Can curriculum design influence medical students’ attitudes to psychiatry? A comparison of two different approaches

Abstract

Medical students with poor attitudes toward psychiatry are unlikely to choose it as a career, and current psychiatry recruitment is inadequate for future NHS needs. Amending medical school curricula has been suggested as one solution. We performed a unique naturalistic mixed-methods cross-sectional survey of two sequential cohorts in a UK medical school, before and after the restructuring of the entire MBChB curriculum. As well as increasing integration with other specialties, the emphasis placed on psychiatry increased throughout the course, but the final psychiatry block reduced from 8 to 6 weeks. Students experiencing the refreshed curriculum had better attitudes to psychiatry and psychiatric patients and were more positive about psychiatry as a career for themselves and others, compared to students on the old curriculum. This was demonstrated both quantitatively using validated rating scales (12/30 questions ATP-30 and 1/6 questions PEAK-6) and qualitatively using free-text responses. Restructuring undergraduate medical curricula to enhance integration may yield added value, including the potential to improve attitudes to specialties previously learned in silos, such as psychiatry. This may improve recruitment and the understanding of mental health for all future doctors.

Ethical approval

Approval for this survey was granted by senior faculty including the Head of Medical Education at Warwick Medical School, and the Biomedical and Scientific Research Ethics Committee at the University of Warwick (REGO-2015-1671).

Disclosure statement

The authors report no conflicts of interest. The authors alone are responsible for the content and writing of this article.

Glossary

‘Three-dimensional’ integration in curriculum design: A curriculum that is structured around three dimensions of integration:

Dimension 1: vertical integration between core science and clinical practice, using themes common across the whole curriculum (such as “values, law, and ethics”);

Dimension 2: horizontal integration of medical specialties by focusing learning outcomes around core clinical presentations (e.g. fatigue) rather than specific diseases;

Dimension 3: curriculum spiral of increasing complexity, that encourages students to re-visit and build upon previously experienced material as they progress through their training (de Cates et al. 2018).

Additional information

Funding

This work was completed whilst AdeC was in receipt of an NIHR Academic Clinical Fellowship.

Notes on contributors

Angharad N. de Cates

Dr. Angharad de Cates, BM BCh (Hons), BA, MSc, MRCPsych, is a Specialty Registrar in General Adult Psychiatry, and currently a Wellcome Trust Clinical Doctoral Fellow at the University of Oxford. This research was undertaken whilst she was an Academic Clinical Fellow in Psychiatry at the University of Warwick, and she remains an Honorary Research Fellow there.

Paul de Cates

Dr. Paul de Cates, BM BCh, BSc (Hons), DRCOG, MMedEd, MRCGP, FHEA, is a GP Partner and Academic Lead for Phase III MBChB at Warwick Medical School with responsibility for learning, teaching, assessment, and support of medical students in their final two years of training. He is also currently External Examiner at Keele University School of Medicine.

Swaran P. Singh

Professor Swaran Singh, MBBS, MD, FRCPsych, DM, is a Professor of Psychiatry at Warwick Medical School, Head of the Mental Health & Wellbeing Unit, and Deputy Head of the Division of Health Sciences. He is also Associate Medical Director at Coventry and Warwickshire Partnership Trust and a Commissioner for the UK Equality and Human Rights Commission.

Steven Marwaha

Professor Steven Marwaha, PhD, MRCPsych, MSc, MBBS, MA, BA, is a Professor of Psychiatry at the Institute of Mental Health, Birmingham, and until September 2018 was a Reader in Psychiatry at Warwick Medical School. Prior to this, he was a Clinical Lecturer at UCL. He also works as an Honorary Consultant Psychiatrist.