Teaching medical students psychiatry in Central Europe Cyril Höschl Centre of Neuropsychiatric Studies, Psychiatric Centre Prague & Charles University, 3rd Medical Faculty, Prague European 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. Microbiology, propedeutics, pharmacology, pathology etc. Clinical rotations (internal medicine, surgery, paediatrics, gynob) E.g., psychopathology E.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 20 th 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 Integrated Problem oriented

Structure of a New Curriculum

At the end of CYCLE I, there are included at least one month lasting integrated conferences (discussions) CYCLE I: 1 st and 2 nd 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, histology Function: biochemistry, physiology Medicine: examination tools Structure: anatomy, histology Function: biochemistry, physiology Medicine: 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: 1 st and 2 nd 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, histology Function: biochemistry, physiology Medicine: examination tools Structure: anatomy, histology Function: biochemistry, physiology Medicine: examination tools

Integrated curriculum CYCLE II (Principles of clinical medicine): 2 nd & 3 rd year Basic Clinical Problems – Module C 1.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 Psychiatry

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 hours 3 hours 81 hours 50 hours 40 hours

Teaching psychiatry Psychiatry participates in or teaches: Obligatory elective courses: Brain and behaviour Biological psychiatry Brain imaging Psychotherapy 30 hours for selected students 15 hours for selected students

Teaching psychiatry Psychology participates in or teaches: I st cycle, Module E-Methodology II nd cycle, Module C-Basic clinical problems (pain) Obligatory elective: Social psychology 16 hours 2 hours 15 hours

Teaching psychiatry Psychiatry participates in or teaches: State exam in neurobehavioural sciences (neurology, psychiatry, psychology) 148 hours seminars and practices 75 hours electives 148 hours seminars and practices 75 hours electives 18 hours seminars and practices 15 hours electives 18 hours seminars and practices 15 hours electives Plus enormous teaching burden in lower non-magisterial studies (e.g., nurses, public health etc.)

New curriculum Pros: Students are better motivated New curriculum more reflects needs of real life Acquired knowledge and skills have longer retention The proces of learning is more natural New approach changes the attitudes towards psychiatry for better – destigmatization Psychiatry is more recognized as a full-fledged medical discipline

New curriculum Cons: Students have no comparison with the old one Teachers often boycott its implementation Acquired knowledge and skills are somewhat less voluminous than in traditional curriculum The 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 psychiatry in Central Europe Cyril Höschl Centre of Neuropsychiatric Studies, Psychiatric Centre Prague & Charles University, 3rd Medical Faculty, Prague European 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