Birth Order and Sibling Gender Ratio of a Clinical Sample Short Communication Comparison of Two Different Curricula in Psychiatry Clerkship at Tehran University of Medical Sciences Maryam Tabatabaee, MD 1 Homayoun Amini, MD, MPH 1 Fattaneh Abdi Masouleh, MSc1 Ali-Akbar Nejatisafa, MD 1,2 Mohammad Arbabi, MD 1,2 Majid Sadeghi, MD 1 Vandad Sharifi, MD 1 S. Ali Ahmadi-Abhari, MD 1 Azim Mirzazadeh, MD 3 Emran Mohammad Razzaghi, MD, MPH 1 Ahmad Ali Noorbala, MD 1 1 Department of Psychiatry, Objectives: The aim of this study was to evaluate the efficacy of a new Tehran University of Medical psychiatry clerkship curriculum which was designed to improve the Sciences, Tehran, Iran knowledge and skills of medical students of Tehran University of Medical 2 Psychiatry and Psychology Sciences (TUMS), Iran. Research Center, Tehran Methods:This quasi-experimental study was conducted in two University of Medical Sciences, consecutive semesters from February 2009 to January 2010. In total, 167 Tehran, Iran medical students participated in the study. In the first semester, as the 3 Department of Internal control group, the clerks’ training was based on the traditional curriculum. Medicine, Imam Khomeini In the next semester, we constructed and applied a new curriculum based Hospital, Center for Educational on the SPICES model (student-centered, problem-based, integrated, Research in Medical Sciences community-based, elective and systematic).At the end of the clerkship, (CERMS), Tehran University of the students were given two exams: Multiple Choice Questions (MCQ) to Medical Sciences, Tehran, Iran. assess their knowledge, and Objective Structured Clinical Examination (OSCE) to assess their skills. Baseline data and test performance for Corresponding author: each student were analyzed. Maryam Tabatabaee, MD Results: Compared to the control group, students in the intervention Assistant Professor, Department group showed significantly higher OSCE scores (P= 0.01). With respect of Psychiatry, Tehran University to MCQ score, no significant difference was found between the two of Medical Sciences, Roozbeh groups. Hospital, South Kargar Ave., Conclusions: The results suggest that the revised curriculum is more Tehran 13337, Iran. effective than the traditional one in improving the required clinical skills in Tel: +98-21-55412222 medical students during their psychiatry clerkship. Fax: +98-21-55419113 Email: Key words: Psychiatry, Clerkship, Education, Medical students, Curriculum [email protected] Iran J Psychiatry 2013; 8:3: 145-148 A substantial proportion of patients who are University of Medical Sciences (TUMS), visited by general practitioners are suffering from undergraduate medical education includes2 years of psychiatric illnesses, while only about one third of basic sciences course, 4 years of clerkship and 18 psychiatric cases are correctly detected (1). It is months of internship,lasting7.5 years. Psychiatry crucial that psychiatric teaching is relevant and clerkship in TUMS was a 4-week essential course useful to future doctors to ensure that patients with taken in the fourth or fifth year; and the students psychiatric illnesses receive appropriate care for both were assigned to Roozbeh Hospital (Tehran, Iran), their physical and mental health problems (2). In the and spent 1.5 days per week in outpatient clinics and last decade, medical schools’ curricula have been 4 days on inpatient services. They also attended reformed to better prepare students for their future didactic seminars on psychiatry during a 4.5-month careers (3).Medical education curriculum in Iran semester. Each student's clinical performance was follows a discipline-based, teacher-centered and assessed by residents and attending physicians. hospital-based approach (4), but more attention has Then, a written exam in the form of “multiple choice recently been paid to curriculum reform. At Tehran Iranian J Psychiatry 8:3, August 2013 ijps.tums.ac.ir 145 Tabatabaee, Amini, Abdi Masouleh et al questions” was given to students at the end of the widely known modern method for assessment of semester skills. Students spent 3 days per week in the . The curriculum for psychiatry clerkship was outpatient clinic and in the hospital’s emergency traditional and revision was needed. The range of room; and the remainder of their time was spent on concerns about the traditional curriculum included: inpatient services, but the control group spent more 1) a need for integrated clinical and theoretical time in the inpatient setting. In our unrevised education;2) a need for learning objectives to go curriculum program, like traditional curricula in beyond knowledge acquisition, and including other countries, the most common form of fundamental clinical skills; and 3) a need to align the assessment was a written examination (9) . final assessment to the stated learning objectives (5). At the end of the clerkship, students took two In developing the new curriculum, we took steps to examinations. First, they were given Multiple Choice adopt some part of the SPICES model (student- Questions (MCQ) for knowledge assessment, which centered/teacher-centered, problem- was set by faculty members of the Department of based/information-gathering, integrated/discipline- Psychiatry in TUMS who were either psychiatrists or based, community-based/hospital-based, psychologists. elective/uniform and systematic/apprenticeship- No significant differences were found between the based) (6). two groups in terms of discrimination index and The goal of this study was to evaluate the efficacy of difficulty index. Also, the Objective Structured a new psychiatry clerkship curriculum for improving Clinical Examination (OSCE) was administered to medical students’ knowledge and skills. students to assess their skills. Moreover, we conducted the OSCE with five stations to evaluate Material and Methods the students’ skills in psychopathology, mental status examination, suicide or violence risk assessment and case formulation. The raters were trained psychiatry This quasi-experimental nonrandomized comparative residents, and for each OSCE station raters were the study was conducted in the two consecutive same for the two groups semesters from February 2009 to January 2010. All . Baseline data and test performance were analyzed medical students who started their required 4-week using SPSS 17.Age, (NCBSES) and Grade Point psychiatry clerkship in Tehran University of Medical Average (GPA) were assessed using independent Sciences during this period were invited to student’s t test or the Mann-Whitney test (depending participate in this study. Information on demographic on whether or not the distribution was normal). and educational factors was obtained at the time of Gender was assessed using chi square test. entry into the study. Demographic and educational factors were assessed To compare educational background between the two using the Mann-Whitney’s test and the examination groups, National Comprehensive Basic Sciences scores were compared by independent T-test. P-value Examination Score (NCBSES) and Grade Point was set at 0.05. Average (GPA) were used. NCBSES is a national multiple choice question exam, which is set at the end of the two-year basic sciences course. Maximum Result score for NCBSES is 200, and maximum score for GPA is 20. GPA is the mean of scores of clinical In total, 167 medical students started their required courses psychiatry clerkship from February 2009 to January . In the control group, the clerks’ training was based 2010. The control and the intervention groups on the traditional curriculum. In the next semester, consisted of 67 and 89 students, respectively. Eight we constructed and applied a new curriculum which students in the control group and3 in the intervention was approved by the Department of Psychiatry. The group did not agree to participate in the assessment major changes in the new undergraduate curriculum portion of the study. Demographic and educational data included: 1)Integration of clinical training with of the two groups are demonstrated in table 1. There teaching“ Theory of Psychiatry” in a 4-week course were no significant differences between the two groups (as opposed to the old curriculum where didactic with the exception of the mean age which was higher lectures and the rotation of 4-week psychiatry in the control group. clerkship were not simultaneous.(;2)Conducting 16- Compared to the control group, students in the hour workshops to teach the essential topics (7, 8), intervention group showed significantly higher OSCE which included effective skills in communication, scores. Furthermore, no significant difference was history taking and interviewing, examining mental found between the two groups with respect to MCQ state and ability to recognize, assess and initiate the scores (Table 2). management of common psychiatric problems(instead of 6-hour lecture in the previous curriculum(;3)Doubling clinical practice in outpatient clinics;4) Using the Objective Structured Clinical Examination (OSCE),which is the most 146 Iranian J Psychiatry 8:3, August 2013 ijps.tums.a c.ir Comparison of Two Different Curricula in Table 1: Comparing Age, Gender, and Outcome Measures in Two Groups of Medical Students Entering Psychiatry Clerkship based on New vs. Traditional Curriculum two groups Curriculum Old New Statistic P-value Variables Age (year) 23.5 ± 0.5 23.9 ± 1.8 T or z 0.016 Gender (female) 55.2% 44.3% א2 0.178 NCBSES (Mean± SD) 142 ± 29 144 ± 28 T or z 0.417 GPA (Mean± SD) 16.3 ±1.2 16 ±1.1 T or z 0.342 NCBSES: National Comprehensive Basic Sciences Examination Score GPA: Grade Point Average Table 2: The comparison of final assessments between control group and intervention group Curriculum Old New df t P- value (Control group) ( Intervention group) Assessments OSCE (score± SD) 68.3±13.0 74.0±14.5 154 2.55 0.012 Max100 MCQ (score± SD) 15.0±1.7 14.7±1.8 148 1.01 0.313 Max20 Discussion developing countries. Psychological Medicine 1980; 10:231-241. 2. Oakley C, Oyebode F. Medical students' views The finding of this study revealed that the new about an undergraduate curriculum in curriculum, by adopting more outpatient clinical psychiatry before and after clinical placements. practice, integrated education and using interactive, BMC Med Educ 2008; 8:26. students-centered teaching methods in workshops, is 3. Watmough S, Garden A, Taylor D. Pre- more effective than the traditional method in improving registration house officers’ views on studying the required clinical skills of medical students during under a reformed medical curriculum in the their psychiatry clerkship. UK. Medical Education 2006; 40: 893-899. Limitations and Recommendations 4. Tavakol M, Murphy R, Torabi S. Medical education in Iran: An exploration of some This study was limited to medical students at one curriculum issues. Medical Education Online institution, and therefore not generalizable to other 2006; 11: 1-8. programs or specialties. Small sample size and the 5. Burke MJ, Brodkey AC. Trends in impossibility to blind the examiners are other Undergraduate Medical Education: Clinical limitations of the study. Certainly, more revision of our Clerkship Learning Objectives. Academic curriculum together wither form of medical education Psychiatry. 2006; 30: 158-165. curriculum is needed. Also, designing a randomized 6. Harden RM, Sowden S, Dunn WR. blind research approach is required. To develop a Educational strategies in curriculum modernized curriculum, we should put emphasis on development: The SPICES model. Medical Education. 1984; 18:284 – 297. competence-oriented, community-oriented and 7. Ring H, Mumford D, Katona C. Psychiatry in integrated education (4, 13,14). the new undergraduate curriculum. Advances in Psychiatric Treatment. 1999; 5: 415-419. Acknowledgements 8. Sensky T. 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