It has recently been emphasized that the world of medical education is far from being a “level playing field,” but is unfairly angled toward a fortunate few (1). Medical education in developing countries is faced with a number of significant challenges, including medical migration, leading to a shortage of suitably qualified educators, and the difficulties with successful implementation of modern teaching strategies such as problem-based learning (2).

The teaching of psychiatry within the developing world is a particular challenge, for a number of reasons. The human resources available for mental health care in most low-income and middle-income countries are very limited, and shortages are likely to persist. The poorest countries spend the lowest percentages of their overall health budgets on mental health (3). Also, training facilities in these countries are grossly inadequate to make up for the scarcity of professionals (4). Further difficulties are the frequent scarcity of public-health perspectives in mental health leadership and, in many low-income countries, the poor working conditions and low status of the mental health professions (5).

Ghana is a West African nation with a population of approximately 20 million. Ghana has a total of five psychiatrists currently in practice, one of whom works in Kumasi. The teaching of psychiatry in Kumasi has been a part of the medical degree program at the Kwame Nkrumah University of Science and Technology (KNUST) since 1982 (6) and is conducted by the Department of Behavioral Medicine, which now comprises one psychotherapist (JA-P), two psychologists, and one psychiatrist on its academic faculty. Students attend an introductory course on the biological basis of behavior and psychology in the first 3 years of the medical course and an introduction to psychiatry module in the clinical years that covers the history of psychiatry, history-taking, mental state examination, psychopathology and classification, and treatment of psychiatric disorders.

For the last 3 years, a short, 3-day review course in general adult psychiatry has been conducted at the KNUST medical school by two visiting consultant psychiatrists, one from the U.K. (RL) and one from Australia (JL). The development of this focused teaching intervention has come from an ongoing collaboration between KNUST and colleagues in the U.K. over several years (7, 8), and represents a collaboration among three institutions of medical education: two in the developed world (The University of Western Australia and The Peninsula Medical School, UK) and one in the developing world (KNUST). The current principal aim of this collaboration is to improve the mental health education of doctors-in-training within a context in which mental health resources are scarce. A second related aim is to increase interest in psychiatry as a career option.

In December 2007, the course was delivered for the second consecutive year to final-year medical students 6 months before their final examinations. Informal feedback from the previous year suggested that an improvement in the students' knowledge-base in psychiatry had been observed in the final examinations. It was decided to formally evaluate the impact of the course in 2007.

The course consists of six 1-hour lectures over a 3-day period, complemented by role-play demonstrations with a focus on core clinical-interviewing skills. There is also a separate discussion session on psychiatry as a career for interested students. The lectures cover the psychiatric history, the mental state examination, common mental disorders, psychosis, drugs and alcohol, psychiatry's relationship with medicine, and psychiatric emergencies. The course is delivered to the whole of the final-year student group within existing available lecture slots.

In December 2007, the course was delivered for the second consecutive year. Informal feedback from the previous year suggested that an improvement in the students' knowledge-base in psychiatry had been observed in the final examinations. It was decided therefore to conduct a summative evaluation of the course in 2007. Students were asked to complete a general psychiatric knowledge questionnaire before and immediately after the course. This was an 18-item questionnaire designed for this study and directly related to the content of the course (available from the authors on request). The students were also asked to rate their attitude toward psychiatry as a career, on a 5-point scale, with 1 being Least Interested and 5 Most Interested in a career in psychiatry. No spontaneous narrative feedback or comment was sought from the students.

The same 18-item questionnaire was used to reassess the students' knowledge, without advance warning of the test, 1 month after the course. The students received no further teaching in psychiatry between the review course and the 1-month follow-up evaluation.

Ethics Committee approval for the study was obtained through KNUST.

Knowledge

The average result on the knowledge test pre-course was 52% (N=129; range: 10%–82%) and post-course was 78% (N=122; range: 20%–100%), constituting a 50% increase in knowledge from baseline for the average student. At 1-month follow-up, the average result on the knowledge test was 76% (N=126; range: 36%–100%).

Interest

The proportion of students showing considerable interest in a psychiatric career (4 or 5 on the attitude question) increased from 19% pre-course to 32% post-course. The proportion of students still showing considerable interest in pursuing a career in psychiatry was 21% at 1 month after the course.

The data presented indicate that the final-year students at KNUST gained improvement in general psychiatric knowledge as a result of attending the review course when assessed immediately after the final teaching session of the course. This is encouraging for a relatively short teaching intervention that is limited by other commitments the students have within their medical training at this time as well as limitations on the lecturers' time. In regard to knowledge retention, it was encouraging to find very little drop-off in the mean knowledge scores at reevaluation after 1 month. However, it should be noted that the same questionnaire was administered before and after the course and at follow-up. Thus, improvement may relate to practice with these particular questions, although no specific feedback was given on correct answers other than through the content of the course itself. Another limitation of the study was the absence of a control group.

We were also interested in evaluating the effect of the course on students' interest in pursuing a career in psychiatry. We have previously reported that the interest in psychiatry among final-year students at KNUST was comparable with medical students in Spain, although less than that of U.S. students at a similar stage of training (8). In this previous study, conducted 12 months before the current study, we found that 15% of the then final-year medical students at Kumasi were considering a career in psychiatry, a little less than at baseline in the current study. The results of this current study indicate that immediately after the course, the level of interest in psychiatry as a career improved significantly, but follow-up at 1 month indicates that the level of interest had decreased almost to the pre-course level. So, although the improvement in knowledge was shown to be sustainable, at least over a 1-month period, the increased interest in psychiatry as a career generated by this course appears to wane within a few weeks.

It is not clear how best to increase interest in psychiatry among medical students. The existing literature indicates that there is often a disparity between a positive attitude toward psychiatry and the choice of psychiatry as a career (9–11). Various reasons have been suggested for this disparity, including the perception that psychiatrists earn less or are less respected than other doctors, and we found these factors to be relevant in our previous study of students at Kumasi (8).

The potential for future partnering between medical institutions and universities in the developing world and their western equivalents to enhance knowledge and interest in psychiatry and to promote postgraduate training should be developed further (3, 5, 12). In this way, psychiatrists based within western institutions can play a positive role in supporting colleagues in developing countries such as Ghana.

At the time of submission, the authors reported no competing interests.