On Becoming a Teacher: Reflections on Teaching and Learning in Psychiatry Residency and Beyond.

Abstract

Although over a decade has passed since my postgraduate year (PGY) 2 in psychiatry residency, it was a formative year for me as a psychiatrist and teacher. It felt, in many ways, like another PGY-1 year in terms of the transitions I faced. Although I was relieved and excited to (finally) be a full-fledged psychiatry resident rather than the “psych” resident passing through various rotations—internal medicine, emergency, and palliative care—I also felt the weight of expectation on my shoulders. This is the true test now—core inpatient and outpatient psychiatry, psychotherapy, and psychopharmacology—the heart of psychiatric practice. What if I didn’t like it? What if I wasn’t any good at it? And now they’re asking me to teach clinical clerks? Wasn’t I one just recently? Fast-forward 6 years from my PGY-2 year. I am sitting in a class of 14 other “scholars” in the Education Scholars Program (ESP) as a newly minted attending physician. I’ve been supported to attend by the chief of my department and I feel as nervous as I did inmy PGY-1 and 2 years of residency. Do you ever shake this feeling? Didn’t I just pass the requisite licensing exams and complete a fellowship? Haven’t I “arrived”? We were asked on the first day of class in the ESP to communicate our metaphors for teachers and teaching. The answers are both expected and unexpected—a chameleon, constantly adjusting to learners and the context, a guide on a journey, and an orchestra conductor. One answer from a thoughtful surgeon resonates with me. He speaks of his experience in Japanese martial arts and the term senseiwhich means “teacher” in Japanese. The surgeon says sensei’s literal translation is something like “the one who came before.” This term honors the perspective that teachers have in terms of imparting wisdom and perspective and I realize, in reflecting on this, that this is what I lacked as a PGY-2: bright eyed and bushy tailed; I had no idea how formative and meaningful teaching and being taught by talented and dedicated teachers would be inmy career development. I also had no sense of how impactful my contribution to teaching medical students could be. As doctors, I think we implicitly value teaching and learning. We are, after all, supposed to be “lifelong learners” and we’ve invested a lot in becoming doctors, but that’s just it, isn’t it, the essence of being a lifelong learner: Each of us is always in the process of becoming, learning, and growing. It’s never done. However, in those first months in PGY-2 and the years that followed it was the wisdom and guidance from the “ones who came before,”my/our teachers who provided time, guidance, safety, wisdom, knowledge, a sympathetic ear, perspective, inspiration...and so much more that helped to provide the “secure base,” to borrow a term from Bowlby [3], from which I could explore and become the clinician and educator I am today. Another flash forward and backwards. It’s 3 years into my being an attending physician and I am sitting in a faculty development program called “Train the Trainer” that is meant to teach faculty how to deliver a teaching skills program. I’m Acad Psychiatry (2016) 40:380–381 DOI 10.1007/s40596-014-0260-2