Psychiatry is a branch of medicine concerned with the biopsychosocial study, aetiology, assessment, diagnosis, intervention and prevention of mental, emotional and behavioural disorders, alone or coexisting with other medical or surgical disorders across the lifespan (Royal College of Physicians and Surgeons of Canada, 2009). The curriculum remains the cornerstone for shaping doctors’ experience and covering principles of undergraduate teaching. Psychiatric teaching courses provide students with the necessary knowledge base and skills, and help develop an appropriate attitude towards mental health (Dogra, Reference Dogra2009; Royal College of Psychiatrists, 2011).
Tomorrow's Doctors, by the UK General Medical Council, outlined outcomes and standards for undergraduate medical education in the UK. The standards cover the domains of patient safety, quality assurance, review and evaluation, quality, diversity and opportunity, student selection, curriculum design and development, and assessment (General Medical Council, 2009). Doctors need to learn assessment, diagnosis and management of common psychiatric conditions presenting to all health settings. Undergraduate psychiatric teaching gives future doctors the knowledge, skills and attitudes to be able to manage common mental health problems (Walton & Gelder, Reference Walton and Gelder1999).
International morbidity and the burden of mental illness on people, communities and nations are fully recognised and shape service planning in all countries (World Health Organization & Ministry of Health, 2009). The World Psychiatric Association and the World Federation for Medical Education have published guidelines for curriculum development (Tasman et al, Reference Tasman, Kay and Udomratn2009).
Medical education in Sudan started at the beginning of the 19th century (Ahmed, Reference Ahmed2012). However, there has been significant growth in the number of universities and medical schools currently providing undergraduate education (Ahmed, Reference Ahmed2012). Mental health services in Sudan faces challenges from stigma and lack of resources, affecting provision of care, training and education (Ali et al, Reference Ali, Saeed and Sultan2013). Psychiatric hospitals exist mainly in the capital Khartoum, where the majority of consultant psychiatrists work (O'Connor et al, Reference O'Connor, Loughlin and Sommers2012). Reports on recruitment in the psychiatric literature showed a need to focus on undergraduate psychiatric education, to improve knowledge and attitudes (Langley et al, Reference Langley, Lomas and Schofield2015) and to destigmatise psychiatry by using innovative teaching techniques and regular visits to psychiatric units.
The purpose of this paper is to study the current state of psychiatric teaching and curriculum in all universities in Sudan.
Method
Medical colleges currently registered with the Ministry of Higher Education in Sudan were identified. Psychiatrists involved in teaching were named and contacted. A cross-sectional survey model was used to interview all teaching staff, and data were collected. Interviews were conducted by the research team. Data were analysed using Excel.
Results
Of the 32 medical colleges identified, 18 were in Khartoum and 14 were in different states. Twenty were governmental institutions, while 12 were private. Half of the medical colleges opened during the past 15 years, with 30% opening in the past 10 years. Psychiatric departments with permanent teaching staff were available in 9 out of the 32 colleges.
A psychiatry curriculum was available in 17 medical colleges, while 22 used a block teaching system. Teaching of psychiatry was focused around the 4th and 5th academic years in 93% of the colleges. Psychiatry was taught as a separate subject in 22 colleges, while in 10 colleges it was taught as part of medicine. All colleges used lectures as the main method of teaching, although tutorials and seminars were also used by 44% of schools. Clinical teaching was used in 81% of colleges, while the remainder had no access to clinical teaching.
Of the colleges that used clinical teaching, 66% had access to in-patient facilities, and 50% had access to out-patient clinics only. Emergency teaching in psychiatry was limited, and electroconvulsive therapy training was offered in only six colleges (18.7%).
There are four psychiatric in-patient facilities in Khartoum that are regularly utilised for teaching (Tigani Almahi, Alidressi, Taha Baashar and the military unit). All 18 medical colleges in Khartoum use the same in-patient facilities for clinical teaching to a variable degree, including the private colleges. Colleges outside Khartoum have difficulty accessing in-patient facilities for clinical teaching locally.
A separate psychiatry examination is used as an assessment by 78% of the colleges, while in the remainder, assessment is done as part of the medicine examination. Assessment methods used include best answer questions (84%), problem-solving (72%), objective structured clinical examination (44%), oral examination (41%) and long clinical case examination (34%). Clinical examination in psychiatry is mandatory for passing the final assessment in 17 medical colleges.
Discussion
The expansion in higher education and opening of new governmental and private universities and colleges during the past two decades has led to an increased number of medical graduates with varying degrees of exposure to psychiatric teaching. The result shows a difference between older and newly opened medical schools in the presence of a psychiatric department and permanent staff. This could be owing to the shortage in qualified psychiatrists. However, there is a requirement that these newly opened medical schools should have a psychiatric curriculum and that teaching is provided.
New medical colleges seem to face difficulties organising clinical teaching, as most theoretical teaching is provided through contractual arrangements, but this is not the case for clinical teaching. Only nine medical colleges have psychiatric departments with permanent staff (40 psychiatrists).
No psychiatric curriculum was available in the majority of private medical colleges; instead, these seem to rely on available psychiatrists. We argue that the availability of a psychiatric curriculum is paramount to delivery of undergraduate psychiatry, and that it should become a requirement for colleges applying for registration. The teaching and assessment processes need regular monitoring by the General Medical Council (Ring et al, Reference Ring, Mumford and Katona1999).
The expansion in undergraduate medical education has been welcomed, owing to a continuous out-of-country migration of doctors; however, the quality of undergraduate teaching may have been compromised.
We did not assess the influence of gained knowledge and skills on provision of mental health services.
Conclusion
Medical education in Sudan has grown vastly with the establishment of new governmental and private medical colleges. However, psychiatric undergraduate teaching and curricula need further development.
There is gap in the availability of curricula, psychiatric departments and resources, especially in the newly opened medical colleges. There is a need to raise the profile of psychiatric teaching and to reform undergraduate psychiatric teaching using a unified approach to psychiatric teaching and assessments.
Future psychiatric teaching and curriculum development should reflect the needs of future doctors.
Recommendations
• Development of psychiatry departments to lead and implement the changes in undergraduate psychiatric teaching
• A new undergraduate psychiatric curriculum that meets the knowledge, experience and attitude needs of contemporary psychiatry and future doctors
• Improved availability of resources, including teaching staff, for undergraduate psychiatric teaching
• A collaborative approach to medical undergraduate education in Sudan
• A model curriculum to be shared with all medical colleges
Open access
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