Psychiatric Curriculum
Core Curriculum in Psychiatry for Medical Students
The need for psychiatry in the medical curriculum,
That psychiatry should occupy a major part in the medical curriculum is now generally agreed. There are three reasons for this agreement.
First, the general approach of psychiatry which stresses the unity of body and mind is important in the whole of medical practice.
Secondly, skills that are learned in psychiatry are important for all doctors: for example the ability to form a good relationship with a patient, to assess the mental state, and to impart distressing information.
Thirdly psychiatric problems are common among patients seen by doctors working in all branches of medicine: for example it is known that among outpatients attending specialist clinics about 15 per cent of those given a diagnosis have an associated psychiatric disorder, and an average of 20-30 per cent of those given no medical diagnosis have a psychiatric disorder. Psychiatric disorders are even more frequent among patients attending general practice.
Therefore, all future doctors must know about these psychiatric problems not only because they are common, but also because their management involves much medical time and resources, and gives rise to many serious incidents.
Psychiatry in the medical curriculum
Psychiatry's generalized approach stresses the unity of body and mind. Skills learned in psychiatry are useful to all medical practitioners. Psychiatric problems are common among patients seen by doctors working in all branches of medicine.
The core curriculum
The core component in the psychiatric curriculum is the minimum that is required by medical students who, after qualification, will enter further training whether they are to work as specialists or in primary care. All doctors must demonstrate minimum level of competency required for management of the commonly encountered psychiatric morbidity, regardless of whether they choose a career in primary care (general practice) or work as specialists.
Attitude objectives
Since most students will not enter psychiatry, the acquisition of appropriate attitudes is of primary importance. It is important that the objective of imparting these attitudes is in the teachers mind throughout his interaction with students. Most of the attitudes to be acquired while learning psychiatry do not differ from those needed to practice the rest of medicine. It is important that students develop appropriate attitudes to psychiatry as a medical discipline. These attitudes will be encouraged particularly during the teaching of psychiatry but it is important that they are not negated during the teaching of other subjects.
It is important that attitudes are not merely expressed verbally by students but are also internalized, directing how students respond to patients and their colleagues. Each of the attitudes listed below should be translated into corresponding action.
Attitudes concerned with medical practice generally
Students should:
Recognize that the profession of medicine requires lifelong learning.
Show capacity for critical thinking and constructive self-criticism.
Be able to tolerate uncertainty and be open-minded to the views of others.
Be able to work constructively with other health professionals.
Attitudes towards patients and their families
Students should:
Respect patients and understand their feelings.
Recognize the necessity of good doctor patient relationships.
Appreciate the value of the developmental approach to clinical problems emphasizing the stages of the life cycle and longitudinal perspective of illness.
Recognize the importance of the family and the wider environment of the patient.
Attitudes to psychiatry as a medical discipline.
Students should:
Recognize the value of psychiatry as a medical discipline.
Integrate humanistic, scientific and technological aspects of knowledge of psychiatry.
Recognize the importance of the promotion of mental health and the prevention of psychiatric disorders.
Knowledge objectives
The knowledge objectives of psychiatry include psychiatric symptoms and syndromes, psychological aspects of medical disorders, ("psychological medicine"), and psychosocial issues including stigma. Psychiatric symptoms and syndromes, and their treatment, are taught and learned in the context of an integrated biological, psychological and social approach.
Whatever level of detail is chosen concerning each individual disorder, collectively these should provide opportunities to:
illustrate the approach to etiology in psychiatry,
provide opportunity for the discussion of attitude objectives and teaching of skills objectives,
Provide instruction concerning action that should be taken.
Skills objectives
The skills required by medical students range from those with which they need only be familiar (in the sense of being aware that they are practiced by others, e.g. dynamic psychotherapy), to those skills which students are expected to perform competently themselves. Many of the skills students learn in psychiatry overlap with those learnt in the other branches of medicine.
Skills to be acquired:
Doctor-patient interpersonal skills
They include the skills of:
• "active listening"
• Empathy
• Non-verbal communication
• Opening, controlling and closing an interview
Information gathering skills
• Take the history of patient's complaints and a life history
• Carry out a physical examination, taught also in other parts of the curriculum.
• Also includes skills necessary to assess the functioning of:
the patient's family
the family's ability to contribute to the patients' care
Information evaluation skills
• Select the crucial pieces of information for making a diagnostic formulation and undertake a differential diagnosis
•Make a personality assessment
• Evaluate the role of personal and social factors in the patient's behavior
• Formulate a plan of management which includes the points at which referral to a specialist will be appropriate.
Information-giving skills
• Pass information to patients to promote health
• Explain the implications of a diagnosis
• Inform patients about the beneficial and potential adverse effects of treatment
Reporting skills
Report verbally or in writing to:
medical colleagues, lay people including the relatives of patients
non-medical agencies involved in the care of patients
Promote public education
Treatment skills
• Promote compliance with prescribed treatment
• Basic prescribing skills for the psychiatric disorders commonly encountered by non- psychiatrists.
• Recognize adverse effects of treatment and distinguish them from symptoms of illness
Learning skills
• Sustain self-directed independent learning such that the student will be able to keep abreast with new advances in psychiatry and psychological aspects of medical practice throughout professional life.
Teamwork skills
• Co-operate with:
medical colleagues
other health care workers
patient and family organizations
community services
The general public in arranging the care of patients with psychiatric problems and for promoting mental health.
The Students are required to understand in general terms:
A. The contribution of scientific research to psychiatric aetiology and treatment.
B. Those aspects of the biological, psychological and social sciences which can increase understanding of these conditions and the way such factors interact.
Guidelines for the teaching and learning of psychiatry
• Self-directed, problem-based learning
• Locally produced teaching aids
• Exposure to a range of patients in different settings
• Integrated delivery of the various teaching methods including problem-based learning PBL, patient clerking sessions, teaching Objective Structures Clinical Examination (OSCE) sessions, case conferences, and the Medical School Days (MSD)
General guidelines for the teaching of psychiatry
Students should see a range of patients including those typically managed in primary care, general hospitals, and community based clinics as well as those treated in psychiatric facilities. Teaching should be about problems of relevance to students’ likely future clinical experience and not focused on specialized practice of psychiatry. Patients from primary care may be more relevant to this aim than those in a psychiatric in or outpatient practice.
Assessment
A distinction is to be made between two types of assessment. Formative assessment is designed to give feedback to the student about his progress as he proceeds. Summative assessment is carried out at the end of the courses for purposes of grading.
The students will evaluate at the end of each rotation; and also during their annual examination.
Assessment of knowledge
Recall of factual information *Multiple choice questions
* Couplet OSCE’s
*Interpretation of da
*Couplet OSCE’s
* Appropriately constructed MCQs
Assessment of Clinical skills (problem solving)
* Mini C Ex
* Couplet OSCE’s
* MCQ’s
Assessment of skills
The assessment methods will include objective structured clinical examinations (OSCEs), Mini Case Examination (Mini C Ex), while professional development skills assessment component will include formative and summative assessments, carried out by their respective tutors during week 3 and 7, respectively
Assessment of attitudes
Assessment of attitudes, incorporated in the professional development rating scale, to be carried out by the respective tutor, will be determined by the students’ responses to the patients, and the views expressed in case discussions, seminars and tutorials.
The distribution of assessment marks End-of-course assessment:
Mini case Ex = 27.5 marks
Attendance = 2.5 marks
Annual assessment:
MCQ = 35 marks
OSCE’s: 16 stations = 25 marks
INTERVIEWING SKILLS
By the end of the clerkship, the student will conduct an interview in a manner that facilitates information-gathering and formation of a therapeutic alliance.
Specifically, the student will be able to:
1. Explain the value of skilful interviewing for patient and doctor satisfaction and for obtaining optimal clinical outcomes.
2. Demonstrate respect, empathy, responsiveness, and concern regardless of the patient's problems or personal characteristics.
3. Identify his or her emotional responses to patients;
4. Identify strengths and weaknesses in his or her interviewing skills;
5. Discuss the above perceptions (Objectives 3 and 4) with a colleague or supervisor in order to improve interviewing skill;
6. Identify verbal and non-verbal expressions of affect in a patient's responses, and apply this information in assessing and treating the patient;
7. State and use basic strategies for interviewing:
disorganized,
cognitively impaired,
hostile/resistant,
mistrustful,
circumstantial/hyperverbal,
unspontaneous/hypoverbal,
and potentially assaultive patients;
8. demonstrate the following interviewing skills: appropriate initiation of the interview; establishing rapport; appropriate use of open-ended and closed questions; techniques for asking "difficult" questions; appropriate use of facilitation, empathy, clarification, confrontation, reassurance, silence, and summary statements; soliciting and acknowledging expression of the patient's ideas, concerns, questions, and feelings about the illness and its treatment; communicating information to patients in a clear fashion; appropriate closure of the interview;
9. state and avoid the following common mistakes in interviewing technique: interrupting the patient unnecessarily; asking long, complex questions; using jargon; asking questions in a manner suggesting the desired answer; asking questions in an interrogatory manner; ignoring patient verbal or non-verbal cues; making sudden inappropriate changes in topic; indicating patronizing or judgmental attitudes by verbal or non-verbal cues (e.g., calling an adult patient by his or her first name,questioning in an oversimplified manner, etc.); incomplete questioning about important topics;
10. Demonstrate sensitivity to student-patient similarities and differences in gender, ethnic background, sexual orientation, socio-economic status, education, political views, and personality traits.
Electives:
For the designated period students pursue what interests them, with the approval of a responsible tutor. There is no reason why everybody has to study the same thing, as in the traditional curriculum. The core plus options model, now operating in the UK, aims at encouraging self-learning skills and at reducing factual overload in the curriculum: two-thirds of the curriculum is a common core, which emphasizes discipline content, critical thinking, communication and interview skills; while one-third is left available for special study modules selected by the student from an array of options available in the medical school, for in-depth learning according to specific interests and needs. Electives may involve foreign travel, but succeed best when the parent school and the host institution which the student visits for the clinical attachment confer responsibly.
The Department has offered the following two electives for the current academic year:
People with Disabilities