Sorcerer's apprentice: The initial phase of training and education in psychiatry

Abstract

Summary Society's demands for increased and more varied services and the expansion of the field of psychiatry from within, coupled with the information explosion, have put considerable strain upon psychiatric training and education. In spite of fundamental insights into training and educational needs, no pedagogic methods have been developed to increase teaching and learning efficiency and effectiveness. A narrow, pragmatic view and a shift toward an eclectic orientation from a psychoanalytic-theoretic base led to considerable neglect of the core curriculum and the basic skills. Instead, the residents are expected to have experience in all newly developing areas of our field, rather than achieve depth in the core curriculum and the basic skills. This smorgasbord-type of training leads to a “Jack-of-All-Trades, Master of None.” This training is supplemented by formal instructions, the educational part of the residency experience, which also strives to be all-inclusive and eclectic rather than truly integrated. We have redefined the basic skills and the core curriculum and have suggested that experience with learning in the initial phase of psychoanalysis and psychotherapy can serve as guidelines for a systematic pedagogy for training and education in psychiatry. We have reasserted that the diagnostic-therapeutic “instrument” is the doctor's personality, his “mental apparatus.” His methods and skills are observation, evocative listening, empathy, intuition and introspection. The folk tale of the “Sorcerer's Apprentice” provided us with clues and parallels for the examination of the climate and methods of teaching and learning. We concluded that some methods of teaching and some climates for learning play into the trainee's “Apprentice Complex” and contribute to the development of his learning blocks. We suggested a method to deal with the problems of learning, presented by the proneness to the “Apprentice Complex” and by the nature of what is to be learned. The method has to avoid an excessively didactic and overly supportive approach by the teacher. The initial phase of training and education for the psychiatrist has to involve primarily his immediate use of himself and his skills in a dyadic relationship, without introducing artificial barriers to learning in the form of premature theoretical studies. The emphasis is on the word “premature,” since we do not propose an anti-intellectual climate or a training and education devoid of the necessary acquisition of information, accumulated knowledge and theory. As a matter of fact, our approach is designed to prepare the ground for their better assimilation rather than mere registration. In case seminars and in individual supervision, our method involves helping the trainee reflect upon the workings of his diagnostic-therapeutic “instrument.” Focus upon each individual skill and then especially upon those leading to emotional understanding, represent techniques to “break in” the instrument for its task. Allowing the beginner to discover his own mode of thinking and feeling in his professional experiences is the crucial learning task of the initial phase. It has to be the core experience of a core curriculum, if what he is taught is not to be for the resident “empty words of incantation” or be what Fenichel calls “dynamically ineffective knowledge.” We have postulated that to expand training and education in depth and breadth from such a solid base will guard against the kinds of devastating experiences the “Sorcerer's Apprentice” had. We have finally reviewed some of the difficulties encountered in our teaching and suggested that empathy for the resident's predicament and certain specific changes in the teacher's posture might further improve the chances of good teaching and good learning.