Showing papers in "Academic Psychiatry in 1996"

Teaching psychiatry? Let hollywood help! : suicide in the cinema.

Abstract: Commercial films on videotape may be helpful in teaching medical students and residents about psychiatry. Recommendations are made on the use of specific films to illustrate various aspects of suicide, including depression, posttraumatic stress disorder, adolescent pressures and suicide, suicide gesture vs. suicide attempt, and the spiritual and philosophical aspects of suicide. In the Appendix, the authors list several dozen films depicting suicide that might be used for teaching purposes.

What and how psychiatry residents at ten training programs wish to learn about ethics.

Abstract: The study's objective was to survey what and how psychiatry residents want to learn about ethics during residency. A 4-page questionnaire developed for this study was sent to 305 residents at 10 adult psychiatry programs in the United States. One-hundred and eighty-one (59%) of those surveyed responded. Seventy-six percent reported facing an ethical dilemma in residency for which they felt unprepared. Forty-six percent reported having received no ethics training during residency. More than 50% of the respondents requested that "more" curricular attention be paid to 19 specific ethics topics and more than 40% for 25 topics. Preferences with respect to learning methods are presented. This survey may provide guidance in structuring the content and process of ethics education for psychiatry residents. These findings should stimulate the efforts of faculty to commit time and attention to this important curricular area.

A Pilot Course for Residents on Sexual Feelings and Boundary Maintenance in Treatment

Abstract: Surveys indicate that between 6% and 10% of psychiatrists report sexual contact with patients. Surveys also indicate that only a small minority of psychiatrists feel that they have received adequate teaching about this unethical behavior. Educational efforts aimed at reducing sexual exploitation of patients would be of value to trainees, patients, academic programs, and the profession. The authors report their experience with a pilot 6-session course for residents, and a longer model course is outlined. Such education should be mandatory in U.S. residencies. Mandated instruction would be consistent with both the high priority training directors have reported placing on the subject of sexual misconduct in ethics teaching, and with the widespread calls for increased education on this important subject.

Using problem-based learning to enhance the psychosocial competence of medical students.

Abstract: This article provides an overview of adult learning principles and reviews their applicability and effectiveness in enhancing learner acquisition of psychosocial competencies. It presents a brief critique of traditional models of teaching medical students, reviews general principles of adult learning, describes the method of problem-based learning (PBL), summarizes data about outcomes of PBL, and suggests mechanisms through which PBL may enhance psychosocial learning. The author emphasizes the roles of small group interaction, exposure to diverse viewpoints, integrated presentation of psychosocial issues in cases, learning to adapt to uncertainty, and similarities with the process of psychotherapy as possible mediators for enhanced psychosocial learning through PBL.

Clinical ethics teaching in psychiatric supervision.

Abstract: Supervision of psychiatric residents provides a natural context for clinical ethics teaching. In this article, the authors discuss the need for ethics education in psychiatry residencies and describe how the special attributes of supervision allow for optimal ethics training for psychiatry residents in their everyday encounters with ethical problems. Ethical decision making in clinical settings is briefly reviewed, and a 6-step strategy for clinical ethics training in psychiatric supervision is outlined. The value of the clinical ethics supervisory strategy for teaching and patient care is illustrated through four case examples.

A Curriculum for Learning About American Indians and Alaska Natives in Psychiatry Residency Training

Abstract: EDITOR’S NOTE: This article is the the third of six residency training curricula written for psychiatric educators by members of the American Psychiatric Association’s (APA) minority and underrepresented component committees. The first curriculum (on homosexuality) appeared in the Summer 1994 issue of Academic Psychiatry, the second curriculum (on gender and women’s issues) in the Winter 1995 issue. Commissioned by the APA Assembly, these curricula are intended to represent collectively a state-of-the-art description of psychiatric residency training regarding the needs of individuals from minority and traditionally underrepresented populations within the United States. They may be seen as a companion work to the growing body of clinically oriented volumes on the subject of the interaction of culture, ethnicity, and psychiatry. They are valuable resources and serve as guideposts for psychiatric educators. The remaining three curricula will appear in upcoming issues. A curriculum is pro posed for teaching psychiatric residents about the diagnosis and treatment of American Indians and Alaska Natives. The historical context, contemporary myths, and the rationale for the inclusion of curriculum materials on Indians in residency training are presented. The curriculum for the 4 years of residency training is then briefly described, and the knowledge, skills, and attitudes needed by residents are outlined. In postgraduate year (PGY)-1 and PGY-2, the curriculum includes a basic history and description of Indian people, information on myths about the group, and psychiatric epidemiology and psychopathology. In PGY-3, information is included on clinical care, as well as on related areas such as service utilization and illness prevention. In PGY-4, a seminar is proposed in which psychotherapy and other clinical cases are discussed. (Academic Psychiatry 1996; 20:5–14)

A National Survey of Training Directors About Education for Prevention of Psychiatrist-Patient Sexual Exploitation

Abstract: Residency directors were surveyed about education related to prevention of psychiatrist-patient sexual exploitation. Ninety-nine percent said they provide at least 1 session on this topic, 49% offer a formal course on it, and 83% indicated that this instruction should be mandatory. Eight percent of these educational programs had been instituted within the prior 10 years, and 55% of these programs had been instituted within the prior 4 years. Great variability was found in the precise nature of the instruction offered. By contributing to increased awareness, better treatment, and possibly to prevention of unethical behavior, such education can benefit patients, trainees, and the profession, and should be required for accreditation.

Ethics and Child and Adolescent Psychiatry

Abstract: This article describes the development and experience of one child and adolescent psychiatry training program’s approach to the creation and content of an ethics curriculum. Currently, a series of lecture-discussions covering ethics and forensic subjects are presented during the first year. Ethical principles, models, and reasoning are introduced, and their knowledge is deemed important to arrive at sensible resolutions of clinical dilemmas. Simultaneously, an emphasis on discussion of ethical dimensions of cases is expected during conferences, clinical experiences, and supervision throughout the 2 years of training. This article presents an analysis of one case for illustration. In addition, questions educators should consider prior to curriculum construction, related to the goals of instruction in ethics, are reviewed.

Teaching ethics in psychiatry : a problem-based learning approach.

Abstract: During the last two decades, the teaching of ethics in the field of medicine, particularly in psychiatry, has become the subject of increased attention. For this type of training to be effective, it should be practical (as opposed to theoretical), focused on the decision-making process (as opposed to the rote learning of concepts), and, eventually, self-directed. This article suggests that a problem-based learning approach is an ideal method for reaching these goals. A case illustration is presented to underscore the effectiveness of the method, as well as a rationale for its use. This article will assist psychiatric educators in becoming familiar with this approach and will encourage them to use this method in their training programs.

Resident and Faculty Evaluations of a Psychiatry Night-Float System

Abstract: This study used self-report questionnaires to examine resident and faculty perceptions of a new night-float schedule for coverage of a psychiatric emergency room compared with a traditional night-call system. The residents reported improved well-being, educational experience, and performance of clinical duties under the night-float system compared with a traditional call schedule. The faculty had a generally favorable impression of the new system. Night-float systems may provide a means of improving psychiatric residents’ emergency room and outpatient experiences without compromising patient care, although further studies are needed to measure fully the cost-benefit ratio of such programs.

Fifteen Years of Teaching Psychiatric Law and Ethics to Residents

Abstract: In 1978, the authors, a psychiatrist and a lawyer, began a course in law and ethics for postgraduate year A psychiatry residents that continues today. The authors review the course in terms of its evolution, effect on residents and faculty during the course, evaluation by residents immediately after the course and since graduation, and future prospects of such a course being started at other institutions.

On the future of psychotherapy supervision in psychiatry.

Abstract: Because psychotherapy supervision skills are learned primarily through experience as a psychotherapy supervisee, today’s diminished training in psychodynamic psychotherapy can negatively influence future instruction in this important treatment modality. The author discusses role preparation for psychotherapy supervisors, suggests minimum standards for supervisor proficiency, and recommends ongoing instructional skills training.

Supervisor evaluation : from theory to implementation.

Abstract: The evaluation of supervisors and assessment of teaching effectiveness are vital for academic psychiatry programs. The literature on teaching evaluation in classroom settings is reviewed briefly, followed by a summary of the available literature on supervisor evaluation in clinical medicine and psychiatry. While student evaluation forms of supervisor's teaching ability may be reliable and valid, this popular form of assessment is insufficient to fulfill all the purposes required of such evaluations. The development and implementation of a new process for supervisor evaluation is described for the University of Toronto's Department of Psychiatry.

Ethics in Academic Psychiatry

Abstract: I t is an honor to have been asked to write this cOfil:Illentary for a timely and important addition to the academic literature on ethics in psychiatric training. In 1991, the Ethics Committee of the American Psychiatric Association (AP A) reviewed Coverdale's (1) contribution at the AP A's annual meeting that indicated the paucity of ethics training in psychiatric residency programs. Although excellent educational materials about sexual misconduct produced by the APA were in wide use, the need for the development of a comprehensive model curriculum in ethics was clear. A task force, chaired by Mary Marshall Overstreet, J.D., M.D., developed the curriculum, which was approved by the APA Board of Trustees in December 1995 (2). Because times are rapidly changing in . psychiatry, there is even more need for attention to the ethical foundation of our profession. There are pressures to reconsider ethical positions as we are urged to pay attention to current mores, customs, and science. With all the travails related to poorly conceptualized or administered managed care, we also hear a call for an ethical paradigm shift from some of our colleagues. These critical issues have been discussed indepth at conferences held by the APA Ethics and Managed Care Committees (3) and by the American Medical Association (AMA) (4). In this issue of Academic Psychiatry, we have views of those recently in training as well as those who have attempted to delineate their best approaches to the teaching of ethics. In \"What and How Psychiatry Residents at Ten Training Programs Wish to Learn About Ethics,\" Roberts et al. surveyed residents on what they think about their ethics training. Their results indicated that although the residents thought ethics training was important, they felt the subject was not given adequate time in their formal education. It is distressing that there still is a high percentage of residents (46%) saying that ethics is not being taught. One of the many interesting points in the survey was that the residents felt that there was more than enough training on issues involving sexual misconduct, touching of patients, and financial coverage of patient treatments. The ethical problems related to doctor-patient sex, boundary violations, and ethical dilemmas surrounding the financing of psychiatric treatment indeed are the areas most subject to both ethical complaint (i.e., sexual misconduct) and deep ethical concern (i.e., treatment financing under managed care). The authors accurately point out the need for educators not to be miSguided by resident preference in these areas. The differences in gender-related learning styles is an important new contribution, and educators in ethics need to be sensitive to these. It is hoped that the authors will repeat this survey in order to assess the impact of new curriculum development on ethics teaching. Roberts et al., in \"Clinical Ethics Teaching in Psychiatric Supervision,\" outline a comprehensive, thoughtful, and individualized teaching method through clinical su-

Medical school electives and recruitment into psychiatry : a 20-year experience.

Abstract: Part of psychiatry's recruitment problem is a result of defections among students who were planning careers in psychiatry when they entered medical school. The authors present data from a 20-year (1974-1993) experience at the University of Maryland that shows that students who expressed a preference for psychiatry as a career in the freshman year were four times more likely to enter psychiatric residency training after graduation if they participated in the Combined Accelerated Program in Psychiatry (CAPP), a 4-year psychiatric elective program, than if they pursued the regular undergraduate psychiatric program. More than 20% of the CAPP students who preferred nonpsychiatric careers as freshmen were "converted" to psychiatry and later entered psychiatric residency programs. Recent changes in the ideology and economics of our profession have neither lessened the popularity of the CAPP nor diminished its apparent ability to shelter students preferring psychiatry from the stigmatizing experiences of medical school.

Residency Applicants in Psychiatry

Abstract: With the continued decline in the number of U.S. medical graduates entering psychiatry residencies and the possibility of a decrease in the number of funded psychiatry training positions in the near future, this study aimed to update our understanding of why applicants choose a residency program. For 5 years (1989–1993), all applicants interviewed for postgraduate year-1 psychiatry positions at Long Island Jewish Medical Center/Hillside Hospital were asked to rank factors that influenced their program choice. The factors that were rated as most important, in declining order, were location (67.9%), reputation (46.2%), integration with a medical school (35.9%), resident satisfaction (33.2%), and quality of faculty (33.2%).

Psychiatric education at a veterans affairs medical center.

Abstract: The authors describe how a small and relatively low-functioning psychiatric teaching program at a Department of Veterans Affairs (VA) medical center was transformed over a 6-year period into an active and well-functioning program for both medical students and residents. Steps were taken to address trainees' negative perceptions about VA patients and faculty, recruit and support an education-oriented staff, and improve the "user-friendliness" of the system. Efforts were made to integrate education into the missions of a variety of clinical and research programs while emphasizing the convergence of trends in the field of psychiatry with the VA experience. Data are presented indicating improvements in student and resident evaluations. Training was significantly expanded on inpatient units, chemical dependence units, a research unit, and an outpatient clinic. The authors offer suggestions that may be helpful to those developing psychiatric education at other academically affiliated VA medical centers.

A brief history of psychotherapy in graphic display.

Abstract: Students of psychotherapy, faced with the variety of contemporary approaches, and their many major contributors, may find it difficult to see “the forest for the trees.” If overwhelmed, they may uncritically limit their view to that provided by one or a few teachers, or even abandon the whole endeavor in favor of medication treatments. Three maps displaying a brief history of the psychotherapy, some of its major figures, and the primary contributors to 10 current methods, are presented. Potential uses for these maps in student education are discussed.

Medical students' attitudes on specialist physicians' social and sexual contact with patients

Abstract: To assess medical students' attitudes toward social and sexual contact with patients by physicians from three medical specialties (internal medicine, obstetrics-gynecology, and psychiatry), 326 students were surveyed at one medical school and 239 students responded (response rate = 73.3%). Most students perceived that arranging to date and/or dating and genital sexual contact were not appropriate either during a patient visit or concurrent with ongoing treatment. However, as many as 20% of the male students and 3.5% of the female students said that genital sexual contact with patients concurrent with treatment was (sometimes or usually) appropriate, depending on the specialty. Significant gender differences were found in attitudes about physician-patient sexual contact. Genital sexual contact was also significantly less likely to be perceived as appropriate for psychiatrists, as might be expected, than for obstetrician-gynecologists and internal medicine specialists. These results are discussed in relation to current codes of ethics.

A Survey of Child and Adolescent Psychiatry Residents

Abstract: This study attempted to discover how child and adolescent psychiatry residents chose their training programs, what they intended to do with their careers, and how they perceived their educational experiences. The survey was distributed to all psychiatry residents in the United States through their training directors in 1990. The authors received 310 responses. Significant differences were noted between male and female residents. Most residents expressed an intention to go into private practice after training. There were significant differences in residents interested in private practice vs. academic careers. The residents had applied to comparatively few programs and made training decisions early. The study generated objective information that may yield more specific recruitment strategies for child and adolescent psychiatry.

Geriatric training in adult psychiatry residency training programs.

Abstract: The authors surveyed all Accreditation Council for Graduate Medical Education-accredited psychiatry residency training programs in the United States to determine 1) the type and amount of geriatric training provided, and 2) differences in the programs that door do not offer geriatric training for residents. Substantial geriatric training was offered in 50.7% of all programs. Compared with the programs without geriatric training, these programs were more likely to be in a Psychiatry Department, with a Division of Geriatric Psychiatry and/or a geriatric fellowship program. These data suggest that current geriatric training in many psychiatry residency programs is inadequate to prepare residents for treating elderly patients and to encourage residents to pursue careers in geriatric psychiatry.

Self-directed learning in a psychopathology course.

Abstract: Self-directed learning has been identified as an essential element of professional development. In this approach, students receive in advance a complete set of objectives and didactic knowledge (cognitive) learning materials, are provided opportunities to develop skills with actual or simulated clinical experiences, and adapt a broad and flexible array of educational media to their individual learning styles. In the development of a self-directed psychopa-thology course for second-year medical students, the authors incorporated four modifications to the traditional lecture and small group (faculty-directed) approach: 1) independent (self-directed) learning with no prescribed study times or sequence to the material, 2) use of student and facult y-directed interviews of patients, 3) greater freedom for selecting teaching methods in small groups, and 4) elimination of formal lectures. The authors describe the educational results with such an approach.

The role of the psychiatrist : defining methods, theories, and practice in the time of managed care.

Abstract: This essay proposes that the division between biological and psychotherapy-oriented psychiatry originates in the discipline’s reliance on two fundamentally different methods of inquiry, that is, the medical-biological and the empathic-narrative. These terms are defined and distinguished from psychotherapy and psychodynamic psychiatry, as well as from general humanistic qualities in medicine. The division within the field may be fueled by a lack of clarity with respect to these concepts. The author argues that the essence of psychiatry is defined by a balanced combination of both methods. Psychiatry does not consist only of basic methods, but also of rules and guidelines for clinical practice, and of knowledge and theories used in the application of the methods. The role expectations for psychiatry in the managed care environment are examined and their effects upon methods, theory, and practice are analyzed. Some suggestions for dealing with the challenges of health care reform are offered.

Exploring the ethics of cost containment in psychiatric training.

Abstract: With the introduction of managed health care, the medical field finds itself in what seems to be an ethically compromised position. Changes in society have created a new role for the physician: that of manager of health care resources. Ethical principles have not evolved quickly enough to keep pace with these changes. Psychiatry faces unique problems because mental health care costs have been singled out for reduction by health care purchasers. Despite this present state of turmoil and transition, the profession needs to provide its students with the necessary training to practice ethical psychiatry. The author suggests teaching strategies and exercises to assist faculty wishing to include the ethics of cost containment in their curriculum.