Attitude

Objectives

It is important that students develop appropriate attitudes to psychiatry as a medical discipline. These attitudes need to be encouraged during the teaching of psychiatry and other disciplines. It is important that teachers model these attitudes and that students have the ability to internalise them, not only express them verbally. Internalising occurs in the way that students work with patients and members of staff.

Attitudes concerned with medical practice generally

Students should:

recognise that the profession of medicine involves life-long learning
show capacity for critical thinking and constructive self-criticism
be able to tolerate uncertainty and acknowledge the opinion of others
be able to work constructively with other health professions.

Attitudes towards patients and their families

Students should:

recognise the value of good doctor-patient relationships
appreciate the value of the developmental approach to clinical problems emphasising the stage of the life cycle and longitudinal perspetive of the illness
recognise and respect the importance of the family and the wider environment of the patient and the contribution that culture, religion and social circumstances make to health and illness.

Attitude towards psychiatry as a medical discipline

Students should:

recognise the value of psychiatry as a medical discipline
integrate humanistic, scientific and technological aspects of knowledge of psychiatry
recognise the importance of promotion of mental health and the prevention and treatment of psychiatric disorders.

Knowledge

Objectives

The knowledge objectives of psychiatry include psychiatric symptoms and syndromes, psychological aspects of medical disorders and psychosocial issues. Psychiatric symptoms, syndromes and their treatment are to be learned in the context of an integrated biological, psychological and social approach.

Specific conditions

Delirium and Dementia – Diagnosis, Aetiology and Principles of Management.
Alcohol and Drug Abuse and Dependence – Presentation, Complications, Prevention and Treatment.
Schizophrenia – Diagnosis, Aetiology, Short and Long Term Management Principles.
Depression and Bipolar Affective Disorder – Diagnosis, Aetiology, Co-morbidity and Management.
Post Traumatic Stress Disorder, Acute Stress Disorder and Adjustment Disorder – Recognition and Management.
Anxiety Disorders and Obsessive Compulsive Disorder – Recognition and Management.
Somatoform Disorder, Hypo-chondriasis and Psychological Factors Affecting Medical Conditions– Aetiology, Recognition and Management.
Eating, Sleep and Sexual Disorders – Recognition and Management.
Personality Disorders – A conceptual understanding and their influence on physical and mental disorders.
Child and Adolescent Psychiatric Disorders – Recognition and Management of common disorders within a developmental framework.
Old Age Psychiatry – Impact of aging on Health and Illness.

Special areas of importance

These areas are critical to the treatment and practice of psychiatry in New Zealand.

Maori Mental Health - New Zealand history and the significance of The Treaty of Waitangi for Maori health, Maori models of mental health, well-being and illness, Barriers to mental health care and implications for treatment.
Recovery – an understanding of recovery principles as described in The Mental Health Commission’s Blueprint for Mental Health Services in New Zealand and basic competencies required in using a recovery approach in working with people who have mental disorders.
Pharmacology – Treatments of major and minor mental disorders including side effects of treatment.
Psychotherapy – Basic Principles of interpersonal and cognitive behavioural psychotherapies and psycho-education in the treatment of mental disorders.
Rehabilitation – Concepts of long term management of people with long term mental illness.
Risk Assessment –Recognition and basic management of dangerousness to self or others.
Ethical Issues – General Principle and their application to psychiatry including confidentiality, competency, informed consent, autonomy and beneficence.
Legal Issues – Basic knowledge of the Mental Health Act.

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Skills

Objectives

These expand and overlap from basic consultation skills but have an emphasis on the psychiatric setting.

Communication skills

These skills include the ability to communicate professionally with people of all ages and their families and those from other ethnic groups. Importantly it includes the ability to identify high-risk situations such as suicidal intent, child abuse or dangerousness.

Students should:

learn to take a formal psychiatric history including incorporating information from other sources
be able to take a drug and alcohol history
examine all dimensions of the mental state with the expectation that it will be used regularly in the assessment of patients
develop a basic understanding of the strong emotional relationship that often exists between patient and doctor especially within the realm of psychiatric illness and have the competence to use this to facilitate good communication in the interest of the patient
appreciate the importance of forming a therapeutic alliance and the role of empathy
be able to engage and interview a Maori patient and their whanau having regard for any specific cultural issues that may be important
be able to engage and negotiate treatment with often frightened or resistant patients in non psychiatric settings
be able to engage and examine a patient whose mental state is such that compulsory treatment under the mental heath act may be necessary
be able to undertake these tasks in a community or hospital setting
use principles of recovery in working with patients and their families
share information with the patient and family including the implications of diagnosis and benefits and disadvantages of treatment
understand how to adapt assessments for different developmental stages..

Information evaluation skills

Select the crucial pieces of information for making a differential diagnosis. ;
Evaluate the role of the personal and social factors in the patient’s presentation.
Formulate a management plan including when to refer for specialist assistance.

Treatment skills

Encourage adherence to treatment and explore and eliminate barriers to this. ;
Basic prescribing skills especially for psychiatric disorders commonly encountered by non psychiatrists.
Recognise adverse effects of treatment and distinguish them from illness.

Learning skills

Sustain self directed independent learning such that the student will keep up to date with new advances in psychiatry and psychological aspects of medicine throughout their professional life..

Teamwork skills

To cooperate with medical colleagues and other healthcare workers.
To be aware of patient and family organisations and other community services that support and promote mental health..

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