Characteristics of undergraduate training in psychiatry

Undergraduate psychiatric training greatly varies across different countries and university sites. Some medical schools include psychiatry programmes as optional, and others have only 2 weeks of mandatory formal training in psychiatry.^{Reference Ng, Chan, Shields, Pinto da Costa and Okpaku8} A recent survey promoted by the International Federation of Medical Students’ Associations (IFMSA) in collaboration with the WPA noted that psychiatry education is mandatory in 81 out of the 83 surveyed countries, and is an elective course only in two countries (Ethiopia and Nigeria).^{Reference Pinto da Costa, Dima and Ng9} Furthermore, the duration of classes on theory significantly varies across countries (e.g. from just 1 day to more than 30 days); Nigeria and Burkina Faso do not have any practical classes at all. Even in Western countries, some medical schools offer only 4 weeks of training in psychiatry.^{Reference Pinto da Costa, Dima and Ng9} Undergraduate psychiatric training in the USA is longer than it is in Asian and Pacific regions. Methods for evaluating students’ knowledge and competencies also vary among countries, although the most common way of assessing it is multiple choice questions. The format of teaching does not significantly vary, with most medical schools offering a combination of lectures, bedside teaching and computer-based learning.^{Reference Ng, Chan, Shields, Pinto da Costa and Okpaku8} Overall, the survey conducted by IFMSA shows that undergraduate psychiatric education is not given enough prominence in undergraduate medical curricula.

Unmet needs and the way forward for undergraduate training in psychiatry

A number of unmet needs in undergraduate psychiatric education have recently been highlighted in the literature. In particular, the limited availability of tutors, highly trained faculty members and clinicians at several sites is adversely affecting the quality of provided and perceived undergraduate training.^{Reference Korszun, Dharmaindra, Koravangattu and Bhui10}

Second, in some contexts, limited resources are a significant obstacle to good-quality training, especially in relation to access to adequate facilities and evidence-based educational materials.

Many traditional educational methods are not easily applied in undergraduate psychiatric education (e.g. some patients may be reluctant to disclose their mental problems to students because of delusional thoughts; others may feel that the presence of a third person breaks the therapeutic alliance with their psychotherapist). Furthermore, in many sites, students have limited access to psychiatric patients at the bedside, and thus gain little practical knowledge of many psychiatric disorders.^{Reference Ramalho, Montenegro, Djordjevic, Braš, Christodoulou, Mezzich, Botbol, Christodoulou, Cloninger and Salloum11}

Therefore, novel methods to teach psychiatry should be put in place and trialled. It is beyond the scope of this paper to systematically review all the innovative teaching models used in psychiatry, so we have selected some of the most promising approaches to outline here.

Simulation techniques offer one innovative solution. Techniques such as student role-play and simulated patients have been found to improve the communication skills and empathy of undergraduate medical students and seem to be very well accepted.^{Reference Bagacean, Cousin, Ubertini, El Yacoubi El Idrissi, Bordron and Mercadie12} These techniques are used to teach history taking and formulating a management plan and can depict challenging clinical situations (e.g. acutely agitated patients) or rare syndromes, which would otherwise be neglected during training.^{Reference Baessler, Ciprianidis, Rizvi, Weidlich, Wagner and Klein13}

Another innovative solution is the use of movies as an educational tool. Watching movies and videos with students may allow them to discuss misconceptions about mental disorders in a relaxed setting (i.e. not in the patient's presence) and whether the clinical descriptions are accurate or not. Using videos to teach particular topics to medical students has been shown to result in improved recall of those situations.^{Reference Hankir, Holloway, Zaman and Agius14}

The Psychiatry Early Experience Programme (PEEP) was proposed in 2015 in the UK. Medical students are paired with specialists in psychiatry, to shadow them while on-call and for one regular day shift during each of their jobs.^{Reference Holt, Mirvis, Bao, Cross, Hussain and Hutchings15} By joining the programme, students are exposed to a wide range of mental health problems and develop insight into psychiatric trainees’ work. The students can also attend lectures given by psychiatric experts and clinical sessions with patients. The programme looks very promising, as confirmed by the fact that many students who joined it developed more positive attitudes towards psychiatry and seemed less reluctant to choose psychiatry as a specialty.^{Reference Holt, Mirvis, Bao, Cross, Hussain and Hutchings15}

In 2019, the American Psychiatric Association launched the Psychiatry Student Interest Group Network (PsychSIGN), a networking initiative that includes students interested in psychiatry. It provides resources and mentoring opportunities for students to help them to deepen their interest in the field.^{Reference Pinto da Costa, Dima and Ng9, Reference PsychSIGN16}

Interprofessional training wards offer another innovative teaching opportunity. These enable students and trainees from different health professions to work in collaboration to manage the medical treatment and rehabilitation of real-life patients, taking a multidisciplinary perspective.

Finally, another aspect to be improved is related to providing feedback to medical students at the end of their rotation in psychiatry. A recent study carried out in Sweden using a structured feedback tool found that medical students were more satisfied at the end of the rotation period if they had received structured feedback on their internship.^{Reference Nasir, Öster and Ramklint17}