Courses

Psychiatry

Welcome to your Psychiatry Clerkship! Contrary to what you might think at the outset, most of you will find this experience enjoyable and rewarding, as well as integral to your understanding of the patients encountered in almost any Medical Discipline. It is well known that a significant number of patients present to their Primary Care Physicians with Psychiatric Problems (Depression, Anxiety, Substance Abuse). Similarly, a number of medical specialties regularly encounter Psychiatric Issues in their treatment of patients. Though most of you will not ultimately pursue a career in Psychiatry, all will need to be familiar with common Psychiatric Presentations and Treatments to practice good medicine in any field.

Course Number: 142741
Hourly activities per week
Duration: 4 weeks
Lectures: 20
Night Call: No
Inpatient: 0
Weekend: Yes
Outpatient: 30
Student Number: 6
Others
House Staff used as faculty: No
Total: 50
Educational Philosophy of the Psychiatry Clerkship
Psychiatric interview, diagnosis, evaluation and treatment are a critical part of every physicians work. The Plastic Surgeon looks for the patients with Body Dysmorphic Syndrome so not to operate on someone whose nose is the problem this week and their breasts are the problem the next. The General Surgeon looks for the patient with Bulimia or Binge-Eating Disorder to find good candidates for Bariatric Surgery. The Pediatrician might diagnose Asthma but must evaluate the child for Second-Hand Smoke Exposure. Everybody evaluates and treats Major Depression. In fact, while Psychiatrists prescribed nearly all of the Anti-Depressants in 1980, the diagnosis and treatment of Depression has become so well understood that Primary Care Physicians, such as OB-GYN, Internal Medicine and Family Medicine Physicians, now prescribe most Anti-Depressants. Anxiety and Panic Disorders are not far behind in prevalence and treatment by Non-Psychiatric Physicians.

On this rotation, students will learn how to do a Mental Status Exam and a DSM Interview for all major Patient Groups. The Department has programmes from Pediatric to Geriatric ages and evaluating patients across the various stages of life is important. In Addiction Psychiatry, breath, blood, and urine testing make Intoxication and Withdrawal Diagnoses easier. Still, most physicians do not pick up on the clues that would put Drug Abuse or Dependence in a differential diagnosis to Chest Pain, to CVA or to Infertility. Yet, Stimulant Abuse is a common cause of Cardiovascular Disease and CVA and Infertility is commonly associated with Cannabis or Alcohol-Use Disorders. The presence of Substance Abuse Disorder and a Psychiatric Illness, so-called 'Double-Trouble,' is common and the student will learn to recognise these patients and evaluate Suicidality. Suicide is seen in Substance Abuse Disorders, Depression, Bipolar Illness and other Psychiatric Illness. The student will understand the Psychiatric Diagnostic Process, the Treatment Team and the modern treatment of the major DSM Categories.
The student will learn about Tobacco, Alcohol, Drugs of Abuse and Eating Disorders as they account for the majority of the diseases and premature death in the world according to the recent studies. Prevention of Illness is a part of every physician’s mission and it starts with Tobacco, Alcohol and other Drugs. The student will learn to order and interpret Breath-Testing for Alcohol, BAC and Drug- Testing.

In a recent JAMA Article (JAMA 291:1263-4, 2004), the authors concluded that the leading causes of death are not Heart Disease, CVA, Injury, Diabetes and Respiratory Illness but are Tobacco, Over-Eating and Lack of Exercise, Alcohol, Microbial Agents, Toxic Agents, Suicide and Accidents and Firearms. If we look at the available Mortality Data in Palestine, we find that these are the major causes of death in our Country. Behavior that causes diseases, seen everywhere and by every physician, will be related to Prevention and are a focus of this Clinical Rotation's Approach to the study of Human Behavior. The medical student should expect to learn that 9 of the 10 times in the incidences in Lung Cancer are merely the Natural Pathological consequence of exposure to Tobacco, just as Alcohol Abuse and Dependence cause Cirrhosis and Over-Eating results in Hypertension and Diabetes. The Article concludes that as the number of deaths from Infectious Diseases and Sexual Behaviour continue to decline, increased deaths are reported and related to Over-Eating, Tobacco, Alcohol and Drugs. Finally, the student will learn about the Psychiatric Medicine, the Root Causes of Disease, Disability and Death in the United States.

Course Objectives

Learning/Instructional Activities are designed to achieve competency in each of six Core Areas. As such, student performances are assessed and evaluated upon the degree of mastery of these graduation competencies. The six Core Competency Areas to be addressed are:

Professionalism
Learning Objectives

  • Demonstrates respect for, and honesty with, patients, families and members of the Health Care Team.
  • Puts the patient’s well-being before self-interest.
  • Demonstrates an ability to resolve conflicts between personal moral convictions and the patient’s choices.
  • Demonstrates an understanding of patient’s rights, a sensitivity to issues involving cultural and ethnic diversity, and communicates an attitude of caring.
  • Demonstrates punctuality, appropriate attire and appropriate respect for superiors.

Learning Activities

  • Instruction and role-modelling by the Faculty, residents and staff during clinical activities.
  • Discussion during Ethics Case Presentation Lectures on Ethics in Psychiatry.

Evaluation Method

  • Direct observation by the Faculty, residents and staff during clinical activities and didactics.
  • Discussion during Case Presentation. Oral examination.

Interpersonal Relationships and Communication Skills

Learning Objectives

  • Demonstrates an ability to inquire about the patient's family and support systems, accurately assesses patient expectations and assumptions, and effectively engages patients and family in verbal communication.
  • Demonstrates effective communication with various Treatment Team Members, colleagues and instructors alike.
  • Demonstrates an ability to consider other viewpoints.
  • Presents Data and communicates Diagnostic Information to others. This Learning Objective also includes a demonstration of good interviewing technique (including empathy and sensitivity), the ability to present case material and the ability to accept constructive feedback.

Learning Activities

  • Instruction and role-modelling by the Faculty, residents and staff throughout the Rotation.
  • Practice oral examinations and final oral exam exercises.

Evaluation Method

  • Direct observation by the Faculty, residents, staff and the Healthcare Team.
  • Participation in didactics and case conferences. Oral Examination.

Medical Knowledge
Learning Objectives

  • Demonstrates a good fund of knowledge about Common Clinical Presentations and their Management.
  • Demonstrates the ability to identify information relevant to Clinical Problems, generate a ranked Differential Diagnosis, explain a mechanism for each aspect of the Patient's Problem and evaluate and critically-analyse conflicting Scientific/Clinical Data and Hypotheses.

Learning Activities

  • Instruction and role-modelling by the Faculty, residents and staff during the entire Clerkship.
  • Independent reading of Recommended Texts, including extensive materials provided in the area of Addiction Medicine.
  • Formal Didactic Curriculum, Case Conferences, Grand Rounds Presentations, “Mini-Lectures” and In-patient Team Rounds.

Evaluation Method

  • Discussion and direct observation by the Faculty, residents, staff and the Healthcare Team on Team Rounds and in Outpatient Clinics.
  • Oral examination.
  • Written examinations.
  • Direct observation during didactics, case presentations.

Patient Care
Learning Objectives

  • Demonstrates the ability to perform a Comprehensive, as well as a more Problem-Focused Psychiatric History and Examination and to interpret and use Laboratory and Diagnostic Studies.
  • The ability to recognise and initiate treatment for Life-Threatening Psychiatric Emergencies.
  • Adequate Medical Record-Keeping and the ability to access Data and Information Systems.

Learning Activities

  • Instruction, observation, and discussion with the Faculty, residents and staff during Clinical Activities.
  • Didactic Curriculum. Independent reading of Required Texts.

Evaluation Method

  • Assessment by the Faculty and residents during Clinical Activities.
  • Oral Examination.
  • Written Examinations.

Systems-Based Practice
Learning Objectives

  • Includes demonstration of a Practical, Cost-Efficient Approach to Diagnosis and Treatment and the ability to engage the patient and their family in the Plan.
  • A knowledge and appreciation of Alternative Medicine and other Treatment Options.
  • Demonstrates an understanding of the roles and competencies of other Health Care Professionals and engages them in the delivery of Health Care as part of the Team Approach.
  • Shows an understanding of Cultural Diversity as well as the Social, Psychological and Economic Factors integral in any Health Care Delivery System.

Learning Activities

  • Instruction and role-modelling by the Faculty, residents and staff. Ethics Case Conference.
  • Didactics on Ethical and Legal Issues in Psychiatry, as well as Community Psychiatry.
  • Inpatient work with Disposition and Placement, Drug-Assistance Programmes and Treatment.
  • Planning Community-Based Rotations, which provide more hands-on experience, with the co-ordination of services to indigent populations.

Evaluation Methods

  • Observation by the Faculty, residents and staff during Clinical Activities in both Inpatient and Outpatient settings (demonstration of student initiative and skill in navigating various systems of Healthcare Delivery and advocating for their patients).
  • Student presentation of Disposition, Systems- Based Approach to Treatment Planning in Oral Examination.

Practice-Based Learning and Improvement
Learning Objectives

  • Includes the ability to analyse the quality and implications of Medical Literature, identify future areas of inquiry and communicate information to peers.
  • Ability to incorporate new material into the treatment of patients.
  • Demonstrates appropriate self-assessment.

Learning Activities

  • Instruction by the Faculty and residents; participation in Team Rounds; Self-Learning Activities such as independent “reading-up” on patients, Online Course Materials; incorporating/applying Didactics; Formative Feedback Self-Assessment.
  • Evaluation Methods observed by the Faculty, residents and staff during Cinical Activities- particularly the level of student initiative to expand their knowledge-base through outside reading and application of material; student response to Formative Feedback/ use Constructive Comments in an Oral Examination format.

Learning Modules
Module One

The first module focuses on the essential elements of Psychiatric Assessment.
Students learn how to perform a comprehensive Psychiatric Interview, including a Mental Status Examination, and Case/ Presentation formulation. Students become familiar with various signs of Psychopathology and how best to characterise and document these findings. Students are taught how to perform a Psychiatric Review of Systems, covering major categories of mental illness: Mood Disorders, Anxiety Disorders, Psychotic Disorders, Substance Use Disorders, Disorders of Childhood, Personality Disorders, and Geriatric Psychiatry. The Biopsychosocial Approach to Patient Care is presented in this module and emphasised throughout the Course.

Module Two

The second set of lectures explores the origins of Psychopathology through the study of Child Development. Here, students learn about the importance of a Developmental History in the assessment of children and adults, and begin to appreciate some of the Psychiatric Disorders that are most commonly seen in childhood and adolescence. This section goes on to thoroughly survey the most common Psychiatric Disorders that are encountered in the Primary Care Setting. The interplay of Body and Mind becomes readily apparent in the exploration of the Somatoform Disorders, in which Psychiatric Conflicts manifest as Physical Signs and Symptoms in general practice. The interface between Psychiatry and Neurology is explored in a discussion of Delirium and Dementia, and the overlap between General Medical Conditions and Psychiatric Presentations is emphasised.

Module Three

The final section addresses the field of Addiction Medicine and comprehensively explores Biopsychosocial Treatment approaches to a variety of Psychiatric Disorders. A wide range of treatment modalities will be discussed, including both Pharmacological and Non-Pharmacological Approaches. Psychotropic Medications are thoroughly explored, including Antidepressants, Antipsychotics, Mood Stabilisers, Anxiolytics, and others. Psychotherapy and other Psychosocial Treatments are compared and contrasted.

Course Description

This Course is a four-week Clinical Rotation that provides a General Experience in Inpatient and Outpatient Psychiatry. Students will receive an overview of the Major Diagnostic Categories, the Therapeutic Modalities and the settings of Modern Clinical Psychiatry. Students will gain competence in the Psychiatric Diagnostic Interview, including the Mental Status Exam, and in the Assessment and Treatment of various Psychiatric Disorders, including those related to Substance Use.
During the Clerkship, students are assigned to four-weeks of a General Psychiatry Experience. On this rotation, the student is an integral member of a Treatment Team with specific Patient Care Duties. As such, the student is responsible for the evaluation and management of patients.

To supplement the Clinical Experience, students attend a comprehensive Seminar Series covering the full breadth of major Diagnostic Entities and Treatment Modalities. In addition, students attend several informal teaching sessions by various Clinical Faculty Members and residents.

Method of Evaluation

Item
%
Clinical Performance & attitude assessment
30%
Research Project
30%
Written final exam
40%

Recommended Textbooks

  • Psychiatry made ridiculously simple
  • Blueprint Psychiatry

Reference Textbook

  • Kaplan & Sadock's Comprehensive Textbook of Psychiatry (2 Volume Set) by Benjamin J. Sadock (Editor),  Virginia A. Sadock (Editor).
  • Lippincott Williams & Wilkins Publishers; 7th edition (January 15, 2000).

Clinical Nutrition

The importance of Nutrition in Medical Practice has been highlighted in recent years by the publication of a number of reports from the Department of Health and International Agencies, such as the World Health Organisation. The Department therefore provides medical students with the opportunity to spend an intercalating year studying Nutrition and its relation to Clinical and Population Health.

Course Number: 140641
Hourly activities per week
Duration: 2 weeks
Lectures: 30
Night Call: no
Inpatient: 10
Weekend: No
Outpatient: 10
Student Number: All
Others: NO
House Staff used as faculty: Yes
Total: 50

Course Objectives

  1. Choose and evaluate Nutrition Assessment Data and devise a range of Estimated Needs for Nutrition Support in light of available clinical information and constraints.
  2. Translate Assessment Goals into a Parenteral Nutrition Regime and Plan for implementation, monitoring, management and discontinuation to optimise patient tolerance and safety.
  3. Compare and contrast the “two-in-one plus piggyback lipid” and the Total Nutrient Admixture System(s) used for delivering Parenteral Nutrition.
  4. Outline Principles and Alternatives for the Design and Delivery of Specialised Nutrition Support in Clinical Conditions including: Renal, Liver and Respiratory Failure; Pancreatitis, Hypermetabolism (Metabolic Stress), Cancer/BMT, GI Conditions and Short Gut.
  5. Calculate the Daily Nutritional Needs of a Neonate or Pediatric Patient including: kcal, protein, fat carbohydrate, electrolytes, minerals, trace elements, vitamings and NPC:N. Translate these Needs into a Regime, including those components for a typical patient.
  6. Describe the importance of Home Care in current Medical Practice, and outline the Pharmacist’s role in providing Home Nutrition Support in specific settings.
  7. Outline the major advantages and limitations of Enteral Nutrition by various routes and describe the categories of commercially-available Enteral Products and situations where each may be clinically indicated.
  8. Identify and clinically screen for major as well as common Drug-Nutrient Interactions, and outline strategies for prevention and management.
  9. Apply the discussed principles in simulated patient case examples.

Course Subjects
Country Focused Nutrition Policies and Programs

Reduction of Micronutrient Malnutrition
Growth Assessment and Surveillance

Nutrition in Development and Crisis

Nutrition in Disease States

  • Organ Failure.
  • Nutrition Support Topics: Short Bowel, IBD, Obesity.
  • Specialised Nutrition Support II: Hypermetabolism and Stress.
  • Drug-Nutrient Interactions.
  • Parenteral and Enteral Access.
  • Enteral Nutrition.
  • TPN Preparation.
  • TPN in Pediatrics and Neonates.
  • Nutrition Support in Cancer.
  • Nutrition Support in BMT.
  • Nutrition Support in Hyperemesis Gravidarum.

Course Description

This Course focuses on Nutrition and Disease. It is organised around a didactic component of thirty lectures and study case- presentation components. The Course is designed to develop skills in the use of Clinical Nutrition for the prevention and treatment of Diet-Related Health Problems, such as Cardiovascular Disease, Diabetes, Hypertension and Kidney Disease. The Course will consist of lectures, discussions, tutorials and experiential assignments.

Method of Evaluation

Item
%
Case Studies and Self-Assessment Questions
50%
Research Project
50%

Community Medicine

This Course is designated to provide students with the chance to examine Social, Behavioral and Environmental Community Health-Related Issues and the controversies that surround them.
Group and presentation work will be emphasised. There will be an overview of the Organisation, Financing, and Delivery of Health Services in Palestine, with particular emphasis on an analysis from Professional, Organisational, Community and Systems Perspectives. Reviews of the Etiology, Epidemiology, and Approaches to the Prevention of Infectious and Chronic Diseases will be offered. Aspects of Risk Factors, Transmission, Pathogenesis, Immunology, Case Management and Control Programmes are discussed.

Course Number: 14276
Hourly activities per week
Duration: 5 weeks
Lectures: 15
Night Call: No
Research Project: 15
Weekend: No
Outpatient: 20
Student Number: 6
Others
House Staff used as faculty: No
Total: 50

Objectives
Knowledge Objectives

Upon completion of the Training, the student will understand

  • The Concepts of Community-Oriented Primary Care including:
  • Occupational Medicine
  • Community Health Resources
  • School Health
  • Community Health Education
  • Public Health Services
  • Environmental Health
  • Maternal and Child Health
  • Health Management and Health Systems

Skill Objectives

Upon completion of the Training, the student will be able to carry a Field Search of the important health subjects related to Community Medicine as follows:

  • Identify Preventive Health Needs for children and mothers.
  • Identify Job-Related Health Risks.
  • Identify Community Resources for the elderly.
  • Identify the major types of Community Health Resources, including:
  1. Governmental
  2. UNRWA
  3. NGO
  4. Private
  • Identify School-Related Health Problems.
  • Identify the methods for Information-Transfer to Community Populations.
  • Describe the Physician’s Role in Community Health Education.
  • Use Public Health Resources at the Local, National and International Levels to help patients.
  • Assess the impact on Patients’ Health of exposure to:
  1. Toxic Wastes
  2. Air Pollution
  3. Water Pollution
  4. Industrial Materials

Finally, students should be able to describe the Public-Health Role of the Physician in communities.

Course Description

This is a five credit-hours Course offered to sixth-year students. It is designed to introduce students to the practice of Community Medicine. Students rotate into different Clinics and Sites, including Ante-Natal Care for baby and mother, Immunisation, Food Processing and Handling and Industrial Medicine. They also attend didactic lectures and group discussions. Students are asked to perform a Community-Based Research.

Method of Evaluation

Item
%
Clinical Performance & attitude assessment
30%
Research Project
30%
Written Examination at the end of the year
40%
total
100%