Reflections on medical education in psychiatry in the Middle East

Summary

This reflection explores the unique challenges and opportunities in psychiatric medical education in the Middle Eastern region. The variation in aspects of teaching across the region can be explained by the influence of cultural and religious perspectives on the understanding of mental illness. Key barriers include pervasive stigma, shortages of teaching staff and limited clinical placements. Innovations like virtual learning and regional collaboration offer pathways to strengthen curricula, enhance competency-based assessment and further improve the future of psychiatry education.

Cultural, historical and systemic contexts influence psychiatric education. The extent of undergraduate education in psychiatry varies significantly across institutions and countries within the Middle Eastern region. Although some Gulf countries are now on par with the systems that have developed over a much longer period, e.g. in Europe and the USA, others are continuing to expand and strengthen their programmes at an admirable pace.

Many medical schools in the Middle Eastern region use traditional, discipline-based curricula, although some are now following an integrated, problem-based approach, and others have started to adopt competency-based curricula that encourage relatively early clinical exposure. There has been a rapid growth in medical schools in the Middle East, which reflects increasing population needs and national investment in healthcare. However, significant variations still exist in comparison with more established health education systems. Understanding and analysing these differences is essential to appreciate the unique regional challenges and to identify opportunities for further improvement. Psychiatric education in the Middle East is reflecting the barriers of stigma, limited visibility and cultural attitudes towards mental illness that are common in many parts of the world.

Psychiatry entails imparting a deep appreciation of the cultural underpinnings of distress, family structure and faith. Psychiatric practice is significantly influenced by the cultural context, and teaching psychiatry in the Middle East thus requires taking into consideration collectivist values, family involvement in care, and cultural and religious perspectives on mental illness. Principles such as patient confidentiality, autonomy and shared decision-making are important and being applied in the region, without compromising ethical standards. Similarly, psychiatric practice and education in the region are influenced by legal and policy frameworks, as elsewhere. When it comes to mental health legislation and its effective application, there is significant variation from region to region, and this may affect both psychiatric practice and training (Althani 2023).

Cultural context and stigma

Culture plays a pivotal role in how mental illness, and its treatment, are perceived. In many societies, including some in the Middle Eastern region, psychological distress or dysfunction is usually viewed through a spiritual or religious lens (Zolezzi 2018). Faith, family or social obligation may be considered more relevant than a biomedical model to explain mental illness (Okasha 2004). Medical students may find it challenging to reconcile prevailing cultural views with what is taught in the lecture halls.

Psychiatric terminology may confuse students when they have to understand it within the local idiom, which often has terms rather different from those found in the textbooks. For example, major depressive disorder may be described in local parlance as fatigue, somatic symptoms or spiritual imbalance. Ensuring that such local and religious idioms are incorporated into teaching becomes essential to enable students to better understand psychiatric illness in the community.

English is the medium of instruction in most medical schools in the Middle East. But students and doctors encounter patients who speak either Arabic or another local language. This adds another layer of complexity. The nuances of layman’s language and technical terminology thus assume even more importance when communication with patients occurs in a language that lacks certain terms to describe symptoms. This specific challenge perhaps may not be equally relevant in other regions, where the language of teaching and patient communication are more aligned.

It is imperative that psychiatric teaching is delivered in a culturally relevant manner, especially when dealing with diverse cultures. Educators must ensure that students possess the skills and flexibility to integrate standard diagnostic criteria with patients’ own explanatory models. Unless social and cultural factors are incorporated into psychiatric training, there is a risk that psychiatry will be viewed as alien, irrelevant or even in conflict with prevalent norms.

Religious beliefs, family expectations and wider social norms also contribute to stigma towards mental illness in the region. Concerns related to family reputation, social standing and the individual’s prospects in various domains of life may influence both disclosure of symptoms and engagement with psychiatric services. These realities necessitate specific adaptations in medical education strategies. Undergraduate teaching should therefore include culturally grounded case discussions and reflective exercises that prepare students to engage sensitively with patients and families. Teaching models should guide students to apply ethical principles such as confidentiality and autonomy in keeping with the local legal and cultural contexts.

Furthermore, stigma towards psychiatry is a global problem and the Middle Eastern region is no exception (Dardas 2015, 2019). Research suggests that in the Middle East, medical students consider psychiatry lower in terms of prestige, career prospects and credibility than other medical specialties (El-Rufaie 2011). Although attitudes towards psychiatry may be more favourable in some other parts of the world, the Middle Eastern region has witnessed steady progress in recent years in recognition of psychiatry as a discipline, in advocacy and public support, and in its visibility on the curriculum.

Clinical placements are crucial in shaping positive attitudes towards psychiatry. Students witness patients getting better, appreciate the role of the family and interact directly with patients. This is pivotal in changing perceptions. Students get an opportunity for experiential learning and role modelling, which make them more likely to promote mental healthcare in the future.

Clinical exposure, teaching staff and resources

Psychiatry placements in undergraduate medical education in the Middle East usually last 2 to 4 weeks and in some cases may be combined with neurology. Limited exposure prevents students from gaining a thorough understanding of the subject at their level and from observing the specialty sufficiently to appreciate its clinical dynamics and the nuances of patient care, which are important in shaping professional attitudes. Adequate observation, on the other hand, might allow students to identify aspects of psychiatry that appeal to them as a career choice, developing interest and potentially influencing career decisions.

Teaching staff (faculty) shortages continue to pose a significant challenge in psychiatric education in the Middle East. This is particularly true in subspecialties such as child and adolescent psychiatry, psychiatry of intellectual disability (learning disability) and forensic psychiatry. Even where clinicians are available who could take on a teaching role in a subspecialty, they are heavily engaged in clinical and service responsibilities, which leaves limited time for teaching or curriculum development. Likewise, psychiatric facilities available for teaching are also limited. Teaching methods currently mostly rely on didactic lectures, but new learning methods such as case-based discussions, simulation, objective structured clinical examinations (OSCEs) and workplace-based assessments (WPBAs) are being increasingly embraced.

Competency evaluation, research opportunities and quality assurance

Assessment of medical students in the region is primarily carried out through tests relying on factual recall. A predominantly knowledge-based approach does not adequately develop or assess competencies related to attitudes, communication, clinical reasoning and overall performance. As mentioned above, more sophisticated methods such as OSCEs, WPBAs, portfolios and competency evaluations have been adopted in some systems more recently and are gaining momentum. Awareness of the need to balance formative and summative assessments and to integrate competency-based evaluation is growing in the region. The increasing recognition of the importance of assessing attitudes, communication and clinical reasoning will help provide a broader picture of student competence.

Exposure of medical students to psychiatric research is growing in the region and this aligns with the global trend. This is indeed a welcome trend and will ensure that future doctors are equipped with the skills necessary to engage in psychiatric research. However, progress is still constrained by limited dedicated infrastructure, relatively insufficient mentorship and a less established culture of inquiry at the undergraduate level (Okasha 1998). Although medical education accreditation frameworks in the Middle East may not be as robust and long-established as elsewhere, some institutions have already implemented systems to ensure rigorous external and internal monitoring of teaching, assessment and clinical exposure, and others are in the process of doing so. At the policy level, it is evident that efforts are being made to strengthen this area and support the ongoing improvement and growth of medical education standards in the region.

Innovations and emerging opportunities

Despite the challenges outlined above, several opportunities and innovations have emerged. The rapid growth of digital technology during the COVID-19 pandemic has opened new ways for medical teaching. Virtual teaching and learning have already become an integral part of education, with possibilities for greater educator availability, international collaboration and more cost-effective methods of delivering teaching.

Technology is also enabling regional collaboration and joint training initiatives. This allows for an expanded pool of supervisors, wider exposure to diverse practice environments, and opportunities for research networks focusing on cultural psychiatry and service development.

At the same time, innovations such as simulation-based training and digital assessment tools are beginning to supplement traditional teaching. These offer students safe and interactive environments to practise skills and receive structured feedback. Technology-enhanced learning has the potential to transform higher education in the Middle Eastern region by improving accessibility, equity and quality (Eltaiba 2025). If such approaches are sustained and systematically integrated into curricula, they hold the potential to address shortages of teaching staff, strengthen psychiatric training and reduce disparities between institutions across the region.

Reflections and recommendations

In conclusion, medical education in psychiatry presents a variety of challenges and some opportunities in the Middle East. It is imperative to envisage a roadmap for how psychiatry education in the region can be further evolved to become both culturally relevant and globally informed.

Reducing stigma by providing more visibility to psychiatry on the curriculum is paramount. Psychiatry rotations (clerkships) must be of adequate duration and feature modern teaching methods, including case discussions, ethics sessions, and ongoing student evaluation and guidance. Students must be equipped with skills to better understand patients’ narratives, experiences and family perspectives. A consistent shift from factual recall-based testing towards competency-based assessment is essential.

Tapping into technological potential is another key step. Even in settings with limited availability of teaching staff, creative approaches such as telepsychiatry clinics, regional partnerships and shared teaching resources can be of great help. Simulated patients can provide safe, structured opportunities to practise communication skills. Now that artificial intelligence (AI) is taking the world by storm, it is crucial for educators in the Middle East to develop innovative ways for psychiatry teaching through effective utilisation of AI.

Educators should design a psychiatry curriculum that is more tailored to the region. Emphasis should be on enabling students to appreciate psychiatric illness within the context of culture. This will improve their diagnostic accuracy, and translate into better care and improved patient experience.

Institutions in the Middle East must continue the valuable efforts to engage in staff development and build on the progress already achieved. Sustained investment in teaching skills, assessment methods and educational scholarship will further enhance the capacity of educators and the quality of medical education. Strategic international collaboration and exchange programmes can further strengthen the quality of psychiatry education.

Finally, it is imperative to encourage research in local educational policies and practices. Publishing work on psychiatric education in the Middle East allows for academic growth and sharing perspectives with colleagues around the globe.