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Psychodynamic Concepts and Their Application – A Curriculum for Fourth Year Medical Students. Robert F. McFadden, MD Alexandra H. Sawicki, PGY1 Emory University Nadia H. Sawicki, PGY1 Emory University. Abstract:
Robert F. McFadden, MD
Alexandra H. Sawicki, PGY1 Emory University
Nadia H. Sawicki, PGY1 Emory University
We report on a four-week curriculum developed to teach psychodynamic concepts to fourth year medical students. The course will provide students entering the field of psychiatry the conceptual foundation for doing a psychodynamic evaluation and developing an elementary case formulation. Introducing such an interactive curriculum would alter the make-up of current faculty by bringing analytically and psychodynamically-oriented faculty into contact with students earlier in the students’ psychiatric training. Currently, residents usually experience training in psychodynamic concepts late in their residency. However, creating a curriculum for medical students that will satisfactorily outline the topic, be usable in residency, and encourage further interest while maintaining an achievable breadth is a significant challenge with little precedent. Follow-up with students who took this independent study course is a future consideration.
In developing this four-week curriculum we identified the following learning objectives: 1) Acquire a strong, basic foundation in psychodynamic concepts and dynamic formulation 2) Apply psychodynamic principles in the evaluation and diagnosis of patients at a local arts college and develop treatment and disposition planning. 3) Encourage students’ interest in mental processes and support this interest with faculty involvement. Once these goals were outlined appropriate texts for the course were selected.
Overall Purpose – Design a Psychiatry Elective in Psychodynamic Concepts
Set Specific Goals for the Course
1) Read, discuss, and develop a strong, basic foundation in psychodynamic concepts
2) Learn to apply psychodynamic principles to clinical work even early in residency.
3) Learn to write a dynamic formulation.
Record Details of Course – Time spent, teaching methods, etc
Review Course – Evaluate what succeeded and what could be changed to improve the course for the future
Challenges of teaching
Psychodynamics to medical students:
Importance of teaching
psychodynamics to medical students
How have educators taught
psychodynamic concepts in the past?
Length of course: 4 weeks
Participants: 1 instructor, 2 students
Meetings: 1-3 hours daily
1) Weekly observation of an attending physician conducting intake interviews
2) Daily discussion of readings
Readings: 2 core books + 1 chapter
MSIV elective, Psychiatry Department
Not counted as a sub-internship
“By Departmental Arrangement”
Offered 1-2 months of the year
Consider requiring a case write up/application
Discussion of the readings
Self-directed reading and research
Concise Guide to Psychodynamic Psychotherapy7
Psychodynamic Concepts in General Psychiatry8
Psychoanalytic Case Formulation9
Akhtar, Salman. The Damaged Core: Origins, Dynamics, Manifestations, and Treatment. Lanham, MD: Jason Aronson, 2009, 113-146 (Chapters 7&8, The Analyst’s Office and Listening)
Akhtar, Salman. New Clinical Realms: Pushing the Envelope of Theory and Technique. Northvale, NJ: Jason Aronson, 2003, 179-210. (Chapters 8&9, From Schisms through Synthesis to Oscillation and Mentorship)
Akhtar, S. and Samuel, S. The Identity Consolidation Inventory (ICI): Development and Application of a Questionnaire for Assessing the Structuralization of Individual Identity. The American Journal of Psychoanalysis: 69, 53-61, 2009.
Cohen M., Kay A., Youkaim JM, Balacius JM. Identity Transformation in Medical Students. The American Journal of Psychoanalysis: 69, 43-52, 2009.
Coltart, NE. The Assessment of Psychological-Mindedness in the Diagnostic Interview. British Journal of Psychiatry (1988): 153, 819-820.
Marguiles, A. and Havens, LL. The Initial Encounter: What to Do First? American Journal of Psychiatry 138:4, 421-428, April 1981.
Williams, Gianna: Reflections on Some Dynamics of Eating Disorders: ‘No Entry’ Defences and Foreign Bodies.International Journal of Psycho-Analysis 78: 927- 939 (1997).
Additional Chapters from Psychodynamic Concepts in General Psychiatry ed. by Harvey Schwartz. Chapter 18- The Depressed Male Homosexual Patient and Chapter 21- The Patient with Bulimia
Excerpts from: Get Me Out of Here by Rachel Reiland
Topics We Learned Best:
-more case-based learning for those who have limited opportunity to observe psychodynamic interviews.
The more observed psychodynamic interviews the better.
Reintroduce dynamic concepts to medical schools’ psychiatry clerkships.
1) Expose potentially interested students to intellectually challenging topics within psychiatry
2) Give future doctors in all specialties basic information about psychotherapy
3) Improve future physicians’ understanding of psychodynamic aspects of the patient-physician relationship