Teaching medical students Teaching medical students psychiatry in Central psychiatry in Central

EuropeEurope

Cyril Höschl Cyril Höschl

Centre of Neuropsychiatric Studies,Psychiatric Centre Prague

& Charles University, 3rd Medical Faculty, PragueEuropean Psychiatric Association

FEAM meeting, Rome, 5 May 2011

Challenges in psychiatric education

During 20th century medicine dramatically changed, particularly in technical terms

Challenges in psychiatric education

During 20th century medicine dramatically changed, particularly in technical terms

Medical curriculum in Europe, however, remained mostly the same!

Medical curriculum has been splitted into „theoretical“, „preclinical“, and „clinical“ parts, roughly 2 years each.

Each discipline has been splitted into „general“ and „special“ part.

Physics, (bio)chemistry, biology, anatomy, histology, physiology etc.

Physics, (bio)chemistry, biology, anatomy, histology, physiology etc.

Microbiology, propedeutics, pharmacology, pathology etc.

Microbiology, propedeutics, pharmacology, pathology etc.

Clinical rotations (internal medicine, surgery, paediatrics, gynob)

Clinical rotations (internal medicine, surgery, paediatrics, gynob)

E.g., psychopathologyE.g., psychopathology E.g., diseasesE.g., diseases

Challenges in psychiatric education

Motto:

Learning theory, the student is mainly interested in its purpose (the medicine); training medicine, the student is mainly interested in the causality (the theory).

Ctirad John

So in every stage of curriculum, the spontaneous motivation was somewhat missing.

Challenges in psychiatric education

Reasoned statement for change: Undergraduate curriculum in CEE did not reflect

changes in medicine in 20th century. The classical medical curriculum did not respect

clinical needs on the undergraduate level. Old curriculum did not motivate enough to learn the

theory. Lack of context of the training, Plenary lectures prevailed as a form of education.

This form of the study is considered to be significantly less efficient than more active forms of studies in medicine.

Objectives of a New Curriculum

To adjust medical studies to the “state of art”.To support more individual contacts of students

both to teachers and to patients. By means of practical involvement, to increase the

motivation of students to study theory and to perform research.

To support active training forms and the acquisition of skills and correction of attitudes.

Objectives of a New Curriculum

To develop active forms of the acquisition, classification and interpretation of information.

To support critical thinking and the ability to discuss.

To evaluate long-term feedback from students.The individualisation of the training will lead to

better quality of a limited number of graduates.

Desired features of a New Curriculum

IntegratedProblem oriented

Structure of a New Curriculum

The medical study isdivided into three cycles

CYCLE I: 1st and 2nd year – Basic Biomedical Sciences CYCLE II: 3rd and 4th year - Principles of Clinical Medicine CYCLE III: 5th and 6th year - Clinical Training

Each cycle consists of modules andcourses.

A module can contain courses.

Structure of a New Curriculum

At the end of CYCLE I, there are included at least one month lasting integrated conferences (discussions)

CYCLE I: 1st and 2nd year

Basic Biomedical Sciences (draft)Modules:

A. Structure and function of human body

B. Cell biology and genetics

C. Methodological basis of medicine

D. Needs of the patient

X. Course: Medical terminology (Latin) with examination following the 2nd term

XX. Course: Sports

Structure: anatomy, histologyFunction: biochemistry, physiologyMedicine: examination tools

Structure: anatomy, histologyFunction: biochemistry, physiologyMedicine: examination tools

Structure of a New Curriculum

At the end of CYCLE I, there are included at least one month lasting integrated conferences (discussions)

CYCLE I: 1st and 2nd year

Basic Biomedical Sciences (draft)Modules:

A. Structure and function of human body

B. Cell biology and genetics

C. Methodological basis of medicine

D. Needs of the patient

X. Course: Medical terminology (Latin) with examination following the 2nd term

XX. Course: Sports

Structure: anatomy, histologyFunction: biochemistry, physiologyMedicine: examination tools

Structure: anatomy, histologyFunction: biochemistry, physiologyMedicine: examination tools

A. Structure and function of human body

1. Support of the body and movement2. Metabolism. Energy production and storage3. Distribution of nutrients and oxygen (lungs, heart,

vessels and blood)4. Reproduction5. Memory and regulatory systems (neurology,

endocrinology, immune systems)

Participating departments: anatomy, histology,embryology, biochemistry, physiology, immunology,medical ethics, gynaecology and other clinicalspecialities ad hoc.

Examination: "Structure and function of humanbody" following the 4th term

A. Structure and function of human body

1. Support of the body and movement2. Metabolism. Energy production and storage3. Distribution of nutrients and oxygen (lungs, heart,

vessels and blood)4. Reproduction5. Memory and regulatory systems (neurology,

endocrinology, immune systems)

Participating departments: anatomy, histology,embryology, biochemistry, physiology, immunology,medical ethics, gynaecology and other clinicalspecialities ad hoc.

Examination: "Structure and function of humanbody" following the 4th term

Integrated curriculum

CYCLE II (Principles of clinical medicine): 2nd & 3rd year

Basic Clinical Problems – Module C1. Inflammation and fever

2. Pain

3. Behavioural disturbances

4. Dyspnoe and chest pain

5. Abdominal problems

6. Fatigue and loss of weight

7. Oedema

8. Bleeding

9. Cutaneous changes

10. Locomotion disorders

11. Other and uncertain problems

12. Failure of vital functions

13. Trauma

14. Disorders of reproduction and development

15. Ageing and dying

Departments: internal medicine, surgery, dermatology, neurology, ENT, ophthalmology, obstetrics and gynaecology, psychiatry, psychology, paediatrics, pathology, pathophysiology, infection, orthopaedics, urology, burn medicine, ethics, emergency medicine, microbiology, pharmacology, clinical chemistry, immunology

Examination: "Basic clinical problems" following the 8th term

PsychiatryPsychiatry

PsychiatryPsychiatry

PsychiatryPsychiatry

PsychiatryPsychiatry

PsychiatryPsychiatry

PsychiatryPsychiatry

PsychiatryPsychiatry

PsychiatryPsychiatry

Teaching psychiatry

Psychiatry participates in or teaches:Propedeutics (examination, hearing patient)Basic clinical problems (e.g., pain, mental

disorders)Clinical rotations in neurobehavioural sciences

(psychiatry, neurology, clinical psychology)

14 hours14 hours

3 hours3 hours 81 hours81 hours

50 hours50 hours 40 hours40 hours

Teaching psychiatry

Psychiatry participates in or teaches:Obligatory elective courses:Brain and behaviourBiological psychiatryBrain imagingPsychotherapy

30 hours for selected students

30 hours for selected students

15 hours for selected students

15 hours for selected students

15 hours for selected students

15 hours for selected students

15 hours for selected students

15 hours for selected students

Teaching psychiatry

Psychology participates in or teaches:

Ist cycle, Module E-Methodology

IInd cycle, Module C-Basic clinical problems (pain)

Obligatory elective: Social psychology

16 hours16 hours

2 hours2 hours

15 hours15 hours

Teaching psychiatry

Psychiatry participates in or teaches:

State exam in neurobehavioural sciences (neurology, psychiatry, psychology)

148 hours seminars and practices75 hours electives

148 hours seminars and practices75 hours electives

18 hours seminars and practices15 hours electives

18 hours seminars and practices15 hours electives

Plus enormous teaching burden in lower non-magisterial studies (e.g., nurses, public health etc.)

New curriculum

Pros:Students are better motivatedNew curriculum more reflects needs of real lifeAcquired knowledge and skills have longer

retentionThe proces of learning is more naturalNew approach changes the attitudes towards

psychiatry for better – destigmatizationPsychiatry is more recognized as a full-fledged

medical discipline

New curriculum

Cons:Students have no comparison with the old oneTeachers often boycott it’s implementationAcquired knowledge and skills are somewhat

less voluminous than in traditional curriculumThe process of learning is jeopardized by

quantitative incentives to admit as many students as possible

Teachers are not skilled enough to implement PBL in full.

Teaching medical students Teaching medical students psychiatry in Central psychiatry in Central

EuropeEurope

Cyril Höschl Cyril Höschl

Centre of Neuropsychiatric Studies,Psychiatric Centre Prague

& Charles University, 3rd Medical Faculty, PragueEuropean Psychiatric Association

•Not easy•Traditionally quite uniform•Needs changes following the development of MHC•Implemented in few pioneering schools only•Needs assessment•Needs investment

•Not easy•Traditionally quite uniform•Needs changes following the development of MHC•Implemented in few pioneering schools only•Needs assessment•Needs investment