Acad Psychiatry 33:80-81, January-February 2009
doi: 10.1176/appi.ap.33.1.80
© 2009 Academic Psychiatry
Medical Student Participation in an Adult ADHD Outpatient Clinic: An Ideal Setting for Education in Outpatient Psychiatry
Martin W. Wetzel, M.D., Department of Psychiatry, University of Nebraska Medical Center, Omaha
To the Editor: Concern persists regarding medical students’ opinions of psychiatry, the quality of psychiatric education, and subsequent long-term attitudes toward patients with mental illness (1). Studies indicate medical students’ opinions are influenced by preconceived ideas and the types of patients they encounter (1–3). Medical students highly value outpatient psychiatric care experiences in primary care settings, but most training occurs in inpatient programs, community mental health centers, and consultation-liaison services (4), where students see patients suffering from chronic, severe, and disabling conditions that represent a minority of illness prevalence (5). Medical student training that is limited to these settings is more likely to reinforce negative attitudes among trainees (6). Most academic settings limit opportunities to witness the successful, long-term outcomes typical of most psychiatric care and may bias student perceptions about mental illness outcome (4, 6).
To address these concerns and enhance medical student psychiatric education, the University of Nebraska Medical Center (UNMC) introduced medical students into an outpatient clinic for adults with attention-deficit/hyperactivity disorder (ADHD).
Since 2006, third-year medical students have participated in the Adult ADHD Assessment Center at UNMC. Students meet patients representing a wide range of socioeconomic groups (including physicians and their families). Appointments include new assessments and follow-up visits. Students receive an orientation packet describing goals for the clinical experience, expectations of participation, and reference materials. When patients check in, they are informed of medical student involvement.
Initial assessments are conducted by faculty while medical students sit in and take notes on a template. The case is later staffed with the attending physician. For follow-up appointments, medical students greet patients in the waiting room, escort them to a room, and conduct a one-to-one interview typically lasting 10 minutes. Students obtain patient vital signs, review medications, and ask one or two high-priority discussion questions. Students are encouraged to explore the patient’s past history to expand the visit context. When the attending physician enters the room, the student gives a verbal report, and the attending physician concludes the session. The entire encounter is reviewed after the patient exits.
Adult ADHD is a common disorder, with a community prevalence of 4% of the general population (7); ADHD is also associated with comorbid anxiety, mood, and substance use disorders (8). Although the primary goal in the adult ADHD clinic is first-hand evaluation and management of patients with this pervasive diagnosis, adult ADHD outpatient clinics also offer multiple opportunities for students to treat these common comorbid psychiatric disorders.
Epidemiology studies reveal that a very high percentage of adult patients with ADHD will receive treatment for comorbid mental disorders, but not for their undiagnosed ADHD (7). For many patients, the identification and treatment of ADHD proves to be a key piece of solving a lifelong puzzle of dysfunction. As opposed to feeling "back to normal" following an episode of major depression, adults treated for ADHD often report feeling they can think normally for the first time in their lives.
Adults with ADHD typically experience good treatment efficacy (9), and students hear compelling first-hand histories of good outcomes from psychiatric treatment. In our clinic over 90% of patients allow medical student participation. Successfully treated patients with ADHD eagerly share their experiences and—as reported in other settings—patients are enthusiastic to educate future physicians about the important relevance of mental health care (10).
Medical student participation in adult ADHD outpatient clinics is ideal for student training in psychiatry. Students are exposed to a broad range of common mental health disorders with good prognoses, similar to conditions frequently seen in primary care settings. Students also hear first-hand histories of good treatment outcomes and high patient satisfaction with psychiatric services.
Medical student evaluations of this clinical experience are universally positive. Objective data are needed to assess students’ perceptions resulting from their experience and to further confirm our opinion that the adult ADHD outpatient clinic offers an exceptional educational opportunity to positively influence students’ opinions about psychiatric patients and the psychiatric profession.
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REFERENCES
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- Kessler RC, Adler L, Barkley R, et al: The prevalence and correlates of adult ADHD in the United States: results from the national comorbidity survey replication. Am J Psychiatry 2006; 163:716–723[Abstract/Free Full Text]
- Sobanski E, Bruggemann D, Alm B, et al: Subtype differences in adults with attention-deficit/hyperactivity disorder (ADHD) with regard to ADHD-symptoms, psychiatric comorbidity and psychosocial adjustment. Eur Psychiatry 2007; 23:142–149[Medline]
- Biederman J, Spencer TJ, Wilens TE, et al: Long-term safety and effectiveness of mixed amphetamine salts extended release in adults with ADHD. CNS Spectr 2005; 10:16–25[Medline]
- Doshi M, Acharya S, Wall D: Mentally ill inpatients’ experiences and opinions on seeing medical students: a questionnaire study. Med Teach 2006; 28:568–570[CrossRef][Medline]
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