||The Institute of Living, Inpatient Psychiatry Service
||David Pepper, M.D.
|# of Students:
||Maximum of two
||Third Year Curriculum, including Clinical Psychiatry Rotation
Coordinator, Medical Student Education
This elective is designed to provide advanced training in the psychiatric care of seriously ill patients in the acute inpatient unit of a large metropolitan psychiatric hospital. The student will acquire an appreciation for the complexity of the diagnosis and treatment of acutely ill patients who also often have chronic psychiatric disorders.
Students will refine their fund of knowledge and their interviewing, diagnostic, psychopharmacologic, psychotherapeutic and management skills in the care of complex and acutely ill psychiatric inpatients. They will function as subinterns and as members of the teaching service, managing their patients with greater autonomy under the direct supervision of the attending. Common problems include decompensated psychotic disorders, mood disorders, anxiety disorders, substance use disorders, and personality disorders.
Under the supervision of an experienced attending psychiatrist, the student is responsible for the evaluation, diagnosis, treatment planning, and management of patients referred to the inpatient psychiatric service of The Institute of Living/Hartford Hospital. The responsibilities of the student include the initial psychiatric evaluation, confirmation of all diagnoses, pharmacologic and behavioral management, focused individual/family psychotherapy, and participation in disposition planning. The student is responsible for a caseload of up to three patients, and he/she will begin to acquire the skills needed to assume the leadership role of a psychiatrist on an interdisciplinary inpatient mental health team. The student will have the opportunity to follow one or two patients referred at discharge to the extensive day treatment program facilities on grounds. Night call is not required but is an elective adjunct to this rotation. (University requirements for subinternship objectives mandate call.)
- To refine the subtlety and complexity of one’s psychiatric evaluations.
- To extend the range and complexity of psychiatric diagnoses with which the student is familiar.
- To refine the capacity to prioritize and defend one’s comprehensive differential diagnosis.
- To extend the student’s knowledge and utilization of psychotropic medications and their associated complications.
- To gain some experience in the conduct of group and short-term supportive psychotherapy and in the co-leading of family interventions.
- To understand the role of inpatient hospitalization in the continuum of care of psychiatric patients and the importance of disposition planning in maintaining this connection.
Under the leadership of the attending psychiatrist, the student functions in the role of the primary psychiatrist on a multidisciplinary treatment team that includes 3rd year medical students, PG I’s or II’s, social workers, and nurses. The team attending psychiatrist provides supervision in the care of each patient seen by the students daily in work rounds and teaching rounds. In addition, the attending meets with the student one hour per week in individual supervision. Each student is provided with an additional hour of individual psychotherapy supervision. More structured educational experiences include weekly Inpatient Case Conferences, Psychiatry Grand Rounds, weekly Emergency Psychiatry Conferences, and bimonthly Psychopharmacology and Neuroscience Rounds.
The Institute of Living is the area’s largest psychiatric hospital, with extensive resources across the continuum of psychiatric care. There are 130 inpatient beds at this facility. The patients on the adult units range in age from 18 (including first break psychotic and mood disorders) to 65. The average length of stay is seven days. Patients come from a wide range of socioeconomic, ethnic, and cultural backgrounds.
The student is evaluated directly by the supervising attending psychiatrist, who provides midpoint feedback on progress and a final verbal and written evaluation upon conclusion of the rotation.