[Training in iterative hypothesis testing as part of psychiatric education. A randomized study]

BACKGROUND

The improvement of medical education is at the center of efforts to reform the studies of medicine. Furthermore, an excellent teaching program for students is a quality feature of medical universities. Besides teaching of disease-specific contents, the acquisition of interpersonal and decision-making skills is important. However, the cognitive style of senior physicians leading to a diagnosis cannot easily be taught. Therefore, the following study aimed at examining whether specific training in iterative hypothesis testing (IHT) may improve the correctness of the diagnostic process.

MATERIALS AND METHODS

Seventy-one medical students in their 9th-11th terms were randomized to medical teaching as usual or to IHT training for 4 weeks. The intervention group received specific training according to the method of IHT. All students were examined by a multiple choice (MC) exam and additionally by simulated patients (SP). The SPs were instructed to represent either a patient with depression and comorbid anxiety and substance use disorder (SP1) or to represent a patient with depression, obsessive-compulsive disorder and acute suicidal tendencies (SP2).

RESULTS

All students identified the diagnosis of major depression in the SPs, but IHT-trained students recognized more diagnostic criteria. Furthermore, IHT-trained students recognized acute suicide tendencies in SP2 more often and identified more comorbid psychiatric disorders. The results of the MC exam were comparable in both groups. An analysis of the satisfaction with the different training programs revealed that the IHT training received a better appraisal.

CONCLUSIONS

Our results point to the role of IHT in teaching diagnostic skills. However, the results of the MC exam were not influenced by IHT training. Furthermore, our results show that students are in need of training in practical clinical skills.

A randomized study of iterative hypothesis testing in undergraduate psychiatric education

OBJECTIVE

Iterative hypothesis testing (IHT) or related strategies of diagnostic decision making have been taught in many curricula for medical students but not in psychiatry. We therefore asked whether the addition of training in IHT may add to the quality of the psychiatry course.

METHOD

Seventy-two medical students were randomized to four weeks problem-based learning or to IHT. Knowledge and skills of the students were tested using a multiple choice exam and simulated patients.

RESULTS

Iterative hypothesis testing-trained students recognized more diagnostic items and more often identified comorbid psychiatric disorders and acute suicidal tendencies. Acquisition of general psychiatric knowledge and global satisfaction with the course were similar in both groups.

CONCLUSION

We conclude that teaching IHT to medical students may enhance their clinical ability to recognize complex disease patterns. Further studies are required concerning the enhancement of clinical skills in the psychiatric specialty.

[Psychotherapy in chronic depression]

Patients with chronic depression constitute a problem group because of therapy resistance, symptom severity, and impaired psychosocial functioning. Compared with healthy groups, they show increased comorbidity with psychological and medical disorders, report more adverse conditions in childhood, show problematic interpersonal behaviors, and differ in structural characteristics of their thought processes. For these reasons, several specific treatment manuals have been developed for this target population. First results suggest that specific psychotherapy may be effective in chronic depression.

[Anxious (avoidant) personality disorder]

The anxious (avoidant or fearful) type of personality disorder has a lifetime prevalence of 5%, which makes it the most common form of personality disorder. Although it is one of the leading risk factors for severe depressive illnesses, anxiety disorders, substance dependence, eating disorders and chronic pain, its importance is frequently underestimated. Ambulatory treatment comprises psychoeducation, self-management and training in social competence.

[Borderline personality disorder]

Characteristics of a borderline personality disorder include emotional instability and a self-threatening lack of impulsive control. As a result, interpersonal relationships are rendered difficult. The central elements of treatment are psychoeducation, self-management, improved stress tolerance and awareness, emotion managment and training in social competence.