Clinical Problems in Consultation Psychiatry

Long day on the C-L Psychiatry service. I logged 2.8 miles and 33 floors on my step counter. I barely had time to eat lunch. This post is going to be short.

We were treated to outstanding presentations on fascinating topics over the last couple of days and they were given by top-notch medical students. One of them summarized the literature on mental illness in the population of incarcerated women. The other was a great overview of catatonia.

The students put a lot of work into them. The data search was obviously thorough and their presentations were polished. They had very well organized PowerPoint slides.

They were among the best examples of Clinical Problems in Consultation Psychiatry (CPCP) learning sessions in recent memory. The CPCPs were a frequent feature in my previous blog, The Practical C-L Psychiatrist.

The CPCP was developed by a former teacher of mine, William R. Yates, MD. He was the head of the C-L Psychiatry service years ago before moving on to the University of Oklahoma in Tulsa.

He’s a part time research psychiatrist for the assessment team at the Laureate Institute for Brain Research. They do research diagnostic assessments for a variety of imaging, genetic and biomarkers studies in mood, anxiety and other brain disorders.

The CPCP format is:

A weekly case conference held Wednesdays from 8:00 a.m. to approximately 8:45 a.m. Each week, a case is selected from the Daily Review Rounds Records to illustrate a clinical problem for the next week’s meeting.  The residents are assigned dates when they rotate. The medical students are welcome and even encouraged to participate as well.

This is a practical way to approach teaching the Practice-Based Learning & Improvement Core Competency. This helps develop the habit of reflecting on and analyzing one’s practice performance; locating and applying scientific evidence to  the care of patients; critically appraising the medical literature; using the computer to support learning and patient care; facilitating the education of other health care professionals. This is applying principles of evidence-based medicine (EBM) to clinical practice.

  • Evidence-based medicine is a systematic approach to use up to date information in the practice of medicine
  • Skills are needed to integrate the available evidence with clinical experience and patient concerns
  • Application and evaluation of EBM skills will provide a frame-work for life-long learning.

Self-evaluation is vital to the successful practice of EBM:

  • Am I asking answerable clinical questions?
  • Am I searching the literature?
  • Am I becoming more efficient in my searches?
  • Am I integrating my critical appraisals into my practice?

The assigned resident is responsible for searching the literature and selecting one or two teaching papers for the conference. Presentations will begin with a review of the case, followed by a summary of the references with subsequent round table discussion.

Circulate copies of 2-4 pertinent articles to team members including psychiatric nurses and faculty. A copy machine is available in the departmental administration office. Consult staff can also assist with obtaining copies.

Presentations begin with a 5-minute summary of the case with discussion of both psychiatric and medical aspects of evaluation and management. The remaining time is spent summarizing the pertinent data in the articles. Residents and medical students are encouraged to use the case conference material as preparation for submitting a case report or letter to the editor.

Bill and a former chief resident of psychiatry, Dr. Terri Gerdes, published a paper about the CPCP (then called problem-based learning in consultation psychiatry) in 1996:

Yates, W. R. and T. T. Gerdes (1996). “Problem-based learning in consultation psychiatry.” Gen Hosp Psychiatry 18(3): 139-144.

               Abstract: Problem-based learning (PBL) is a method of instruction gaining increased attention and implementation in medical education. In PBL there is increased emphasis on the development of problem-solving skills, small group dynamics, and self-directed methods of education. A weekly PBL conference was started by a university consultation psychiatry team. One active consultation service problem was identified each week for study. Multiple computerized and library resources provided access to additional information for problem solving. After 1 year of the PBL conference, an evaluation was performed to determine the effectiveness of this approach. We reviewed the content of problems identified, and conducted a survey of conference participants. The most common types of problem categories identified for the conference were pharmacology of psychiatric and medical drugs (28%), mental status effects of medical illnesses (28%), consultation psychiatry process issues (20%), and diagnostic issues (13%). Computerized literature searches provided significant assistance for some problems and less for other problems. The PBL conference was ranked the highest of all the psychiatry resident educational formats. PBL appears to be a successful method for assisting in patient management and in resident and medical student psychiatry education.

The year that was published was the first year of my appointment to the Clinical Track faculty in the department of Psychiatry at The University of Iowa Hospitals and Clinics. I learned a lot from Bill.

And I’m confident that the students who presented their own CPCPs this week will teach many other trainees in their careers.

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