How to study psychiatry? Some recommendations.

In talking to medical students and junior medical officers one key difference that strikes me about the challenges of studying medicine these days versus when I was in medical school (approximately 20 years ago) is the amount of information that is now available through various sources.

I am often told by students that they are overwhelmed by the amount of resources available to help them study psychiatry.

In previous generations you could pretty much deal with one major text (my favourite for psychiatry was Kaplan & Sadock which is still quite good) some lecture notes and clinical experience.  Now there is a much wider array of resources many of it free and open access or #FOAM (which if you don’t know by know stands for Free Open Access Medical Education).

In some ways this is akin to the challenge in evidence based medicine which is apparently doubling or trebling or something in content every year (sorry its hard to keep up ???? ).

Whereas in the past the medical educator had a strong content creation or expert role that is no longer the case or necessary.  This can be either perceived as threatening or liberating.  I tend to the liberating side as it allows me to focus my limited times on other aspects of medical education one of which is curation of content.

So in the spirit of the “medical teacher as curator” here are some of my personal recommendations:

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[ts-fab]

I am often told by students that they are overwhelmed by the amount of resources available to help them study psychiatry…  So in the spirit of the “teacher as curator” here are some of my personal recommendations.

TextBooks

Something for FREE!:

The Health Education & Training Institute, NSW provides an excellent free resource called Acute Psychiatric Management.

It is aimed at junior doctors encountering psychiatry situations for the first time.  It has well written short chapters on topics such as: assessment after self harm, working with Aboriginal and Torres Strait Islander people, the various medications, the Mental Health Act NSW and dealing with aggression.  It covers a considerable amount of the curriculum for final year medical students at the JMP and has the added bonus of being NSW specific.

General Texts:

There’s still nothing like flicking through a good textbook to help you get a good broad sense of the subject.  There are many general psychiatry texts available but I’d highly recommend Foundations of Clinical Psychiatry by Bloch & Singh as its an Australian text, somewhat briefer but still comprehensive than the New Oxford Textbook of Psychiatry or Kaplan & Sadock’s Synopsis (where the title Synopsis is somewhat deceiving).  The Fourth Edition comes post DSM V.

For something a little briefer and more practical I’d recommend Crash Course in Psychiatry.  The current printed edition comes with a handy free eBook download and the chapters are very practical.  Part I chapters are about patient presentations e.g.  the patient with low mood, the patient with suicide or self-harm intent, the psychotic patient.  Part II is about diseases & disorders.  Part III covers history, examination, investigation and management.

Specific Texts:

As to whether you also require a more specific text for particular aspects of psychiatry the two issues that commonly crop up are phenomenology (mental state exam) and psychopharmacology.

So far as I am aware there is no text on phenomenology that would be of use to medical students.  In general phenomenology and the mental state exam is covered well enough in the general texts above.

If you are interested in getting a bit further into phenomenology psychiatry trainees usually study Sim’s Symptoms in the Mind and there should be a copy of this in most medical libraries.  I studied Fish’s Clinical Psychopathology which is more condensed than Sims.  This text went out of circulation but has recently been republished by the Royal College in UK, although reviews are variable.  It may be a little more difficult to find in libraries.

For psychopharmacology there are many options but you really can’t go past Stephen Stahl as  a resource for understanding how the major classes of psychotropics work and in particular how side effects arise.  The problem is which version of Stahl as there are many.

If you have access to any of the Stahl textbooks via your university either library or online I’d recommend doing that.  If not you might consider purchasing either Essential Psychopharmacology or some of the briefer Illustrated Guides, in particular the ones on antidepressants, mood stabilizers and antipsychotics.

As an alternative the Australian produced Therapeutic Guidelines Series produces an excellent pocket sized psychotropic guide which should suffice and in particular covers dealing with aggression in psychiatry settings well (HINT: possible exam scenario)

 

Video Resources

A study of psychiatry lends itself quite nicely to the visual medium.  Many students find it helpful to observe videos of patient interviews (which are normally simulated) in particular to learn how to take a psychiatric history and to learn about mental state examination and phenomenology.

Below are some curated youtube videos and associated resources as well as some links to other websites where some good videos can be found.  These are very useful for practising describing the MSE in particular.  I would encourage you to watch the videos and then try to write the MSE findings down straight afterwards.  Do this before you go and look at any explanatory notes.

The best Australian source I have found is from the Palmerston Organisation

As part of the Perth Co-occurring Disorders Capacity Building Project 3 case vignettes complete with video explainers were developed for a target audience of alcohol and drug counsellors in order to better teach the mental state examination.  Because the target audience is in a related field to psychiatry I think the videos are also pitched quite well at a medical student and JMO level.  In particular the approach taken is to not get overly pedantic about precise phenomenological descriptions but to describe well the findings.

 

A training guide complete with an overview of the MSE in the 3 cases is provided here.

Booklet

A suggested guide to MSE is provided here.

MSE Guide

Across the Tasman the University of Auckland have developed a series of videos for a medical student and general practice trainee audience.  Unfortunately, these are not available on a streaming service or creative commons (I have asked) so you will have to go here to check them out yourself but they are very good albeit a little dated (from the 90s by the look of it).

The University of Nottingham have also published a series of example video interviews which are once again very handy for practising the MSE.  Again they are a little bit dated but I think demonstrate some good signs, including some of the interesting findings in relation to appearance and behaviour.

Finally the other Newcastle University has an extensive youtube channel with videos demonstrating a range of disorders as well as some abnormal movements, including catatonia and dystonia.

Psychiatry Teacher Newcastle University

 

Blog Sites

One helpful blog site I have found is Geeky Medics which has what appears to be an expanding repertoire of content.  Their mental health stuff is somewhat hidden under the broad title of “communication skills”.

The onthewards site (COI I’m the CTO and occasional blogger for this one) also has quite a few good posts as well as podcasts.

I’d be interested to hear of any other recommendations.  Please put a comment below.

Podcasts

onthepods is the podcasts section of onthewards, which is a site tasked with providing useful content for medical students and doctors starting out in their careers.

I am involved as CTO of this site.  Occasionally I also get on the pods or blog.

So far we have covered the following mental health topics:

Patients experiencing suicidal thinking

Psychosis

Anxiety

Code Black

Toxicology Part 1 & Part 2

Alcohol Withdrawal

Altered Consciousness

Confused Elderly Patients

Guidelines

Guidelines are particularly useful in psychiatry in relation to management approaches.  The better ones will cover off on both biological, psychological and social as well as also the approach to assessment (i.e. confirming the diagnosis).

Sadly in Psychiatry there is no well curated spot to go with a comprehensive list of quality guidelines.  A lot of groups have started to develop guidelines and then run out of steam or discovered that others have already produced some quality guidelines and so not wanted to duplicate.

The Royal Australian and New Zealand College of Psychiatrists had a bit of a go at guidelines a few years ago and produced some good guidelines written in both health professional and consumer format for panic disorder, deliberate self harm, eating disorder, mood disorder and schizophrenia as well as endorsing a number of others.

 

RANZCP Guidelines

Another great source of guidelines (not just for mental health) is the National Institute for Health and Care Excellence in the UK.

 

NICEGuidelines

 

Finally, if you do have access to Up To Date it does have some helpful information on a range of conditions which I have found to be useful in the past.

 

 

eLearning

For those with access to the NSW Health Learning Management System there are some very good mental health modules available. Including “Mental Health Basics” and a short module on Mental State Examination.  In addition all the MHPOD modules (see below are available here).

The MHPOD site is a Federal Government initiative which houses a vast array of free eLearning resources.  Its undergoing a rebuild and will eventually allow for self-registration.  Unfortunately, there is no information as to when this will be available.

Finally the RANZCP has a number of good eLearning resources including 4 on Aboriginal and Torres Strait Islander mental health that are publicly accessible.

Practice Exams

I used the Trick Cyclists website to help study for my Psychiatry exams in the 2000s.  Its still going strong.  Most of these practice OSCEs are too advanced for a medical student so I’d advise modify them in groups and then practice on each other.

 

Trick Cyclists
I’d really welcome some suggestions as to how to improve upon the above resources.  Please leave me a comment below if you found any of these resources useful or unhelpful.  Also, if you come across something else that you think should be shared please let me know.
Anthony Llewellyn
I was born on Mouheneenner land in Hobart, Tasmania and I pay my respect to the traditional owners of lands I live and work on and elders past and present. My two most important roles in life are proud husband and father of two boys. I am a psychiatrist and medical educationalist from Newcastle. From 2012 to 2016 I was the (Executive) Medical Director of HETI. I am now currently working in Newcastle in private practice part-time as well as teaching and training medical students, junior doctors and psychiatry trainees. I am also enrolled in a PhD in medical education. I continue to play a role in #FOAMed websites, in particular onthewards and the #ICEBlog.
Anthony Llewellyn
Anthony Llewellyn

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