To the Editor: We are writing to describe a pilot study training medical students in a telepsychiatry developmental-disabilities clinic. Physicians are not sufficiently trained to care for individuals with developmental disabilities (DD) (1, 2). DD are severe, chronic disabilities, such as intellectual disability, autism, or cerebral palsy, that begin before age 22 (3). Parents of children with DD report that physicians do not understand their child's condition (4), and doctors state that children with DD are harder to treat than other individuals with special healthcare needs, such as those with diabetes or congenital heart conditions (5). A previous article described how a telepsychiatry clinic that specializes in the treatment of patients with DD can be used to train general psychiatry residents and child psychiatry fellows (6). The results suggested that those with less clinical experience, in this study, the residents, benefited the most from the training. In response, our division introduced a brief training intervention for third-year medical students, hoping to make an impact earlier on.

The Cedars Sinai Telepsychiatry Developmental Disabilities Clinic has ongoing clinics with patients from rural California communities who lack access to local psychiatric care. The clinic uses a collaborative consultation model, and patients are treated by their primary-care doctors. The room set-up allows for approximately eight trainees, including residents, fellows, and medical students for each clinic.

During their 6-week psychiatry clerkship, students rotate through the clinic for two sessions on consecutive weeks. The sessions are 2 to 3 hours long. In the training, the students review medical records, observe patients during clinical appointments, take part in discussions of patients' treatments, and write mental status examinations (MSE) based on their observations. At the end of each session, they discuss their MSEs and impressions with the attending child psychiatrist. The study compared the first and final day MSEs for appropriate descriptions. Also, students' attitudes to this population were surveyed before and after the training in a questionnaire developed for this study. This study was approved by the IRB, and participants provided informed consent. Participants were third-year medical students scheduled to participate in telepsychiatry. The MSE was utilized as a structure for teaching students by directing and prompting their observations and for understanding of those patients who had language, cognitive, or other limitations. The discussion with medical students focused on describing patients in a humanistic, person-centered manner. Residents rotating in this clinic were previously noted to overuse psychiatric jargon to describe patients, such as "paucity of speech" to describe a child with autism who had limited communication skills. Also, residents noted characteristics and symptoms that were absent in a patient (e.g., no speech, no insight, no paranoia), rather than describing what was present (e.g., happy; interacts with parents, uses some sign language).

The MSE given to the medical students had five separate categories: 1) general appearance and behavior; 2) affect; 3) cognition; 4) thought process; and 5) thought content, with key "areas-to-observe" listed in each category. For example, under "general appearance and behavior," the instructions included "Describe how the patient interacts with caretaker." Each section had designated space to write. Students completed this during each patient interview, which was 30 to 60 minutes long. Two child psychiatrists not involved with the intervention or data collection independently rated MSEs written during the first and second training session, using a rubric designed for this study. They were blind to whether the MSE was from the first or second session. During different points in the year, six groups of students participated in our study, yielding 17 total participants. Of the 16 who reported demographic and education information, 9 were students from UCLA, and 7 were from USC; 9 were women, and 7 were men; 12 students had at least some previous experience with people with DD. For seven of these students, this included exposure to patients. The MSE ratings did not improve (Z [15]=—0.342; p>0.05). In fact, more than half scored an average of at least 4.5 out of 5 on their MSEs from the first training session, indicating that they were already able to successfully complete the training. This was consistent with the attending physician's observations during the training itself. Participants expressed positive attitudes toward the rotation.

The most valuable aspects of the training were exposure to child psychiatry, exposure to patients with DD, and the opportunity to discuss cases with the attending child psychiatrist. Students suggested providing reading materials about the conditions seen, and having more space for visitors to observe. After the training, students felt that assessment of patients with DD was not as difficult as they had initially thought it would be, but showed no other changes in the attitude survey. Students' MSE performance did not improve from their initial to final assessment. This is likely due to the unanticipated high baseline capabilities demonstrated in the first MSE they wrote. Reasons for this may be that, given a specific written guide to describe what they see and sufficient time and space to do so, students can accomplish this without having to be "taught." The attending psychiatrist may then help them learn to use their observational skills to assess and understand a patient further. This pilot study has obvious limitations, such as the use of nonvalidated measures, small sample size, and lack of a comparison group. Also, the MSE done in the first training session was completed during the training itself and contained instructions on the sheet, and therefore was not a true pretest of their abilities.

Hopefully, future studies can better evaluate effective time-limited training exposures with this population and accurately assess how they affect medical students. Telepsychiatry can provide new opportunities for medical students to be exposed to specialty populations that are currently unavailable to them in traditional clinics. Also, telepsychiatry creates a "bedside" teaching setting with these distant patients and may also increase student participation in discussions (7). This type of teaching intervention requires few additional educational resources and has the potential to integrate successfully with existing telemedicine programs.