Undergraduate Psychiatry Education Research Articles

Undergraduate psychiatry education in India: Where do we stand on the crossroads?

Undergraduate psychiatry education in India: Where do we stand on the crossroads?

Board #101 - Research Abstract Simulation in Undergraduate Psychiatry Education

Hypothesis Undergraduate medical education is increasing the use of simulation-based methodologies to expand students’ exposure to complex clinical scenarios.1-2 While a review of the literature was conducted in 2008 looking at the role of simulation within psychiatric education, emphasis on this review was placed more broadly on all areas of psychiatric education and primarily the role of standardized patients and role play.3 The hypothesis of this paper was to see if additional and potentially more promising approaches to simulation were influencing curriculum development within undergraduate psychiatric education. This paper will review the existing literature on simulation methodologies used specifically within undergraduate psychiatry education and provide an overview of most commonly used approaches to date. The goal is to identify innovative and useful simulations and potential gaps in the use of simulation within the undergraduate psychiatry curriculum. Methods The authors searched the MEDLINE, ERIC, and PsychINFO databases to 2014 using multiple search terms, including simulation, standardized patients, psychiatry, undergraduate education and medical student. A manual refined search of the yielded results specifically including medical students, a range of simulation methodologies (e.g., use of standardized patients, virtual reality, and e-learning simulation modules) was conducted. Literature that indirectly related to the defined search parameters was also included. The authors reviewed each paper manually to determine the type of simulation used and to determine the appropriateness of the use of simulation as a learning modality to enhance teaching, medical student learning and/or assessment. The psychiatry area of focus for the simulation learning was also ascertained. Results The refined search criteria yielded a total of 352 articles examining the use of simulation-based methodologies within undergraduate psychiatry education. Areas of focus included the use of simulation to support learning, assessment, changing attitudes about psychiatry, decreasing stigma, and building empathy among medical students. Of the 352 articles generated, 85 dealt specifically with the use of simulation in undergraduate medical education and spanned a period from 1977 to 2013. Seventy-three percent of the papers looked at the use of standardized patients and 19% utilized an online or web based simulation intervention. Five papers looked at virtual patients in enhancing education. The vast majority of the papers reviewed used simulation in teaching or skill building while seventeen percent discussed its value in assessment or Objective Structured Clinical Examination. Two papers discussed the value of simulation in building cultural competency among medical students.4-5 Conclusion Despite the varied uses of simulation across many health disciplines, little has changed in undergraduate psychiatric education since the 2008 review.3 Some papers focused on skills such as communication skills, empathy and decreasing stigma in psychiatry.6-10 Expanding on these is essential since they are relevant to all facets of the practice of medicine. While a small percentage of papers used simulation-based e-learning models or virtual patients, given the significant resource required for SPs and the challenges in accommodating such learning experiences within an already dense curriculum, these modalities show promise.11 Virtual patients, are reflective of the emergence of the field of telepsychiatry and enable more opportunities for simulation-based learning across a diverse set of contexts.2 Future directions include evaluating the efficacy of these interventions using models of learning to inform future curriculum development in undergraduate psychiatry.12

Burden of mental illness and the need for better undergraduate education in psychiatry.

Burden of mental illness and the need for better undergraduate education in psychiatry.

Remediation Practices in Canadian Psychiatry Clerkships

There is a lack of information regarding interventions for undergraduate students at Canadian medical schools who require remediation during their psychiatric training. The need for a theoretical framework to guide remediation has been identified. In this study, we sought to characterize remediation taking place in undergraduate psychiatry education, particularly during clerkship. A secondary goal was to ascertain whether those responsible for remediation were aware of the stages of change (transtheoretical) model, and whether they formally incorporated this framework (or another) into their remediation processes. A short six-question survey on remediation practices was e-mailed to educators responsible for undergraduate psychiatry education at all 17 Canadian medical schools as identified through the Canadian Organization of Undergraduate Psychiatry Educators (COUPE). The response rate was 67 %. Respondents' overall impressions of their school's remediation process were that it was "highly effective" (25 %), or "somewhat effective" (67 %); 8 % reported being unsure of its effectiveness. While 75 % of survey respondents were aware of the stages of change model, only 17 % reported using this framework: no alternate theoretical frameworks were reported. The most common form of evaluation was multiple-choice question (MCQ) exams, and the most common form of remediation was exam rewrites. There is little information regarding the long-term outcomes of remediation, and further research would be useful in formulating recommendations regarding best practices.

Undergraduate psychiatry education: the challenges ahead

SummaryThis commentary discusses the key issues facing undergraduate psychiatry teaching and the factors inhibiting psychiatrists' roles as medical educators. Potential solutions to allow psychiatrists to fully embrace their teaching role are presented. A particular focus is on enhancing teaching skills, challenging student perceptions of psychiatry and ensuring that teaching is protected, valued and appropriately rewarded. This requires a concerted approach on individual, organisational and policy levels.

Seeking Common Ground Between Medical Humanities and Basic Sciences

Letters to the Editor Psychiatry Encompasses Much More Than Clinical Neuroscience To the Editor: We commend the efforts of Reynolds and colleagues 1 to achieve “the reintegration of undergraduate and graduate medical education in psychiatry and neurology under the rubric of clinical neuroscience.” As supervisors and teachers of psychiatry residents, we also agree with those authors that “psychiatry is grounded in clinical neuroscience” and that our residents need a “deeper understanding of genetics, pathophysiology, functional neuroanatomy and neuropsychopharmacology.” However, we believe psychiatry is grounded in much more than clinical neuroscience, and that Reynolds and colleagues have given short shrift to the philosophical, social, psychological, and humanistic foundations of psychiatry. Indeed, though we proceed from different premises than do Healy and Mangin, 2 we agree with their comment that psychiatry “need[s] more, rather than less, philosophy and psychology within the discipline.” One of us (R.P.) has coined the term encephiatrics to encompass a broad-based, pluralistic discipline that incorporates not only the clinical neurosciences but also elements of philosophy, literature, and the world’s spiritual traditions. 3 We do not regard these substantive disciplines as mere elective “frills” in psychiatric education; rather, we believe that residents in psychiatry should be exposed to the humanities and social sciences as an integral and required part of their training. Indeed, the psychiatry residency program at SUNY Upstate Medical University is now developing a “humanities track” for residents who wish to concentrate their studies in this area. We also believe that fostering competency in providing cognitive-behavioral, interpersonal, psychodynamic, and other forms of “talk therapy” must remain a central focus in a resident’s education, so that all aspects of a patient’s illness may be addressed comprehensively and compassionately. In our view, these points were not adequately stressed by Reynolds and colleagues. Ghaemi 4 argued that the pluralism of psychiatrist and philosopher Karl Jaspers “has still failed to be adequately appreciated by the psychiatric profession.” We fully agree. To put it in clinical terms, “The clinician who can instantiate the neurobiology of serotonin in the context of the existential dilemma of the patient . . . has a far better chance of preventing suicide than one who is entrapped in a solitary paradigm.” 5 Ronald Pies, MD Department of Psychiatry, SUNY Upstate Medical University, Syracuse, New York, and Tufts University School of Medicine, Boston, Massachusetts; (ronpies@massmed.org). Cynthia M.A. Geppert, MD, PhD, MPH Department of Psychiatry and Religious Studies Program, University of New Mexico, Albuquerque, New Mexico.

Psychiatry Encompasses Much More Than Clinical Neuroscience

To the Editor: We commend the efforts of Reynolds and colleagues1 to achieve “the reintegration of undergraduate and graduate medical education in psychiatry and neurology under the rubric of clinical neuroscience.” As supervisors and teachers of psychiatry residents, we also agree with those authors that “psychiatry is grounded in clinical neuroscience” and that our residents need a “deeper understanding of genetics, pathophysiology, functional neuroanatomy and neuropsychopharmacology.” However, we believe psychiatry is grounded in much more than clinical neuroscience, and that Reynolds and colleagues have given short shrift to the philosophical, social, psychological, and humanistic foundations of psychiatry. Indeed, though we proceed from different premises than do Healy and Mangin,2 we agree with their comment that psychiatry “need[s] more, rather than less, philosophy and psychology within the discipline.” One of us (R.P.) has coined the term encephiatrics to encompass a broad-based, pluralistic discipline that incorporates not only the clinical neurosciences but also elements of philosophy, literature, and the world’s spiritual traditions.3 We do not regard these substantive disciplines as mere elective “frills” in psychiatric education; rather, we believe that residents in psychiatry should be exposed to the humanities and social sciences as an integral and required part of their training. Indeed, the psychiatry residency program at SUNY Upstate Medical University is now developing a “humanities track” for residents who wish to concentrate their studies in this area. We also believe that fostering competency in providing cognitive-behavioral, interpersonal, psychodynamic, and other forms of “talk therapy” must remain a central focus in a resident’s education, so that all aspects of a patient’s illness may be addressed comprehensively and compassionately. In our view, these points were not adequately stressed by Reynolds and colleagues. Ghaemi4 argued that the pluralism of psychiatrist and philosopher Karl Jaspers “has still failed to be adequately appreciated by the psychiatric profession.” We fully agree. To put it in clinical terms, “The clinician who can instantiate the neurobiology of serotonin in the context of the existential dilemma of the patient … has a far better chance of preventing suicide than one who is entrapped in a solitary paradigm.”5 Ronald Pies, MD Department of Psychiatry, SUNY Upstate Medical University, Syracuse, New York, and Tufts University School of Medicine, Boston, Massachusetts; ([email protected]). Cynthia M.A. Geppert, MD, PhD, MPH Department of Psychiatry and Religious Studies Program, University of New Mexico, Albuquerque, New Mexico.

Changes in Undergraduate Clinical Psychiatry Teaching in Scotland since “Tomorrow's Doctors”

This paper reviews the factors which have driven changes in undergraduate education in psychiatry since the 1993 publication of "Tomorrow's Doctors",' after which it describes current undergraduate curricula in the four Scottish medical schools teaching clinical psychiatry. Reasons underlying the differences between curricula are discussed. The authors suggest that research in medical education, alongside communication and debate between medical schools and across specialties, would lead to more uniform and evidence-based curricula.

Simulated patients in undergraduate education in psychiatry

This paper describes the use of simulated patients in medical education and how actors have been deployed with medical students in Aberdeen. The advantages and disadvantages of using actors for student education are summarised and we conclude with some possible future developments. At the outset, it may be helpful to outline some definitions, as in the review by Barrows (1993). A ‘standardised patient’ is an umbrella term for both an actual patient who is trained to present his or her own illness in a standardised way and also for a simulated patient who is a well person trained to portray an illness in a standardised way. This paper will use these terms but will relate mainly to the use of professional actors (not volunteers from the general public, who are often deployed by medical teachers) as simulated psychiatric patients.

Undergraduate psychiatry education: Present scenario in India

Byline: Indla. Reddy One of the main objectives of Indian Psychiatric Society for the year 2007 is to focus on undergraduate Psychiatry education in all the medical colleges in our country. We have formed a special task force for this purpose, and we are working on this issue seriously. Let me highlight some of the reasons why Indian Psychiatric Society is very serious about Psychiatry education in the Undergraduate curriculum. In 1835, Madras Medical College was the first medical college to be started in India. Since then, more and more medical colleges have come up. Perhaps, now it is a lucrative business to set up a medical college, and that's amply evident in the mushrooming of new private medical colleges. At present there are about 260 medical colleges, with a total of 30,000 medical seats. Four states - Andhra Pradesh, Maharashtra, Karnataka and Tamil Nadu - have 125 medical colleges, with a total of 16,000 seats. Medical Council of India is the regulatory authority, which recognizes medical colleges, lays down medical curriculum and presents standards for medical education. The burden of mental illness on health and productivity throughout the world has long been profoundly underestimated. Data developed by the massive Global Burden of Disease study conducted by the World Health Organization, the World Bank and Harvard University reveal that mental illness, including suicide, accounts for over 15% of the burden of disease in established market economies, such as the United States.[sup] [1] This is more than the disease burden caused by all cancers.[sup] [1] The World Health Organization's Global Burden of Disease study reported that mental disorders comprise four of the top five sources of premature death and disability in 15-44 year olds.[sup] [1] Various studies indicate that at least 20-50% of patients attending any primary-care hospital have significant psychological disorders.[sup] [2] Many mental-health problems are typically first seen as somatic presenting complaints, and thus the general-health sector is a natural entry point for appropriately identifying and treating mental-health problems.[sup] [3] Many patients also continue to find care for psychiatric problems more acceptable when provided by their primary-care doctors.[sup] [3] There is evidence to suggest that basic mental-health services generally can be managed in primary health-care organizations with considerable cost savings and without detrimental effects on health. For this to happen, an average medical graduate should be in a position to at least identify mental disorders and refer to a specialist, if not treat the same. The willingness to approach a psychiatrist is much more if the patient is referred by a primary health-care physician. Majority of the people seek help from nonpsychiatry physicians and general practitioners. General practitioners frequently fail to detect and treat emotional distress in many of their patients. Major rift exists between Psychiatry and the rest of Medicine, which is detrimental to both the disciplines. This vacuum can be filled to a great extent by including Psychiatry education in the undergraduate curriculum. India has a huge primary health-care network. Empowering the medical officers with psychiatric knowledge during their undergraduate training can go a long way in increasing psychiatric care across the length and breadth of this huge nation. Bhore committee in 1946 emphasized the need for training in social aspects in medical education and recommended the setting up of psychiatry departments in every general hospital. …

Current Issues in Undergraduate Psychiatry Education: The Findings of a Qualitative Study

Recruitment into psychiatry is correlated with the quality of undergraduate medical school teaching programmes and with a commitment of major resources to teaching students. There is an extensive literature related to attitudes towards psychiatry but less on the learning and teaching of psychiatry. To identify the current issues in undergraduate psychiatric education in the UK for lead teachers at UK medical schools. Semi-structured telephone interviews with psychiatric leads at UK medical schools. A total of 26 participants were interviewed from 23 different medical schools. Three key areas of problems were identified: issues related to teaching personnel (e.g. conflict of time), teaching resources and impact of teaching on recruitment (e.g. role models; stigma). Eight potential solutions to address the problems were identified and these included improving the quality of teaching, improving the perceived value of the discipline and recruiting teachers. There are several problems facing teachers in psychiatry but the teachers are also able to identify solutions which need support from both education and health if they are to be implemented.

"How Am I Doing?": Many Problems But Few Solutions Related to Feedback Delivery in Undergraduate Psychiatry Education

Giving performance feedback to students in psychiatry requires particular delicacy and skill since a critique of the subjective artistry of the psychiatric interview may be felt more personally than a critique of an objective skill, such as eliciting a reflex or applying a stethoscope to the chest. Thus, one would expect that psychiatrists 1) are adept at giving feedback and 2) have written about the nuances of feedback delivery in psychiatric education. After a curricular needs assessment in our program revealed that feedback delivery was being neglected at all levels of training, a review of the medical education literature was conducted to find explanations for preceptor difficulty with performance feedback delivery in undergraduate psychiatric education. A qualitative content-analysis review of the PubMed and OVID literature on feedback delivery and medical education was conducted. Several articles were available on feedback delivery in medical education, but only one of the studies was specific to undergraduate psychiatric education. Several articles offered practical tips to address deficiencies in the feedback process, but there was little to no explanation for the reasons behind the deficiencies. Reasons for the challenges faced by medical students and teachers during feedback conversations have not been fully explored in the literature. In contrast to other areas of medicine, little has been written specifically about feedback to students in undergraduate psychiatric education. Although there are many resources to assist medical educators with feedback delivery skills, an understanding as to why physicians and students struggle with feedback conversations is needed. Reasons for the apparent disconnect between what should be happening and what is actually happening during feedback conversations with undergraduate psychiatry students need to be understood. The authors hypothesize causes for the problems with feedback delivery in undergraduate psychiatric education.

Trends in Undergraduate Medical Education: Clinical Clerkship Learning Objectives

To assist and inform the process of revising learning objectives for the psychiatry clerkship, a comprehensive review of the current state of learning objectives endorsed by national specialty organizations for core clinical clerkships was undertaken. National specialty organizations that have developed and endorsed clerkship learning objectives were identified and learning objectives and support materials were reviewed. All core clinical clerkships have learning objectives developed and endorsed by national specialty organizations. The format for organizing these learning objectives varies widely among specialties from lists of topics of interest to exhaustive curriculum resource guides. Most specialty clerkship learning objectives have undergone extensive revision since 2000 or are currently in the revision process. Comparisons and trends in specialty clerkship learning objectives and curriculum resources are discussed. Revision of psychiatry clerkship learning objectives will benefit from adoption of features utilized by other specialties, including: prioritizing objectives; emphasizing contextual learning and skills mastery; linking learning objectives to support resources such as clinical cases, recommendations for instructional methodology, assessment strategies, and performance expectations; and shifting the focus of undergraduate psychiatry education beyond the clerkship to the entire four-year curriculum.

Mentally ill inpatients’ experiences and opinions on seeing medical students: a questionnaire study

Research involving general patients suggests that most patients agree to be involved in medical education but prefer not to discuss personal or stress related issues with/in front of medical students. We explore the opinions and experiences of mentally ill in-patients of their involvement in undergraduate medical education in psychiatry. The study shows that patients attach importance to students seeing real patients and that the patients are happy to be seen by medical students. Most patients benefit from seeing a student and few suffer detriment. They experience anxiety prior to the student-patient interview which dissipates during the interview. Mentally ill patients agree to see medical students for similar reasons to other patients. It is important to obtain full consent from patients who see medical students.

Psychiatrists Cited for Contributions To Research, Service Delivery

Back to table of contents Previous article Next article APA InstituteFull AccessPsychiatrists Cited for Contributions To Research, Service DeliveryEve BenderEve BenderSearch for more papers by this authorPublished Online:19 Dec 2003https://doi.org/10.1176/pn.38.24.0020aA number of psychiatrists were honored by APA at its 2003 Institute on Psychiatric Services in Boston for their outstanding work in psychiatric rehabilitation, education, and research, among other accomplishments.These are the 2003 awardees:• C. Edward Coffey, M.D., APA/APAA Administrative Psychiatry Award, for excellence in psychiatric administration. Coffey is vice president of behavioral health, chair of the department of psychiatry, and the Kathleen and Earl Ward chair of psychiatry at the Henry Ford Health System in Detroit.• Jeffrey L. Geller, M.D., M.P.H., Arnold L. Van Ameringen Award, for outstanding contributions to the field of psychiatric rehabilitation. Geller is a professor of psychiatry and director of public sector psychiatry at the University of Massachusetts Medical School.• Frederick S. Sierles, M.D., APA/NIMH Vestermark Psychiatry Educator Award, for outstanding contributions to undergraduate, graduate, or postgraduate education and career development in psychiatry. Sierles is a professor of psychiatry and behavioral sciences and director of continuing medical education in psychiatry at Finch University of Health Sciences–Chicago.• Marvin I. Herz, M.D., APA/APF Alexander Gralnick Award for Research in Schizophrenia, for outstanding research in schizophrenia (see Original article: page 16). Herz is a professor of psychiatry at the University of Miami School of Medicine.• Edwin J. Mikkelsen, M.D., Frank J. Menolascino Award, for significant contributions to psychiatric services for people with mental retardation. Mikkelsen is an associate professor of psychiatry at Harvard Medical School.• Sir Michael Rutter, M.D., Marmor Award, for significantly advancing the biopsychosocial model of psychiatry. Rutter is a professor of developmental psychopathology at the Institute of Psychiatry at Kings College in London and deputy chair of the Wellcome Trust.• Abraham J. Twerski, M.D., Oskar Pfister Award, for outstanding contributions to the field of psychiatry and religion. Twerski is the founder and medical director emeritus of Gateway Rehabilitation Center in Pittsburgh. ▪ ISSUES NewArchived

Teaching psychiatry in an integrated medical curriculum.

Efforts to improve the psychiatric competence of the general medical workforce must include an appraisal of how psychiatry is taught in medical schools. As a contribution to this appraisal a description is given of psychiatric education in the innovative undergraduate medical curriculum at the University of Newcastle. An outline of the features which characterise medical education at Newcastle is provided and the way in which the teaching of psychiatry is organised within this framework is presented. The characteristics of the Newcastle undergraduate program in psychiatry include its integration with teaching in other clinical and basic science disciplines, continuity throughout the entire five years of the course, and the emphasis on skills acquisition and their assessment. The relative merits and disadvantages of the Newcastle approach to undergraduate psychiatry education are presented and the problem of assessing the effectiveness of this approach by outcomes measurement, particularly of integrated competencies and their application in general medical settings, is discussed.

The evaluation of teaching in undergraduate psychiatric education: students' attitudes to psychiatry and the evaluation of clinical competency

There is an increasing demand for improved skills by medical graduates in the psychosocial aspects of medical care. Psychiatrists as educators need to play an important role in the development and evaluation of education in many areas of the undergraduate curriculum in addition to the continuing education of graduates. In this review approaches to the evaluation of undergraduate psychiatric education are discussed with particular emphasis on students' attitudes to psychiatry. Key issues that remain to be addressed include the clarification of the most appropriate goals for undergraduate education in psychiatry, the most valid means of evaluating such educational programmes, particularly clinical competency and, finally, the many tasks in improving the status of the psychosocial aspects of medical care for students and their clinical teachers.

Problems and Solutions in Undergraduate Medical Education in Psychiatry

Directors of medical student education in psychiatry were surveyed. The most pressing problems in undergraduate medical education in psychiatry were identified as: (1) not enough teachers; not enough teaching time; overcom-mitted, overworked, burned out, and poorly motivated faculty; (2) lack of support, recognition, tenure, and monetary rewards for committed teachers; (3) not enough funding for psychiatric undergraduate medical education; (4) low status and poor image in psychiatry; (5) diverse curricular concerns. Discussed in this paper are solutions to these complex problems which will require ongoing departmental, institutional, regional, and national efforts. Leadership by departmental chairmen is essential to preserve the quality of psychiatric education with the rapid changes in health care dynamics.

The behavioural sciences and undergraduate education in psychiatry.

The Behavioural Sciences are becoming increasingly important in medical education and in medical treatment. But medical students and the profession generally, appear to have difficulty accepting behavioural sciences as a valid part of the curriculum and in the practice of medicine. One of the reasons for this may be related to a narrow definition of the physician's social role in the years following the adoption of the Flexner Report in 1911 which emphasized the model of the physician/scientist. The perennial model of the physician occupying a social role in which science is used to increase and rationalize responsiveness to suffering has been eroded in favour of the pursuit of the scientific as the essential goal of medicine. The newer, "softer", sciences of anthropology, ecology, economics, psychology and sociology have not fitted into the professional self-perception of the medical role. Furthermore, some departments of behavioural science have adopted an intellectual stance at times antagonistic to the rest of the medical school emphasizing the shortcomings of the profession in its delivery of health care. The aspirant medical student may have been disaffected by teachers who do not embody acceptable role models. Students should receive specific instructions in the social role of the physician, physicians should be actively involved in teaching the behavioral sciences and the curriculum should at all times emphasize the relevance of the behavioural sciences to the daily practice of medicine.

THE USES OF TELEVISION IN TEACHING PSYCHIATRY

Abstract The A.U.T.P. Working Party on the Applied Uses of Television was set up after the A UTP/ASME Conference on Undergraduate Education in Psychiatry and Behavioural Science held in Manchester in 1971. A group of Position Papers on the Uses of Television in Teaching Psychiatry has been published by the Working Party (AUTP, 1977), under the chairmanship of Professor David Goldberg. By his kind permission, two of these papers are here reprinted: one concerns the uses of television in undergraduate teaching of psychiatry; the other, ethical aspects of the use of television in psychiatry.