Comparative Observations in the Teaching of Psychiatry to Undergraduate Medical Students

COMPARATIVE OBSERVATIONS IN THE TEACHING OF PSYCHIATRY TO UNDERGRADUATE MEDICAL STUDENTS JOHN ROMANO, M.D.* Twelve years ago in this city I read a report in which I stated my conviction that the central concern ofpsychiatry in medical education is the scientific humanization ofbiology (i). Due attention, I pointed out, must be directed to the unique properties ofhuman as contrasted to infrahuman behavior. This report, based on many years ofpersonal experience with the students and faculties ofsix medical schools in the United States, contained references to students' preparation for medical school; current theories and practices ofmedical science; and certain problems, both ofsubstance andmethod, encountered inteaching psychiatry to medical students. Concludingremarkswere: "Tothosewho accusemedicineofbecomingtoo scientific, I wouldanswerthat it has not become scientific enough. It has onlyjust begun to use methods ofscientific inquiry into areas ofhuman experience previouslydealtwithandapproachedbyintuitiveandinspirational means. As I see them, the functions ofmedicine are to acquire knowledge and to help man free himself both from the enslavement of pain and disease and from the equal enslavement ofmorbid fear and guilt." Since then, I have had additional opportunities in my daily work with the students and faculty ofour medical school to profit from further experience. I have also had the opportunity to participate in various national and sectional groups concernedwith pkrining for medical research and education. In the academic year 1959-60, due to the generosity of the Commonwealth Fund of New York and my own university, I had the enviable * Professor and Chairman, Department ofPsychiatry, University ofRochester School ofMedicine and Dentistry; Psychiatrist in Chief, Strong Memorial and Rochester Municipal Hospitals, Rochester, New York. This paper was read at the Third World Congress ofPsychiatry, in Montreal, Canada, onJune 6, 1961. 519 opportunity ofa sabbatical year offellowship study during which I chose, among other objectives, to learn what I could ofmedical education. I was particularly interested to learn about the teaching ofpsychiatry to medical students in various medical schools in the United Kingdom and Ireland, Western European countries, Moscow in the U.S.S.R., and in the Middle East. Obviously any serious and systematic attempt to make comparative judgments necessitates knowledge and understanding of a vast array of historical events which precede the moment ofobservation. This is sufficiently evident if one makes comparative studies of schools within the United States. The point becomes imperative when one attempts to compare the substance and method ofteaching in medical schools in foreign countries. Similarly, the hazards ofsmall, even selective samples, must be obvious. In this brief report, I shall make no attempt to document the many published references on the subject with which I am familiar, nor will I cite the names ofthe many persons with whom I visited and who were most hospitable to me on my visits to their schools. It may be useful to begin with a briefstatement ofthe American scene. It is that with which I am most familiar and may serve as a backdrop to observations in other countries. American concern about education is well known. Medical education shares vigorously in this concern. Multiple determinants since the end ofWorld War II have accelerated and intensified this interest in medical education. Many, ifnot most ofour medical schools, both public and private, are in the midst ofactive expansion, in space and structure as well as infunction. We have added materially to the number of our faculty members and in some schools to the number of students in a class. Research activities ofour faculties and, increasingly, of our students have expanded. We face many problems today—the subsidy ofmedical education and medical research; the costs ofpatient care; the growing relations between the medical school and the community in which it exists. Faculties ofour medical schools are engaged in studies of the preparation of students for medicine and of the selection procedures for admission to medical schools. Medical school faculty committees throughout the nation are studying the curriculum, particularly as it relates to integrating the teaching of different disciplines. There is interest in assessing students in operational as well as in traditional examination procedures. There are studies ofteaching practices and ofthe characteristics 520 John Romano · Teaching Psychiatry Perspectives in Biology and Medicine · Summer 1962 ofsuccessful and unsuccessful teachers. A few bold persons have...