Showing papers in "Academic Psychiatry in 1994"

A curriculum for learning in psychiatric residencies about homosexuality, gay men, and lesbians

Abstract: Homosexuality was redefined by the American Psychiatric Association in 1973 as a variation in sexual orientation rather than a mental illness, and recent research has greatly expanded knowledge about homosexuality, gay men, and lesbians. However, generally speaking, neither a non pathological perspective nor this new information has been integrated into psychiatric residency curricula. This absence compromises the ability of residency programs to train residents to be broadly competent in dealing with issues related to these topics. Learning about homosexuality, gay men, and lesbians should be integrated into all psychiatric residencies, and a curriculum to serve as a basic model for this necessary professional training is proposed.

Teaching Psychiatry Through Literature

Abstract: The author proposes a simple systematic way to analyze short stories as if they were case histories. Class discussions are organized around five basic questions, stated in the article, and use Erikson’s framework of life stages to translate life experiences into the language of psychic conflict. Fiction writers effectively dramatize psychological and developmental issues in a way that makes them real and memorable to psychiatric residents. Stories may be of particular value in illustrating the process of change and in exploring the topic of prognosis, which are often overlooked in more traditional teaching formats. The author has presented this approach at several recent meetings of the American Association of Directors of Psychiatric Residency Training and the American Academy of Child and Adolescent Psychiatry, and workshop participants have reported success in its use, which depends on the teacher’s clinical rather than literary skills.

Future career choices of women psychiatric residents : is research included?

Abstract: In an attempt to understand the paucity of women in psychiatric research, a descriptive pilot survey of women psychiatry residents in three residency programs was undertaken in 1992 to investigate the factors that influenced career choice and interest in research Only 5% of the respondents intended to pursue an academic career with an emphasis on research; 60% listed a research career as their last choice Significant factors that affect professional training and subsequent career choice included the women's desire for a nurturing training environment, availability of mentors/role models, and personal and family considerations

Student education and recruitment into psychiatry : a synergistic proposal.

Abstract: The authors propose that the most effective recruitment strategy is a strong psychiatric curriculum positioned as a relevant and integral part of undergraduate education for primary care physicians. The necessary ingredients are educational leadership by the chair, a multifaceted curriculum, shared teaching with generalists, and an emphasis on gender and ethnic minority issues. In changing times, it is essential that psychiatric educators remain at the center of the educational stage and continue to attract medical students through sharing the excitement of the intellectual and clinical challenges in psychiatry.

The skewing of psychiatry

Abstract: Two of the most influential factors in psychiatry over the past decade have been the increasing availability of more sophisticated psychotropic medication and the widespread acceptance of DSM-III. These factors, along with the increased use of computers, have dramatically skewed the field toward an atheoretic symptom/syndrome orientation and away from an appreciation that meaning is an indispensable aspect of human life. This threatens to lead to a serious deterioration in our capacity to communicate with, understand, and treat people. In championing the notion that "biology drives psychology," psychiatry must not lose sight of the fact that often "psychology drives biology." Modest training proposals are offered to counterbalance these trends.

The literature and medicine seminar for medical students : a potential recruitment tool.

Abstract: Literature and medicine (L-M) seminars have been used occasionally in psychiatric training programs, and their use has been sparingly described in the literature. A similar seminar designed for preclinical medical students, employing short stories focused on medically related themes, was offered as an elective in 1991. By asking enrollees about their future specialty choices, the author found that the L-M seminar predominantly attracted those students who were drawn to the "patient-oriented" specialties. In addition, both psychiatric expertise and sensitivity to student concerns and interests were necessary for the seminar to succeed. It is proposed, therefore, that the L-M seminar provides a novel opportunity for psychiatric educators to attract and encourage patient-oriented students to consider psychiatry as a future specialty choice early in their training.

Gender Differences in Career Paths in Psychiatry

Abstract: Although psychiatry has one of the highest proportions of women entering its residency programs, women have not assumed a proportionate amount of academic or research leadership positions in the field. This literature review identifies three general groups of models that explain disparities between men’s and women’s careers, but these do not fully account for observed differences in psychiatric practice and academic progression of women in psychiatry. Gender differences in career paths in psychiatry are not only affected by individual traits and choices, but also by economic factors. Theories based on organizational discrimination, and systems and market factors are also reviewed. No single explanatory model accounts for disparities between the careers of men and those of women. Because psychiatric practice patterns may be broadly distributed across labor sectors, more diverse career patterns are possible in psychiatry than in more constrained and traditional fields. Research on gender differences in psychiatry careers must consider not only the individual work style and choice, but also the position of individuals within the organization and the position of those organizations across the labor market.

An emerging consensus in behavioral science course content.

Abstract: The results of a survey of North American medical schools (N = 65) about the content of their behavioral science courses are presented. Child psychological development and psychodynamic theory are the most frequently taught subjects in the schools (for 94% and 88% of the programs, respectively). Greater agreement on topics is found than in earlier surveys. The historical reasons for disagreement on content and objectives are explored and proposals for reform are offered.

Perspectives on Screening and Interviewing International Medical Graduates for Psychiatric Residency Training Programs

Abstract: The authors have found that international medical graduates (IMGs) constitute a valuable pool of applicants for residency training The wide variation in their medical educations, prior careers, and cultural backgrounds requires a special approach to screening and interviewing IMGs The authors share techniques and viewpoints developed in their program to screen applicants about their autobiographical statements, medical credentials, reference letters, and visa and immigration statuses Interviewing guidelines that are sensitive to the applicant’s career phase and that assess the person’s interest in psychiatry, communication skills, character, acculturation, family context, and suitability for the specific residency program are presented

What Components Should Be Evaluated in a Psychiatry Residency

Abstract: In this pilot study, the authors examined faculty responses to a proposed new evaluation form for residents. Because past research on priorities for psychiatric residency curricula have depended on direct surveys, previous findings may represent auricular ideals instead of what faculty actually evaluate. The goal of the study was to draw inferences about priorities in psychiatric education by studying what components (knowledge, skills, and attitudes) of a psychiatry residency that faculty are willing to spend their time evaluating. The responses were grouped by agreement about whether the item 1) could be evaluated on their site, 2) could be evaluated during psychotherapy supervision, 3) should be combined with other items, and 4) should be eliminated. The results showed much agreement about which items to include and little agreement about which ones to exclude. Fundamental psychiatric skills and attitudes were rated as most important, and there was widespread interest in a diversity of knowledge, skills, and attitudes that psychiatric residents should possess. The authors found this method, which could be easily applied to other programs, useful in setting auricular priorities.

Neurological proficiencies for psychiatrists : a pilot survey.

Abstract: Faculty at the University of California at Los Angeles were surveyed regarding appropriate proficiencies for general and subspecialty trained psychiatrists with respect to a number of neurological problems. Survey responses were obtained from 40 psychiatrists and 7 neurologists, representing 69% and 70%, respectively, of those surveyed in each group. Five levels of proficiency were defined, ranging from making a screening diagnosis to instituting definitive treatment and having laboratory expertise. Psychiatrists’ expectations ranged from screening to monitoring proficiencies for a wide range of higher cortical func tion neurological disorders. Higher expected proficiencies were noted for schizophreniform symptoms of epilepsy, acute extrapyramidal reactions, tardive dyskinesias, dementias, and depressive syndromes associated with brain damage.

Psychiatric residency directors' use of computers in their training programs.

Abstract: Over 73% (169) of psychiatric residency training directors who responded to a survey believe that computer instruction should be provided to residents. The survey instrument, a questionnaire, was mailed to residency directors of general and child psychiatry programs (N = 314) in 1991. The authors found that computers are available for resident use in 165 (79%) programs, but only 87 (38%) residency programs provide computer instruction for their trainees. Over 85% (182) of the directors have used computers, with 45% (90) of them using computers at least 3 hours per week. The directors’ own use of computers is strongly associated with typing skill level and familiarity with different software packages. There is a discrepancy between the amount of computer instruction provided for residents and the amount the directors desire. The authors also found that most directors are not familiar with software packages developed specifically for psychiatrists that are now available.

Conflict With Physician Pregnancy Revisited

Abstract: A 10-year follow-up survey found medical school physicians (N = 200) at one institution were more interested in and accepting of pregnancy among colleagues. A greater number of physicians in 1990 than in 1980 reported that pregnant colleagues maintained their work efficiency and interest in medicine. Fewer physicians in 1990 reported being inconvenienced during a colleague's pregnancy, and fewer perceived hiring women of childbearing age to be a risk to the optimal functioning of their departments.

What Are We Training For? : A Follow-up Survey of a Child Psychiatry Training Program.

Abstract: The authors report the results of a 1990 survey of 91 graduates of the 2-year training program in child psychiatry at the University of Toronto. The participants, who completed their training between 1982 and 1989, completed a structured questionnaire designed to assess current patterns of practice, consultation, and academic activities. The respondents were also asked which aspects of their training were relevant to their current practice and what topics would be of interest for continuing medical education. The implications of the results for planning child psychiatry training curricula are discussed. (Academic Psychiatry 1994; 18:88-94).

Litigation in residency training programs and suggested due process guidelines for "residents in trouble".

Abstract: Litigation involving the dismissal of residents has increased in the past decades. A review of relevant court decisions and their implications for residency training programs is provided. To assure due process in such cases and to help programs deal fairly with situations involving problem residents that may never come to frank dismissal, a set of guidelines to assist training programs in dealing ivith residents "in trouble" is presented. The guidelines were developed collaboratively at University of California at Los Angeles (UCLA) and the University of Southern California (USC) and were reviewed and approved by the local hospital, university, and Veterans Affairs counsels to assure compliance with institutional policies and procedures regulating due process for employees and students. The guidelines were also reviewed and approved by an American Association of Directors of Psychiatric Residency Training (AADPRT) task force, but they were never published or widely distributed. Although modifications of these guidelines may be required to meet local educational or institutional variations, or to meet variations in state law or precedent, these suggestions provide a useful template with which to develop adequate and effective due process procedures.

A Survival Guide for Aspiring Academic Psychiatrists

Abstract: Many residents in psychiatric residency training are interested in an “academic career” Recognizing that current academic departments require excellent teachers, clinicians, and administrators in addition to researchers, medical schools and their universities are wrestling with titles and tenure as they attempt to provide opportunities via a variety of academic career paths. What constitutes the most suitable career path for the academic aspirant depends on the person’s goals, motivations, interests, values, personality style, talents, background, and training, as well as historically and geographically available training, mentoring, and employment opportunities. The authors examine alternative definitions of “academic success,” relate these to the variety of personality types and opportunities found in academic settings, and provide some guidelines for advancement along the available career paths.

Training residents in psychotherapy for psychotic patients : curricular constraints and clinical suggestions.

Abstract: In recent years, residency programs have neglected to teach psychotherapy for psychotic patients to their trainees. This training has value in teaching residents how to more fully understand psychopathology, to understand the concept of the unconscious, and to work more effectively in using combined pharmacopsychotherapy with psychotic patients. The author suggests that an "affect-centered" psychotherapy approach is both clinically appropriate and educationally useful with psychotic patients. Recommendations for teaching this approach are given.

Psychiatric resident moonlighting : a review and modest proposal.

Abstract: Moonlighting by psychiatric residents remains controversial, with debate surrounding the ethical, legal, financial, and educational risks involved in the practice. The authors present a literature review of resident moonlighting, which encompasses the policy positions of various organizations responsible for graduate medical education; surveys of various groups and specialties regarding the prevalence, form, and justification for moonlighting; and models of moonlighting programs in several institutions. The authors conclude with specific proposals for research regarding psychiatric resident moonlighting and, more importantly, emphasize the need for research on the effects of moonlighting on resident performance and education.