1. PSYCHIATRY DEC 17,2013 MEC REVIEW

2. RECOMMENDATIONS Update Objectives - done Update Essential skills/conditions language – done Essential skills/conditions – delirium. Learning Tools Learning Environment/Activities Residents as Teachers

3. DELIRIUM New Hampshire Hospital: The admissions process actively screens out patients with delirium. NHH assigned students (max of 32 per year) do call at DHMC and may see this condition in this setting. However, that is not reliable enough to have this as an essential condition. Therefore, we would petition the MEC to reassign delirium to an alternative clinical service (eg medicine or surgery).

4. LEARNING ASSESSMENT TOOLS Recommendation Consider Mini-CEX Considering: Oral Board model - Last week of clerkship 30 min interview 5 min student prep 10 min presentation 10 min feedback 4 trained evaluators To standardize evaluation and feedback Formative and Summative feedback (12.5 points) Reporter skills (5 pts) Interpreter (2.5 pts ) Manager Early (2.5 pts) Proficient (2.5 pts)

5. LEARNING ENVIRONMENT/ACTIVITIES Recommendation: Outpatient : “enhance experience across sites.” Current schedule : DHMC – ½ day in the same clinic across 5 weeks. NHH – ½ day at Heater Rd Primary Care. VA – 1 full day at WCBH Claremont. CPMC – ½ to 1 full day in child clinic. Working toward: DHMC – working with attendings and residents on more active student role. NHH – adding an additional ½ day in another DHMC based integrated clinic (GIM or OB/GYN) VA – re-new student involvement in PMHC walk-in clinic – which has received the 2005 American Psychiatric Association Gold Achievement Award and the 2007 VA Advance Clinical Access National Champion Award. CPMC – actively working with Dr. Chung to expand this experience. Site visit planned for March 2014

6. LEARNING ENVIRONMENT/ACTIVITIES Recommendation: Didactics : “more interactive” Current schedule : DHMC/NHH/VA – ½ day all together each Friday 1 -4pm. Case centered discussion based is the goal. But drifts back to power point format CPMC – 2 students with Dr. Chung, very case based (no need to change) Considering: DHMC – 3 sessions will change to SBM-like live patient interview and discussion. (students interview) Mood disorders - Dr. Holtzheimer Psychotic disorders - Dr. Noordsy Substance use - Dr. Nordstrom NBME review session (as we are starting to see a downward trend in average test scores)

7. LEARNING ENVIRONMENT/ACTIVITIES Recommendation: Assignments : “checklist” AssignmentDue dateTo whom Resilience reflection paper 7pm the Thursday before the Friday resilience session Drs. Duncan and Frew Health Care Systems reflection paper 7pm the Thursday before the Friday HCS session Drs. Duncan and Frew Critical Thinking Write-up (DHMC and VA) Emailed the Tuesday before their assigned presentation date Drs. Riblet and Wilson Clinical Write-ups (look like the critical thinking write-up and include a self-reflection paragraph at the end – see page 11 of syllabus for details) Need to complete 2 by the end of the rotation. The first is due at the mid-point feedback and the second is due on the final Friday of the rotation. Attending Physicians (First write- up will be graded by either Dr. Duncan or Dr. Frew. The second is to be graded by your unit attending.)

8. LEARNING ENVIRONMENT/ACTIVITIES Recommendation: Call hours : “more equitable.” Current schedule : Call is 5pm to MN DHMC – 3 nights NHH – 2 nights at DHMC 2-3 admission nights at NHH – end before MN VA – 2 nights at DHMC and phone call for VA CPMC – 4 nights. Changes already made: NHH and VA – used to have a 12 - 24 hour weekend call. Now is an 8 hour shift more on par with evening call.

9. RESIDENT AS TEACHERS Recommendation: “Assure distribution of policies and objectives” Consider Survey Monkey to track and document. Changes: Chris Bolka is working with pediatrics coordinator to implement the same system.