Undergraduate teaching of child and adolescent psychiatry in Australia: survey of current practice

The impact of facilitators and rural immersion on medical student engagement during a child and adolescent mental health videoconference workshop

OBJECTIVE

Child and adolescent mental health (CAMH) disorders are a major public health problem in Australia, especially outside metropolitan areas. The issue is compounded by a shortage of child and adolescent psychiatrists (CAPs). CAMH receives minimal coverage in health professional training, training opportunities are scarce, and support for generalist health professionals, who treat most cases, is lacking. Novel approaches to early medical education and teaching are required to strengthen the available skilled workforce in rural and remote settings.

METHOD

This qualitative study explored the factors influencing medical student engagement in a CAMH videoconferencing workshop as part of the Rural Clinical School of WA.

RESULTS

Our results confirm the priority of personal characteristics of medical educators, over clinical and subject matter expertise, on student learning. This research affirms that general practitioners are well-placed to facilitate recognition of learning experiences, especially given that students may not readily recognise exposure to CAMH cases.

CONCLUSION

Our findings support the effectiveness, efficiencies, and benefits of utilising general medical educators in supporting child and adolescent psychiatry expertise in delivering subspecialty training within medical school curricula.

Experiences of French medical students during their clerkship in adolescent psychiatry: a qualitative study

The epidemiology of adolescent psychiatric disorders and the relational complexity of their management make exposure to adolescent psychiatry essential during medical school. However, some clinical particularities can complicate the students' learning experiences. Our work aimed to explore the experience of being a medical student during clerkships in adolescent psychiatry. Following the Interpretative Phenomenological Analysis qualitative approach, 20 semi-structured face-to-face interviews were conducted with medical students at the end of their clerkship in adolescent psychiatry. Three super-ordered themes emerged to describe their experience: in-depth self-exploration calling on emotions, thoughts and experiences; changes in the view of adolescent mental health; better understanding of the role and meaning of adolescent psychiatric care and how to approach it. Identification between students and patients could result from time-related factors (the end of adolescent brain remodeling, long, demanding studies, and financial and material dependence). In addition, the predominant use of non-analytical clinical reasoning processes-less valued in the rest of the graduate curriculum-poses a challenge for students. Indeed, for a student to find his or her place in adolescent psychiatry requires the student to reinvent him or herself, because the codes are different (no gown, less well-defined tasks, etc.). Finally, the excess prevalence of mental disorders among medical students requires increased vigilance on the part of tutors. For all these reasons, close, attentive tutoring seems essential to support students, while these clerkships afford a real opportunity for students to broaden their interpersonal skills.

Child and adolescent psychiatry training in Australia and New Zealand

The specialty of Child and Adolescent Psychiatry was formally recognised in the 1930s. The Faculty of Child and Adolescent Psychiatry was established in 1964 in Australia, as a subspecialty in The Royal Australian and New Zealand College of Psychiatrists (RANZCP). The aim of the current article is first to provide a brief summary and overview of the current status of Child and Adolescent Psychiatry (CAP), followed by an outline of the requirements of the Training Program for CAP in Australia and New Zealand. The training required to become a fully qualified child and adolescent psychiatrist in Australia and New Zealand consists of different stages and takes the form of competency-based training. Information relating to assessment types, supervision and research requirements is also described. Accreditation procedures for the training program are stipulated by RANZCP to monitor standards and to ensure consistency within the programs delivered across Australia and New Zealand. Employment opportunities for trainees upon completion of the program are discussed. In summary, this article highlights the requirements of the training programs for CAP in Australia and New Zealand.

Teaching undergraduate medical students Child and Adolescent Psychiatry (CAP): a Delphi study on curriculum content

BACKGROUND

The prevalence of psychiatric disorders in children and young people is high but despite this, many doctors have difficulty identifying and managing psychiatric disorders presenting in this age group. The purpose of this study was to determine appropriate curriculum content in Child and Adolescent Psychiatry (CAP) for a Graduate Entry Medicine (GEM) course. Doctors with a background in primary care who were also involved in undergraduate teaching rated how necessary they considered a number of knowledge, skills and attitudes items were for inclusion in the CAP curriculum.

METHODS

An online questionnaire study was carried out using modified Delphi methodology in two rounds. The questionnaire was derived from a list of CAP learning objectives and/or curricular content obtained from a thorough review of the literature. 23 of the 24 doctors who had agreed to participate went on to complete the round one questionnaire (95.8% response rate) with 19 also completing round 2 (82.6%). Where there was high agreement (70% or more) amongst participants, items were considered as having sufficient consensus to either accept or reject them. Mean scores were then used as a way to prioritise items.

RESULTS

At the end of round two, there was consensus to consider including 26 of the 34 knowledge items, 16 of the 20 skills items and three of the four attitudes items in the CAP curriculum. The most highly rated knowledge, skills and attitudes items were depression/ suicide; communicating with children, young people and families; and rapport building. The majority (83.3%) of round two responders, considered that the current amount of CAP teaching time was "too little".

CONCLUSIONS

Delphi methodology proved useful for determining consensus and the priority rankings of the CAP knowledge, skills and attitudes items can now be used to help educators determine which topics to focus upon. The study findings support the need for additional CAP teaching time in the GEM curriculum and will help to shape new CAP content. Additional formal CAP teaching time has already been incorporated into the psychiatry speciality attachment, a new clinical skills session has been developed and CAP topics have been introduced into written and clinical examinations.

The status of radiation oncology teaching in Australian and New Zealand medical schools

INTRODUCTION

Radiation therapy is a core component of curative and palliative cancer treatment; however, its indications and benefits remain poorly understood across the medical profession.

METHODS

An electronic survey focussing on curriculum content, teaching and assessment in radiation oncology and plans for curriculum change was developed. The Faculty of Radiation Oncology, Royal Australian and New Zealand College of Radiology (RANZCR) distributed the survey to all 24 Australian and New Zealand medical schools. The survey was conducted from November 2017 to January 2018 following ethics approval.

RESULTS

Sixteen of the 24 (67%) medical Faculties in Australia and New Zealand responded. Ninety-four percent of Faculties had no formal radiation oncology curriculum. Most Faculties (87%) dedicated <15% of the total medical course to oncology, of which the majority (63%) dedicated <10% to radiation oncology. At least 50% of Faculties did not offer formal radiation oncology teaching to all students. When offered, students' exposure to radiation oncology was often <5 days over the entire course (44%). The majority of medical schools (73%) are planning curriculum changes in the next 5 years; however, most have no intention of changing radiation oncology teaching.

CONCLUSION

Radiation oncology continues to be underrepresented in medical curricula throughout Australia and New Zealand with no plans for improvement by Faculties. This study supports the need for formal advocacy for improving radiation oncology education in medical schools and will form the basis of new national recommendations for radiation oncology curriculum development.

Child and adolescent psychiatry: which knowledge and skills do primary care physicians need to have? A survey in general practitioners and paediatricians

Primary care physicians (PCPs) play a key role in the initial assessment and management of children and adolescents with mental health problems. However, it is unclear whether current medical education curricula sufficiently equip PCPs for this task. The aim of this study was to investigate, which child and adolescent psychiatry (CAP)-related skills and knowledge PCPs say they require in their daily practice. A questionnaire was generated, employing a modified two-step Delphi approach. Besides socio-demographic items, the questionnaire contained 17 CAP-related knowledge items and 13 CAP-related skills items, which had to be rated by importance in daily practice. The questionnaire was distributed to 348 office-based paediatricians and 500 general practitioners (GPs) in Germany. The overall return rate was 51.3% (435/848). Regarding CAP-related knowledge, both paediatricians and GPs rated somatoform disorders and obesity as highly important for daily practice. Moreover, paediatricians also deemed regulatory disorders during infancy (e.g. crying, sleep disorders) as important, while GPs assessed knowledge on paediatric depression as relevant. For paediatricians and GPs, the most relevant CAP-related skills were communicating with children and adolescents and their parents. Additionally, paediatricians rated differentiating between non-pathologic and clinically relevant behaviour problems very relevant, while GPs considered basic psychotherapeutic skills essential. The CAP-related knowledge and skills perceived relevant for doctors in primary care differ from the majority of current medical school CAP curricula, which cover mainly typical, epitomic CAP disorders and are predominantly knowledge-oriented. Therefore, medical education in CAP should be amended to reflect the needs of PCPs to improve healthcare for children and adolescents with mental health problems.

Child and Adolescent Psychiatry Training: A Global Perspective

Training programs aim to produce child and adolescent psychiatry professionals who are competent at both clinical work as well as health promotion through teaching and research. Child psychiatry training programs not only offer training in teaching the clinical skills of the discipline of child and adolescent psychiatry but also strive to help with the development of professionalism, ethical behaviors, and leadership skills in their trainees. Ultimately, it is the children of the world who stand to gain by having a skilled work force that adheres to the highest global standards when it comes to the provision of mental health services.

Clinical placements in mental health: a literature review

Gaining experience in clinical mental health settings is central to the education of health practitioners. To facilitate the ongoing development of knowledge and practice in this area, we performed a review of the literature on clinical placements in mental health settings. Searches in Academic Search Complete, CINAHL, Medline and PsycINFO databases returned 244 records, of which 36 met the selection criteria for this review. Five additional papers were obtained through scanning the reference lists of those papers included from the initial search. The evidence suggests that clinical placements may have multiple benefits (e.g. improving students' skills, knowledge, attitudes towards people with mental health issues and confidence, as well as reducing their fears and anxieties about working in mental health). The location and structure of placements may affect outcomes, with mental health placements in non-mental health settings appearing to have minimal impact on key outcomes. The availability of clinical placements in mental health settings varies considerably among education providers, with some students completing their training without undertaking such structured clinical experiences. Students have generally reported that their placements in mental health settings have been positive and valuable experiences, but have raised concerns about the amount of support they received from education providers and healthcare staff. Several strategies have been shown to enhance clinical placement experiences (e.g. providing students with adequate preparation in the classroom, implementing learning contracts and providing clinical supervision). Educators and healthcare staff need to work together for the betterment of student learning and the healthcare professions.

[What do medical students expect of lectures in child and adolescent psychiatry?]

OBJECTIVE

In child and adolescent psychiatry (CAP) lectures are the most common teaching format for medical students. Besides conveying basic knowledge and skills related to the medical management of children and adolescents with mental health problems, lectures also play a decisive role in the recruitment of future residents for this discipline. Thus, knowledge of the expectations of medical students of lectures is a crucial factor.

METHOD

1,029 medical students at ten German medical schools were surveyed with a questionnaire in a cross-sectional design.

RESULTS

Items perceived as most important were knowledge of disorders (73 %), medical skills in handling children and adolescents (61 %), and differential diagnosis of normal and abnormal child behaviour in children and adolescents (59 %). 71 % set a high value on patient presentation, while 41 % expressed ethical concerns about presenting mentally ill minors in lectures.

CONCLUSIONS

The expectations of medical students toward CAP lectures are mainly related to the transfer of specialty-related knowledge and generic skills. The important area of teaching attitudes could best be covered via patient presentations, which are desired by most students. However, ethical concerns over patient presentation also need to be discussed with students.

Teaching child and adolescent psychiatry to undergraduate medical students - A survey in German-speaking countries

OBJECTIVE

To conduct a survey about teaching child and adolescent psychiatry to undergraduate medical students in German-speaking countries.

METHODS

A questionnaire was sent to the 33 academic departments of child and adolescent psychiatry in Germany, Austria, and the German-speaking part of Switzerland.

RESULTS

All departments responded. For teaching knowledge, the methods most commonly reported were lectures and case presentations. The most important skills to be taught were thought to be how to assess psychopathology in children and how to assess families. For elective courses, the departments reported using a wide range of teaching methods, many with active involvement of the students. An average of 34 hours per semester is currently allocated by the departments for teaching child and adolescent psychiatry to medical students. Required courses are often taught in cooperation with adult psychiatry and pediatrics. Achievement of educational objectives is usually assessed with written exams or multiple-choice tests. Only a minority of the departments test the achievement of skills.

CONCLUSIONS

Two ways of improving education in child and adolescent psychiatry are the introduction of elective courses for students interested in the field and participation of child and adolescent psychiatrists in required courses and in longitudinal courses so as to reach all students. Cooperation within and across medical schools can enable departments of child and adolescent psychiatry, despite limited resources, to become more visible and this specialty to become more attractive to medical students. Compared to the findings in earlier surveys, this survey indicates a trend towards increased involvement of academic departments of child and adolescent psychiatry in training medical students.

[What do medical students learn in the elective course in Child and Adolescent Psychiatry?]

OBJECTIVE

A course in child and adolescent psychiatry and psychotherapy is optional for medical students within the Medical Curriculum Munich (MeCuMLMU). Aims of the course are to give insight into the specialty of child and adolescent psychiatry and to help students acquire basic skills. The focus is on psychopathology and on communication skills.

METHOD

A course comprising 23 teaching units and limited to twelve students is taught over four days within one week twice per semester. Child and Adolescent Psychiatry is introduced by means of case presentations of children in different age groups, each with externalizing, and internalizing disorders and with developmental delay, and by a clinical round in the teaching hospital affiliated to the University. Case examples of children are presented by video. In group discussions guided by a teacher students learn to formulate a psychopathological status. Role-plays derived from the clinical examples and video-based feed-back provides students with the opportunity to improve their communication skills.

RESULTS

The course is evaluated by means of a written examination, in which a psychopathological status must be written down independently. Students and teachers evaluate the seminar in a structured way. Videotapes of the role-plays are analyzed by the teachers after the course. In a sub-sample, a follow-up evaluation was carried out six months later.

CONCLUSIONS

The seminar offers an excellent opportunity to introduce medical students to child and adolescent psychiatry and to recruit and inspire a future generation of child and adolescent psychiatrists.

Current teaching of paediatric musculoskeletal medicine within UK medical schools--a need for change

OBJECTIVES

Doctors involved in the assessment of children have low confidence in their clinical skills within paediatric musculoskeletal (pMSK) medicine and demonstrate poor performance in clinical practice. Core paediatric clinical skills are taught within undergraduate child health teaching but the extent and content of pMSK clinical skills teaching within medical schools is currently unknown. The aim of this study was to describe current pMSK teaching content within child health teaching at UK medical schools.

METHODS

Structured questionnaires were sent to child health leads at all medical schools within the UK delivering clinical teaching (n = 30).

RESULTS

Child health teaching was delivered in all responding medical schools (n = 23/30) predominantly by paediatricians (consultants and senior trainees) and within secondary care. pMSK clinical skills teaching was included in 9/23, delivered predominantly within lectures and featured uncommonly in assessment (6/23, 26%). pMSK clinical skills were reported as being less well taught than other bodily systems, although the majority ranked pMSK to be of equal importance, with the exception of development.

CONCLUSIONS

pMSK clinical skills medicine is not part of core teaching within child health in the majority of UK medical schools. There is a need to understand the barriers to effective pMSK clinical skills teaching, to achieve consensus on what should be taught and develop resources to facilitate teaching at undergraduate level.

Child psychiatry curricula in undergraduate medical education

OBJECTIVE

To review the literature describing the content and time allocated to undergraduate medical education curricula in child and adolescent psychiatry and make recommendations about child and adolescent psychiatry teaching goals and curricula content.

METHOD

A literature search from 1970 to February 2007 using the key words undergraduate, curriculum, teaching, education, psychiatry, child, adolescent, and medical school, was conducted using PubMed, PsycINFO, and Web of Science.

RESULTS

There is limited agreement about curricula content for undergraduate child and adolescent psychiatry teaching programs in medical schools, with a wide range of objectives identified by different programs. On average, the time allowed for teaching child and adolescent psychiatry is small. There is also great variation in the time allocated by different medical schools. In many countries, the number of child and adolescent psychiatrists with academic appointments is limited, and child and adolescent psychiatry programs are developed and taught by a small number of teaching staff at each medical school.

CONCLUSIONS

Medical schools should reconsider the relatively low priority given to teaching child and adolescent psychiatry to medical students. The child and adolescent psychiatry profession must identify clear learning goals for a longitudinal developmentally appropriate model of child and adolescent psychiatry education commencing at an undergraduate level in medical schools and continuing through residency and fellowships. There is a need to promote national and international standards for teaching in this area and to encourage stronger collaborations between teaching staff across different medical schools.