Intercalated BMedSc Psychological Medicine Rachel Upthegrove

Senior Lecturer

Consultant Psychiatrist

Background

• The option of taking an extra year to complete an Intercalated Degree, either classed as a BSc or BMedSc, has long been a tradition for students in UK medical Schools.

• Large increase in students talking this option, reflecting the increase in medical student numbers and the increasingly competitive market for foundation year posts.

• Recent figures suggest between 30-50% of all British medical students obtain an intercalated degree.

• Likewise the range of courses on offer has increased.

Previously:

• Intercalating was taken only between pre-clinical and clinical years

• Basic science subjects of Anatomy, Biochemistry and Pathology.

• History of Medicine was one of the few alternatives on offer.

Why Intercalate: GMC

• The development of research skills

• In depth study in areas of particular interests over an extended period.

• Tomorrows Doctors 2003/9: “factual information must be kept to the essential minimum that students need at this [undergraduate] stage of their medical education”.

• Thus students are not able study subjects in any great depth; medical students’ education must be spread thinly to cover all subjects needed to practise safely as doctors.

• Intercalated degrees offer an opportunity to counter this

Why Intercalate: Students

• “Getting your name on PubMed.”

• “Extra letters on your CV”.

• “Foundation Applications”

• “Widening experience”

• New Skills

• “ A change is as good as a rest”.

• “Free time”??!!

Why Intercalate: Psychiatry

• Opportunity to study subjects akin and closely related to psychiatry also offers a window of opportunity through which to encourage and nurture interest

• Students now are increasingly obliged to choose a future specialty at an early stage, to polish and improve portfolios and gain extra “points” for short-listing at the foundation year stage.

• Psychiatry cannot afford to miss the opportunity intercalating offers to attract both interest and indeed recruitment of the highest calibre students.

Current Courses:

• Psychology

• Neuroscience

• Neuroscience and Mental Health (Imperial)

• Psychological Medicine (Birmingham)

The Birmingham Course: Psychological Medicine

• Lisa Jones, Femi Oyebode and Rachel Upthegrove

• Began in 2005 and has proved extremely popular from the outset with both internal and external students.

• Unique opportunity to study in depth subjects with real relevance to clinical psychiatry in a self directed manner.

• Sits along-side other BMedSc degrees in Public Health, History of Medicine, Ethics and Law and International Health

The Birmingham Course: Psychological Medicine • Integrates the scientific disciplines:

Psychology, Psychiatry Psychopathology in the arts.

• These themes are the main focus of the taught program in the first

semester.

• Strong focus on research and students spend the second semester completing a research project in an area of psychiatry that interests them.

• Assessments are mainly coursework based and students are given the freedom to determine their own areas for further study.

Objectives: • Commonly used research methods and data analysis

techniques within health and medicine.

• Legal and ethical frameworks of medical research.

• The neurobiological basis of processes of the mind and behaviour.

• The neurobiological basis of mental illnesses.

• The portrayal of psychiatry and psychopathology in the arts.

• The value of fictional narratives, poetry, biography, letters and journals in medical education

Semester 1: Themed Weeks Week Neurobiology of

Psychological

Processes

Neurobiology of Mental

Illness

Psychiatry and

Psychopathology in the Arts

1 Emotion

Pathological affect Kay R. Jamison “An Unquiet Mind”

2 Aggression & personality

Neurobiology of Psychopathy Elfrieda Jelinek “Piano Teacher” and “Wonderful Times”

3 Visual perception

Illusions & visual hallucinations

“The Black Monk” Chekhov “The Doors of Perception” A. Huxley

4 Auditory perception

Musical & auditory hallucinations

“Memoirs of My Nervous Illness” Daniel Schreber

5 Stress and Learning Neurobiology of Anxiety Disorders

“All Quiet on the Western Front” Erich Maria Remarque

6 Memory

Dementias

“Iris” John Bayley

7 Thinking & intelligence

Abnormalities of belief “Dairy of a Madman” Nicoli Gogol “Spider” Patrick McGrath

Semester 2: Research Projects

Examples from this year:

Systematic review, collecting new data, analysis of pre-existing data

• Antipsychotic medication use and birth outcomes in pregnancy

• Psychological well being in stoma patients: and online survey

• Drivers for recruitment in psychiatry

• Effectiveness of Risperidone Consta: a 2 year mirror study

• Medication Use in Bipolar Disorder

• Self Harm in minority ethnic groups

Assessed by placement report in the form of a Journal paper

Success:

• 12-14 students per year

• The most popular intercalated option

• Highest calibre students

• 11% go on to choose psychiatry (compared with ~3% average)

Selected Student Publications: • Cultural and social influences of negative illness appraisals in

first-episode psychosis. Early Intervention in Psychiatry 5(10):1751-7893

• Depressive symptoms in tourette syndrome and affective disorders: a controlled study. J Neurol Neurosurg Psychiatry. 2013 Sep;84(9):e1.

• The entrainment test in tremor assessment: influence of historical factors and clinical methodology. Neurol Neurosurg Psychiatry. 2013 Sep;84(9):e1

• The subjective experience and phenomenology of depression following first episode psychosis: a qualitative study using photo-elicitation’ Journal of Affective Disorders. 2013;149(1-3):166-74

• Is the degree of cognitive impairment in patients with Alzheimer's disease related to their capacity to appoint an enduring power of attorney? Age Ageing 36: 527-531.

• Young people in coerced drug treatment: Does the UK Drug Intervention Programme provide a useful and effective service to young offenders? Addiction Research and Theory 17(1),17 – 29

What you need to set up:

• Wonderful colleagues: expert teaching in psychology, psychiatry, course leadership, student support etc etc

• Access to experts

• Dedicated admin

• Researchers willing to support students

• Teaching staff: some protected time

Challenges:

• Course timetable: themed weeks..

• Selection of Students

• Research project support

Further Information:

• http://www.intercalate.co.uk/

• r.upthegrove@bham.ac.uk

Acknowledgements:

• Dr Lisa Jones: Course lead

• Dr Lesley Roberts: BMedSc Program Director

• Prof Femi Oyebode

• Students!

• ..........Introducing Maria Spears

Introducing …..

Dr Maria Spears BMedSc, MBChB

BMedSc •Enrolled on Psychological Medicine Intercalated degree course 2012/13 (University of Birmingham)

•Between 4th and 5th Year

•Had always wanted to Intercalate

•Enjoyed 4th Yr Psych placement

•Psych elective in New Zealand

•Advice from staff involved with BMedSc

A bit about my project • Predicting treatment response to brief eclectic psychotherapy using

coping behaviours in patients with chronic PTSD (AMC Amsterdam)

• Utrecht Coping List (Self report questionnaire)

The Academic Medical Centre, University of Amsterdam

Challenges

• Data on hormone levels

• Small sample size

• Confounders

• Individually led

• Working within a research environment and in a different country

• Trying to extract a project appropriate for dissertation

Open Minds

• OM: a scheme to encourage young people to discuss mental health topics and reduce stigma attached to mental health in young adolescents (started at UCL)

• Co-ordinator of Birmingham branch

• Over 100 members

• Psychiatry lectures on mental health topics

• Train students to go into schools and deliver sessions on mental health for students aged 13 and over

Reading for Well Being

• Using literature and poetry to generate discussion about mental health with patients and medical students

Future Plans

• Complete Foundation Years in South Yorkshire

• Commence Core Psych Training or Broad Based Training

• Specialise in CAMHT/Addiction/Perinatal?