Exposure of Emergency Medicine Clerkship Students to Psychiatric Emergencies
Abstract
Learning Objectives: To determine if a dedicated didactic and clinical curriculum in psychiatric emergency care would improve medical student comfort and perceived ability to assess psychiatric emergencies. It is believed these parameters would increase with this intervention.
Background: Medical students rotating in the emergency department (ED) are often discouraged or otherwise limited from seeing patients with psychiatric emergencies. Little is known about students’ perceived preparedness and comfort levels in the assessment of individuals with acute mental health related complaints.
Objectives: To determine if a dedicated didactic and clinical curriculum in psychiatric emergency care would improve medical student comfort and perceived ability to assess psychiatric emergencies. It is believed these parameters would increase with this intervention.
Methods: Over a 10-month study period, students rotating in an Emergency Medicine (EM) clerkship at a large community-based ED received 1-2 hours of EM attending-led psychiatric case-based discussions in addition to an 8-hour clinical experience with the ED behavioral health team, assessing a wide scope of behavioral health emergencies. An identical pre-and post-rotation 10 question survey (1-10 Likert scale) was given regarding their comfort level and perceived abilities to assess aspects of this patient population. Statistical assessment was performed utilizing the Wilcoxon signed rank test.
Results: Seventeen students completed this voluntary study to completion seeing a mean of 4.8 patients during their 8-hour clinical experience, about 60% presenting with acute suicidal ideation. A mean improvement in the Likert scale was noted in “comfort in evaluation and interviewing” [+1.82 (p<0.01)], “decision-making for appropriate disposition” [+2.41(p<0.01), and “screening for acute suicidal risk” [+1.76 (p<0.01)]. Similar improvement patterns of these parameters were also shown for complaints of acute mania and acute psychosis.
Conclusion: Focused education and exposure to patients with psychiatric emergencies had a positive impact on medical students’ perception of their ability to assess and manage this population. This may lead to greater preparedness among incoming EM residents.