Medical Students Medical Students

Improving the Education in Psychiatry Experience in Medical School

June 20, 2016

On May 25th 2016, the Russian Federation Ministry of Health, Moscow Health Department, and the Department of Psychiatry and Medical Psychology of Pirogov Russian National Research Medical University (RNRMU) held the first All-Russian scientific conference with international participants: “The University Clinic of Psychiatry: Alliance of Science and Practice.” The Conference was devoted to the 110th anniversary of RNRMU and the Department of Psychiatry and Medical Psychology.

As the Organizing Committee of the conference explains:

“University Clinics have made important discoveries in the field of practical and fundamental medicine as well as formed progressive ethical and social norms.” Topics covered included history, research, the clinical challenges of modern practice, social aspects of the reform era, and questions related to education. More information can be obtained at uni-cinic.ucoz.com or via e-mail at psycho.rnrmu@gmail.com

Driven by the desire to rise to today’s challenges in health care and a mission to improve human health, many medical schools worldwide are undertaking initiatives to optimize medical school education.

The growing “dehumanization of medical practice” erodes public trust. A concerted effort to align medical education to current and future societal needs is needed now more than ever.

The process by which medical students acquire clinical competency has long been my interest. As a former student at RNRMU and a former preceptor for students at the Harvard Medical School-Cambridge Integrated Clerkship (CIC), I have had an opportunity to review CIC with a global network of colleagues and share my insights into how a longitudinal supervisory relationship between clinicians/ preceptors and medical students can transform medical students educational experience.

The Cambridge Integrated Clerkship (CIC) continuity-of-care curriculum, first described in the New England Journal of Medicine in 2007, emphasizes holistic patient care as a model for optimizing medical education. According to David Hirsh, MD, its Director and Co-founder, We created the CIC because the patient must be our center — we seek to master science in order to serve patients. Traditional block rotations do not allow students to connect to, know, and serve their patients the way master clinicians and scientists should.” “The goal of the CIC,” he notes “is to return to our highest ideals in all fields—to foster the excellence that patients rightly expect of us….The program seeks to inspire greatness in service to patients and to scientific discovery. We intend to prepare leaders who will use their gifts to relieve human suffering. The CIC model makes a difference to our students and to our patients.” Backing this sentiment, co-author Malcolm Cox, MD, and former Dean of Education at Harvard Medical School observes that, “What is most important about this new model of medical student education is that it gets at the very heart of professional identity formation—forging and maintaining relationships among patients, learners, and teachers.”

Researchers who have compared the knowledge, skills, and attitudes of students completing the CIC with those of students completing traditional block third-year clerkships have found that CIC students performed as well or better than did their peers at academic and clinical tasks while also expressing a stronger sense of connection with their patients. The students also enjoyed substantially higher satisfaction with their medical training.

Longitudinal Integrated Clerkships (LICs) are now rapidly growing in size, number, and diversity, both nationally and internationally. As one medical student reflected on challenging moments during her clerkship, “During those moments of low-morale and exhaustion it was these relational memories and continued feeling of gratitude and closeness that served to propel me forward.”

Similarities exist in the values of both educational models: the CIC and the Russian National Research Medical University. The curriculum of both systems was designed with great care, combining art and science with a humble respect for human nature beneath an umbrella of trust and mutual respect.

Both systems offer multiple opportunities for creating an interpersonal context that fosters learning rather than the “downloading” of content to students. Learned ideas add deeper meaning to previous experience and knowledge and thus better prepare students for future independent learning. A mentor-student relationship is established and nurtured by both programs. In the words of Richard Tiberius, “Relationships are as essential to teaching as the flour in the cake. The reason that we often fail to appreciate the importance of relationships is that we have inherited misconceptions about teaching, about learning and about the nature of the mind. For thousands of years people have theorized about the mind and about learning and drawn conclusions about the nature of teaching. The earliest concepts we have of mind are of psyche, a Greek word for breath, because of the observed relationship between breathing and life.” (Essays on Teaching Excellence. Toward the Best in the Academy. Volume 5, Number 8, 1993-1994. The Why of Teacher/Student Relationships. Richard G. Tiberius, University of Toronto).

My hope is to engage in a dialogue on disseminating the best ideas that the international education community has to offer and to facilitate interaction among colleagues abroad by sharing novel and meaningful insights that could harness powerful lessons and strengthen medical culture.