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  IN THIS Article
 ::  Abstract
  ::  Materials and Method
  ::  Results
  ::  Discussion
Introduction of ...
 ::  References

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BRIEF REPORT
Year : 2023  |  Volume : 69  |  Issue : 4  |  Page : 221-223

Introduction of psychological skills laboratory in medical education


Department of Psychological Medicine, Faculty of Medicine and Health Science, Universiti Malaysia Sarawak, Malaysia

Date of Submission27-Apr-2023
Date of Decision22-Jun-2023
Date of Acceptance27-Jun-2023
Date of Web Publication11-Aug-2023

Correspondence Address:
Dr. C H Ting
Department of Psychological Medicine, Faculty of Medicine and Health Science, Universiti Malaysia Sarawak
Malaysia
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/jpgm.jpgm_341_23

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 :: Abstract 


Depression and anxiety are common psychological issues among university students, yet many of them hesitate to seek professional help due to stigma. Unfortunately, university curricula often lack self-help strategies to manage these challenges and provide timely support to those in need. To address this gap, we introduced the Psychological Skills Lab (PSL) component in the undergraduate medical curriculum, which emphasizes experiential learning to promote self-determination and autonomy in health promotion. The lab allows active interaction among students, lecturers, and peers through activities like presentations, peer reviews, in session practice, gratitude journals, group discussions, and role plays. PSL helps students develop skills, empathy, mindfulness, and self compassion through regular interactions. This innovative teaching approach raises mental health awareness and empowers students to assist others when required. Thus, by incorporating self-help measures into the curriculum, students are better equipped to manage their emotional well-being while supporting those around them.


Keywords: Empathy, medical education, psychological skills laboratory


How to cite this article:
Chen Y Y, Ting C H. Introduction of psychological skills laboratory in medical education. J Postgrad Med 2023;69:221-3

How to cite this URL:
Chen Y Y, Ting C H. Introduction of psychological skills laboratory in medical education. J Postgrad Med [serial online] 2023 [cited 2023 Nov 30];69:221-3. Available from: https://www.jpgmonline.com/text.asp?2023/69/4/221/383539




Chen and Ting: PSL in medical educationChen and Ting: PSL in medical educationThe increasing prevalence and severity of mental health difficulties among university students is a critical issue for universities and their wider communities. Grégoire et al.[1] reported that mental health problems brought a profound influence on students' quality of life and had a negative impact on their academic performance leading to burnout and eventually dropping out from university. During the COVID-19 pandemic, the prevalence of depression and suicidal thoughts of university students in Malaysia increased from 15.5% and 12.9% to 29.4% and 14%, respectively.[2],[3] There is a worrying correlation between the majority of university students and mental health issues. Even before the outbreak, the rate of Malaysian students suffering from mental health problems has doubled in less than a decade (10% in 2011 to 20% in 2016).[4]

Nonetheless, it was discovered that the low rate of the utility of professional assistance could have worsened the issue. In the United States, only 21% of university students who experienced anxiety sought professional support.[5] Over half were unaware of the presence of mental health treatments and felt it had become more difficult to assess mental health care since the pandemic.[5] In Malaysia, only 3.8% of university students had engaged with the university mental health support systems.[6] However, little is known about the actions a university could take to effectively support mental well-being, especially incorporating the mental health elements in academic course design and teaching several strategies to maintain psychological well-being.[7] Although some recognized the need for holistic training, the practical psychological skills of self-help had not been emphasized much in the medical curriculum.

It is important to employ a positive psychology strategy that offers novel ways to strengthen psychological resilience and promote mental health.[8] A specific course at the university level that incorporates positive self-help measures to manage their own emotions while preparing these medical students to deliver interventions to people around them would be crucial.

Psychological skill laboratory as a training tool

Psychological skill laboratory (PSL) is a teaching pedagogy proposed that medical students can recognize their emotional needs and act as therapists by providing brief psychological interventions to their patients before one could receive any formal psychological intervention. It emphasizes the importance of experiential learning given that self-determination and autonomy are key elements to promote psychological well-being while cultivating humanistic values.

Traditional medical pedagogy encourages objectivity, standardization, and emotional detachment to maintain a professional distance from patients, to make objective clinical decisions, and to regard patients as equally deserving of care.[9] However, traditional pedagogy tends to minimize the value of subjectivity, the function of emotions, and the therapeutic potential of relationship and solidarity.[10] This strong emotional suppression and deficiency in the training in engaging emotions can potentially lead to exhaustion and burnout.

PSL emphasized a more holistic human capacity with the element of human curiosity as a precondition that facilitates medical students' capability to make an effort to listen to others' unique experiences with their physical illness and delicately express this understanding to them.[9] With the skills learnt and in-session practice, it promotes students' ability to self-reflection, awareness, interpretation of emotional responses of self and others, empathy, and the development of insight and sensitivity to be moved and acts accordingly to their own and others' emotional or physiological needs. The ability to observe emotions in others, feel, and respond to those emotions is particularly important to healthcare workers and is considered as one of the key clinical skills in medical education. The empathetic relationship develops during the process, and quality of care reinforces therapeutic results. However, there are still many difficulties in regard to implementing these values and empathy in clinical practice as a relatively high percentage of health professionals (70%) struggled to develop empathy in their service.[9],[10] Research outcomes suggest that the lack of self-awareness and a lack of appropriate training as well as emotional dysregulation are among the factors that contribute to a low level of empathy.[11] Thus, the objective of this study is to explore the perspectives of medical students on the introduction of psychological skills into the medical curriculum.


 :: Materials and Method Top


Study design and population

We collected the students' feedbacks in practicing PSL, and a preliminary thematic analysis was applied. There were 301 medical students aged 22–23 years old with 71% of females (29% male) included in this brief report.

PSL

The PSL consists of six sessions (2 h per session)

  1. Healthy lifestyles and self-care;
  2. Mindfulness and relaxation techniques;
  3. Introduction to cognitive behavioral therapy;
  4. Active listening and communication skills and psychological first aid;
  5. Behavioral analysis and problem-solving techniques;
  6. Values, goal setting, and self-compassion.


Each session includes activities such as role-plays, small group discussion and reflection, therapeutic exercises, and case-based content to comprehensively incorporate empathy and compassion training into medical education. Handouts, audio, and video clips were also uploaded to eLeap (an online platform for student learning). For details, please refer to the supplementary document[Additional file 1].

Throughout the six sessions, students were encouraged to make their own gratitude journal as a takeaway activity to promote self-reflection, to cultivate appreciation, and to build greater resiliency. This exercise was continued for six weeks with few feedback and sharing sessions throughout the six weeks. The purpose of this feedback was to clarify ambiguities, to motivate, and to change their perspectives to a more compassionate manner that they are kinder to themselves and others.


 :: Results Top


In general, we received positive feedbacks from the students for having these sessions. Some expressed that they managed to reflect on themselves and experienced self-discovery through the activities, while others felt having free therapeutic sessions in facing emotional turmoil and it was very healing.

“Very enlightening and eye-opening. I learned a lot of things, discovered a lot about myself and other people. These skills can be applied even if I don't go into psychiatry.”

“Overall, the psl were interesting, fun and free therapy for me. After each session, I am able to review back my life and start doing better.”

“I found this session very meaningful because it help(s) me when I was in grief and suffering pain.”

The interactive practical sessions also empowered the students to learn to be more empathetic toward patients and be kind to own self.

“The skill labs were very helpful in teaching the important basic skills a doctor should have when they are treating their patients.”

“PSL is useful in terms of helping me to be more aware and mindful including teaching ways to handle a patient. I find myself applying the things taught during PSL sessions during my daily life and I felt calmer.”

This PSL also motivated students to be more mindful and willing to make small changes in their life. Students' feedback is that they are equipped with skills to be their own therapist to self-help. Students also commented that they noticed and appreciated more minor things that they ignored previously.

“It's a new way of learning for us. I get to notice and appreciate all the minor things happening around me. I can apply those skills I learned in the future for my patient or anyone in need.”

“Studying medicine is hard. Gratitude journal is an eye-opening experience and I'm glad we got to do it- more thankful of little things in life, try new things, and self-care is important.”

“The sessions are definitely wake-up calls to me. I notice that I neglect basic sleep hygiene, diet, planning and exercise. This posting reminded me how important those aspects are in my life. I learned so many useful skills here.”


 :: Discussion Top


PSL was introduced with the hope that medical students can be their own therapists and provide timely psychological intervention to their patients and/or clients. From the students' feedbacks, it showed that PSL is beneficial for medical students in regulating their own emotions through self-discovery and compassion to self and others.

Paying attention and taking care of students' mental health is as essential as imparting psychiatric knowledge. Current medical education focused more on practical clinical knowledge, skills, and professionalism. However, regulations for undergraduate medical education do not place a lot of emphasis on psychological skills and emotional health.[12] As a result, PSL offers several trainings to improve student's mental health and empathy, which is consistent with the majority of research's recommendation that focus be placed on a more holistic education via experiential learning and self-reflection.[10] PSL used different creative educational methods such as journaling, role-play, and simulation games that has been suggested to instill empathetic skills.[7],[10],[13]

Laughey et al. suggested that in addition to a formal curriculum that lays out through lecturers and seminars, there is a shortage of informal curriculum examples like response to patients' emotions, soft skills, validating, showing compassion, and reflecting other's emotions.[14] Further investigation showed that empathetic modeling and the relationship between lecturers and students enhance their mental well-being, self-compassion, and empathy.[8],[10],[13]

In conclusion, imparting psychiatric knowledge is as essential as paying attention to the mental well-being of the students to provide a supportive and nurturing education system and hence more resilient doctors in the future.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.


 :: Introduction of Psychological Skills Laboratory in Medical Education Top


The PSL consists of six sessions

  1. Healthy lifestyles and self-care;
  2. Mindfulness and relaxation techniques;
  3. Introduction to Cognitive Behavioural Therapy;
  4. Active listening and communication skills and psychological first aid;
  5. Behavioural analysis and problem-solving techniques;
  6. Values, goal setting, and self-compassion.


Each session includes activities such as role-plays, small group discussion and reflection, therapeutic exercises, and case-based content to comprehensively incorporate empathy and compassion training into medical education. Handouts, audio and video clips were also uploaded to eLeap (an online platform for student learning). The following is a summary of each session:

Healthy lifestyles and self-care

This session emphasized healthy lifestyles and promotes self-care using some essential psychological concepts. The topics encompass a wide range of daily life circumstances and socio-emotional activities such as sleep hygiene, gut, and mental health, healthy social media use, healthy relationship, palliative care and euthanasia, Pavlov theory (conditioning), toxic positivity, disenfranchised grief and decriminalize suicide. Students were divided into groups and were randomly assigned the topic. The students were given 15 minutes to brainstorm and made a simple presentation, followed by a Q & A session. After each presentation, the lecturer would provide a summary and conclude how the topic could be related to self and mental health.

Mindfulness and relaxation techniques

In this session, students were instructed to walk in a circle in the class. Following that, the students were asked several questions such as “Do they notice which leg step out first when they started walking?” or “How were their hands moving when they were walking?”. Next, the students were asked to walk mindfully with prompts. The lecturer would then share about mindfulness and its benefits as well as other mindfulness practices, for example, mindful playing, mindful drinking and etc. In addition, the students also learnt the relaxation techniques such as deep breathing exercises, distraction, and meditation coupled with in-class practice.

Introduction to Cognitive Behavioural Therapy (CBT)

A brief introduction to the concept and principles of CBT was given. Subsequently, the students would work in pairs or a group of three to discuss a problem regarding the thinking process. They would help each other to identify the cognitive errors and practice reframing the cognitive process, hoping to instil behavioural changes.

Communication skills: Active listening and psychological first aid (PFA)

Many students expressed challenges in communicating with patients in a psychiatric setting and wished to learn effective communication with the clients. In this session, the lecturer introduced some active listening and communication skills, such as signposting, closed and open-ended questioning, etc, together with some good and bad communication examples. The students were introduced the PFA concepts in this session, with the aim that they could adopt an empathetic approach in dealing with a life crisis. Following that, role-plays on pre-designed scenarios and feedback would be gathered after the session to evaluate on what was done well and how to improve the communication further.

Behavioural analysis and problem-solving techniques

This session started with a case discussion after a brief introduction of behavioural analysis or functional analysis, and students were asked to identify the target behaviour with its antecedents and consequences. By understanding the functions of the behaviours, students could give relevant suggestions and advice. Bearing in mind that each behaviour serves a function, they were asked to share a problem of their own. Following the IDEAL model for problem-solving techniques, they would identify one problem that they faced in the past, describe clearly their problem and its outcome, explore any other possible alternative strategies or solutions with pros and cons, anticipate the possible outcomes and act on the chosen strategies, and finally review the effects of the actions taken and learn from the mistakes.

Values, goal setting, and self-compassion.

This session began with students sharing their experience of becoming medical students and future clinicians. Explore and discuss the challenges that they might face in the future and the reasons for them to stay in the profession. Introduce the differences between values and goals by using some prompted questions. This was followed with some videos to motivate students and facilitate self-compassion.

Throughout the six-session, students were encouraged to make their own gratitude journal as a takeaway activity to promote self-reflection, to cultivate appreciation and build greater resiliency. This exercise was continued for 5 weeks with few feedback and sharing sessions throughout the five weeks. The purpose of this feedback was to clarify ambiguities, to motivate, and to change their perspectives to a more compassionate manner that they are kinder to themselves and others.



 
 :: References Top

1.
Grégoire S, Lachance L, Bouffard T, Dionne F. The use of acceptance and commitment therapy to promote mental health and school engagement in university students: A multisite randomized controlled trial. Behav Ther 2018;49:360-72.  Back to cited text no. 1
    
2.
Ghazali SR, Chen YY, Mohamad M, Yein LP, Razali ZA, Pauzi N, et al. Lifetime trauma, symptoms of psychological disturbance, and suicidal ideation among university students in Malaysia. Curr Psychol 2022;14.  Back to cited text no. 2
    
3.
Keshavarzi F, Megan C, Sin CK, Wei CC, Ming CC, Yin CW. The impact of COVID-19 pandemic on the mental health of college and university students. ASEAN J Psychiatry 2021;22:1-7.  Back to cited text no. 3
    
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Hezmi MA. Mental health a major concern in coming years among Malaysian students. Universiti Teknologi Malaysia. 2019. Available from: http://people.utm.my/azril/mental-health-a-major-concern-in-coming-years-among-malaysian-students/. [Last accessed on 2021, Nov 11].  Back to cited text no. 4
    
5.
Adams SH, Schaub JP, Nagata JM, Park MJ, Brindis CD, Irwin Jr CE. Young adult anxiety or depressive symptoms and mental health service utilization during the COVID-19 pandemic. J Adolesc Health 2022;70:985-8.  Back to cited text no. 5
    
6.
Goodwin J, Behan L, Kelly P, McCarthy K, Horgan A. Help-seeking behaviors and mental well-being of first year undergraduate university students. Psychiatry Res 2016;246:129-35.  Back to cited text no. 6
    
7.
Pohontsch NJ, Stark A, Ehrhardt M, Kötter T, Scherer M. Influences on students' empathy in medical education: An exploratory interview study with medical students in their third and last year. BMC Med Educ 2018;18:231.  Back to cited text no. 7
    
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Barry MM. Generic principles of effective mental health promotion. IJMHP 2007;9:4-16.  Back to cited text no. 8
    
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Halpern J. From idealized clinical empathy to empathic communication in medical care. Med Health Care Philos 2014;17:301-11.  Back to cited text no. 9
    
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Shapiro J, Youm J, Kheriaty A, Pham T, Chen Y, Clayma R. The human kindness curriculum: An innovative preclinical initiative to highlight kindness and empathy in medicine. Educ Health (Abingdon, England) 2019;32:53-61.  Back to cited text no. 10
    
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van Ryn M, Hardeman RR, Phelan SM, Burke SE, Przedworski J, Allen ML, et al. Psychosocial predictors of attitudes toward physician empathy in clinical encounters among 4732 1st year medical students: A report from the CHANGES study. Patient Educ Couns 2014;96:367-75.  Back to cited text no. 11
    
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Malaysian Medical Council. Standards for Undergraduate Medical Education. 2022. Available from: https://mmc.gov.my/wp-content/uploads/2020/01/STANDARDS-FOR-UNDERGRADUATE-MEDICAL-EDUCATION-Version-1.2-Updated-on-15-January-2020.pdf. [Last accessed on 2021 Nov 11].  Back to cited text no. 12
    
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Riess H, Kelley JM, Bailey RW, Dunn EJ, Phillips M. Empathy training for resident physicians: A randomized controlled trial of a neuroscience-informed curriculum. J Gen Intern Med 2012;27:1280-6.  Back to cited text no. 13
    
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Laughey WF, Atkinson J, Craig AM, Douglas L, Brown ME, Scott JL, et al. Empathy in medical education: Its nature and nurture—A qualitative study of the views of students and tutors. Med Sci Educ 2021;31:1941-50.  Back to cited text no. 14
    




 

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