Undergraduate psychiatric education: a snapshot of medical students across the world
Authors: Mariana Pinto da Costa, Katerina Dima, Roger M.K. Ng
Journal: World Psychiatry (2019)

The exposure to psychiatry during medical education can contribute to increase recruitment and retention in the specialty1, 2. This is particularly important as psychiatry as a career choice seems to be on the decline worldwide3. Furthermore, while psychiatric education at the postgraduate level has been researched to some extent4-6, very little is known about how this education is included in undergraduate curricula at the global level, and even less about how medical students actually receive it across the world. To address this question, we asked medical students themselves to clarify the means they are taught psychiatry in their undergraduate courses, comparing differences across regions and countries. For this endeavor, the International Federation of Medical Students' Associations (IFMSA) and the WPA established a collaboration7. The IFMSA is the largest medical student organization worldwide, representing 1.3 million medical students from 125 countries. An online survey was developed, which was circulated through the online platforms of the IFMSA to representatives of national member organizations. The questions in the survey explored whether psychiatry is included in the undergraduate curriculum, what is the duration of the practice and/or theory classes, and how the knowledge/competencies evaluation is made. The survey was conducted between March and May 2018. Representatives from 83 countries responded (response rate: 66.4%). Psychiatry was reportedly included as a mandatory course in 81 out of 83 countries, and as an elective course in two countries (Ethiopia and Nigeria). The reported duration of theory classes varied greatly: in 37 countries these lasted more than 30 days; in 29 countries 16 to 30 days; in 17 countries 1 to 15 days. The duration of practice classes was evenly distributed: 1 to 15 days in 29 countries, 16 to 30 days in 28 countries, and more than 30 days in 24 countries. Two countries (Nigeria and Burkina Faso) reported not having practice classes at all. Comparing the results between world regions, countries from the Asian and Pacific region reported a shorter duration of education in psychiatry, while America seems to offer the longest exposure. Moreover, different methods of evaluation of knowledge and competencies acquired seem to be used. Singular multiple-choice question-type (MCQ) testing was the most frequently reported method. In fact, it was a standalone evaluation method in 17 countries, and it was used amongst other methods in 57. These findings show that worldwide countries do seem to recognize the importance of undergraduate psychiatric education, although clearly placing more emphasis on theoretical than on practical teaching. The same principle is applied in the evaluation process, as MCQ and summative assessment seem to be favored. This worldwide survey targeting medical students is the largest ever conducted in terms of number of countries included, which is a major strength. Respondents were the representatives of national member organizations of the IFMSA, which have first-hand knowledge on whether and how psychiatric education is offered in their countries. However, only 66.4% of national representatives responded, and it cannot be excluded that countries in which no undergraduate psychiatric education is provided could not be detected because their representatives did not participate in the survey. Furthermore, the respondents may not always have a full knowledge of their national situation, and there might be variations of psychiatric education across universities in the same country, which may have not been captured in the survey. Still, this survey is an initial effort to understand whether medical schools truly expose medical students to psychiatric education in the various countries of the world. It remains to be seen to which extent, if any, medical schools encourage students to opt for a career in psychiatry, especially considering the significant shortage of mental health workforce and its growing impact on global health8. We hope these findings may help to raise awareness of how psychiatric education is included in the curriculum of medical students across the world, from the perspective of those who receive it.