COLLEGE OF HEALTH SCIENCES

SCHOOL OF CLINICAL MEDICINE

Discipline of Psychiatry

CMED6MH2 - MENTAL HEALTH 2

LOGBOOK
MBChB 6 - 2018
CONTENTS PAGE

BLOCK STRUCTURE 3

COURSE OBJECTIVES 3

BLOCK CONTENT 4
Information for students

CORE TOPICS 4

PRESCRIBED TEXTBOOKS 5

PSYCHIATRIC UNITS 5

ETHICAL GUIDELINES 5

D P REQUIREMENTS 6
Attendance

PORTFOLIO GUIDELINES 7
Presentation of Portfolio 7
Case Reports 8

ASSESSMENTS 9
Requirements 9
Exam Structure 9

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1. BLOCK/COURSE STRUCTURE
The duration of the block is 7 weeks. Examinations are conducted in the 7th week.
Tutorials are conducted every Monday at medical school. Attendance at all
tutorials is compulsory and will be registered. Students will be allocated to a general
hospital Psychiatric unit for 3 weeks and a psychiatric hospital for 3 weeks. General
hospital psychiatric units are located at Addington and King Edward VIII Hospitals.
The Psychiatric hospital in the EThekwini District is King Dinuzulu Hospital.

Students will be allocated to groups at the respective hospitals and will be taught in
the relevant wards and the instruction will include: ward etiquette, ethics, history
taking and clinical examination. A list of student allocations will be displayed on the
notice board outside the Undergraduate Teaching Admin office at Medical School.
NO alterations will be allowed to the student allocations. Students have to remain in
their allocated groups.

Clinical Tutorials will be conducted in the wards from Tuesday to Friday at any time
from 8:00am - 4:00pm. The mid-block long case assessments will take place from
week 4 onwards. It is necessary for the group to nominate a representative who will
liaise with the Administrator, Chantal Paul, 0312604331, paul@ukzn.ac.za and tutors
regarding any problems that may arise at each of the teaching sites.

2. COURSE OBJECTIVE
The objective of the clinical component in the 6th year of study is to equip the
students with the clinical skills to be able to identify, assess and manage a patient
with a mental health illness.

At the end of the module the student should be able to acquire or improve the
following skills:

1. Elicit, identify and interpret clinical signs and symptoms using psychiatric
terminology

2. Take, record and present a comprehensive case history

3. Draw up a list of differential diagnosis and a working diagnosis with factors

for and against using DSM V criteria and terminology

4. Request and interpret necessary special investigations

5. Clinically manage common psychiatric conditions

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6. Understand and manage psychiatric disorders within a bio-psychosocial
framework

7. Know and utilize the resources of the community including social welfare
services.

8. Acquire knowledge of the laws and ethics relevant to psychiatric practice

9. A sound knowledge of the principles of psychopharmacology including

the appropriate use of psychotropic drugs, dosages, side-effects and drug
interactions.

10. An understanding of the Principles of Psychopharmacology in the elderly

and physically ill patients who have concomitant psychiatric disorders.

11. Basic problem solving and counselling skills

INFORMATION for Students

 During your rotation you are expected to familiarize yourself with the
admission procedures, psychiatric emergencies and the assessment and
management of all in and out patients in the rotation to which you have
been allocated.

 You must be able clerk new patients as well as stable out-patients

 You are expected to join a team in the ward to which you have been
allocated and familiarize yourself with all that registrar’s patients.

 You are expected to read around your cases and participate actively in
the ward rounds. Attendance is therefore compulsory.

 Discuss all cases with your registrar and have a good understanding of the
drugs utilized in that patient the dose of the drug/s and the results of
investigations that were undertaken.

3. CORE TOPICS
1. Psychiatric Emergencies
2. Mental Health Care Act
3. Schizophrenia Spectrum and other Psychotic disorders
4. Depressive Disorders
5. Anxiety Disorders
6. Trauma and stress related disorders

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7. Bipolar and related disorders
8. Substance Related and addictive disorders
9. Neurocognitive Disorders
10. Neurodevelopmental disorders
11. Neuropsychiatric Manifestations of HIV
12. An approach to Psychotherapy
13. Neuropsychiatric Manifestations of Epilepsy
14. Somatic Symptom Disorder
15. Adjustment Disorder
16. Feeding and Eating Disorder
17. An approach to Insomnia

4. PRESCRIBED TEXTBOOKS
1. Oxford Textbook of Psychiatry for Southern Africa
Second edition
Edited by Jonathan Burns and Louw Roos

5. PSYCHIATRIC UNITS
Students will be allocated to a consultant according to a roster on the notice
board outside the Undergraduate office, main admin building on the 4th floor.

1. Addington Hospital,
Ward O4A

2. King Dinuzulu Hospital

Psychiatry Seminar room

3. King Edward VIII Hospital

Ward A

6. ETHICAL GUIDELINES FOR STUDENTS

1. Students should identify themselves to the nurse in charge of a ward and

request her permission to enter the ward.

2. Students must obtain permission from patients prior to examining them.

3. Do not phone or visit relatives of patients for collateral information.

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4. Do not divulge any information about patients. All information given to
you by patients must be regarded as confidential.

5. You must wear ID badges or lab coats. Failure to do so will result in you
being denied access to patients.

6. Do not divulge your personal details (address, telephone no’s ) to patients.

7. Please be cognizant of meal and visiting times in the ward.

7. DULY PERFORMED (DP) REQUIREMENTS

Attendance
1. Attendance of this block is compulsory. During the seven weeks you will
spend in Psychiatry, you will be expected to be present in the department from
08h30 to 13h00 every Monday and from 08h00 to 16h00 Tuesday to Friday at the
allocated hospitals.

2. Attendance will be registered at:

 Consultant ward rounds
 Registrar ward rounds
 Grand rounds
 Tutorials

3. A minimum of 80% attendance is necessary at all of the above in order to

qualify you to attend the end of block and end of semester exams.

4. Non- attendance must be accounted for in writing to the consultant by a

medical certificate. Absence will only be condoned for legitimate reasons.
Students will be required to make up for missed tutorial/lectures.

5. Each student will have a log book which must be presented to the
Consultant/Registrar/Medical officer to sign on the day of the tutorials. It is the
responsibility of the student to ensure the log book is signed on the day of the
ward round/intake/case presentation. No signatures will be given retrospectively.

6. Since optimum clinical exposure is necessary to achieve clinical

competence, any student who fails to attend at least 80% of the academic
programme may not obtain a DP even in the presence of a valid reason.

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PORTFOLIO GUIDELINES

1. You are required to clerk at least one patient from following diagnostic
categories:
1. Schizophrenia spectrum and other psychotic disorders
2. Depressive Disorder
3. Bipolar related disorders
4. Substance related and addictive disorders
5. Any other disorder

2. Students are expected to submit their portfolio of five (5) cases. Failure to
comply with any of the above will result in the student not being granted a DP
certificate.

3. These patients must be followed up and daily records must be made in

your case portfolio until the patient is discharged or your rotation is completed.

4. Students who do not hand in their portfolios will be denied a DP certificate.

Students must have their portfolios on hand every day.

5. Note in particular, that your learning should be built around typical clinical
presentations, rather than diseases. That is: The approach to and differential
diagnosis of patients presenting with psychotic , mood , anxiety and cognitive
symptoms rather than learning facts about this disease or that disease. This is how
your exams will be constructed.

Presentation of the Portfolio:

The Folder:
1. All sheets must be neatly inserted into a file. Cases must be separated with
cardboard inserts. Loose sheets are not acceptable.

2. Portfolios may be legibly hand written or typed.

3. The front cover or first page must contain the students name, student
number, Hospital and dates of the block.

4. This next page must contain a plagiarism declaration.

5. The next page must contain a numbered list of the patients and their
diagnoses. The actual case reports follow.

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The Case Reports:
1. Each case in the portfolio should consist of a focused history, examination
findings, clinical assessment and problem list (which includes the differential
diagnosis) and relevant laboratory plus radiology results. It will also contain follow
up notes detailing the patients clinical course and management to the point of
discharge. When clerking of patients seen by you on a single occasion without
ongoing follow up will not suffice and indeed will risk you failing the portfolio.

2. Each case must represent a patient who was properly interviewed and
examined by you. The emphasis of the assessment is upon your engagement with
the patient over the course of his/her illness. Incorporation of material merely
copied out of hospital notes will result in failure, and if done dishonestly, or copied
from another student or fabricated, will constitute a serious offence.

3. Case reports should not be lengthy dissertations and preferably not more
than 2-3 pages per case. It is important to note that your understanding of the
clinical cases in the portfolio will be assessed and not the aesthetic appearance
of the content.

4. You are welcome and encouraged to follow each report up with

additional resource material, such as relevant articles or your own notes, but note
that everything in your portfolio is examinable in the context of your patient even
the extra information. If you include it you must be prepared to discuss it, not as
freestanding information, but in terms of how it relates to your patient.

5. Your portfolio itself will not be marked. All your marks will come from your
ability to discuss the patient’s records verbally in an oral interview. Do not waste
time making the actual folder look beautiful. Your job is to have clerked the
patient properly, thought carefully about how the history and physical findings
relate to the problem list you drew up.

6. Use your experience of clerking the patient to decide what you do and do
not know and take steps to improve your knowledge and skills, and to have used
the opportunity to follow the patient’s course until the time of discharge and see
how this relates to the investigations, management and prognosis.

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8. ASSESSMENTS
Your portfolio contains details of patients whom you clerk and upon whom you
base your self-directed learning. This portfolio will be assessed in the final week of
your block via a dialogue between yourself and an examiner.

Requirements:
You will need to have minimum of 5 cases by the end of the block. 2 cases will be
examined in an oral examination by the Department of Psychiatry. You should be
able to explain your case confidently and discuss any aspect around the case
including the clinical assessment, diagnosis, investigations, management and any
complications which may have arisen.

We expect you to be able to:

 Discuss a relevant differential for each presenting complaint, ordered by
probability, given the context of the patient and the environment in which
we practise.
 Describe clinical features (history and/or examination findings) that would
help you differentiate between the different causes of each complaint.
 Formulate a short list of relevant, cost-effective investigations that would
assist you in determining the specific cause (diagnosis) of each one of
these complaints.
 Anticipate and interpret the results of the investigations you have selected.
 Recommend appropriate management and comment on the course of
the patient as observed by you.

There are three (3) individual components that need to be passed independently.

1. Continuous Assessment (in block) - 30%

2. Clinical component (EOB) - 40%

3. Theory component (EOB) - 30%

The continuous assessment will comprise of:

1. A directly observed assessment of attitude, patient engagement and
verbal communication skills 5%

2. A directly observed assessment of history taking skill

5%
3. Long Case examination - 20%
You will be expected to clerk and present a patient who will be allocated to you. You will
be expected to do a full case presentation according to the Maudsley Clerking format
(which you are familiar with) after which you will be assessed and questioned around the
case.

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Clerking time : 60 minutes
Consolidation time : 15 minutes
Presentation time : 20 minutes
Question/comments : 10 minutes

Mark Allocation for Long Case

History MSE - 0%
Differential Diagnosis - 40%
Final Diagnosis - 10%
Management - 50%

The long case examination is formative as well as summative. You will receive feedback
from the examiner although your actual mark will not be revealed.

The Clinical component will comprise of:

1. Written and Clinical OSCE - 20%

2. Portfolio - 20%

The Theory component will comprise of:

MCQ - SBA

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