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Teaching medical students psychiatry in Central Europe

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.

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Teaching medical students psychiatry in Central Europe

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  1. 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

  2. Challenges in psychiatric education • During 20th century medicine dramatically changed, particularly in technical terms

  3. Challenges in psychiatric education Physics, (bio)chemistry, biology, anatomy, histology, physiology etc. • 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. Clinical rotations (internal medicine, surgery, paediatrics, gynob) Microbiology, propedeutics, pharmacology, pathology etc. E.g., psychopathology E.g., diseases

  4. 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.

  5. Challenges in psychiatric education Reasoned statement for change: • Undergraduate curriculum in CEEdid 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.

  6. Objectivesof 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.

  7. Objectivesof 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.

  8. Desired features of a New Curriculum • Integrated • Problem oriented

  9. Structure of a New Curriculum

  10. Structure: anatomy, histology Function: biochemistry, physiology Medicine: examination tools Structure of a New Curriculum 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 At the end of CYCLE I, there are included at least one month lasting integrated conferences (discussions)

  11. Structure of a New Curriculum Structure: anatomy, histology Function: biochemistry, physiology Medicine: examination tools 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 At the end of CYCLE I, there are included at least one month lasting integrated conferences (discussions)

  12. Integrated curriculum Psychiatry CYCLE II (Principles of clinical medicine): 2nd & 3rdyear 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 Psychiatry Psychiatry 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 Psychiatry Psychiatry Psychiatry Psychiatry

  13. Teaching psychiatry 14 hours 3 hours 81 hours 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) 50 hours 40 hours

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

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

  16. Teaching psychiatry Psychiatry participates in or teaches: • State exam in neurobehavioural sciences (neurology, psychiatry, psychology) 148 hours seminars and practices 75 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.)

  17. 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

  18. New curriculum Cons: • Students have no comparison with the old one • Teachers often boycott it’s implementation • Acquired knowledge and skills are somewhat less voluminous than in traditional curriculum • The process of learning is jeopardizedby quantitative incentives to admit as many students as possible • Teachers are not skilled enough to implement PBL in full.

  19. Teaching medical students psychiatry in Central Europe Cyril Höschl • Not easy • Traditionally quite uniform • Needs changes following the development of MHC • Implemented in few pioneering schools only • Needs assessment • Needs investment Centre of Neuropsychiatric Studies, Psychiatric Centre Prague & Charles University, 3rd Medical Faculty, Prague European Psychiatric Association

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