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Year : 2012  |  Volume : 25  |  Issue : 3  |  Page : 213

The Psychiatric Scrapbook: Fantasizing from the Patient's Perspective

1 Leiden University Medical Center, Department of Psychiatry, The Netherlands
2 Leiden University Medical Center, Center for Innovation in Medical Education, Leiden, The Netherlands

Date of Web Publication29-Mar-2013

Correspondence Address:
Andries JM de Man
Leiden University Medical Center, Center for Innovation in Medical Education, Albinusdreef 2, P.O. Box 9600, 2300 RC Leiden
The Netherlands
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Source of Support: None, Conflict of Interest: None

DOI: 10.4103/1357-6283.109795

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How to cite this article:
Gosselink MJ, de Man AJ. The Psychiatric Scrapbook: Fantasizing from the Patient's Perspective. Educ Health 2012;25:213

How to cite this URL:
Gosselink MJ, de Man AJ. The Psychiatric Scrapbook: Fantasizing from the Patient's Perspective. Educ Health [serial online] 2012 [cited 2023 Jun 6];25:213. Available from:

Dear Sir,

Empathy is the core of the doctor-patient relationship, professionalism and good medical practice, and should be cultivated in medical education with high priority. In the context of patient care, empathy can be defined as a cognitive attribute, with an affective root, that involves an understanding of patient's emotions, experiences, concerns, and perspectives. In the third year of our preclinical problem-based curriculum, students follow a three-week course 'Psychiatric Diseases', in which diagnosis and therapy of psychiatric disorders are taught. Interwoven with these aspects, we discuss the psychiatric patient's personal perspectives about these diseases.

Many students have difficulties imagining having mental symptoms and their consequences. This may have serious implications for the ability of students to be empathetic toward patients with mental illness. As a result, they may develop stigmatizing attitudes. This is worrisome, as in their future-practice, all will encounter patients with (co-existing) mental illness. Stigmatizing attitudes may result in limitations in care.

We developed a teaching model with imagination as a tool. We aimed at enhancing the student's involvement with a patient, framed by theoretical knowledge. This was done by provoking students' fantasy and reflection by having them write and read from an imaginary patient's point of view. Twenty-five students were instructed to write two narratives from an imaginary psychiatric patient's perspective. The narrative had to be written from the patient's point of view, in a first-person's perspective monologue and in a vivid way, drawing focus on the patient's perception of the disease, considering affective, cognitive, and situational aspects. Narrative contents had to comply with the guidelines and terms of the Diagnostic and Statistical Manual of Mental Disorders (4 th edition). Furthermore, from the doctor's perspective, students had to defend their first treatment of choice and/or interventions in the individual patient. Finally, as in a scrapbook, accompanying illustrations such as photos had to be provided. Moreover, each case was required to include a short movie fragment, either made by the student or provided from the internet (e.g., from YouTube). The product was assimilated into an e-learning module: an online-scrapbook. Each item occupies a web page, which visually consists of two scrapbook pages. The left page contains the narrative; the right page contains the illustrations, video, diagnosis, therapeutic plan, and student's name.

In the evaluation, both the writers and readers of the online scrapbook evaluated its usefulness as 'very good'. They stated that they obtained a 'real life' illustration of the theoretical background they have learned. The immersion made them feel 'close to reality'. Both writing and reading the psychiatric scrapbook encouraged students to reflect. The exercise triggered their curiosity, leading to growth of emotional and cognitive attachments to psychiatric patients. Students revealed that, subjectively, they had gained more insight into both patients' and doctors' perspectives. The imaginary 'standing in patients' shoes' reduces students' emotional distance between the self and the patient. Overall, engagement is of importance in the growth of empathy and also in educational achievement and enjoyment, skills all necessary for future professionalism.

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