Delivering a Catatonia Clinical Skills Exam for Medical Students: a Pilot Design

Abstract:

Background: Catatonia is a neuropsychiatric syndrome with behavioral and motor symptoms that is prevalent in acute medical settings, yet frequently poorly recognized (Solmi, 2018; Wortzel, 2021). While the psychiatry clerkship is an ideal rotation to teach catatonia, many medical students may not encounter this syndrome during their brief psychiatry clinical rotation. An educational module from the University of Rochester Medical Center used the Bush-Francis Catatonia Rating Scale (BFCRS) to teach the assessment of catatonia, along with a training manual, knowledge tests, and video demonstrations with a standardized patient (Wortzel, 2022). We aimed to design a more interactive method of teaching all clerkship students about catatonia, using an in-person simulation with standardized patients.  





Methods: The authors developed a clinical skills exam (CSE) that specifically addresses catatonia. We trained professional standardized patients (SPs) regarding portraying the signs and symptoms of catatonia. The authors watched a random subset of CSEs to ensure the SPs portrayed the catatonia symptoms accurately and reliably. The CSE scenario included evaluating a SP for catatonia and obtaining collateral by phone from a family member, portrayed by the same SP. The staff of the learning center monitored the time used by the students. After conclusion of the CSE, small groups of students met with a faculty member for a learning session about catatonia. This CSE was a required non-graded activity for the clerkship. Students had a pre-reading assignment about various causes of altered mental status. As part of routine course evaluation, the students were anonymously surveyed regarding the CSE experience.





Results: We will discuss the results from the 2-year pilot including the number of participants, the accuracy of the SPs portraying catatonic symptoms, the time the students needed for the encounter, as well as the results from the post-clerkship survey.





Discussion: Based on preliminary data from the beginning of our pilot, we found that our SPs consistently demonstrated signs of catatonia to the satisfaction of expert observers. It also appears that the students found this CSE valuable. As catatonia is often “missed” in non-psychiatric settings, we feel that an earlier catatonia clinical experience for all learners will help ensure that this syndrome remains on the differential for appropriate patients.





Conclusion: We believe that utilizing a CSE to teach catatonia in psychiatry clerkship rotations not only results in better retention, but also ensures that all medical students experience this encounter. We hope to empower more medical schools to consider adopting such an experience.


 

References:

• Solmi M, Pigato GG, Roiter B, et al. Prevalence of Catatonia and Its Moderators in Clinical Samples: Results from a Meta-analysis and Meta-regression Analysis. Schizophrenia Bulletin. 2018; 44(5):1133–1150. https://doi.org/10.1093/schbul/sbx157 


• Wortzel JR, Maeng DD, Francis A, et al. Prevalent gaps in understanding the features of catatonia among psychiatrists, psychiatry trainees, and medical students. J Clin Psychiatry. 2021; 82(5):21m14025. https://doi.org/10.4088/JCP.21m14025  


• Wortzel JR, Maeng DD, Francis A, Oldham MA. Evaluating the Effectiveness of an Educational Module for the BushFrancis Catatonia Rating Scale. Acad Psychiatry. 2022; 46:185–193. https://doi.org/10.1007/s40596-021-01582-0