Medical student opinion of methods used to teach child and adolescent psychiatry

Medical student opinion of the various methods used to teach child and adolescent psychiatry at Westminster Medical School, London was determined with reference to four general teaching objectives. Their ratings and comments concerning the different methods were used to evaluate the various techniques and make suggestions concerning the planning of undergraduate teaching programmes in child and adolescent psychiatry.     

Child and adolescent psychiatry placements in specialist psychiatric training: a regional study

Before beginning higher professional training in one of the subspecialties, all psychiatry trainees must complete a general professional psychiatric training. At this stage, some but not all will undertake a clinical placement in child and adolescent psychiatry. Fifty-seven trainees who had completed one of the 15 child and adolescent psychiatry placements in a Regional Health Authority, took part in a semi-structured telephone interview. The trainees were asked to compare the child and adolescent psychiatry placement with a general adult psychiatry placement with respect to the training received in a number of areas. These areas were considered to be important to psychiatrists of all future subspecialties and included: assessment, communication, psychological interventions and psychological theories. In addition, subjects were asked about their general professional training as a whole and the role that child and adolescent psychiatry placements should play. The interview included quantitative and qualitative components. The findings suggest that child and adolescent psychiatry placements can make a significant contribution to a number of important areas of general professional development and that there would be considerable support for strengthening the role of such placements in psychiatry training.     

Teaching psychiatric ethics

In the last decade, we have witnessed a burgeoning of interest in ethical issues amongst psychiatrists. Teaching of the subject, however, remains at a rudimentary stage. Various approaches to such instruction are available, particularly modelling (students observe their experienced counterpart), the case method (examining specific clinical situations which involve a need for ethical decision-making), and the seminar approach (trainees are exposed to a core body of knowledge, mainly theoretical in nature). Faced with these different teaching models, the University of Oxford Department of Psychiatry has opted for a blend of all three approaches, which incorporates two goals: an increase in the trainees' sensitivity to the many intricate moral dilemmas facing the psychiatric profession; and their familiarity with salient concepts in moral philosophy which constitute a basis for ethical reasoning and which have a bearing on clinical practice. The teaching programme comprises the following: a pair of trainees prepares a presentation on an aspect of psychiatric ethics under the supervision of a senior psychiatrist. A moral philosopher assumes the role of discussant of the ethical problems raised by the trainees; this is followed by a general discussion. Topics have included involuntary hospitalization, dual loyalty, suicide, psychiatric diagnosis, and ethical issues in various spheres of psychiatric practice such as sex therapy, psychotherapy and child psychiatry. The approach has worked effectively and proved rewarding to all participants involved.     

Medical students'' attitudes to psychiatry in Chile

There is controversy about the influence of psychiatric clerkships on medical students' attitudes to psychiatry. In general, studies in developed countries have found a short-lasting improvement in attitudes to psychiatry after a psychiatric clerkship. The present study was designed to measure changes in medical students' attitudes following a psychiatric clerkship in a developing country. Medical students from the Faculty of Medicine, University of Chile were interviewed before and after a psychiatric clerkship using a translation into Spanish of an attitude-to-psychiatry questionnaire used previously in the UK. The results were similar to those reported from developed countries. There was a marked early improvement in students' attitudes following their psychiatric clerkship which gradually faded over 3 years. There is scope for improvement in psychiatric undergraduate medical teaching in Chile and this might help to make more lasting improvements in attitudes to psychiatry among medical students.     

Students'' attitudes towards psychiatry

Using a reliable measure, a self-administered questionnaire (ATP), and adequate numbers of students, this study demonstrates the negative effects of general medical/surgical training and the positive effect of the psychiatry clerkship on students' reported attitudes towards psychiatry. A negative view of psychiatry at the beginning of the clerkship may make students reluctant to improve their interview skills but is otherwise unimportant in determining their reactions and performance in the clerkship. Medical students' interest in psychiatry as a career increases during the psychiatry clerkship but this merely offsets the decline in interest that occurs at other stages during the clinical training. Much of the attitudinal change that occurs during the psychiatry clerkship is maintained into the pre-registration year but the housemen recorded a significant negative change on the items concerning efficacy of psychiatric treatment and attitudes towards psychiatric patients. Additional training by psychiatrists during the pre-registration year might increase the motivation of young doctors to detect and treat psychiatric illness which they will encounter in all branches of medicine.     

The development and evaluation of a method of teaching liaison psychiatry to medical students

A method is described of teaching medical students aspects of psychiatry related to their work with physically ill patients. The teaching requires few resources and focuses on a limited number of educational objectives centred on the acquisition of knowledge of psychiatry relevant to medical practice. The course comprised eight weekly one-hour seminars held during the first clinical year attachment to medical firms, prior to the students' psychiatry attachments. Clinically based, traditional 'bedside' teaching was used, involving patients known to the students. In a preliminary analysis of the effects of the teaching, students who had participated in the seminars scored significantly better on a test of liaison psychiatry knowledge than a matched group who had not experienced the course.     

Assessment of clinical psychiatric skills in final-year medical students: the use of videotape

Sixty final-year medical students had their clinical performance in psychiatry assessed by the following three methods: a multiple choice questionnaire based on a series of short videotaped interviews with psychiatric patients; the examination of a traditional long 'case' with presentation of the history, mental state findings and formulation about diagnosis and management to a panel of three examiners; and a conventional oral examination about the principles and practice of psychiatry with a different trio of examiners. The total mark on the videotape session correlated significantly with the combined clinical and oral marks. There was also a significant positive correlation between the total video marks and the individual clinical marks, but none between the marks obtained during the video and oral components of the examination. However, the significant positive correlations between the video marks and those of the clinical examination were modest and only accounted for not more than 14% of the variance. Inspection of the distribution of correct answers to the videotape questions shows that students do best in identifying mental state symptoms and signs and in choosing the correct diagnosis. They do less well in the areas of aetiology and treatment. Indeed, optimal performance in the latter distinguishes those who do well in the clinical/oral examination from those whose performance is mediocre. The significance of these findings to the teaching and assessment of psychiatric skills in medical students is discussed.     

Survey of the teaching of disability and rehabilitation to medical undergraduates in the UK

The objective of the following survey was to attempt to establish to what extent the undergraduates in medical schools in the UK were being exposed to structured teaching of disability and rehabilitation (i.e. seminars, lectures, group discussions). A questionnaire and covering letter were sent to 25 medical schools exploring how the teaching was performed and whether it utilized the active involvement of disabled people and/or their carers. It also attempted to ascertain the degree of interdisciplinary teaching occurring. Results showed that rheumatology, general practice and geriatrics were predominantly responsible for this teaching, with little structured teaching in ENT and ophthalmology. Five schools (25%) reported back that no structured teaching was occurring in any department. As expected, there was a larger proportion of positive responses on opportunistic teaching (ward rounds, outpatients). Additional invited comments on the questionnaire revealed a variety of innovative activities taking place in different medical schools. It is recognized that a questionnaire of this nature has limitations; nevertheless, it did reveal gaps in the teaching of disability and rehabilitation, with several responses indicating that excess pressure on the curriculum from other subjects left little or no space at the present time. Our survey suggests that disability and rehabilitation are given insufficient emphasis in undergraduate teaching. In particular, more active involvement of patients and their carers should be encouraged. The small proportion of schools which teach rehabilitation as a defined specialty no doubt reflects the inadequate academic structure at present in this field.     

Postgraduate psychiatric training The Royal College of Psychiatrists survey of consultants in general psychiatry appointments in 1975–1978

Since 1966 all recently appointed consultants in general psychiatry in the United Kingdom have been asked to rate their training experiences. Four postal surveys have been made at three yearly intervals, of 574 consultants appointed in the period 1 October 1965—30 September 1978. This paper reports the findings from the responses of 162 consultants appointed 1975–1978.
Fifty per cent, or fewer, reported satisfactory training in special forms of psychotherapy, addiction, work in the community, mental handicap, forensic psychiatry, administration, research, psychogeriatrics, work with longstay patients, rehabilitation, medico-legal work, group psychotherapy, work in a therapeutic community, child psychiatry, epidemiology and postgraduate teaching. Those who had been at the Maudsley Hospital considered that they had experienced the best training, while those who had been at peripheral hospitals the worst. Progress has been made in the past 3 years, notably in the fields of individual psychotherapy, community work and forensic psychiatry.     

Changes in attitudes towards psychiatry among medical students: correlation of attitude shift with academic performance

This study investigates the changes in attitudes to psychiatry and level of psychiatric knowledge among medical students before and after formal teaching on psychiatry. Teaching led to the development of more favourable attitudes (particularly among women) towards psychiatry, but doubt remained after teaching about the 'scientific' status of the discipline. Initial attitudes did not relate to academic performance but, those developed after teaching showed a significant positive correlation with it.     

Behavioural sciences teaching in UK dental schools

A survey was conducted of the dental schools in the UK, inquiring about the teaching of psychology, sociology, epidemiology and psychiatry to dental undergraduates. Epidemiology was the most frequently taught and assessed subject, followed by psychology and sociology. Overall, the results indicate an increased concern with and attention to behavioural sciences teaching.     

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

OBJECTIVE: To explore the impact of undergraduate psychiatry placements in primary care settings on students' learning and attitudes to mental illness. DESIGN: Questionnaire survey and qualitative in-depth interviews. SETTING: A primary care-based psychiatry undergraduate teaching programme at Royal Free and University College Medical School, London. PARTICIPANTS: 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. RESULTS: 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. CONCLUSIONS: 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.     

Management of somatic presentations of psychiatric illness in general medical settings: evaluation of a new training course for general practitioners

An improved teaching package is described which aims to help general practice trainees manage somatized presentations of psychological distress. The package comprises a training videotape in which a reattribution model is demonstrated, with material for role-play of new skills and small-group video feedback of consultations. Eighteen general practice trainees attending an 8-week course in psychiatry participated fully in the somatization management teaching programme. The teaching package was evaluated by blind rating of general interview skills and model specific skills demonstrated by trainees during 10 to 15-minute clinical interviews with professional role-players. Ratings were made on pre-training and post-training videotaped interviews. A significant improvement was demonstrated in general interview skills. Improvements were also noted in specific reattribution skills post-training. The evaluation revealed that skills in the model can be effectively learned, and that improvements in the package have resulted in its improved efficacy.     

Psychiatry as compared to other career choices: a survey of medical students in Hong Kong

A questionnaire was administered to two groups of medical students, one preclinical and the other clinical, to assess their career choices, opinions of six specialties (including internal medicine, general practice, obstetrics and gynaecology, paediatrics and psychiatry as well as surgery) and anxieties about psychiatry. It was found that both groups of students conceptualized clinicians according to stereotypes which were modified but not abated by clinical exposure. Although the clinical students compared to preclinical students attributed more positive personality traits to psychiatrists, students interested in taking up careers in psychiatry were few in both groups. Compared to the preclinical class, clinical students were less worried about disturbed patients and emotional involvement with patients, but were more concerned about their deficiency in knowledge and skills relevant to psychiatry.     

The effect of a psychiatric attachment on students' attitudes to and intention to pursue psychiatry as a career

OBJECTIVES: This study examined determinants of students' attitudes to psychiatry and intentions to pursue psychiatry as a career, considering: (1) experiences during the clinical attachment; (2) type of curriculum (traditional or problem-based), and (3) student characteristics (age and gender). The relationships between attitudes, career intentions and academic performance were examined. METHOD: Fourth year medical students (n = 379) completed questionnaires at the beginning and end of an 8-week psychiatry attachment to assess their attitudes to psychiatry, career intentions and experiences during the attachment. Students completed two assessments consisting of a multiple choice paper and a clinical viva. Consecutive cohorts of students receiving a traditional curriculum (n = 188) and a problem-based curriculum (n = 191) were compared. RESULTS: Students' attitudes to psychiatry improved and intentions to pursue psychiatry as a career increased during the attachment. These changes were predicted by specific experiences during the attachment, such as receiving encouragement from consultants, seeing patients respond well to treatment and having direct involvement in patient care. There was no difference in change in attitudes or career intentions between the two cohorts. Students with more favourable attitudes or career intentions at the outset did not report more favourable experiences during the attachment. Attitudes and career intentions were unrelated to performance in psychiatry assessments. Improvement in attitudes was related to an increased intention to pursue psychiatry as a career. CONCLUSIONS: Change in attitudes and career intentions was dependent on the actions of the clinical teachers. Undergraduate teachers may have an important influence on the numbers of doctors who choose this specialty as a career.     

Teaching behaviour therapy to psychiatrists with a structured learning format

A 5-day, in-service training in behaviour therapy, which was attended by six psychiatrists, is described. The course covered principles of behavioural assessment and therapy within a structured learning format. The results of this systematic approach are presented in terms of six measures, administered before and after training. Two of these assessed attitudes to treatment, one gauged knowledge of behavioural principles and the remaining three evaluated the psychiatrists' skills in some key areas of behaviour therapy. Statistically significant improvements were found on the knowledge questionnaire and on one skill measure. These results were compared to those obtained by a control group (n = 18) and a course-trained group (n = 65) of qualified psychiatric nurses. The main conclusion drawn was that the course succeeded as an efficient learning programme, developing understanding and skills of value both clinically and in terms of collaborative teamwork.     

The ATP 30—a scale for measuring medical students' attitudes to psychiatry

The development and validation of a thirty item, Likert-type scale designed to measure medical students' attitudes to psychiatry—the ATP-30 (Attitudes Toward Psychiatry—30 items)—are described. We had hoped to demonstrate that 'attitude to psychiatry' was not a unitary matter but an amalgam of attitudes to a number of things to do with psychiatric practice. This hope was not fulfilled, as a unitary dimension was obtained. A positive change in the attitudes of students toward psychiatry was demonstrated in third and fourth medical year students in relation to exposure to psychiatry. Such a change was not demonstrable in two classes of occupational therapy students exposed to a course in psychiatry. The reasons for this difference between medical students and occupational therapy students are discussed—there possibly being important implications here for psychiatric curriculum planning in medical school. Lastly, we have demonstrated that the positive change in attitudes amongst medical students was transient rather than lasting—a matter which most studies of attitude change do not address. In spite of the apparent impermanence of the positive change in attitudes among medical students, there are a number of possible uses to a scale such as the ATP-30, and these are discussed.     

Influence of gender on undergraduate performance in psychiatry at Ibadan, Nigeria

OBJECTIVE: This study examined the influence of gender on undergraduate performance in psychiatry among final year medical students at the University College Hospital, Ibadan, Nigeria. METHODS: Results in all parts of the examination in psychiatry for the 2001 graduating class were obtained. In addition, performance scores were obtained for entrance examinations to medical school, preclinical subjects (anatomy, physiology and biochemistry) and clinical subjects (paediatrics, obstetrics and gynaecology, internal medicine and surgery). The mean marks according to gender, with 95% intervals, were calculated and tested for significance. RESULTS: A total of 234 students (160 men and 74 women) took the examinations in psychiatry. Women performed better than men in both the multiple choice questions (MCQ) examination (P = 0.0044) and the clinical assessment (P= 0.0000063). The women were significantly younger than the men (P = 0-0000007) and performance in both parts of the examination decreased with increasing age. There were no differences between the genders in entrance examination scores or preclinical scores but there were significant differences between the genders in performance in clinical subjects such as paediatrics, obstetrics and gynaecology and internal medicine. CONCLUSION: Women performed better than men in all parts of the psychiatry examination, with the difference being more marked in the clinical aspect. A superior performance on the part of women was noted in all clinical subjects. However, where an examination did not involve verbal interaction, there was no difference in performance between the genders. A direct correlation between increasing age and decreasing performance in examinations was also seen.