The Future Of Psychiatry Medical Student Education

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 ► Linked

to medical education in general ► Designed from the perspective of ƒ What students should learn ƒ How they learn best ► Built

April 29, 2005

upon sound educational principles

American Psychiatric Association’s Medical Student Education Summit

1

Approach ► Learner-focused

ƒ ƒ ƒ ƒ

All students Primary care bound Neurosciences investigator 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

2

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

April 29, 2005

symptom

American Psychiatric Association’s Medical Student Education Summit

3

Special Topics ► Abuse ► Capacity ► Involuntary

April 29, 2005

commitment

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

4

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 ► Early

identification ► Mentorship ► Neuroscience electives and research

April 29, 2005

American Psychiatric Association’s Medical Student Education Summit

5

Clinical psychiatry bound ► Broaden

ƒ ƒ ƒ ƒ ƒ ƒ ƒ ƒ

knowledge & skills

Basic science research CAM Emergency medicine Endocrinology Neuroanatomy Neurology Neuropathology 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

6

Pre-clerkship Formal Curriculum ► Maximize

ƒ ƒ ƒ ƒ

active learning. Examples:

Case based ILM Small groups (problem sets, PBL) 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 WebWeb-based ILM April 29, 2005

American Psychiatric Association’s Medical Student Education Summit

7

Advanced Formal Curriculum ► Sub-internship

ƒ Rigorous ƒ Psychiatry bound ► Electives,

groups

designed for target student

ƒ Primary care focus ► Research

April 29, 2005

curriculum (throughout all years) 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

8

Assessments ► Objective

assessments of student mastery ► Consistent minimum standards ► Enhanced tools ƒ ƒ ƒ

OSCE’s 360 assessments 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

9