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Academic Psychiatry, VOL. 30, No. 2
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BRIEFREPORT   |   March 01, 2006 
A Neurosciences-in-Psychiatry Curriculum Project for Medical Students
David C. Dunstone
Academic Psychiatry 2006;30:166-169.
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Received March 24, 2005; revised August 31, 2005; accepted September 23, 2005. Dr. Dunstone is affiliated with Michigan State University/Kalamazoo Center for Medical Studies, Department of Psychiatry, Kalamazoo, Michigan. Address correspondence to Dr. Dunstone; MSU/KCMS Psychiatry, 1722 Shaffer Rd, 3rd Floor, Kalamazoo, MI 49048; dunstone@kcms.msu.edu (E-mail). Copyright © 2006 Academic Psychiatry.

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Abstract
Objective: Incorporating new neuroscience findings relevant to psychiatry into the medical school curriculum is challenging, especially at the level of clinical learning. In this pilot project, third-year medical student volunteers in their required 8-week clerkship participated in an e-mail-based experience relating contemporary neuroscience to psychiatry. Methods: A faculty preceptor guided participants using one of the participants’ patient work-ups as a platform to explore questions related to the neurosciences. Participants were surveyed for follow up. Results: Eleven of 13 eligible students agreed to participate in the study during one academic year. Data is qualitative, consisting of the responses of the students and the formulations and feedback of the preceptor as the project proceeded. Conclusion: Participants were successful in identifying symptom complexes in the sample history and in exploring their questions in the literature and with one another. The protocol is well-suited to distance learning, is relevant to psychiatric education, and is flexible in its application.Abstract Teaser
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    We looked for ways to incorporate the learning of neurosciences pertinent to psychiatry within our undergraduate medical curriculum, particularly the clerkship. There is a growing body of literature concerning the incorporation of new findings in the neurosciences within the preclinical curriculum (1, 2). However, this area of curriculum is not reported in the contemporary medical education literature relevant to the clerkship, with the exception of particular model curricula specific to the teaching of neuropsychopharmacology (3). Our pilot project was intended to draw on students’ previous experience with problem-based learning by having them work as a group via e-mail correspondence. They were asked to contemplate a selected case of a typical psychiatric patient utilizing questions that explore various symptom complexes, a construct derived from a suggestion of Hyman and Fenton (4). It was anticipated that these "symptom complexes" could be addressed by reference to the current literature in the neurosciences, serving as a vehicle for integration with clinical psychiatric practice.
    Objectives for the experience included: 1) using this strategy to study distance learning in a population of third-year medical students; 2) designing a flexible format so clerkship participants might utilize time not otherwise occupied; 3) developing a project relevant to students working at different sites on campus, in which clinical experiences may be dissimilar in content and form; 4) discovering a variant of problem-based learning relevant to the clerkship experience; 5) exploration of a method of delivering pertinent scientific information to students on campuses who may not have direct access to faculty facile with the neurosciences.
    Additionally, this was anticipated to be a "value-added" aspect of the clerkship, giving students an opportunity to revisit and expand upon neuroscience material taught during the first 2 years of medical school. The model promoted in this exercise utilizes emerging knowledge and technology to explore pertinent areas at a time of limited resources.
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    Protocol

    Medical students were recruited to participate in a voluntary exploration of neuroscience pertinent to psychiatry during their required 8-week clerkship in psychiatry. Students were to submit a work-up of a patient within the first 2 weeks of the clerkship. One of these was selected for the group to pursue, first by submitting questions of interest relevant to the neurosciences, then, with prompting, refining the questions and searching for supporting materials in the current neurosciences literature. With each interchange, the preceptor would work to focus the exploration on issues pertinent to the material from the literature each student submitted. He also sought examples that related the discussion to psychiatry, especially toward clinical factors. All responses were shared with all participants via e-mail. Also, a presentation software file of the developing case discussion was attached to all e-mail exchanges. Subsequent groups’ productions were to be compared and studied. Follow-up would include surveys of all participants for evaluation of the experience.
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    Subjects

    Volunteers were students assigned to the required clerkship in psychiatry during their third year, initially from those rotating through one campus of this community-based medical school. Institutional Review Board (IRB) approval was obtained (5), and volunteers were informed about all aspects of the study before agreeing to participate. Eleven of the 13 eligible students agreed to participate in the study (March-June, 2004). The exercise was conducted with one preceptor.
    Most of the data in this project is qualitative, consisting of the responses of the students and the formulations and feedback of the preceptor as the project proceeded through each 8-week cycle. Once engaged in the process, all participants completed the project. Student submissions and the interchange between individual students, groups of students, and a preceptor represent a major aspect of the "data" collected in this study and are summarized in Figure 1, which is representative of the process.
    A telephone follow-up survey of the participants conducted by our department several months after the experience elicited:
    The preceptor estimates that each 8-week iteration of the project consumed 20 hours of his time. The students each reported spending 6 to 7 hours total.
    Regarding original objectives, it seems evident that the participants were successful in identifying specific symptom complexes in the sample history, and in exploring their questions in the literature. The use of simple telecommunication and computer technology provided an inexpensive, available, and appropriate platform for their exploration, and permitted interaction between parties who might be at any distance from one another. It is less clear that the findings had useful clinical significance for the students, although the potential contributions seemed evident to the preceptor.
    In this particular model of learner-centered learning (8), concepts from the literature regarding diagnostic teaching (9) and progressive formalization (10) were prominent. Our emphasis was on encouraging students to shift from an expectation of instruction by teachers and preceptors to developing an individual cognitive map they might use for personal study (11). In this regard, the participants demonstrated considerable skill in imaginative exploration and synthesis of their findings. With more such exercises, they may adopt the method demonstrated here as a pattern for lifelong learning.
    In a larger sense, this project provides an example of the combination of problem-based learning with information technology-assisted education (cyberspace learning) (12—16). It is consistent with the recommendations of Rubin and Zorumski (17) ("… [S]tudents should develop an understanding that molecular and cognitive neurosciences, genetics, and epidemiology are critical to understanding mental illnesses.") and Taylor and Vaidya’s urging "assessing a patient’s psychopathology beyond what is necessary to apply DSM criteria" (18) as being necessary for good patient care.
    Future efforts should include exposure to more students and preceptors, and some objective measure of learning as a result of the exercise. Although the subjective reports were uniformly positive, using such devices as pretest/posttest methodology could provide a more objective short-term measure of learning. In this particular instance, the impact on departmental curriculum is yet to be determined, although inclusion of this protocol as a criterion for "honors" designation is being considered.
    The preceptor for such a project need not be expert in applications of neuroscience to psychiatry, but should be knowledgeable about the expanding field of neurosciences, in general, as well as about the practice of psychiatry and teaching (19). What seems more important is the capacity to discover the degree of understanding a student has of the subject, so new information can be built upon an existing base of knowledge (20).
    While the numbers of participants in this project is small and outcome measures are subjective, participants demonstrated the utility of deriving symptom complexes from typical psychiatric patients’ presentations, using questions derived from these complexes as a platform for study of the neurosciences literature, and, with guidance from a preceptor, utilizing their findings to enhance patient care. The protocol is suited to distance learning, is relevant to psychiatric education and feasible, and is flexible in its applications, both in terms of expertise and time.
     
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    FIGURE 1. Representative Sample of Preceptor/Student Interchange
    This study was presented in a workshop at the annual meeting of the Association for Directors of Medical Student Education in Psychiatry, Montreal, Quebec, June, 2004.
    The author thanks the students who participated in this study, the faculty of the Michigan State University College of Human Medicine Department of Psychiatry for their support and encouragement, and Michael Liepman for his editorial assistance.
    1+
    .
    Grunze H, Strupp M, Ronnebert T, et al: Problem-based learning in medical education: integrated "nervous system and behavior" course at the Munich Ludwig Maximilian University. Der Nervenarzt 2004; 75(1):67—70
     
    2+
    .
    Giffin BF, Drake RL: Gross anatomy of the head and neck and neuroscience in an integrated first-year medical school curriculum. Anat Rec 2000; 261(2):89—93
     
    3+
    .
    Mohl PC: Model curricula: an introduction. Acad. Psychiatry 2001; 25:87—89
     
    4+
    .
    Hyman SE and Fenton WS: What are the right targets for psychopharmacology? Science 2003; 299:350—351
     
    5+
    .
    IRB#:C03—006, Michigan State University
     
    6+
    .
    Jenike MA: The "geriatric difference": depression Dx, office workup, preoperative assessment." Geriatrics 1986; 41:26
     
    7+
    .
    Linehan MM: Dialectical Behavioral Therapy of Borderline Personality Disorder. New York: Guilford, 1993
     
    8+
    .
    Bransford JD, Brown AL, Cocking RR (eds): How People Learn: Brain, Mind, Experience and School, National Academy Press, Washington DC, 2000
     
    9+
    .
    Ibid, pp. 134-135
     
    10+
    .
    Ibid, pp. 137-138
     
    11+
    .
    Glaser R, Baxter GP: Assessing Active Knowledge, CSE Tech. Rep. number 516, Center for the Study of Evaluation, National Center for Research on Evaluation, Standards, and Student Testing, UCLA, http://cresst96.cse.ucla.edu/products/reports_set.htm
     
    12+
    .
    Wolfson L, Willinsky J: Situated learning in high school information technology management. J Res Comp Educ 1998; 31(1):96—110
     
    13+
    .
    Cheesman R: Moving the Roskilde model into cyberspace: problem-based learning in groups in a net environment, paper presented at the 7th Conference of Baltic University Rectors, Roskilde University, Denmark, 16—18 June 1999, http://akira.ruc.ak/∼robin//pubs/CBUR99.pdf
     
    14+
    .
    Abell ML, Galinsky MJ: Introducing Students to Computer-Based Group Work Practice. J Soc Work Educ 2002; 38(1):39—54
     
    15+
    .
    Gilliver RS, Randall B, Pok YM: Learning in cyberspace: shaping the future. J Comp Assist Learn 1998; 14:212—222
     
    16+
    .
    Roberts J: Learning to learn—over the Internet. Can cyberspace assist education in the health domain? Br J Healthcare Comput Info Manage 1999; 16(9):32—34
     
    17+
    .
    Rubin EH, Zorumski CF: Psychiatric Education in an Era of Rapidly Occurring Scientific Advances. Acad Med 2003; 78:351—354
     
    18+
    .
    Taylor MA, Vaidya NA: Psychopatholgy in neuropsychiatry: DSM and beyond. J Neuropsychiatry Clin Neurosci 2005; 17(2):246—249
     
    19+
    .
    Bransford JD, Brown AL, Cocking RR: OP.CIT. pp 31, 45—47
     
    20+
    .
    Byrnes JP: Cognitive Development and Learning in Instructional Contexts, 2nd ed, Boston, Allyn & Bacon, 2001
     

    FIGURE 1. Representative Sample of Preceptor/Student Interchange
    +
    1+
    .
    Grunze H, Strupp M, Ronnebert T, et al: Problem-based learning in medical education: integrated "nervous system and behavior" course at the Munich Ludwig Maximilian University. Der Nervenarzt 2004; 75(1):67—70
     
    2+
    .
    Giffin BF, Drake RL: Gross anatomy of the head and neck and neuroscience in an integrated first-year medical school curriculum. Anat Rec 2000; 261(2):89—93
     
    3+
    .
    Mohl PC: Model curricula: an introduction. Acad. Psychiatry 2001; 25:87—89
     
    4+
    .
    Hyman SE and Fenton WS: What are the right targets for psychopharmacology? Science 2003; 299:350—351
     
    5+
    .
    IRB#:C03—006, Michigan State University
     
    6+
    .
    Jenike MA: The "geriatric difference": depression Dx, office workup, preoperative assessment." Geriatrics 1986; 41:26
     
    7+
    .
    Linehan MM: Dialectical Behavioral Therapy of Borderline Personality Disorder. New York: Guilford, 1993
     
    8+
    .
    Bransford JD, Brown AL, Cocking RR (eds): How People Learn: Brain, Mind, Experience and School, National Academy Press, Washington DC, 2000
     
    9+
    .
    Ibid, pp. 134-135
     
    10+
    .
    Ibid, pp. 137-138
     
    11+
    .
    Glaser R, Baxter GP: Assessing Active Knowledge, CSE Tech. Rep. number 516, Center for the Study of Evaluation, National Center for Research on Evaluation, Standards, and Student Testing, UCLA, http://cresst96.cse.ucla.edu/products/reports_set.htm
     
    12+
    .
    Wolfson L, Willinsky J: Situated learning in high school information technology management. J Res Comp Educ 1998; 31(1):96—110
     
    13+
    .
    Cheesman R: Moving the Roskilde model into cyberspace: problem-based learning in groups in a net environment, paper presented at the 7th Conference of Baltic University Rectors, Roskilde University, Denmark, 16—18 June 1999, http://akira.ruc.ak/∼robin//pubs/CBUR99.pdf
     
    14+
    .
    Abell ML, Galinsky MJ: Introducing Students to Computer-Based Group Work Practice. J Soc Work Educ 2002; 38(1):39—54
     
    15+
    .
    Gilliver RS, Randall B, Pok YM: Learning in cyberspace: shaping the future. J Comp Assist Learn 1998; 14:212—222
     
    16+
    .
    Roberts J: Learning to learn—over the Internet. Can cyberspace assist education in the health domain? Br J Healthcare Comput Info Manage 1999; 16(9):32—34
     
    17+
    .
    Rubin EH, Zorumski CF: Psychiatric Education in an Era of Rapidly Occurring Scientific Advances. Acad Med 2003; 78:351—354
     
    18+
    .
    Taylor MA, Vaidya NA: Psychopatholgy in neuropsychiatry: DSM and beyond. J Neuropsychiatry Clin Neurosci 2005; 17(2):246—249
     
    19+
    .
    Bransford JD, Brown AL, Cocking RR: OP.CIT. pp 31, 45—47
     
    20+
    .
    Byrnes JP: Cognitive Development and Learning in Instructional Contexts, 2nd ed, Boston, Allyn & Bacon, 2001
     
    +
    +

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