Committee Member: Adrienne Bentman, M.D.

Duration: One Month

Months Offered: All months except August

No. Of Students: Maximum of 1

Prerequisite: Third Year Curriculum

Contact Person: Adrienne Bentman, M.D. at 545-2629; (FAX) 545-4273.

Description of Clerkship:

This elective is designed to provide advanced training in the psychiatric care of seriously ill patients in a large metropolitan general hospital. The elective is a valuable adjunct to the CORE requirements for those students interested in or curious about pursuing a career in psychiatry. The rotation is also appropriate for those students interested in pursuing alternate fields but who desire advanced training in the diagnosis and management of emotional and behavioral problems in the general medical setting.

Purpose:

Students will learn medical aspects of psychiatry including the diagnosis of psychiatric and neurologic syndromes, behavioral neurology, psychopharmacology, and how to contend with difficult patients. Common problems addressed include depression, anxiety, delirium, dementia, palliation in terminal disease, physical and drug-induced psychiatric states, functional psychiatric states in the medical setting, competence to engage in treatment decisions, and refusal of treatment. Patients are seen on all services but most prominently on the general medical and surgical, oncology, ICU, OB/GYN, organ transplantation, trauma, and HIV services.

Format:

The student is responsible, under the supervision of the consultation/liaison attending group, for the care of patients referred to the Consultation/Liaison Psychiatry Service at Hartford Hospital. The responsibilities of the student include the initial psychiatric diagnostic evaluation, assessment of the needs and interrelationships of members of the multidisciplinary treatment team, pharmacologic management, individual/family short-term psychotherapy when indicated, and daily progress notes and communication with members of the patient’s treatment team. The student carries 5-10 patients in consultation at any one time. Night call is not required but remains an elective adjunct to this rotation.

1. To learn biological psychiatry in-patients with medical/psychiatric illness.
2. To develop a basic knowledge of psychopharmacology in the medical setting.

3. To develop a framework for thinking about behavioral neurology.
4. To enhance one’s capacity to listen to patients.
5. To develop a framework for deciphering the complexity of the patient-family-medical team interface.

Teaching:

The student functions as an integral part of the Consultation/Liaison Psychiatry Service. Teaching is clinically based and didactic in nature. It consists of daily work rounds and daily educational walk rounds with the attending and other members of the consultation team. Weekly individual supervision is provided by a senior attending psychiatrist. As a member of the attending staff, the residency’s Associate Training Director has direct oversight of the student’s work. More structured educational experiences include weekly Psychiatry Grand Rounds, twice monthly Consultation/Liaison Case Conferences, and regular case-based medical/psychiatric literature reviews.

Patient Population:

Hartford Hospital is the city’s largest general hospital at 450 beds. The patient population ranges in age from 18 to geriatric and patients hail from a wide range of socioeconomic, ethnic, and cultural backgrounds. The length of stay on the consultation service ranges from 1-90 days with an average of 7 days. 1300 consultations are provided each year to the Hartford Hospital medical population.

Evaluation Process:

Evaluative information is solicited from all attendings on the service. The primary supervisor provides the student with feedback on their progress at mid-point and with a final verbal and written evaluation at conclusion of the rotation.

Instructions:

Interested students should contact Adrienne Bentman, M.D. at 545-2629.