Addiction Psychiatry

Sites: McLean
Director(s): Hilary Connery, John Roseman
Prerequisites: HMS Principal Clinical Experience (Core Clinical Clerkships) or equivalent
Offered: Full time for one month
Location: MCLH - McLean Hospital (10)
Open to Exclerks: No (HMS only)
Description: This is a four week advanced elective in addiction psychiatry. During the first week of the rotation, students will spend mornings as observer participants in the group-based treatment of the McLean Belmont Ambulatory Treatment Program Partial Hospital, with afternoons spent both in didactic sessions led by psychiatry residents, addiction psychiatry fellows and / or addiction psychiatry faculty, and in meetings with senior addiction psychiatry faculty based at sites throughout McLean Hospital�s Alcohol and Drug Abuse Treatment Program. During this week, students will observe the intake and psychiatric management process for patients in this level of care. During the second week of the rotation, students will spend mornings observing at an acute residential treatment, McLean Fernside (in Princeton, MA), and afternoons at McLean Naukeag (in Ashburnham, MA). During the third and fourth weeks of the rotation, students will spend mornings at the adult detoxification unit on the McLean Hospital campus in Belmont, MA. During the afternoons of these final two weeks, students will rotate through the men�s residential treatment unit for uniformed services (LEADER = Law enforcement, Active Duty military, and Emergency Responders), Adolescent residential treatment program for patients with addiction and co-occurring psychiatric disorders (in the McLean Hospital Division of Child and Adolescent services), interspersed with ongoing didactic training and senior faculty meetings. During the rotation, students will observe the psychiatric care offered to patients with substance use disorders and other psychiatric disorders, participate through their observed interviewing of patients, and be asked to formulate a mental status exam and initial diagnostic impressions based upon their interviews. There is no overnight call or weekend requirements during the rotation.
Incorporation of Basic Science Content and Evidence-Based Medicine:
Students will draw upon the criteria for substance use disorders based on DSM-V criteria. The rotation will teach students to conceptualize alcohol and drug dependence in terms of biological, psychological, and sociocultural factors, in the context of state of the art care that utilized the latest evidence in medication management, psychosocial treatments specifically including self-help treatments and professionally delivered cognitive behavioral treatments. Students will be taught the current prevalence of substance use disorders in the United States and sociocultural factors contributing to substance use, including the influence of social/family networks in the initiation of substance use, protective and risk factors for substance use, and iatrogenic contributions to substance use disorders. They will be introduced to legal and ethical aspects of treatment interventions including patient capacity, autonomy, and consequences of substance use affecting driving privileges, child care or custody, or legal status. Students will learn commonly co-occurring medical and psychiatric illnesses seen in substance-using populations and approaches to treatment. Standardized assessments such as the Clinical Opiate Withdrawal Scale for opioid withdrawal and the Clinical Institute Withdrawal Assessment for alcohol withdrawal will be key components of the rotation.
Grade Criteria:
Honors with Distinction: More often than not, the student has performed at levels that exceed the expected level for training. While not necessarily unique, he/she has consistently demonstrated excellent to outstanding clinical skills, presentations and oral exam performance, write-ups and fund of knowledge, is highly motivated, reliable and well attuned to patients, families and staff, reads widely, and shows a consistent interest in seeking out and incorporating feedback, extending skills and knowledge, and contributing to the team. The student has demonstrated performance that would typically merit enthusiastic recommendation to a leading residency training program. Honors: Student's work is consistently solid in all respects; in at least several areas, the student's work has been very good to outstanding. Although not truly exceptional, the student is consistently motivated, reliable, and organized, and works well with patients, staff and faculty. By the end of the rotation, he/she can be trusted to perform and present a thorough, reasonably efficient evaluation on a complex patient and generate an appropriate differential diagnosis and treatment plan. He/she has completed all expected tasks during the rotation and has sometimes sought out additional opportunities for learning and contributing during the rotation. Pass: Student has generally demonstrated proficiency with the basic material and skills expected of a student at this level of training but has shown limited motivation to learn during the rotation and has demonstrated one or two areas which though not frankly deficient would benefit continued improvement. Examples include occasionally superficial or disorganized write-ups or presentations, occasional notable omissions or errors in a history or MSE, some gaps in knowledge of basic psychopathology or therapeutics, occasional difficulty in interactions with patients, family or staff. Any significant deficits that raise serious concern about the student's ability to function appropriately in a clinical setting warrant a grade of Unsatisfactory rather than Satisfactory. On the other hand, reliable, motivated students who have demonstrated at least adequate proficiency in all areas of assessment and notably superior performance in some areas of assessment should generally receive Honors. Unsatisfactory: Student has shown significant deficits in any one of the major areas of assessment including obtaining and documenting clinical information, generating adequate differential diagnoses and treatment plans, exhibiting an adequate fund of knowledge about psychopathology and psychiatric treatment modalities, communicating and interacting appropriately with patients, family and staff, demonstrating reliability, integrity, collegiality and cultural sensitivity, and showing motivation to learn and to improve. The deficit(s) observed cause serious concern about the student's ability to deliver appropriate evaluation or care to patients with psychiatric disorders and/or to conduct themselves with the professionalism expected of third year medical students.