Presentation from the International Congress of the Royal College of Psychiatrists 24-27 June 2014, London

1. Intercalated BMedSc
Psychological
Medicine
Rachel Upthegrove
Senior Lecturer
Consultant Psychiatrist

2. Background
• The option of taking an extra year to complete an Intercalated
Degree, either classed as a BSc or BMedSc, has long been a
tradition for students in UK medical Schools.
• Large increase in students talking this option, reflecting the
increase in medical student numbers and the increasingly
competitive market for foundation year posts.
• Recent figures suggest between 30-50% of all British medical
students obtain an intercalated degree.
• Likewise the range of courses on offer has increased.

3. Previously:
• Intercalating was taken only between pre-clinical and clinical
years
• Basic science subjects of Anatomy, Biochemistry and
Pathology.
• History of Medicine was one of the few alternatives on offer.

4. Why Intercalate: GMC
• The development of research skills
• In depth study in areas of particular interests over an extended
period.
• Tomorrows Doctors 2003/9: “factual information must be kept to
the essential minimum that students need at this [undergraduate]
stage of their medical education”.
• Thus students are not able study subjects in any great depth;
medical students’ education must be spread thinly to cover all
subjects needed to practise safely as doctors.
• Intercalated degrees offer an opportunity to counter this

5. Why Intercalate: Students
• “Getting your name on PubMed.”
• “Extra letters on your CV”.
• “Foundation Applications”
• “Widening experience”
• New Skills
• “ A change is as good as a rest”.
• “Free time”??!!

6. Why Intercalate: Psychiatry
• Opportunity to study subjects akin and closely related to
psychiatry also offers a window of opportunity through which
to encourage and nurture interest
• Students now are increasingly obliged to choose a future
specialty at an early stage, to polish and improve portfolios
and gain extra “points” for short-listing at the foundation year
stage.
• Psychiatry cannot afford to miss the opportunity intercalating
offers to attract both interest and indeed recruitment of the
highest calibre students.

7. Current Courses:
• Psychology
• Neuroscience
• Neuroscience and Mental Health
(Imperial)
• Psychological Medicine (Birmingham)

8. The Birmingham Course: Psychological
Medicine
• Lisa Jones, Femi Oyebode and Rachel Upthegrove
• Began in 2005 and has proved extremely popular from
the outset with both internal and external students.
• Unique opportunity to study in depth subjects with real
relevance to clinical psychiatry in a self directed manner.
• Sits along-side other BMedSc degrees in Public Health,
History of Medicine, Ethics and Law and International
Health

9. The Birmingham Course: Psychological
Medicine
• Integrates the scientific disciplines:
Psychology,
Psychiatry
Psychopathology in the arts.
• These themes are the main focus of the taught program in the first
semester.
• Strong focus on research and students spend the second semester
completing a research project in an area of psychiatry that interests
them.
• Assessments are mainly coursework based and students are given
the freedom to determine their own areas for further study.

10. Objectives:
• Commonly used research methods and data analysis
techniques within health and medicine.
• Legal and ethical frameworks of medical research.
• The neurobiological basis of processes of the mind and
behaviour.
• The neurobiological basis of mental illnesses.
• The portrayal of psychiatry and psychopathology in the arts.
• The value of fictional narratives, poetry, biography, letters and
journals in medical education

11. Semester 1: Themed Weeks
Week Neurobiology of
Psychological
Processes
Neurobiology of Mental
Illness
Psychiatry and
Psychopathology in the Arts
1 Emotion Pathological affect Kay R. Jamison “An Unquiet Mind”
2 Aggression & personality Neurobiology of Psychopathy Elfrieda Jelinek “Piano Teacher”
and “Wonderful Times”
3 Visual perception Illusions & visual hallucinations “The Black Monk” Chekhov
“The Doors of Perception” A.
Huxley
4 Auditory perception Musical & auditory
hallucinations
“Memoirs of My Nervous Illness”
Daniel Schreber
5 Stress and Learning Neurobiology of Anxiety
Disorders
“All Quiet on the Western Front”
Erich Maria Remarque
6 Memory Dementias “Iris” John Bayley
7 Thinking & intelligence Abnormalities of belief “Dairy of a Madman” Nicoli Gogol
“Spider” Patrick McGrath

12. Semester 2: Research Projects
Examples from this year:
Systematic review, collecting new data, analysis of pre-existing data
• Antipsychotic medication use and birth outcomes in pregnancy
• Psychological well being in stoma patients: and online survey
• Drivers for recruitment in psychiatry
• Effectiveness of Risperidone Consta: a 2 year mirror study
• Medication Use in Bipolar Disorder
• Self Harm in minority ethnic groups
Assessed by placement report in the form of a Journal paper

13. Success:
• 12-14 students per year
• The most popular intercalated option
• Highest calibre students
• 11% go on to choose psychiatry (compared with ~3% average)

14. Selected Student Publications:
• Cultural and social influences of negative illness appraisals in
first-episode psychosis. Early Intervention in Psychiatry
5(10):1751-7893
• Depressive symptoms in tourette syndrome and affective
disorders: a controlled study. J Neurol Neurosurg Psychiatry.
2013 Sep;84(9):e1.
• The entrainment test in tremor assessment: influence of
historical factors and clinical methodology. Neurol Neurosurg
Psychiatry. 2013 Sep;84(9):e1
• The subjective experience and phenomenology of depression
following first episode psychosis: a qualitative study using
photo-elicitation’ Journal of Affective Disorders. 2013;149(1-
3):166-74
• Is the degree of cognitive impairment in patients with
Alzheimer's disease related to their capacity to appoint an
enduring power of attorney? Age Ageing 36: 527-531.
• Young people in coerced drug treatment: Does the UK Drug
Intervention Programme provide a useful and effective service
to young offenders? Addiction Research and Theory 17(1),17 –
29

15. What you need to set up:
• Wonderful colleagues: expert teaching in psychology,
psychiatry, course leadership, student support etc etc
• Access to experts
• Dedicated admin
• Researchers willing to support students
• Teaching staff: some protected time

16. Challenges:
• Course timetable: themed weeks..
• Selection of Students
• Research project support

17. Further Information:
• http://www.intercalate.co.uk/
• r.upthegrove@bham.ac.uk

18. Acknowledgements:
• Dr Lisa Jones: Course lead
• Dr Lesley Roberts: BMedSc Program Director
• Prof Femi Oyebode
• Students!
• ..........Introducing Maria Spears

19. Introducing …..
Dr Maria Spears
BMedSc, MBChB

20. BMedSc
•Enrolled on Psychological Medicine Intercalated degree course 2012/13
(University of Birmingham)
•Between 4th and 5th Year
•Had always wanted to Intercalate
•Enjoyed 4th Yr Psych placement
•Psych elective in New Zealand
•Advice from staff involved with BMedSc

21. A bit about my project
• Predicting treatment response to brief eclectic psychotherapy using
coping behaviours in patients with chronic PTSD (AMC Amsterdam)
• Utrecht Coping List (Self report questionnaire)
The Academic Medical Centre, University
of Amsterdam

23. Challenges
• Data on hormone levels
• Small sample size
• Confounders
• Individually led
• Working within a research environment and in a different country
• Trying to extract a project appropriate for dissertation

24. Open Minds
• OM: a scheme to encourage young people to discuss mental
health topics and reduce stigma attached to mental health in
young adolescents (started at UCL)
• Co-ordinator of Birmingham branch
• Over 100 members
• Psychiatry lectures on mental health topics
• Train students to go into schools and deliver sessions on mental
health for students aged 13 and over

25. Reading for Well Being
• Using literature and poetry to generate discussion about
mental health with patients and medical students

26. Future Plans
• Complete Foundation Years in South Yorkshire
• Commence Core Psych Training or Broad Based Training
• Specialise in CAMHT/Addiction/Perinatal?