Extended Psychiatric Interview and Medical Students: A Tool for Teaching Psychotherapeutic Skills
Davis, Hillel, Aronzon, Rami, Rosca-Rebaudengo, Paula, Guttmann, Flor, The Israel Journal of Psychiatry and Related Sciences
Abstract: Background: There is difficulty in teaching medical students clinical psychiatric skills, specifically the clinical interview and general psychotherapeutic technique. We present a way to convey to students the ability to assess and make contact with patients while being aware of and utilizing their own presence as part of the therapeutic process. We describe a model for teaching these skills based on a prolonged clinical interview. Methods: Medical students in their second clinical year interview new attenders at a public mental health clinic treating a range of neurotic and personality related disorders. Each student is assigned one patient whom he interviews independently at three weekly sessions lasting an hour. The students remain the sole therapeutic contact and are instructed to conduct an open interview with the purpose of maintaining therapeutic contact while gathering relevant information and assessing psychopathology. Supervision is conducted in a group session each week. Results: It is our impression that despite initial resistance, the students display a remarkable ability to conduct the prolonged interview in the form of a very brief therapeutic encounter. They show considerable appreciation of the basic issues involving transference and counter-transference. Over 20 years experience, there have been no reported adverse reactions in patients assessed in this process. Conclusions: The supervised experience of an extended psychiatric interview, performed independently by medical students, facilitates the learning and acquisition of basic psychotherapeutic concepts and skills. We propose this model as an effective way of introducing medical students to the psychotherapeutic aspects of psychiatry.
The teaching of clinical psychiatry to medical students presents a challenge involving the teaching of both clinical skills as well as knowledge and attitudes. The clinical skills involved are not specific to psychiatry but to the teaching of all medical disciplines (1). In psychiatry, the clinical interview is the main diagnostic tool and also has considerable therapeutic implications. It is thus, probably, the most important feature of psychiatric clinical training (2).
The clinical interview provides a setting where the student learns to relate to the patient and develop his or her ability to listen, display understanding and empathy while guiding a clinical conversation and assessing the medical problems presented. The interviewer is both inside and outside the process; interacting with, while at the same time observing the patient and his own reactions.
For both student and expert alike, the interview provides a tool and setting to experience and observe what happens in the space between the patient and the interviewer. In both interviewing and in psychotherapy the art consists of the ability to facilitate, participate in, experience and observe simultaneously the processes of this in-between space.
Psychiatric clerkships are rated by many medical students as less than optimal experiences and considered as "a holiday," an attitude that can negatively affect learning (3). Part of this disaffection with psychiatry seems to be due to a failure in assigning the students responsibility during the clerkship (3, 4). Moreover, it has been commented that medical students see proportionally too many cases of psychotic illness compared with minor psychiatric conditions and are thus not adequately trained in basic communication skills and the ability to handle some of the more subtle interpersonal aspects of doctor-patient relationships (5, 6). Compared to more traditional in-patient-based clerkships, out-patient psychotherapy based clerkships can provide training in these areas and it has been shown that the students themselves prefer this approach (6). Teaching medical students psychotherapy has long-term benefits: providing experience for the potential psychiatrist, providing awareness of psychosomatic complaints often missed in hospital practice and dealing with the psychological issues raised by treating physically ill patients with an increased awareness of both transferential and counter-transferential processes (7, 8). …