Place In Psychiatry Research Articles

Teaching undergraduate psychiatry in a forensic setting

Typically, medical students do not learn about psychiatry in forensic settings. Depending on their interests and their medical school, they might have access to special study modules or elective placements in their final year. We introduced undergraduate psychiatry placements at our regional

Teaching recovery to medical students.

Community mental health services are evolving toward more holistic, patient-centered, recovery-based practices. This change necessitates an attitudinal shift from mental health workers, and training in recovery principles is helpful in achieving this change. Medical students often have narrow, doctor-centered concepts of mental health care. Traditional clinical placements in psychiatry do little to address this. We evaluated a recovery-focused teaching program for medical students in psychiatry. Medical students' knowledge of recovery from mental illness was assessed before and after either a 6-week traditional or recovery-focused clinical placement in psychiatry, using the Recovery Knowledge Inventory. A validated questionnaire was used to assess attitudes toward mental illness before and after the placements. Focus groups were conducted before and after the recovery teaching. One hundred nineteen medical students participated; 23 experienced the recovery teaching program while 96 had a traditional placement (23 in the same center as the recovery teaching program and 73 in other centers). There were no significant differences between groups at baseline. After recovery teaching, medical students significantly increased their recovery knowledge and had more positive attitudes toward mental illness and psychiatry when compared with those who had a traditional placement. The focus groups revealed greater optimism and more holistic concepts of recovery from mental illness. The recovery teaching program was associated with increased knowledge of recovery principles and more positive attitudes toward mental illness. Psychiatric clinical placements for medical students should include an explicit recovery focus.

Foundation Programme psychiatry placement and doctors' decision to pursue a career in psychiatry

Aims and methodThis study analyses whether there is a relationship between a psychiatry placement during the UK Foundation Programme and appointment to psychiatry training. A survey was distributed to all foundation year 2 doctors in the UK to determine how many have exposure to psychiatry before specialty applications and whether such exposure correlates with choosing psychiatry as a career.ResultsThe study showed that 14.6% of foundation doctors had exposure to psychiatry prior to specialty applications. Of these, 14.9% chose psychiatry as a career in contrast to only 1.8% of those who did not have psychiatry exposure (χ2P = 0.0008; risk ratio 8.19).Clinical implicationsThis study adds weight to calls to increase the proportion of psychiatry posts in the Foundation Programme as part of a broader strategy to improve recruitment. To answer this question categorically, we suggest a prospective cohort study looking at how attitudes and career preferences change with exposure to psychiatry posts.

Student learning needs in psychiatry

PurposeThis study aims to explore the area of learning materials used by students in their psychiatry placement in more detail, and to identify any gaps not adequately filled currently. It also seeks to explore student interest in psychiatry and whether they are considering pursuing it as a future career.Design/methodology/approachThis was a cross sectional study, using questionnaires completed by medical students about their psychiatric undergraduate placement at Manchester University.FindingsOf 144 students, 126 responded (response rate 87.5 per cent). Students spent a mean of 10.1 hours a week studying psychiatry (outside formal teaching). Handouts from lectures or tutors were most commonly used (by 95.2 per cent of respondents) with journals and podcasts being the least common (18.5 per cent and 17.5 per cent, respectively). Psychiatric textbooks were the most useful material for learning about psychiatry. Students identified the need for better quality, more structured and more frequent teaching (n=58). They also identified a need for greater clinical experience and increased availability of resources such as textbooks.Research limitations/implicationsKnowing what materials and resources students prefer to learn from will be crucial to maximize the delivery of an enjoyable and educational psychiatry module. This in turn may result in more students choosing psychiatry as a career. Larger studies are required to support the findings in this study.Originality/valueTo the authors' knowledge, there is very little published research into what materials medical students use to learn for their psychiatry placement.

Lectures versus case discussions: randomised trial of undergraduate psychiatry teaching

Aims and methodTo test whether medical students find case-based discussion of child psychiatry more educationally stimulating and more enjoyable, and whether this leads to greater knowledge acquisition than traditional didactic lectures. Four cohorts of Cambridge medical students (n = 54) were randomised to case-based discussion or traditional didactic lectures for two topics in their psychiatry placements. Enjoyment and stimulation were determined by feedback forms; knowledge acquisition was tested by an end-of-placement exam.ResultsStudents in case-based discussion groups scored significantly higher than students in the lecture groups in the extent to which they enjoyed the teaching session (P = 0.006); the extent to which they understood the principles of management of real-life patient problems (P = 0.044); and their interest in looking up further information (P = 0.003). There was no significant difference in exam performance (P = 0.9).Clinical implicationsMedical students find case-based discussion more engaging and enjoyable than didactic lectures, with no reduction in exam performance.

Medical students' beliefs and attitudes towards schizophrenia before and after undergraduate psychiatric training in Greece

The aim of the present study was to explore medical students' beliefs and attitudes towards people with schizophrenia (PwS) prior to receiving any training in psychiatry and to assess the impact of the psychiatric placement on changing them. A questionnaire addressing beliefs, attitudes and desired social distance from PwS was distributed to all final year medical students before the beginning of their 4-week undergraduate psychiatric placement and upon its completion. Students did not endorse stereotypes commonly attached to PwS, such as being dangerous, lazy or of lower intelligence, but they held the view that PwS are unpredictable and suffer from split personality. Furthermore, the baseline level of desired social distance was found to increase as the intimacy of the interaction increased, and the only variable associated with it was personal experience of serious mental illness. Moreover, the placement was found to have either no influence at all or in a negative direction. Upon its completion more students were found to believe that PwS cannot recover, have no insight into their condition, cannot make reasonable decisions, cannot work in regular jobs and are dangerous to the public. No difference was recorded in social distance scores. A close and critical examination of the various elements of the undergraduate placement in psychiatry is needed in order to develop an evidence-based, fully rounded education with an anti-stigma orientation.

Are some subspecialties better with foundation doctors?

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P-830 - The influence of medical school placement on psychiatry as a speciality career choice

The career choices of medical students change often during the course of their training. Recent changes to the UK medical training structure force graduates to specialise earlier in their careers. This would make medical school placements even more important in speciality choice. In the UK psychiatry is one of the most undersubscribed specialities. There are many possible reasons. However, there are very few areas where the profession can exert any influence. Currently, the only available option seems to be to compete with other specialities for the limited number of medical graduates available for postgraduate training. To assess the influence of placement experience at medical school on student speciality preference and hence subsequent career choice. 50 medical students from a UK university were asked to rank 8 medical specialities from 1–8 (1 = most preferred, 8= least preferred) before and after placements in those respective specialities. The average ranks before and after placements were then compared. The average specialty ranks before and after placements were: Speciality (before: after), Dermatology (6.2:6.1), Otolaryngology (4.7:4.6), Geriatrics (5.0:4.8), General Practice (3.4:3.5), Obstetrics and Gynaecology (2.7:2.8), Ophthalmology (5.9:5.9), Paediatrics (3.3:3.2) and Psychiatry (4.8:5.1). The results show that whilst placements in Geriatrics, Paediatrics and Otolaryngology led to an increases in preference +0.2, +0.1, +0.1 respectively. Psychiatry placement led to a large decrease in preference of −0.3. Therefore, specialities such as psychiatry that find it hard to attract medical graduates may benefit from focussing on improving medical student teaching and experience.

Student attitudes to psychiatry and their clinical placements

Background: Medical students consistently report low rates of interest in psychiatry as a career over time with negative perceptions of the specialty. Only 3–6% of students enter the specialty.Aim: To explore medical students’ current career choices and attitudes to psychiatry and factors affecting these.Methods: Medical students at four UK medical schools completed a questionnaire related to career specialty choices and psychiatry and their psychiatry placement experiences.Results: A total of 905 questionnaires were returned. Psychiatry was first career specialty choice in 4% but in the top three choices in 14%. The students in this group who had undertaken clinical placements were more positively inclined towards psychiatry, given more opportunities to practice and receive feedback on psychiatric skills, and more inclined to practice psychiatry later.Conclusion: One in seven students is interested in psychiatry. Psychiatrists need to find ways to identify these students and target them with individually tailored interventions to help recruitment into the specialty.

Improving psychiatry training in the Foundation Programme

Aims and methodWe explored the views of foundation doctors on psychiatry placements to inform further post development. Following criticism of some South Thames Foundation School (STFS) psychiatry placements, STFS staff reviewed existing information on post quality and 21 foundation doctors in psychiatry posts took part in three focus groups.ResultsTrainees are concerned about the general quality of posts (including supervision and induction); isolation of mental health trusts from ‘acute’ trusts; the professional position of junior psychiatrists; and responsibilities related to the Mental Health Act and risk assessment. Requirements for posts to address these issues have been developed and are now being implemented locally.Clinical implicationsThe conclusions are relevant to the quality management of foundation posts in mental health trusts, responses to the Collins Report (2010) and future recruitment into psychiatry.

Alys Cole-King: a pioneer of suicide mitigation in the UK

Alys Cole-King: a pioneer of suicide mitigation in the UK

P03-537 - How medical student placements at a psychiatry hospital can be utilised to make psychiatry a popular career choice

It is perceived that negative attitudes towards mental illness in undergraduate medical students can impact student's decision in choosing psychiatry as a medical career. Improvement in psychiatry placements for undergraduate medical students can result in changing student's attitude towards psychiatry as a career choice. We demonstrate how students’ placements from various medical schools at a major psychiatric hospital contributed towards enhancing student's interest towards psychiatry. Medical students who had their placement over the last one year were contacted for an anonymised student perspective survey.While majority of students did not have psychiatry as their potential career choice before they started their placements more than two third rated psychiatry as a potential career choice based on their experience from the placements. This encouraged us to improve the placement standards based on student's perspective. Students suggested that more use of medical training in psychiatry, improvement in teaching and placement standards and more psychiatry placements before specialised training can contribute towards making psychiatry as one of the popular career choices. Student's preferred interactive teaching sessions including case based discussions and informal teaching sessions during ward rounds and clinics. Overall students found their placements helpful but more so to perform well in their examinations as compared to coverage of full psychiatry curriculum.It is planned to conduct the survey again after necessary changes based on student's perspective to evaluate whether further improvement in placements can continue in contributing towards increasing medical recruitment in psychiatry.

P03-585 - Patient centred teaching: is it effective in teaching psychiatry to medical students?

Aimsof this 2-staged study were to assess knowledge gain of medical students following an individual episode of patient-centred teaching. Participant satisfaction was also assessed.BackgroundThe education of medical students is an important role for trained medics using adabtable teaching methods, appropriate to the demands of students and medical universities. Delivery of patient-centred teaching in UK is ad-hoc, minimal and not standardised. However, medical education still tends to be delivered in the in-patient environment, where there is little supervision and students often have to identify patients on their own. Paucity exists in the evidence of whether bedside teaching assists in knowledge gain.MethodIn Derby, a Patient-centred clinic was developed in 2008. We conducted a pre-intervention/post-intervention comparison study to measure the knowledge gained during a teaching session. Participants were medical students from University of Nottingham, and in-patients at the Unit. Following this, standards were set and assessing questions were changed to multiple choice style questions in January 2010.Resultsshow that there is an immediate knowledge gain, of an average of 22%. Students are satisfied with this method of teaching and patients have felt that their input has been valued. The second part of the study has confirmed these findings.ConclusionsThe study demonstrates usefulness of patient-centred education in improving clinical knowledge. Adoption of this form of teaching will benefit not only medical students in their psychiatry placement in Derby, but also the wider medical student population. This method can also be implemented in other acute medical specialties.

De mens in zijn totaliteit. De antropologische benadering in het werk van Lammert van der Horst (1893-1978)

The totality of man. The anthropological approach to psychiatry in the work of Lammert van der Horst (1893-1978) The anthropological approach was one of the new approaches to psychiatry that emerged in the interbellum. In the Netherlands professor Van der Horst (VU-university Amsterdam and the municipal University of Amsterdam) was its most prominent proponent. The general idea of the anthropological approach was to integrate the various ways of knowing then available. A psychiatric disease was seen as the result of a failure in the self-realisation of the individual person. This required to consider all relevant aspects relating to the patient’s existence. How to tailor these ideas to concrete forms of diagnosis and methods of treatment was no easy matter and Van der Horst devoted himself all his life to this task. He first sought to classify man in three or four types of character inspired by the works of Heymans and Kretschmer. Then he tried to give the specific human aspect its place in psychiatry by introducing a ‘pneumatic’ dimension in his analysis of persons. He also connected this dimension to Calvinism, the church he belonged to. In the 1940’s he made a turn towards existentialism and tried to connect this philosophy to anthropological psychiatry. In spite of its fragmentary appearance I believe it is possible to discern a degree of continuity in the work of Van der Horst. The concern with the specifically human was always central to him. Moreover Van der Horst saw no strict divide between addressing questions in psychiatry and thinking about the greater questions of life which provides an explanation for his meandering thoughts. The dissertation of J.H. van den Berg which appeared in 1946 offers an interesting contrast to Van der Horst. To Van den Berg the anthropological approach was no more than a method best developed by Binswanger. Van den Berg tested this method and concluded that the approach could offer hermeneutic insights at points where methods of the natural sciences fell short. These restrictions had the sake of clarity. In stark contrast, and in spite of all his efforts, many aspects in the work of Van der Horst remained obscure. However his search for an overarching anthropological approach to psychiatry is still interesting to us because it questions what the borders of the field actually are. Since the various approaches to psychiatry are still at best loosely integrated this question is of continuing relevance.

Postmodernism and psychiatry

have highlighted some of theimportant positive aspects of foundationyear placements in influencing careerchoice into psychiatry.The jubilant articlecarries an optimistic account from trainersand trainees who share the champagne ofsuccessful mentoring. Unfortunately, thedarker side of wider experience whileseeking foundation placements inpsychiatry has been overlooked.The number of places available for FY1and FY2 placements in psychiatry are verylimited, and as of now not representa-tional of subsequent requirements thespecialty has during core training.There isan urgent need for such ‘potentialdemand’ v. supply statistics to be madeclear and compared across variousspecialties.The perennial recruitment issuecould be seen in correct perspective whenlevel playing fields are ensured followingthe implementation of ModernisingMedical Careers.Despite being a trainee with significantinterest in exploring psychiatry as a careerchoice, the placements in my current FY2rotation were ready-made with noelement of choice. On the wake of Boyleet al’s account, it is important to solicitand analyse national data on foundationplacements in psychiatry and rate ofconversion into core psychiatric training.Creating such foundation maps ofpotential psychiatry placements acrossdeaneries may help interested trainees toplan their careers. One could argue thatpsychiatry must be given more foundationslots than some relatively oversubscribedspecialties.If one is allowed to make a deductionfrom personal experience, mostspecialties look at foundation doctors asinconsequential cogs in the churningwheel of hospital machinery.Very fewminutes in the 120 days of a foundationplacement are spent in motivating thetrainee to consider a specific specialtycareer. In addition, the educationalmeetings and professional activities inmost hospital units tend to concentrateeither on core trainees or making a ‘safedoctor’out of foundation trainees.Thereis an immense hidden potential forpsychiatry to convert a substantialnumber of hesitant doctors into promisingand passionate specialists for the future, ifsome collective and timely effort is takento recognise the prospect here.Bearing in mind that at least a quarterof all psychiatrists explore other special-ties before choosing psychiatry as theircareer,

Medical students' views about an undergraduate curriculum in psychiatry before and after clinical placements

BackgroundIt has been suggested that medical students wish to focus their learning in psychiatry on general skills that are applicable to all doctors. This study seeks to establish what aspects of psychiatry students perceive to be relevant to their future careers and what psychiatric knowledge and skills they consider to be important. It is relevant to consider whether these expectations about learning needs vary prior to and post-placement in psychiatry. To what extent these opinions should influence curriculum development needs to be assessed.MethodsA questionnaire was distributed to medical students before they commenced their psychiatry placement and after they had completed it. The questionnaire considered the relevance of psychiatry to their future careers, the relevance of particular knowledge and skills, the utility of knowledge of psychiatric specialties and the utility of different settings for learning psychiatry.ResultsThe students felt skills relevant to all doctors, such as assessment of suicide risk, were more important than more specialist psychiatric skills, such as the management of schizophrenia. They felt that knowledge of how psychiatric illnesses present in general practice was important and it was a useful setting in which to learn psychiatry. They thought that conditions that are commonly seen in the general hospital are important and that liaison psychiatry was useful.ConclusionTwo ways that medical students believe their teaching can be made more relevant to their future careers are highlighted in this study. Firstly, there is a need to focus on scenarios which students will commonly encounter in their initial years of employment. Secondly, psychiatry should be better integrated into the overall curriculum, with the opportunity for teaching in different settings. However, when developing curricula the need to listen to what students believe they should learn needs to be balanced against the necessity of teaching the fundamentals and principles of a speciality.

Should comprehensive diagnosis include idiographic understanding?

The World Psychiatric Association has emphasised the importance of idiographic understanding as a distinct component of comprehensive assessment but in introductions to the idea it is often assimilated to the notion of narrative judgement. This paper aims to distinguish between supposed idiographic and narrative judgement. Taking the former to mean a kind of individualised judgement, I argue that it has no place in psychiatry in part because it threatens psychiatric validity. Narrative judgement, by contrast, is a genuinely distinct complement to criteriological diagnosis but it is, nevertheless, a special kind of general judgement and thus can possess validity. To argue this I first examine the origin of the distinction between idiographic and nomothetic in Windelband's 1894 rectorial address. I argue that none of three ways of understanding that distinction is tenable. Windelband's description of historical methods, as a practical example, does not articulate a genuine form of understanding. A metaphysical distinction between particulars and general kinds is guilty of subscribing to the Myth of the Given. A distinction based on an abstraction of essentially combined aspects of empirical judgement cannot underpin a distinct empirical method. Furthermore, idiographic elements understood as individualised judgements threaten the validity of psychiatric diagnosis. In the final part I briefly describe some aspects of the logic of narrative judgements and argue that in the call for comprehensive diagnosis, narrative rather than idiographic elements have an important role. Importantly, however, whilst directed towards individual subjects, narratives are framed in intrinsically general concepts and thus can aspire to validity.

Eliminating unnecessary physical restraints in the community: case studies from Aceh Province, Indonesia

Background In line with the paradigm shift currently taking place in psychiatry, the authors have experienced obstacles and success in developing community based mental health care in Southeast Asia. Objectives: Due to ignorance, prejudice, discrimination and treatment gap persons with mental disorders are often kept in unnecessary restraints. This situation calls for a dramatic change. The authors call attention to the often neglected setting of restraint whilst highlighting resilience and resources of families and the community.

Undergraduate Teaching of Child and Adolescent Psychiatry in Australia: Survey of Current Practice

To identify the goals, content, and time allocated for undergraduate child psychiatry teaching programmes in Australian medical schools. A structured questionnaire designed specifically for the present study was used to identify the goals, content, and time allocated to child psychiatry teaching for undergraduate medical students. Staff responsible for child psychiatry teaching programmes at all 15 medical schools in Australia were contacted and those in 12 schools (80%) agreed to participate. All 12 medical schools provided some teaching relevant to child psychiatry. Teaching was commonly provided as part of general psychiatry and/or paediatric teaching programmes. Between 4 and 12 h were allocated for child psychiatry teaching, with the exception of one school, which assigned 46 h. Ten schools (83%) offered clinical placements in child psychiatry to some or all students, with placements ranging in length from 0.5 days to 8 weeks. However, only four schools (33%) offered clinical placements to all students. Two schools (17%) offered no clinical placements or electives in child psychiatry. The skills required to assess children and families, and knowledge about normal child development were identified as key teaching goals. Barriers to teaching child psychiatry included the lack of academic child psychiatrists in Australia, and the limited time allocated for this teaching in medical school curricula. The amount of time allocated for teaching child psychiatry in Australian medical schools is relatively small and not consistent with the size of the public health problem posed by child and adolescent mental disorders. Staff responsible for teaching child psychiatry need to coordinate their activities more effectively at a national level to identify teaching goals, design curricula, and advocate for high-quality child psychiatry teaching programmes in medical schools.

Teaching undergraduate psychiatry in primary care: the impact on student learning and attitudes

To explore the impact of undergraduate psychiatry placements in primary care settings on students' learning and attitudes to mental illness. Questionnaire survey and qualitative in-depth interviews. A primary care-based psychiatry undergraduate teaching programme at Royal Free and University College Medical School, London. A total of 145/183 (79.2%) students attending the primary care-based programme over 2 academic years completed a questionnaire survey. In-depth interviews were conducted with 14 students, 12 general practitioner (GP) tutors and 20 patients participating in the course. In the questionnaire survey, 121/144 (84.0%) students valued the primary care-based teaching highly. In total, 87/139 (62.6%) students felt their attitudes to mental illness had changed as a result of the course. In-depth interviews demonstrated 4 key benefits of the teaching programme: increasing breadth of experience, understanding the patients' experience, learning about mental illness from a GP's perspective and changing students' attitudes towards mental illness. The students' attitudinal shift comprised 2 main dimensions; 'normalisation' of mental illness and increased empathy. Learning psychiatry in primary care settings offers students a broader experience of a range of patients than in hospital settings and encourages a 'person-centred' approach, which in turn can have a positive impact on their attitudes to mental illness, reducing stereotyping and increasing empathy.