PAPER 14/PC/04
Programme Committee Report
22nd August 2014
Psychological Aspects of Medicine (PAM)
Programme Theme Heads:
Dr Neelom Sharma & Dr Roger Smyth
"The graduate will be able to recognise and assess important psychological and
behavioural aspects of health, illness and disease. They should be able to respond
appropriately to these aspects, and use strategies such as explanation, advice and
reassurance to address them."
Learning Outcomes
The Edinburgh MBChB graduate will be able to:
a) Differentiate between health, illness and disease, and utilise these concepts
in day-to-day clinical practice
b) Routinely evaluate the psychological factors affecting patients’ beliefs about,
and responses to, illness from the individual to societal level.
c) Produce biopsychosocial treatment plans, understanding the importance of
psychological components (such as reassurance).
d) Analyse the bi-directional relationship between medical illness and
psychological symptoms.
e) Distinguish illnesses which are primarily psychological in origin (such as
somatoform disorders) from those where distinct pathology is identified, and
recommend appropriate treatments.
f) Consider the psychological factors affecting behavioural change and
concordance with treatment.
g) Discuss adaptation to major life changes (such as bereavement or receiving a
terminal diagnosis) and consider the abnormal adjustments that might occur
in these situations.
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General Comments

Feedback from last year focused on the need to develop more of an ‘architect,
not labourer,’ approach to the programme theme. We have attempted to do
so, while continuing to develop course content which we ourselves deliver.

In the last 3 years, we have attempted to heavily revamp course content,
update resources and deliver much more teaching across the curriculum
(feeling that PAM’s ‘presence’ in the curriculum may not have been sufficient
in previous years). This has been challenging, and we acknowledge our role is
still evolving.

In terms of learning outcomes, PAM has had little difficulty aligning with
Tomorrow’s Doctors (and the revised learning outcomes reflect TD very
closely); the main issues are delivery of the content itself and ensuring that
competence is assessed and mapped appropriately.
Updated Content 2013-14


All years
New EEMeC PAM Resources page written (see Appendix A)
We have contacted all Year 1-3 Year Heads and Module Organisers to offer
input in terms of assessment, learning outcomes, course content. Once this
process is complete, we plan to contact Years 4 and 5 organisers.

Years 1 & 2
Year 1 HES: ‘Ethics and Mental health’: This lecture has been revised to
reflect changes in the course itself. Feedback is awaited.

Linked assessment year 1 HES: Short essay and MCQ questions, as requested.

PBL cases: the PBL case of Huntington’s Disease is now almost ready to go
live, and should do so in Year 2 Semester 2 2014-15.

The PBL case on medically unexplained symptoms has been drafted, and is in
the editing stages. Both PBL cases currently being worked on are
collaborations between PAM and HES.

Option for SSC1 placement within Psychological Medicine, RIE (Dr Steel).

We are working with Donald Thomson and Hilary Young to incorporate some
PAM content and learning outcomes into the Year 2 Introduction to Clinical
Practice Course.
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
Year 3
‘Vertical theme’ week lecture: ‘Symptoms Without Pathology’ (covering the 4
Year 3 modules) was revised.

End of year assessment OSCE: modified stations were run for PAM OSCE
station this year. We had 100% examiner attendance, and feedback from
examiners was extremely positive.

We have written MCQs for the end of module Locomotor assessment, which
have been added to the question bank.

Years 4 & 5
We have revamped the marking criteria and indicative bibliography for
portfolio overview essays.

NS is now marking Year 4 and 5 overview essays

We have met with Maia Forrester, a child psychiatrist who contributes to the
Child Life and Health Teaching, to assist her in revamping the psychological
aspects of this course.

We have submitted new PAM MCQs to Year 4 Psychiatry
Appendix A: PAM Resources, 22nd May 2014 EEMeC
Internet resources:
1. www.neurosymptoms.org A website written by an Edinburgh neurologist, for
information and self-help of functional symptoms.
2. www.livinglifetothefull.com self-help CBT wesbite, useful for a wide range of
mild-moderate psychiatric symptoms
3. www.nice.org.ukUseful, evidence-based guidance on psychiatric conditions,
and comorbid physical and psychiatric illness. In particular, the guideline on
depression in adults with chronic physical health problems (CG91) is useful.
Textbooks:
1. Oxford Handbook of Psychiatry 3rd Edition (2013) by Roger Smyth and David
Semple. In particular, chapters on Liaison Psychiatry (Ch 19) and Anxiety &
stress-related disorder (Ch 9).
2. ABC of Medically Unexplained Symptoms (2013) Chris Burton (Ed).
3. Companion to Psychiatric Studies 8th Edition (2010) by Johnstone et al. Many
chapters are relevant to PAM.
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Papers:
Below is a small sample of useful papers on the topic. A PubMed or Medline search
will yield more specific results (e.g. if evidence regarding your portfolio cases is
required):
1: Stone J. Functional neurological symptoms. J R Coll Physicians Edinb. 2011
Mar;41(1):38-41; quiz 42.
2: Isaac ML, Paauw DS. Medically Unexplained Symptoms. Med Clin North Am. 2014
May;98(3):663-672.
3: Hatcher S, Arroll B. Assessment and management of medically unexplained
symptoms. BMJ. 2008 May 17;336(7653):1124-8.
4: Edwards TM, Stern A, Clarke DD, Ivbijaro G, Kasney LM. The treatment of
patients with medically unexplained symptoms in primary care: a review of the
literature. Ment Health Fam Med. 2010 Dec;7(4):209-21.
5: Archer J, Bower P, Gilbody S, Lovell K, Richards D, Gask L, Dickens C,
Coventry P. Collaborative care for depression and anxiety problems. Cochrane
Database Syst Rev. 2012 Oct 17;10:CD006525.
6: Atlantis E, Fahey P, Foster J. Collaborative care for comorbid depression and
diabetes: a systematic review and meta-analysis. BMJ Open. 2014 Apr
12;4(4):e004706.
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Appendix B: Learning Opportunities Across the Curriculum
Year 1
Year 2
Year 3
Year 4
Year 5
Concepts of health,
illness and disease
The neuroscience
behind normal and
abnormal human
behaviour.
Specific
psychologicallyinfluenced
syndromes in
cardiovascular (e.g.
functional chest
pain), GI (e.g. IBS),
respiratory (e.g.
panic disorder),
locomotor (e.g.
fibromyalgia)
modules.
Psychiatry:
knowledge and
experience of
managing
mental illness.
GP: As Year 4
Medicine of the
Elderly: aging,
disability, effects
Alcohol problems,
of cognitive
considered
from
GP:
diagnosis
impairment on
Adjustment to life
individual,
familial,
and
individuals and
events: Talking with
societal
perspectives
management
of
carers, death.
Families, Aging,
depression,
disability, terminal
anxiety,
illness, death
Psychological impact
General Medicine
somatoform
of genetic illnesses,
and Surgery:
disorders.
including genetic
Delirium and
Different ways of
Adjustment to
Psychological iatrogenic
screening and
expressing
chronic illness (e.g. support.
psychological
psychological distress: counselling
inflammatory
Referral options complications.
the role of
bowel disease,
(e.g.
Acute
sociodemographics, Psychological
congenital
heart
counselling).
management plans
personality, culture comorbidity in physical
disease)
incorporating
and other factors.
illness, exemplified by
Obstetrics
and
psychological
diabetes mellitus,
Year
3
psychiatry:
Gynaecology:
aspects. Liaison
renal, and liver
The psychology of
introduction
to
pelvic
pain,
psychiatry service.
disease.
health promotion
mental illness, and psychological
its effects on
changes (normal Child Life and
The therapeutic role Neuroendocrinology:
physical health.
and abnormal) Health:
the effects of
of doctor-patient
in the
Developmental
hormones
and
interactions,
puerperium.
OSCE:
the
clinical
disorders, and
metabolic
alternative therapies
interaction
of
their effects on
abnormalities on mood
and the placebo
physical
and
Neurology:
children and
and behaviour.
effect.
psychological
functional
families.
illness.
syndromes,
Developmental
PBL: psychological
PBL: psychological
behavioural
stages.
aspects of real clinical aspects of clinical
effects
of
problems
problems
neurological
Elective
illness (e.g.
stroke, MS)
Symptoms without
pathology
Portfolio
Overview Essay
SSC4
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