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
David Mallott, M.D.: "We have one terra incognita map left in
medicine, and it's the brain."
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
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
Attendees at APA's summit on medical education broke into song to
describe the changing needs of medical students with regard to psychiatric
education. From left are Anthony Rostain, M.D., Eugene Beresin, M.D., Stephen
Scheiber, M.D., and Lowell Tong, M.D.
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,
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,"
"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
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
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.
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.
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
More information about the summit is posted online at<www.psych.org/edu/med_students/summitnew.cfm>.▪