Dataset Information

Disruptive Behavior Disorders and ADHD: A Problem-Based Learning Activity for Psychiatry Clerkship Students.

ABSTRACT:

Introduction

Clinicians are challenged when differentiating the symptoms of attention deficit hyperactivity disorder from those of disruptive behavior disorders such as oppositional defiant disorder and conduct disorder, as many of the core symptoms overlap. Without a correct diagnosis, it is difficult to create an effective treatment plan. This progressive disclosure case was developed with the intention of helping medical students learn the process of clinical evaluation. The purpose of this resource is to provide a lesson plan to teach intermediate/advanced learners how to systematically approach a case with symptoms of disruptive behavior and attention and focus problems in order to improve their ability to establish the correct diagnosis.

Methods

Students were assigned readings, including relevant sections of the Diagnostic and Statistical Manual of Mental Disorders (fifth edition) and a textbook chapter. During a 1-hour class, a child psychiatrist facilitated students in the progressive disclosure case. The learning process included a pre- and posttest.

Results

Students positively perceived the emphasis of important points and showed increased motivation to learn more. Participant evaluations overall were positive, although some students still preferred learning from straight lectures.

Discussion

Feedback led to modifications of the pre- and posttests to reflect a greater emphasis on factual material. Progressive disclosure cases can be used to facilitate structured exposure to clinical topics in child and adolescent psychiatry.

SUBMITTER: John N

PROVIDER: S-EPMC6464466 | biostudies-literature | 2016 Sep

REPOSITORIES: biostudies-literature

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Publications

Disruptive Behavior Disorders and ADHD: A Problem-Based Learning Activity for Psychiatry Clerkship Students.

John Nadyah N Shelton Pheston P Diamond John J

MedEdPORTAL : the journal of teaching and learning resources 20160928

<h4>Introduction</h4>Clinicians are challenged when differentiating the symptoms of attention deficit hyperactivity disorder from those of disruptive behavior disorders such as oppositional defiant disorder and conduct disorder, as many of the core symptoms overlap. Without a correct diagnosis, it is difficult to create an effective treatment plan. This progressive disclosure case was developed with the intention of helping medical students learn the process of clinical evaluation. The purpose o ...[more]

PMID: 31008252

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Project description:BackgroundThe German clerkship ("Famulatur") is the first phase in medical education, in which students learn from a physician's perspective. According to the German Licensing Regulations for Physicians, students shall "familiarise" with providing care. However, specific learning objectives for the clerkship are not defined, although the acquisition of different competencies is implicitly demanded. Therefore, an additional understanding of the clerkship students' learning experience is needed. The goal of this study is to explore the student's learning perspective and experiences in the clerkship.MethodsTwelve guideline-based interviews were conducted with third year medical students. All participants completed their first clerkship. A qualitative content analysis was performed. The inductively identified categories were transferred into a quantitative questionnaire using a 5-point Likert-scale to explore their relevance in a validation cohort. The questionnaire was completed by 222 clinical students of the Otto-von-Guericke-Universität Magdeburg.ResultsThe qualitative analysis led to 26 individual items assigned to 4 main categories that describe the clerkship experience: 1) "coping with insecurities", 2) "the clerkship as a social arrangement", 3) "the clerkship as a learning opportunity" and 4) "the clerkship as a teaching opportunity". In the quantitative validation cohort, category one yielded a well-balanced result (median 3 = "neither agree nor disagree"; IQR 2-4), items addressed in categories 2-4 were generally supported by the students, predominantly selecting "strongly agree" or "agree" (Median 2; IQR 1-2 for each category). Students rated the role of the clinical team as especially important for their learning success and feared exclusion or negative reactions.ConclusionsThe medical clerkship provides an institutional, professional, and social framework, in which students are learning. Insecurities arose from curricular inconsistencies, a high dependency on the clinical team as well as the absence of specific learning objectives. Therefore, a better curricular integration regarding the semester structure and the learning objectives of the German clerkship is needed.

Project description:ObjectiveYouths with disruptive behavior disorders (DBD) (conduct disorder and oppositional defiant disorder) have an elevated risk for maladaptive reactive aggression. Theory suggests that this is due to an elevated sensitivity of basic threat circuitry implicated in retaliation (amygdala/periaqueductal gray) in youths with DBD and low levels of callous-unemotional traits and dysfunctional regulatory activity in the ventromedial prefrontal cortex in youths with DBD irrespective of callous-unemotional traits.MethodA total of 56 youths 10-18 years of age (23 of them female) participated in the study: 30 youths with DBD, divided by median split into groups with high and low levels of callous-unemotional traits, and 26 healthy youths. All participants completed an ultimatum game task during functional MRI.ResultsRelative to the other groups, youths with DBD and low levels of callous-unemotional traits showed greater increases in activation of basic threat circuitry when punishing others and dysfunctional down-regulation of the ventromedial prefrontal cortex during retaliation. Relative to healthy youths, all youths with DBD showed reduced amygdala-ventromedial prefrontal cortex connectivity during high provocation. Ventromedial prefrontal cortex responsiveness and ventromedial prefrontal cortex-amygdala connectivity were related to patients' retaliatory propensity (behavioral responses during the task) and parent-reported reactive aggression.ConclusionsThese data suggest differences in the underlying neurobiology of maladaptive reactive aggression in youths with DBD who have relatively low levels of callous-unemotional traits. Youths with DBD and low callous-unemotional traits alone showed significantly greater threat responses during retaliation relative to comparison subjects. These data also suggest that ventromedial prefrontal cortex-amygdala connectivity is critical for regulating retaliation/reactive aggression and, when dysfunctional, contributes to reactive aggression, independent of level of callous-unemotional traits.

Dataset Information

Disruptive Behavior Disorders and ADHD: A Problem-Based Learning Activity for Psychiatry Clerkship Students.

Introduction

Methods

Results

Discussion

Publications

Disruptive Behavior Disorders and ADHD: A Problem-Based Learning Activity for Psychiatry Clerkship Students.

Similar Datasets

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