MEDICAL STUDENT EDUCATION IN PSYCHIATRY
College of Physicians and Surgeons, Columbia University
The Department of Medical Student Education in Psychiatry located at the New York State Psychiatric Institute is responsible for approximately 500 medical students in a psychiatry curriculum at the Columbia University College of Physicians & Surgeons that extends throughout the four years of medical school. Dr. Janis Cutler, Professor of Clinical Psychiatry, is Director of the division and Dr. Kelli Harding, Clinical Research Fellow, is the Assistant Director.
Psychiatric Medicine 1 is a 25-hour long course given in the second semester of first year. It consists of lectures followed by small group discussion (12 - 13 students per group). Students spend one third of the course time in lecture and two thirds in group. Lectures and group discussion focus on the psychiatric interview, the mental status examination, and the psychiatric syndromes that affect mood and thought, including schizophrenia, depression, bipolar disorder, dementia and delirium, as well as eating disorders. The clinical aspects of these disorders are illustrated with videotaped patient interviews and case material in lectures, and with live patient interviews in the group sessions. Relevant neurobiological material is considered with an emphasis on its application to phenomenology, etiology, and disease course. One group session is devoted to meeting with a volunteer from the National Alliance of the Mentally Ill (NAMI) in order to better understand the experience of the chronic mentally ill from the family’s perspective. Group preceptors are members of the faculty and senior residents.
Psychiatric Medicine 2 is a continuation of Psychiatric Medicine 1 in terms of its format and objectives. It occurs during the first semester of second year. The course is 40 hours long and again consists of a 1:2 split between lectures and small groups for discussion and patient interviews. Major psychiatric disorders that are discussed include anxiety disorders, personality disorders, somatoform disorders, and sexual disorders. Normal child and adolescent development is presented and supplemented by interviews with children supervised by child psychiatry fellows and faculty. Principles of psychiatric treatment are introduced. All groups attend one session at St. Luke’s Dual Diagnosis Inpatient Unit to interview a patient with co-morbid psychiatric and substance abuse disorders. The topics of treatment and substance abuse are coordinated with the curriculum in Pharmacology and Clinical Practice. The topics of interviewing, history-taking, and clinical reasoning are coordinated with the curriculum in Clinical Practice and Physical Diagnosis. By the end of Psychiatric Medicine 2, students are expected to have a basic understanding of how to describe a patient's psychiatric history and mental status and begin to generate a differential diagnosis. Assessment of each student’s acquisition of knowledge and clinical skills is based on performance in group as well as on a final examination that includes evaluation of a videotaped patient.
Third year students spend their five-week psychiatry clerkship assigned to one of the following sites: Presbyterian/Psychiatric Institute, Creedmoor Psychiatric Center, St. Luke’s/ Roosevelt, or Harlem Hospital. Clinical work is mainly located on inpatient services. Students follow assigned patients, participating in their daily care, including writing progress notes, with close attending and resident supervision. Clinical work also includes several hours per week in outpatient adult and child psychiatry settings. All students are on-call 2-3 times in the CUMC psychiatric emergency room, and many have a consultation- liaison experience. In addition to their clinical assignments, all students participate in six hours per week of seminars that address central topics, including treatment (pharmacologic and psychotherapeutic) and child psychiatry. Some sites provide additional didactic exposure, such as journal clubs, as well. Assessment of students' clinical proficiency is based on observation of patient interviews, presentation of cases, and written work, including at least two written case formulations. Achieving a passing score on the NBME Psychiatry Subject Test, which is administered at the end of the clerkship, is required to pass the rotation.
The department offers a number of electives in the fourth year. Students can choose a purely clinical elective or can have a research experience ranging from a basic science to a clinical setting.
The College of Physicians and Surgeons has an active Psychiatry Student Interest Group, which sponsors several events during the academic year. Dr. Cutler is the Faculty Adviser. Every spring the Department of Psychiatry hosts a Welcome Reception for first year medical students during Psychiatric Medicine 1, providing students with the opportunity to mingle with senior faculty as well as residents. Columbia students are active participants in psychiatry student interest groups on the national level with representatives to the American Psychiatric Association’s PsychSIGN [link] http://www.psychsign.org/index.html (Psychiatry Student Interest Group Network) attending PsychSIGN activities at the APA’s Annual Meeting as well as specific Region 2 Conferences.
The Department of Medical Student Education in Psychiatry has several ongoing educational research projects. Areas of interest include medical student career choice, students’ attitudes towards psychiatry, and the comparative efficacy of various pedagogical strategies.
