Reflections on psychosomatic medicine as a third-year medical student clerkship: an integrated experience that demonstrates the biopsychosocial model.

The proper place for psychiatry education and experience in themedical school curriculum has evolved over time. Some institutions have limited the time spent on the required third-year psychiatry clinical clerkship to 4 weeks. Most institutions offer a 6-week clerkship, but there have been questions as to whether maintaining this level of experience is viable, given additional curriculum demands (1). Within the clerkship itself, change is “in the air.” A traditional experience at many schools has been a clerkship spent entirely at an inpatient facility. Increasingly, there is a call for greater integration of psychiatry and other medical specialties, in addition to clinic-based and longitudinal experiences during clinical clerkships. Diversification of clerkship sites has resulted in opportunities for other models to compete with the familiar inpatient rotation, with similar educational value (2). Inpatient psychosomatic medicine (PSM) offers several advantages for the third-year clerkship. The patients are admitted to the medical center, so that the third-year clerks experience psychiatric illness in the context of acute and/or chronic medical illness, operationalizing the biopsychosocial model (3–7). Students on PSM services manage several streams of clinical data (including laboratory values and neuroimaging results) and communications from nursing staff and other health professional disciplines. They must interact with physicians from other medical and surgical specialties, receive consultations, and provide recommendations. PSM services regularly manage cases of delirium and dementia, illnesses that are critically important in the general-hospital population (8). Perhaps most important for third-year students is the opportunity to experience the specialty of psychiatry being practiced in a medical model, co-located with other specialty colleagues, in a collaborative environment. One commonly sees students who possess the empathic and intellectual gifts to become psychiatry residents, yet hesitate to consider the specialty for fear of “not being a real physician anymore.” These students may experience PSM as a model where one can continue to be fully integrated into the medical and surgical environment while still being able to utilize psychiatric assessment and psychotherapy skills. Also, the PSM setting provides a clear example of clinical practice from a biopsychosocial model consistent with the framework taught to students in other specialties.