Undergraduate medical education of Psychiatry in the West

Abstract

Byline: Jolyon. Dale, Vishal. Bhavsar, Dinesh. Bhugra Undergraduate training in Medicine has been through a major structural change in the UK in the past decade or so. The focus on training has been on problem-based learning and is student led. This has raised the profile of some subjects; including Psychiatry, which is now increasingly being used for communication skills training in both primary- and secondary-care settings. In this paper, we illustrate some of the themes as exemplified in the UK training. Some of the special additions are in the field of Special Study Modules which can focus on a number of psychiatric conditions, in addition to the clinical attachments that students are expected to undergo. Training in Psychiatry at the undergraduate level is crucial for a number of reasons. In the United Kingdom, the prevalence of psychiatric disorders in the community lies at 20%.[sup] [1] Of the total population presenting with symptoms in primary care, the prevalence increases to 25%;[sup] [1] but amongst general hospital inpatients, the prevalence increases to 40%, with the highest rates amongst Accident and Emergency department admissions. These observations indicate that a high prevalence of mental illness is seen in the United Kingdom. This also means that medical professionals will regularly come into contact with those with mental illness, regardless of their hospital specialties or whether they work in the primary care. These findings are not confined only to the UK. A cross-European study in 2004 showed that 25% of people will suffer from mental illness at some point in their life.[sup] [2] In the USA, the national comorbidity survey undertaken between 2000 and 2003 showed that 46.4% of Americans will suffer from mental illness at some stage of their lives.[sup] [3] It therefore makes sense that an understanding of both the diagnosis and management of psychiatric disorders should form an important element of both the teaching and assessment of competence in undergraduate Medicine everywhere. In this paper, we illustrate some of the components from the West, using UK curricula as an example. We also illustrate some of the strengths and weaknesses of the teaching of Psychiatry in undergraduate education in the United Kingdom. We believe that Psychiatry education in medical schools provides an important avenue for the development of generic doctoring skills - such as communication skills, which are at the heart of General Medical Council (GMC), the body responsible for regulating doctors; these expectations are outlined in Good Medical Practice. Also listening, empathy and a holistic approach to patient management can be learnt through Psychiatry and Psychology. Teaching around core common mental disorders such as depression and eating disorders serves as understanding of paradigms of the biopsychosocial model of disease across a number of acute and chronic conditions. Psychiatry Teaching There are 27 medical schools in the United Kingdom that are recognized by the General Medical Council (GMC).[sup] [4] The GMC sets and monitors standards in undergraduate education in the UK and is the main body responsible for assessing and maintaining standards for undergraduate training compared with Post-Graduate Medical Education and Training Board (PMETB). The core education outcomes, published by the GMC Education Committee in February 2006, recognize that is for medical schools to design detailed curricula and schemes of assessment to meet the knowledge, skills, attitudes and behavior that we require of all medical graduates.[sup] [5] Thus there may be some freedom for the medical schools to develop their curricula; it is the GMC which monitors them. There is an ongoing debate as to the need for a generic curricula; the Strategic Options Report recognizes that medical students need to be given a wide range of knowledge, particularly early in their careers as this forms a solid basis for handling clinical situations. …