Preparing Tomorrow’s Psychiatrists: What We Need to Do

The curricula of psychiatric residency and fellowship training literally shape the future of our field—absent our educational enterprise, there are no new psychiatrists. At a time of dramatic change in our science, with nearly daily breakthroughs in genetics and neuroscience; a health care system undergoing transformation; and pressures on graduate medical education, to fail to look broadly at the future of psychiatric training would be shortsighted. In addition, concerns have been raised in the field about the focus of current training and how to incorporate the elements of neuroscience and integrated care in a curriculum that is already complex and under pressure to streamline. While there are many groups charged with the specific oversight of elements of the psychiatric residency experience, we believed that APA, representing the field as a whole, was in the best position to convene the type of high-level review that might inform future planning and thinking on these important topics.

With this framework in mind, the Board of Trustees voted last summer to create the Ad Hoc Work Group on Education and Training. This group included leaders from many parts of our field who are members of APA, as well as formal representation from the training directors’ organization (AADPRT), the chairs’ association (AACDP), the American Board of Psychiatry and Neurology (ABPN), and many others. We asked them to take on the tasks of assessing how we are currently training psychiatrists, identifying critical educational goals that will allow us to meet projected future needs, and making recommendations on the best ways forward. The work group, convened in August 2014, was chaired by one of the authors of this column—Richard F. Summers, M.D., co-director of residency training at the Perelman School of Medicine of the University of Pennsylvania. The group’s charge was to review current pressures on residency education and training, including the following areas:

• Graduate medical education (GME) funding

• Curriculum changes, especially related to areas such as neuroscience

• Changing models of health care delivery (that is, integrated care and payment models)

• Research training

At our Board meeting last month, Dr. Summers presented the work group’s comprehensive report, which included several major overarching recommendations. The report and its recommendations were unanimously approved by the Board.

First, the report recommended that APA must take an ongoing leadership role in advocating for the necessary changes in residency education so that psychiatrists of the future are prepared to meet the public health needs of Americans with psychiatric illness. This will best be accomplished by partnering effectively with the education organizations in the field and with other primary care medical organizations.

Second, APA should vigorously advocate for maintaining and increasing funding for GME, including funding for training in innovative care delivery systems. This also includes advocacy for maintaining psychiatry as a designated primary care specialty in recognition of the unique role that psychiatrists play as the principal physicians for many people with mental illness, especially serious mental illness.

Third, the work group recommended that general psychiatry training programs should remain four years in length because of the knowledge and skill set that will be required in a rapidly changing field. Four years of training is more than warranted due to the need to learn the greater volume of clinical knowledge in our field, including in the areas of neuroscience and integrated health care. Robust exposure to psychosomatic medicine, geriatric medicine, substance abuse/addiction treatment, and integrated care during general residency training will be required to ensure that psychiatrists are well trained to meet the clinical demands of the future. Child and adolescent psychiatry and forensic psychiatry will also continue to be important aspects of training, as will training to ensure that psychiatrists are culturally competent.

Fourth, the work group found that an increase in clinically applicable neuroscience knowledge has created a pressing need for curricular development in this important area, which will undergird so much of our understanding of psychiatric illness going forward.

Two position statements were proposed based upon these third and fourth points:

• General psychiatry residency training should be of four years’ duration with an enhanced focus on the curricular elements noted above. The historic exception for child and adolescent psychiatry as a two-year training sequence after the third year of residency should be maintained.

• There is a need for increased focus on neuroscience education.

As position statements of APA require formal review and approval by the APA Assembly, these statements are now being referred to the appropriate APA components for review, after which they will go the Assembly for consideration.

Fifth, the work group made programmatic recommendations to the APA Department of Education and Council on Medical Education and Lifelong Learning to support faculty development, act as a convener of medical education groups in psychiatry, and increase offerings that focus on collaborative care.

Finally, the report calls for increased collaboration between APA’s Council on Medical Education and Lifelong Learning and other APA councils to evaluate research training, conduct needs assessments, synthesize recruitment data, and promote training for integrated care.

The work group members reaffirmed the importance of traditional components of residency training, including the physician-patient relationship, professionalism, and psychotherapy, and noted that these important areas have also been strongly supported by the Psychiatry Milestones, the new ACGME framework that shapes residency education.

We owe our thanks to those who served on the work group and volunteered so generously to bring forward this comprehensive report: In addition to Dr. Summers, they are Sheldon Benjamin, M.D., Tami Benton, M.D., Carol Bernstein, M.D., Lara Cox, M.D., M.S., Jed Magen, D.O., M.S., Michele Pato, M.D., Laura Roberts, M.D., John Sargent, M.D., Christopher Thomas, M.D., Glenda Wrenn, M.D., ADMSEP Representative Greg Briscoe, M.D., AAP Representative Carlyle Chan, M.D., ABPN Representative Jeffrey Lyness, M.D., AACDP Representative Mark Rapaport, M.D., and AADPRT Representative Christopher Varley, M.D. Members of the APA staff were also a key part of this work.

Because of the Board’s action in response to this forward-looking document, we believe that future psychiatrists will be better positioned to help all individuals who need our care. ■