Psychiatry

Fourth Year Medical Student Electives

Jason Rosenstock, M.D.
Director, Medical Student Education

Office of Medical Student Education
3811 O'Hara Street, E-529
412 246-5122

Pitt Students Contact:  Kesha Fincher (412)246-5122  finchercd@upmc.edu

Away Students Contact:  Eileen McKenna (412)246-6497  mckennae@upmc.edu

Students may participate in a number of acting internships available in Psychiatry for either four or eight weeks. The student will be assigned to an inpatient unit at Western Psychiatric Institute and Clinic. This experience will enhance your skills in dealing with assessment and management of psychiatric patients. Inpatient units available for acting internships include: Geriatrics, Schizophrenia, Dual Diagnosis (drug and alcohol), General Adult, and Eating Disorders.

OBJECTIVES:

1. Conduct comprehensive psychiatric interviews and mental status examinations.
2. Gather clinical data, generate differential diagnoses, formulate working diagnosis and manage treatment.
3. Plan and implement biopsychosocial treatment plan for patients with psychiatric illnesses.
4. Utilize the resources and skills of related mental health professionals.

• FACULTY: Wun Kim, MD; Gennady Berezkin, M.D.

Students may participate in a four or eight week elective in Child and Adolescent Psychiatry available through Western Psychiatric Institute and Clinic's Child and Adolescent Inpatient Service.  The student will be a member of a multidisciplinary team consisting of attending psychiatrist, social worker, nurse practitioner, teacher and nursing staff.  The student will manage assigned patients directly under the guidance of attending physician.  Acting interns will interact with families and the patient's outpatient treatment team to gain collateral information, update case progress, and provide psychoeducation.

• FACULTY: Viveca Meyer, MD and Pediatric Consultation & Liaison Psychiatry

The Triple Board (TB) Acting Internship at the University of Pittsburgh Medical Center (UPMC) has been designed to provide the interested medical student with an exposure to the interface of pediatrics and child psychiatry.

This four week internship will focus primarily on the psychiatric consultation-liaison service at Children’s Hospital of Pittsburgh.  This service provides inpatient and outpatient consultation to a wide variety of general and specialty pediatric services within this large pediatric hospital. Medical students will see patients and present them to one of a team of child psychiatrists and psychologists who work in this setting.

In addition to this primary focus, medical students will also participate in clinical activities specific to either pediatrics or psychiatry.  He/she will be able to attend the Tuesday pediatric outpatient continuity clinic and the Thursday child psychiatry outpatient continuity clinic designated for the Triple Board residents.  Opportunities may also be available for medical students who have a particular area of interest such as early development, developmental disabilities, child advocacy, adolescent medicine, children with affective and anxiety disorders. Particular areas of interest should be conveyed to the medical Student Coordinator and every effort will be made to accommodate that request.

Lastly, medical students will participate in the daily pediatric noon conference, the psychiatry didactics (on Thursday afternoons), and both the pediatric and psychiatry grand round series.

We hope this broad exposure will pique one’s interest in Triple Board Training at the University of Pittsburgh as an exciting and diverse training program.

OBJECTIVES:

1. Develop psychiatric assessment and interviewing skills applicable to pediatric medical settings.
2. Verbalize complex relationship between subjective distress, physical disease, and psychiatric disorders.
3. State modes of adaptation for children and families confronted with physical illness, including those struggling with medically unexplained physical symptoms
4. Management of pediatric psychiatric problems, including formulating initial treatment plans
5. Verbalize principles of consultation/liaison with healthcare professionals in pediatric medical setting

• FACULTY: Various (arranged by Jason Rosenstock, MD)

Students interested in getting experience in clinical psychiatry outside of the core Clinical Neurosciences Clerkship may benefit from this elective, which will link up students with inpatient attendings at Western Psychiatric Institute and Clinic.  Students will develop basic skills in the interviewing and assessment, diagnosis and management of psychiatric patients.  Inpatient units available include: Schizophrenia, Dual Diagnosis (drug and alcohol), General Adult, Adult/Adolescent.

• FACULTY: Stephen Zerby, M.D.

The Psychiatric Emergency Service elective can be taken as a four, eight or twelve week clerkship.  the Psychiatric Emergency Service (WPIC Diagnostic Emergency Center - DEC) is a twenty-four (24) hour psychiatric emergency faculty, which provides the following clinical functions: emergency psychiatric assessment and stabilization, diagnostic evaluation, crisis therapy and referral.  The student will join the DEC team, functioning as Acting Intern and receive 1:1 supervision and case-based learning each shift from both DEC attendings and residents. 

The elective will build on the MS-III experience, by placing the student in an increasingly responsible role with respect to providing both diagnostic and therapeutic interviewing, crisis stabilization, and treatment planning.  The student will work toward functioning as team leader, working alongside core DEC staff and graduate-level trainees, and seeing patients on flexibly-scheduled shifts.  The course will emphasize experiential learning over didactic, but students will be expected to participate in Case Conferences.  There will be opportunities available to also gather experience in providing phone-based Crisis Therapy.

OBJECTIVES:

1. Identify and understand major psychiatric syndromes while developing an expertise in the use of the DSM IV classifications

2. Learn a variety of basic and advanced interviewing techniques useful in a variety of related settings including family practice, internal medicine, emergency medicine and psychiatry

3. Describe the key biopsychosocial aspects of the patient's condition and its context

4. Determine the most appropriate treatment modality and programs which can best provide that treatment

5. Identify the most appropriate social or community resources available to meet patients' needs

6. Conduct a psychiatric interview effectively, thoughtfully, and efficiently under emergency room conditions

7. Conduct psychiatric interviews with patients with varied forms and levels of disturbance

8. Conduct a thorough lethality assessment for both suicidal and homicidal ideation

9. Identify subtle indications of underlying psychotic process

10. Recognize delirium and dementia and other syndromes suggesting the need for immediate medical evaluation

11. Organize the clinical information and emergency psychiatric treatment under faculty supervision

12. Determine under supervision the most appropriate clinical disposition for a given patient

• FACULTY: Stephanie Richards, M.D. [Course Director], Michaelene Landy, M.D., Mohammad Shak, M.D., Mark Miller, M.D., Adam Gordon, M.D., Daphne Bickett, M.D., Kenneth Thompson, M.D., Sara Hamel, M.D., Jennifer Icon, M.D., Jeannette South-Paul, M.D.
• LOCATION: McKeesport Hospital, Neighborhood Living Center, Hazelwood Family Health Center, Children's Hospital, Shea Clinic, Latterman Family Health Center, Geriatric In-Home Support, The East End Clinic and Shadyside Family Health Center

This four-week elective is designed to allow students to learn psychiatry in various primary care settings.  Learning will also be interdisciplinary and will involve working with various healthcare professionals including social workers, nurse practitioners, primary care physicians and psychiatrists.  Students will divide their time between the various clinics that are stated above.  There will be some flexibility to allow for individual student interest and individual projects are encouraged.  The main goal of the elective is to learn to identify and manage psychiatric illness in the primary care setting.

OBJECTIVES:

1. Become familiar with the presentation of psychiatric illness in the primary care setting, with a focus on depression, anxiety disorders and substance abuse.
2. Learn appropriate history-taking skills to be able to identify psychiatric illness in the primary care setting.
3. Learn appropriate management of psychiatric illness in the primary care setting and when referral is indicated.
4. Gain an appreciation of how psychiatric illness may impact on physical illness.
5. Learn to work effectively as a member of the health care team. 
6. Gain an appreciation for the special needs, both psychiatric and physical, of three different underserved populations; African American, Adolescents and the Homeless

• FACULTY: Rameshwari Tumuluru, M.D.

This is a four-week elective in which the student will manage adolescent patients in Day Treatment Program.  It is designed to deliver intensive psychiatric treatment to teens.  Students will work one-on-one with attending psychiatrists to diagnosis, assess, and manage patients along with attending weekly treatment teams and group sessions.  Elective field trips can be made to Shuman Juvenile Detention Center, general outpatient clinics and adolescent day partial.

OBJECTIVES:

1. Demonstrate acceptable interviewing skills with adolescent patients.
2. Demonstrate professional skills while working with mental health and other health care specialists.
3. Manage complicated adolescent patients treated in an outpatient setting.
4. State the signs and symptoms of common adolescent psychopathology, ADHD, MDD, ODD, CD, Drug and Alcohol Abuse.
5. Prescribe appropriate pharmacotherapy interventions to common adolescent disorders; ADHD, MDD, and Dysthymia.

• FACULTY: Lalith Solai, MD

This course will provide students with an introduction to psychiatric care of the geriatric patient - new assessments, interviewing, psychotherapy and pharmacotherapy, collaboration with geriatricians and other related experiences (in-home geriatric assessments, liaisoning with inpatient units, etc.)

• FACULTY: Lalith Solai, MD [Course Director], U. Channamalappa, MD, R. Marin, MD, J. Tew, MD, R. Basu, MD

Geriatric Psychiatry is a four or eight-week elective that can be tailored to the interest of the student.  Arrangements can be made to spend time on the Geriatric Inpatient Units, The Benedum Geriatric Outpatient Clinic, The Alzheimer's Disease Research center, Nursing Homes and In-Home Geriatric assignments.  Supervision will be built in on all components and learning objectives will focus on assessment, utilization of multiple services for the elderly and psychotropic drug management in the elderly.

OBJECTIVES:

1. Multidisciplinary assessment of the elderly patient, including medical, social and family history
2. Assessment of cognitive function using the Mini-Mental Status Examination
3. Evaluation and management of older patients with Alzheimer's disease and other causes of Dementia, affective disorders and late life psychoses
4. Evaluation of the elderly patient's family and the determination of their roles in the treatment of the older patient
5. Use of psychotropic drugs in the elderly.

• FACULTY: Steve Zerby, MD; Jason Rosenstock, MD and others  

This elective experience will help students develop skills at psychiatric interviewing as well as assessment of new patients.  It consists of 40% time in the psychiatric emergency room doing evaluations with faculty and resident preceptors, 40% rotating at other sites (child, adult, geriatric) doing assessments of new ambulatory patients, plus a full day of didactics and supervision.

• FACULTY:  Kurt Ackerman, MD

This four or eight-week elective focuses on psychiatric problems in medical and surgical patients. Under the supervision of faculty, the student responds to requests from physicians for psychiatric evaluation of patients on inpatient units throughout the medical center. The student conducts the clinical evaluation, investigates any ward management difficulties, assesses the role of the patient's family in the clinical problem, makes treatment recommendations and provides appropriate follow-up during the patient's hospital stay. The multidisciplinary team on the service attempts to integrate the biological with the psychosocial perspective to achieve a comprehensive view of patient care. Learning opportunities include: supervised clinical assessments; hospital rounds; case conferences; and seminars.

OBJECTIVES:

1. Diagnose and treat psychiatric disorders in patients with diverse types of physical illness.
2. Verbalize the complex interplay between the physical and psychosocial aspects of health and illness in patients being followed.
3. State the impact of hospital, family and social systems on patients being followed.
4. Presentation of a common psychiatric condition in hospitalized medical patients to the Consult/Liaison team.

• FACULTY: Kevin Patterson, MD

This four-week elective focuses on psychiatric and general medical problems in a variety of patients.  Students will work on the Consultation/Liaison Service at St Margaret’s, where, under the supervision of faculty, the student responds to requests from physicians for psychiatric evaluation of patients on inpatient units. The student conducts the clinical evaluation, investigates any ward management difficulties, assesses the role of the patient's family in the clinical problem, makes treatment recommendations and provides appropriate follow-up during the patient's hospital stay. The multidisciplinary team on the service attempts to integrate the biological with the psychosocial perspective to achieve a comprehensive view of patient care.  Students will participate in family medicine case conferences, attend outpatient experiences at primary care clinics, participate in palliative care interventions, and work on the Medical Care of the Psychiatry Patient (MCPP) service at WPIC.  Learning opportunities include: supervised clinical assessments; hospital rounds; case conferences; and seminars.  This elective can prepare a student for combined family medicine/psychiatry residency programs.

• FACULTY: Mario Cruz, MD; Michelle Barwell, MD and others

This elective will help students learn how to care for seriously and persistently mentally ill adults and adolescents who are in community-based psychiatric treatment programs. The flagship experience will be with the Community Treatment Team (CTT), an assertive community treatment approach to caring for very ill patients with different diagnoses. Students will precept with team psychiatrists, get exposure to group and individual therapy, and follow one or two patients for continuing care over the month. Home visits and other community outreach will be an integral part, along with collaboration with a variety of team members and other providers. Students will also be involved in case management, treatment teams, and systems liaisoning (e.g., helping patients leave state hospitals and return to the community).

• FACULTY: Jason Rosenstock, M.D.

 The Intensive Outpatient Program of SRRSMI helps acutely ill psychiatric patients stabilize in the community.  A two to twelve week program, the IOP serves as a step-down for hospitalized patients or a way to divert deteriorating patients from inpatient units.  SRRSMI IOP patients have a mix of mood and psychotic disorders, frequently with significant comorbidities.  Most of the treatment occurs in group settings, from 10 a.m. to 3 p.m. daily, with additional individual and family sessions through the week, all provided by the multidisciplinary treatment team.  The medical student on service in IOP would participate in a variety of clinical experiences: 1) running group psychotherapy sessions; 2) carrying a small caseload of individual patients for both individual psychotherapy and pharmacotherapy; 3) conducting family sessions as indicated; 4) performing assessments and intakes on new patients referred for treatment; and 5) participating in treatment meetings.  Supervision will be provided by the IOP psychiatrists.

OBJECTIVES:

1. Improve psychiatric assessment and interviewing skills.
2. Hone abilities in differential diagnosis and treatment formulation.
3. Learn and conduct skill-based supportive and behavioral therapies for acutely ill psychiatric patients.
4. Observe and conduct group psychotherapy.
5. Understand how a continuum of care functions to help patients avoid inpatient hospitalization.
6. Develop skills to improve collaboration with other disciplines and treatment settings.

• FACULTY: Charles Perrotta, M.D., Kristina Johnson, Ph.D.

The John Merck Program specializes in the assessment and treatment of children, adolescents and adults who have a developmental disability and behavioral/mental health disorder, with a special focus in autism spectrum disorders.  Outpatient and inpatient assessment and treatment services are available in specialized programs for children, adolescents and adults.  The reason for admission is acute psychiatric/behavioral symptomatology (i.e. aggression, depression, impulsivity, hyperactivity, self-injurious behaviors, etc).   The treatment team consists of a psychiatrist, behavioral psychologist, psychiatric social worker, special education teacher and psychiatric nurse.

OBJECTIVES:

1. Learn about etiologies and presentations of mental retardation and autism
2. Learn differential diagnosis of neuropsychiatric disorders in the developmentally disabled population using DSM-IV
3. Work on a treatment team and learn inpatient case formulation and therapeutic management skills
4. Learn about working with children, adolescents and adults with developmental disabilities and psychiatric/behavioral disorders in different treatment settings (i.e., inpatient, outpatient, day treatment and community)
5. Learn behavioral, psychosocial, and pharmacological treatments

• FACULTY: Douglas Moul, MD; Patrick Strollo, MD; Charles Atwood, MD

This course combines the expertise of psychiatry and pulmonary medicine to give students a unique educational experience in assessing and managing patients with sleep disorders.  For their four week experience, students will be expected to learn how to evaluate patients for sleep problems by taking a sleep history and fitting complaints into a general medical and psychiatric context, ultimately making recommendations on  work-up (e.g., polysomnography) and treatments (e.g., behavioral therapy for insomnia).  The goals of this elective are: 1) to provide a basic knowledge of sleep, including aspects of neurophysiology, sleep regulation and the relationship of sleep stages to other physiological processes; and 2) to allow the student to develop basic skills in the application of this knowledge to the comprehensive assessment of patients with complaints of disturbed sleep. Students will assist in the evaluation of patients with a variety of sleep disorders, including insomnias, hypersomnias, parasomnias, and breathing-related sleep disorders like obstructive sleep apnea.  Students will participate in history taking and in the administration of a semi-structured interview to patients and their bed partners. They will also learn general and specific principles and procedures of polysomnography and will participate in the process of data interpretation and treatment recommendations. Students will also attend clinics and observe sleep studies, in order to learn about specialized techniques for evaluating sleep apnea.  Inpatient consultations will round out the clinical experience for students.  A pediatric sleep experience will be included.  Students will also be able to work on ongoing research projects and participate in formal educational activities such as sleep grand rounds and journal club.

• FACULTY: Various

Unique clinical experiences in psychiatry can be arranged through the office of medical student education.

• FACULTY: David Axelson, MD, and Boris Birmaher, MD

The Child and Adolescent Affective Disorders Service offers a four week elective to senior medical students. The elective provides outpatient experience with problems related to depression anxiety, obsessive compulsive disorder and bipolar disorder in children and adolescents. The goals of this elective are: 1) to understand the manifestations of affective disorder in childhood and adolescence; 2) to learn structured assessment techniques for childhood Axis I psychiatric disorders; and 3) to become familiar with several different research methodologies used in this population including neuroendocrine and pharmacological treatment studies.

OBJECTIVES:

1. Learn epidemiology and nosology (classification) of affective disorders during childhood and adolescence.
2. Differential diagnosis of Axis I disorders in subjects from age six to adulthood.
3. Indication for psychopharmacological treatment of childhood depression and  bipolar and anxiety disorders, also safety and side effect considerations particular to children.
4. Conduct a structured interview of both parent and child with use of techniques appropriate to the age and development of the child.
5. Formulate a specific treatment plan.
6. Critically review neuroendocrine and pharmacological treatment studies.

REQUIREMENTS: Please schedule at least two (2) months in advance.

• FACULTY: J. Richard Jennings, Ph.D.

This eight-week elective provides an introduction to the techniques used to study the autonomic nervous system responsivity to psychological events in humans. Autonomic control of somatic function provides a mechanism for psychological influence on physiology and pathophysiology. Basic non-invasive electrophysiological techniques will be taught as well as basic research. Readings in a specific area of psychophysiological research on a clinical issue (also termed Behavior Medicine) will supplement laboratory work.

OBJECTIVES:

1. Basic electrophysiological techniques
2. Major forms of psychophysiological responses
3. Possible psychophysiological influences on one disease
4. Successfully collect at least one type of electrophysiological data
5. Effectively critique a published article in psychophysiology
6. Design a feasible psychophysiological experiment

• FACULTY: James M. Perel, Ph.D.

In this four-week (4) period, several central neurotransmitter systems will be described, and their possible roles will be examined in relation to effects caused by selective pharmacological agents. Catecholamines, serotonin, and their transporters, acetylcholine, GABA, cholecystokinin, opiates, neuropeptide Y, and NMDA, will be selected in relation to experimental evidence regarding their functions, relevant signal transduction systems, and presumed roles in various psychopathologies.

OBJECTIVES:

1. Independently conduct a thorough library search.
2. Effectively critique and evaluate published research papers.
3. Write a comprehensive document based on a critical literature review.
4. Learn basic aspects of neurotransmitter, neurochemical pharmacology and pharmacokinetic dynamic mechanisms.
5. Become familiar with considerations which should be taken when information obtained under experimental conditions are used for clinical applications.

• FACULTY:  Psychiatry staff

This course provides students an opportunity to pursue independent research in a chosen area of interest within the field of psychiatry.  Students are encouraged to design their independent study electives around their individual interests.  Examples of research areas include but are not limited to: Epidemiology of major psychiatric disorders, Outpatient management of cognitive disorders, Outpatient behavioral treatment of anxiety disorders, Behavioral techniques in the management of general medical disease, and Outpatient substance abuse disorders and their management.  Dr. Rosenstock is available to assist you in designing your elective.

• FACULTY: Marsha Marcus, Ph.D., Lin Ewing, R.N., Ph.D.

A four or eight week rotation aimed at familiarizing the student with theory and practical applications of Clinical Behavioral Medicine across the life span.

OBJECTIVES:

1. Understand theoretical foundations of Behavioral Medicine approaches
2. Learn basic components of behavioral assessment and intervention
3. Identify clinical indications for Behavioral Medicine assessment and intervention
4. Observe and/or participate in several Behavioral Medicine assessments and interventions
5. Critically evaluate the Behavioral Medicine literature in a specific area of interest (with faculty support)

REQUIREMENTS: Must have prior permission of contact person.

• FACULTY: Psychiatry staff

This course provides students an opportunity to work with a faculty member and participate in an active research project.  Students will be able to take part in all phases of the research project from design to presentation.  Examples of research areas include, but are not limited to: Mood Disorders, Child and Adolescent Disorders, Behavior Interventions, Psychopharmacology, Personality Disorders, Substance Use Disorders and Psychotherapy.  Dr. Rosenstock is available to assist you in selecting an area of research.