Mental health teaching in Somaliland undergraduate medical education

1. Psychiatry course
Dr Jibril I.M Handuleh, MBBS MPH
Lecturer in mental health, Amoud Medical School
Email: djibril@amoud.edu.so
Phone: +252654453324

2. Mental health course 2019/2020
• Undergraduate year 5 mental health course
• Introduces mental health for medical students
• lecture, clinical based course
• Delivered three times a week/clinical setting
• clinical attachment with mental health ward or in community
• Course debates and journal clubs
• Student essays
Note: The psychiatry course is delivered with a visiting professor of psychiatry in
the UK Dr Daniel Fekadu who will be at Amoud University between October and
December 2019 King’s College London Visits will be in April 2020. The course
lecturer and the visiting team will discuss how best to deliver the 2 week
teaching within the mental health course

3. Student tasks
• several tasks are associated with the course
1. Essay- 1200 words
2.Clinical attachment- Each student presents a minimum of 3 cases
3.Journal club to discuss interesting clinical journal articles in psychiatry
4.Global mental health debate- Debating a mental health issue relevant
to Somalis in the horn of Africa, diaspora and the state of mental
health at regional/international level
5.Midterm exam
6.Final exam

4. Course goals
Overall Goal
• Goals are intended to meet academic goals of psychiatry course
based on Amoud University Medical School Curriculum to help
students assess and manage mental health disorders relevant to the
Somaliland context.

5. Course objectives
• 1. Using appropriate interview techniques, the student will be able to elicit a complete psychiatric
history from psychiatric and medical patients and will be able to amplify or confirm the patient’s
history by information from relatives and/or any collateral source.
2. The student will be able to perform a mental status exam, mini mental state exam or physical
examination emphasizing aspects pertinent to the psychiatric evaluation and a mental status
examination sufficiently comprehensive to detect, at a minimum, disorders of orientation,
thinking, mood, and cognition.
3. The student will be able to select and apply major diagnostic tests and procedures including
laboratory tests, neuroimaging tests, psychometrics, and electroencephalography in psychiatric
practice relevant to Somaliland health system.
4. The student will be able to identify psychiatric emergencies (e.g., suicidal, violent, or delirious
patients; withdrawal symptoms) and be familiar with their management. In particular, the student
will develop a repertoire of questions and interpretive skills sufficient to permit estimation of the
likelihood of suicide and methods of safeguarding against it.

6. • 5. The student will recognize and apply principles of giving and receiving
consultation to patients and their family members.
6. The student will recognize basic processes of judicial commitment in
Somaliland and other basic forensic issues.
7. The student will effectively utilize the processes of patient education,
reassurance, and support. The student will learn indications for, and gain some
familiarity with, other psychological interventions.
8. The student will be able to describe the clinical presentations, course, and
prognosis of the following disorders with special emphasis on findings
discriminating among them:
a. Depressive Disorders (e.g., Major Depression)
b. Neurocognitive Disorders (e.g. Delirium, Dementia)
c. Schizophrenia Spectrum and Other Psychotic Disorders
d. Bipolar Disorders
e. Anxiety Disorders (e.g., Panic Disorder, GAD, Social Anxiety)
f. Addictive Disorders
g. Child or Adolescent Psychiatric Problems (e.g., ADHD, Conduct Disorder)
h. Personality Disorder (e.g., Borderline, Anti-Social, Paranoid)
i. Stress related disorders
j. Eating Disorders

7. 9. The student will identify and describe somatic treatments:
a. Common pharmacologic treatments, including indications,
contraindications, and side effects of antianxiety agents, antidepressants,
antipsychotics, and sedative-hypnotics.
b. Electroconvulsive (ECT) treatment indications and effects.
10. The student will be able to detect common psychiatric disorders in the
aged.
11. The student will be able to identify common psychiatric disorders first
diagnosed in infancy, childhood, or adolescence, maternal mental health
or geriatric psychiatry.
12. Student will learn critical appraisal, presentation and Evidence based
mental health practice
13. Student will learn issues related to mental health practice in low and
middle income countries

8. References
• Core reference books
• MhGAP mental health version 2.0, 2017
• Mastering psychiatry, 2015
• Psychiatry Clerkship Guide, Second Edition, Manley, 2007.
• Clinical Psychiatry for Medical Students, Third Edition, Stoudemire, A. 1998.
• Introductory Textbook of Psychiatry, 6th Edition, Black and Andreasen. 2014.
• Psychiatry (House Officer Series), Seventh Edition, Tomb, 2007.
• Crush course psychiatry, 2015
• Sim’s signs of the mind, 2015
• Clerkship in psychiatry: First Aid , 2018
• 2.To help prepare students for the shelf exam:
• Lange Q & A Psychiatry, Tenth Edition, Oransky, 2011.
• The Medical Basis of Psychiatry
• Comprehensive Textbook of Psychiatry, Ninth Edition, Kaplan. 2009.

9. Course teaching plan
Date Classroom lectures
Saturdays/Sundays
Classroom
writing support
Tuesdays
Clinical rounds Journal club/global
mental health debates
October-November 2019 Lectures Essays on
mental health
Starts in early
October
-
December 2019-February 2020 Lectures
Midterm
Final exam
OSCE mocks
Clinical rounds at
mental health
ward/community
3 or 4 days/week
Wednesday/Thursday
mornings at mental
health ward when the
course gets very
advanced. Venue will
be lecture hall in the
hospital or the mental
health ward waiting
area
Any change of the plan will be shared in due course
Note: Clinical attachment in psychiatry will start in the second week of October 2019 when students get general
knowledge related to the course and the visiting professor joins Amoud University earlier this month.
Supervision dates will be in the mental health ward and evaluation forms.

10. How you will be assessed?
Grade A B C D F
Points 90-100% 80-89% 70-79% 60-69% Below 60%

11. Assessment tasks
Task
No.
Assessment Tasks Individual
or Group
Weighting
%
What is the
duration /
length?
When should I
submit?
Where should I
submit it?
1 Essay Individual 25 1200 words
November
26,2019
Handover to
lecturer
2 Daily attendance Individual 10
December 15,
2019
Handover to
lecturer
3 Midterm test Individual 15 90 minutes
December
25,2019
Handover to
lecturer
4 Clinical attachment Individual 10 8 weeks Same day
Handover to
lecturer
5 Global Health Individual 10 8 weeks January 25,2020
Handover to
lecturer
6
Attendance and
conference/Journal
club Individual 10 8 weeks
Same day as the
conference/journa
l club
Handover to
lecturer
7 Final exam Individual 20 120 minutes February 1,2020
Handover to
lecturer
Total 100%

12. Assessment Task 1: Essay
Goal:
This task allows student to undertake in depth study of a topic selected by the instructor on a common
mental health issue affecting the Somali societies within East Africa or in diaspora setting
Timeline: October 2- November 25, 2019 Deadline to submit: November 26,2019
Product: Essay
Format: • Individual task
• Standard essay structure
• 1200 words
• Harvard Referencing style
Criteria:
You will be assessed on the quality and clarity of the essay to communicate your
writing, in addition to:
 Depth of analysis and critical appraisal of literature
 Coherence of the argument presented
 The use of relevant sources to support your findings
 Academic communication including structure, grammar and referencing
 No plagiarism which will result in 0% marking
Generic skill assessed Skill assessment level
Coherence
Communication Graduate
Writing skills
Referencing Graduate

13. Assessment Task 2: Midterm test
Due date: December 25, 2019
Goal: The aim of the quiz is to enable you to review important foundational concepts in
mental health that can be found in the prescribed text and lecture material
Product: written Quiz of 50 questions
Format: Multiple choice questions of 90 minutes’ duration using a Closed-Book format and
access to material found in the lectures on Blackboard
Criteria: Accurate discipline knowledge and ethical practice
Generic skill assessed Skill assessment level
Knowledge Developing
Skills Developing

14. Assessment Task 3: Clinical attachment
Goal:
This task allows student to undertake clinical assessment of a client in hospital, outpatient or community
setting where student does full history taking. Physical exam, mental state exam and formulation
Timeline: October 15, 2019- December 10, 2019
Product: Outpatient and inpatient clinical clerkship
Format: • Individual task
• Standard case presentations
• case discussions
• Communication skills
Criteria: You will be assessed on the quality and clarity of the case to communicate findings, in addition
to:
 Quality of the presentation
 Through and systematic clinical appraisal
 The use of relevant sources to support your findings
 Articulation of your clinical judgement
Generic skill assessed Skill assessment level
Knowledge
Communication Graduate
Clinical judgement
Problem solving skills Graduate

15. Assessment Task 4:Global mental health lecture series and debates
Goal:
This task allows student to undertake in depth debateof issue relevant for mental health neurological and
substance misuse disorders in low and middle income countries
Timeline: December 2019-January 30, 2020
Product: Debate/lecture
Format:  Individual task/group task or argument generated by the lecturer and lectures
 Round table discussion
 Video will be played in class relevant to topic
 Q and A with expert
Criteria: You will be assessed on the quality and clarity of the arguments to communicate findings, in addition
to:
 Critical judgement of global health topic
 Coherence of the argument presented
 The participation of student in the discussion
 Academic communication including structure, respect of other opinion
Generic skill assessed Skill assessment level
Clinical connections
Communication Graduate
Practical analysis
Knowledge Graduate

16. Assessment Task 5 : Attendance and journal club
Goal:
This task is to make sure that every student’s attendance of a journal club and overall class/clinical
clerkship is kept and rewarded . Rehearsals for mental health OSCEs is included here
Timeline: December 1, 2019 - February 1,2020
Product: Recording of attendance
Format:
•
•
Individual task
Participation of journal club
OSCE rehearsals
Criteria: You will be assessed on the n umber of absentee rates
 The use of relevant sources to support your findings
 Calculation of attendance by every student to all activities of the course
Generic skill assessed Skill assessment level
Communication Graduate
Information literacy Graduate
Assessment
T a sk 6 Final exam
Goal:
Overall assessment of knowledge, skills and attitudes of the students on the course at the end of the study
time.
Exam date: February 10, 2020
Product: Exam questions
Format: • Individual task
• Standard MCQ structure
• Long and short questions will be asked in the exam
Criteria: You will be assessed on a closed book exam on skill s, knowledge and ethics in clinical psychiatry
Generic skill assessed Skill assessment level
K nowledge Graduate
Skills
Attitude Graduate

17. What are the course activities?
5.1 Directed study hours
Lecture: Total of 6 hours available in class teaching/week
Field/clinical support: 14 hours per week x 10 weeks
Simulated Learning Activity in global health debates/journal
clubs - 2 hours per day for 2 days/week

18. Teaching
Week Date
What key concepts/content will I
learn?
What activities will I engage in to learn the
concepts/content?
Directed Study Activities
Independent Study
Activities
2-8/10/19
6/10/2019
13/10/2019
History of psychiatry View course lectures Prescribed readings
Psycho pathologies on Blackboard YouTube lectures
Task 1 & 2 are introduced Tutorial activities
9-16/10/19
17/10/2019
17/10/2019
Clinical interview View course lectures Prescribed readings
Formulation /management
Task 1 and 2 continue Tutorial Activities
20-27/10/2019
20.10.2019
20.10.2019
Mood disorders View online lectures Prescribed readings
Suicide and self-harm/risk
assessment
Bipolar disorder Tutorial Activities View online media on Blackboard
Other depressive disorders
24.10.2019
Eating Disorders View online lectures Prescribed readings
Anxiety disorders Tutorial Activities View online media on Blackboard
1-8/11/2019
27/10/2019
Stress related disorders View online lectures Prescribed readings
Personality and impulse
disorders
Tutorial Activities View online media on Blackboard
4/11/2019
8/11/2019
Schizophrenia and
other psychotic
disorders
View online lectures Prescribed readings
Psychopharmacology Tutorial Activities View online media on Blackboard
Courseoutline

19. Teaching
Week Date
What key
concepts/content will I
learn?
What activities will I engage in to learn the concepts/content?
Directed Study Activities
Independent Study
Activities
8-15/11/2019
10/11/2019
14/11/2019
Substance use disorders View course lectures Prescribed readings
Neuropsychiatry disorders on Blackboard YouTube lectures
Psychiatry emergency Tutorial activities
17/11/2019
19/11/2019
Somatization disorder View course lectures Prescribed readings
Psychotherapy
Tutorial Activities
15-22/11/2019
24/11/2019
28/11/2019
Organic disorders View online lectures Prescribed readings
Sleep disorders
Sexual disorders Tutorial Activities View online media on Blackboard
Sleep disorders View online lectures Prescribed readings
Tutorial Activities View online media on Blackboard
29/11/2019-
6/12/2019 1/12/2019
View online lectures Prescribed readings
Women mental health Tutorial Activities View online media on Blackboard
View online lectures Prescribed readings
Tutorial Activities View online media on Blackboard

20. Teaching
Week Date
What key
concepts/content will I
learn? Directed Study Activities
Independent Study
Activities
7-14/12/2019 8/12/2019
Consultation liaison
psychiatry View course lectures Prescribed readings
on Blackboard YouTube lectures
Old age psychiatry Tutorial activities
10/12/2019
View course lectures Prescribed readings
Child and adolescent
mental health Tutorial Activities
15-22/12/2019
15/12/2019
19/12/2019
Forensic psychiatry View online lectures Prescribed readings
Ethics and human rights in
psychiatry
Tutorial Activities View online media on Blackboard
22/12/2019
National mental health
Global Mental Health
Issues
Burden
Human rights
Careers in psychiatry
View online lectures Prescribed readings
Tutorial Activities View online media on Blackboard
View online lectures Prescribed readings
Tutorial Activities View online media on Blackboard

21. Guidelines for the Essay paper
♦ 10 pages (excluding Figures and reference list), double-spaced, font-size no smaller
than 10 pt and margins no smaller than 1/2 inch. No hand-written papers will be
accepted. MAXIMUM TEXT LENGTH IS 10 PAGES, I will not read additional
pages.
♦ The term paper is due on January 10, 2019. Term papers handed in late will be
deducted 10% plus 2% for each additional day late.
♦ Inform me of your term paper topic as soon as possible and before you start writing
(email or personal meeting). The list of topics shown is not restrictive -- you may
choose another topic, provided it is related to the course and has been approved by me.
♦ Be as concise as possible in the choice of topic. A topic like “Mood Disorders” is too
broad. Graduate students: It is recommended that you write about a topic related to your
thesis, if relevant to the course.
♦ Have an introduction that clearly indicates the topic of the paper and make sure you
follow your indicated topic.
♦ Use references that are current. Some of the references may be books or reviews, but
make sure to refer to some up-to-date original articles. Do not just provide a summary
of a chapter or a review, but demonstrate your ability to read and interpret the current
literature.
♦ References in text and bibliography should use a non-numbered style (e.g., APA).
♦ Make sure the references in your text match with your bibliography.
♦ If you use published figures or tables, clearly indicate the source.
♦ End your paper with a brief summary of your main conclusions.
♦ DO NOT PLAGIARIZE.

22. Term Paper – Example Topics
The below examples are not “ready-to-go” topics, but examples of past student papers.
Your actual topic has to be discussed with the me before you start writing.
• Electroconvulsive therapy and memory functions.
• Hormonal treatment of stress-related memory symptoms.
• Selective inhibitors of MAO and their relevance to treatment of depression.
• Recent advances in the mechanisms of action of lithium.
• Antidepressants as neuroprotective agents.
• Neurochemistry of panic disorder.
• Nitric oxide – a role in CNS regulation?
• Prefrontal cortex changes in obsessive-compusive disorder.
• Neuropsychiatric consequences of cortical lesions.
• Transdiagnostic psychiatry – brain and behavioural evidence
• Memory changes in Posttraumatic Stress Disorder.
• Alterations of attention in anxiety disorders.
• Neuroimaging in psychotherapy.
• Biological aspects of cognitive changes in eating disorders.
• Dopamine receptor subtypes and the actions of antipsychotic drugs.
• Glutamate and schizophrenia.
• Brain functions and psychotherapy.
• AIDS-related dementia.
• The role of allopregnanolone in anxiety and depression.
• Gender issues in the etiology of depression/anxiety disorders.
• Biochemical theories of Alzheimer dementia.
• Changes of default-mode functional brain activity in schizophrenia.
• Neurosurgical management for refractory obsessive-compulsive disorder
• Functional neuroanatomy of emotion-cognition dysregulation in schizophrenia.

23. 1. The number of cases students will encounter in clinical exposure
Total Number of Number of New Number of
Diagnosis Follow - up
Patients Patients
Patients
Depression disorders 10 4 6
Bipolar Disorder 4 2 2
Anxiety disorders
Maternal mental health disorder 6 3 3
Somatization disorder 2 1 1
Schizophrenia / Psychotic disorders 4 2 2
Childhood mental health disorder 1 0 1
Substance Disorders 3 1 2
Organic disorders 2 0 2
Old age mental health disorder 2 1 1

24. 1. Journal Club organization
Lecturer will pick up a relevant clinical psychiatry paper, share with students one week before
the discussion time and lead the journal club with interns and medical doctors interested in
psychiatry clinical research appraisal.
This will be 2 hours’ critical appraisal exercise
2. Mental Health Debates
Lecturer will organize mental health debate topic with students and lead the debate with the
students. Topics will be selected based on local and regional/international mental health issue
affecting Somali patients.
Debates will be 2 hours long.

25. Essays and research project
• Lecturer will teach research project and essay writing once every
week to familiarize students what is needed in the assignments
• Students will have guidance on individual and group activities
• Tuesday October 15, 2019 every student will receive essay topics
• Essays are to encourage students to learn practically academic writing
• Research projects aims to prepare students for undergraduate
student thesis work that will be part of the final exams along with
written exams and OSCEs.

26. Essay topic
Psychiatry: is it a medical specialty or social science?
Jinn does not cause mental health disorder: Do you agree with the statement? If not why?
Women are more likely to be mentally ill rather than men: how much do you agree with this statement?
Are mental health disorders genetic diseases?
mentally ill patients should never marry: Do you agree or disagree with this statement?
Does mental health disorder tend to run in poor societies?
Why we should ban Qat in Somaliland?
Why young people like to chew Qat?
Does Qat cause mental health disorder?
What is cultural bound psychiatry?
Why young people smoke cigarettes?
Does mental health disorder lead to life crisis?
Is mental health disorder associated with Sixir, magic or evil eye?
Is mental health disorder a disease of cursing by someone?
Is mental health disease treatable or untreatable?
Do someone marry a mentally sick person or person with strong family history of mental disease?
who is responsible for the care of the mentally sick people?
society dislikes mentally sick people: how much you agree with or disagree with this statement?
Is relation a protective factor in mental health disorders?
mentally sick people who commit crime must be punished as insane people: Do you agree or disagree with this statement?
Why we chain people with psychiatric disorders?
unemployed people are more likely to be crazy people: Do you agree or disagree with the statement?
stressful lifestyle of students can lead to mental health disorders: Do you agree or disagree with the statement?
Every student has an assigned essay topic and anyone who wants to propose a topic
will be allowed to come up with his/her own topic

27. Teaching materials
• Flipcharts- by student/faculty not lecturer’s responsibility
• Whiteboard markers - faculty
• Projector - faculty
• Laptop- every student brings laptop for class
• Pens/notebook- everyone

28. Ground rules
• Chew your gum before you come to the class
• Class starts 6.30 AM. You are kindly requested to come to class
on time before 6.30 AM.
• cell phones must be switched off or at least be in silent mode
in the class
• Attendance is taken in class/ward
• Deadlines are deadlines. Any delay will result in losing marks
• Raise your hand if you want to ask a question
• Chatting, laughing and making calls are to be made at the
outside of the class

29. THANKS FOR LISTENING
HOPE WE ENJOY NICE TIME IN THE COURSE- DR JIBRIL
ANY QUESTIONS, SUGGESTIONS OR DISCUSSIONS!