Longitudinal Ambulatory Clinical Experience – Behavioral Sciences and Mental Health Pathway (lace-mhp): a novel Clinical Experience Ali Asghar-Ali, md and Christopher Martin, md michael E

Longitudinal Ambulatory Clinical Experience – Behavioral Sciences and Mental Health Pathway (LACE-MHP): A Novel Clinical Experience Ali Asghar-Ali, MD and Christopher Martin, MD Michael E. DeBakey VA Medical Center Menninger Department of Psychiatry, Baylor College of Medicine

• “In participating in this LACE experience, I was reminded of what I have felt for a long time – that children are very powerful people.  That …is the very reason why I went into teaching middle school and why I have been interested in child psych as a medical specialty.”

• CONCLUSIONS:
• LACE-MHP provides exposure to longitudinal ambulatory psychiatry
• AND
• Broadens students' appreciation for community based interventions

• The LACE-MHP supplements traditional psychiatry rotations with a longitudinal ambulatory psychiatry rotation and innovative community and classroom experiences

• BACKGROUND:
• Medical schools have extensive didactic instruction and clinical rotations that emphasize biological and hospital-based
• psychiatric treatments.
• Experiences in outpatient psychiatry, influences of psychiatry,
• and psychosocial treatments are greatly lacking in medical
• school curricula.

• PROGRAM STRUCTURE:
• The LACE-MHP is a specialized pathway in the Longitudinal
• Ambulatory Care Experience (LACE) students for third year
• medical students.
• Students are selected into the pathway based on an essay
• reflecting their interest in mental health.
• For the entire third year, Thursday afternoon is reserved for
• LACE activities
• The first half of the year (August-December) involves weekly
• visits with a board certified psychiatry preceptor in an
• ambulatory, community setting.
• The latter half of the year exposes the students to a variety of
• community sites and innovative seminars.

• WORKSHOPS & DISCUSSION GROUPS (SAMPLE):
• Intersection of spirituality and the practice of psychiatry
• Electroconvulsive therapy
• Movie club facilitated by Dr. Glen Gabbard
• Cross-cultural communication in psychiatry
• Book club (book selected by students)

• PRECEPTOR COMPONENT:
• Supervised one-on-one by preceptor
• Opportunities to sharpen psychiatry knowledge and skills
• Build a mentoring relationship
• Discuss career opportunities in psychiatry
• Challenges of practicing medicine
• Ethical dilemmas that arise during clinical care
• Six seminar series titled, Therapy 101: Introduction to
• Psychotherapy
• Students learn the basics of the practice of psychotherapy
• No such curriculum identified in our search of the
• literature

• COMMUNITY SITES (SAMPLE):
• AA meeting
• Community residential facility for persons with mental retardation
• Tour of shelter and transitional living facilities
• Center for children who have been victims of abuse
• Forensic unit at prison

• PATHWAY COMPONENTS

• The LACE-MHP is a third year medical student course that promotes physician competency in managing the psychiatric, social, spiritual, and cultural needs of patients.

• The LACE-MHP underscores the interface of psychiatry with culture and the role of psychosocial interventions.

• “

• “My patient, who I’ll call Mr. L, came in very angry about his life and his pain…  I took the time to discuss many life issues with him…  I realize that his journey through addressing his mental health issues will be a long one.  I feel honored to have helped him embark along that path.  Just taking the time to sit and listen to him – non-judgmentally – certainly meant a lot to both of us.  Yes, I will remember to always listen to my patients.”

• Community site - Midtown Terrace, Houston, TX

• Community site - Brookwood Community, Brookshire, TX

• ASSESSMENTS AND EVALUATIONS:
• Students complete evaluations of their preceptors and
• each of their community sites
• A reflection essay is required for each six-month segment
• of the pathway
• Grading is based on the number of sessions attended