Problem-based learning in consultation psychiatry

Advanced undergraduate medical students' perceptions of basic medical competences and specific competences for different medical specialties - a qualitative study

BACKGROUND

Medical graduates should have acquired basic competences that enable them to practice medicine independently as physicians and to enter postgraduate training in any specialty they wish. Little is known about advanced undergraduate medical students' perceptions of basic medical competences needed to start postgraduate training and about specialty-specific competences. This qualitative study aims to identify medical students' perceptions of basic medical competences and specific competence requirements for different specialties.

METHODS

In December 2020, sixty-four advanced undergraduate medical students participated in the role of a resident in a competence-based telemedicine training simulating a first day in postgraduate training. After the training, eight focus group interviews were conducted about students' perceptions of basic medical competences and specialty-specific competences using a semi-structured interview guide. The interviews were transcribed and analysed thematically according to the six steps of Braun and Clarke. The analysis was carried out by an inductive search for themes, which were deductively assigned to the six competence areas of the requirement-tracking questionnaire (R-Track).

RESULTS

Regarding basic medical competences, four R-Track competence areas could be identified as main themes. The students considered 'Social-interactive competences' to be particularly relevant for basic clinical work, including 'Structuring information', 'Tactfulness', and 'Stress resistance'. Students especially emphasized 'Concentration' as an important aspect of the competence area 'Mental abilities'. Among 'Personality traits', 'Honesty' was mentioned most frequently, and students were also aware that 'Expertise' is particularly important for 'Motivation'. For different specialties, some competence areas were newly added to the competences needed for the respective specialty. For surgery, the competence areas 'Sensory abilities' and 'Psychomotor & multitasking abilities' were mentioned anew. 'Sensory abilities' were also newly attributed to radiology. 'Mental abilities' were mentioned as new competence area for psychiatry and internal medicine, while for anaesthesiology, 'Psychomotor & multitasking abilities' were newly added.

CONCLUSIONS

Advanced students seem to be well aware of basic competences needed for clinical practice. Good consensus between students and physicians was only found for psychiatry-specific competences. Medical schools should support their students in matching their perceptions of competences needed for specific specialties with specialty-specific requirements for a realistic choice of a specialty for postgraduate training.

Training Psychiatry Residents in Descriptive Psychopathology: A Systematic Review

PURPOSE

Descriptive psychopathology (DP, sometimes called psychopathology or phenomenology) is the language of psychiatry and is dedicated to the description of mental symptoms. Due to its importance, there is an ongoing case to put it back at the heart of psychiatry and its training. This study seeks to examine the literature on how to train psychiatry residents in DP, including reported educational interventions and educational methods.

METHOD

The authors conducted a systematic review following the PRISMA and BEME guidelines to identify literature on how to train psychiatry residents in DP. In May 2019, they searched in Embase, ERIC, PsycINFO, PubMed, Scopus, and Web of Science; of 7,199 initial results, 26 sources were finally included for analysis. The assessment tools were the CRAAP test, Kirkpatrick's 4 levels, and (when applicable) the Medical Education Research Study Quality Instrument (MERSQI).

RESULTS

The mean CRAAP score was 38.885 of a possible 50 (SD 0.983; range: 36.859-40.910). Fourteen sources (53.8%) had some kind of training evaluation: Kirkpatrick's level 1 was present in nearly all (13) and was the highest in half of them (7). Regarding the educational interventions, the mean MERSQI score was 10.592 of a possible 18 (SD 2.371; range 9.085-12.098). Lectures were the most widely reported educational method (5); among those in clinical settings, the live supervised interview with feedback was the most usual (4).

CONCLUSIONS

Despite its core importance as the language of psychiatry, the literature about training psychiatry residents in DP is scarce and heterogeneous. General lack of training evaluation and ongoing overemphasis on Kirkpatrick's levels 1-2 at the expense of levels 3-4 are causes for concern. During the review process, the authors identified a selection of educational interventions that could serve as the basis for the design of new training efforts in both clinical and nonclinical settings. Topics for future research are also suggested, such as the role of DP in competency-based training frameworks now in vogue and a series of neglected contents. Finally, the combined use of the CRAAP test and the MERSQI may be useful for future systematic reviews in medical education.

Online Curriculum in Transplant Psychiatry

BACKGROUND

Transplant psychiatry is a subspecialty of consultation-liaison psychiatry that focused on evaluation, treatment, and research of mental health problems in organ transplant recipients and organ donors. To date, there is no literature about training programs that would ensure psychiatrists acquire the necessary knowledge and skills required to meet the clinical needs of these patients.

OBJECTIVES

The author describes the implementation of an online curriculum in transplant psychiatry created at the request of physicians located outside the United States.

METHOD

A 3-session online interactive course focused on knowledge relevant to transplant psychiatry was held in the fall of 2018. While the instructor was based in the United States, all attendees were located in Pakistan. The impact of the course was evaluated via precourse and postcourse surveys assessing knowledge level, interest in transplant psychiatry, and level of comfort with transplant psychiatry evaluations in the pretransplantation and posttransplantation settings.

RESULTS

Nine participants attended at least one of the 3 sessions, and 6 attended all 3 sessions. There were no significant events regarding the implementation of the curriculum. The response rate to the questionnaire was 100% before the course and 88.8% after the course. Precourse and postcourse tests indicated the curriculum had a positive impact on the level of knowledge and level of confidence in addressing problems relevant to transplant psychiatry.

CONCLUSIONS

Online curriculum for highly specialized areas of psychiatry is feasible and can have a positive impact on knowledge levels and confidence in addressing clinical challenges.

Advancing the Mission of Consultation-Liaison Psychiatry Through Innovation in Teaching

BACKGROUND

Consultation-liaison (C-L) psychiatry, similar to other medical specialties, relies on the education of students, residents, fellows, and life-long learners for growth of the field. C-L psychiatry is unique as it exists at the intersection of psychiatry with other medical subspecialties. Traditional teaching methods have been used in C-L psychiatry programs for more than 50 years, while technology has recently advanced as available resources and the learning styles of today's learners have evolved. A growing number of younger trainees are taking advantage of new ways to learn.

OBJECTIVES

We sought to examine both traditional and novel teaching methodologies and how each of these educational methodologies fits within adult learning theory and in the context of how digital natives learn about C-L psychiatry.

METHODS

In this narrative review, we drew upon the experiences of the authors as both life-long learners and educators. We then reviewed the literature pertaining to teaching methods that have been used in C-L psychiatry as well as emerging methods that could potentially be used in C-L psychiatry.

RESULTS

C-L psychiatry has used traditional teaching methods such as readings, didactic lectures, case-based rounds, and problem-based learning. Novel teaching methodologies such as teaching rotations, simulations, social media, podcasts, movie clubs, and the use of mobile tablet computers have been used in general psychiatry and other medical specialties, while literature specific to C-L psychiatry was sparse.

CONCLUSIONS

Opportunities abound to make use of new teaching methodologies and technologies to appeal to future generations of C-L psychiatrists.

[Training in iterative hypothesis testing as part of psychiatric education. A randomized study]

BACKGROUND

The improvement of medical education is at the center of efforts to reform the studies of medicine. Furthermore, an excellent teaching program for students is a quality feature of medical universities. Besides teaching of disease-specific contents, the acquisition of interpersonal and decision-making skills is important. However, the cognitive style of senior physicians leading to a diagnosis cannot easily be taught. Therefore, the following study aimed at examining whether specific training in iterative hypothesis testing (IHT) may improve the correctness of the diagnostic process.

MATERIALS AND METHODS

Seventy-one medical students in their 9th-11th terms were randomized to medical teaching as usual or to IHT training for 4 weeks. The intervention group received specific training according to the method of IHT. All students were examined by a multiple choice (MC) exam and additionally by simulated patients (SP). The SPs were instructed to represent either a patient with depression and comorbid anxiety and substance use disorder (SP1) or to represent a patient with depression, obsessive-compulsive disorder and acute suicidal tendencies (SP2).

RESULTS

All students identified the diagnosis of major depression in the SPs, but IHT-trained students recognized more diagnostic criteria. Furthermore, IHT-trained students recognized acute suicide tendencies in SP2 more often and identified more comorbid psychiatric disorders. The results of the MC exam were comparable in both groups. An analysis of the satisfaction with the different training programs revealed that the IHT training received a better appraisal.

CONCLUSIONS

Our results point to the role of IHT in teaching diagnostic skills. However, the results of the MC exam were not influenced by IHT training. Furthermore, our results show that students are in need of training in practical clinical skills.

Can problem-based learning address content and process?*

Problem-based learning was used to address the learning process and traditional content in a one semester nonmajors biochemistry course. Three different pedagogical strategies were evaluated in three versions of the course. The first version exclusively utilized literature-based learning (analysis of primary literature articles in small groups) with almost no lectures from the instructor. Classroom assessment addressed the research process, not content. In the second version, literature-based learning was supplemented with a 75-min lecture by the instructor before each article was analyzed as well as additional lectures as deemed necessary. Classroom assessment addressed process (70%) over content (30%). The third version was lecture-based, with the emphasis on traditional content; lectures were supplemented with literature analysis. Classroom assessment emphasized content, but about 10% of each exam focused on the research process. Student evaluations of the three versions of the course showed no significant difference in opinions about the format of the course. Postcourse interviews with students 1) confirmed previous studies that showed that the literature-based format greatly increased the involvement of students in their own learning, 2) showed that literature-based learning is compatible with an equal focus on content and process, and 3) showed that supplementing lecture-based teaching with literature-based learning does not empower students to manage their own learning, although student response to this instructional method was positive.

Reasons for poor attendance at an MRCPsych academic programme

Objectives: To examine potential reasons for poor attendance at the lecture programme and exploring possible alternatives to existing course structures.

Method: A postal questionnaire was circulated to all basic specialist trainees and consultants in the Irish Psychiatric training committee Eastern Region

Results: Response rates were 73 % and 44 % for consultants and trainees respectively. Respondents expressed concern about the content, relevance and structure of the current lecture programme.

Conclusion: Change is required to the current lecture programme which should give due consideration to the opinions of trainees and consultants. A number of suggestions are made based on the study findings.

The patient's voice in a problem-based learning case

OBJECTIVE

Problem-based learning (PBL) relies upon trigger material, often a paper case, to stimulate self-directed enquiry and group discussion. We describe the process of writing a PBL case based upon a patient's narrative account of her experiences of psychiatric illness, and the possible benefits of that collaboration for the patient, as well as for student learning.

CONCLUSION

Real patients are under-utilized in teaching, as are their narratives, and both are believed to be resources worthy of further attention.