San Juan Bautista School Of Medicine

Caguas, Puerto Rico 

Clinical Sciences 

Department of Psychiatry and 

Behavioral Sciences 

Course PSYCHIATRY 320 

Student Syllabus 

Author: 

Preparation Date: June 2008 

Revision Date: July 2011 

Revised By: 

Approved by: 

Myrta N. Sifonte, MD 

Department of Psychiatry and Behavioral Sciences 

Myrta N. Sifonte, M.D. 

Psychiatry Coordinator 

Curriculum Sub-Committee Year III 

Academic Year 

2011-2012 

Escuela de Medicine San Juan Bautista 

Clinical Sciences 1

Department of Psychiatry and Behavioral Sciences 

PSYCHIATRY 320 

THIRD YEAR 

Credits: Six (6) 

Duration: 

6 weeks 

Classroom: 

Correctional Psychiatric Hospital 

First Hospital Panamericano 

San Juan de Capestrano Hospital 

Corporacion SANOS 

San Juan Bautista School of Medicine 

Schedule: 

Monday to Friday 8:00a.m. to 4:30 p.m. 

Previous Requirements: Approved Basic Sciences Program 

COORDINATOR AND PROFESSORS INFORMATION 

Professor: 

Myrta N. Sifonte, M.D. 

Coordinator 

Office hours: 

By appointment 

Telephones: 

Office: 787-743-3038 

Cellular : 787- 460-2006 

Professor: 

Dr. Francisco Sanchez-Longo 



Telephones: 

Office: 787-743-3038 

Cellular : 787-244-7244 

Escuela de Medicina San Juan Bautista 


2

Professor: 

Carmen Martinez Cotto, MD 




Telephones: 

Office: 787-758-8019 ext. 2117 

Professor: 

Sergio Matos, MD 




Telephones: 


Professor: 

Raul Rivera Mendez, MD 




Telephones: 


Professor: 

Lilliana Bicchi Consuegra, MD 




Telephones: 


Professor: 

Sylvia P. Johnson, M.D. 




Telephones: 


Professor: 

Lydia Fernandez Abalde, MD 




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Telephones: 


Professor: 

Luis H. Negron, M.D. 




Telephones: 


Professor: 

Hilda Rivera Cartagena, M.D. 




Telephones: 


Professor: 

Carmen Tejada, M.D. 




Telephones: 


Professor: 

Celestino Flores Carmona, M.D. 




Telephones: 


Liaison SJBSOM-SANOS: 

Coordinator at First 

Hospital Panamericano: 

Dr. Myraida Rivera, Corporacion SANOS 

Ms. Aida Santiago 



4

RULES 

See Description in the Clerkship General Rules File 

PSYCHIATRY CLERKSHIP 

I. General Description 

The Psychiatry Clerkship is a six week clinical course that provides 

third year medical students with a solid foundation in the 

fundamentals of the evaluation, diagnosis, treatment, and 

appropriate referral of patients with mental health disorders. 

II. 

III. 

Prerequisites 

The first four semesters of the required EMSJB curriculum must be 

successfully completed prior to starting clerkship rotations 

including the Behavioral Medicine Course . 

Purpose 

The purpose of the Psychiatry Clerkship is to develop the student’s 

clinical skills in the diagnosis and treatment of patients who have 

mental disorders. Students will develop their skills in a variety of 

diagnostic and treatment procedures that are commonly involved 

in psychiatric care. 

IV. 

Course Objectives 

By the completion of the Clerkship, the student will be expected to 

master the following objectives: 

A. Skills: 

1. Based on the observations of clerkship faculty and/or the 

clerkship director, the student will demonstrate the ability 

to: 

a. Perform a complete psychiatric evaluation that will 

include identifying data, history of present illness, a 

psychosocial history, past psychiatric history, past 

medical history, current medical problems, 

alcohol/substance abuse history and mental status 

exam, summation and differential diagnosis 

b. Perform a problem focus exam 

c. Perform a mini mental status exam 



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d. Do a risk assessment for suicide or potential to do 

harm to others and discuss an intervention plan 

e. Verbally present a case, the presentation will 

include present and past history, an assessment, 

differential diagnosis, a provisional diagnosis and 

treatment plan 

2. Based on the review of the clerkship director and 

clerkship faculty, the student will demonstrate the 

ability to: 

a. Write a case in a form satisfactory for a medical 

record 

b. Use technology to locate evidence based 

psychiatric information 

3. Based on the observations of clerkship faculty and/or 

the clerkship director, the student will demonstrate the 

ability to: 

a. Demonstrate respect, empathy, responsiveness, 

and concerns regardless of the patient’s problems 

or personal characteristics. 

b. Keep boundaries, recognize transference issues 

and set limits with patients. 

c. Verbally communicate in a manner understood by 

the patient and effective for gathering history. 

d. Be able to use basic strategies for interviewing 

disorganized, hostile/resistant, mistrustful, 

circumstantial/hyperverbal, hypoverbal, and 

potentially assaultive patients. 

4. Using a PDA, computer or other technology that 

accesses current evidence based medical information; 

the student will research topics of relevance to the 

clerkship. The information discovered will be of 

sufficient clinical utility to be included in evaluating and 

diagnosing a patient, formulating a treatment plan or 

composing reports/presentations on psychiatric topics. 

B. Knowledge: 

1. Based on the observations of clerkship faculty or the 

clerkship director during patient rounds, case 

presentations and small group discussions, the student 



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will demonstrate the knowledge in the following core 

areas: 

a. Mental illnesses to include major depression, 

dysthymic disorder, bipolar disorder, adjustment 

disorders, generalized anxiety disorder, panic 

disorder, social phobia, obsessive compulsive 

disorder, substance and alcohol use, the three 

clusters of personality disorders with a particular 

focus on borderline personality disorder, 

schizophrenia/psychosis, dementia and delirium, 

somatoform disorders, factitious disorder, 

malingering and sleep disorders. 

b. Criteria A for the illnesses listed in the 4 th edition of 

Diagnostic and Statistics Manual of Mental 

Disorders for the conditions listed above. 

Demonstrate an understanding of the use of DSM 

IV 

c. Psychopharmacology to include the usage of 

anxiolytics, antidepressants (and ECT), 

antipsychotics, mood stabilizing agents, 

anticholinergics, acetylcholinesterase inhibitors, and 

namentine, psychostimulants, and beta blockers in 

treating the mentally ill. 

2. During discussions with faculty, the student will 

demonstrate and analysis of the role of the following in 

the comprehensive evaluation and management of a 

psychiatric patient: 

a. The comorbidity of mental, neurological and medical 

illnesses. 

b. The use of laboratory and various types of scans 

(CT, PET, MRI, etc.) to evaluate for mental illness 

or for the ongoing monitoring of medications. 

3. The student will construct and present to faculty an 

organized treatment plan addressing the findings of the 

evaluation. In addition to recommending medications 

using the principles of psychopharmacology, this 

presentation will demonstrate to the faculty: 



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a. Recognition of the signs, symptoms, and risk factors 

for suicide, homicide and withdrawal from drugs and 

alcohol. 

b. The ability to asses the need to be hospitalized, 

versus treatment as an outpatient. 

c. The ability to utilize the basic concepts of various 

psychotherapies and propose ways to incorporate 

them into a treatment plan. 

4. For either incorporating into the treatment plan or 

using to assist in solidifying a difficult diagnosis, the 

student will demonstrate to the attending: 

a. A conceptual understanding of the indications for 

psychological testing. 

5. From the collection of information about the patient, 

the student will demonstrate to faculty: 

a. Recognition of the signs of abuse in all ages 

b. The differing presentations of mental illness over 

the life span. 

C. Attitudes and behaviors: 

1. In case presentations, patient write-ups and 

discussions with clerkship directors and preceptors, 

demonstrate the ability to remain objective and nonjudgmental 

toward a patient regardless of lifestyle and 

life choices. Empathy is a quality worth acquiring and 

diversity is rarely boring. 

2. No matter the setting (inpatient wards, ambulatory care 

centers, hallways, waiting rooms) the importance of 

confidentiality of psychiatric information will be 

demonstrated in discussing and interactions with 

attendings, colleagues, nurses, office staff, etc. 

3. During post evaluation discussions with attendings 

and/or intake personnel the student will be able to 

discuss the basic ethical issues in psychiatry such as 

involuntary treatment, the duty to warn about risks, 

reporting abuse (especially in children and elderly), 

and acceptable as well as unacceptable interactions 

with patients. 



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4. Explain to faculty when and why to refer to a 

psychiatrist a patient being seen in a primary care 

setting for a mental condition. 

5. The student will demonstrate in case discussions with 

faculty and/or participation in multidisciplinary 

treatment team meetings, the role these next three 

items play in aftercare planning, compliance with 

treatment and maintaining a mentally ill person in the 

community: 

a. The biases in society, medicine in general, the law, 

and other arenas toward the mentally ill and how to 

be an advocate when necessary 

b. The barriers to treatment placed by society, the 

system, the mentally ill person himself, third party 

payers, etc. 

c. The need to work with community resources 

available for all age groups and know to which 

organization to contact for this type of assistance. 

(Social Services, Council on Aging, Children 

Services, etc.) 

V. Community Medicine 

Since our School is defined as a “community-based institution”, 

Community Service is an institutional project that involves all 

constituencies with different actions and activities related to the 

community initiative. It is expected that through diverse strategies, the 

student will realize his\her original commitment to society in their roles 

as citizens and professionals 

COMMUNITY PROGRAM 

Is a Community Medicine Service-Learning activity developed in 

response to community-identified concerns in which third year medical 

students have an active participation. Students are involved in a direct 

intervention with patients (drug users, homeless, HIV, mental diseases), 

family, and community throughout outreach programs. There is a 



9

connection between their academic coursework (psychiatry rotation) and 

service combined with reflection. 

OBJECTIVES 

Community Medicine Emphasis 

o Apply the general concepts and practice of community 

medicine 

Medical Knowledge Emphasis 

o Apply basic sciences knowledge and Clinical Medicine 

Professionalism Emphasis 

o Demonstrate professional attitudes, behaviors, compassion and 

humanism. 

o Recognize the world of practicing physicians throughout a 

variety of common community medical situation. 

o Understand the interactions between physicians, patients, 

families, community leaders, and community. 

Clinical Skills Emphasis 

o Communicate and interact effectively with the patients, families, 

community promoter, both verbally and in writing. 

o Obtain and record medical information 

Research and Information Literacy Emphasis 

o Increase the skills in critical review of literature 

EVALUATION 

The process of intervention with the patient and family in the community 

will be encouraged and evaluated through the following aspects: 



10

o Professionalism: Evaluation of Student Professionalism by Health 

Co-workers (see form CE-016) (20%) 

o Each student has to perform a clinical and psychiatric history to 

each patient seen and discuss the case with the psychologist or 

case manager (20%) 

o Evaluación de Profesionalismo del Estudiante por pacientes y 

familiares (CE- 014) (10%) 

o Student written report of community activity (see form CE-022) 

(20%) 

o Information Literacy (each group MUST analyze a scientific article 

of Additive disorders) (10%) 

o Attendance and punctuality: Student should attend every day 

schedule: 8:30 am to12:00n; except Tuesday 1:00 pm to 4:00 pm. 

Every day you MUST sign the attendance list. (20%). Failure to 

comply will decrease in 5% your grade 

VI. 

Curriculum 

A. The curriculum consists of: 

1. Performing clinical activities under direct supervision 

2. Observing clinical activities by faculty 

3. Reading assigned material 

4. Attending didactic presentations 

5. Performing other assigned duties that are designed to assist 

the student in learning to perform core psychiatric skills with 

increased proficiency 

B. The students will typically have the opportunity to: 

1. Observe and/ or conduct diagnostic evaluations with 

psychiatric patients 

2. Observe the presentation of patients who meet diagnostic 

criteria for many of the major DSM-IV-TR categories. 

3. Identify the essential and associated features of the relevant 

DSM-IV-TR diagnoses. 

4. Observe and/or participate in diagnostic decision making 

5. Observe and/or participate in the process of designing a 

treatment plan for psychiatric patients 



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6. Observe and/or participate in a multi-disciplinary treatment 

approach for psychiatric patients. 

7. Observe and/or participate in the psychopharmacological 

treatment of patients within the major DSM-IV-TR diagnostic 

categories. 

8. Study the clinical use of psychotropic medications, including 

indications and contraindications, dosage scheduling, and 

modes of action. 

9. Study the clinical presentation and treatment of common 

pharmacological side effects, such as extrapyramidal 

symptoms and tardive dyskinesia. 

10. Observe and/or conduct patient education about 

psychotropic medications. 

11. Document and/or observe documentation of diagnostic and 

management activities utilizing the medical record system 

employed at the clerkship site. 

VII. 

Topics to be discussed 

Patient Type or Core 

Condition 

Mental Status 

Examination 

DSM IV TR 

Major Depressive 

Disorder 

Bipolar Disorder 

Methodology 

Lecture or Self 

Directed Study or 

OB or Case 

Learning Based 



OB or Case 




OB or Case 




Person in 

Charge 

Attending 

Physicians 

Attending 

Physicians 

Attending 

Physicians 

Attending 

Physicians 



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OB or Case 


Dysthymia and 


Cyclothymia 


OB or Case 


Schizophrenia 



OB or Case 


Schizoaffective Disorder Lecture or Self 


OB or Case 


Panic Disorder 



OB or Case 


Post Traumatic Stress Lecture or Self 

Disorder 


OB or Case 


Obsessive Compulsive Lecture or Self 

Disorder 


OB or Case 


Generalized Anxiety Lecture or Self 

Disorder 


OB or Case 


Delirium, Dementia and Lecture or Self 

Amnestic Disorders Directed Study or 

OB or Case 


Substance Use Disorders Lecture or Self 


OB or Case 




Attending 

Physicians 

Attending 

Physicians 

Attending 

Physicians 

Attending 

Physicians 

Attending 

Physicians 

Attending 

Physicians 

Attending 

Physicians 

Attending 

Physicians 

Attending 

Physicians 

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Alcohol Abuse, 

Dependence 

Personality Disorders 

Eating Disorders 

Somatization Disorders 

Malingering, 

Hypochondriasis, 

Factitious Disorder 

Psychotherapies 

Pharmacotherapy 

Children and Adolescent 

Psychiatric Disorders 



OB or Case 




OB or Case 




OB or Case 




OB or Case 




OB or Case 




OB or Case 




OB or Case 




OB or Case 


Attending 

Physicians 

Attending 

Physicians 

Attending 

Physicians 

Attending 

Physicians 

Attending 

Physicians 

Attending 

Physicians 

Attending 

Physicians 

Attending 

Physicians 



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METHODOLOGY 

The third year clerkship will consist of direct clinical instruction through 

the following list but limited to: 

o Short topic discussions as scheduled by attending physicians 

o Conferences 

o Lectures 

o Case based discussions with coordinator 

o Standardized patients 

o Ward rounds 

o Bedside teaching 

o Case presentation 

o Computer assisted instruction 

o Library study, search of literature on specific topics 

o Student participation in community program 

HOMEWORK: All students must read and study the required reference 

for the assigned topic as they are expected to be prepared for the 

discussion of these topics. 

OSCE: All student s are required to take one formative and one 

summative examination in the psychiatry clerkship. During both 

encounters the student is required to hand in a written history including a 

mental status examination, diagnosis, and treatment plan. Attendance to 

these exams is compulsory. Students who score below 70% in the 

summative examination must take a make-up exam, after a remedial 

session. The summative examination score represents 15% of the final 

grade and the score for written report for the case represents 5% of the 

final grade. 

Subject Exam: All students must take and pass and end-of-clerkship 

exam (SHELF). Students, who obtain a failing score in the subject exam, 

must take it again at a specified later date. A student who fails to pass 

the Subject Exam on three occasions must repeat the clerkship. A 

remediation plan will be implemented for any student who fails to pass 

the Subject Exam on the first attempt. Participation in the remediation 



15

program is compulsory. The Subject Exam score represents 40% of the 

final grade. 

Patient type or 

core condition 

Psychiatry Clinical Encounter Grid 

Number required Level of 

to be seen (real Student 

or simulated) Responsibility 

Clinical 

Setting (O,I, 

SU) 

Major Depressive 3 OB, P O,I,SU 

Disorder 

Bipolar I 2 OB,P O,I,SU 

Bipolar II 1 OB,P O,I,SU 

Dysthymia 1 OB,P O,SU 

Other Affective 

1 OB,P O,SU 

Disorders 

Schizophrenia 3 OB,P O,I,SU 

Schizoaffective 

1 OB,P O,I,SU 

Disorder 

Psychosis NOS 1 OB,P O,I,SU 

Other Psychotic 

2 OB O,I,SU 

Disorders 

Panic Disorder 1 OB O,I,SU 

Post Traumatic 

Stress Disorder 

Obsessive 

Compulsive 

Disorder 

Generalized 

Anxiety 

Disorder 

1 OB O,I,SU 

1 OB O,I,SU 

1 OB O,I,SU 



16

Patient type or 

core condition 

Number required 

to be seen (real 

or simulated) 

Level of 

Student 

Responsibility 

Clinical 

Setting (O,I, 

SU) 

Other Anxiety 

1 OB O,I,SU 

Disorders 

Alcohol 

2 OB,P O,I 

Dependence 

Alcohol 

1 OB O,I 

Withdrawal 

Cannabis 

1 OB,P O 

Dependence 

Cannabis 

1 OB O 

Withdrawal 

Opioid 

2 OB,P O,I 

Dependence 

Opioid 

1 OB O,I 

Withdrawal 

Cocaine 

2 OB,P O,I 

Dependence 

Cocaine 

1 OB O,I 

Withdrawal 

Benzodiazepine 

1 OB O,I,SU 

Dependence 

Benzodiazepine 

1 OB O,I,SU 

Withdrawal 

Anorexia 1 OB O,SU 

OB= Observation (CR only) 

P= Participation (Hx/PE and CR) 

O= Outpatient 

I=Inpatient 

SU: Stabilization Unit 

VIII. Student Responsibilities 

Please refer to Clerkship General Rules File 

IX. 

Course Evaluations and Grading Procedures 

Please refer to Clerkship General Rules Guide 



17

X. Work Schedule 

8:00am 

Hour 

Arrival 

Daily Work Schedule 

Activity 

9:00- 10:00am Morning Report 

8:30-12:00 m Assigned patient interview and evaluations (inpatient) or 

conference 

12:00-1:00pm 

1:00-2:00pm 

2:00-3:00pm 

3:00-4:30pm 

Lunch 

Clinical case presentation and discussion with the staff 

psychiatrist or conference 

Psychiatry consulation evaluation or conference 

Patient Interviews 



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XI. 

Learning Resources 

A. Textbook: 

Title: 

On Call Psychiatry 

Author: 

Carol A. Bernstein 

Publisher: 

ISBN: 

141602574X 

Publication Date: 2006 

Edition: 

Third 

Library Code: 

Approximate Cost: $54.95 

Considerations: 



Elsevier Health Sciences 

This book is the ideal text for practical acute psychiatric intervention. The 

book emphasizes the most common psychiatric management of acute 

psychiatric patient. Exceptionally effective in teaching you how to handle 

the complex interplay of psychological and biological factors in human 

development in a very simple structuring action. 

B. References 

1. Kaplan, Harold and Benjamin Sadock. Kaplan and Sadock's 

Comprehensive Textbook of Psychiatry. 9 th Edition. Williams and 

Wilkins, 2009. ISBN: 0781734347 Library Code: WM 100 K17 2004 2 

Vol. Set: Vols. 1 & 2. 

2. Kaplan, Harold and Benjamin Sadock. Synopsis of Psychiatry, 

Behavior Science-Clinical Psychiatry. 10 th Edition. Maryland: 

Williams and Wilkins, 2007. ISBN: 0-683-30330-9 Library Code: WM 

100 Fr VIII 1998. American Psychiatric Association. 

3. Diagnostic and Statistical Manual of Mental Disorder (DSM IV-TR) 

4 th Edition. Washington, D.C., American Psychiatric Press, 2000. 

ISBN: 0-89042-024-6. Library Code: WM 15 D536 1994 

4. American Psychiatric Association. A Psychiatric Glossary. 8 th Edition; 

Washington, American Psychiatric Press, 1994. ISBN: 0-88048-508-6. 

Library Code: WM 13AM VII 1994 

19

C. Supplementary Readings: 

1. High-Yield-Behavioral Science, 3 rd Edition. Lippincott Williams & 

Wilkins, 2009 

2. Behavioral Sciences Pre-Test, 9 th Edition. McGraw-Hill, 2002 

3. Psychiatry Pre-Test, 12 th Edition. McGraw-Hill, 2009 

4. First Aid for the Psychiatry Clerkship, 3 rd Edition. McGraw-Hill, 

2011 

D. Journal Materials 

E. Videos: 

1. The American Journal of Psychiatry, American Psychiatric 

Association, American Psychiatric Association Press Washington, 

D.C., 2011 

2. Journal of the American Academy of Child and Adolescent 

Psychiatry, The American Academy of Child and Adolescent 

Psychiatry, Washington, D.C., 2011 

1. The Hidden Nature of Man 

2. Controlling Aggression and Hostility in Psychiatric Patient, The 

Psychosis Heralding a New Era, Milestone Medicine,1997, Janssen 

Pharmaceutical 

3. The Clinical Implications of Neuroreceptor Occupancy in the 

Management of Psychosis, Psychlink, Interactive Medical Network, 

2000, Janssen Pharmaceutical 

4. Treatment Options in the Psychosis, The Psychosis Heralding a 

New Era, Milestone Medicine, 1997, Janssen Pharmaceutical 

5. Using Antipsychotic Agents in Bipolar Disorder, The Psychosis 

heralding a new Era, Milestone Medicine, 1996, Janssen 


6. A Guide to Prevention, Recognition and Treatment in the Era of 

Atypical Antipsychotics, Brown University School of Medicine, 2000 

7. I am Still Here (The Truth of Schizophrenia),Janssen 

Pharmaceutical, 1997, Jansen Pharmaceutical 

8. Understanding Obsessive Compulsive Disorder, Solvay 

Pharmaceutical, 1997 



20

9. Minimental State Examination, Pfizer, 1997 

10. Understanding Social Anxiety Disorder, SmithKline Beecham, 1999 

11. Preserving Cognitive Function in Schizophrenia, The Psychosis 

Heralding Area, Milestone Medicine, 1998, Janssen 


12. The Pathophysiology of Schizophrenia and Implications for Drug 

Therapy, Milestone Medicine,1996, Janssen Pharmaceutical 

13. Identification and Management of the First Episode of 

Schizophrenia, The Psychoses Heralding New Era, Milestone 

Medicine, 1996 ,Janssen Pharmaceutical 

14. Antypsyhotic Agents and Adverse Events, The Psychoses 

Heralding a New Era, Milestone Medicine, 1996, Janssen 


F. Internet Resources: 

URL 

American Psychiatric Association 

www.psych.org 

American Academy of Child & Adolescent 

Psychiatry 

www.aacap.org 

American Medical Association 

www.ama_assn.org 

National Institute of Mental Health 

www.nimh.nih.gov 

www.findlaw.com 

Content 

Find news, research, clinical 

resources, education, guidelines and 

public information 

Home page of AACAP. Information 

on developmental, behavioral, 

emotional and mental disorders 

Professional and advocacy 

organization for the medical 

profession. 

Find news and events, research, 

clinical trials and information for 

practitioners. 

Text of Supreme Court Decisions 



21

San Juan Bautista School Of Medicine

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