Mind, brain and person: reviewing psychiatry's constituency

Objective: To clarify monist, dualist, and pluralist philosophy that could help psychiatrists to explain how mental and physical states relate in general.Method: Varieties of monism and dualism are summarised and the problems that they entail for psychiatry are briefly described. Pluralism in the mind-body debate is reviewed in relation to the concept of a person, and mathematical representations are formulated to capture the relation between mind, body and person.Results: Monism, dualism and a conjunctive approach to mind and body are rejected in favour of a non-conjunctive pluralism that locates logical primacy at a person. Accordingly, mind and brain are extricates among a plurality of extricates of a person. This conceptualisation accounts for both the intimacy between mental and physical states in some instances and the distance in others.Conclusion: The patient, rather than a mind or a body, has been logically and historically at the centre of psychiatric practice. This suggests psychiatry has its own epistemology that is logically primary in relation to its contributory subjects (biology, psychology, sociology, etc). Keywords: philosophy, models/theories of psychiatry, dualism, monism, pluralism South African Psychiatry Review Vol. 9(2) 2006: 93-9

Medical students' perceptions of their development of ‘soft skills' Part II : The development of ‘soft skills' through ‘guiding and growing'

BackgroundThis paper reports on medical students' views on the ways in which their ‘soft skills' were developed. It is the result of a study on soft skills among two groups of students before and after curriculum reform at the School of Medicine of the University of Pretoria. One of the aims of the reform was to provide more teaching and learning opportunities for the development of soft skills. Soft skills include professional interpersonal and social skills, communication skills, and professional and ethical attitudes.MethodsAs symbolic interactionism was used as the theoretical framework to guide the research, qualitative methods were used to collect the data. A purposive-theoretical sample of 42 final-year medical students from the traditional curriculum and 49 from the reformed curriculum was recruited. Data were collected by means of focus groups, individual in-depth interviews and autobiographical sketches. ResultsThe same categories of comments emerged from the data collected from the study participants from both the traditional and the reformed curriculum. The students ascribed their behaviour related to soft skills to personality and innate features. They had varying opinions on whether soft skills could be taught, but there was as a strong feeling that teaching should focus on principles and guidelines for dealing with difficult situations. They believed that, in the end, they should take responsibility for their own development of soft skills. Most participants felt they could at least grow through exposure to teaching activities and the observation of role models. They also indicated that they had developed their soft skills and constructed their own identity through their interaction with others. Their definition of situations was shaped by their interactions with doctors and educators, fellow students and other health professionals. Interaction with patients was considered the most important. For both groups of students their third year was a watershed, as it is the first year of more intensive patient contact and the beginning of serious learning from interaction with patients. The views on the development of soft skills differed very little between the traditional and reformed curriculum groups, except that students who had followed the reformed curriculum felt more prepared through the increased teaching and training efforts. Further consideration needs to be given to the intention of the changed curriculum compared to the actual effect. The way in which the participants in the study described their development of soft skills could be categorised as a complex interplay between ‘being' and ‘becoming'. Instead of using the word ‘acquisition' of soft skills, ‘development' seemed to be more appropriate. The metaphor of ‘guiding' and ‘growing' also captures the development of these skills better than the terms ‘teaching' and ‘learning'.ConclusionTeaching activities in the clinical years should be adapted with a view to facilitating the students' professional growth. New models for the development of medical educators should be created and institutional barriers should be investigated.For full text, click here: SA Fam Pract 2006;48(8):15-15

The conceptualisation of "soft skills" among medical students before and after curriculum reform

Objective: This paper reports on the conceptualisation of "soft skills" as part of a study carried out among two groups of undergraduate medical students before and after curriculum reform at the School of Medicine of the University of Pretoria. Congruent with a call from the World Psychiatric Association, the curriculum reform that was undertaken aimed, inter alia, to place more emphasis on soft skills, including professional interpersonal and social skills, communication skills, and professional and ethical attitudes. Methods: Qualitative methods were used to arrive at a descriptive comparison of the conceptualisation of soft skills by final-year medical students of the traditional curriculum with those of final-year students who had followed the reformed curriculum. A purposive-theoretical sampling method was followed; 42 students from the traditional curriculum and 49 from the reformed curriculum were sampled. Data were collected from seven focus groups, 16 individual interviews, and 23 essays (autobiographical sketches). Results: Both groups of students revealed conceptualisations of soft skills that were similar in kind. The themes they pinpointed were the doctor-patient relationship; relationships with other professionals; being a good listener; explaining things to patients; using good communication skills; establishing rapport with patients from different cultural backgrounds; having a professionally correct attitude; being really interested in patients' well being; having empathy; coping with patients, managing difficult situations, and being ethical and professional. However, the traditional curriculum students offered fewer examples and described fewer experiences that exemplified their soft skills. Students following the reformed curriculum gave rich accounts of their conceptualisation in terms of their own experiences and practical examples of how soft skills had been or could be used, particularly in difficult interpersonal situations. Moreover, they came up with helpful ways of dealing with difficult situations, which surpassed the suggestions offered by the students following the traditional curriculum. Conclusion: The educational and training efforts of the reformed curriculum are associated with an adeptness on the part of the students at applying soft skills to the demands of difficult clinical situations. Keywords: soft skills, interpersonal skills, doctor-patient relationship, professional socialisation South African Psychiatry Review Vol. 9(1) 2006: 33-3

Medical students on the value of role models for developing 'soft skills' - "That's the way you do it

Objective: The Soft Skills Project examined the professional development of medical students at the University of Pretoria, especially their doctor-patient interaction skills and professional socialisation. This paper reports on one of the findings of the project, namely the importance that medical students attach to role models in the development of soft skills. Methods: We used a qualitative method with symbolic interactionism and grounded theory as framework. Fourty two final-year students from the last cohort following the traditional curriculum at the University of Pretoria in 2001, and 49 final years from the first cohort following the reformed curriculum in 2002 were recruited. Data were collected by applying focus groups, in-depth, individual interviews, as well as autobiographical sketches. Data were captured by means of audio tape recordings, transcripts of the tapes, researchers' field notes, and written accounts by students, and were analysed by using a general inductive approach. Results: There were no striking differences between the comments of the two groups. Students considered registrars to be the most influential role models in the clinical teaching context, followed by specialist consultants. Their idea of a good role model was a clinically and academically competent doctor that cared about patients, had good interpersonal skills, and who could inspire students. Students needed and appreciated good role models to help them to develop their own soft skills. They expected guidance and behavioural examples from clinical teachers. Although there were competent role models, the students were exposed to poor role models. Poor role models mainly affect students negatively. Students tend to imitate and perpetuate unacceptable behaviour. Furthermore, poor role models have a negative emotional effect on students and are detrimental to their moral and learning environment. Sometimes, poor role models have a paradoxical positive effect in the sense that they inform students how not to behave. Conclusion: Medical schools and medical doctors working with medical students should be consciously aware of the importance of role models both when allocating clinical teachers to students, and while performing duties with students. It is especially necessary to realise that poor role modelling has important detrimental effects on students. Therefore, an attempt should be made to ensure that not only clinical examination skills, but also soft skills, are demonstrated at the bedside. Measures to ensure adequate exposure of students to positive role models could include: staff development; the identification of good role models to guide registrars; and a reallocation of tasks, where possible, to increase the exposure of students to the ‘natural' role models. Keywords: soft skills, role models, medical students, professionalism South African Psychiatry Review Vol. 9(1) 2006: 28-3

The prevalence of common mental disorders and PTSD in the UK military: using data from a clinical interview-based study

<p>Abstract</p> <p>Background</p> <p>The mental health of the Armed Forces is an important issue of both academic and public interest. The aims of this study are to: a) assess the prevalence and risk factors for common mental disorders and post traumatic stress disorder (PTSD) symptoms, during the main fighting period of the Iraq War (TELIC 1) and later deployments to Iraq or elsewhere and enlistment status (regular or reserve), and b) compare the prevalence of depression, PTSD symptoms and suicidal ideation in regular and reserve UK Army personnel who deployed to Iraq with their US counterparts.</p> <p>Methods</p> <p>Participants were drawn from a large UK military health study using a standard two phase survey technique stratified by deployment status and engagement type. Participants undertook a structured telephone interview including the Patient Health Questionnaire (PHQ) and a short measure of PTSD (Primary Care PTSD, PC-PTSD). The response rate was 76% (821 participants).</p> <p>Results</p> <p>The weighted prevalence of common mental disorders and PTSD symptoms was 27.2% and 4.8%, respectively. The most common diagnoses were alcohol abuse (18.0%) and neurotic disorders (13.5%). There was no health effect of deploying for regular personnel, but an increased risk of PTSD for reservists who deployed to Iraq and other recent deployments compared to reservists who did not deploy. The prevalence of depression, PTSD symptoms and subjective poor health were similar between regular US and UK Iraq combatants.</p> <p>Conclusion</p> <p>The most common mental disorders in the UK military are alcohol abuse and neurotic disorders. The prevalence of PTSD symptoms remains low in the UK military, but reservists are at greater risk of psychiatric injury than regular personnel.</p

Rate accelerations in nuclear 18S rDNA of mycoheterotrophic and parasitic angiosperms

Rate variation in genes from all three genomes has been observed frequently in plant lineages with a parasitic and mycoheterotrophic mode of life. While the loss of photosynthetic ability leads to a relaxation of evolutionary constraints in genes involved in the photosynthetic apparatus, it remains to be determined how prevalent increased substitution rates are in nuclear DNA of non-photosynthetic angiosperms. In this study we infer rates of molecular evolution of 18S rDNA of all parasitic and mycoheterotorphic plant families (except Lauraceae and Polygalaceae) using relative rate tests. In several holoparasitic and mycoheterotrophic plant lineages extremely high substitution rates are observed compared to other photosynthetic angiosperms. The position and frequency of these substitutions have been identified to understand the mutation dynamics of 18S rRNA in achlorophyllous plants. Despite the presence of significantly elevated substitution rates, very few mutations occur in major functional and structural regions of the small ribosomal molecule, providing evidence that the efficiency of the translational apparatus in non-photosynthetic plants has not been affected

Limited access to an individual’s mental content: a constraint on the strength of our knowledge in courts

No abstract available