Eric R. Marcus, M.D., Director, Undergraduate Psychiatric Education
Janis Cutler, M.D., Co-Director, Undergraduate Psychiatric Education

The Department of Medical Student Education in Psychiatry at the New York State Psychiatric Institute is responsible for approximately 500 medical students in five affiliated hospitals including New York State Psychiatric Institute, Creedmoor Psychiatric Center, Columbia-Presbyterian Medical Center, St. Luke's-Roosevelt Hospital Center and Stamford Hospital.

We supervise a teaching curriculum at the Columbia University College of Physicians & Surgeons that extends throughout the four years of medical school on a year round basis. The department is also responsible for helping to develop the whole medical school curriculum. We are also generating research in medical education--organization, curriculum, and the developmental process of medical students in their training. The division is administered by Dr. Eric R. Marcus, Director; Dr. Janis Cutler, Co-Director and Ms. Edith White, Administrator. Program development and the organization of teaching and research are done by the central staff of our division. The teaching is done by the full-time and voluntary faculty of the Department of Psychiatry. Because we are one of the largest teaching departments of psychiatry in the world, we are able to offer teaching programs with a wide range and considerable depth. The first-year course in psychiatry at the medical school begins with psychopathology. Although this is heuristically illogical, the research in our division has shown that medical students' identification with physicians starts very early in their training and is the major motivating factor for their learning. Therefore, clinical psychiatrists teach this course, the students see patients immediately, and the focus is on illness. The course thereby provides students with one of their first introductions to patient care and to the general principles of interviewing. This course was again rated outstanding and in the past few years has been one of the highest rated courses in the first year of medical school.

The second-year course continues the teaching of psychopathology, adds a developmental context and, in addition, provides an introduction to different types of therapy. Students continue to see patients. Small group discussion follows every lecture. The end of the course coincides with Department of Medicine courses on medical interviewing and physical examination. The students then receive a combined psychiatric-medicine experience integrating information and techniques in the two fields. It continues to be among the highest rated courses in the second year of the medical school curriculum.

Our third-year psychiatry clerkship, five weeks in length, is our most intensively supervised course and is the most demanding of faculty time. Student ratings consistently place it among the highest of the clinical clerkships at the medical school. Because of changes in hospital services, this course has required continued administrative attention to keep the quality of the experience high. Affiliated hospital teaching sites have struggled to do their best amidst the health care funding crisis. A major part of our job this year has been to rally enthusiastic support among full-time and voluntary faculty so that teaching remains a high priority. Dr. Scott Masters, Director of Residency and Medical Student Training has put considerable effort into maintaining the quality of the St. Luke’s/Roosevelt clerkship site. Dr. Louis Linfield at Creedmoor State Hospital continues his efforts to assure the outstanding quality of the educational experience there. The clerkship site at Stamford Hospital under the direction of Dr. Bruce Shapiro is going extremely well.

Our fourth year electives continue to provide the broadest range of experience in clinical and research psychiatry. The electives attract top Columbia students as well as students from other medical schools around the country and the world. In addition, our department is one of only two in the medical school that offers humanities electives in the fourth year to medical students. Students work on artistic projects that reflected the influence of their medical training on their artistic sensibilities, skills, and approaches. In return, their work helpfully adds to our medical student education division’s research on the professionalization process.

Outcome measures of the education program remain high with students performing above average on national board exams and with outstanding student reviews of courses in psychiatry.

Curricular Changes
The new curriculum introduced over the last several years in the first two years of medical education at the Columbia University College of Physicians and Surgeons, has broadened the base of medical education from the basic biological sciences to include the epidemiological and human behavioral sciences. It has gone outstandingly well. The new curriculum integrates all three sciences with clinical work beginning in the first year. The Department of Medical Student Education in Psychiatry continues to play a major leadership role in providing relevant pedagogical theory, in organizing subsections of teaching, in developing curricular materials, in faculty development of teaching technique and attitude, and in implementing the teaching program of this project. The new curriculum has been greeted with great excitement by the faculty and students.

2001 continued the ability of our curriculum to place each student in a clinical selective with some patient responsibility from the first days of their medical education. None of this experimental teaching could work without the integrating format of small group discussions which take place weekly throughout the first year. Student discussion from their own actual case experience relates their thinking processes, their basic science, epidemiological and behavioral science databases and approaches, and the clinical case topics, all under the enthusiastic leadership of their small group leader who becomes their benevolent mentor for the first year of medical education. The emotional influence of medical school is discussed with them so that a more integrated intellectual and emotional experience can result. This has enabled more immediate and beneficial rapport with patients, a better doctor-patient relationship as well as a less traumatic educational experience for students. Psychiatric faculty have been instrumentally involved in planning and manning this aspect of the medical school curriculum.

In 2001, we have been able to introduce elements of the clinical practice sequence into the 3rd year clerkships in pediatrics and are beginning to do so in medicine. We have been able to articulate and synchronize core teaching goals for all of the clerkships in the medical school. This has involved a shift towards a coordinated general medical education that has not existed previously at the school. Speciality training is now taught as an elaboration of basic core medical teaching objectives instead of a replacement. Next year we intend to extend this program in the 3rd year medical clerkships.

Research Projects
Research continued on the emotional process of becoming a doctor. The insights gained from this long research project are being applied to the curriculum of the medical school. Feedback from the curriculum and student experiences confirm the findings of developmental research. Publications continue.

Dr. Cutler continues her research on medical student career choice and the implications that has our psychiatry curriculum. A change made in our third year curriculum, the introductory orientation which now includes an overview of typical psychological stresses on the clerkship, and a debriefing session at the end of the clerkship, are reaping results in higher student satisfaction and a higher recruitment rate into psychiatry. It is another example of the effectiveness of psychologically based research for psychiatric and medical education.

The psychiatry textbook Psychiatry by Drs. Cutler & Marcus, specifically geared towards the clinical years of medical school for which there are few specially targeted text, has been successfully received, highly reviewed, and has been translated and published in Italian.

Dr. Cutler presented papers at the Association of Directors of Medical Student Education in Psychiatry. One was on medical student responses to the bombing of the World Trade Center and the other was on success as a new clerkship director. Dr. Marcus gave nine presentations at national and local meetings. The two areas he spoke on were combined psychiatric treatments of severe co-morbid illnesses and also on the unconscious process of becoming a doctor.

Awards
Drs. David Lowenthal and Michael Pawel were recipients of the American Psychiatric Association’s Roeske Certificate of Recognition for Excellence in Medical Student Education. Dr. J John Mann received the department’s medical student Lecturer of the Year Award. Dr. Marcus is President of the Association for Psychoanalytic Medicine and President elect of the District Branch of the American Psychiatric Association. He remains of the Chair of the Committee on University and Medical Education at the American Psychoanalytic Association and is counselor at large of that organization. Dr. Cutler was elected to the executive council of the Association of Directors of Medical Student Education in Psychiatry.