Dr. Klapheke and his colleagues are having the modules peer reviewed and plan to submit them to MedEdPORTAL, making them available online as a free national database for use by medical schools across the country. Dr. Klapheke and the CSI Task Force have produced five modules so far and plan to produce a total of 14 that encompass the major disorders in Psychiatry.

“These modules utilize educational technology and state-of-the-art simulation in a most effective way for educators and students,” Dr. Klapheke said.

The Liaison Committee on Medical Education (LCME), which accredits medical schools, requires third- and fourth-year students to learn through actual clinical experiences. Finding a sufficiently broad variety of such experiences at available clinical placement sites for students can at times be a challenge. As Dr. Klapheke explained, a medical student in a six-week psychiatric rotation may well see multiple patients with depression, but might not see sufficient patients with more uncommon disorders. “These self-learning modules can help fill in those gaps,” he said.

Dr. Klapheke’s module was filmed in the College of Medicine’s Clinical Skills and Simulation Center, where standardized patients received scripts detailing their symptoms. During the self-learning module, students see video clips showing how a psychiatrist interviews and interacts with the patient. These interactive modules have students take a series of quizzes to test their learning, offers feedback on their answers, and allows them to study at their own pace.

Dr. Klapheke and the CSI group showed the modules on laptop computers at the ADMSEP conference:  “People were waiting in line to get a look at them. It was a delight to get name recognition for Â鶹ԭ´´ and for both the College of Medicine’s Educational Technology staff and Clinical Skills and Simulation Center.”

Dr. Klapheke credited Dale Voorhees, director of learning systems, who filmed and edited the training videos, and Alex Chacon, classroom support specialist, for the graphics and design of the winning poster. “This was a team effort,” he said. “Dale, Alex and the Clinical Skills team did a spectacular job.”

Dr. Nanton’s research used standardized tests and structured interviews to determine the veracity of the inmates’ reported symptoms and to see if their geographical location or the severity of their crime was a variable in their malingering. His findings included:

“Drug-seeking on the basis of feigned mental illness is an issue globally. Many of the participants at the conference were dealing with that,” Dr. Nanton said. “But as forensic psychiatrists, we are also dealing with feigned mental illness in other legal contexts like disability, worker’s compensation and Social Security.”

Dr. Nanton said he first became interested in forensic psychiatry while in medical school at Tulane University. “I took a forensic psychiatry course and thought it was the most interesting thing I’d ever heard about,” he said. “Before that, I was thinking of going into radiology. Forensic psychiatry seemed like more fun.”

Before coming to the Â鶹ԭ´´ College of Medicine this year, Dr. Nanton worked as a forensic psychiatrist at the University of California, Davis. There he performed violence risk assessments at Napa State Hospital, provided clinical psychiatric care to inmates at the Sacramento County Jail and conducted court-ordered and private assessments to determine if inmates were competent to stand trial and were criminally insane.

Solid organ transplants – of the kidney, liver, heart and lungs – have become almost commonplace. Virtually everyone knows someone who has received such a transplant and communities often have support groups who help transplant patients cope with the physical and emotional aspects of their condition. But “composite tissue” transplants – of the face, hand and larynx—are innovative and unique, meaning doctors and patients must confront more unknowns and uncertainties as to how to assess candidates and anticipate outcomes. 

Candidates for hand transplantation have experienced the physical and psychological trauma of amputation, and frequently even those who have adjusted extremely well still feel incomplete, Dr. Klapheke said. They may raise mirrors in their homes to avoid seeing the missing hand, and they talk openly of missing the wonders of human touch (hugging loved ones with both hands) or even “the little things” like buttoning a shirt or throwing a ball with their children.  

Innovative transplants can have a futuristic or even “science fiction” aspect for patients that psychiatrists must address with patients.  For example, unlike a transplanted kidney, a transplanted hand is constantly visible to the patient, who notices the new limb’s different skin, texture and coloring. In assessing candidates for hand transplantation, the patient’s coping skills and level of personality organization (potential for psychological regression in the face of marked stress) must be carefully assessed.

As part of Grand Rounds, Dr. Klapheke presented the case of a health care professional who experienced a traumatic loss of his hand. The patient was assessed pre-transplant as having a well integrated sense of self despite the amputation, but he still felt “damaged” and longed to feel “whole again.” After the transplant he was delighted and felt full ownership of the new hand, but four days after his surgery, the media breached confidentiality and reported that the transplant donor had died while in prison for manslaughter. Now the patient, whose job had been to save lives, had the hand of a man who had killed two people. “I was obviously even more concerned about how well the patient would be able to integrate this new hand into his sense of himself,” Dr. Klapheke said, but the patient was able to immediately respond to the news story by stating, “It’s okay. This is my hand now.  It is my blood that courses through it, and I control what it does.  It is my hand.”

After the transplant and rehabilitation, this patient carried his son onto the baseball field and with his new hand threw out the first pitch at a professional game featuring his favorite team, the Philadelphia Phillies. Over ten years later, he has continued to demonstrate psychological resilience and remains delighted with “my (new) hand.”