As the new director of the Department of Psychiatry & Behavioral Sciences clerkship program, Cerrone Cohen, MD, an assistant professor in both psychiatry and behavioral sciences and family medicine and community health, recognizes the valuable opportunity the clerkship gives Duke University medical students, while also getting equally energized about the vital long-term role it can play in preparing students to help address the mental health crisis in the U.S.
After a year of foundational sciences and principles, second-year medical students get hands-on learning opportunities in the four-week psychiatry clerkship. Students are paired with clinical teams in acute inpatient psychiatric care services, emergency room psychiatric care services, and consultation liaison psychiatry hospital-based services across several hospitals and health systems. Students also participate in a half-day weekly outpatient clinic experience and may be assigned to a weekend call shift in the emergency department or inpatient hospitalization.
Collaborating with providers across Duke University Hospital, Duke Raleigh Hospital, the Durham Veterans Affairs Medical Center, Central Regional Hospital, and other facilities, he arranges in-depth learning rotations for students with multiple clinical teams. Students interact closely with and learn from a range of providers, including psychiatrists, psychologists, emergency physicians, residents, social workers, discharge planners, and more.
Through this approach, students develop an understanding of how an interdisciplinary team works together to effectively care for behavioral health patients. Students help provide care to children, adolescents, and adults, including medically admitted patients, those with psychiatric conditions, and those with psychiatric comorbidities, in a variety of settings. Every four weeks, Cohen repeats the program with a new cohort of medical students.
Prior to becoming the clerkship director in July 2022, Cohen served as the assistant program director for the family medicine residency program for four years. Through this transition, he went from working with trainees who are “all in” with their chosen specialty to those who are still deciding on their path as a physician—and getting what might be their only exposure to dedicated training in behavioral health clinical care.
“The clerkship experience could be the deepest dive into real-world mental health services that our students ever receive.”
— Cerrone Cohen, MD
“The psychiatry clerkship plays a major part in solving the mental health access and treatment crisis, both now and in the future,” explains Cohen. Only about five percent of medical students nationwide choose psychiatry as a specialty, and the resulting lack of providers means that most behavioral health care in the U.S. happens outside of a psychiatrist’s office—in internal medicine offices, pediatrician offices, and primary care clinics. “The clerkship experience could be the deepest dive into real-world mental health services that our students ever receive.”
“Aside from therapy and medication management, the students are exposed to the reality of mental health care services in America. They see first-hand how healthcare costs, stigma, inequities in access, and other challenges combine to create the mental health crisis at hand,” says Cohen. “We give them a front-row seat to the dramatic way that social determinants of health impact daily lives. They see how the things that we take for granted each day play a huge role in how successfully we can manage our own mental health. It’s an exposure they don’t always get in other rotations.”
Cohen, who is double-boarded in family medicine and psychiatry, says he has “always straddled the line between the two different specialties.” He came to Duke in 2015 after completing medical school at the Medical University of South Carolina and a combined residency in family medicine and psychiatry at the University of California Davis Medical Center. In addition to leading the clerkship program, Cohen provides outpatient primary care and mental health services. He’s also a member of Duke Primary Care’s collaborative care team, where he assists primary care providers in treating patients for depression and anxiety.
What does the future of the clerkship look like to Cohen? He shares that his “big hope” is to grow the experience beyond four weeks and expand student opportunities in the outpatient arena. In the long run, he hopes the program will influence more students to choose to pursue a medical career in psychiatry.
“We want to knock on their door, and once they open it, we hope they will open it wide,” says Cohen. “Either way, it’s really exciting to teach behavioral health to medical students who don’t necessarily see themselves as mental health providers,” says Cohen.
Cohen believes students will leave the psychiatry clerkship knowing that no matter what specialty they pursue, they’ll need to—and will be equipped to—help their patients manage their mental health. “They may not see themselves as a future behavioral health care provider, but they will be called upon to be one. I want to them to have a quality experience to carry through to their patients, wherever they land.”