NU674 Unit 1 Outpatient Clinic Learning Objectives Example

Six Objectives, Six Written Products: Clinical Learning Objectives for a First PMHNP Rotation in a County Outpatient Psychiatry Clinic

[Student Name]

Purdue University Global

NU674: PMHNP Diagnosis and Management Across the Lifespan Clinical I

Unit 1 Clinical Learning Objectives

[Instructor Name]

[Date]

The clinic is composite; volumes and targets are bracketed. Preceptor lines are left blank.

The Clinic

The rotation is in a county outpatient psychiatry clinic that serves adults and adolescents, many on public insurance. According to the orientation packet, a typical week for one prescriber includes [six to eight] new adult intakes, [two to three] adolescent intakes with a parent present, [25 to 30] brief medication follow-up visits of [20] minutes, and several same-day risk assessments for patients who disclose suicidal thoughts. Documentation is completed in a structured electronic template, and preceptors review student notes before they are signed.

This is my first psychiatric rotation. I have completed courses in psychopathology and psychotherapy but have not conducted a psychiatric intake or written a mental status examination for a real patient. I am comfortable talking with adults and less comfortable with adolescents and parents together.

Why These Six

The six objectives follow the clinic's actual week rather than a textbook list. Adult intakes and brief returns make up most of the schedule, so two objectives address them. Adolescent intakes are fewer but are the interviews I feel least ready for, and risk assessments are infrequent but carry the highest stakes, so each has its own objective. The mental status examination and the formulation run through every intake and are where my documentation is most likely to fall short, based on feedback from my simulation course, which noted that I tend to write conclusions instead of observations.

How the Objectives Are Built

Each objective names the interview type, the skill, the written product, the standard the preceptor will apply and a review point. The written product is the key: a preceptor who sat in on an interview can compare my note with what happened, line by line.

Objective 1: Adult Intake History

Interview: new adult intake. Skill: gather a history of present illness that places symptoms on a timeline, with onset, course, triggers and treatments tried. Written product: the history of present illness section of the intake note. Standard: the preceptor can reconstruct the course of illness from my note alone, and no key element is missing on review. Target: [eight] intakes by week [8], with the last [four] needing no major revision. Review: week [8].

Objective 2: Mental Status Examination in Observational Language

Interview: any intake. Skill: write a mental status examination that describes what I saw and heard rather than interpreting it, for example recording response latency in seconds instead of writing "slowed." Written product: the mental status examination section. Standard: every line can be confirmed by a preceptor who observed the interview. Target: [ten] examinations by week [10]. Review: weeks [5] and [10].

Objective 3: Adolescent Intakes With a Parent Present

Interview: adolescent intake. Skill: structure the interview to include time with the adolescent alone, explain confidentiality and its limits to both, and gather each person's view. Written product: an intake note that records both perspectives separately and documents the confidentiality discussion. Standard: the note shows who reported each item. Target: [four] adolescent intakes by week [12]. The PHQ-9 modified for adolescents will be used as a screen; in a validation study in adolescents it showed good sensitivity and specificity for major depression (Richardson et al., 2010). Review: week [12].

Objective 4: Suicide Risk Screening and Assessment

Interview: any patient who screens positive. Skill: use the Columbia Suicide Severity Rating Scale to screen and, when positive, complete a structured risk assessment with a safety plan. The scale has shown good validity and sensitivity to change across settings (Posner et al., 2011). Written product: the risk assessment and safety plan. Standard: the risk formulation is supported by the documented factors, and the plan names specific steps and contacts. Target: [five] assessments completed with the preceptor present by week [8], and then [three] with the preceptor reviewing afterward. Review: week [8] and week [14].

Objective 5: Brief Medication Follow-Up Visits

Interview: 20-minute return visit. Skill: in [20] minutes, measure symptoms with a standard scale, check side effects and adherence, and make one clear decision. Written product: a focused follow-up note. Standard: the note states the score, compares it with the last one, and links the decision to the change. The PHQ-9 will be used for depression follow-ups, a validated nine-item severity measure (Kroenke et al., 2001). Target: [30] follow-up notes by week [14], completed within the visit time. Review: week [14].

Objective 6: Formulation

Interview: any intake. Skill: write a formulation paragraph that explains why this person is presenting now, using facts from the evaluation. Written product: the formulation paragraph. Standard: every claim in the formulation can be traced to a documented fact. Target: [six] formulations by week [14]. Review: week [14].

Each objective names a document because a document is what the preceptor can hold against the interview; a feeling of competence is not.

Outside the Scope of These Objectives

These objectives do not record hours or patient counts, which belong in my clinical log. It does not include prescribing decisions, which remain with my preceptor in this first rotation.

Preceptor Agreement

Preceptor: ______________________

Date: ______________________

Changes: ______________________

References

Kroenke, K., Spitzer, R. L., & Williams, J. B. W. (2001). The PHQ-9: Validity of a brief depression severity measure. Journal of General Internal Medicine, 16(9), 606-613. https://doi.org/10.1046/j.1525-1497.2001.016009606.x

Posner, K., Brown, G. K., Stanley, B., Brent, D. A., Yershova, K. V., Oquendo, M. A., Currier, G. W., Melvin, G. A., Greenhill, L., Shen, S., & Mann, J. J. (2011). The Columbia-Suicide Severity Rating Scale: Initial validity and internal consistency findings from three multisite studies with adolescents and adults. American Journal of Psychiatry, 168(12), 1266-1277. https://doi.org/10.1176/appi.ajp.2011.10111704

Richardson, L. P., McCauley, E., Grossman, D. C., McCarty, C. A., Richards, J., Russo, J. E., Rockhill, C., & Katon, W. (2010). Evaluation of the Patient Health Questionnaire-9 Item for detecting major depression among adolescents. Pediatrics, 126(6), 1117-1123. https://doi.org/10.1542/peds.2010-0852