Supervision: The challenge of the new student

Abstract

SYCHIATRY IS CHANGING. Many of its practitioners are rethinking goals and tactics.’ The current psychiatric resident differs from his predecessors as he questions his teachers with an intensity and persistence only occasionally seen in earlier years. Nicholi, writing about campus disorders, suggests that remoteness and invisibility of some administrators alienated a large segment of the college community and facilitated outbursts against authority figures.’ Recent experience with psychiatric residents suggests that the problem students described by Nicholi are now in graduate programs. Student dissatisfaction, which has demanded reevaluation of teaching methods in universities throughout the country, has lately affected the teaching and learning in psychiatry. Students appear who spent their adolescent and young adult years in a youth culture that has taught that authority must be rejected, that history is irrelevant, that feelings and intuition are the standards by which all behavior should be judged. Experienced teachers have found that these students are lacking in objectivity, scientific curiosity, or scholarship, are intolerant of opposing views, and, at times are accustomed to extravagant praise for minimal accomplishment. Disputing or ignoring teachers is not only acceptable to some students, but thought of as a display of integrity and true feeling. In this context, the teacher’s task becomes difficult and challenging. Supervision, the tutorial one-to-one relationship, traditionally the keystone of psychiatric education, may be a particularly useful approach in the training of the contemporary candidate. Supervision encompasses several tasks. Its teaching aspect has been ably reviewed by Escoll and Wood.3 Much also has been written about the supervisor-student relationship and about problems in learning which arise from unconsciously motivated attitudes. 3-1o Undue emphasis on these two aspects of psychiatric education implies that the teacher’s principal task is that of psychotherapist and the student is primarily a patient. Even Tarachow, who begins the discussion of the supervisory process with the warning that it differs from psychotherapy, flounders at the conclusion, stating “ . . . in a sense it (supervision) is a variety of psychotherapy.” i1 Escoll and Wood suggest that the supervisor may “help the resident integrate the varying influences to which he is exposed.“3 We propose that integration of varying influences is not possible, and that the supervisor must help the resident maintain a critically calm position in face of data which cannot be made to agree. Supervision involves authority and responsibility. Escoll and Wood appear to be describing the traditional situation where the student expects to learn from his teachers, and where the teachers are confident that their psychotherapeutic skills will see them through most difficulties.3 The supervisors of the ‘70’s increasingly encounter a