In his article “A Neurosciences-in-Psychiatry Curriculum Project for Medical Students,” David Dunstone, M.D., (1) informs us that psychiatric educators face an era with dramatically reduced protected time to teach during a period in which a wealth of electronic resources exists—a situation requiring creative educational strategies. Clearly and reproducibly, Dr. Dunstone presents a model that “utilizes emerging knowledge and technology to explore pertinent areas, such as the relationship between contemporary neuroscience and psychiatry, at a time of limited resources.” The strategy is commendably creative and attempts—probably successfully—to fulfill multiple manifest and unspoken goals of his clerkship, including using distance learning, utilizing student time “not otherwise occupied,” fostering equivalency of student experiences assigned to multiple clerkship sites, extending problem-based learning from the first 2 years of medical school into the clerkship, and updating students and the faculty mentor on neuroscience developments related to psychiatry. It is also a fine example of practice-based learning since actual clinical examples drawn from patients in the clerkship are starting points for Internet-based literature searches. Dunstone’s model is responsive to suggestions made in articles by Hyman and Fenton (2)—which should be required reading for faculty—Rubin and Zorumski (3), and Taylor and Vaidya (4) regarding the clinical and research importance of teaching and learning about neuropsychiatry and neuroscience beyond the DSM system and the content of United States Medical Licensing Examination Steps 1–3.
As Dunstone suggests, replicating this model at Michigan State, and perhaps several other schools, and quantifying student satisfaction and other data, would help to document its efficacy. If the model is efficacious, its educational strategy could be used in clerkships and residency programs in any specialty—not just psychiatry—and could be applicable to any important subject. Even if the strategy is not effective when applied to multiple clinical sites simultaneously, “local” patient care and individual and small group teaching could be enhanced with prompt on-site Internet access to the medical literature.
I was struck by how much of Dunstone’s model is a response to common problems in psychiatry and other clerkships and in psychiatric and psychopharmacological research and education pertaining to “limited resources” and trends in the specialty, such as overreliance on the DSM system in teaching, testing, and research. For example, the fact that the model is used during students’ “time not occupied” is both a strength and weakness because, while this is a fine use of “slack time,” top-notch clerkships should have practically no slack time—with students interviewing patients and families, charting, presenting, and being supervised about them, in addition to attending scheduled conferences.
It is not hard to postulate that during the past decade, student slack time has increased as demands for faculty clinical productivity have increased (5), and reliance on student and trainee charting has decreased. To improve the quality of psychiatric and general medical education, more resources must be made available from every possible source to protect clinical faculty time for teaching. Reliance on students is too often perceived—albeit correctly—as taking extra uncompensated time during a busy clinical day. Nowadays, students are rarely viewed as skillful members of the healthcare team who can enhance the team’s clinical efficiency and effectiveness. Since data show that utilizing students adds time to a clinician’s day (6, 7), models could be developed (e.g., military “medics” and physician assistants) whereby students who have gained clinical skills and basic competencies during the first 2 years of medical school and in prior clerkships can use their skills to everyone’s benefit—including patients’—in the third and fourth years, and, as a result, third-party payers may better accept students as relevant healthcare team members who contribute to clinical efficiency and effectiveness.
Further, the model is used to deliver “pertinent scientific information to students who may not have direct access to faculty facile with the neurosciences,” which presents some degree of difficulty because of contemporary psychiatrists’ exposure to extensive clinical neuroscience research (including imaging and behavioral genetics) in the Decade of the Brain, and the burgeoning of the fields of behavioral neurology and neuropsychiatry beginning in the late 1970s, with wonderful textbooks (8–11) available in both areas. Also germane is the relative inattention to diagnostic validity and to dimensional models of personality by researchers, clinicians, clinical educators, DSM, and national board examinations. I agree with Rubin and Zorumski’s recommendation that medical schools should teach more about basic neuroscience and its clinical applicability to all future students. I also agree with Taylor and Vaidya’s recommendation that medical schools and psychiatry residencies should teach more about the behavioral neurology of psychopathology, and with Hyman and Fenton’s recommendation that research should consider behavioral neurologic and other symptom complexes in psychiatric disorders rather than relying almost exclusively on insufficiently validated DSM constructs. To this end, neuropsychiatrists and behavioral neurologists should participate more in the construction of medical licensing examinations and in teaching in medical student and residency education programs.