Residency Training Directors Research Articles

Inconsistency Hinders Progress in Psychotherapy Training

Back to table of contents Previous article Next article Education & TrainingFull AccessInconsistency Hinders Progress in Psychotherapy TrainingMark MoranMark MoranSearch for more papers by this authorPublished Online:19 Oct 2012https://doi.org/10.1176/pn.47.20.psychnews_47_20_10-aAbstractResidency training in cognitive-behavioral therapy (CBT) has become much more consistently developed, and while psychodynamic therapy is widely taught, there is a lack of consensus regarding its content and a need for more rigorous evaluation of “competence.”Those were the principal findings from a nationwide survey of psychiatry residency training directors regarding training in psychotherapy in the September 1 Academic Psychiatry.Authors Donna Sudak, M.D., and David Goldberg, M.D., surveyed U.S. general psychiatry training directors about the amount of didactic training, supervised clinical experience, and numbers of patients treated in the models of psychotherapy (psychodynamic, CBT, and supportive) mandated by the Residency Review Committee of the Accreditation Council for Graduate Medical Education (ACGME).Sudak is acting director of residency training and director of psychotherapy training at Drexel University College of Medicine. Goldberg is residency training director and chair of psychiatry at California Pacific Medical Center.Sudak and Goldberg received 82 valid returned surveys out of 185 sent, for a total response rate of 45 percent. Not all respondents answered all questions, but almost all (76) answered the questions about required seminar and supervised clinical hours and minimum number of patients.The researchers found that the largest amount of didactic training occurs in psychodynamic psychotherapy. Approximately 70 percent of programs provide more than 30 hours, with nearly 25 percent reporting 70 hours or more. Almost one-third offer less than 30 hours over the course of residency training.Less time is devoted to CBT didactics, with two-thirds of programs offering less than 30 hours; one-third, more than 30 hours. But Sudak and Goldberg noted that this marks a significant increase from 2001, when only 13.1 percent of programs offered more than 30 hours. About 85 percent of programs reported less than 30 hours of supportive-therapy didactics, but it is not possible to know whether they were included as part of psychodynamic or CBT training.The findings regarding didactic training are largely encouraging, suggesting that residency programs have responded to a mandate from the ACGME for psychotherapy training. Psychodynamic therapy is widely taught, but establishing consensus regarding its content and more rigorous evaluation strategies would improve resident competence, they wrote.And supportive therapy, the most widely practiced form of treatment, needs better definition and pedagogy development.In an interview with Psychiatric News, Sudak, who is president of the Academy of Cognitive Therapy, said that following the ACGME mandate for training in psychotherapy, CBT educators worked hard to develop curricula and educational tools and measuring instruments that have helped training directors adopt CBT training. Psychodynamic psychotherapy and supportive therapy training would benefit from the same approach, she said.“Training directors are incredibly busy, and training requirements are extremely rigorous,” Sudak said. “The more psychotherapy educators can help training directors by providing defined methods by which they can train their residents to a high level of proficiency, the more likely will psychotherapy training be adopted.”Regarding supervised clinical experiences, responses indicated wide variability: Most programs (73.3 percent) indicated they offer more than 30 hours of supervised clinical psychodynamic therapy, and half of those require greater than 70 hours of supervised training. However, one-quarter of programs offer less than 30 hours total.CBT supervised clinical experiences have dramatically increased over this decade, to 46.8 percent of programs with over 30 hours and only 6.5 percent with no hours. Approximately half of the programs report more than 30 hours of supervised clinical work in supportive therapy.“Effective psychotherapy training requires suitable patients,” Sudak and Goldberg stated. “We did not assess how long patients are treated, but residents often provide therapy in settings where treatment can be brief, inconsistent, or incomplete. Furthermore, there are no clear guidelines as to what the optimal didactic and supervised clinical experiences are to produce ‘competent’ residents.”They concluded that there has been considerable progress over the past decade in psychotherapy education, but inconsistencies remain in the amount and quality of training experiences offered to residents. “There is enormous variation from program to program in how much training is offered, and it’s always a lot easier to have 20 sessions of didactic class than it is to have a clinical service with available patients and faculty to supervise,” Sudak told Psychiatric News. “That remains the challenge of psychotherapy education. But psychotherapy is a core discipline of psychiatry that needs to be attended to by training directors, and the more we can make it an efficient thing to do, the more training programs will respond.” “Trends in Psychotherapy Training: A National Survey of Psychiatry Residency Training” is posted at http://ap.psychiatryonline.org/article.aspx?articleID=1359984. ISSUES NewArchived

John M. Oldham, M.D., M.S., 138th President, 2011–2012

Back to table of contents Previous article Next article PerspectivesFull AccessJohn M. Oldham, M.D., M.S., 138th President, 2011–2012Robert Michels, M.D.Robert MichelsDr. Michels is the Walsh McDermott University Professor of Medicine and University Professor of Psychiatry at Weill Medical College of Cornell University, New York.Search for more papers by this author, M.D.Published Online:1 Oct 2012https://doi.org/10.1176/appi.ajp.2012.1691003AboutSectionsPDF/EPUB ToolsAdd to favoritesDownload CitationsTrack Citations ShareShare onFacebookTwitterLinked InEmail John Oldham was born in Muskogee, Oklahoma. A critical event occurred just a few minutes before: the birth of his twin brother Jim, who is here with us today. Jim, a retired Professor of Labor Law at Georgetown, labored unsuccessfully to keep his younger brother in his place, but as today demonstrates, John persevered. Their father worked in the natural gas industry, and they moved among a number of Texas cities before they completed high school, a pattern we see replicated in John’s career. He received a B.S. in engineering from Duke, an M.S. in neuroendocrinology and an M.D. from Baylor, to which he returned in 2007 as Professor of Psychiatry, Executive Vice Chair and Chief of Staff of the Menninger Clinic. In the intervening 40 years, he interned at St. Luke’s in New York, trained in psychiatry at Columbia, met his wife Karen, a physician, served in the Air Force, completed his psychoanalytic training, and was on the faculties of Columbia, Cornell, and the Medical University of South Carolina. While rising to the peak of every aspect of psychiatry, he and Karen raised Madeleine, the director of a research and development lab for the creation of new plays at the Berkeley Repertory Theater, and Michael, a neuroscientist at the Broad Center of UCSF, studying how patterns of gene activity change over space and time. Both are with us today.The Oldham household also includes 12 cats and two birds, so John has had ample experience herding large and heterogeneous flocks—good preparation for the presidency of the APA.I first met John when I was Residency Training Director at Columbia, where he was a resident and then Chief Resident, and again when we were both on the Cornell faculty. I was senior to him and spent a fair amount of time trying to find something that I could teach him, but with little success. John is a natural clinician, a skilled administrator of complex systems (two academic departments, three major psychiatric hospitals, the New York State mental health system through the 9/11 crisis, and now our profession). He has made important scientific contributions to the study of personality disorders and is a master teacher, with awards from students. The theme he selected for this meeting is “integrated care.” He himself has integrated his several talents into becoming a remarkable leader. Last year, he emphasized four priorities for the APA: psychiatry as part of medicine, quality treatment, integrated care, and research and education. It is hard to imagine someone whose personal traits and professional experience could better suit him to lead the profession in pursuing this agenda.Dr. Michels is the Walsh McDermott University Professor of Medicine and University Professor of Psychiatry at Weill Medical College of Cornell University, New York.Address correspondence to Dr. Michels, 525 East 68th Street, New York, N.Y. 10065; [email protected]cornell.edu (e-mail).Presented at the 165th Annual Meeting of the American Psychiatric Association, Philadelphia, May 5–9, 2012. FiguresReferencesCited byDetailsCited ByNone Volume 169Issue 10 October 2012Pages 1030-1030 Metrics PDF download History Published online 1 October 2012 Published in print 1 October 2012

Pediatric Residency Training Director Tobacco Survey II

To assess the current status of pediatric residency training on tobacco use and smoke exposure. A nationwide survey of all pediatric residency training directors in the United States was conducted from November 2010 to May 2011 via use of surveymonkey.com. The survey assessed training director characteristics, attitudes and beliefs about pediatricians' role in addressing tobacco control in patients and parents, past training in tobacco use and smoke exposure, inclusion of tobacco control in their training curriculum, and barriers to inclusion. Data are presented as percentages, with χ(2) tests of significance. Sixty-five percent of programs included tobacco control in the curriculum, and training directors who received past training in tobacco prevention and control were significantly more likely to include tobacco use and smoke exposure than those without training. The vast majority of training programs focused on health effects as opposed to intervention, failed to employ active learning to teach tobacco intervention skills, did not evaluate resident tobacco knowledge and skills, and did not encourage use of medications to help parents quit smoking. Pediatric residency training programs must do more to prepare residents to address tobacco use and smoke exposure. Given the many competing priorities of residency training, there is a need to explore new ways of integrating tobacco control into the 3-year curriculum.

Pediatric Residency Training Director Tobacco Survey II

Pediatric Residency Training Director Tobacco Survey II

Associate Residency Training Directors in Psychiatry: Demographics, Professional Activities, and Job Satisfaction

The purpose of this study was to characterize associate training director (ATD) positions in psychiatry. An on-line survey was e-mailed in 2009 to all ATDs identified through the American Association of Directors of Psychiatric Residency Training (AADPRT). Survey questions elicited information regarding demographics, professional activities, job satisfaction, and goals. Of 170 ATDs surveyed, 73 (42.9%) completed the survey. Most respondents (71.3%) had been in their positions for 3 years or less. Many ATDs indicated that they were involved in virtually all aspects of residency training; 75% of respondents agreed that they were happy with their experience. However, specific concerns included inadequate time and compensation for the ATD role in addition to a lack of mentorship and unclear job expectations. Thoughtful attention to the construction of the ATD role may improve job satisfaction.

Professionalism and the Internet in Psychiatry: What to Teach and How to Teach It

The digital revolution has had a profound impact on medicine and patient care. Patients have a growing expectation that they can find medical information on the web and discuss it with their physician by e-mail (1). Physicians, including psychiatrists, are increasingly using blogs and Twitter to promote their practices (2, 3). The internet itself is used as a vehicle for therapeutic modalities, even psychotherapy (4). Social networking among patients, physicians, and other “friends” are blurring boundaries as never before (5, 6). The potential clinical, legal, ethical, and professionalism issues in using the internet and digital media in psychiatry have been outlined elsewhere, including explicit recommendations for resident education in this area (7). This article focuses on how to teach residents about appropriate use of the internet. The evidence of unprofessional online behavior among physicians and the complexity of the potential issues raised with internet use in psychiatry suggest that psychiatric residents, educators, and administrators need explicit teaching about potential clinical, ethical, and legal pitfalls of internet use. In 2010, the President of the American Association of Directors of Psychiatric Residency Training (AADPRT) established a Taskforce on Professionalism and the Internet, charged with reviewing the literature and creating a curriculum to teach psychiatric trainees about online professionalism. Participants in a Taskforce-run workshop on this subject were asked for examples from their own experience of online professionalism concerns (8), and an outpouring of vignettes ensued. TheTaskforce undertook to create a curriculum based on vignettes designed to promote similar discussion. The principles elicited in these vignettes might be seen as extensions of well-established principles of professionalism (9, 10). Trainees accustomed to continual use of interactive technologies, however, may overlook boundary and other professionalism issues if they are not made explicit in training. The curriculum strives to address principles, rather than specific technologies, since the latter are expected to continue to evolve rapidly. The vignettes in this curriculum (available online at aadprt.org (11)) are designed for either group discussion or individual study; they are accompanied by relevant references and a teacher’s guide. The vignettes are organized around nine issues that may be relevant to various teaching venues: liability, confidentiality, and privacy; psychotherapy and boundaries; safety issues; mandated reporting; libel; conflicts of interest; academic honesty; “netiquette;” and professionalism remediation. We discuss the first eight of these topics, using vignettes from the curriculum for illustration. Where vignettes are based on actual cases, all identifying details are disguised.

The Unspoken Tyranny of Regulatory Agencies: A Commentary on The ACGME Resident Survey

Residency training directors dread various moments— for instance, when the Residency Review Committee (RRC) reviews their program, or Match Day. Another such moment of anxiety is when residents answer the Accreditation Council for Graduate Medical Education (ACGME) Resident Survey. This survey asks residents about their compliance with duty hours and their opinions of faculty, the feedback they receive, the educational content of the teaching, their program’s resources, and, finally, their overall experience. These are seemingly fair, important questions. Why would anyone dread seeing the answers? What would be wrong with a survey asking this information about the program? Why would anybody think that this is not a good and useful survey? In my opinion, at least four cardinal problems with the ACGME Resident Survey may trigger training director anxiety and dread. The first problem is the validity and comprehensibility of the survey questions. Fahy and colleagues (1) suggested that the responses obtained on the ACGME Survey might inaccurately reflect the magnitude of noncompliance found in certain areas, and they proposed that this discrepancy might be due to the limited range of responses available on the survey. Sticca and colleagues (2) reported that 14% of residents admitted to not answering the questions truthfully, and 37% of residents felt that the survey did not provide an accurate evaluation of their work-hours. These authors felt that a tool in which 1 in 7 responders admits to answering questions falsely and 1 in 5 responders had difficulty interpreting the questions may not be a valid evaluation tool. In contrast, Holt and colleagues (3) found that the ACGME Survey demonstrated a high degree of internal reliability and thus felt that this survey was a reliable, valid, and useful tool for evaluating residency programs. Holt and colleagues (3) also reported that programs having resident-identified duty-hour issues were more likely than those without such issues to have received duty-hour citations from residency review committees (sic). These are contradictory results. Some might question the first two studies (1, 2) because they were conducted by surgeons who have been unhappy with the implementation of the 80 duty-hour limit. Othersmay question the third study (3) because it was conducted by the main stakeholder and creator of this survey: the ACGME itself. Unfortunately, these studies, as well as many critics of this survey, focus on just one part of the survey—duty-hours —which is probably the most objective part of the ACGME Resident Survey. I have a harder time with the interpretation of some questions in the other parts of the survey. For instance: “How sufficient is the supervision you receive from faculty and staff in your program?” (Possible answers: Extremely, Very, Somewhat, Slightly, Not At All); “Thinking about the faculty and staff in your program overall, how interested are they in your residency education?” (same answers); or “Thinking about the faculty and staff in your program overall, how effective are they in creating an environment of scholarship and inquiry?” (same answers) are all very subjective questions. Their interpretation could vary profoundly from resident to resident. Similarly, the question “In your opinion, howoften do your rotations and other major assignments provide an appropriate balance between your residency education and other clinical demands?” sounds ambiguous. What constitutes an appropriate balance is a matter of opinion, and this question raises further questions: What is considered education? Is seeing patients under attending supervision “clinical demand”or “education”? Is classroom teaching the only form of education? Or consider another question—“Howoften do youwork in interdisciplinary teams to care for patients?” What does the answer “Somewhat/Sometimes” mean? Are we expecting that residents work always in interdisciplinary teams? If they see patients in individual therapy (i.e., no interdisciplinary team), does it mean “noncompliance”? I could discuss Received April 6, 2011; revised June 28, November 2, 2011; accepted November 2, 2011. Send correspondence to Richard Balon, M.D., Wayne State Univ., Univ. Psychiatric Center; e-mail: rbalon@wayne.edu Copyright © 2012 Academic Psychiatry

What’s Deterring Med Students From Psychiatry Careers?

Back to table of contents Previous article Next article Annual MeetingFull AccessWhat’s Deterring Med Students From Psychiatry Careers?Mark MoranMark MoranSearch for more papers by this authorPublished Online:20 Apr 2012https://doi.org/10.1176/pn.47.8.psychnews_47_8_30-aAbstractThis year’s match results, in which the number of U.S. seniors choosing psychiatry residencies dropped from 640 last year to 616, has generated discussion among leaders and members of the American Association of Directors of Psychiatric Residency Training (AADPRT).Sandra DeJong, M.D., chair of the recruitment committee for AADPRT, told Psychiatric News that the downward trend for psychiatry likely stems from a combination of factors including continuing stigma about psychiatry and mental illness among medical students, concerns about the uncertainty around health care reform and its impact on psychiatry, and the carveout of reimbursement for psychiatric treatment from that for general medical treatment. Moreover, she added, psychiatry has not done the best job promoting itself.“Clearly there is not a lot of medical student interest in psychiatry early on, and it diminishes when students go to apply for residencies,” she said.DeJong told Psychiatric News that recruitment into the profession is a problem for the international community and that the World Psychiatric Association is studying barriers to recruitment.Steven Schlozman, M.D., who is codirector for medical student education in psychiatry at Harvard Medical School and a training director in child and adolescent psychiatry at Massachusetts General Hospital, posted extensive comments about recruitment on the AADPRT list serve that he agreed to share with Psychiatric News.“We know that even among students who say they are ‘very interested’ or ‘interested in psychiatry’ and who have relatively stable opinions with regard to that question throughout medical school, a surprisingly low percentage choose psychiatry,” Schlozman wrote. “When asked why they don’t, they cite the opinion of peers and of other non-psychiatric doctors” as inhibiting factors.He added that students themselves glean from the carveout psychiatric payment system that “there must be something off or less valid about psychiatry.”Among those students who tend to both like and choose psychiatry, Schlozman said the following traits stand out:A positive experience with psychiatric treatment (often psychotherapy)An interest in the humanitiesSomeone in the family with significant psychiatric illnessA positive experience on the clerkshipClerkship experience long enough to demonstrate change in patientsA charismatic mentorSchlozman said there is some evidence to suggest that an ambulatory or consultation-liaison experience can create enthusiasm for psychiatry more than the traditional inpatient experience can. “There are also suggestions that having psychiatrists as core members of medical school leadership and on curriculum planning helps,” he said.Schlozman added, “We know that medical students very much dislike the strength with which we express our disdain for one another in our field. The literature suggests that when medical students hear one psychiatrist directly criticizing another aspect of what is traditionally thought of as psychiatry, the students are very turned off.”But Schlozman said there is a great opportunity for recruitment into psychiatry. “If you ever have the pleasure of reading the essays students write to get into medical school, you’ll note that … they all want lasting relationships with patients,” he said. “This ought to be a slam dunk in recruiting to psychiatry if students really want this and if we could remove the preconceptions about our field. Psychiatry offers a near bullseye for this generation of students who desire to be with their patients in lasting ways.” ISSUES NewArchived

US Psychiatric Residents’ Treatment of Patients With Bipolar Disorder

We aimed to evaluate the practice patterns of US postgraduate year (PGY) levels 3 and 4 psychiatric residents in the treatment of patients with bipolar disorder (BD) types I and II. We also aimed to determine whether confidence in prescribing mood stabilizers is associated with residents' practice patterns. The residency training directors of 182 Accreditation Council for Graduate Medical Education-accredited US psychiatric residencies were solicited for study participation via e-mail. Their chief residents were asked to forward an online survey Web link to all PGY-3 and PGY-4 residents in their program. The survey was a cross-sectional, online questionnaire, evaluating residents' treatment choices for their BD patients in their psychopharmacology clinics during the last academic year (July 1, 2009, to May 1, 2010), along with resident confidence level in using mood stabilizers. The survey Web link was distributed to 769 residents, and 177 (23.0%) responded to the survey. The percentage of residents who did not initiate treatment in the past year with mood stabilizers was 24.5% for lithium, 26.9% for lamotrigine, 36.7% for valproate, and 73.6% for carbamazepine. Confidence in initiating treatment with each of the 4 mood stabilizers was significantly associated with the number of patients treated with each mood stabilizer in the past year. Residents reported having the lowest confidence with carbamazepine followed by lamotrigine, lithium, and valproate. Experience prescribing first-line treatments for BD, such as lithium and valproate, is inadequate for many US psychiatric residents. Psychiatry residency directors should ensure that their residents have sufficient opportunity to pharmacologically treat BD patients so that these young physicians may develop confidence using an array of evidence-based treatments.

Teaching “Global Mental Health:” Psychiatry Residency Directors' Attitudes and Practices Regarding International Opportunities for Psychiatry Residents

The authors surveyed Psychiatry Residency Training Directors' (RTDs') attitudes about the role and feasibility of international rotations during residency training. A 21-question survey was electronically distributed that explored RTDs' beliefs about the value, use, and availability of international clinical and research experiences during residency. Of 171 RTDs, 59 (34.5%) completed the survey; 83% of respondents rated the importance of global mental health education as 3-or-above on a scale of 1 (least important) to 5 (most important), but only 42% indicated that such opportunities were made available. The value of such opportunities was thought to lie primarily in professional development and cultural exposure, less so for enhancing core knowledge competencies. Obstacles to such opportunities included lack of accreditation, financial resources, and faculty/administrative support and supervision. RTD respondents endorsed the value of international experiences during residency, but their availability and educational impact are not fully supported.

Early Career Psychiatrist Already Fulfilling Ambitious Plans

An associate residency training director, Claudia Reardon, M.D., plans to use a World Psychiatric Association fellowship to build on current plans to create a global mental health elective for her psychiatry residents.

Social Media Link You in but Raise Thorny Patient Issues

Social Media Link You in but Raise Thorny Patient Issues

Director of Residency Training, Do Your Job!

Director of Residency Training, Do Your Job!

Residents, Training Directors Get New Duty-Hour Rules

Residents, Training Directors Get New Duty-Hour Rules

MITs Gain Leadership Opportunities

Back to table of contents Previous article Next article Residents' ForumFull AccessMITs Gain Leadership OpportunitiesMelinda Fierros, M.D.Melinda FierrosSearch for more papers by this author, M.D.Published Online:4 Jun 2010https://doi.org/10.1176/pn.45.11.psychnews_45_11_024In 2009, the APA Board of Trustees sunsetted several councils and committees in an effort to reorganize APA into a leaner, smarter, more efficient, and more effective machine.One of the committees that was sunsetted was the Committee of Residents and Fellows. Since that time, an interim residents' work group has been working to develop a new member-in-training (MIT)-led committee that would exemplify smart organization and innovation. I am happy to report that the Board of Trustees voted at its March meeting to approve the creation of the Corresponding Committee of Members-in-Training (CoMIT), which will report to the Council on Medical Education and Lifelong Learning. It will also submit a report to the Board of Trustees at least once a year, at the president's discretion.The CoMIT will be composed of the member-in-training trustee, who will also chair the committee, the member-in-training trustee-elect, an Assembly Committee of Members in Training (ACOM) representative from each of APA's seven geographic areas, the Residency Review Committee MIT liaison, APA's MIT liaison to the AMA, and one MIT representative from each of APA's nine councils.This new committee will facilitate communication and collaboration among MIT representatives to the APA councils, Board of Trustees, and Assembly and residents involved in the Residency Review Committee and AMA. It will meet monthly via conference call or Skype and was scheduled to meet for the first time at APA's 2010 annual meeting in New Orleans at press time. The price tag for such a large collaborative group, you ask? Under $750 a year. Amazing. Efficient. Brilliant.Among the many tasks that this committee will be spearheading is the initiation of a resident leadership program that will enable MITs to develop leadership skills in their field of interest, with the assistance and guidance of APA.Many of the ideas for this leadership initiative came from a residents forum in March at the 2010 annual meeting of the American Association of Directors of Psychiatric Residency Training, where residents suggested the development of several Powerpoint presentations on common mental health topics, such as diagnosing and treating depression or OCD, for example. These presentations could be accessed easily by members on the APA Web site; this would facilitate chief residents or faculty “teaching on the fly” while on rounds, thus benefiting both the teacher and those being taught. Others suggested creating modules, again accessible on the APA Web site, on topics particularly relevant to residents and early career psychiatrists, such as learning to teach to colleagues at different levels of training, from medical students to faculty; starting a private practice; picking the best electronic medical record system; and tips on mental health coding.Another suggestion was the revamping of the current APA resident communication engine, which has been described by some residents as antiquated, redundant, and inefficient. Steve Koh, a current resident leader on ACOM, has developed a communication proposal that calls for the creation of a more Web-like system of communication; it would immediately assess every new or renewing member's interests, level of involvement, areas of research, and demographics and develop an individualized profile, much as social-networking sites do. At a glance, residents would be able to see where they fit in to APA, the district branch of which they are a member, and the names of national leaders and gain access to instant communication with those leaders. Seamless. Effortless. Exciting.Other endeavors include the development of a formalized mentoring program and collaborating with the APA Elections Committee on the development of a policy for the use of social-networking sites as a campaigning tool.I want to thank you very much for affording me the opportunity to serve as your representative on the Board of Trustees over the last two years. The experience was invaluable, and I consider myself fortunate to have been able to meet and work with the many talented and diligent resident leaders in whose hands I leave you. Stay tuned, as many more trailblazing MIT ideas are about to come to life. Melinda Fierros, M.D., completed her term as the MIT trustee on the APA Board last month. ISSUES NewArchived

Preparing the Next Generation of Leaders in Clinician-Education and Academic Administration

Interest has been increasing in supporting the career advancement of faculty clinician-educators in psychiatry. This is best evidenced by the development of the Clinician-Educator Section of the Association for Academic Psychiatry in 2003. Over the past few decades, the role of the clinician-educator has grown, as have the responsibilities. Not only are clinician-educators teachers in the classical sense, but they are often called to serve as leaders in multiple realms: clinical program chiefs, residency training directors and innovators, hospital administrators, advisers to managed care organizations, consultants for legislative policy change, physician educators, and disseminators of information to the community at large (1, 2). Despite expectations for academic career advancement being relatively clear cut for faculty dedicated to research, promotion criteria for clinician-educators are widely ill defined (3). As a result, clinician-educators often have difficulty advancing in academic rank, even though their impact on a system may be remarkable. Levinson and Rubenstein (4) highlight the problems with “the present system of recognition for clinician-educators—i.e., the requirement for regional and national reputation, the lack of reliable measures of clinical and teaching excellence, and the lack of training opportunities for young clinician-educators.” To address such issues, some major academic centers have developed clinician-educator faculty tracks that more clearly define career paths (3, 5). Historically, psychiatric residents have not been explicitly targeted for nonresearch career paths during residency. As a result, many graduating psychiatrists are behind in developing the formal skills necessary to take on leadership roles within the academic and clinical infrastructure. This contrasts with efforts to create research training opportunities from medical school onward (6). In recent years, several U.S. psychiatric residency training programs have attempted to address this shortcoming by creating specialized residency training tracks for clinician-educators. The first of these appears to be the University of Michigan’s Clinical Scholars Track, established in 1998 (7). Likewise, Baylor’s Menninger Department of Psychiatry developed a Clinician-Educator Track, and the University of California Davis created a specialized Teaching Track. This trend is encouraging, but in general, specialized residency training tracks geared toward clinicianeducators are still in the early stages of development, and it is unclear how successful these tracks have been in promoting their aims into long-term faculty careers. Furthermore, none of the existing tracks explicitly focus on developing the administrative skills crucial to the promotion of young physicians into subsequent leadership roles in academic or other care delivery settings.

Match Finds More Graduates Picking Careers in Psychiatry

Back to table of contents Previous article Next article Professional NewsFull AccessMatch Finds More Graduates Picking Careers in PsychiatryMark MoranMark MoranSearch for more papers by this authorPublished Online:16 Apr 2010https://doi.org/10.1176/pn.45.8.psychnews_45_8_002AbstractA total of 670 U.S. medical school graduates matched into psychiatry residency positions in this year's National Resident Matching Program (NRMP), exceeding last year's total of 656.The percentage of matching graduates in psychiatry was the same as last year—4.5 percent. That percentage has remained relatively stable since 2006.In all, 1,075 psychiatry residency slots were filled. As in the past, the positions not filled by U.S. medical graduates were filled by international medical graduates (U.S. and non-U.S. citizens), Canadian students, and students who graduated from medical school in previous years.The match—in which the choices of graduating medical students are “matched” with those of residency programs—is typically watched as an indicator of workforce size and makeup in the various medical specialties for the coming years.One notable feature of this year's match was its size: 30,543 applicants participated, the largest number in history, according to the NRMP.But perhaps most notable was the increase in the number of students matching into primary care specialties. There was a 9 percent increase over 2009 in the number of U.S. medical school seniors who matched with residency positions in family medicine. And there was a 3 percent increase for internal medicine and a 2 percent increase for pediatrics.“The AAMC is extremely encouraged that more graduating U.S. medical students this year chose primary care for their residency training,” AAMC President Darrell Kirch, M.D., said in a statement. “The increases for family medicine, internal medicine, and pediatrics in this year's match are welcome steps in the right direction for improving our health care system and our nation's health.“Many factors go into a new doctor's choice for residency training. An AAMC survey last fall indicated that nearly 50 percent of U.S. medical schools had instituted or were considering programs or policies to encourage interest in primary care. We believe the results of this year's match demonstrate that the nation's medical schools are making progress in their efforts to encourage more new doctors to pursue careers in primary care. A strong primary care system is an essential part of good medicine.”Other notable trends of the match this year include the following: •. Neurological surgery, orthopedic surgery, dermatology, and otolaryngology were the most competitive fields for applicants. At least 90 percent of those positions were filled with U.S. medical school seniors.•. All but five positions were filled of the 1,187 available in obstetrics-gynecology, and 915 positions were filled by U.S. seniors, a number that has increased for the sixth consecutive year.•. The number of U.S. medical school seniors going into emergency medicine increased for the fifth consecutive year. That field filled 1,182 of the 1,556 first-year positions.For psychiatry, this year's numbers reflect stability—though the specialty is one of the less competitive residencies, it continues to attract a small percentage of medical students interested in the brain, mind, and behavior.Sidney Weissman, M.D., a former APA trustee and past president of the American Association of Directors of Psychiatric Residency Training who has maintained a long-time interest in workforce trends, believes that the evidence that both psychological and somatic therapies affect the brain, mind, and behavior is a feature that can make psychiatry attractive to tomorrow's physicians.“Psychiatry has a unique opportunity in the next three years to impact recruitment,” he said in an analysis of match results he sends to interested parties each year. “The publication of DSM-5 in 2013 means that psychiatry as a discipline will be in the spotlight. We must use it effectively to showcase our field.“I believe we must alter some of our language. We speak of pharmacotherapy and psychotherapy. The former impacts on the brain, but people are left to wonder where psychotherapy works. I would propose, since all therapy impacts on the brain and all therapy alters psychological functioning, we might describe psychotherapy as has having two functions—somatic and psychological. The publication of the new DSM gives us an opportunity to address our use of language.”The results of the 2010 match are posted at <www.nrmp.org>. ISSUES NewArchived

Education on Genetics for Psychiatric Residents

Two papers by Hoop et al. (1) and Winner et al. (2) in this issue of Academic Psychiatry call attention to the increasingly important need for psychiatric residents to receive a thorough grounding in the role of genetics and genomics in psychiatry as it will be practiced in the future. Taken together, the papers suggest that the topic of genetics is currently slighted in the curricula of many U.S. psychiatric residency training programs. An understanding of genetics will be critical to future psychiatrists not only for a fuller understanding of the etiology of disease entities, but also for an appreciation of the cause and treatment of psychiatric symptoms. Brain imaging techniques and genetics together are already providing correlative data to shed light on variability of presentation of some illnesses. For example, apolipoprotein E epsilon4 carriers with Alzheimer’s disease have been shown to have greater atrophy in the parietal cortex bilaterally and in the right hippocampus than noncarriers with Alzheimer’s disease (3). Surprising developmental discoveries involving the genetics of neurodegeneration are also being made. As an example, children and adolescents carrying the epsilon4 allele of the apolipoprotein E gene have been found to have, on average, thinner entorhinal cortices as demonstrated by MRI than do those carrying other alleles (4). Differences in the tendency to pay more attention to positive or negative elements in the environment have been shown to have a genetic basis. Individuals homozygous for the long allele for the promoter region of the serotonin transporter gene (5-HTTLPR) were recently found to show a marked bias to selectively pay attention to affectively positive material and to selectively avoid affectively negative material in their environment relative to those carrying at least one of the long alleles for the promoter region, meaning the homozygous long-allele carriers seem more likely to “look on the bright side,” which may explain their lower susceptibility to mood disorders than short-allele carriers (5). Research is ongoing on the interaction between trauma and genetic vulnerability to trauma. Variability in the promoter region of the serotonin transporter gene may be associated with the degree of emotional resilience shown by different individuals exposed to trauma (6). Integrating the most up-to-date scientific information into psychiatry training has been a priority since residencies in psychiatry were introduced. Genetics has been cited as a topic of critical importance in the curriculum of psychiatric residencies in several papers published over the past 15 years (7–9); the publication of two papers on the topic in this issue highlights the recognition of the need for the presence and standardization of a strong didactic curriculum in genetics in residencies. The Psychiatry Program Requirements of the Accreditation Council for Graduate Medical Education (10) currently state, “The didactic curriculum must include the following components: . . . the biological, genetic, psychological, sociocultural, economic, ethnic, gender, religious/spiritual, sexual orientation, and family factors that significantly influence physical and psychological development throughout the life cycle” (emphasis added). We believe that the professional associations of individuals involved in psychiatric residency education, including the American Association of Directors of Psychiatric Residency Training (AADPRT) and the Association for Academic Psychiatry (AAP) can play a useful role in helping to develop standard curricula in genetics by incorporating educational materials such as suggested readings, videos, and audiovisual presentations that training programs of all sizes could use to teach the fundamentals of psychiatric genetics to their residents. The two articles published in this issue of Academic Psychiatry together describe the opportunity that currently confronts residency training programs: to successfully educate psychiatrists about the rapidly expanding field of psychiatric Received and accepted November 6, 2009. The authors are affiliated with the Department of Psychiatry and Behavioral Medicine at the Medical College of Wisconsin in Milwaukee, Wisconsin. Address correspondence to Joseph B. Layde, M.D., J.D., Medical College of Wisconsin, Department of Psychiatry and Behavioral Medicine, 8701 Watertown Plank Rd., Milwaukee, WI 53226; jlayde@mcw.edu (e-mail). Copyright © 2010 Academic Psychiatry

Psychopharmacology Curriculum Field Test

As part of an effort to improve psychopharmacology training in psychiatric residency programs, a committee of residency training directors and associate directors adapted an introductory schizophrenia presentation from the American Society of Clinical Psychopharmacology's Model Psychopharmacology Curriculum to develop a multimodal, interactive training module. This article describes the module, its development, and the results of a field trial to test its feasibility and usefulness. Nineteen residency programs volunteered to use the module during the first half of the 2007-2008 academic year. Evaluation consisted of a structured phone interview with the training director or teaching faculty of participating programs during February and early March 2008, asking whether and how they used the curriculum, which components they found most useful, and how it was received by faculty and residents. Of the 19 programs, 14 used the module and 13 participated in the evaluation. The most commonly used components were the pre- and postmodule questions, video-enhanced presentation, standard presentation, problem- or team-based teaching module, and other problem-based teaching modules. No two programs used the module in the same fashion, but it was well received by instructors and residents regardless of use. The results of this field trial suggest that a dynamic, adult-centered curriculum that is exciting, innovative, and informative enough for a wide variety of programs can be developed; however, the development and programmatic barriers require considerable time and effort to overcome.

Economic Crisis Taking Toll on Americans' Mental Health

Economic Crisis Taking Toll on Americans' Mental Health