Delivering undergraduate teaching

Teaching psychiatry to medical undergraduates is a responsibility that is shared between many psychiatrists. Some psychiatrists have job titles such as ‘clinical teaching fellow’ or ‘lecturer’, which make it clear that teaching medical undergraduates is one of their responsibilities. However, most practising psychiatrists, such as specialty registrars (CT1–ST6) and consultants, have job titles that do not explicitly indicate that they are medical teachers. The diverse range of psychiatrist job titles and employers may incorrectly imply that only some psychiatrists are responsible for teaching and others are solely involved in clinical work or research.

Psychiatrists who are in formal teaching jobs, such as lecturers, have special responsibilities for teaching and additional teaching duties. However, practising psychiatrists are not exempt from teaching duties if medical undergraduates are attached to their clinical team. Box 1 highlights the educational obligations of all doctors.

Delineation of teaching responsibilities

A wide range of psychiatrists and other professionals teach medical undergraduates. It is therefore important to ensure that there is a clear delineation of teaching responsibilities to prevent overlap and duplication, which waste time and may prevent full delivery of the undergraduate syllabus. An obvious issue is to define reasonable limits and avoid unnecessary duplication when subjects overlap (Reference SeftonSefton 2005). In teaching psychiatry to undergraduates, psychiatrists must recognise that there is considerable overlap with other disciplines. Teaching on neurochemicals and neuroreceptors, for example, may already have been delivered by physiologists before the medical undergraduates begin their psychiatry rotations. Individuals teaching psychiatry should therefore check to ensure that duplicate teaching is avoided.

Lecturers, teaching fellows, tutors and other formal teaching staff affiliated to the medical school often deliver didactic lectures, help organise teaching and arrange summative examinations. Teaching in clinical settings is delivered by psychiatric clinicians on the ground. In some parts of the UK, NHS clinicians take on formal teaching duties and deliver most of the teaching.

Box 2 outlines the division of teaching responsibilities in the UK between practising clinicians and medical school staff. It highlights the teaching responsibilities that all psychiatric clinicians have and also the additional teaching responsibilities of formal teaching staff affiliated to the medical school. This delineation of teaching duties is explored further in the next section, which describes the various teaching roles of psychiatrists.

Teaching principles

Delivery of good clinical teaching is underpinned by sound principles and approaches. This section aims to explore a number of teaching principles and approaches that have been found to be effective by research (Reference IrbyIrby 1994; Reference Kernan, Lee and StoneKernan 2000).

The following teaching principles, outlined by Reference IrbyIrby (1994) and Kerman et al(2000), have been recommended by the American Psychiatric Association (2002) in their practical guide to teaching for psychiatric residents.

1. • Actively involve students, asking many questions

2. • Challenge students to reason with clinical information and explain their choices Students need to have the opportunity to assimilate pertinent clinical information, arrive at a differential diagnosis and explore possible alternatives.

3. • Capture attention and have fun Teachers who make the material come alive help students to remember cases and teaching points. Specific ideas include role-playing (a resident can play the part of a patient with a particular symptom, complaint or mental status finding) or playing games (e.g. some services use a game-quiz format to ask students and more junior residents about specific topics).

4. • Connect the case to broader concepts Help students to generalise from a case or problem. For example, if a patient presents with suicidal ideation, discuss the epidemiology of and risk factors for suicide, ways of asking about suicidal thoughts and intent, and/or broaden the topic by including the relationship between depressive symptomatology, severity and suicide.

5. • Teach by modelling patient interactions Demonstrate interviewing techniques for students and observe students’ interviews and physical examinations.

6. • Meet individual learners’ needs Ask students ‘What would you like to learn on this rotation?’ and ‘What kinds of issues or topics in psychiatry specifically interest you?’ and address these. Be aware that different people have different learning styles.

7. • Support learners’ autonomy and show respect Supporting autonomy means working from the student's perspective to promote their active engagement.

8. • Be practical, relevant, selective and realistic Think about what students (most of whom will not become psychiatrists) really need to take away from their psychiatry clerkship. It is usually wise to avoid bombarding students with esoteric bits of knowledge. Have students research specific issues related to interesting cases in which they are involved. Use gaps in team members’ knowledge as opportunities for medical students to do a literature search and present a 5- to 10-minute talk.

9. • Provide feedback and evaluation This is an obvious, but often inadequately realised, aspect of teaching. In general, students benefit from prompt, specific and direct feedback.

A useful five-step approach to clinical teaching (Reference Neher, Gordon and MeyerNeher 1992) has also been recommended by the American Psychiatric Association:

1. 1 Get a commitment from the student Ask the student for their interpretation of the case or data.

2. 2 Probe for supporting evidence This allows further refinement of your appraisal of how the learner is approaching clinical problems or material. Questions might include: ‘What leads you to think that?’ or ‘What is your differential diagnosis?’

3. 3 Encourage discussion.

4. 4 Reinforce what was right Praise the learner for specific actions and responses.

5. 5 Correct a mistake or teach a general rule If there are mistakes to be corrected, choose one and focus on it. Often you can gently correct mistakes by teaching a general rule.

In the delivery of teaching, psychiatrists should consider applying these approaches and principles. UK psychiatrists must be especially mindful of the need to tailor teaching to suit the needs of medical undergraduates in the UK. These teaching approaches and principles are broadly applicable to all medical undergraduates, but common sense needs to prevail in applying them in the UK. Teaching that is not focused on the needs of the learner is less likely to be effective (National Student Forum 2009).

Delivering tomorrow's doctors

The ultimate goal of delivering teaching to medical undergraduates is to produce doctors of tomorrow who will have the appropriate knowledge, skills and attitudes to serve the public. In the delivery of teaching to medical undergraduates, psychiatrists must be mindful of the goals and recommendations of the General Medical Council (GMC).

The changes in medical education that the GMC recommends (General Medical Council 1993) include reducing the burden of factual information imposed on medical students, encouragement of learning through curiosity and use of a wide range of technological resources (Box 4).

Burdening students with large amounts of information in lectures is no longer thought to be a good way of delivering teaching to undergraduates. New learning approaches such as problem-based learning in small groups are deemed to be effective (Reference NewmanNewman 2003) and should be used in conjunction with the appropriate support of technological resources (General Medical Council 1993).

Rather than imparting knowledge directly to medical students, psychiatrists should encourage self-learning and provide support and guidance to help medical undergraduates achieve their learning objectives.

Encouraging students to adopt a deep learning style where they learn because they believe that the learning is relevant and useful can assist the learning process (Oxford Centre for Staff Development 1992). Surface learning that is motivated solely by a desire to complete a course should be discouraged (Reference Entwistle, Thompson and TaitEntwistle 1992). In this regard, the onus is on the psychiatrist to motivate students and demonstrate to them the relevance of psychiatry to their future clinical practice.

In shaping the doctors of the future, psychiatrists must not only take into account new methods of teaching delivery. They must also be mindful of the competencies that medical undergraduates must attain to enable them to be competent doctors. These competencies or expected outcomes that medical undergraduates must attain before graduation have been set out by the GMC in the latest revision of Tomorrow's Doctors (General Medical Council 2009) and are laid out in Box 5.

These competencies or expected outcomes raise the question of what psychiatrists should teach medical undergraduates to ensure that they will graduate with the appropriate knowledge, skills and attitudes.