Problem-Based Behavioral Science and Psychiatry

Problem-Based Behavioral Science and Psychiatry

edited by Anthony P. S. Guerrero, MD, and Melissa Piasecki, MD. Springer, New York, NY, 2008, 461 pages, $79.95.

This book illustrates the use of the problem-based method in the pedagogic teaching of behavioral science and psychiatry. Whereas most psychiatric texts use clinical cases to emphasize and illustrate issues presented in the text, this unique book first provides cases to use as teaching tools and then, over and over, emphasizes the use of the problem-based learning method to master the contents of the teaching. As stated in the Introduction, "Basic textbooks do not easily connect their lessons with the complexity of clinical reality.’ ¦Problem-based learning’ ¦involves the detailed study of patient cases, with a primary goal of identifying topics for self-study relevant to the cases.’ ¦Through understanding cases, [students] learn psychiatry" (p. vii). "The book is a learning tool as much as a content resource" (p. viii).

As cited by the authors, Norman and Schmidt state that problem-based learning "aims to endow learners with the skills of clinical reasoning, cooperative learning, and patient-based integration of knowledge" (p. 3). In addition to the prose content, this is a "how-to" book using diagrams and schemas to illustrate the problem-based method. The schema presented and used repeatedly throughout the book involves 4 concepts: What are the facts? What are your hypotheses? What do you want to know next? and What specific information would you like to learn? It also involves utilization of the bio-psycho-social-cultural-spiritual model/formulation. With regard to the latter, it is interesting that there is no reference to the famous George Engel presentation of the classic biopsychosocial model espoused in Science in 1977, nor to its elaboration by Hoyle Leigh and Morton F. Reiser of Yale.

The book is divided into 4 sections: Human Behavior, Healthcare Principles, Behavioral Neuroscience, and Clinical Psychiatry. Topics covered in Healthcare Principles include childhood development, effects of experience on brain development, learning principles of human behavior, sexuality throughout the life cycle, adaptation and coping in the medical setting, and violence and abuse. The third section takes up issues of the doctor-patient relationship, ethics, culture, quantitative measures, death and dying, and end-of-life care. The final section reads more like a volume for consultation-liaison psychiatry and includes the usual variety of psychiatric clinical disorders: substance abuse; mood disorders and suicide; and anxiety, somatoform, personality, cognitive, sleep, eating, and sexual disorders. All sections start with case vignettes and encourage the conceptual framework of the problem-based learning schema described above.

In one sense, this is a fairly mechanical presentation of concepts, with minimal dynamic or in-depth description of the meaning of behavioral and psychiatric symptoms, underlying conflicts, or examination of the latent issues underlying the manifest behaviors and symptoms presented. For example, the mechanisms explaining the somatoform disorders are quite elementary. However, patients with these disorders are some of the most difficult patients for physicians to relate to and treat, and they require considerable skill to manage.

This is an interesting and important book for teaching the principles of behavioral science and psychiatry. Unique in its presentation and format, the book is an excellent alternative for teachers of medical students, residents, and fellows. It is an important addition to the many texts discussing psychiatry in primary care medicine and general hospital psychiatry, as well as a useful volume for beginners attempting to master an understanding of this complex discipline of medicine. The authors have offered an innovative case method approach as a teaching paradigm from which teachers have much to gain.

James J. Strain, MD
jim_strain@hotmail.com

Author affiliation: Mount Sinai School of Medicine, New York, New York. Financial disclosure: None reported.

doi:10.4088/JCP.09bk05205

© Copyright 2009 Physicians Postgraduate Press, Inc.