Teaching Psychiatry E-Book

• Herausgeber: John Wiley & Sons
• Kategorie: Fachliteratur
• Sprache: Englisch

Seitenzahl: 551

Veröffentlichungsjahr: 2011

Beschreibung

In psychiatry, as in all of medicine, clinicians are frequently involved in training students and residents yet few have themselves been trained in pedagogy. Improving the quality of psychiatric education should both improve the quality of psychiatric care and make the profession more attractive to medical students. Written by a team of international experts with many years of experience, this comprehensive text takes a globally relevant perspective on providing practical instruction and advice on all aspects of teaching psychiatry. It covers learning from undergraduate and postgraduate level to primary medical and community settings, enabling readers to find solutions to the problems they are facing and become aware of potential issues which they can anticipate and be prepared to address. The book discusses curriculum development using examples from around the world, in order to provide trainees with the basic attitudes, knowledge and skills they require to practise psychiatry.

Features:

• Instruction on developing a curriculum for Residency training, teaching interviewing skills, teaching psychotherapy and using new technology
• Innovative ways of engaging medical students in psychiatry and developing their interest in the specialty, including experience with new types of elective and research options and development of roles for students in patient care
• Focuses throughout on how to teach rather than what to teach
• Includes descriptions of workplace-based assessments
• Discussions of both theoretical and practical perspectives and examples of particular innovations in the field using case studies

Presented in a thoroughly readable and accessible manner, this book is a primary resource for all clinicians involved in teaching psychiatry to medical students and trainees.

Leseprobe

Contents

Cover

Title Page

Copyright

Contributors

Foreword

Chapter 1: Overview: The Need for Improvements in Psychiatric Education

Chapter 2: Recruitment of Psychiatrists: the Key Role of Education

2.1 Introduction

2.2 Stigma

2.3 The Selection Process: Getting to Know the Target Audience

2.4 Undergraduate Teaching Programmes

2.5 Clinical Undergraduate Placements: ‘What Made You Choose Psychiatry?’

2.6 Innovative Ways of Recruiting into Psychiatry

2.7 Conclusion

Chapter 3: Ethical Issues in Teaching Psychiatry

3.1 Introduction

3.2 Medical Power, Ethics and Doctor–Patient Relationship

3.3 The Teacher

3.4 The Student

3.5 The Institution

3.6 Teaching Ethics in Psychiatry

3.7 Conclusions

Chapter 4: Developing a Medical Student Curriculum in Psychiatry

4.1 Introduction

4.2 The Evidence and Context

4.3 Developing the Curriculum

4.4 Developing a Core Curriculum: Example from the UK

4.5 Implementing the Curriculum

4.6 Summary

Appendices for the Core Curriculum in the UK

Acknowledgments

Chapter 5: Teaching Behavioural Sciences

5.1 Introduction

5.2 Background

5.3 History of Teaching Behavioural and Social Aspects of Medicine

5.4 Rationale of Teaching Behavioural Sciences

5.5 Who Teaches Behavioural Sciences?

5.6 Who Decides What and How to Teach?

5.7 When is the Proper Time to Teach Behavioural Sciences?

5.8 Methods of Teaching Behavioural Sciences

5.9 Difficulties/Barriers and Recommendations Regarding Teaching Behavioural Sciences

5.10 Conclusion

Chapter 6: Problem-Based Learning and Psychiatric Education

6.1 Introduction

6.2 Method and Philosophy of Problem-Based Learning

6.3 Problem-Based Learning: The Evidence Base in Undergraduate Training

6.4 Advantages and Disadvantages

6.5 PBL in Undergraduate Psychiatry: An Example from Maastricht University (The Netherlands)

6.6 The Use of PBL in Postgraduate Psychiatric Training

6.7 Problem-Based Learning in Psychiatric Education: The Future

Appendix 6.1

Chapter 7: Psychiatric Residency Curriculum: Development and Evaluation

7.1 Introduction

7.2 Historical Context

7.3 Psychiatric Curriculum's Function

7.4 Curriculum Content (The Terrain)

7.5 Educational Modalities

7.6 Developmental Considerations and Timing (Pacing the Map)

7.7 Implementing the Curriculum

7.8 Assuring Continued Quality and Improvement

7.9 Challenges

7.10 Model Curricula Illustrations

7.11 Conclusion

Chapter 8: Acquisition of Psychiatric Interviewing Skills

8.1 The Salience of the Consultation

8.2 Teaching Psychiatric Interviewing

8.3 Acquisition of Basic Therapeutic Skills

8.4 Specific Methods for Teaching Skills

Chapter 9: Teaching Psychotherapy in the Classroom and in Supervision

9.1 Introduction

9.2 Teaching Psychotherapy in the Classroom

9.3 Supervision

9.4 Administrative Issues in Psychiatry Education

9.5 Conclusions

Chapter 10: Teaching Psychotherapy: Case Discussion Groups

10.1 Introduction

10.2 What are Case Discussion Groups?

10.3 What Learning Takes Place in CDGs?

10.4 Example of a Case Discussed in a CDG

10.5 Discussion

Chapter 11: Teaching Research Methods: ‘Doing Your Own Research’

11.1 Introduction

11.2 Thinking of an Idea

11.3 Reading Round the Subject

11.4 Deciding on the Method

11.5 The Research Protocol

11.6 Sample Size

11.7 The Time Budget

11.8 Conclusion

Chapter 12: Teaching Psychiatry Students About Cultural Diversity

12.1 Introduction

12.2 Definitions of Key Terms

12.3 Issues That Need Consideration

12.4 Educational Philosophy and Its Influence on Programmes Developed

12.5 Educational Models: Ideal Types of ‘Cultural Expertise’ and ‘Cultural Sensibility’

12.6 Does Training In Cultural Diversity Improve Clinical Outcomes?

12.7 Practical Tips for Teaching Diversity

12.8 Summary

Chapter 13: Teaching Psychiatry in Primary Care

13.1 Why Teach Psychiatry to Primary Care Workers?

13.2 Meeting the Educational Needs of the Primary Care Team

13.3 Developing a Curriculum: What do Primary Care Workers Want and Need to Know?

13.4 Engaging Psychiatry in the Task

Chapter 14: The Standardized Patient

14.1 Introduction

14.2 The Standardized Patient

14.3 Teaching Formats

14.4 The Case

14.5 Training SPs for Teaching

14.6 Assessment with Standardized Patients

14.7 Technology and the Standardized Patient

14.8 Conclusion

Chapter 15: Patients as Teachers: Involving Service Users

15.1 Distant Origins

15.2 Royal College Examinations

15.3 Hitting the Road

15.4 ‘Patients Teaching Doctors’

15.5 Thames Valley STARS

15.6 The National Knowledge and Understanding Framework for Personality Disorder

15.7 Partnership in a Learning Network

15.8 Building Capacity in the Regions

15.9 The Impact of Service User Involvement

9.10 Recommendations

Web Resources

Chapter 16: Technology for Psychiatric Educators

16.1 Introduction

16.2 Classroom Tools

16.3 Collaborative Learning Tools

16.4 Portable Learning Tools

16.5 Finding Online Content

16.6 Practice Tools

16.7 Ethical, Boundary and Legal Issues

16.8 Future Trends in Education Technology

Chapter 17: Assessment in Psychiatric Education

17.1 Introduction

17.2 Training

17.3 Knowledge Assessment

17.4 Skills Assessment

17.5 Professionalism

17.6 Who Passes

17.7 Summary

Chapter 18: The Support and Welfare of the Student

18.1 Introduction

18.2 An International Perspective

18.3 Psychiatric Illnesses

18.4 Common Stressors in the Lives of Students Today

18.5 Unique Issues for Ethnic Minority and International Medical Graduate (IMG) Trainees

18.6 How We Can Assist

18.7 Key Points

Chapter 19: Psychiatrist Educators

19.1 Introduction

19.2 Examples of Teacher Training Programmes

19.3 Methods for Teaching Psychiatric Educators

19.4 Target Groups for Psychiatrist Educators

19.5 Recommendations

Index

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Library of Congress Cataloging-in-Publication Data

Teaching psychiatry : putting theory into practice / [edited by] Linda Gask, Bulent Coskun, David Baron p. ; cm. Includes bibliographical references and index. ISBN 978-0-470-68321-7 (cloth) 1. Psychiatry-Study and teaching. I. Gask, Linda. II. Coskun, Bulent. III. Baron, David A. [DNLM: 1. Psychiatry-education. 2. Curriculum. 3. Psychotherapy-education. WM 18] RC459.T43 2011 616.890076-dc22 2010035694

A catalogue record for this book is available from the British Library.

This book is published in the following electronic formats: ePDF: 978-0-470-97453-7;

Wiley Online Library: 978-0-470-97454-4; ePub: 978-0-470-97493-3

Contributors

Maarten Bak Department of Psychiatry and Neuropsychology, Maastricht University, PO Box 616, 6200 MD Maastricht, The Netherlands

David Baron Department of Psychiatry, Keck School of Medicine, University of Southern California, 2250 Alcazar St, CSC 2202, Los Angeles, CA 90033, USA

Sheldon Benjamin Department of Psychiatry, University of Massachusetts Medical School, 55 Lake Avenue North, Worcester, MA 01655, USA

Maria R. Corral Department of Psychiatry, University of British Columbia, St. Paul's Hospital, 1081 Burrard Street, Vancouver, BC V6Z1Y6, Canada

Bulent Coskun Department of Psychiatry, Kocaeli UniversityMedical School, University of Kocaeli, Umuttepe Kampusu 41 380, Kocaeli, Turkey

Michael Curtis Standardized Patient Program,William Maul Measey Institute for Clinical Simulation and Patient Safety, Temple University School of Medicine, Room 361, Medicine Education andResearch Building, 3500N. Broad Street, Philadelphia, PA 19140-5104, USA

Rob van Diest Department of Psychiatry and Neuropsychology, Maastricht University, PO Box 616, 6200 MD Maastricht, The Netherlands

Nisha Dogra Greenwood Institute of Child Health, University of Leicester, Westcotes House, Westcotes Drive, Leicester LE3 0QU, UK

Mark Oliver Evans Gaskell House Psychotherapy Centre, Swinton Grove, Manchester M13 0EU, UK

Rodolfo Fahrer Department of Mental Health, School of Medicine, University of Buenos Aires, 2436 J. Salguero, Piso 8, Buenos Aires, Argentina

Glen O. Gabbard Department of Psychiatry and Behavioural Sciences, Baylor College of Medicine, 6655 Travis Street, Suite 500, Houston, TX 77030, USA

Linda Gask School of Community Based Medicine, University of Manchester, NPCRDC, 5th Floor Williamson Building, Oxford Road, Manchester M13 9LP, UK

David P. Goldberg Institute of Psychiatry, King's College, 16De Crespigny Park, London SE5 8AF, UK

Rex Haigh Berkshire Healthcare NHS Foundation Trust, Fitzwilliam House, Skimped Hill Lane, Bracknell RG12 1LD, UK

Cyril Höoschl Psychiatrick'e centrum Praha (Prague Psychiatric Centre affiliated with Charles University), U' stavn'? 91, 181 03 Prague 8 - Bohnice, Czech Republic

Niranjan Karnik Pritzker School of Medicine, The University of Chicago, 5841 S. Maryland, MC 3077, Chicago IL 60637, USA

Kath Lovell Emergence Community Interest Company, 59Weltje Road, Hammersmith, London W6 9LS, UK

Brian Lunn School of Medical Sciences Education Development, The Medical School, Newcastle University, Royal Victoria Infirmary, Queen Victoria Road, Newcastle upon Tyne NE1 4LP, UK

Amanda B. Mackey Department of Psychiatry and Behavioral Sciences, University of Louisville School of Medicine, 501 E. Broadway Suite 340, Louisville, KY 40202, USA

Maria Margariti Eginition Hospital, Department of Psychiatry, University of Athens, Vasillissis Sofias Avenue 72-74, Athens 115 28, Greece

Adriana Mihai Psychiatric Department, University of Medicine and Pharmacy Tg Mures, 38 GH Marinescu Street, 540130TG Mures, Romania

Driss Moussaoui Ibn Rushd University Psychiatric Centre, Rue Tarik Ibn Ziad, Casablanca 20000, Morocco

Michael F. Myers Department of Psychiatry & Behavioral Sciences, SUNY Downstate Medical Center, 450 Clarkson Avenue, Brooklyn, NY 11203, USA

Allan Tasman Department of Psychiatry and Behavioral Sciences, University of Louisville School of Medicine, 401 E. Chestnut Street, Suite 600, Louisville, KY 40202, USA

Jon van Niekerk Rivington Unit, Royal Bolton Hospital, Greater Manchester West Mental Health Foundation Trust, Bolton BL4 0JR, UK

Raja Vellingiri Badrakalimuthu Cambridge and Peterborough NHS Foundation Trust, Ida Darwin Site, Fulbourn, Cambridge CB21 5EE, UK

Hugo de Waal East of England Deanery, Block 3, Ida Darwin Site, Fulbourn Hospital, Fulbourn, Cambridge CB21 5EE, UK

Foreword

This book aims to cover the history and future of medical education in psychiatry at every level of training from the undergraduate to medical student, to the resident and practitione rafter graduation. This is a challenge that is very well met by the authors. The contributors represent educators from around the world and reference other dedicated educators over the centuries, from Hippocrates to the present. All this to make the point that we live in one world and that, perhaps more than ever with advanced communication and technology, we can and should learn from each other.

This text discusses effective ways for how to teach and learn, as psychiatric educators, including how to promote life-long learning. Some chapters focus on learning throughout one’s psychiatric career, while others look at specific aspects of career development. For instance, Chapters 2 and 4 consider recruiting and teaching medical students about psychiatry - of great interest at a time when we need to attract quality graduates into our discipline.

Importantly, this book is about educational methods and several chapters (5, 7, 8, 9, 10, 11, 14 and 18) review techniques for teaching residents, not just behavioural science, but interviewing skills, psychotherapy techniques and some introductory elements of clinical research. The skills imparted during psychiatric education are also required by primary care physicians, who treat many patients with comorbid ‘physical’ and psychiatric illnesses and often are the only available mental health providers. Other chapters (6, 10, 13 and 15) therefore present models for teaching interviewing and psychotherapy skills to primary care providers. Further, there is a comprehensive description of how one can learn life long through problem-based learning techniques (Chapter 6). These chapters also make the point that effective psychiatric teaching at all levels, including primary care, must include ward work, outpatient work and, particularly, community work, and highlight the various ways this can be done.

The use of technology in psychiatric education is addressed specifically in Chapter 16.

This states that while technology can facilitate the educational process, it raises ethical issues that cannot be ignored. Ethical issues relevant to the whole educational process are described in Chapter 3, which notes that ever-expanding medical improvements create new social phenomena that must be addressed. It also highlights the need to become more global in our approach to education as we deal with regional variations in the delivery of psychiatric care. Chapter 12, Teaching Psychiatry Students About Cultural Diversity, takes ethical issues in another direction by describing the essence of culture and how cultural issues are intercalated into our everyday lives. It emphasizes that cultural diversity training, at any level of career development, involves the educational concepts of ‘cultural expertise’ and ‘cultural sensibility’.

A strength of this book is that the multiple contributors do not just discuss what has been done and what needs to be done in the future, but consider the assessment and evaluation of the educational process as it proceeds. Chapter 17, Assessment in Psychiatric Education, features the key components of assessment, from formative to summative elements. It makes the point that assessment of the process of learning shapes the teaching and learning that will follow.

Throughout the book, excellent tables and ‘boxes’ provide the reader with take-home information that they can adapt to their own situation. Each of the 19 chapters can stand alone in giving the reader both a general curriculum, as well as specific tools to teach.

In closing, in the final chapter, the authors remind us that: ‘The word “doctor” comes from the ancient term “docere”. The translation of this word is not “to diagnose” or “to treat”, but rather “to teach”. When we stop and think about what we do as physicians, and particularly as psychiatrists, it is clear that we work to help our patients maintain health or treat disease. Teaching them how to maintain emotional homeostasis and better deal with life stress is an important component of every treatment strategy and clinical intervention.’

Finally, we are presented with examples of how to teach our patients, their families, our students and ourselves.

This text provides a global perspective on teaching psychiatry, at every level, from a process point of view. It is not a ‘what to teach’ manual as much as it is a ‘how to teach’. I believe it is a valuable addition to the psychiatry education literature geared for the teacher as well as useful to their students who want to better learn how to teach in their turn.

Michele T. Pato

Professor and Associate Chair of Education Department of Psychiatry and the Behavioral SciencesKeck School of Medicine, University of Southern California

1

Overview: The Need for Improvements in Psychiatric Education

Linda Gask1, David Baron2 and Bulent Coskun3

1School of Community Based Medicine, University of Manchester, Manchester, UK

2Department of Psychiatry, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA

3Department of Psychiatry, Kocaeli University Medical School, Kocaeli, Turkey

Education includes more than the cognitive transmission of knowledge. Learning requires an affective and psychomotor component as well. Psychiatrists are uniquely qualified to appreciate, and apply, core tenets of the educational process.

This book developed out of recognition amongst the co-editors of a need for more attention within our profession to both the art and the science of teaching psychiatry. As past Chair (Gask) and present Chair (Coskun) and Co-Chairs (Gask and Baron) of the Section of Education of the World Psychiatric Association, we have debated the developments in teaching over the last decade, and have noted that our own speciality has sometimes seemed rather slow to adopt some of the newer educational technologies, using ‘technology’ in the broadest sense of the word to mean the methods and tools that can be brought to bear to solve a particular problem in society. In many parts of the world, psychiatric teaching is still delivered using a combination of the formal lecture programme, combined with the apprenticeship hands-on experience in the hospital and out-patient clinic often with limited supervision. As two young colleagues of one of the editors wrote in the Psychiatric Bulletin many years ago when reflecting on the experience of the trainee:

No-one except you and the patient really know what happens when you take him for an interview. You learn from your own mistakes behind the closed door.

—Adams and Cook [1]

A view that will still be familiar to many of those starting psychiatry today.

However, at the same time we recognized that our own decisions to enter the profession were not always so much governed by the now quite traditional methods that were used in our teaching, but the qualities of an individual and often charismatic teacher who inspired enthusiasm for finding out about what sometimes seems like a quite difficult and nebulous subject to many students. In the chapter which follows this brief introduction, Cyril Höschl and Jon van Niekerk explicitly address the important role that education has to play in addressing the ‘recruitment crisis’ in psychiatry and the negative attitudes that medical students have been found to possess towards our speciality. This is followed by a discussion by Driss Moussaoui of the need to specifically address ethical issues in the teaching of psychiatry. In Chapter 4, a comprehensive overview of the development of an undergraduate curricula is presented by Nisha Dogra, Cyril Höschl and Driss Moussaoui using a model developed by the Royal College of Psychiatrists in the United Kingdom (UK) as an example. In a companion chapter, Amanda Mackey and Allan Tasman specifically examine the design of the residency curriculum; an up-to-date overview of methods in assessment is provided in a later chapter by Brian Lunn, Maria Corrall and Adriana Mihai.

How to teach ‘behavioural sciences’ in ways that seem to be relevant and interesting to undergraduate students (some of us remember this being addressed in a particularly uninspiring way in dusty lecture theatres) is covered by one of the co-editors, Bulent Coskun. Problem-Based Learning is one of the newer ‘technologies’ to arrive in medical education, and how this can be used in both undergraduate and postgraduate or residency education is addressed by an international group of authors: Badrakalimuthu, van Diest, Bak and de Waal. Those seeking a more literal use of the term ‘technology’ will find the chapter by Sheldon Benjamin and Maria Margariti extremely enlightening.

The art and skills of listening and talking with patients is central to our professional lives and we make no apologies for our emphasis on acquisition of both basic interviewing skills (Gask) and more complex skills in conducting psychotherapy (in chapters by both Glen Gabbard from the United States of America (USA) and Mark Evans from the United Kingdom), in addition to specific chapters dealing with innovative techniques, such as the Standardized Patients (Michael Curtis and Dave Baron), and with imaginative involvement of real users of our services (from Rex Haigh and Kathleen Lovell).

Looking beyond the teaching of psychiatrists, we have also addressed the other important roles that teachers of psychiatrists have to play, specifically in training in primary care (Gask, Coskun and Fahrer), where the vast majority of people with mental health problems receive care. Many psychiatrists will be involved in teaching in this setting, but we also need to consider how to teach psychiatrists to be educators within the community (Baron and Coskun) and, finally, how we can help our students to acquire the skills to carry out a research project of their own (addressed by David Goldberg).

We set out to try and get an international team of authors to work with us in producing this book and, through this collaboration, we believe new international alliances have been forged. From our correspondence with the writing teams this does indeed seem to be the case but it has not always been easy. As one of the authors commented in his e-mail correspondence with us, it was a little ironic that the vagaries of new technology (failure in e-mail) made it difficult for him to deliver to us as early as he had hoped a chapter which addressed use of new technologies in medicine.

It is our hope that readers will find this compendium of knowledge about how, what, where and, above all, why to teach psychiatry. We need to inspire ourselves before we can inspire our students, whoever they may be. Quality education is our best recruiting tool, shaper of public health policy sensitive to the needs of our patients, the keystone of the research process and the most important component of clinical care. We must all teach wisely. Our profession depends on it.

Reference

Adams, G. and Cook, M. (1984) Beginning psychiatry. Bulletin of the Royal College of Psychiatrists, 8, 53–54.

2

Recruitment of Psychiatrists: the Key Role of Education

Cyril Höschl1 and Jon van Niekerk2

1Prague Psychiatric Centre affiliated with Charles University, Prague, Czech Republic

2Rivington Unit, Royal Bolton Hospital, Greater Manchester West Mental Health Foundation Trust, Bolton, UK

2.1 Introduction

The image of psychiatry as a modern medical specialty that deals with a vast range of mental disorders, some of which are very common in the general population, and that delivers a variety of therapeutic interventions, some of which are among the most effective that medicine has at its disposal, is currently unfamiliar to the general public in most countries of the world.

—Mario Maj, President, World Psychiatric Association

The case to make for recruiting more psychiatrists is an easy one. The reports of a ‘Recruitment crisis’ in the developed world need to be put into context, however. The World Health Organization (WHO) recommends that there should be approximately one psychiatrist per 10 000 population, but most countries fall far below this level [1]. The WHO Mental Health Atlas 2005 showed that one fifth of the more than 100 countries supplying figures spent less than 1% of their health budget on mental health. This despite estimates that one third of global disease burden is caused by brain diseases and that more than three quarters of the costs of brain diseases are attributed to mental disorders [2]. The survey of 192 countries did show a slight increase in the total number of psychiatrists, from 3.96 to 4.15 per 100 000 people worldwide, since 2001; however, distribution across regions ranged from 9.8 in Europe to just 0.04 in Africa. In 47.6% of countries covering 46.5% of the world's population, there is less than one psychiatrist per 100 000 population. The trend is set for this disparity to increase. Recruitment in developing nations is also undermined by medical immigration of potential psychiatrists to developed nations.