Showing papers in "Academic Psychiatry in 1982"

Consultation-Liaison and Inpatient Psychiatry Clerkships: Comparison of Learning Outcomes and Student Attitudes

Abstract: Medical students at the Tulane University School of Medicine were randomly assigned to either a consultation liaison setting (N=35) or inpatient psychiatry setting (N=59) for their four week junior clerkship in psychiatry. No significant differences in factual core knowledge were revealed in the departmental exam between the two groups. Student attitudes were positive about the role of psychiatry in the consultation liaison setting and both groups accepted a holistic/humanistic approach to patient care. Students in both groups were equivocal in their opinion about the futility of much of the practice of psychiatry and leaned toward rejecting the notion that the knowledge and technology of psychiatry is sufficient to handle its patients. None of the three areas generated a significant difference in attitudes between the consultation liaison and inpatient psychiatry students. This study demonstrates that the consultation liaison clerkship fulfills the departmental goals for the education of third year students. Furthermore, the study calls upon psychiatric educators to convey to the students the advances in the field and to acquaint them with the therapeutic tools at their disposal in a positive, enthusiastic manner.

Psychiatry Clerkship Design: Student Preferences

Abstract: Medical students in four different psychiatric clerkship settings rated anonymously their overall learning experience and each of 37 specific aspects of their clerkship experience. Students also listed the five most important and the five most dissatisfying aspects of the clerkship. Highest average ratings were accorded to: seeing patients with a variety of diagnoses and in a variety of settings; studying under faculty who teach well and are interested in students’ learning; and learning interviewing. Lowest ratings were for supervision by residents, and learning psychotherapy and psychoanalytic theory. There were no significant differences in ratings among clerkships. The data firmly support two conclusions: that the essence of a satisfying clerkship is a great deal of skillfully supervised contact with patients, and that students view the learning of interviewing, psychiatric diagnosis, and psychopharmacology as significantly more important than the learning of psychoanalytic theory and psychotherapy. An ideal psychiatry clerkship—as suggested by the data—is described.

The Hidden in Clinical Supervision: A Method to Know and Affect What’s Going on in There

Abstract: The utilization of a one-way mirror, a wireless microphone for the supervisor, and a “bug-in-the-ear” earpiece for the supervisee constitutes, in the author’s opinion, an excellent alternative method of supervision. It allows the supervisor to be able to unobtrusively observe the therapist and patient, gives the supervisor a chance to help a learning therapist “on the spot,” so to speak, and to positively reinforce and shape meaningful, empathic, therapeutic responses. This method of supervision has been used over a period of years with residents, medical students, social workers, nurses, psychology interns, etc. Most commonly, supervisees initially feel threatened by the “bug-in-the-ear,” which can be minimized by following some “do’s” and “don’ts.” The literature about supervision and some of the methods employed by other investigators are briefly reviewed.

Changes in Student Attitudes About a Psychiatric Career

Abstract: The authors surveyed 97 third-year medical students before and after a six-week psychiatric clerkship to determine which factors influenced their decisions about psychiatry as a possible career choice. Four attitudinal themes emerged that seemed to negatively affect the students’ perception of psychiatry. The students were concerned that psychiatry made insufficient use of medical knowledge and skills, was too abstract, evoked unpleasant personal feelings, and that patients were unresponsive to treatment. A comparison of pre- and post-clerkship attitudinal themes suggested that the students’ reservations about specializing in psychiatry declined with clinical experience. These findings, if confirmed by more definitive study, suggest the need to reappraise the psychiatric curriculum for medical students.

Childhood Sexuality in the Psychiatric Textbook

Abstract: In spite of a marked liberalization in adult attitudes toward sexuality over the past thirty years, there has been little change in cultural attitudes toward childhood sexuality. An analysis of fifteen psychiatric textbooks in current use reflect this bias as these books continue to associate childhood sexuality with various pathologies. Overall, the most positive view is provided by child psychiatric textbooks, those authored by women and those in the area of child psychiatry. The author illustrates these contentions through a statistical analysis and quotes, from various textbooks. She discusses how the negative bias toward childhood sexuality influences other aspects of residency training.

Behavioral Science Texts in U.S. Medical Schools

Abstract: With few guidelines to follow, behavioral science courses in American medical schools have a wide latitude in their design and curriculum. As part of a more global survey of the teaching of behavioral sciences, the authors collected data concerning the use and choice of textbooks for such courses. The textbooks reported as required by one or more schools are identified. The survey data are analyzed and discussed.

Educating Psychiatry Residents to Become Psychiatric Educators

Abstract: Residency training has generally ignored the need to educate residents to become psychiatric educators. A model is described which provides residents with experience in being supervisors and using other teaching methods. Attention to this issue may enhance the future role of psychiatrists and perhaps provide new insights into the general educational process of any kind of student.

Content Categories of Behavioral Science Questions at Nine Medical Schools

Abstract: This study investigated behavioral science curricula content from nine medical schools. Nineteen major behavioral science content areas were identified from an analysis of 1,920 objective behavioral science test questions. Considerable variation was found across the nine schools in terms of emphasis of content areas taught in behavioral science. Suggestions are offered for replication and extension of the present investigation.

Residency Training Priorities: International and Child Versus Adult Comparisons

Abstract: The authors have attempted to ascertain the priorities for training in both adult and child psychiatry through questionnaires based on widely accepted residency training objectives. The results obtained are based on the first 76 returns. Significant differences between countries and specialities are reviewed. The authors found that there are few differences when priorities are compared for training in the United States, Canada and Australia. Similarly the priorities for training in child psychiatry are virtually the same as those for adult psychiatry although additional objectives had to be added for the subspecialty area.

Medical Students’ Attitudes Toward Psychiatry and Psychiatrists

Abstract: We conducted a survey study of medical students attending the 1980 American Medical Student Association (AMSA) Convention to determine what their attitudes were toward psychiatry and psychiatrists. A sample group of 103 participants were given a two part survey, consisting of a verbal interview portion and a written portion, that utilized a 1–5 scale where 1 was positive and 5 negative. Our data showed that a majority of respondents, in both the verbal and written portion of the survey, had a positive attitude toward psychiatry. Though a positive attitude existed toward psychiatrists it was not as strong as toward psychiatry.

Influence of Residents’ Race on Dispositions in a Psychiatric Walk-In Clinic

Abstract: A retrospective survey of 517 patients seen by PG-1 residents in a psychiatric walk-in clinic was performed; significant differences are reported in diagnosis given and referrals made between black and white residents. These differences are discussed in terms of the staff’s perception of attitudinal differences between these two groups of residents.

Two Years’ Experience with the Psychiatry Resident in-Training Examination

Abstract: The annual Psychiatry Resident In-Training Examination (PRITE) was developed by a consortium of professional and educational organizations as a service available to residency training programs under policies intended to maximize standardization, minimize data bias, and prevent misuse. It provides a nonthreatening educational experience for residents through standardized administration, feedback to examinees based on comparisons with educational peers, detailed or summarized feedback to training directors, and availability of test questions and reference bibliographies as study aids. Each test resembles the written Psychiatry Board Examination in style, format, and method of administration, but differs in goals, content, method of construction, population tested, feedback provided, and manner in which results are used. Although initially controversial, the PRITE was very well accepted by the residents and training programs that participated in 1979 and 1980.

A Survey of a Freshman Medical Student Class: Will Psychiatry Recruit Well in the ’80s?

Abstract: In a pilot assessment of recruitment potential for psychiatry in the 1980s, the authors surveyed a class of 90 entering medical school freshmen as to their background, demography, interests, and possible career choices. Of fifteen possible specialty choices, psychiatry ranked eighth in popularity, with fully 11% of the students expressing high interest and an additional 32% mild interest in psychiatry as their career choice. The class as a whole was clinically, humanistically, and altruistically oriented, and expressed most interest in “interpersonal” clinical specialties, of which family medicine was by far the number one choice. The authors review their findings in the light of the literature and statistics on psychiatric education, and conclude that, although one must be cautious about generalizing from only one class in only one school, a pool of interested students may well exist for ultimate recruitment to psychiatry in the ’80s. The authors suggest some strategies to research this issue further and to increase the likelihood that interest will be translated into actual specialty choice.

Family Psychiatry and the Medical Student: The Marital and Family Assessment Seminar

Abstract: This paper addresses itself to the importance of the family as it affects individual patients seen by the medical student in a psychiatric clerkship. The clerkship and the seminar in marital and family assessment are geared to sensitize the student to the stresses upon the family, the nature of family systems as well as his role in his own family. A brief review of the literature pertaining to the importance of family systems in understanding the individual is presented as is a model for medical student training in marital and family systems. A follow-up with the first 80 student-participants is presented. The seminar attempts to integrate theory, application, and self understanding in providing the physician-to-be with a grounding in assessment skills which will be necessary in his future practice.

Planning and Implementing a Positive Psychiatric Rotation

Abstract: The decreasing number of graduating medical students applying to psychiatric residency programs gives cause to examine what factors might be influential. More specifically, what factors contributing to attitudes about psychiatry might be amenable to different teaching approaches during the medical school curriculum? This article describes the clinical training experience of third- and fourth-year medical students in a combined university and private hospital setting. A survey at the end of the rotation demonstrated that medical students’ attitudes toward psychiatry can shift toward the positive if the clinical experience meets the immediate needs of the student physicians.

Using NBME Subject Examinations as a Pretest to Identify Medical Students “At Risk” in a Behavioral Sciences Course

Abstract: Pretesting students has been considered a sound educational practice but the reports of its utility in medical education are sparse. The purpose of the study was to demonstrate the usefulness of the NBME Subject Examination as a pretest to identify students “at risk” in a medical school behavioral sciences course. The results indicated that the pretest was helpful in documenting course effectiveness and that it and other measures could be used to provide an early prediction of students’ behavioral sciences course grades.

The Relative Effectiveness of Personality and Academic Measures in the Prediction of Psychiatry or Nonpsychiatry Medical Specialty Preferences

Abstract: The purpose of this study was to determine which of several personality, mood state, and academic measures were best able to predict an interest in psychiatry specialization among third-year medical students. Prior to and after the core psychiatry rotation, 340 students were given a battery of psychological tests. These measures, along with MCAT scores, psychiatry exam scores, and final rotation grades, were entered into three stepwise discriminant analyses to predict the students’ preference for either psychiatry or nonpsychiatry specialization. The results indicated that the mood state and anxiety measures were relatively more effective in predicting students’ preferences.

A Psychiatric-Pediatric Liaison Program that Assesses Attitudes

Abstract: Significant increases in the number of hours pediatricians devote to counseling families have been documented in the literature, However, approximately half of young pediatricians in practice believe their residency provided insufficient experience in managing psychosocial and developmental disorders. The Behavioral Pediatrics Program is offered in the first year of pediatric training. Based in the Neonatal Unit (inpatient) and the Continuity Care Clinic (outpatient), it emphasizes interviewing parents to help residents gain confidence in ambiguous situations. Data collected at the end of the WSU/CHM program’s first year indicated that residents’ actual experiences in the Neonatal and Continuity Care modules were strongly associated with their rating. The program had impact on resident views of the importance of interviewing and normal development, but resistance to learning psychosocial perspectives was also clear. A number of changes in the program were made after evaluation.

Perceptions of Physicians as Expressed by Americans Studying Medicine Abroad

Abstract: The perceptions that fifty-one Americans studying medicine abroad had of six types of medical practitioners were assessed. Surgeons were viewed as being aggressive and adventurous and internists were perceived as being analytical, knowledgeable and probing. These findings are similar to those previously reported for Americans studying medicine in U.S. medical schools.

Faculty and Housestaff Priorities in Psychosocial Education: Results of a Questionnaire

Abstract: The authors surveyed houseofficers in internal medicine and faculty members integrally involved in the psychosocial curriculum using a previously published questionnaire. Results indicated strong agreement in priorities between the two groups (correlation coefficient—0.85). Items identifying broad conceptual skills and those related to practical application were similarly integrated. These data tend to support the concept of providing both levels of knowledge in a training program to allow more comprehensive teaching in psychosocial areas.

Medical Student Teaching by Psychiatric Residents

Abstract: During their clinical clerkships medical students receive a significant portion of their instruction from residents. Students complain of the quality of resident teaching and how they are treated. This paper describes recurrent problems students have encountered and offers suggestions for minimizing these difficulties.

Common Mistakes Made in Psychiatric Evaluation by Beginning Therapists

Abstract: As part of their clinical experience in hospital outpatient clinics, residents and medical students are often required to evaluate new psychiatric patients for eventual treatment or referral. This is a difficult assignment. The present study attempts both to improve our understanding of the factors which are most troublesome for trainees, and to alert those who supervise their training.

Women in Academic Psychiatry: A Status Report

Abstract: The authors report on the results of a national survey of psychiatric residency training programs conducted to determine the number of women appointed as chief residents and the proportions of men and women residents taking full-time positions in academic departments of psychiatry immediately following residency training. Significant numbers of women were chief residents in 1977-1978 and 1978-1979, although in 1978–1979 women were somewhat under-represented in the group of chief residents, relative to their numbers in the pool of eligible trainees. Twenty-six percent of the women and thirty-three percent of the men finishing training in June 1978 entered full-time academic positions. Further study is recommended.

Identification of the Psychiatric Resident at Risk for Suicide

Abstract: Records of the application interviews of four psychiatric residents ultimately known or suspected of having committed suicide and 110 randomly selected residents were retrospectively reviewed. An operational definition of an abnormal mental status exam was devised which was positive in three of the four residents who suicided but in only five of the 110 randomly selected resident applicants. This is significant at the 0.0001 level by Chisquare analysis.

The British Model of Postgraduate Training in General Psychiatry

Abstract: An outline of postgraduate training in general psychiatry in the U.K. is given, together with brief details of how this training is organized and supervised. Four postal surveys of senior psychiatrists who recently completed training have revealed much dissatisfaction with standards of supervised experience, particularly special forms of psychotherapy, addiction, work in the community, mental handicap, forensic psychiatry, research, psychogeriatrics, work with long stay patients, child psychiatry and epidemiology. Those who gained most of their experience at University Hospitals and the Institute of Psychiatry have expressed higher levels of satisfaction than those who had spent most of their training period in peripheral psychiatric hospitals. The former group performed better in the membership examination of the Royal College of Psychiatrists. There are indications that the inspection and approval visits of the Royal College of Psychiatrists and of the Joint Committee of Higher Psychiatric Training are beginning to raise the general level of training.