Residents training in the mental status examination

Introduction of a standardized report form improves the quality of mental status examination reports by psychiatry residents

The quality of mental status examination (MSE) reports in consecutive admission notes by psychiatric residents was compared before and after the introduction of a structured, pre-printed MSE form that had been designed for teaching and quality of care purposes. We found the use of the form to be associated with a marked improvement in the quality of the reports; however, an important item not on the form was less likely to be recorded than with an unstructured record of the MSE. We conclude that the use of structured MSE forms leads to a significant improvement in the comprehensiveness of MSE records. We therefore recommend that some version of a comprehensive, structured MSE form be adopted for use on adult inpatient psychiatry units where residents are being trained.

Towards selective and improved performance of the mental status examination

Performance of mental status examinations (MSE) is often useful but is not warranted for all new patients, except for training, research, special request, or policy. Reasons for doing MSE must be weighed against possible detrimental effects on patients or on patient-clinician relationships. Both sides are reviewed. Methods for ameliorating or preventing adverse effects are described. Validity of findings using MSE are frequently doubtful and examiners often misinterpret their significance. A decision tree is presented to help decide whether to use the MSE in particular instances.

Residents performance on the mental status examination

Twenty-six residents watched a videotape of the mental status examination of a psychotic patient, then wrote their assessment of the patient's mental status. The residents' reports were independently graded by the authors. The residents' marks were compared to performance on departmental oral examinations. Results showed that global or qualitative assessment of mental status performance was reliable. Excellent interrater reliability was achieved when the assessment criteria for sub-items of the mental status were well defined.