Showing papers in "Academic Psychiatry in 1992"
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TL;DR: Even though concerns about managed care are a source of extraordinary distress among psychiatrists today, many residents are not being provided with adequate preparation and training to deal with those concerns.
Abstract: Even though concerns about managed care are a source of extraordinary distress among psychiatrists today, many residents are not being provided with adequate preparation and training to deal with those concerns. When young psychiatrists leave their training programs and enter practice, they are experiencing profound demoralization. Much of their dysphoria appears to be a result of the impact of specific aspects of the managed care system on the preexisting psychological characteristics of psychiatrists. Preventive strategies to minimize this impact are discussed.
102 citations
TL;DR: A nationwide survey of ethics education during psychiatry residency found that nearly all agreed that ethics should be a part of the core curriculum, but there was a need to focus attention on the teaching of psychiatric ethics.
Abstract: The authors conducted a nationwide survey of ethics education during psychiatry residency. Of the 136 program directors and 95 chief residents responding, nearly all agreed that ethics should be a part of the core curriculum. Program directors reported that most programs (60%) did offer a formal seminar series or course. However, 26 programs (19%) had no planned discussion of ethics in any seminar and fewer than 30% of all programs held seminars on the issues considered most worthy of formal attention, including psychiatrist-patient sexual contact, confidentiality, and forced treatment. The discrepancy between what program directors and chief residents believe should be taught and what is actually being taught indicates a need to focus attention on the teaching of psychiatric ethics.
21 citations
TL;DR: The results suggest teaching awards serve an important recognition function, but a lesser motivational function in academic psychiatry.
Abstract: Teaching as a faculty activity is often undereinphasized in medical faculty reward systems for a variety of reasons. One method of recognizing teaching excellence has been through annual teaching awards offered by many departments and colleges. The authors surveyed department of psychiatry faculty regarding teaching awards, particularly questioning whether such awards influence teaching behavior or serve a motivational function. The results suggest such awards serve an important recognition function, but a lesser motivational function in academic psychiatry.
14 citations
TL;DR: Nine areas of development of the psychodynamic psychotherapist in supervision are identified with an emphasis on the beginning trainee, which helps the supervisor to be more skillful in the difficult business of psychotherapy supervision.
Abstract: Supervision is a fundamental component of every clinical training program that teaches psychodynamic psychotherapy. However, the development of the psychodynamic therapist in supervision has been a relatively unexplored area. This article identifies nine areas of development of the psychodynamic psychotherapist in supervision, with an emphasis on the beginning trainee. The areas explored include aspects of the therapist’s understanding of the patient and aspects of the therapist’s use of himself or herself in the psychotherapy. Consideration of the trainee in each of these areas helps the supervisor better understand the specific strengths and weaknesses that the trainee brings to their work together and enables the supervisor to be more skillful in the difficult business of psychotherapy supervision.
10 citations
8 citations
TL;DR: A questionnaire was developed to assess the skillfulness of therapists from the perspective of the supervisor, and those who espoused self psychology based more of their appraisal of skill fulness on the trainee’s use of the supervisory relationship.
Abstract: A questionnaire was developed to assess the skillfulness of therapists from the perspective of the supervisor. This supervisor report yielded two scores: one for psychotherapeutic techniques and one for the educational alliance. These scores had high internal consistency and were relatively independent of one another. Ratings of proficiency in psychotherapeutic techniques accounted for 54% of the variance in supervisors’ rating? of global skillfulness; educational alliance contributed an additional 12%. Compared with other supervisors, those who espoused self psychology based more of their appraisal of skill fulness on the trainee’s use of the supervisory relationship.
7 citations
TL;DR: The impact of collaboration increases tremendously after key thresholds of involvement are attained and a “critical mass” of faculty exerts a synergistic effect that shifts both the state agency and the university department to new functional states.
Abstract: Developing state-university collaboration is the process of creating mechanisms to couple two systems for mutual benefit. Collaboration requires setting new organizational boundaries for both the state agency and the university and developing new patterns of information flow within and between the organizations. Each organization’s homeostatic properties resist change; this resistance must be balanced by leaders’ attention to the organization’s developmental needs. The impact of collaboration increases tremendously after key thresholds of involvement are attained and a “critical mass” of faculty exerts a synergistic effect that shifts both the state agency and the university department to new functional states.
7 citations
TL;DR: Male respondents were more likely than female respondents to believe that pregnancy interfered with work performance and to anticipate personal inconvenience from a peer’s pregnancy.
Abstract: Fifty-eight residents at two training sites at Cornell University Medical College responded to our questionnaire on attitudes toward pregnant peers. Male respondents were more likely than female respondents to believe that pregnancy interfered with work performance and to anticipate personal inconvenience from a peer's pregnancy. When residents of each gender were asked to estimate the opposite gender's responses to the same questions, men more accurately hypothesized what their female peers would say. Women overestimated the degree of negative male responses and underestimated male willingness to provide special considerations such as schedule changes for their pregnant colleagues.
7 citations
TL;DR: Only half of the residents reported that they felt adequately prepared to identify and initially manage a substance-abusing adolescent, whereas a somewhat higher percentage of the directors felt that their residents were adequately prepared for this function.
Abstract: Residents anddirectors of accredited child and adolescent psychiatry programs (N = 117) in the United States were surveyed (with a response rate of 89% and 76.9%, respectively) to determine the extent and adequacy of training offered for the identification and management of substance abuse disorders. Of the responders, 24% of the residents indicated some exposure (≥1 hour) to an adolescent drug abuse treatment facility during their training. In contrast, 46% of the directors reported that their residents had such exposure. Residents consistently reported training to be less adequate than did directors. Only half of the residents reported that they felt adequately prepared to identify and initially manage a substance-abusing adolescent, whereas a somewhat higher percentage of the directors (59%) felt that their residents were adequately prepared for this function.
6 citations
TL;DR: The authors present an innovative approach for providing freshman and sophomore medical students with their initial exposure to the problems of alcohol and other drug abuse through small interactive group seminars.
Abstract: The authors present an innovative approach for providing freshman and sophomore medical students with their initial exposure to the problems of alcohol and other drug abuse. Students in small interactive group seminars teach each other about the major areas of substance abuse: treatment, prevention/education, research, and law enforcement. They are aided by group moderators, by resource professionals, and by recovery teachers as they make field trips, attend 12-step meetings, and get background material. They utilize audiovisuals, role-plays, and programmed patients in a report/debate format. Effects of this seminar on their attitudes have been measured and are presented.
6 citations
TL;DR: A group of child and adolescent psychiatry educators in the Association for Academic Psychiatry have developed didactic aids, termed modules, for curricular development in child psychiatry training programs, which consist of sets of references designed to communicate the essence of a subject area.
Abstract: A group of child and adolescent psychiatry educators in the Association for Academic Psychiatry have developed didactic aids, termed modules,for curricular development in child psychiatry training programs. These modules consist of sets of references designed to communicate the essence of a subject area. The design is flexible, allowing the modules to be used by programs with varying amounts of time available for teaching the designated subject. The project has been endorsed by the major organizations representing education in child psychiatry. Eight modules are available for distribution, and a mechanism is in place for creating others. The authors believe this concept will be equally useful in adult psychiatry programs.
TL;DR: The authors review some of the educationalliterature on outcome evaluation and suggest ways psychiatry residencies might be prepared to measure outcomes within their current procedures should the Residency Review Committee move in this direction.
Abstract: During the last decade there has been a shift within accreditation circles toward evaluating educational outcomes as measures 01 institutional effectiveness in addition to educational inputs and process, which historically have been emphasized. The U.S. Department 01 Education has incorporated outcome assessment into the regulations required 01 any accrediting body it funds or recognizes. Although these regulations do not directly apply to accreditation 01 psychiatry residencies, their impact may be feit indirectly. The authors review some 01 the educationalliterature on outcome evaluation and suggest ways psychiatry residencies might be prepared to measure outcomes within their current procedures should the Residency Review Committee move in this direction.
TL;DR: It is concluded that little standardization exists in CT training, and a minimum requirement is proposed for CT training in general psychiatry residency programs.
Abstract: Cognitive therapy (CT) is a relatively new mode of psychotherapy that is effective in the treatment of depression and other psychiatric disorders. The training directors of all U.S. general psychiatry residency programs were surveyed on the amount of time offered in teaching and supervision of CT and in other treatment modalities. Of the 127 responders, 91 % offer some classroom instruction in CT, 54% offer trainees supervised clinical experience, and 23% require such experience. The ranges of instructional time offered and number of patients treated per resident are broad. Thirty-seven percent of training directors consider graduating residents as qualified to practice CT, and 11% consider graduating residents as qualified to supervise others in CT. The authors conclude that little standardization exists in CT training, and they propose a minimum requirement.
TL;DR: An extensive program in continuing education in psychotherapy for voluntary faculty, which operates within a division of psychotherapy, to increase the number and quality of psych therapy supervisors available to train residents.
Abstract: This article describes the development and nature of an extensive program in continuing education in psychotherapy for voluntary faculty, which operates within a division of psychotherapy. A major goal of the program is to increase the number and quality of psychotherapy supervisors available to train residents.
TL;DR: This study confirms the value of resident evaluations addressing clinical skills, but it highlights discrepancies in expectations and merits of several methods of evaluation.
Abstract: This survey assessed the perceptions of psychiatry residents and faculty about resident evaluations. Current residents, former residents, and faculty of a psychiatry residency program were asked about the value and effect of feedback in 15 specific areas and rated their preferences for evaluation methods. Residents and faculty most valued feedback that addressed practical clinical skills. Evaluations reportedly improved skills in half of the areas surveyed. Most respondents preferred face-to-face evaluations from individual faculty. This study confirms the value of resident evaluations addressing clinical skills, but it highlights discrepancies in expectations and merits of several methods of evaluation.
TL;DR: The authors review the organization and processes of this outpatient program, now in its third year, which serves to provide comprehensive outpatient psychiatric training, track and review patients seen by the trainees, and ensure quality of care.
Abstract: To provide a more structured experience in outpatient psychiatric training, the UCLA Neuropsychiatrie Institute’s outpatient department organized outpatient management teams. Each team is supervised by a pair of faculty psychiatrists. PGY-3 and PGY-4 teams also include a psychologist and a social worker. The teams serve to provide comprehensive outpatient psychiatric training, track and review patients seen by the trainees, and ensure quality of care. In this way, the teams have successfully linked educational, clinical, and administrative tasks. The authors review the organization and processes of this outpatient program, now in its third year.
TL;DR: The authors describe the advantages of combining the use of a resource matrix with a set of program-specific priorities to design training opportunities for residents that simultaneously meet multiple program objectives.
Abstract: Rural child and adolescent psychiatry residency programs offer unique training opportunities with a distinct and underserved population. These programs also face the challenge of organizing teaching resources with maximum efficiency to compensate for low population density, geographical isolation, and a scarcity of available faculty. Using a case example, the authors describe the advantages of combining the use of a resource matrix with a set of program-specific priorities to design training opportunities for residents that simultaneously meet multiple program objectives. Potential results of this application may include expanded clinical services, new research opportunities, and easier recruitment of faculty.
TL;DR: Recommendations for prophylactic measures include education, strong supervisory support to explore countertransference issues, and the use of a case conference at points of transfer.
Abstract: Therapist-initiated transfers of dynamic psychotherapy patients, precipitated by the need for residents to have a broad exposure to varied services, are common phenomena in residency training settings. Both the transferring therapist and the patient may experience these transfers as distressing. The inexperienced therapist may initiate inappropriate transfers, incomplete terminations, or social behavior toward the patient. A case example is presented and discussed in light of the relevant literature. Recommendations for prophylactic measures include education, strong supervisory support to explore countertransference issues, and the use of a case conference at points of transfer.
TL;DR: The author presents the results of a 1988–1989 survey of directors of psychiatry residency training programs dealing with this subject and related questions, and the findings are analyzed and discussed.
Abstract: For several years there has been ongoing discussion in the psychiatric literature of a presumed decline in the teaching ofpsychodynamic psychiatry in psychiatry residency training programs. Studies that have quantitatively focused on this subject are reviewed in this article. The author presents the results of a 1988–1989 survey of directors of psychiatry residency training programs dealing with this subject and related questions. The findings of the study are analyzed and discussed.
TL;DR: Criteria used in recommending faculty for promotion in medical school—based departments of psychiatry are identified and it is called into question whether tenure track can practically continue as a faculty classification.
Abstract: The objective of this study was to identify criteria used in recommending faculty for promotion in medical school—based departments of psychiatry. Chairs of 125 departments in the United States were asked to complete a 39-item questionnaire on departmental demographics and the expectations for academic performance of tenure-track, non-tenure-track, part-time, and medical research faculty. Different criteria were reported for the classifications of faculty studied, but not for promotion of the same class of faculty to different academic ranks. The increasing need for faculty to generate revenue blurs the distinction between tenure-track and non-tenure-track faculty and calls into question whether tenure track can practically continue as a faculty classification.
TL;DR: Residents’ attitudes toward referring subjects to other residents’ research studies and toward conducting their own research projects were explored, and the learning opportunity provided by working with a faculty mentor was rated as the key motivator.
Abstract: This study explored residents’ attitudes toward referring subjects to other residents’ research studies and toward conducting their own research projects. With respect to referring subjects to other research investigations, the ease of the referral mechanism and potential benefits to patients were of prime importance to residents. With respect to participating in their own research projects, the learning opportunity provided by working with a faculty mentor was rated as the key motivator. A lack of available time and an abundance of other clinical demands discouraged research activity. Suggestions are offered for residency training programs that wish to increase resident interest and participation in research projects.
TL;DR: The authors discuss the results of a questionnaire sent to medical schools to assess textbooks and computer software used in teaching behavioral science and clinical psychiatry, and certain texts emerged as frequently used.
Abstract: The authors discuss the results of a questionnaire sent to medical schools to assess textbooks and computer software used in teaching behavioral science and clinical psychiatry. Attributes concerning presentation, theoretical viewpoints, and topics covered were rated by 75 respondents. Certain texts emerged as frequently used. Although the books rated will become outdated, consumers can use the assessment attributes from the questionnaire to examine forthcoming texts. Authors considering new books or revisions may want to know why certain books are popular and to address areas identified as weak in existing textbooks. The software market needs entrees.
TL;DR: This study evaluates the responses of board-certified physicians to fictional residency applicants’ personal statements, which were identical except for gender, and female physicians in both groups rated male candidates as less hardworking than did male physicians.
Abstract: Sexism has been perceived at all levels of medical education. Although specialty training has been scrutinized from various perspectives, there have been few objective assessments of sexual discrimination in the selection of candidates. This study evaluates the responses of board-certified physicians to fictional residency applicants’ personal statements, which were identical except for gender. Male and female physicians from six specialties in which women were overrepresented and six specialties in which women were underrepresented all favored female candidates. Female physicians in both groups rated male candidates as less hardworking than did male physicians. Implications of these and other findings are discussed.
TL;DR: The ability to rate clinical phenomenology in psychiatric patients in a live format is shown to be a measurable trait that improves slightly over time in some areas and varies in relation to some of the independent variables studied.
Abstract: A central concern of psychiatric educators is how medical students learn to evaluate psychopathology and clinically relevant behaviors during a psychiatric clerkship. The purpose of this study is to determine what characteristics of the students studied correlated with their accuracy in rating patient psychopathology and also whether the students show improved accuracy in rating after a 6-week clerkship in a university medical school department of psychiatry. The study analyzes student ratings of various aspects of psychopathology in live patient-faculty interviews. The accuracy of student ratings compared with faculty ratings constitutes the dependent variable. The role of students' attitudes toward psychiatry, overall grade performance, and personal background constitute the independent variables; these variables are analyzed in relation to the accuracy of student ratings. The authors attempt to determine if student ratings improve during clerkship. The ability to rate clinical phenomenology in psychiatric patients in a live format is shown to be a measurable trait that improves slightly over time in some areas and varies in relation to some of the independent variables studied. Results of the study are compared with previous work in this area. The limitations of the paradigm employed and the requirements for studying the problem in a more systematic and effective way are outlined.
TL;DR: In rank order, location, academic position, teaching opportunities, and research opportunities were the most appealing factors; VA hospital setting, fringe benefits, and administrative opportu-nities had the least appeal.
Abstract: To explore factors influencing academic job seekers, the author surveyed 49 applicants for six regular faculty positions at a university and Veterans Affairs (VA) medical center in Oregon. Candidates used active inquiry (40.0%) and advertisements (35.6%) as their pri-mary search methods, applied for an average of 6.75 jobs, expected the search to take 73 months, and confined their search to specific geographical areas (75.5%). In rank order, location, academic position, teaching opportunities, and research opportunities were the most appealing factors; VA hospital setting, fringe benefits, and administrative opportu-nities had the least appeal. Most applicants were moderately satisfied with current jobs and even more satisfied with psychiatry as a career. Related studies are discussed. Three of the six positions were not filled; the author discusses barriers to successfully recruiting academic psychiatrists.