An important dimension is defined in requiring students to answer why which clinical hypotheses are incorrect,
why they would proceed with a therapy. Additionally, educators in the field set field specific foci. Examples of these
foci are dimensions of communication in psychiatry, interdisciplinary referral communication in laboratory
medicine, and the systematic approach to a clinical examination for orthopedic surgery and traumatology.
The aim of the case-based e-learning is in transforming declarative knowledge into procedural knowledge, so that
students are already accustomed to procedural algorithms for the simulated patient encounter.
2.1.3 Simulated Patient contact
Students are required to successfully complete the e-learning course by correctly answering all questions before
being taking part in the seminar. The SP seminar has the aim of applying and transforming procedural knowledge
into procedural skills. Here the student is required to observe, give feed-back on and perform a complete psychiatric
consultation, including conducting a mental status examination and taking a psychiatric history, creating a clinical
hypothesis or diagnostic hypothesis, deciding on further case management, and finally suggesting relevant therapy
options using all previously learned skills.
The SP employs the use of professional actors who have received training in embodying patients, requiring
students to employ both the declarative knowledge and clinical reasoning learned in the textbook and e-learning
cases. Actors learn their “roles” using prepared and anonymized patient case data. After the course, students are
assessed both by educators, peers and themselves with communication-portfolios documenting their simulated
consultations.
The aim of the SP seminar is in transforming and training previous procedural knowledge as a skill, experiencing,
documenting and reflecting on difficulties that arise from new dimensions of face-to-face communication with
mentally ill patients.
2.1.4 Learning assessment
Final assessment is performed in the end of the 4th year in the Objective Structured Clinical Examination (OSCE),
again in SP contact. Marks are given for all three aspects: declarative knowledge (i.e. Did the student remember to
conduct each part of a standard mental status examination?), procedural knowledge (i.e. Did the student correctly
manage the case, adhering to indicated modus operandi?) and communication skill (i.e. Did the student demonstrate
empathy or understanding during the consultation?).
2.2 The psychiatry specific approach
We attempted to integrate a dual approach to understanding mental illness in educational materials, on the one
hand the well-established mental-function and mental-structure in juxtaposition with, the biological mechanisms of
brain function. Both are taught in parallel within the template (neuro)-anatomy and physiology, (neuro)-pathophysiology
and disease process, epidemiology and genetics template for each mental illness.
The subjects: Anatomy and physiology, patho-physiology and disease process, and epidemiology and genetics
find their basis in neurophysiology and brain function: Translational evidence and mouse models allow us to
cultivate our understandings of complex interactions such as epigenetic modulations and their effects in
interpersonal relationships. Functional imaging of psychiatric diseases allows greater insight into these altered brain
functions although the search for the morphological substrate of affective and executive sub-functions in mental
illness is still a matter of intense discourse. Our aim in creating a structured multi-faceted approach to understanding
psychiatric diseases is to cultivate a wider declarative knowledge base unto which students may network and
associate clinical reasoning and clinical skills.
The rhetoric approach in the textbook material is designed to leave the authoritarian domain: An explanatory
“These are the facts” towards an extended elucidation of the investigative process, a discussion of relevant
experiments and data. One difficulty lies in determining the didactic relevance of the material while simultaneously
not over-encumbering the student with minutiae. We believe this approach allows the student to construct her own
understanding of the complexities of each mental illness.