Increasing learning during the psychiatric residency

Abstract

P OSTGRADUATE TRAINING in the field of psychiatry is currently in a state of flux, with vany fronts. Most institutions offering psychiatric residency training programs are in the process of painful reevaluation and change, attempting to integrate into their core curricula the disparate models associated with psychoanalytic psychology, community mental health, behavior modification, psychopharmacotherapy, family therapy, and a host of other models that reflect special interests of individual training centers. This situation was clearly apparent in a “white paper” of the Association for Academic Psychiatry’ which resulted from the 1973 meeting of Career Teachers in Psychiatry examining the goals, methods, and effectiveness of psychiatric residency training programs in the United States. In attempting to answer the questions, “What is a psychiatrist now? What should he be in the next decade?” it was stressed that the psychiatrist has and probably will continue to have multiple roles. He must not only have knowledge of prevalent theories of personality development and sociocultural determinants of behavior and of how to diagnose patients according to a descriptive nosology, but also know how to relate these to a theory of psychopathology. The Career Teacher Group specified that the psychiatrist should be able to do the following: “(A) He should be able to use the somatic therapies, including ECT and psychopharmacological agents. (B) He should know how to practice the various psychotherapies. He should be skilled in the forms of individual therapy in current practice that have some validity and be able to apply this ability to individuals and to work with larger social units. Training in individual therapy is essential; training in group therapy, family therapy, and behavior modification are desirable. (C) He should know the concepts and practices of community psychiatry, including consultative techniques and aspects of preventive psychiatry. (D) He should have the tools and motivation for continuing his own education after training. He should be familiar with diagnostic and therapeutic techniques with children and adolescents.“’ In the presence of such expectations, an emotionally charged problem has emerged for psychiatric residents that interferes with the teaching-learning process,” is increasing in frequency, is unrelated to training milieu (e.g. inpatient or outpatient settings), and can occur at any stage of residency training. The problem begins when the resident experiences the realities of current psychiatric practice that tend to clash with his preexisting concepts or fantasies.