Longitudinal Ambulatory Clinical Experience

1
Longitudinal Ambulatory Clinical Experience
Behavioral Sciences and Mental Health Pathway
(LACE-MHP) A Novel Clinical Experience Ali
Asghar-Ali, MD and Christopher Martin, MDMichael
E. DeBakey VA Medical CenterMenninger Department
of Psychiatry, Baylor College of Medicine
The LACE-MHP supplements traditional psychiatry
rotations with a longitudinal ambulatory
psychiatry rotation and innovative community and
classroom experiences
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.

• 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

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.
PATHWAY COMPONENTS

• 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.

• 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

• 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.

• 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

Community site - Midtown Terrace, Houston, TX
Community site - Brookwood Community, Brookshire,
TX

CONCLUSIONS LACE-MHP provides exposure to
longitudinal ambulatory psychiatry AND Broadens
students' appreciation for community based
interventions
My patient, who Ill 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.

• 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)