Teaching medical students psychiatry in Central Europe Cyril Höschl Centre of Neuropsychiatric...
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Teaching medical students Teaching medical students psychiatry in Central psychiatry in Central
EuropeEurope
Cyril Höschl Cyril Höschl
Centre of Neuropsychiatric Studies,Psychiatric Centre Prague
& Charles University, 3rd Medical Faculty, PragueEuropean 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.
Physics, (bio)chemistry, biology, anatomy, histology, physiology etc.
Microbiology, propedeutics, pharmacology, pathology etc.
Microbiology, propedeutics, pharmacology, pathology etc.
Clinical rotations (internal medicine, surgery, paediatrics, gynob)
Clinical rotations (internal medicine, surgery, paediatrics, gynob)
E.g., psychopathologyE.g., psychopathology E.g., diseasesE.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 20th 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
IntegratedProblem oriented
Structure of a New Curriculum
The medical study isdivided into three cycles
CYCLE I: 1st and 2nd year – Basic Biomedical Sciences CYCLE II: 3rd and 4th year - Principles of Clinical Medicine CYCLE III: 5th and 6th year - Clinical Training
Each cycle consists of modules andcourses.
A module can contain courses.
Structure of a New Curriculum
At the end of CYCLE I, there are included at least one month lasting integrated conferences (discussions)
CYCLE I: 1st and 2nd 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, histologyFunction: biochemistry, physiologyMedicine: examination tools
Structure: anatomy, histologyFunction: biochemistry, physiologyMedicine: 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: 1st and 2nd 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, histologyFunction: biochemistry, physiologyMedicine: examination tools
Structure: anatomy, histologyFunction: biochemistry, physiologyMedicine: examination tools
A. Structure and function of human body
1. Support of the body and movement2. Metabolism. Energy production and storage3. Distribution of nutrients and oxygen (lungs, heart,
vessels and blood)4. Reproduction5. Memory and regulatory systems (neurology,
endocrinology, immune systems)
Participating departments: anatomy, histology,embryology, biochemistry, physiology, immunology,medical ethics, gynaecology and other clinicalspecialities ad hoc.
Examination: "Structure and function of humanbody" following the 4th term
A. Structure and function of human body
1. Support of the body and movement2. Metabolism. Energy production and storage3. Distribution of nutrients and oxygen (lungs, heart,
vessels and blood)4. Reproduction5. Memory and regulatory systems (neurology,
endocrinology, immune systems)
Participating departments: anatomy, histology,embryology, biochemistry, physiology, immunology,medical ethics, gynaecology and other clinicalspecialities ad hoc.
Examination: "Structure and function of humanbody" following the 4th term
Integrated curriculum
CYCLE II (Principles of clinical medicine): 2nd & 3rd year
Basic Clinical Problems – Module C1. 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
PsychiatryPsychiatry
PsychiatryPsychiatry
PsychiatryPsychiatry
PsychiatryPsychiatry
PsychiatryPsychiatry
PsychiatryPsychiatry
PsychiatryPsychiatry
PsychiatryPsychiatry
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 hours14 hours
3 hours3 hours 81 hours81 hours
50 hours50 hours 40 hours40 hours
Teaching psychiatry
Psychiatry participates in or teaches:Obligatory elective courses:Brain and behaviourBiological psychiatryBrain imagingPsychotherapy
30 hours for selected students
30 hours for selected students
15 hours for selected students
15 hours for selected students
15 hours for selected students
15 hours for selected students
15 hours for selected students
15 hours for selected students
Teaching psychiatry
Psychology participates in or teaches:
Ist cycle, Module E-Methodology
IInd cycle, Module C-Basic clinical problems (pain)
Obligatory elective: Social psychology
16 hours16 hours
2 hours2 hours
15 hours15 hours
Teaching psychiatry
Psychiatry participates in or teaches:
State exam in neurobehavioural sciences (neurology, psychiatry, psychology)
148 hours seminars and practices75 hours electives
148 hours seminars and practices75 hours electives
18 hours seminars and practices15 hours electives
18 hours seminars and practices15 hours electives
Plus enormous teaching burden in lower non-magisterial studies (e.g., nurses, public health etc.)
New curriculum
Pros:Students are better motivatedNew curriculum more reflects needs of real lifeAcquired knowledge and skills have longer
retentionThe proces of learning is more naturalNew approach changes the attitudes towards
psychiatry for better – destigmatizationPsychiatry is more recognized as a full-fledged
medical discipline
New curriculum
Cons:Students have no comparison with the old oneTeachers often boycott it’s implementationAcquired knowledge and skills are somewhat
less voluminous than in traditional curriculumThe 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 Teaching medical students psychiatry in Central psychiatry in Central
EuropeEurope
Cyril Höschl Cyril Höschl
Centre of Neuropsychiatric Studies,Psychiatric Centre Prague
& Charles University, 3rd Medical Faculty, PragueEuropean 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