Almost Psychiatry: The Impact of Teaching Child and Adolescent Mental Health Studies to Undergraduate College Students

OBJECTIVE

The Child and Adolescent Mental Health Studies (CAMS) program is housed in a Liberal Arts undergraduate college of a large research university. Psychiatrists, clinical psychologists, and social workers at the university's medical center teach the courses. The purpose of this study is to evaluate the extent to which CAMS encourages graduates of the program to pursue a career in child and adolescent mental health (CAMH).

METHODS

In 2015-2016, graduates of the CAMS program were invited to participate in a mixed methods study. In addition to statistical analyses, qualitative thematic analyses were performed to interpret free-text responses.

RESULTS

Forty-five percent (314/702) of invited graduates completed the online survey. Interviews were conducted with 11% (34/314) of participants by study staff over the phone. Quantitative results suggested that 81% (149/185) of participants enrolled in educational programs after graduation due to an interest in CAMH. A significantly higher proportion of the total sample (t = 3.661, p < .001) reported that they changed their career goals while undergraduate students compared to those who did so after graduation. Results of qualitative interviews with 34 participants uncovered five key themes unique to CAMS that may explain the program's influence on graduates' career choices and career development: practitioners-as-instructors, instructor mentorship, novel course content, experiential learning opportunities, and career training and skills.

CONCLUSIONS

Quantitative and qualitative results indicated that teaching college undergraduate students about CAMH encourages them to set career goals within the field. These findings suggest the utility of implementing similar programs at other undergraduate colleges.

Education in Psychopathology in Europe: Results from a Survey in 32 Countries

OBJECTIVES

The aim of the present paper is to assess the current status of training on psychopathology in Europe and to identify the unmet needs of training on psychopathology.

METHODS

An online survey was carried out during the period July-December 2013. Forty-one representatives of early career psychiatrists of their national associations were invited to participate. Each respondent was asked to provide the collective feedback of the association rather than that of any of its individual officer or member.

RESULTS

Thirty-two associations returned the questionnaire out of the 41 contacted (response rate, 78%). All respondents recognized psychopathology as a core component of training in psychiatry. According to respondents, the primary aims of psychopathology are (a) to assess psychiatric symptoms (47%), (b) to understand patients' abnormal experiences (33%), and (c) to make nosographical diagnosis (20%). A formal training course in psychopathology is available in 29 out of the 32 surveyed countries. In most countries, (a) there is not a defined number of hours dedicated to psychopathology, (b) teaching is mainly theoretical, and (c) a structured training on psychometric tools is missing. At the end of the training, about half of trainees is not satisfied with received training in psychopathology.

CONCLUSIONS

According to European early career psychiatrists, there is the need to rethink training in psychopathology, which should be at the heart of training in psychiatry and the key element of psychiatric practice. Education in psychopathology is affected by several unmet needs, such as lack of appropriate training in the use of psychometric instruments, lack of supervision, and lack of practical skills.

Psychopathology in a Galaxy Far, Far Away: the Use of Star Wars' Dark Side in Teaching

Star Wars is well known, timeless, universal, and incorporated into shared culture. Trainees have grown up with the movies, and based on their enduring popularity, attending psychiatrists are likely to have seen them too. This article highlights psychopathology from the Dark Side of Star Wars films which can be used in teaching. These include as follows: borderline and narcissistic personality traits, psychopathy, PTSD, partner violence risk, developmental stages, and of course Oedipal conflicts.

Teaching Psychopathology in a Galaxy Far, Far Away: The Light Side of the Force

Star Wars films are among the top box office hits of all time. The films have been popular internationally for almost 40 years. As such, both trainees and attending psychiatrists are likely to be aware of them. This article highlights a vast array of psychopathology in Star Wars films which can be useful in teaching, even when the characters are considered the "good guys". Included are as follows: histrionic, obsessive-compulsive, and dependent personality traits, perinatal psychiatric disorders, prodromal schizophrenia, pseudo-dementia, frontal lobe lesions, pathological gambling, and even malingering. As such, Star Wars has tremendous potential to teach psychiatric trainees about mental health issues.

Psychiatry's Next Generation: Teaching College Students About Mental Health

OBJECTIVE

The authors describe an integrated area of study for undergraduate college students that targets an increase in knowledge of mental health issues in children, adolescents, and emerging adults; encourages mental health service utilization on college campuses; and exposes young minds to the possibilities of working with children and adolescents in the mental health field.

METHODS

An overview of the program is provided, including the resources required to oversee and manage the program, student requirements, a description of the role that clinicians and researchers play as the program faculty, and an explanation of the tuition model.

RESULTS

The program currently includes 40 courses with an annual enrollment of over 3000 students, resulting in departmental revenues that currently exceed $11 million per year. Student evaluations of the courses are very positive, and in a program survey students reported that their participation in the program had a positive impact on their life (84.2%) and impacted their career choice (60.2%).

CONCLUSIONS

The benefits of the program include a valuable outreach to college students regarding the importance of seeking help for mental health issues, a positive influence on early career decision-making, opportunities for clinical and research educators to develop their scholarly areas of interest, and a significant source of departmental discretionary revenues.

Cinematherapy and film as an educational tool in undergraduate psychiatry teaching: a case report and review of the literature

Film possesses an extraordinary power and offers an unrivalled medium for entertainment and escapism. There are many films that revolve around a mental illness theme and the medical specialty that most commonly features in motion picture is psychiatry. Over the last few decades films have become increasingly used as an educational tool in the teaching of psychiatry topics such as mental state examination to undergraduate students. Above and beyond its utility in pedagogy, film also has the power to heal and the term cinematherapy has been coined to reflect this. Indeed, there are case studies of people with first-hand experience of psychopathology who report that watching films with a mental illness theme has contributed to their recovery. We provide a first person narrative from an individual with schizophrenia in which he expounds on the concepts of cinematherpy and metaphorical imagery in films which theme on psychosis.

[Psychopathology and film: a valuable interaction?]

BACKGROUND

Film or film fragments are often used in psychopathology education. However, so far there have been very few articles that have discussed the benefits and limitations of using films to explain or illustrate psychopathology. Although numerous films involves psychopathology in varying degrees, it is not clear how we can use films for psychopathology education.

AIM

To examine the advantages, limitations and possible methods of using film as a means of increasing our knowledge and understanding of psychiatric illnesses.

METHOD

We discuss five examples that illustrate the interaction of film and psychopathology. On the one hand we explain how the psychopathological concepts are used in each film and on the other hand we explain which aspects of each film are valuable aids for teaching psychopathology.

RESULTS

The use of film makes it possible to introduce the following topics in psychopathological teaching programme: holistic psychiatric reasoning, phenomenology and the subjective experience, the recognition of psychopathological prototypes and the importance of context.

CONCLUSION

There is undoubtedly an analogy between the method we have chosen for teaching psychopathology with the help of films and the holistic approach of the psychiatrist and his or her team. We believe psychopathology education can benefit from films and we would recommend our colleagues to use it in this way.

Development, implementation, and evaluation of a movie-based curriculum to teach psychopathology

BACKGROUND

Because medical students' attitudes toward psychiatry are often fostered by media, we provided an elective movie-based seminar to teach psychopathology.

DESCRIPTION

We assessed attitudes toward psychiatry by using the Attitudes towards Psychiatry (ATP 35) scale in a pre-post design. Furthermore we evaluated the knowledge of diagnostic criteria in a pre-post design within one sample.

EVALUATION

Of the 75 students who attended the seminar during 3 consecutive semesters, 54 (60.8% female) participated in the pre-post assessment. We observed a significant positive change in attitudes toward psychiatry and a significant gain of knowledge.

CONCLUSIONS

Using movies is a feasible and effective method to teach psychiatry.

[The cinema as a device for teaching complexity in mental health]

This article proposes the use of Cinema as an instrument for a complex approach to Teaching in the field of Clinical Psychiatry and Psychopathology in Mental Health. With this aim, intends a different look that pretends the approach not only to the conceptual structures on Psychopathology, but also to the complexity involved, choosing Cinema as a powerful way of "empathic recreation". Based on previous work by several authors, the theoretical framework that supports this modality is presented in the philosophical, cognitive, pedagogical-didactic aspects and their consequences into teaching within Mental Health. This task also implies addressing the historical evolution of the representation of subjectivity in fiction. In this way, a new perspective to those working in the field of mental health, as subjects involved in continuous learning processes, is presented. This perspective emphasizes the interactions underlying psychic problematical.

[The discourse on mental disorders in the Hispanic short novel: Amado Nervo's case]

The evolution of Amado Nervo's novellas shows a constant communication with the paradigmatic shifts in the field of psychopathology. His metafictional constructs foreground a playful treatment of some of medicine's key ideas. In some cases, the narrow limits of positivistic psychopathology are overcome in order to anticipate notions that obtain scientific status with modern psychology.

[Psychopathology service on ships]

The aim of this study was to describe the specific engineering services and suitability of candidates for the psychophysical performance. Navy ships are equipped with equipment and weapons are controlled by electronic devices ship and crew. Advanced technology puts high demands on operator. For the ship's staff are recruited soldiers of the psychophysical characteristics predisposing to this kind of action. The paper uses personal experience to work in military units of the Navy, and data from the literature. Terms of sailing ships off the summer season are defined as difficult. The crew during a combat mission felt the risks associated with movements of the ship in difficult meteorological conditions, and associated with the implementation of the task. The development of ship's technical equipment, working in isolated groups, functioning within a limited space, noise, vibration, electromagnetic waves heighten the emotional burden on crew members. Military service on Navy ships require high psycho-physical predisposition, resistance to stress. The crucial factor is proper selection among the candidates based on psychiatric and psychological counseling for military and medical jurisprudence. Also plays a significant role for training doctors and specialists in psychoprophylaxy of military units in the field of mental hygiene.

Uses and limitations of simulated patients in psychiatric education

OBJECTIVES

The use of standardized patients (SPs) is becoming prominent as a learning and evaluation tool in both undergraduate and graduate medical education. As increasing attempts are made to extend this tool to psychiatric training and education, it has been suggested that SPs can be useful not only to expose students to the variety of psychopathologic states, but also to teach and assess complex interpersonal processes such as empathic engagement and psychodynamic psychotherapy. The author argues that current enthusiasm for this modality should be tempered with caution about its limitations.

METHODS

Current uses of SPs in psychiatry as described in the psychiatric education and general medical education literature are critically reviewed.

RESULTS

Inherent problems in the use of SPs in psychiatry are described as they relate to the nature of empathy and the uniquely interpersonal nature of psychiatry.

CONCLUSION

SPs are useful additions to our educational toolbox but have intrinsic limitations for our field due to psychiatry's roots in the nature of empathy and the patient-psychiatrist relationship. Standardized patients are most appropriate for exposing trainees to a variety of psychopathologies and testing very discrete skills; the use of SPs is most problematic for teaching psychotherapy and assessing complex interpersonal skills, such as empathic responsiveness.

Developing a psychopathology curriculum during child and adolescent psychiatry residency training: general principles and a problem-based approach

Psychopathology is one of the core elements in a curriculum on child and adolescent psychiatry. Because there is no best-evidence model described for teaching this topic, an approach must be developed in each program that meets the standards set out by the Residency Review Committee and fully prepares its graduates to be competent child and adolescent psychiatrists. Methods used for teaching psychopathology may vary widely among programs and should be based on a sound educational rationale and adult learning principles that emphasize life-long, self-directed learning. This article describes an overall approach to curriculum design and expands on the use of problem-based learning as an educational method for teaching psychopathology in a child and adolescent psychiatry residency program.

Integrated problem-based learning in the neuroscience curriculum--the SUNY Downstate experience

BACKGROUND

This paper reports the author's initial experience as Block Director in converting a Conventional Curriculum into a problem-based learning model (PBL) for teaching Psychopathology. As part of a wide initiative in curriculum reform, Psychopathology, which was a six-week course in the second-year medical school curriculum, became integrated into a combined Neuroscience block. The study compares curriculum conversion at State University of New York (SUNY), Downstate, with the experiences at other medical centres that have instituted similar curricula reform.

METHODS

Student satisfaction with the Conventional and PBL components of the Neuroscience curriculum was compared using questionnaires and formal discussions between faculty and a body of elected students. The PBL experience in Psychopathology was also compared with that of the rest of the Neuroscience Block, which used large student groups and expert facilitators, while the Psychopathology track was limited to small groups using mentors differing widely in levels of expertise.

RESULTS

Students appeared to indicate a preference toward conventional lectures and large PBL groups using expert facilitators in contrast to small group mentors who were not experts. Small PBL groups with expert mentors in the Psychopathology track were also rated favorably.

CONCLUSION

The study reviews the advantages and pitfalls of the PBL system when applied to a Neuroscience curriculum on early career development. At SUNY, conversion from a Conventional model to a PBL model diverged from that proposed by Howard S. Barrows where student groups define the learning objectives and problem-solving strategies. In our model, the learning objectives were faculty-driven. The critical issue for the students appeared to be the level of faculty expertise rather than group size. Expert mentors were rated more favorably by students in fulfilling the philosophical objectives of PBL. The author, by citing the experience at other major Medical Faculties, makes a cautious attempt to address the challenges involved in the conversion of a Psychopathology curriculum into a PBL dominated format.

Psychopathology in neuropsychiatry: DSM and beyond

The case reports described in this article indicate that current neuropsychiatric practice is strongly limited by reliance on the Diagnostic and Statistical Manual of Mental Disorders (DSM). Knowledge of new psychopathology that will enable the neuropsychiatrists and neuroscientists identify specific areas of brain dysfunction is essential to modern practice of neuropsychiatry. Today, less than 20% of neuropsychiatry and neuroscience programs teach such psychopathology.The development of brain imaging and metabolic measurement technologies; the continuous and rapid introduction of many new pharmaceutical agents into clinical care; and the various, detailed editions of the Diagnostic and Statistical Manual of Mental Disorders (DSM) have all shaped modern psychiatric training and thus future psychiatric practice. This "shaping" is observed most often in the teaching of psychopathology and of mental status examinations, both currently focusing on how to recognize and elicit the clinical features needed to apply the criteria set by the DSM. Once DSM criteria are met, a best-choice treatment plan based on DSM diagnosis is selected from an array of pharmacotherapy algorithms. It is assumed that the known reliability of the DSM system maximizes the likelihood that these diagnostic decisions are valid and treatment choices are therefore appropriate. Descriptive psychopathology that goes beyond the DSM is primarily relegated to historical consideration and rarely pertains to issues regarding patient care.

[Parent psychoeducation groups in the treatment of adolescents with eating disorders]

Parents of adolescents with eating disorders show high levels of emotional distress, which may contribute to less functional coping with the illness of their child. In our department a psychoeducational group program is been offered to the parents of 153 children and adolescents with anorexia and bulimia nervosa. According to their own reports parents are highly interested in gaining information about the eating disorder and appreciate this means of support to help them to cope with the illness of their child.

Use of standardized patients to enhance a psychiatry clerkship

Changes in psychiatric health care delivery driven by such major shifts as deinstitutionalization, community-based care, and managed care have greatly altered the educational milieu for third-year psychiatry clerkships. Students may be assigned exclusively to alcohol and substance abuse treatment units, consultation-liaison services, or outpatient clinics, and may not have as broad an exposure as is desirable to patients with a variety of psychiatric illnesses. The authors describe a pilot course they developed in 2001, Clinical Psychiatric Assessment and Diagnosis, for third-year medical students at the Uniformed Services University of the Health Sciences medical school. The course uses standardized patients (SPs) to help students gain broader clinical experience. In psychiatry, a growing body of literature supports the acceptability, reliability, and validity of objective structured clinical examination assessment using SPs for medical students. Only a few articles report the use of SPs to primarily teach psychiatry instead of evaluating student proficiency in clinical psychiatry. Since this course was developed, the National Board of Medical Examiners announced that all medical students will be required to pass a clinical skills test in order to practice medicine, beginning with the class of 2005. The examination will use SPs modeling different clinical scenarios. In light of this change, many medical schools may have to reevaluate and possibly revamp their curriculums to insure sufficient acquisition of clinical skills in different specialties. The use of SPs in psychiatry could provide an effective, primary clinical teaching experience to address this new requirement as well.

[AMDP system and psychopathology (author's transl)]

The psychopathological scale of AMDP system is voluntary limited to descriptive aspects of psychopathology. If the term psychopathology could be considered identical to psychiatric semiology, the words signs and symptoms go above the descriptive stade: the greek name sumptôma contains sun (with) and piptein (appear), while the word sign is an intellectual deduction of observed symptoms. In the AMDP-3, the sense of evaluated symptoms results from the configurational approach, for example a factor analysis. The splitting of german psychopathological concepts in items and the evaluation of these items in relation to observable compounds bind to their configurational structure will, no doubt, permit to avoid the obstacle of a different conceptualisation of the same symptoms from one school to the other. Furthermore, the AMDP-3 scale and its manual constitute a remarkable teaching instrument for psychopathology, not always enough appreciated.