Educators Explore Ways to Pique Interest in Psychiatry

There are a number of ways medical educators can ensure that medical students benefit from a compelling and thought-provoking psychiatry curriculum that will help them to excel in medicine, no matter what specialty they choose to enter.

This was one of the messages to medical educators who gathered at APA headquarters in late April for the APA President's Summit: Educating a New Generation of Physicians in Psychiatry.

The Association of Directors of Medical Student Education in Psychiatry cosponsored the meeting, which was attended by psychiatry clerkship and residency directors, deans of medical schools, and leaders of national accreditation and certification programs in psychiatry.

The summit, according to Deborah Hales, M.D., director of APA's Division of Education and Career Development, kicked off a two-year campaign that will culminate in a consensus statement about how best to teach psychiatry to medical students.

As part of the campaign, APA will promote discussion among medical educators in psychiatry and other specialties through a Web site on the education summit. The site includes information about the objectives of the summit and links to “stimulus papers” and presentations by guest speakers.

Psychiatry Not a Mystery to Students

One of the speakers was David Mallott, M.D., associate dean of medical education and an associate professor of psychiatry at the University of Maryland. He described the characteristics common to many of the men and women attending medical school today. They have traditionally been thought of as ambitious and perhaps competitive, but today that's even more true: many have been “on the rat race since kindergarten.”

For the most part, he continued, they are computer savvy and can absorb vast amounts of information, which is best delivered to them in a crisp, concise manner.

According to data from more than 11,000 first-year medical students gathered by the Association of American Medical Colleges (AAMC) between 2002 and 2004, three-quarters of medical students reported taking at least one psychology course as undergraduates “for personal reasons,” Mallott said.

“The idea that our students are chemistry wonks with no interest in what we have to offer” is incorrect, he remarked.

Mallott observed that “psychiatry is not a mystery to these kids.” Many medical students, he pointed out, have friends and family members who have been treated for such disorders as depression and attention-deficit/hyperactivity disorder.

Data from the AAMC survey show that many medical students majored in the sciences as undergraduates, so Mallott reasoned that it is unwise to spend a great deal of time in the first year “recreating material they have already learned.”

In the first two years of medical school, Mallott said, material related to psychiatry is best taught by psychiatrists. “The worst thing we can do is turn the material over to social workers and psychologists to teach,” he said, “not because they can't teach it, but if medical students don't see us as having ownership” in the teaching process, “they will never come back to us.”

Mallott presented additional data from the AAMC's 2004 Medical School Graduation Questionnaire suggesting that only 64 percent of medical students agree that psychiatry residents are effective teachers.

“My guess is that this response represents the fact that we use our least experienced trainees as models and teachers for our medical students—not, as most of the other specialties do, our chief residents,” who are more sure of themselves and serve as better models for students, he said.

Exploring the Unknown

In general, physicians working in other areas of medicine are more sure of the mechanisms of certain diseases and treatments than those in psychiatry, he said, which can actually work to the advantage of psychiatric educators.

“We have one terra incognita map left in medicine,” he said,“ and it's the brain.”

He suggested that psychiatry faculty “sell the uncertainty” that exists within psychiatry.

“We need to invite our students to come along on a ride into that uncertainty—to show them just how amazing the central nervous system is, how it behaves, and what happens when it goes wrong” regardless of whether they plan to specialize in psychiatry, said Mallott.

Psychiatry educators do not need to restrict teaching experiences to the curriculum. They can sponsor extracurricular activities or “special interest groups” offering students the chance to build clinical skills in psychiatry in a variety of settings, he said.

Focus on Common Mental Illnesses

Furthermore, he continued, medical educators should focus on teaching students about common psychiatric illnesses, such as depression, anxiety, and substance abuse disorders.

“These are the mental health problems that nonpsychiatrists encounter on a daily basis in their practices,” he noted. “Do our students really need to know the fine points that differentiate a patient with schizoaffective disorder from a sick bipolar patient?”

When faculty members assume that medical students who are not interested in specializing in psychiatry are not interested in the field of psychiatry, they are usually mistaken, Mallott said.

Medical educators should never view students as “heathens in need of conversion by psychiatric missionaries,” he cautioned.

The third and fourth years of medical school are opportune times to“ teach students who are interested in psychiatry but not in becoming psychiatrists,” Mallot said.

“Career choice is not about us getting shut out. Instead, it should be an opportunity for us to invite psychiatry into their future lives.”

More information about the summit is posted online at<www.psych.org/edu/med_students/summitnew.cfm>.▪