COMMUNITY PSYCHIATRY, SOCIAL PSYCHIATRY, AND COMMUNITY MENTAL HEALTH WORK: SOME INTER-PROFESSIONAL RELATIONSHIPS IN PSYCHIATRY AND SOCIAL WORK.
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OBJECTIVE: The attitudes of medical students towards psychiatry and psychotherapy were examined considering the extent of their education, previous psychiatry experience, the evaluation of the course, their career intentions and socio-demographic variables. METHODS: Five hundred and eight medical students in their second, fifth, ninth and tenth semester completed a questionnaire on "Attitudes Towards Psychiatry" (ATP-30). RESULTS: With 508 participants (return quota: 88%), the study showed no overall change in attitude in the ATP-30 during the course of the study. No general change in attitude following practical training in psychiatry was found. The more positive the psychiatry course was rated the more positive attitudes towards psychiatry were. Female students and students with psychiatry/psychotherapy experience had a significantly more positive attitude towards psychiatry as a subject. Overall 5.8% of all students showed a very positive attitude towards psychiatry. CONCLUSION: A positive education experience as well as personal experience increases the probability of a positive student attitude towards psychiatry. In order to assure adequate care for the mentally ill, it should be a fundamental aim of medical education to promote positive attitudes towards the mentally ill and psychiatry. It remains to be investigated, however, whether an improvement in the attitudes of students towards the psychiatry discipline is sufficient to increase the number of students who would like to become psychiatrists or whether other factors are more deciding such as career opportunities, conditions of further education, or income potential.
OBJECTIVE: The Accreditation Council on Graduate Medical Education (ACGME) requires that general psychiatry residency training programs provide trainees with exposure to forensic psychiatry. Limited information is available on how to develop a core curriculum in forensic psychiatry for general psychiatry residents and few articles have been published on the topic. METHODS: The objective of this article is to provide an overview of forensic psychiatry topics likely to be of benefit to general psychiatry residents. RESULTS: The article is intended to be a springboard for future development of forensic curricula suitable for residents rather than a blueprint for an educational program. CONCLUSION: Although most general psychiatry residents will not specialize in forensic psychiatry, a working knowledge of basic concepts in forensic psychiatry should be considered an important component of general psychiatry education.
BACKGROUND: The practice of Evidence-Based Psychiatry started in the 1990's, however prior to this time the practice of psychiatry did have an evidenced base though not structured and systematically spelt out. This study aimed to review the development of the concept and practice of Evidence-Based Psychiatry and to identify position of Nigerian psychiatry in it. METHODS: Narrative reviews were made from information obtained from scientific publications i.e. (books and journals) and internet-based electronic articles. RESULTS: Evidence-Based Psychiatry emerged from Evidence-Based Medicine in the 1990's and aims to base practice on the best available evidence. The evidence is graded into A, B, and C, depending on the study design. Also critical to the practice of Evidence-Based Psychiatry is the availability of high-grade evidence and an efficient means of storing and retrieving it. Evidence-Based Psychiatry uses a systematic approach and involves five steps. Its scope covers aetiology, diagnosis, intervention, and prognosis. CONCLUSION: A comprehensive definition of Evidence-Based Psychiatry is given. There is a suggestion to change the term 'Evidence-Based' to 'Systematic Evidence-Based'. The right way to determine if a therapeutic intervention is evidence-based is to consider if the process that led to it is systematic in terms of the five steps of Evidence-Based Psychiatry. Nigeria is yet to develop structures required for Systematic Evidence-Based Psychiatry.
OBJECTIVE: To integrate child psychiatry into a psychiatry clerkship OBJECTIVE Structured Clinical Examination (OSCE). METHOD: Child psychiatry OSCE stations were designed to evaluate clerk' skills in the identification of 4 common conditions. Child psychiatrists wrote case scenarios and checklists and supported standardized patient (SP) training for the stations. A bank of 4 child psychiatry OSCE stations is now available for use in the psychiatry OSCE. Child psychiatry faculty have been trained as examiners for ongoing administration of his OSCE. RESULTS: This bank of child psychiatry OSCE stations has examined 402 clerks. Mean student scores for content were 68% to 86% and for process were 69% to 76%. Station reliability and examiner feedback were acceptable. CONCLUSIONS: Child psychiatry has been successfully integrated into a psychiatry clerkship OSCE. Although the commitment in terms of monetary and faculty costs has been considerable, the accompanying educational benefits of such integration warranted this expense.
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This follow-up study of 234 doctors examined whether improvements in attitudes to psychiatry following an undergraduate psychiatry attachment were maintained after graduation, and explored the relationship between attitudes to psychiatry and intention to pursue psychiatry as a career. Improvements in attitudes following undergraduate psychiatric attachment decayed over time but remained higher than pre-attachment levels. Attitudes of doctors who definitely intended to pursue psychiatry, however, increased at each stage. Attitudes of doctors were predicted by post-attachment attitudes, which in turn were predicted by encouragement from consultants and influences of specialist registrars during the attachment at medical school. There were no differences between a problem-based and a traditional psychiatry curriculum in attitude change. The findings suggest that encouragement during medical school from more senior doctors increases the numbers wanting to pursue psychiatry and may increase the number who subsequently pursue psychiatry as a career.
This is a study of the timing and process of choosing psychiatry as a career. All the psychiatric residents in the Department of Psychiatry, University of Toronto in the academic year 1981-1982 were surveyed. Seventy-eight percent (93 residents) responded. We found that 58.1% had decided to enter psychiatry after graduation from medical school. Of the total group 27% came from family practice programs; 14% of our sample had decided on a career in psychiatry before entering medical school. In our study, 27.9% of the sample decided to choose psychiatry during medical school. The factors which appear influential in determining the choice of psychiatry as a career were interest in psychosocial problems, rejection of other specialties, discovery of prevalence of psychosocial problems in family medicine and other specialties, discovery of effectiveness of psychiatric therapies and the experience of personal psychiatric therapy (23.6%). There is a suggestion that the previous decline in recruitment has been checked and that recruitment is now increasing. The authors discuss recruitment strategies that may increase the selection of the most desirable candidates into psychiatry. If undergraduate teaching emphasized the effectiveness of therapeutic intervention, it is probable that more interested candidates would choose psychiatry earlier.
OBJECTIVES AND METHODS: The main objectives of the research was to identify the merits and demerits of the specialty board certification system, that had been implemented in the other medical societies than the society of psychiatry in Japan. As a measure of the research, we conducted a survey by distributing questionnaires to medical institutions. The subjects of this survey included medical practitioners, other than the psychiatrists, who belong to general hospital, university hospital and the Japan Medical Association. FINDINGS: We received 228 responses out of the subjects. The findings were that 86% of the subjects have acquired the specialty board certificate, and that half of them have more than two kinds of qualifications on the average. Thus, the report suggests that the specialty board certification system have been long pervaded throughout the medical fields outside psychiatry. In addition, the subjects pointed out as the merits of the specialty board certification system that it helps to achieve the higher level of technique, and to organize and sophisticate as well as widen the knowledge of their specialty. They also reported that it contributes to instigate the life-long education and to earn identification and recognition of their specialty from other fields of medicine than their own. Fifty-three percent of the subjects acknowledged the necessity of the specialty board certification system while 13% regarded it unnecessary. This result proves that, despite higher percentage of the doctors with qualifications, the system itself is not approved of with full acknowledgement in the medical world. This rather negative attitudes toward the system is originated in the fact that acquiring and maintaining the certificate, i.e., renewal fees, are considerably high. In fact, as many as 62% of the subjects felt these points as disadvantages of the system. The medical practitioners outside the fields of psychiatry did not show any particular concern about the lack of the specialty board certification system in our field that is distinct as a field of medicine. Only 18% of the subjects expressed that urgent actualization of the system is desirable in our fields. In addition, securing the cites required for learning the technique and giving the exam to the applicants is the most important matter to be concerned. On the contrary, in other fields of medicine, the matter does not need to be discussed. Therefore, this is a problem unique to the fields of psychiatry. CONCLUSION: Although there are disadvantage of the specialty board certification system pointed out as shown above, we believe that it is necessary to introduce the system in the field of psychiatry. These disadvantage are mainly the matter of individual income. We need to consider the introduction of the system from the perspective of sophisticating the quality of psychiatry as a field of medicine in our country. We, the Subcommittee on feasibility of implementing specialty board certification in the Japanese Society of Psychiatry and Neurology have been contemplating over the system up to this moment. The progress has been made to the point of presenting, Discussion of the Specialty Board Certification System in Psychiatry, Yamauchi, May, 1994.