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Assessing Outpatient Teaching In The Clerkship

Linda F. Pessar, M.D.

Eric County Medical Center

Buffalo, New York

As the practice of psychiatry has largely moved from in-patient to out-patient settings, and the educational needs of medical students require knowledge of psychiatric disorders rarely seen on in-patient services, there has been interest in expanding out-patient experiences during the psychiatry clerkship. 

Despite this interest, there is no recently published survey of psychiatry departments to ascertain how much out-patient teaching is available for clerks, what settings have been used, and which experiences have proven successful. 

This Special Interest Group will meet to plan a strategy to evaluate out-patient teaching in the psychiatry clerkship, and make recommendations for expanding this experience.  Future activities of this group may include conducting a national survey about present ambulatory teaching in psychiatry, organizing a multi-institutional collaborative project to develop and evaluate out-patient teaching sites, and creating a model curriculum for outpatient psychiatry.

Cultural Competence in Psychiatric Education:

Moving from Plans to Action

James W. Thompson, M.D., M.P.H.

Melvyn Haas, M.D.

Francis Lu, M.D.

In April, 1999, CMHS and APA sponsored a "mini-think tank" on cultural competence in psychiatric education.  The meeting was small, but widely representative in terms of race and ethnicity, organizational relationships and roles (medical students, residents, faculty, residency training directors, etc.).  The purpose of the meeting was to discuss how to move to the next level with regard to cultural competence in medical student and resident education in psychiatry.  The group came up with many recommendations and suggestions for action, and also identified individuals and organizations which might take the lead in implementing the action items.  In the proposed ADMSEP workshop, Dr. Haas will note the importance of this area to the government, and Dr. Lu will give an overview of necessary definitions and work to date in cultural competence.  Dr. Thompson will then lead the group through the portions of the report dealing with recommendations for medical student education.  Those assembled will act as a "focus group" to give feedback on the recommendations, and provide suggestions for practical actions which might be taken to effect real change in this area. 

RECENT RESEARCH FINDINGS IN MEDICAL EDUCATION

Thomas Mackenzie, M.D., Chair

University of Minnesota Medical School

Minneapolis, Minnesota

Recruitment:  Why Not Psychiatry?

Janis Cutler, M.D.

New York State Psychiatric Institute

Columbia University

New York, New York

Educational goals and objectives:

To describe how medical school curricula, as well as personal background and experiences, seem to play a role in medical students’ choice of a career, specifically focusing on the answer to the question “why not psychiatry?” 

Narrative description:

Semi-structured interviews were conducted exploring medical students’ perceptions of the field of psychiatry as a possible career and their decision-making process with regard to choosing a residency.  These interviews were developed as a follow-up to a study in which self-report surveys were collected rating the significance of issues that influenced students toward or away from psychiatry as a career choice (presented at ADMSEP in 1997).  Response to the surveys suggested that many students viewed psychiatry as a stressful field that they would not find satisfying. 

 Fifty-nine students were interviewed between 1996 and 1998.  Some generalizations can be extracted from the interviews.  For example, students who felt that psychiatry would be “too stressful” based this impression on their emotional reactions during their psychiatry clerkships, and students who were concerned that they would not find psychiatry satisfying described impatience with long-term therapeutic goals and a desire for the immediate gratification of surgical fields.   

In some respects, the interviews defy summarization.  Not surprisingly, each student had his or her own individual story to tell.  Students described similar experiences, such as personal psychotherapy or a close relationship with a mentally ill relative, impacting on their view of psychiatry in a wide variety of ways. 

Overall, students seemed to have a fairly accurate view of the field and of the advantages and disadvantages that it offers as a career.   Very few interviews left the impression that a particular student had made a mistake in deciding against psychiatry.  On the contrary, in describing their career decisions, students appeared to have chosen the field for which they were best suited.   

Audience participation will be encouraged, particularly with regard to the possible impact of these findings on efforts to enhance recruitment.

 Assessing Depressed Mood in Medical Students: What Went Wrong?

Ruth E. Levine M.D., Stephen Bryant Pharm D, Steven Lieberman M.D.,

James Hokanson, Ph.D., and Gwendie Camp Ph.D.

The University of Texas Medical Branch

 Galveston, Texas

Educational Goals:

1)         To sensitize the audience to the issue of depression among medical students

2)         To share our experience with the difficulty of assessing depression in medical students.

3)         To provide a forum for discussion of the topic of methodological issues in performing behavioral science research on medical students. 

Several studies have noted high rates of depression in medical students compared to the general population. Clark and Zedlow (1), using the Beck Depression Inventory (BDI) reported that at least 12% of medical students reported significant symptoms of depression at every measuring point during their first three years compared to a rate of 3-4% for the general population (2). Using clinical interviews, Zoccolillo et al (3) reported a 12% prevalence of major depression during the first two years of medical school. Camp et al (4), using the Zung self rating depression scale, demonstrated scores associated with mild to moderate depression in  20% of students in a traditional curriculum compared to 10% of students in a problem based curriculum.

 In 1998 we began a research project titled “A comparison of depressed mood in medical students from a traditional, a hybrid, and a problem based curriculum.”  We began to administer the BDI along with a number of other measures which had been administered to classes of medical students to compare the impact of the Interactive Learning Tract (ILT) , a Problem Based Curriculum, with the traditional curriculum at the University of Texas Medical Branch in Galveston. These measures are administered upon matriculation, at the end of year 1, the end of year 2, and during year 4. Our hypothesis was that rates of depression might be lower in a problem based or hybrid curriculum compared to the traditional curriculum. Since the school underwent curriculum reform in 1998, we had the opportunity to compare large classes in different curricula.  

After our first administration of the BDI to the class of 2001 at the end of their first year, we noted a lower than expected rate of abnormal scores. Only 2-3% of students scored in the range of 14 or higher, in contrast to clinically significant scores of 12-25% in the Clark study in which the BDI was administered at similar intervals. We hypothesized that the students might have underreported for fear that their scores would be reported to the Dean of Student Affairs, as was outlined in a consent form they had been asked to sign prior to filling out the BDI. Modification of the consent form did not change the low rate of significant scores. We therefore convened focus groups to ask the students their opinions about the study, to ask students if any of them believe scores had been underreported, and the reasons they might hypothesize for why this had happened. In our presentation, we will summarize published data (both positive and negative) regarding medical student depression, describe our BDI data, and report the results of the focus groups. We will then open the floor for discussion of the issue of difficulty in performing behavioral science research on medical students.

1.       Clark DC, Zedlow PB: Vicissitudes of depressed mood during four years of medical school. JAMA 260 (1988): 2521-2528.

2.       Barrett J, Hurst MW, DiScala C, Rose RM: Prevalence of Depression over a 12-month Period in a Nonpatient Population. Arch Gen Psychiatry 35(1978): 741-744

3.       Zoccolillo M, Murphy GE, Wetzel RD: Depression among Medical Students. J Affective Disorders 11(1986):91-96

4.        Camp DL, Hollingsworth ME, Zaccaro J, Cariaga-Lo LD, Richards B: Does a Problem Based Learning Curriculum Affect Depression in Medical Students? Academic Medicine October Supplement, (1994)69;10:25-27.

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