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Undergraduate Clinical Clerkship in Psychiatry

The specialty of Psychiatry embodies all which we value in medicine: knowledge, skill, humanity, relationships and altruism.  It is a complex and alluring specialty, developing in so many ways. 

The purpose of the Psychiatry clerkship is to provide clerks with a range of experiences and opportunities to enable them to recognize and begin to manage psychiatric problems they are likely to encounter in the diverse medical settings they will navigate as physicians.  This enables the acquisition of essential knowledge and skills for recognizing and managing psychiatric and medical issues, irrespective of the diverse medical settings clerks may move to in their medical careers.  


The Psychiatry clerkship rotation is a full-time six-week rotation during which students are exposed to various psychiatric settings.  The rotation comprises several components, including a core clinical placement which generally involves at least two clinical settings, Psychiatry emergency room on-call experience, and a mandatory academic day which includes a series of teaching and tutorial sessions of various formats.  Clinical placements can be in Hamilton, Waterloo or Niagara region, or surrounding community settings (e.g. Burlington, Oakville, Grimsby, etc).


Students and Faculty Supervisors should read and be familiar with our Psychiatry Clerkship Objectives:

Psychiatry Clerkship Objectives


An orientation morning will be held on the first day of the rotation for all sites (except for when the first day falls on a holiday, then it will be held on the second day of the rotation).  The orientation will include a review of the core Psychiatry rotation and its related components, and the logistics of the Psychiatry Emergency Services call experience.  The general rotation objectives and evaluation methods will be discussed at this session.  Students will be notified beforehand as to the details of the orientation location and placement assignments.  Each region will perform their own orientation session.  After orientation student will report either to Dovetale training (if they are placed at the SJH West 5th site), or will report to their clinical placements.  Helpful information for our orientation session can be found on our Medportal Psychiatry Clerkship site.


Each clerk will be assigned to 2-3 clinical supervisors.  The supervisors will be responsible for the supervision, assignment and evaluation of clinical work.  Hamilton clerks will have an opportunity to request their preferences for particular psychiatric subspecialties.  Where possible and appropriate (and dependent on supervisor availability), we will try to accommodate such preferences.   We are not able to accept requests for specific supervisors for the core rotations.  Additional supervisors may be assigned to ensure a thorough learning experience.  Clinical placements should occur in a mix of settings e.g. inpatient, outpatient, general, subspecialty and may include subspecialty areas such as Child & Adolescent, Geriatrics, Mood, Schizophrenia, Anxiety, Forensics, Eating Disorders or Addiction.  These placements occur in academic hospitals, community hospitals, or community clinics.


Wednesdays are a mandatory academic day, consisting of a session with our Resident Teaching Chiefs, a combination psychopharmacology/psychopathology lecture and a tutorial session.  Teaching sessions will encompass a variety of teaching methods including didactic teaching, role play, problem based learning, video clips, clinical scenarios, etc.  We are constantly striving to include innovative and interesting teaching methods.  The non-tutorial teaching sessions will be video-conferenced to the Niagara and Waterloo campuses.  Please see the teaching schedule on our Medportal page for details and related resources.  Clerks will be divided into two smaller groups for tutorial sessions on Wednesday afternoons from 1-3pm.  These groups will be facilitated by an assigned faculty member in the role of tutorial leader.  The topic and format will vary weekly.  Students are expected to prepare in advance of the session.  A student guide will be distributed in advance.  Please see the tutorial schedule and related resources on our Medportal site.  There are E-learning modules available for learning in specific topics (e.g. Mental Health Act forms, Psychotherapy).  Students are to review the E-module forms during their first Psychiatry Emergency Services (PES) shift.  They will be granted access to PTeR, our E-modules for psychotherapy learning through our program. 

As these academic sessions represent mandatory learning activities, attendance will be taken for each session.


The evaluation process is the joint responsibility of the clerk, the clinical supervisor and the tutor.

Student Evaluation Components of This Rotation Include:

1. Student’s clinical performance on wards, in clinics and in the emergency department (i.e. interviewing skills, knowledge of psychiatry, management, professionalism, attitude, etc.).  This is based on clinical evaluations completed by supervisors in MedSIS.

2. Supervisor/Student completion of 6 Psychiatry Direct Observation Tool (P-DOT) forms and submitted to Lisa Kennedy (for Hamilton Students) on exam day*.

3. Completion of 4 MacDOT evaluations by residents in the PES (one for each evening shift and two for each weekend/holiday shift…numbers may vary slightly for Regional Campuses).  Students will print a screenshot and submit to Lisa Kennedy (for Hamilton Students) on exam day*.

4. Students will have 100% completion of the online ECE used to monitor exposure and ensure a minimum set of experiences printed and submitted to Lisa Kennedy (for Hamilton Students) on exam day*.

5. Tutorial leader/participation evaluations

6. Performance on NBME Psychiatry on-line exam

*Students must complete their MacDOTs P-DOTs, ECE trackers by the end of the rotation, failure to do so is a professionalism issue

Student MacDOTs/PDOTs must consist of one each of:

1) Mental status exam

2) Examine for medication-related side effects

3) Assess a patient’s risk of harm to self and/or to others 

 AND one of either:

a) Communicate information about diagnosis, prognosis or therapy to the patient (and/or family)(4,5)


b) Provide clear discharge instructions to a patient (and/or family)

The other 6 are completely up to the student

1) MedSIS Mid and End of Clinical Rotation Evaluations

MedSIS will send supervisor/s a link for Mid-Evaluation completion at the beginning of week 3 to evaluate your progress for the first 3 weeks, and the beginning of week 6 to evaluate your End-Evaluation progress for the last 3 weeks of the rotation.  If the supervisor does not receive this emailed evaluation link they are to contact the program coordinator for their site or the MedSIS administrator to ensure it was sent.  It is the student’s responsibility to book a time to meet with their supervisors to complete the MedSIS evaluations.  Students should also print out their online ECE tracker progress to discuss with their supervisor at each of these MedSIS eval meetings. 

2) Psychiatry Direct Observation Tool Evaluations

The P-DOT has been introduced in replacement of the current "Clinical Encounter Cards" which will encourage quality learning/teaching interaction with an emphasis on direct observation and feedback.  Students are expected to ensure their supervisor completes on average one per week for a total of 6 for the 6 week rotation.  Students have a shared responsibility to ensure it is done in a timely fashion and not left to the end of the rotation.  Five P-DOTs should be completed by faculty supervisors, and only one is allowed to be completed by a resident supervisor.  Students should ensure their supervisors use the comment fields to explain or justify any concerns.  Students also should pre-plan with their supervisors to fill it in together, including a next-steps learning plan.  All 6 of the completed P-DOT forms should be submitted to their clerkship coordinator from their site at the exam where it will be included in the end of rotation evaluation.

3) Psychiatry MacDOT Evaluations

The MacDOT is a Direct Observation Tool pilot project for the Class of 2018.  In the Psychiatry rotation students are to complete all MacDOTs while on call in the emergency department.   Students are responsible for ensuring completion of 1 MacDOT for each weekday 5-11 pm shift and 2 MacDOTs during the course of each weekend on call shift (9 am-11 pm). For most students, this will mean a total of 4 MacDOTs (numbers may vary slightly at the regional campuses).  Although there is no 'grade' for a MacDOT, students must achieve 100% completion by the end of the rotation or the student may be provisional for professionalism.  The residents (or staff psychiatrists) with whom students work in PES will evaluate them using this tool.  The MacDOT is not meant to be an onerous process for anyone involved.  The purpose of the MacDOT is to provide students with ‘on the spot’ feedback, after evaluation of a particular skill (e.g. risk assessment, evaluation of capacity).  A brief student guide on how to use the app is located on our Medportal site.  Prior to the evaluation meeting, students are to download the MacDOT to their smartphone or a stationary computer to provide to the resident for completion. Students will be able to see their feedback on the app and on the medportal dashboard.  Our program tracks their progress on the medportal administrative dashboard.   At end of rotation they are to submit a screen shot of all 4 completed MacDOTs to the program coordinator at their site at the exam.  

4) Online ECE Tracker

The Online ECE Tracker is a tool for program evaluation and curriculum monitoring which includes 14 items (primary presentation, procedure and ProComp).  Students work on completing their ECE tracker throughout the rotation and should not leave until the end of the rotation.  This is monitored by the clerkship coordinator from each site throughout the rotation.  The online tracker must be printed by the student and reviewed by their clinical supervisors at the mid and end evaluation meetings.  Clinical supervisors are to review and confirm the encounters have occurred.  All online ECEs must be logged by the final evaluation meeting and have 100% completion rate for a satisfactory completion of the rotation.   A copy of your completed online ECE tracker is to be given to Lisa Kennedy (for Hamilton students) at the exam. 

5) Tutorial Leader/Participation Evaluations

Our tutors will complete a tutorial evaluation for each student. Tutorial evaluation will be based upon:

  • Knowledge, skills and professionalism (attitude) demonstrated in all tutorial sessions
  • Preparation (including looking up any unresolved topics which were assigned) and participation (quantity and quality) in all tutorial sessions
  • Quality of the tutorial which the student leads (format, leadership, content, objectives, MCQ’s, etc.)
  • Student’s general performance on all MCQ’s across the tutorials

6) NBME Psychiatry On-Line Exam

Students will write an online NBME exam at the end of rotation and require a passing mark of >60%

The final evaluation (transcript) will be a compilation of the above evaluations written in narrative format, completed by the student’s tutorial leader or the Regional Education Leader.

To successfully complete this rotation and have the final evaluation signed off by the Clerkship Director, clerks must:

  • Receive a satisfactory evaluation encompassing clinical placements through MedSIS evals, P-DOTs, and tutorial evaluations
  • Complete all required MacDOTs
  • Maintain and complete the on-line ECE inventory in full
  • Pass the NBME exam with a >60% score

Final assessment:

The Clerkship Director will review the final assessment decision for all students. 

IF you have significant issues raised on your clinical placement component, THEN you will:

      • Receive an “unsatisfactory” for a major issue that needs urgent remediation, OR, receive “provisional satisfactory” on your transcript (for knowledge, clinical skills, or professionalism) when it is felt the issue can be remediated while you continue in the program.
      • You will be referred to Academic Progress Committee (APC) and you will need to appear before the committee so that a personalized remediation plan can be put into place.

 IF you are unsatisfactory on the NBME exam, THEN you will:

      • Receive “provisional satisfactory” on your transcript for knowledge
      • Be referred to Academic Progress Committee for a file review. 
      • APC may decide that you can arrange to re-write the exam OR they may decide that you need to appear before the committee so that a personalized remediation plan can be put into place.  No re-writes can be booked without the approval of APC.  

You are strongly advised to contact your Student Advisor and Student Affairs for support if you are in one of the above situations.  

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