The Future of Psychiatry

Medical Student Education

J.T. Thornhill IV, M.D.
Lowell Tong, M.D.

April 29, 2005 American Psychiatric Association’

Association’s
Medical Student Education Summit

Psychiatric Education
► Linkedto medical education in general
► Designed from the perspective of
ƒ What students should learn
ƒ How they learn best
► Built upon sound educational principles

April 29, 2005 American Psychiatric Association’s

Medical Student Education Summit

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 Approach
► Learner-focused
ƒ All students
ƒ Primary care bound
ƒ Neurosciences investigator
ƒ Clinical psychiatry

April 29, 2005 American Psychiatric Association’s

Medical Student Education Summit

All Students
► Core fundamental knowledge and skills
ƒ Basic neuroscience and human emotional,
interpersonal and cognitive development
ƒ Major psychiatric diagnostic categories
ƒ Undifferentiated patient presentations
ƒ Special psychiatry topics
ƒ Unique communication skills

April 29, 2005 American Psychiatric Association’s

Medical Student Education Summit

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 Diagnostic Categories
► Addiction, substance use and withdrawal
► Anxiety disorders versus severe anxiety
► Mood disorders versus disturbed mood
► Personality disorder versus
interpersonal/family problems
► Somatoform and factitious disorders

April 29, 2005 American Psychiatric Association’s

Medical Student Education Summit

Undifferentiated Patient
► Confused
► Dangerous
► Stressed
► Feigning symptom

April 29, 2005 American Psychiatric Association’s

Medical Student Education Summit

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 Special Topics
► Abuse
► Capacity
► Involuntary commitment

April 29, 2005 American Psychiatric Association’s

Medical Student Education Summit

Communication Skills
► Patient education
► Rapport
► Angry patients
► Patients with serious/chronic mental illness
► Serious news
► Reactions to patients
► Process versus content

April 29, 2005 American Psychiatric Association’s

Medical Student Education Summit

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 Primary care bound
► Detailed knowledge and skills in assessment
and treatment

April 29, 2005 American Psychiatric Association’s

Medical Student Education Summit

Neurosciences investigator bound

► Earlyidentification
► Mentorship
► Neuroscience electives and research

April 29, 2005 American Psychiatric Association’s

Medical Student Education Summit

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 Clinical psychiatry bound
► Broaden knowledge & skills
ƒ Basic science research
ƒ CAM
ƒ Emergency medicine
ƒ Endocrinology
ƒ Neuroanatomy
ƒ Neurology
ƒ Neuropathology
ƒ Neurosurgery
April 29, 2005 American Psychiatric Association’s
Medical Student Education Summit

Curricular Methods
Strong educational infrastructure
ƒ Strong med ed leadership (coordinated UME and GME)
ƒ Faculty development
ƒ Residents as teachers curriculum
Priority on forward-looking, high quality educational
methods
Clear curricular program
• based on learning objectives (definition, mastery) more
than on # of hours or weeks.

April 29, 2005 American Psychiatric Association’s

Medical Student Education Summit

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 Pre-clerkship Formal Curriculum
► Maximize active learning. Examples:
ƒ Case based
ƒ ILM
ƒ Small groups (problem sets, PBL)
ƒ Preceptorships
► Student inquiry-driven balanced with
instructor agenda-driven

April 29, 2005 American Psychiatric Association’s

Medical Student Education Summit

Clerkship Formal Curriculum

► Apprenticeship model
ƒ Traditional, familiar
ƒ “Clin educ has not kept pace with or been responsive
enough to shifting pt demographics and desires,
changing health system expectations, evolving practice
requirements and staffing arrangements, new info, a
focus on improving quality, or new technologies.”
technologies.”
► Innovation
ƒ Learning teams: focus on learning than evaluation
ƒ Longitudinal experiences
ƒ Web-
Web-based ILM

April 29, 2005 American Psychiatric Association’s

Medical Student Education Summit

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 Advanced Formal Curriculum
► Sub-internship
ƒ Rigorous
ƒ Psychiatry bound
► Electives, designed for target student
groups
ƒ Primary care focus
► Research curriculum (throughout all years)

April 29, 2005 American Psychiatric Association’s

Medical Student Education Summit

Informal/Hidden Curriculum
► Forward-looking presence
► Early exposure to field and faculty
► Faculty involved in the full range of medical
school curriculum and activities
► Psych content featured as prominently as
other content (interview pts, OSCE stations)
► Psychiatry Interest groups, Brain Int. Group
► High standards (grades)
April 29, 2005 American Psychiatric Association’s
Medical Student Education Summit

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 Assessments
► Objective assessments of student mastery
► Consistent minimum standards
► Enhanced tools
ƒ OSCE’s
ƒ 360 assessments
ƒ Learner portfolios
► Curricular assessment (incl. performance of
instructors)
April 29, 2005 American Psychiatric Association’s
Medical Student Education Summit

Conclusions
► Difficult
to predict the future
► The time is right for change
► Evidence based medicine incorporated
► Tailored approach to students
► Attention to informal/hidden curriculum
► Improvements will increase learning for all
students, and improved care for all patients

April 29, 2005 American Psychiatric Association’s

Medical Student Education Summit