Medical Student Education Program in Psychiatry and Behavioral Medicine

The third year medical student clerkship at the Medical College of Wisconsin is a four week rotation, working with psychiatrists and other mental health providers at Froedtert Hospital, Children’s Wisconsin, Froedtert Menomonee Falls Hospital, Rogers Hospital, Milwaukee County Behavioral Health Division, Columbia St. Mary's-Ozaukee and the Clement J. Zablocki VA Medical Center. The clinical settings for the rotation include a wide variety of opportunities. Students may be assigned to assist attending psychiatrists in the following settings:

• Inpatient psychiatric units. Students work in either an adult or child and adolescent inpatient unit. The inpatient settings include the Clement J. Zablocki VA Medical Center, Rogers Memorial Hospital, Milwaukee County Behavioral Health Division, and Froedtert Menomonee Falls Hospital, Columbia St. Marys-Ozaukee Campus.
  
  
• Psychiatry consult liaison teams, which serve patients at Froedtert Hospital and at the Clement J. Zablocki VA Medical Center.
  
  
• Emergency Psychiatry. Students can work at the Milwaukee County Psychiatric Crisis Service, a full service psychiatric emergency department, where they have the opportunity to assess and manage emergent psychiatric conditions.
  
  
• Outpatient psychiatry clinics. Several of the sites include weekly outpatient clinic experiences for the students. There is also a rotation for students to work full time in an outpatient clinic at the Clement J. Zablocki VA Medical Center.

Students receive instruction and work alongside psychiatrists at each site. Students also receive a series of didactic lectures by adult and child psychiatrists. The clinical experiences and lectures together help teach students to recognize the difference between emotional problems and mental illness, demonstrate the ability to perform a psychiatric interview that will lead to a formulation of the problem and method of intervention, list major psychiatric diagnostic entities and apply them to case histories, learn about psychotropic medications, learn different modalities used in hospitals to treat patients, and demonstrate the ability to talk with ease to patients who have emotional problems, and effectively manage psychiatric emergency situations.

Adolescent Residential Treatment
M4 Adolescent Residential Treatment. This elective deals with struggling adolescents and young adults with psychiatric illness such as anxiety, mood disorders, eating disorders, ADHD and many others. FOCUS Adolescent Residential Treatment Unit is at Rogers Memorial Hospital’s Oconomowoc Campus serving youth ages 13-17 with a multidisciplinary approach to patient care in a longer term (average length of stay is 2 months). Students will actively participate in treatment.

Consult-Liaison Psychiatry
The Psychiatric Consultation Service at Froedtert Hospital sees approximately 1,000 new consults an academic year. Medical students will have the opportunity to see new and follow-up cases and in doing so will increase their clinical knowledge of the medically ill psychiatric population, as well as improve interviewing skills. Daily clinical rounds and supervision with attending PM psychiatrists provide a great deal of clinically relevant education as students will see a wide variety of complex patients experiencing significant medical, surgical and psychiatric comorbidity. With patient interaction and clinical rounds, it is expected that students will be able to describe psychiatric illness that occur in the medically ill population or due to the treatment of medical illnesses, as well as describe treatment options available in this population. Medical students will also have the opportunity to work closely with the general adult psychiatry residents (PGY III) and the Psychosomatic Medicine fellow. Weekly psychosomatic clinical case conferences, as well as Department of Psychiatry Grand Rounds, are also mandatory educational experiences for medical students on service.

CIU AI
The Complexity Intervention Unit (CIU) is a medical unit at Froedtert Hospital uniquely designed to care for patients with acute medical and psychiatric needs. The CIU is a specialized medical unit that aims to provide collaborative multidisciplinary care. The unit is staffed each week by physicians boarded in both psychiatry and medicine or a combination of medicine hospitalists and consult-liaison psychiatrists. The goals of the unit are to provide comprehensive care by nursing, social work, pharmacy, and physician staff, thereby coordinating a truly biopsychosocial approach to the care of the whole person. The unit will provide a safe environment to care for patients with acute psychiatric needs by a team of providers and staff specialized in the care of both medically and psychiatrically ill patients.

The Complex Intervention Unit Acting Internship enables senior medical students to acquire knowledge and skills in caring for patients with complex medical and psychiatric issues. This is a one-month inpatient clinical experience where medical students will work with physicians dual-boarded in internal medicine and psychiatry, internal medicine hospitalists, and consultation liaison psychiatrists. Medical students will work alongside third-year medical students and residents, being integrated into a coordinated team of nursing, pharmacy, and social work professionals to provide care to patients with complex medical and psychiatric needs. They will participate in diagnostic evaluations, treatment planning, and coordinating care for patients. Each day, they will participate in multidisciplinary team rounds. They will be able to lead patient interviews and write notes. The rotating students have opportunities to participate in the therapeutic recreational activities of the unit, which will provide them with a unique experience during their medical school training, allowing them to observe a variety of therapy modalities utilized in this patient population. Additional learning opportunities will include attending the Department of Psychiatry’s Grand Rounds on Wednesday mornings.

Emergency Psychiatry
This rotation is useful to all students, and may be especially helpful to those who have defined an interest in psychiatry, emergency medicine, or any of the primary care specialties. It is an experiential-based service where students are permitted to progress at their own pace to the point of being the first contact for patients in crisis. There is extensive one-on-one supervision by the staff psychiatrists. Opportunity also exists for time with the Mobile Crisis Service, Walk-in Clinic, Crisis Line, Observation Unit, and Crisis Respite House in the community for interested students. You will have the opportunity to enhance your diagnostic interviewing skills focusing on acuity and the acute precipitant, gain familiarity with techniques of crisis intervention, and expand your understanding of laws regarding involuntary psychiatric hospitalization, and improve familiarity with community resources.

Pediatric Psychiatry
Students will observe and perform inpatient and outpatient psychiatric consultations on children and adolescents. You will be expected to write-up at least two psychiatric cases. You will attend weekly rounds and a weekly consult/liaison case conference. You will also be expected to do a literature review and a short talk on a topic of interest. Goals: to be able to perform a mental status assessment on children and adolescents, to develop knowledge and skill in differential psychiatric diagnoses in children and adolescents with pediatric psychiatry illnesses. To develop the skill of presenting a case and increase knowledge of literature. And lastly, to develop compassion for children and adolescents without over-involvement and appreciate the impact on families of pediatric psychiatry disorders.

Psycho-oncology
The MCW Psycho-Oncology Clinical Elective helps the senior medical student to acquire knowledge and skills in the psychosocial care of cancer patients. This is a one-month outpatient clinical experience where students will work with the multidisciplinary psycho-oncology team and have exposure to both medication management and psychotherapy for the cancer patient. Students will join cancer psychiatrists, Drs. Knight and Molinaro, for their outpatient clinics where they will take part in diagnostic evaluation, treatment planning, and coordinating care for patients with a variety of cancer types and at different stages in their treatment course. They will be able to lead patient interviews and write notes. The rotating student will join our multidisciplinary psycho-oncology therapists, which will provide them a unique experience in their medical school training to see a variety of therapy modalities that are utilized in this patient population. During this experience, students will also present a topic of interest in Psycho-Oncology to this group of providers. Additional learning opportunities will include attending the Department of Psychiatry’s Grand Rounds on Wednesday mornings, MCW Cancer Center Grand Rounds and Seminar Series (as appropriate), and elective participation in psycho-oncology research.

Psychiatry Acting Internship
Students in this rotation have daily one-to-one interaction with faculty. They may participate in student lectures series and in ongoing psychopharmacology drug studies. They will gain inpatient psychiatry experience working in a team-oriented system and operating in a more independent capacity in the evaluation of patients.

Psychotherapy Concepts for Future Physicians
The Department of Psychiatry and Behavioral Medicine's elective, "Psychotherapy Concepts for Future Physicians," is for students who will be entering any medical specialty. The course will introduce and apply psychotherapy principles and frameworks and will include the review and in-depth discussion of different types of psychotherapy.

Through live seminars, case conferences, video recordings, readings, and reflection work, students will learn about concepts that are central to psychotherapy but are also present and impactful in many patient encounters. These include attachment styles, countertransference, defense mechanisms, cultural competence and sensitivity, and the impact of lifestyle choices on patient health. Greater knowledge about these concepts will allow future physicians to understand, and connect with, their patients in a deeper and more nuanced manner, thereby decreasing burnout, enhancing doctor-patient relationships, and improving health outcomes.

Students will also learn about specific theoretical orientations, such as psychodynamic psychotherapy, cognitive behavioral therapy, acceptance and commitment therapy, and dialectical behavioral therapy. Treatments for specific populations and diagnoses will be explored, including couples and families, children and adolescents, older adults, and individuals with obsessive-compulsive disorder, post-traumatic stress disorder, eating disorders, insomnia, substance use disorders, and prolonged grief disorder, among others. Awareness of these therapeutic approaches will allow future physicians in any specialty to speak knowledgably with their patients about psychotherapy treatment and make appropriate and thoughtful referrals.

Recovery Across the Mental Health Treatment Continuum
Recovery Across the Mental Health Treatment Continuum is an elective experience for students with a strong interest in the delivery of mental health treatment and are seeking an opportunity to develop a unique exposure and exploration of the continuum of care. Through a collaboration between the student and course director, identifying high interest topics, a schedule is created to allow the student to experience a wide range of clinical, organizational, and holistic mental health services.