Psychiatry (clinical practice)

Code:

MI626

Acronym:

PSIQ

Keywords
Classification	Keyword
OFICIAL	Medicine

Instance: 2019/2020 - SP (of 09-09-2019 to 31-07-2020)

Active?	Yes
Responsible unit:	Clinical Neurosciences and Mental Health Department
Course/CS Responsible:	Integrated Master in Medicine

Cycles of Study/Courses

Acronym	No. of Students	Study Plan	Curricular Years	Credits UCN	Credits ECTS	Contact hours	Total Time
MIMED	276	Mestrado Integrado em Medicina- Plano oficial 2013 (Reforma Curricular)	6	-	3	30	81

Teaching language

Portuguese

Objectives

The overall objective of this course is the application and development of supervised clinical practice of knowledge, skills and attitudes previously acquired in the Psychiatric Mental Health course in the 5^th year, with particular emphasis on clinical and preventive aspects. It is organized in professional training blocks, which include tutorial practice.

The objective in the area of knowledge is to extend the topics covered in the 5^th year programme, applying them to clinical practice through tutorial monitoring of people with psychiatric disorders, developing individual capacities to carry out medical practice with increasing responsibility and autonomy.

The objectives in the field of skills include the ability development of presentation of clinical cases with autonomy in observation of a psychiatric patient, doing a clinical history and conducting an examination, establishing a diagnosis, differential diagnosis, prognosis and proposal of therapeutic orientation. It also includes bibliographic research capacity and analysis of scientific evidence.

It is also important to raise interns' awareness to aspects of the function and structure of the National Health Service, public health and in particular, the organization of mental health care in Portugal.

The objectives in the field of attitudes should value the communication capacity and the integration in teamwork with multidisciplinary collaboration, with particular emphasis on family, social, psychological, vocational / educational and medical-legal components of the mental illness framework.

One should also appreciate the need for to motivate and to strengthen the scientific basis of clinical decision-making, the methodology of self-learning and continuing education as well as the transmission of knowledge to medical students. Regular cooperation between students in scientific projects will be desirable, instilling an investigative approach early in their career.

Learning outcomes and competences

In the area of knowledge, students are expected to extend what they have learned with contents of the main areas presented in the 5^th year course, in adequacy to clinical practice.

In the scope of skills and abilities, students should gain the following results:

- Capability to develop and present clinical histories in hospital and/or academic meetings.

- Ability to conduct bibliographical research and critical analysis of the best scientific evidence.

- Ability to formulate, for the most frequent psychopathological situations, a probable diagnosis, differential diagnosis, prognosis and select and properly interpret complementary tests (interpretation of psychological assessment and biological imaging or analytical data).

- Establish a short, accurate list of problems, identifying the patient's help request, as well as assessing the urgency of the action required.

- Ability to propose psychopharmacological treatment (clinical recommendations, adverse effects, drug interaction and toxicity).

- Ability to communicate with people, developing skills of psychotherapeutic intervention (support, cognitive-behavioral, psychodynamic, family and group).

- Understanding the organization of the National Health Service and constraints that influence clinical practice and particularly mental health care in accordance with the National Mental Health Plan and Psychiatry and Mental Health Continuing Care Network.

- Ability to contextualize the patient and family, as well as refer them to the network of supportive mental health care.

The results in terms of attitudes, behaviours and values should be as follows:

- Appreciating good communication with the patient and their family (particularly in communicating the diagnosis, counseling and motivation for compliance with psychiatric treatment).

- Appreciating good communication in a multidisciplinary team (integrating the treatment plan, addressing a psychiatric problem as a team).

- Appreciating the social, psychological and educational component of mental illness.

- Appreciating the patient framework in group therapy activities and occupational therapy.

- Developing a framework for medico-legal issues in mental health.

- Motivation to deepen the scientific basis of clinical practice.

- Enhancement of self-learning and continuing medical education.

- Internalization of teaching practice as part of the medical skills.

 

Working method

Presencial

Program

In continuity with the programme defined in Psychiatric Mental Health and the 5^th year course, students should:

• Identify the symptoms and different psychopathological disorders, differentiating from normal psychological functioning.
• Identify the various frameworks of personality disorder, as well as behavioural changes or interpersonal relationships.
• Contextualize the patient in their family, work and social network.
• Evaluate and determine the functional skills of patients.
• Identify situations of individual and social risk, particularly in vulnerable groups, such as the elderly.
• Collect and integrate information in order to allow a global diagnosis.
• Determine the areas of therapeutic competence and standards for follow-up guidance.
• Identify the short, medium and long-term intervention objectives.

Mandatory literature

American Psychiatric Association; Manual de Diagnóstico e Estatística das Perturbações Mentais (DSM-5) (5ª Ed.)., Lisboa: Climepsi , 2013
Casey P, Kelly B; Fish's Clinical Psychopathology: Signs & Symptoms in Psychiatry (3th Ed.), Bristol: The Royal College of Psychiatrists, 2007
Harrison P, Cowen P, Burns T, Fazel M. ; Shorter Oxford Textbook of Psychiatry (7th Ed.). , Oxford University Press, 2017
Taylor D, Barnes T, Young A. ; The Maudsley Prescribing Guidelines in Psychiatry (13th Ed.), Wiley Blackwell, 2018
Sadock B, Sadock V, Ruiz P. ; Kaplan and Sadock's Synopsis of Psychiatry: Behavioral Sciences/Clinical Psychiatry (11th Ed.), Wolters Kluwer Health, 2014
Organização Mundial de Saúde; Classificação de Transtornos Mentais e de Comportamento da CID-10 e Diretrizes Diagnósticas e de Tratamento para Cuidados Primários. Organização Mundial de Saúde, Porto Alegre: Ed. Artes Médicas, 1998
Sampaio D, Figueira ML, Afonso P; Manual de Psiquiatria Clínica, Lisboa: Lidel, 2014
Streiner D, Norman R; Health Measurement Scales – A practical Guide to their Development and Use, Oxford: Oxford University Press, 2008

Teaching methods and learning activities

Clinical practice

Each student will have a tutor in the Mental Health area (Clinical Practice) whom they must shadow in all clinical activities for 2+1 weeks, with a total of 30 hours of contact. The goal is one-to-one teaching in which specific times of teaching and learning with constant feedback are allowed.

Students should collaborate in the clinical activity of the Inpatient, Day Hospital Liaison Psychiatry, Outpatient and Emergency Departments of CHSJ and other affiliated hospitals of the FMUP. Whenever possible, there may be an opening in the clinical internship to primary health care in a community context and in the network of continuing care (particularly in mental health).

Another priority during the period of clinical practice will be promoting involvement in research activities, stimulating the development of these capabilities, in the assumption of their applicability and continuity in the different stages of their professional career.

 

Clinical seminars

These will be developed in clinical areas less thoroughly covered in the previous year and taught by the teachers of the course (video presentations and the use of role-playing might also be possible).

Clinical cases

Each student must submit a case (from the three that are required), observed during the internship in one of the sessions programmed for this purpose, which are coordinated by a teacher. This should include history, probable diagnosis, differential diagnosis, the exams and the proposed therapeutic orientation and prognosis. The presentation should be discussed in group and with teacher/tutor. 

keywords

Health sciences > Medical sciences > Medicine > Psychiatry

Evaluation Type

Distributed evaluation without final exam

Assessment Components

Designation	Weight (%)
Participação presencial	40,00
Trabalho escrito	30,00
Apresentação/discussão de um trabalho científico	30,00
Total:	100,00

Amount of time allocated to each course unit

Designation	Time (hours)
Estudo autónomo	25,00
Frequência das aulas	7,00
Realização de Estágio	24,00
Trabalho de campo	10,00
Trabalho de investigação	5,00
Trabalho escrito	10,00
Total:	81,00

Eligibility for exams

Continuous assessment by the tutors - includes the assessment of skills acquired throughout the course preparing for improved performance, independently of the different activities. The level of knowledge and its suitability to skills (autonomy in clinical psychiatric examination, assessment of communication skills and teamwork) and attitudes (ethical and professional sense, punctuality, attendance, interest and participation, enhancing the social, psychological and educational component of the mental illness) will all be assessed. This evaluation is done by filling in a performance notebook given to the tutors at the end of the clinical internship. Tutors also supervise a group of students, noting the results of observations and actions throughout the internship. Both the quantitative aspects and qualitative performing procedures and actions (assuming the existence of a previous check-list) will be taken in to account, and these should be equally weighted in the final evaluation.

Discussion of the activity report developed during the internship - This report primarily evaluates the presentation of a clinical case followed by the student during their internship (where possible, with the practical component of supervision of the interview by the tutor).

This assessment should ideally also focus on the skills research (bibliographic research capacity, implementation of tools and critical analysis of scientific evidence), oral exposure capability and discussion of the Psychiatric and Mental Health issues. In this sense, the interest and personal commitment of students in their learning should still be considered. The importance given to the scientific basis of clinical practice should be highlighted, as well as the reframing capacity in the environment of the patient and their family. The critical sense and reflective capacity of the student should also be determined, how well they are able to integrate the patient in its broadest context, inherent to the concept of mental health taking a truly holistic view of the patient and the illness.

Final classification - Corresponds to the sum of the marks obtained in the different areas of competencies previously defined.
The minimum number of attendance is considered to be 75%.
Obtaining least than 50% in any of the evaluations means the student has failed.

Calculation formula of final grade

Distributed evaluation without final exam.
Marks above 17  will be confirmed by an oral examination.

Examinations or Special Assignments

Individual performance a clinical history per week (three in total), with further discussion with their teachers. One of these clinical histories will be selected and presented by the student. 

Completion of the performance notebook of clinical activity, over the internship.

Observation of clinical conditions and basic minimum compulsory procedures in a checklist that each teacher must have previously at the beginning of the internship in order to allow the necessary planning.

Classification improvement

There is the possibility of improving the grade confirmed by an oral examination.

Observations

Internal Evaluation of the Training Programme

After conducting a final anonymous survey of satisfaction among the students (including strengths, weaknesses and improvements) there should be a meeting with all teachers and tutors, preferably at the end of the academic year.
This course evaluation should include: overall assessment, evaluation methods and techniques involved, assessment of the teaching and learning context and of teachers' input.