Teaching Psychiatry Residents About Culture-Bound Syndromes: Implementation of a Modified Team-Based Learning Program

Abstract

Diagnostic and Statistical Manual of Mental Disorders (DSM) IV defines culture-bound syndromes (CBS) as “recurrent, locality-specific patterns of aberrant behavior and troubling experience ... indigenously considered to be ‘illnesses,’ or at least afflictions ... generally limited to specific societies or culture areas.” [1] In DSM 5, the definition became “... a cluster or group of co-occurring relatively invariant symptoms found in a specific cultural group community or context (e.g., ataque de nervios).” [2] Psychiatry residents would do well to familiarize themselves with this important group of psychopathologies. For instance, vignettes related to CBS regularly appear on the American Board of Psychiatry and Neurology Board Examination as well as the Psychiatry Resident-InTraining Examination (PRITE®). The Accreditation Council for Graduate Medical Education (ACGME), responsible for accrediting the majority of graduate medical training programs in the USA [3], requires programs to improve residents’ understanding of how a patient’s culture and subculture influence psychopathology. The ACGME does not require a formal, CBS-specific curriculum and does not provide guidelines on how awareness of CBS may be achieved. To this end, we developed a pilot teaching seminar using a modified team-based learning (TBL) approach for psychiatry residents to increase their knowledge of these syndromes. Here, we present the details of this activity as well as the pilot data that we obtained after implementation. Traditional TBL has been used frequently in medicine and psychiatry teaching. It involves pre-class preparation followed by a structured component applying learned concepts into clinical cases [4]. This is accomplished by dividing students or residents into groups where each trainee will interact with others through an active-learning model. InMay 2013, a seminar created and administered by a chief resident (author) was presented to psychiatry residents (Post-graduate year 2, 3, and 4) at the University of Texas Southwestern Medical Center in Dallas. In 1h, 22 psychiatry residents were divided into four groups and presented with six culturally complex psychiatric vignettes. Attendance was voluntary. The vignettes presented patients with one of six different CBS (dhat, latah, pibloktoq, taijin kyofusho, koro, and susto). (The vignettes are available by communication with the author). Residents were asked to select the most likely CBS and associated country of origin from a multiple choice list (average of seven choices including distracters). The vignettes were timed, and scores were calculated after the seminar. The team members were encouraged to use electronic devices to access the internet to answer questions. The team that scored highest at the end of the activity won gift cards to a local coffeehouse to serve as an incentive during the TBL activity. The vignette portion of the exercise was followed by a discussion of each case in which the key symptoms of each CBS were highlighted and distracters addressed. In traditional TBL, there are three phases. Pre-group activities can include reading assignments and a readiness assurance test. The core group activity that follows allows for learned concepts to be applied [4]. In our module, the pre-assigned reading materials were replaced by allowing residents to use digital resources during the learning activity. Three tests were administered for each resident individually: (1) a pre-test before the activity, (2) a post-test administered immediately after the activity, and (3) a remote test administered electronically 4 weeks later. Tests were anonymous and H. Jefee-Bahloul (*) Yale School of Medicine, New Haven, CT, USA e-mail: Hussam.bahloul@yale.edu