Use of standardized patients to enhance a psychiatry clerkship.

Changes in psychiatric health care delivery driven by such major shifts as deinstitutionalization, community-based care, and managed care have greatly altered the educational milieu for third-year psychiatry clerkships. Students may be assigned exclusively to alcohol and substance abuse treatment units, consultation-liaison services, or outpatient clinics, and may not have as broad an exposure as is desirable to patients with a variety of psychiatric illnesses. The authors describe a pilot course they developed in 2001, Clinical Psychiatric Assessment and Diagnosis, for third-year medical students at the Uniformed Services University of the Health Sciences medical school. The course uses standardized patients (SPs) to help students gain broader clinical experience. In psychiatry, a growing body of literature supports the acceptability, reliability, and validity of objective structured clinical examination assessment using SPs for medical students. Only a few articles report the use of SPs to primarily teach psychiatry instead of evaluating student proficiency in clinical psychiatry. Since this course was developed, the National Board of Medical Examiners announced that all medical students will be required to pass a clinical skills test in order to practice medicine, beginning with the class of 2005. The examination will use SPs modeling different clinical scenarios. In light of this change, many medical schools may have to reevaluate and possibly revamp their curriculums to insure sufficient acquisition of clinical skills in different specialties. The use of SPs in psychiatry could provide an effective, primary clinical teaching experience to address this new requirement as well.

Psychological impact of the animal-human bond in disaster preparedness and response.

The authors present an overview of the impact of the animal-human bond on disaster management and highlight the need to further examine the relationship of animals and humans in disaster response. The human connection to animals influences compliance with individual and community evacuation plans. Search and rescue teams with canine units confront physical and emotional demands that affect both handler and animal. The culling of animal populations on a scale such as occurred during the recent foot-and-mouth epidemic in the United Kingdom affects every member of rural society. Livestock farmers and their families endure enormous emotional losses, and veterinarians and government officials who must implement these programs suffer as well. A familiarity with and understanding of these issues is important for psychiatrists and other mental health professionals who are involved in disaster preparedness and response.

Preparing for bioterrorism at the state level: report of an informal survey.

Members of 18 states' departments of mental health were interviewed about their plans for managing the psychosocial impacts of a bioterrorism event. Questions were developed from recommendations of an international conference on planning for bioterrorism ("Planning for bioterrorism," 2000). Information derived from the survey highlights the need for, and the importance of, mental health consultation to the state's planning process. Familiarity with the unique psychological and behavioral consequences of a bioterrorism event in contrast to natural disasters is essential. Realistic training scenarios that incorporate likely psychosocial impacts and appropriate mental health response must be developed.