July 1, 2010

A Guide for Clinical Year USM [Psychiatry posting]

Peace be upon all of you,

Even though psychiatric is being categorized as minor posting, I would rather consider it as major posting because you will spend 4 week during fourth year and 2 week during fifth year. Furthermore, psychiatric case will be tested in long case during professional III examination.

It is a very challenging posting as you are dealing with patient from very mild neurotic cases until severe psychotic cases.

During my time, I was nearly hit with a small table by bipolar patient who was in manic phase. My friend was nearly kissed by a manic patient while some of us even were being attacked by psychotic patient.

However, do not get afraid with all of this. Take it as a challenge. Knowing the underlying psychopathology is very interesting and it makes us think how beautiful our life is. Plus, you will learn a lot from them.

My perception totally changes during this four week course. Initially, I have some prejudice towards them. I am so afraid of them. I still remember that I use to run away from this group of people when I see them at the street.

Ok, now let us get back to the business,

This is what you should prepare for this posting

a) Guide book in Psychiatry by Psychiatric dept.

This book will be given on first day you are registered as 4th year med student. It will guide you on what topic to be stress on, nice to know topic and what should you study during this course.

b) Clerking guide on psychiatry

i. Before you are able to ask question fluently, you absolutely need a template to guide you. Trust me, there are a lot of thing to be covered in history taking. Even me myself still could not fully master the art of history taking in psychiatry. You will not going to get a correct diagnosis if your technique is not correct.

ii. You may get summary of the template for history taking inside the guideline book. Plus, there are few clerking template made by seniors which is for me is marvelous. You may get it from your senior later.

iii. Make sure you familiar with mini mental state test, clock drawing test.

c) Reference book

i. Kaplan & Saddock Pocket Handbook of Clinical psychiatry (I Love this book so much. Very easy to understand.

ii. Oxford textbook of Psychiatry ( I used this book as a compliment for Kaplan& Saddock)

iii. Our department also has published their own psychiatry textbook. For me, I seldom use it but it is good for master student because it has guideline on how to submit a paper. You may buy this book from department if you are interested.

iv. There are few other thick textbook if you wish to know more about psychiatric. However, three books that I have mentioned earlier should be enough for us.

Requirement for the Posting

a) Case presentation

i. You need to present total of 10 cases from USM and HRPZ. Some doctors may just want you to present history of presenting illness; some of them only want the summary. However, occasionally, you will need to present the whole thing.

ii. You need to be pro active to present the case as few of our colleagues fail to finish it and they are not qualified to sit for end posting exam. You may present it to Master student or specialist.

b) Clinical teaching

iii. There will be also a clinical teaching every week which require one of you to present the whole case to the class. You also may get the signature for case presentation from this session.

c) Log book

i. One of the component already being mention in above section (case presentation)

ii. Procedures (10)

iii. Seminar presentation (1)


Every week, you will go to HRPZ once a week. Please check your time table on what day you will go there. You need to book the transportation and inform the doctor in charge there.

Trust me, case there are very interesting. Plus, it will give you headache too. Many of them are still in acute phase and it is so difficult to elicit history from them.

There is also lots of Electro convulsive therapy (ECT) being performed in HRPZ. So you will have plenty of opportunity to observe it.

If you want to go there outside the arranged time, you need to ask permission from HRPZ- in charge person before go there.

e) Ward rounds

During ward round, you may observe doctors do morning counseling to the patient and discuss the management of the patient.

f) Clinics

Most of the time, patient in clinic is stable one or neurotic cases. You may clerk them and present the case to the MO to get a signature. And, take time to clerk full history of neurotic case as you need to write a case write up later.

In the clinic, you may also perform depot injection (IM Injection anti psychotic drug), observe the urine drug test, and do counseling.

g) Seminar

Each of you will be divided into small group to present seminar topic. Therefore, each of you will have a chance to do a presentation. Divide yourself accordingly and discuss with the tutor on what aspect you should cover.

Attendance is COMPULSARY.

h) Department Case Presentation

Four students should pick a case and discuss it in class. Discussion comprise of history taking, physical examination, mental status examination, problem list, differential diagnosis, diagnosis, management and discussion about the case. All presentation must be aid with power point.

i) Visit to Drug Rehabilitation center

Please prepare for this session earlier than the date you suppose to go there. There, you are either to give speech on certain health topic or divide yourself into a small group for discussion session with the detainee.

If you want to give health talk, do not choose topic like smoking, HIV because they have been exposed TOO MUCH on this topic and they are very bored with it.

j) Community program

You are either go to psychosocial rehabilitation center or conduct or program with a theme of psychosocial health for secondary student. This session depend on posting co-coordinator. During my time, we were required to conduct a stress management camp to form three students. Some of my friend went to school to identify learning problem among the student.

k) Case write up

You need to submit two case write up to your supervisor. (1) Neurotic case and (1) psychotic case. Submit it early to avoid problem.

Psychotic means= schizophrenia and its variant and mood disorder.

Neurotic means = other case like anxiety disorder, obsessive compulsive, etc.

l) End posting exam

i. Clinical (depend on lecturer either short case, long case or case discussion)

ii. MCQ

Notes: No on-call for this posting.

Others tips

1) Your leader must arrange a briefing session with block coordinator and nurse in charge at clinic for briefing (rotation) and briefing (clinic and ward)

2) Please keep your distance with your patient at least one arm length.

3) Avoid close contact with patient. Try to avoid if they want to hug you. Some of the patient might invite you to talk in room like pantry. If you follow them, make sure that the door is open.

4) Do not pressure patient especially when they are becoming restless. Angry patient will show sign like they start staring at you, raise their voice, clench their fist, punch the table or threatening you

5) If patient keep wandering around ward, it means they are agitated. Be careful with them especially when you want to interview them.

6) Back off if you suspect that they will attack you.

7) If you are being attack, call for help.

8) For male student, when you are interviewing female patient, keep your distance and be careful. Most of them have intense sexual desire during this time. Don’t be surprised if they hug you, kiss you or even put off their clothes.

9) For female student, it is safer for you to clerk the patient with your partner. Do not go alone except neurotic or stable patient in clinic.

10) Do not entertain patient who ask cigar or alcohol from you

11) Some of them are requesting your phone number or want to borrow your hand phone. There is no right or wrong answer for you to entertain them. It’s all depending on your judgment.

12) Finally, DON’T DISCRIMINATE them as they are also your patient. Be patient with them and do your best to ease their suffering.

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