Showing papers in "Academic Psychiatry in 1995"

Posttraumatic Stress Disorder Symptoms in Resident Physicians Related to Their Internship

Abstract: To evaluate whether stresses experienced by physicians during internship are associated with posttraumatic stress disorder (PTSD) symptoms, the authors administered a standardized questionnaire to assess PTSD symptoms, depressive and anxiety symptoms, and social supports to 212 residents. Thirteen percent of residents met diagnostic criteria for PTSD, including 20% of the women and 9% of the men. PTSD symptoms were significantly more frequent in residents who were single or divorced at the time the questionnaire was administered. There were significant positive correlations between PTSD symptoms and symptoms of both current anxiety and depression, and a significant negative correlation existed between social support and PTSD symptoms. PTSD symptoms attributed to stresses associated with internship, which may be deleterious to physician well-being and potentially to patient care, and suggest the importance of making major changes in postgraduate medical training.

A Psychiatric Residency Curriculum About Gender and Women’s Issues

Abstract: Over the last 30 years, major advances have been made in our understanding of how bio-logical factors and sociocultural influences contribute to gender differences, gender identity formation, and gendered role behavior. Sensitivity to the psychological effects of changing family structure and workforce composition, the contribution of reproductive events, and the high rates of exposure to trauma in women is essential for optimal psychiatric assessment and treatment planning. This knowledge has not been systematically integrated into residency training. The authors present an outline for a curriculum in gender and women's issues, including educational objectives, learning experiences through which residents could meet these objectives, and recommended readings. The authors also discuss potential obstacles and suggest helpful strategies for implementing the proposed curriculum.

Teaching interpersonal psychotherapy to psychiatric residents.

Abstract: Time-limited therapies are increasingly important components of clinical practice. The author describes his experience in teaching interpersonal psychotherapy and brief psychotherapy generally to PGY-3 psychiatric residents in two residency programs. Although residents lack psychotherapeutic experience, they appear to compensate f or needed security in the therapeutic role with enthusiasm and vigor, and to adjust relatively easily to the demands of conducting an active, time-limited approach. Videotaping sessions and having appropriately trained supervisors are important factors for program success.

Gay and lesbian issues in u.s. Psychiatry training as reported by residency training directors.

Abstract: This study reports the results of a survey of U.S. residency training directors that explored the training milieu of gay and lesbian psychiatric residents. Of the 198 training directors surveyed, 134 (67.7%) completed the questionnaire. All but four of the directors reported the inclusion of gay and lesbian issues in the curriculum, most frequently in PGY-3. Using a 5-point rating scale, 47.3% reported that homosexuality was regarded at their programs as “normal” or “somewhat normal,” 51.2% as “neutral,” and 1.5% as “somewhat pathological” or “pathological.” In general, the directors’ overall assessment of departmental attitudes about homosexuality paralleled the findings previously reported by lesbian and gay residents, with some discrepancy concerning the disclosure of sexual orientation to psychotherapy patients. In the earlier study, nearly one-third of gay and lesbian residents reported such disclosure; in the current study, only three training directors (2.5%) regarded this practice favorably. The results of the present study reflect the diversity of opinion found among residency training directors on the topic of gay and lesbian issues.

Stress and Adaptation in Learning and Practicing Medicine

Abstract: In their pursuit of careers in medicine, medical trainees and practicing physicians frequently endure significant levels of biopsychosocial distress. Psychiatry can play an important role in providing education about successful adaptation to a medical career and how to avoid dysfunctional states. The author describes a course designed to provide instruction to help medical students improve their adaptive skills. The course emphasizes preventive methods for maintaining well-being throughout a medical career. Both didactic and experiential methods of instruction are used to teach the class. The course targets a number of topics considered important for adaptation and well-being, using small group discussion to help students explore their ideas and experiences. By use of a concept referred to as the “longitudinal analogous experience,” current experience is explored to provide insights that hopefully will lead to more effective adaptation in the future. The instruction encourages the medical student to develop and use adaptive coping styles and skills to maintain an effective level of overall functioning throughout the training and practice years.

Medical students as role-playing patients : a model for teaching personality styles in the medical setting.

Abstract: "Personality Styles in the Medical Setting," a seminar at the University of California San Francisco School of Medicine during the third-year psychiatric clerkship, has proved efficient, educational, and enjoyable for students and instructor. The seminar teaches an approach to ivorking with a variety of patient personality styles in medical settings. Students role-play patients and doctors during simulated medical interviews, using special Patient Profile Sheets as guidelines for specific personality styles. In postinterview discussions, the students learn a process for gaining insight into the patient's behavior and the doctor's common reactions. A Doctor Review Sheet summarizes effective ways to work with that personality type to achieve a good doctor-patient relationship that will ultimately contribute to better medical care.

Characteristics of medical students and residents who select psychiatry : implications for recruitment.

Abstract: Effective recruitment of psychiatric residents begins with understanding medical students’ motivations for entering psychiatry. The author reviews the recent literature on the personalities of medical students interested in psychiatry compared with those interested in other specialties, the positive and negative factors that medical students cite when deciding whether to enter psychiatry, and the variables that are important to medical students and residents when selecting psychiatry residency programs. The implications of these studies for enhancing recruitment into psychiatry are discussed.

The Neuroscience Perspective and the Changing Role of the Psychiatrist

Abstract: The practice of psychiatry is undergoing rapid and radical changes because of health care reorganization and the advances in basic science. Therefore, psychiatric educators must confront the redefinition of the role of the psychiatrist in the health care system. The model of the psychiatrist who primarily provides office-based psychotherapy is outmoded. Rather, the psychiatrist must become a clinical expert in brain and behavioral sciences, with mastery over an expanding array of diagnostic techniques and responsibility for directing integrated multidisciplinary treatment and rehabilitative services. To ensure this expertise, students must receive a firm grounding in neuroscience, molecular genetics, and brain imaging in addition to the traditional curriculum.

What Is a Balanced Program

Abstract: “Balance” has become the watchword of psychiatry programs. It seems that almost all residency training programs claim to be balanced. But what do we mean by this term? This article summarizes the author’s evolving thinking about what makes for a balanced program and suggests that diversity may be a better term. The author advocates that balance is not as simple as teaching both psychodynamics and biological psychiatry. Instead, it entails a considered, intellectual approach that involves long-term vs. other psychotherapies, neuro-science vs. psychopharmacology, theoretical pharmacology vs. practical pharmacology, social psychiatry vs. treating minority patients, representing all viewpoints in psychiatry vs. integrating them.

Family Therapy Education for Psychiatry Residents

Abstract: Teaching and clinical supervision of family therapy can enhance a resident’s clinical skills and also promote movement from a linear, reductionistic type of thinking to a dynamic understanding of complex systems. Second-year postgraduate residents who completed a 10-month family therapy program were tested for their ability to understand family systems dynamics with the Family Therapy Assessment Exercise. Comparison of their test results before and after the program indicated significant improvement, which was entirely accounted for by improvement in the area of therapeutic skills.

How many psychiatrists do we need

Abstract: Projections of manpower needs based on population growth and possibly improving access are unconvincing because of rapid changes in psychiatric practice and because complex social and political forces are influencing the psychiatrist’s role in the mental health system. Given this basic uncertainty, attempts at filling residency positions at all costs are less than responsible. To serve our field well, efforts should be focused on recruiting “the best and the brightest” of our medical students and on providing quality training that stays in tune with the developments of the field and the evolution of the role of the psychiatrist.

An Observation and Group Dynamics Model for Teaching Psychoanalytic Psychotherapy

Abstract: Teaching and learning psychoanalytic psychotherapy are complex tasks involving the necessary integration of cognitive and affective elements. A model for this process is described that uses long-term observation of the teacher-mentor conducting therapy with a single patient. This method supplements and complements the use of supervision and case conferences to train psychoanalytic psychotherapists. The advantages of the observational mode are considered as well as the dynamics inherent in the group process and the discussion that follows the observation period. Such a pedagogical method emphasizes the important integration of affective and cognitive elements.

Graduate medical education financing in psychiatry.

Abstract: Psychiatry residency training programs are being affected by changes in graduate medical education financing. Program budgets are increasingly being constricted. Training directors will need to be better informed about how programs are financed if they are to function effectively and to advocate successfully f or training funds. The authors illustrate the present mechanisms of graduate medical education financing with examples. The possible effect of the coming reform in health care financing on psychiatry residency training is examined.

Perceived Personal and Institutional Influences on Child and Adolescent Psychiatry Research Careers

Abstract: To assess possible influences on the professional success of child and adolescent psychiatry investigators, all 187 physician-first authors of research posters presented at 4 annual meetings of the American Academy of Child and Adolescent Psychiatry were asked to complete a questionnaire. Responses numbered 147 (79%), with 80% (117/147) spontaneously naming one or more workplace factors, such as excessive clinical, administrative, or teaching demands, as hindrances to their success as researchers. The most important hindrances andfacilitatingfactors are discussed and suggestions are made to promote the development of research investigators in child and adolescent psychiatry.

An annotated bibliography in managed care for psychiatric residents and faculty.

Abstract: A computerized search of the literature on managed care was done using the Health Planning and Administration and the MEDLINE databases. There were 1,892 articles indexed between 1987 and 1993. Additional citations were retrieved through a manual literature search. On the basis of this information, a reading list was compiled for psychiatric residents and faculty. Several psychiatrists were consulted during the selection process. It is important to teach the principles of managed care to psychiatric residents and integrate managed care practice into medical school and residency training, and for this purpose the annotated bibliography will serve as a useful instructional tool.

Sabbaticals : A User's Guide.

Abstract: Academic sabbatical leaves have been offered in the United States since 1880. The author discusses the historical background and rationale for sabbaticals, their evaluation, and practical tips for those planning such an academic leave.

Psychiatry Today : Biology vs. Psychology.

Abstract: This research addresses preferences and theoretical leanings of present-day psychiatrists along the continuum defined at one end by biology and at the other by psychology. A questionnaire was devised and sent to 5,702 randomly selected members of the American Psychiatric Association in 1990. The response rate was 307%. The results were analyzed for two groups: psychiatrists with fewer than 15 years of practice since residency and psychiatrists with more than 15 years of practice since graduation. Although the great majority of psychiatrists in both groups equally valued psychology and biology, the senior group attributed a greater importance to psychological methods, whereas the younger group stressed equally the importance of biology and psychology. This suggests that psychiatry has evolved over the years from a predominantly psychological practice to one with a more equal emphasis on psychology and biology. Recent advances in neuroscience may have shifted the pendulum toward a more balanced willingness of clinicians to consider the broad armamentarium of psychosocial and biological treatments. The results point to the need for further conceptualization into the relationship between biology and psychology and its incorporation into the psychiatric residency curriculum.

Introducing community-based care of the chronically ill into residency education.

Abstract: Few departments have the resources to support an ideal program in community psychia-try. In this article, the authors discuss the difficulties and benefits of introducing long-term community-based treatment of the chronically mentally ill into a residency program with limited resources of time and personnel The residents initially were fearful of the program and tended to avoid its unique community aspects. The authors describe haw they dealt with these problems and haw the program evolved into a well-accepted part of the residency aver its first 4 years of operation. The authors conclude that, even on a time budget of 4 to 6 hours weekly, residents can have a meaningful learning experience in community-based care of the chronically mentally ill.

The Perceived Long-Term Impact of a Psychiatry Clerkship on Personal Growth and Clinical Skills

Abstract: The authors investigated the effects of a psychiatry clerkship that over 14 years has had a constant training philosophy and faculty and has been located in the same acute general hospital setting. In the study, 169 graduates completed a questionnaire on the effects of the clerkship on their knowledge of psychiatry, management of emotional problems in their patients, and personal development. Based on the graduates’ responses, the results reveal that the clerkship indeed has had a lasting impact on its former students. Possible implications for recruitment of students into psychiatry are discussed.

Providing residents with a comprehensive educational program in outpatient psychiatry : integrating an outpatient curriculum into outpatient management teams.

Abstract: As part of their efforts to prepare psychiatry residents for comprehensive, practical outpatient psychiatric practice, the authors have established an organized training program in ambulatory psychiatry. The program consists of outpatient management teams that run from mid-PGY-2 to PGY-4, a specified minimum number of mandatory outpatient hours for continuity patient care, and suggested guidelines for residents’ outpatient experiences. An outpatient management team curriculum has been designed for team leaders and trainees that consists of specific topics in outpatient care, associated learning objectives, and readings for each topic. This curriculum, which supplements our previous program of conferences, individual supervision, and a yearlong psychotherapy seminar series, has been refined over the past 5 years. The authors describe the program and the topics included in the curriculum.