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Student Experiences with Competency Domains During a Psychiatry Clerkship

Received September 18, 2007; revised February 8 and May 6, 2008; accepted May 20, 2008. Dr. West is Associate Professor, Department of Psychiatry, Dartmouth Medical School; Dr. Nierenberg is the Senior Associate Dean for Medical Education at Dartmouth Medical School. Address correspondence to Donald Allan West, Dartmouth Medical School, Psychiatry, DHMC -Psychiatry Level 2, # 1 Medical Center Dr., Lebanon, NH 03756; donald.west{at}dartmouth.edu (e-mail).

OBJECTIVES: The authors reviewed medical student encounters during 3 years of a required psychiatry clerkship that were recorded on a web-based system of six broad competency domains (similar to ACGME-recommended domains). These were used to determine diagnoses of patients seen, clinical skills practiced, and experiences in interpersonal and communications skills, professionalism, practice-based learning and improvement, and system-based practice. The authors aim to understand how students are learning and growing in these domains and to modify the clerkship in an ongoing manner. METHODS: Data were collected from the Dartmouth Medical Encounter Documentation System (DMEDS) for all student encounters in required third-year psychiatry clerkships during academic years 2004–2007, in which students had intensive involvement in patient care. RESULTS: One hundred seventy three students reported a total of 4,676 patient encounters, averaging 27.2 encounters per student and 1.8 psychiatric diagnoses per patient. Students met "learning targets" for anxiety disorder, bipolar affective disorder, depression, personality disorder (borderline), posttraumatic stress disorder, psychosis, schizophrenia, and substance abuse (alcohol), but not for disorders more likely seen in outpatient settings. For the 10 counseling skills learning targets, students only met those for family issues. In the four "newer" competency domains, students reported struggling with issues in 0.3% to 12.6% of encounters. Students documented being challenged by professionalism issues most often and recorded examples of how these competencies played out for them during the clerkship. CONCLUSION: Use of a required web-based medical encounter reporting system for student-patient-faculty encounters during a psychiatry clerkship can be of significant value in assessing what students are seeing, doing, and learning on this required third-year experience. The results provide helpful current information to the clerkship director and data that help the director modify the clerkship on an ongoing basis to better meet students’ educational needs.

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