Medical Student Clerkships and Electives - Eastern Virginia Medical School (EVMS), Norfolk, Hampton Roads

It is an extraordinary time for the respective fields of Psychiatry and Neurology. Recent advances in the neurosciences, genetics, cognitive science, and behavioral medicine are rapidly translating into real understanding and valuable treatments that promise to substantively improve the lives of people with neurologic and mental illness. We are learning more each day about the causes and correlates of these conditions, including their complex interplay and etiologies. With this knowledge, we are beginning to address the true impact of neuropsychiatric illnesses (NPIs) in our culture. This is a time in which we can truly make a difference in the lives of our patients and their families.

As medical students who will eventually join the nation’s physician workforce, it is essential that you become familiar with these issues and actively engage in contemporary assessment and treatment of patients with NPIs. It is important because the prevalence and impact of NPIs and coexisting conditions are daunting. Physicians in all fields of medicine inevitably will encounter these issues. For example, one in five persons will experience a significant mental illness during their lives. Half of patients who present for clinical care in medical settings will have a coexisting mental and/or addiction disorder. Cognitive impairment from conditions such as Alzheimer’s disease and related disorders can erode medical decision-making and ability to follow a medical regimen.

NPI’s shatter lives and adversely affect the treatment of other medical problems. The global, national and local burden of NPIs is almost immeasurable in terms of human suffering and economic impact. Despite changing societal perceptions, mental illness continues to be poorly recognized, highly stigmatized, and until relatively recently, scientifically neglected. However, new advancements in the neurosciences are leading to more effective therapies to minimize the burden of neuropsychiatric illness and potentially halt pathological changes is the brain. The next ten years should see dramatic progress for these patients and their conditions. You can be part of this positive change.

For these reasons, we believe that caring for people who experience and suffer from either neurologic or mental illness is the responsibility of every healthcare professional. Therefore, we ask for your help to answer those questions related to the causes, prevention, and optimal therapeutic approaches to NPIs. We hope that you will maximize this time and learn how these fields of medicine will benefit you and your patients in your chosen residency and beyond. If we may be of further assistance in your clerkship experience, please let us know.

Margaret Meynardie | Clerkship Coordinator | Tel: 757.446.7189 | MeynarM@evms.edu

Please explore the electives we offer below. For additional information about our electives, please explore our course catalog.

PSY 404: Consultation/Liaison Psychiatry

Students are exposed to consultation/liaison psychiatry, a branch of psychiatry specializing in psychiatric care of the medically ill patient. Students participate as an integral member of the consultation team, which is comprised of an attending consultation/liaison psychiatrist, residents and clerkship students. The rotation takes place at Sentara Norfolk General Hospital. Students will be expected to evaluate, present and write up consult cases. They will work closely with the resident and attending physicians and will attend rounds, follow up on assigned cases and attend conferences and grand rounds. Common diagnoses encountered include delirium, dementia, mood, anxiety and personality disorders.

PSY 416: Psychosomatic Medicine (Consultation/Liaison Psychiatry)

Consultation-liaison (C-L) Psychiatry is a branch of psychiatry that entails research, consultation to medically and surgically ill hospitalized patients and education of students and clinicians of all disciplines. The setting for the practice of C-L Psychiatry is the general hospital. Naval Medical Center Portsmouth is a 366-bed general hospital. Fourth-year medical students will learn key elements in an effective C-L team:

Ability to conduct mental status exam and interpret findings in conjunction with laboratory and neuro-imaging
Capacity to assess the potential for suicidality, aggression and agitation within a medical-surgical setting
Ability to work with and clearly communicate findings and recommendations to non-psychiatric physicians, other healthcare workers and families

Students will be exposed to "talking papers," a quick reference outline on key points of an oral briefing, as a form of learning and teaching others during rounds.

PSY 407: Acting Internship in Psychiatry

This course is designed for seniors wishing for a sub-internship experience in inpatient psychiatry prior to beginning residency in psychiatry. Students entering the primary care field who want further experience recognizing and assessing mental illness should also apply.

The purpose of this rotation is to provide increasing amounts of responsibility for treating psychiatric inpatients. Students act as an intern with primary responsibility for patient care including evaluation and treatment.

PSY 408: Addiction Psychiatry

Students are exposed to addiction psychiatry, a branch of psychiatry specializing in the treatment of addictive disorders such as alcoholism and other psychoactive substance dependence. Many of the patients will also have a dual diagnosis. Students will participate as members of a multidisciplinary team, and they will work closely with the attending psychiatrist and other treatment team members. The rotation takes place in an intensive rehabilitative residential setting where patients reside for up to 120 days. This is an intensive and highly structured program, which operates on a biopsychosocial model of treatment with a strong emphasis on the 12-step recovery process. The program is headed by a psychiatrist and includes a program specialist, social worker, addiction therapists and other support personnel. Other treatment tracks include relapse prevention, aftercare and family. Students are expected to actively participate in program activities, to include:

Individual and group therapy
Community meetings
Family counseling
Didactic therapy
Physical, recreational and occupational therapy
Treatment planning
Assessment triage

Students may also be exposed to subspecialty areas including detoxification and inpatient psychiatric substance abuse education. The use of current literature and appropriate references is encouraged. Emphasis is placed on learning the biopsychosocial assessment and formulation as well as on motivational intervening therapy.

PSY 412: Psychiatry Acting Internship

This course is designed for seniors seeking a sub-internship experience in inpatient psychiatry prior to beginning residency in psychiatry. Students entering the primary care field who want further experience recognizing and assessing mental illness should also apply.

Cases of greater interest in maximizing the educational objectives and meeting the student interests will be selected. Particular areas of interest can include substance (alcohol or illicit substances) use disorders, neurocognitive disorders (dementia), psychotic disorders, mood disorders, anxiety disorders, post traumatic stress disorder or personality disorders. The biopsychosocial model is used with a crisis intervention approach. Brief stabilization is followed by return to the community or non-acute level of care. Under the psychiatrist’s supervision, students are responsible for assessing patients and implementing their own treatment plan. Students follow the response to treatment, updating or modifying the plan as required.

PSY 417: Inpatient Geriatric Psychiatry Acting Internship

Students work in the senior treatment area at Sentara Norfolk General Hospital, which is an inpatient geriatric psychiatry unit. This unit hosts a population of patients 65 years or older who often present with dementia, delirium psychosis, anxiety and affective states, alongside the physical impairments of various medical conditions. Students work with the attending physician and gain experience in diagnostic assessments, behavioral and pharmacologic management of psychiatric illness and the education of patients/caregivers. Treatment modalities include the exposure to electroconvulsive therapy, an effective and safe option for medication-refractory depression, psychosis or catatonia in this population. Students follow and manage patients daily and play an active role in team presentations. Common topics on this rotation include polypharmacy, ways to minimize confusional states, interdisciplinary management, palliative care, resources in the community and caregiver burden. Efforts will be made to expose the student to topics of interest.

PSY 419: Army Psychiatry

Military outpatient mental health care is different than general outpatient care in several ways. The goal of treatment is not only symptom improvement, but also evaluation of fitness for duty. There are administrative evaluations not conducted in the civilian sector. This course focuses on new patient evaluations conducted in the outpatient setting.

PSY 420: Rural Outpatient Psychiatry

This clinically-oriented elective provides students with exposure to rural mental health care for children, adolescents and adults in the outpatient setting. Students participate in psychiatric evaluations and develop an understanding of the etiology, presentation, diagnosis, treatment and prognostic variables of psychiatric disorders and the delivery of care in a rural setting. The reals of anxiety, affective/mood disorders, neuro-developmental disorders and psychotic illness will be explored. Through evaluations, follow-up visits and case presentations, students gain an appreciation of formulating cases with attention to biological, psychological/developmental and social/culture perspectives. Elective curriculum includes content on mental health disparities in rural areas and on Virginia's Eastern Shore. We encourage students to develop case reports with their preceptors. Students will live on the Eastern Shore during this rotation in the College of William & Mary – Virginia Institute of Marine Science cottages.

PSY 421: Emergency Psychiatry

This clinically-oriented elective provides student with exposure to Emergency Psychiatry in Sentara Norfolk General Hospital's emergency room. Students participate in evaluations of patients with psychotic, mood, personality and substance use disorders as well as lethality. The student will evaluate the need for emergent psychopharmacology and ultimate disposition.