Psychiatric Bulletin - Letter: Psychiatry for medical students: need for a more holistic approach to teaching?

From: Psychiatric Bulletin -

http://pb.rcpsych.org/content/38/3/138.2.full

Kristina Rodney and Laura Wilkinson

Kristina Rodney and Laura Wilkinson are both ST4 medical students, Newcastle University, Newcastle, UK, email:k.rodney AT newcastle.ac.uk.

We are two medical students who wish to offer a perspective on undergraduate education and psychiatry.

During our student placement, we attended the old age psychiatry module at the Northern Deanery MRCPsych programme focusing on dementia and ethics. This was aimed at trainees and not specifically medical students but we were surprised to find that this was not above our level of knowledge. This prompted discussion of undergraduate psychiatry training more broadly, which we felt focused too heavily on the diagnosis of mental illness and less so on the holistic approach to the patient and their presentation as covered by the MRCPsych course. From our experience of undergraduate psychiatry we feel that the assessment by means of a logbook of conditions encourages students to find patients with a certain diagnosis, and in doing so overlooks the true essence of psychiatry. To our mind this incorporates the ability to consider all aspects of a patient’s life and formulating these, while demonstrating compassion for another person at a time of most need.

Through choosing a 6-week placement in old age psychiatry we have been able to explore the specialty more thoroughly and broadly than facilitated within the standard undergraduate programme, and we have realised how little of psychiatry we have been exposed to as undergraduates. We have become more aware of the importance of considering the patient’s personal and social circumstances alongside their diagnosis, and how these can influence each other. Specifically, the importance of a sound ethical approach to practice has been highlighted through the higher-level teaching we experienced, where the Mental Capacity Act was discussed in detail.

We believe that it would benefit undergraduates to experience a more realistic and rounded placement in psychiatry and truly consider the social implications of mental illness. As it currently stands, undergraduate education in psychiatry is oversimplified to focus on diagnosis and does not acknowledge the capabilities of medical students to adopt a holistic approach. An opportunity to consider all aspects of a psychiatrist’s role may encourage more students to consider a career in this field.

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I have contacted the authors of this letter to inform them of Hodges' model and its scope in assuring holistic and integrated care. The model could also facilitate curriculum development. The authors of the letter are not endorsing Hodges' model, I am seeking to highlight the need for such a resource.

Thanks to:

Lucy Alexander
Rights and Permissions Manager
Royal College of Psychiatrists

HSJ: The NHS and fundamental change ...

 ... governments typically try to will the end but not the means: they try to shift the habits of the NHS while protecting buildings and people; or in Lord Darzi's pithy phrase, they change "the anatomy of the NHS rather than its physiology". p.16.

Finding the pith in Hodges' model (and the problem of refactoring - where would you like to start?):

INTERPERSONAL : SCIENCES

SOCIOLOGY : POLITICAL

individual

PURPOSE cognitive geography (the 'physiology' of mindsets)	Anatomy & Physiology PROCESS  structure, buildings,geography time, events, space
(habituated - ) PRACTICE (collective purposes) team integration	the NHS (organisation) POLICY workforce, funding  local, regional, national, global

group - population

Seddon, N. (2013) Opinion: Learning from international innovators, HSJ, 12 April. 123: 6346; 16-17.

Individual - Group: Axes & Histories

What are the dimensions of the axes that make up the structure of Hodges' model?

Can the individual see the group - the global population - beyond the fresh air in their pocket?

In not seeing the individual, as the global corpus shouts about: "choice", "economic growth", "freedom", "human rights", "democracy", "justice" ... do they see the big picture amid the political smog, the corporate dust storm?

One form human society has so far not generally taken is global. There is still virtually no shared consciousness globally of common struggles or common achievements. Enormous groups - the poor in the Global South for instance - have no sense of forming a single community; in an earlier age, the experience of being subjected to European colonial force failed to create a common anti-colonial front. Even today's most urgent global issues tend to be tackled regionally or nationally: the history of global warming or organised crime is a history of multiple actors, as often as not talking at cross-purposes. p.8.

Prof. Mark Mazower, All together now, FT Weekend, March 9 - 10, 2013, p. 8. Reviewing The Undivided Past: History Beyond Our Differences, by David Cannadine, Allen Lane. 

http://www.ft.com/cms/s/2/edb5b2ea-84d3-11e2-891d-00144feabdc0.html#axzz2OXNCQ1xD
http://www.ft.com/cms/s/0/b1793262-8d6f-11e2-82d2-00144feabdc0.html#axzz2OXNCQ1xD

Society (global trends?) that diminishes the greatest gifts

Last December 15th -16th Harry Eyres' column The Slow Lane in the FT Weekend (p.24) pointed me to the New Economic Forum's pamphlet entitled The New Materialism. Mr Eyres wrote about the The most precious gifts and the fact that things do not last like they used to. Quality lies in things that last, things that are worth repairing and repairable.

The piece prompted me to think back about some of the children's toys. Very gratefully received as gifts, guilt sprung when more of an impulse (impelled) buy: what about the amount of plastic, the oil, the probable lack of longevity in use, the longevity in decay and the some-other-where of waste and disposal?

Recall then the joys of the wooden train set, with non-toxic paint... The toy flung aside as the cardboard box is tossed, turned and crawled into and puzzled about. The reflection took me around a few towns too, the pound shops. It's good when you really can afford to make a choice about what you buy, about quality. The hammer, clearly not ready for hand: unbalanced once home. I'm not saying all 'cheap' screwdrivers are the same, but the slightest amount of torque and the handle is undone. Probably the one cheap find and sometimes free are the watchmaker's screwdriver sets. Eye-saving when the screw on the side of my glasses comes loose and the lens falls out on something soft thus far.

All the mass production and lack of love and care invested in making things - the loss of true craft, as Mr Eyres points out, makes me wonder whether this also pollutes the way we value our health.

Like so much advertising - conditioning - we recognize the true significance of what is happening only when forced to and we ourselves suffer a failure and 'break' in some way, to some degree.

This issue is provoking various responses. An example being Beck's Song Reader, an album released solely as sheet music.

http://www.ft.com/cms/s/2/0b4a2066-06f8-11e2-92b5-00144feabdc0.html#axzz2NyOTAcgA