope you will have a great learning experience.

Best Regards,

Dr. Tuti Iryani Mohd Daud & Dr. Hajar Mohd Salleh Sahimi

Head of Department                 : Assoc. Prof  Dr. Azlin Baharuddin

Module Heads                             : Dr. Farah Deena Abd Samad

                                                  : Dr. Jane Lim Tze Yn

PPA coordinators                     

: Ms. Raynuha a/p Mahadevan     

   : Dr. Shalisah Sharip                     

Curriculum review committees

: Assoc Prof Dr. Tuti Iryani Mohd. Daud (Head)

 : Assoc Prof. Datin Sri Dr. Suriati Mohamed Saini

: Dr. Hajar Mohd Salleh Sahimi

  : Dr. Luke Woon Sy-Cherng                                                           

  : Mrs. Haslinda Alias (supporting staff)

INTRODUCTION TO PSYCHIATRY

This module covers the clinical approach to various syndromes and disorders in psychiatry. By applying basic and clinical sciences, the students learn through an integrated approach of core clinical and PPA components to gain adequate knowledge and skills as well as proper attitude and conduct for a holistic management of patients.

PRE-REQUISITES

Students should have acquired basic:

  • knowledge in biomedical sciences 
  • physical examination skills
  • personal & professional skills

II.  MODULE LEARNING OUTCOMES

On completion of this module, the student should be able to:

Course learning outcomes  
Explain main psychiatric disorders, the principles underlying modern psychiatric theory, commonly used treatments and a basis on which to continue to develop this knowledge.  

Describe the factors influencing normal psychological development.Describe the basic concepts and classification of psychiatric illness.

Describe the current, common psychological and physical treatments for psychiatric conditions, including the indications for their use, their method of action and any unwanted effects.

Identify relevant cultural, ethical and legal issues in psychiatric practice.

Identify the link between physical illness and psychosocial problems.

Describe the relationship between psychiatric illness and family dynamic.

Describe what may constitute risk to self (suicide, self-harm and/or neglect, engaging in high risk behaviour) and risk to and from others for vulnerable individuals (children, people with learning disabilities and elderly).

Describe how to assess and manage psychiatric emergencies, which may occur in psychiatric, general medical or other settings. In particular, be able to describe the elements of a risk assessment and the management of behavioural disturbance.
Apply knowledge related to psychiatric illness, including types, causes and treatment in a clinical situation.  

Take a full psychiatric history, assess the mental state and write up a case. This includes being able to describe symptoms and mental state features, aetiological factors, differential diagnosis, and a plan of management.

Summarise and present a psychiatric case in an organised and coherent way to another professional and be able to discuss management with doctors or other staff involved in a patient’s case.

Assess a patient’s potential risk to themselves and others at any stage of their illness and in particular, be able to assess a patient following an episode of deliberate self-harm.

Plan for a patient’s management: investigation and treatment, including mental health act, investigation forms, referral to other disciplines, medication prescription and referral to other departments.
To display appropriate attitudes necessary to respond empathetically to psychological distress in all medical settings.  

Use an empathic interviewing style, which is suitable for eliciting information from disturbed and distressed patients.

Recognize the importance of the development of a therapeutic relationship with patients.

Show awareness of ideas, concerns and expectations from patients and their family members regarding the illness that they are having and the stigma associated with it.

Recognise the importance of multidisciplinary teamwork in the field of mental illness in psychiatric, community and general medical settings, primary care settings and some non-medical settings.

Exhibit professionalism as medical students and future doctors.  

TEACHING AND LEARNING METHODS

Clinical Exposures

  1. Clinical Teaching Rounds

The purpose ofclinical teaching rounds is to consolidate students’ skills in the areas listed above using the knowledge and understanding of relevant theories learned through other activities.

B.  Grand Ward Rounds

Students will rotate to sit in the grand ward rounds (GWR), held on every Tuesday mornings, from 9am to 12pm. During GWRs, new admissions and difficult cases will be discussed. You will get the opportunity to see how psychiatric interviews are carried out. Please make sure you do not miss this opportunity.

C.   Exposure to Clinic

Students are required to attend clinic sessions to reinforce their psychiatric interview/MSE, counseling and communication skills, and to be exposed to the less severe but more common psychiatric disorders. A group of 3 to 4 students will be assigned to each lecturer. Specialist clinics run twice a week (Monday / Wednesday / Thursday), in the mornings. Students are also encouraged to sit in with medical officers in the outpatient psychiatry clinics in the afternoons (Monday to Thursdays).

D.   On-call duty

Each student is expected to perform on-call duty once during the 7-week posting:

  • To be done in pairs
  • Starting in week 2 of posting
  • Time: 4 pm to 9 pm

Procedures:

  • The monthly on-call roster for medical officers will be uploaded in the online learning management system (LMS).
  • Be mindful that often medical officers may swap on-call duties among themselves.
  • Please confirm the name of the medical officer for night-call on a particular day with the clinic/ward staff and obtain his/her contact number.
  • Introduce yourself to the medical officer so that they can contact you when there are cases to be seen or when there are ward rounds.

Expected activities:

  • Follow on-call rounds with the on-call specialist, medical officer, and house officer.
  • Follow the on-call medical officer whenever there is a case for evaluation.
  • Observe the history taking process and case management.
  • Perform basic procedures e.g. taking vital signs.
  • Fill in the investigation/referral forms.
  • For suitable cases, you may be assigned by the nursing staff/medical officer to clerk the patient before the assessment by the medical officer.
  • Fill in your logbook for the selected case seen during on-call hours. Suitable patients are those presented with emergency (examples: aggression, deliberate self-harm/suicide attempt, medication side effects [acute dystonia, NMS, lithium toxicity, serotonin syndrome], acute delirium). If such patients are not available during your on-call hours, other newly admitted patients or pre-existing patients in the ward can also be accepted.

Arrangement of on-call roster

  • To be arranged by the group leader of medical students.

Place to be on stand-by after office hours

  • You may stay in the patient interview rooms in the wards while waiting for cases.

Didactic Teaching and Learning Methods

  1. Blended learning

Blended learning is an approach to education that combines online educational materials and opportunities for interaction online with traditional place-based classroom methods.

Topics for blended lectures include:

  • History taking, MSE and communication skills;
  • Approach to manage a psychiatric patient and patient-centred care, shared decision making; 
  • Acute reactions to stress and PTSD;
  • Obsessive-compulsive disorder and related disorder;
  • Deliberate self-harm; and
  • Psychological topics.

B.     Workshop        

Topics for workshop include:

  1. History taking & communication skills
  2. Managing aggression

For managing aggression workshop, the dress code for this workshop is long pants and T-shirt for this hands-on session. You will be shown a demonstration managing aggression and will participate in performing the relevant techniques.

C.    Team-based learning (TBL)

Team-based learning topics include:

  • Anxiety disorders;
  • Mood disorders;
  • Psychopharmacology;
  • Psychosis and specifically schizophrenia (with DxR); and
  • Neurocognitive disorders (dementia) (with DxR)

Team–based learning (TBL) is a structured form of small-group learning that emphasizes student preparation out of class and application of knowledge in class. Students are organized strategically into diverse teams of 5-7 students that work together throughout the class.

(https://cft.vanderbilt.edu/guides-sub-pages/team-based-learning/)

DxR Clinician

DxR Clinician is a web-based patient simulation software that allows the student to question the patient, conduct a simulated examination, and order lab tests.

DxR Clinician will be utilized in the TBL activities of the following topics:

  • Neurocognitive disorders (dementia); and
  • Psychosis and specifically schizophrenia

D.    Online lectures

For this posting, we will be making announcements and uploading materials online through an online learning management system (LMS), i.e. UKMFolio (https://ukmfolio.ukm.my/). Please ensure that you check your LMS regularly. We strongly advise you making arrangements to have enough data plan to access the online materials.

Topics for online lecture:

  • Concept and classification of mental illness
  • Normal psychological development
  • Basic psychopathology
  • Substance-related disorders especially alcohol and drugs (acute and chronic effects)
  • Major disorders in childhood and differences in assessment
  • Management of mental health problems in the community
  • Ethics & legal issues
  • Summarize and present a psychiatric case
  • Personality disorder

E.    Field trip

Topic for Field trip: Substance abuse

A field trip will be arranged to Methadone Clinic, Hospital Kuala Lumpur during your posting. You will be going there twice, once in a big group for a lecture, and another time in small groups (6-7 people) to observe in the Methadone Clinic. You are required to document your observation in the logbook.

F. Self-Learning

Students are expected to learn several topics on their own. Students are expected to do some basic literature search and review in order to achieve the learning objectives. Resources include textbooks, lecture notes, and credible websites.

Students are not required to formally present their findings but are expected to be able to apply their understanding of the topics in clinical discussions with their supervisors. Any areas of the topics can be assessed in examinations.

Topics for self-learning include:

  • Eating disorders
  • Learning disability
  • Psychosomatic disorders and comorbidity (mental with physical illnesses)
  • Dissociative disorder
  • Sexual dysfunction
  • Gender dysphoria

Personal and Professional Advancement (PPA)

A. Group project: Activities with patients

Students are expected to carry out activities with patients (inpatients and/or outpatients). Small groups of about  4-5 students should be formed for this purpose. Each small group can choose 2-3 patients to conduct activities with. Students will consult & report to their PPA supervisor on these activities. Students are required to liaise with ward staff (for inpatients) and staff of community psychiatry unit (outpatients) when planning the activities. Staff will monitor the activities. Marks are given based on feedback from staff and patients.

B.  Getting to know the carer

Students are required to interview a carer of a patient with mental illness. They may do so individually or in pairs. They are required to fill up a log sheet following the task and produce a reflective writing to their PPA supervisor.

ASSESSMENTS

A. Prerequisite:

i) Please ensure that you are not involved in disciplinary problems i.e. plagiarism, academic fraud, frequent absenteeism, breach of patient confidentiality etc. Disciplinary actions will be taken if students are found to be guilty of the above actions.

ii) Please ensure satisfactory attendance in all teaching learning methods.

B. Areas for assessment:

Students will be assessed on clinical and PPA components separately. The amount and levels of assessment are according to the importance and relevance of the topics to clinical practice.

Assessment

A.   Formative Assessment

You will be required to complete one mini-CEX with your supervisor before week six. The marks will not be included in your final grade. Instructions on how to complete the mini-CEX are in UKMFolio.

B.   Summative Assessment

a) Continuous assessments

i) Portfolio (Practical assignments)

The students are expected to do activities as listed below and get their portfolio signed for each task. Please register yourself in the MDFolio and UKMFolio websites and select your supervisor. Please complete the required tasks.

  1. Tasks to perform
  1. Reflection on interview experience
  2. Mental state examination
  3. Case summary
  4. Referral letter
  5. Prescribing psychotropics
  6. On-call observation and reflection

2.   Tasks to observe

  1. Electroconvulsive therapy (ECT)
  2. Psychological assessment and/or therapy
  3. Psychoeducation
  4. Home visit
  5. Multidisciplinary team (MDT) meeting
  6. Methadone dispensing

ii)         Observed Long Case

All students are required to clerk and present a case while being observed by their supervisors. This process includes the discussion that will take twenty minutes. This is to reinforce students’ skills of clerking, presenting, and planning the management of any individual psychiatric patient. This is part of continuous assessment.The observed clerking assessment sheet will be uploaded in the portfolio, to assist your preparation. Instructions on how to complete the observed long case is in UKMFolio.

b) End of semester examination

At the end of semester, you will be graded for OBA, EMI, KFQ and OSCE.

For further information, please refer to the Undergraduate Studies- Faculty of Medicine UKM website: www.ukm.my/sppfper