Teaching medical students

[bashir]

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Does anyone have any suggestions of resources to refresh one's memory of what is actually psychiatry shelf material? I'm a pgy-4 who hasn't had students for quite a while and am feeling a bit lost as far what my M3s need to know. I don't remember my shelf, like, at all.

 

[Merely]

I’m an m4 that routinely teaches m3s for their shelf. The book first aid for psychiatry is what I use and so far the majority of them have honored, it’s the best resource imo

 

[Monocles]

First aid for psychiatry is great!

I kept a notebook that I had from M3 year (which were handwritten notes from first aid for psych, case files, uworld qbank, etc) and went back and updated it for a while. My one and only didactics for med students is a 15 min "high yield easy points" session at the end of their rotation to hit stuff that they don't see IRL. If I recall these weird things always pop up on shelves:

- EEG waveforms (tri phasic, that weird one with hepatic encephalopathy, etc)
- down syndrome vs fetal alcohol syndrome questions
- various substance keywords (pupils dilate/constrict, vertical nystagmus, etc)
- quick association keywords like which antipsychotic QT -- ziprasidon! etc

When I run into them later in the hallways they typically tell me that at least half of the things are still on the test and have been happy that we talked about them.

EDIT: actually that's not true, I always do a 10 min "take care of yourself" personal wellness talk at the beginning of the rotation.

 

[MacDonaldTriad]

Our medical school decided to centralize didactics because of an increase in failures with the psych shelf test. This took students away from their clinical sites and infantilized the students because of the increase in cross coverage needed. Ends up someone decided to have the students take the neuro shelf test on the same day as the psych self test and guess which one intimidated the students and got 90% of their study time. I have developed a great distain for these alleged brainiacs with masters in education telling us how we are teaching medical students wrong and make these changes without our input. My distain has been repeatedly reinforced and earned over the last three and a half decades. Of course the idea of shelf tests isn't inherently evil. In my day we didn't have self tests, but now they are taking students away from seeing patients I'm not sure their value added function is justified.

 

[Monocles]

Our medical school decided to centralize didactics because of an increase in failures with the psych shelf test. This took students away from their clinical sites and infantilized the students because of the increase in cross coverage needed. Ends up someone decided to have the students take the neuro shelf test on the same day as the psych self test and guess which one intimidated the students and got 90% of their study time. I have developed a great distain for these alleged brainiacs with masters in education telling us how we are teaching medical students wrong and make these changes without our input. My distain has been repeatedly reinforced and earned over the last three and a half decades. Of course the idea of shelf tests isn't inherently evil. In my day we didn't have self tests, but now they are taking students away from seeing patients I'm not sure their value added function is justified.

Ugh this is so frustrating. I never understood the point of combining psych and neuro into the same block.

At our med school psych and neuro shelves were back to back. However I knew that I was going into psych and our shelves were 5th percentile to pass. I spent the whole 8 weeks reviewing for the psych shelf and started studying for neuro literally the night before.

I got a 13th percentile (lol) in neuro and close to 90th in psych I think.

 

[Stagg737]

Does anyone have any suggestions of resources to refresh one's memory of what is actually psychiatry shelf material? I'm a pgy-4 who hasn't had students for quite a while and am feeling a bit lost as far what my M3s need to know. I don't remember my shelf, like, at all.

I'll support what @Merely and @Monocles said. First Aid for Psychiatry (aka "the purple book") is the best primary resource for M3s imo. Hits the vast majority of high yield points they'll need and fully studying it in ~2-3 weeks is very reasonable. Additionally, there's about 7 chapters in it that if they know inside and out they should pass.

My favorite supplementary sources for them are Case Files and Lange Q&A for qbank questions. Case Files for psych has ~60 cases, and between all of them and the explanations (which include differentials) it has pretty much every diagnosis they'd be tested on as well as the recommended treatments. I like Lange Q&A over UWorld purely from personal experience. When I did UWorld questions my average was >90% and my percentile was the same. My actual shelf wasn't as great and I felt like psych was the only shelf where UWorld wasn't really a great representation of the questions I saw. Looked at Lange Q&A later and it seemed to line up much better and several attendings I talked to later recommended it.

High yield things to help them out are:

- Ways to differentiate between similar conditions
- timelines for conditions in regards to diagnostic criteria (brief psych. ep. -> schizophreniform -> schizophrenia; acute stress d/o vs. PTSD; etc)
- Mania vs. hypomania with BPMD I vs. II
- Personality disorder criteria (particularly schizoid vs. schizotypal and avoidant vs. schizoid)
- Substance abuse (both intoxication and withdrawal)
- Sleep cycles and EEGs (guarantee there will be a question on either K-complexes, sleep spindles, REM, or all 3)
- Major and common medication side effects (EPS, serotonin syndrome, NMS, SJS, sexual dysfunction with SSRIs, teratogenicity of mood stabilizers)
- Unique medication/treatment points (Lithium and Clozapine decrease suicidality, Ebstein's anomaly with Lithium, Buproprion won't cause sexual side effects and can be used for smoking cessation, etc)

I have some 20 minute lectures for a few of these that I go over with med students (Diagnosing bipolar, alcohol lecture, and EPS are my go-tos) and I've had a few people tell me they picked up some points thanks to them, so as far as I know they're still relevant.

 

[thoffen]

Where I'm at they have a good setup with the didactic education which teaches well to the shelf but definitely is clinically relevant and interesting beyond earning a grade. So residents and attendings really don't need to anticipate what they'll be tested on and can focus on what is interesting and relevant to the job and working in medicine overall. If I were you, I'd try to figure out if you're expected to provide some formal didactic education and if so they ought to provide at least learning objectives for you. Otherwise, teach whatever seems important to actually know.

 

[NickNaylor]

When I teach students, I try to focus on content that will be relevant to them as physicians, irrespective of field, rather than what will allow them to do well on the shelf. I've received positive feedback from students when using this approach, and I'm sure there's some crossover with respect to what is clinically relevant and what shows up on the shelf.

They will have plenty of time to study for the shelf and learn the necessary content. A lot of it will have to be self-directed. I would focus on doing what you can to make them good clinicians, not good shelf takers.