for the first week of each rotation) and residents on the C/L service
and outpatient service take turns (approximately in a 1:1 ratio)
a case once per week to a faculty member.
The case is to be written up by the presenter and given to the faculty member
the day before, along with an article from the literature related to
presented case. As long as the article is scientifically interesting,
can be at some intellectual remove and still be a well-chosen article.
A photocopy of the article is also given to the a professor the day before
of the case history and the article are given out to everyone. The
student or resident presents the case for about 10 minutes, and the
topic is discussed by the presenter for about 10 minutes. Nursing and
Work services present brief summaries of their perspective on this
and then the patient is interviewed by the a professor for about 10
The patient will almost always be a current
service patient (generally on the third Wednesday of each month). The
discusses the case with the presenter and the audience, and the
psychiatrist also discusses the case.
rounds have been very
stimulating exercises for the most part, and have improved the learning
experience for the presenters and the audience. Like many other
opportunities in medicine, what people gain from the rounds is very
a function of what they put into it. Writing up the case and thinking
its scientific relatedness has been very useful to the presenters and
the audience. The challenge to the faculty member has also proved useful to
and to the people at the rounds. The patient routinely benefits from
amount of thought devoted to his or her case and life situation.
the Medical Student and Residents
have these goals:
student or resident formulate a patient’s case in a succinct and
do not have these
Relate the case
to one or two pertinent literature articles.
Give a demonstration
of one interview style.
Give a multidisciplinary
perspective on the case.
opinions and ideas about a given case.
or frighten the student or resident.
Questions that will
routinely come up in the rounds:
This will be asked by the patient as well as by the presenter. It
is left to the ingenuity of each participant to work out the answer,
the best answer is when patient, presenter, and the faculty see this as
a cooperative venture.
one fail professor’s
will routinely be asked for. If you are presenting, be prepared
discuss the criteria for the diagnosis you favor and for the diagnoses
in the differential.
The raw clinical
observations will also be asked for.
to describe the components of mental status that you have observed in
presented patient. If you say the patient is depressed, be
to describe the mood in other words, how pervasive it is, whether it is
present day and night or has diurnal variation, and to describe the
symptoms of depression. If you say a patient is in catatonia, you
will be asked to describe specific observations describing the
often come up. Typical questions have to do with receptors and
sites involved with different antidepressants and antipsychotic
Steve Stahl’s textbook, Essential
Psychopharmacology, has more than you need to know.
It is important
to gather as much pertinent history as possible. Old records are
If imaging studies
have been done, you will be asked about the anatomical aspects of the
Think of it as educating whomever is attending the rounds.
you have prepared a written summary and a reasonable article.
has to be done before the morning of the rounds.
Don’t feel badly
about questions you can’t answer. The faculty member can’t answer all
either. You are sometimes asked just so we know the limits of an
excellent student’s or resident’s knowledge.
It helps to catch
the faculty member or whoever is the faculty person conducting the rounds a
before, to get some feedback on the case and the article you have