An Integrated Preclerkship Curriculum in Neuroscience, Psychiatry, and Neurology Robert Michels, M.D.
D
r. Thomas M. Glick and his colleagues in their article "Curriculum in Neuroscience, Psychiatry, and Neurology" (pages 212-218) describe their course as an integrated curriculum, and their description of the curriculum indeed sounds excellentstimulating, intellectually challenging, and weIl integrated. Students like it and seem to leam from it, and faculty are enriched by it as weIl. It is, however, a course, not a full curriculum. The question of its relationship to the rest of the curriculum is only partially addressed here. Which functions have been assigned to it, which are dealt with eisewhere, and which are not dealt with at all? This course is designed to develop "understanding of the mind and behavior as expressions of nervous system activity." There are, of course, other paradigms for understanding mind and behavior-psychological, psychodynamic, sociocu1tural, and developmental, to name a few. We are told that some of these are touched upon in a first-year course, but not whether they are considered as basic sciences of medicine, and we also leam that "many important aspects of development" are not considered because of "inadequate connections to neuroscience." The course teaches the scientific basis of neurology (i.e., neuroscience), and part, but not aIl, of the scientific basis of psychiatry (i.e., neuroscience again). The other fundamental sciences of psychiatry are not taught here. The question is whether they are taught elsewhere, and if not, is this a curriculum decision or a curriculum shortcoming? "
The issue is of particular importance because of the historical prejudices against these paradigms in medicine. These prejudices continue, even though the care and treatment of a large number of psychiatric patients has yet to be affected by neuroscientific understanding and may never be. It would be unfortunate if students were given a subtle but powerful message that these patients, their problems, and the knowledge required to care for them are not part of modern scientific medicine. An analogy would be if students were to leam about the regeneration of neurons, but not the principles of rehabilitation after central nervous system injury. There is a curious "slip" in the language of the paper. We are told that the faculty "comprises one-third neurobiologists,onethird academic psychiatrists, and one-third neurologists" (italics added). What is the "academic" supposed to tell us about the difference between psychiatrists and neurologists? The asymmetric domain of the course content is more apparent in the list of tutorial subjects. The students are supposed to be learning about the "mind and behavior," while the cases in this study concern sciatic nerve compression and myasthenia gravis. Dr. Michels is professor of psychiatry, New York Hospital, Cornell Medical Center, Department of Psychiatry, Payne Whitney Psychiatrie Clinie, New York. Address reprint requests to Dr. Michels, New York Hospital, Cornell University, 525 East 68th St., New York, NY 10021. Copyright Cl 1997 Academic Psychiatry. 111\11
'1 0 '\1\11:11\)0\\1'\111,''''
Neither personality disorders nor family conflict are mentioned. The authors are justifiably proud that their course introduces Harvard students to "the challenges posed by disorders of behavior, thought, and emotion as expressions
of altered nervous system activity." If Harvard does half as good a job in presenting the challenges posed by viewing such disorders as expressions of social factors, developmental processes, and psYchological forces, it should be even prouder.
D
r. Thomas M. Glick and his colleagues in their article "Curriculum in Neuroscience, Psychiatry, and Neurology" (pages 212-218) describe their course as an integrated curriculum, and their description of the curriculum indeed sounds excellentstimulating, intellectually challenging, and weIl integrated. Students like it and seem to leam from it, and faculty are enriched by it as weIl. It is, however, a course, not a full curriculum. The question of its relationship to the rest of the curriculum is only partially addressed here. Which functions have been assigned to it, which are dealt with eisewhere, and which are not dealt with at all? This course is designed to develop "understanding of the mind and behavior as expressions of nervous system activity." There are, of course, other paradigms for understanding mind and behavior-psychological, psychodynamic, sociocu1tural, and developmental, to name a few. We are told that some of these are touched upon in a first-year course, but not whether they are considered as basic sciences of medicine, and we also leam that "many important aspects of development" are not considered because of "inadequate connections to neuroscience." The course teaches the scientific basis of neurology (i.e., neuroscience), and part, but not aIl, of the scientific basis of psychiatry (i.e., neuroscience again). The other fundamental sciences of psychiatry are not taught here. The question is whether they are taught elsewhere, and if not, is this a curriculum decision or a curriculum shortcoming? "
The issue is of particular importance because of the historical prejudices against these paradigms in medicine. These prejudices continue, even though the care and treatment of a large number of psychiatric patients has yet to be affected by neuroscientific understanding and may never be. It would be unfortunate if students were given a subtle but powerful message that these patients, their problems, and the knowledge required to care for them are not part of modern scientific medicine. An analogy would be if students were to leam about the regeneration of neurons, but not the principles of rehabilitation after central nervous system injury. There is a curious "slip" in the language of the paper. We are told that the faculty "comprises one-third neurobiologists,onethird academic psychiatrists, and one-third neurologists" (italics added). What is the "academic" supposed to tell us about the difference between psychiatrists and neurologists? The asymmetric domain of the course content is more apparent in the list of tutorial subjects. The students are supposed to be learning about the "mind and behavior," while the cases in this study concern sciatic nerve compression and myasthenia gravis. Dr. Michels is professor of psychiatry, New York Hospital, Cornell Medical Center, Department of Psychiatry, Payne Whitney Psychiatrie Clinie, New York. Address reprint requests to Dr. Michels, New York Hospital, Cornell University, 525 East 68th St., New York, NY 10021. Copyright Cl 1997 Academic Psychiatry. 111\11
'1 0 '\1\11:11\)0\\1'\111,''''
Neither personality disorders nor family conflict are mentioned. The authors are justifiably proud that their course introduces Harvard students to "the challenges posed by disorders of behavior, thought, and emotion as expressions
of altered nervous system activity." If Harvard does half as good a job in presenting the challenges posed by viewing such disorders as expressions of social factors, developmental processes, and psYchological forces, it should be even prouder.
