Medical student and resident education and training of patient-oriented
psychiatric investigators will be the focus of APA's new president, Michelle
Riba, M.D., along with efforts to develop the field of psychosomatic
At the Opening Session of this year's annual meeting in New York last
month, Riba cited case histories and personal experiences that illustrated the
value of such a focus.
She recalled her own residency when mentors and teachers gave her the
opportunity and resources to pursue clinical research about "medical
clearance" of patients evaluated in the psychiatry emergency room.
She posed the question: How many patients were not medically cleared, and
what happened to them? Did the medical clearance process have value?
"With the help of several faculty, we wrote a protocol to review this
issue and wrote a paper that after many, many rewrites was finally published
in a peer-reviewed journal," she said.
Riba said the experience illustrates the value of an academic environment
that allows trainees to participate in the clinical encounter with patients
and encourages the formulation of clinically valuable research questions.
"If we don't develop a better way to train, mentor, and educate
psychiatry students and residents to develop research careers, psychiatric
research will no longer be undertaken by physicians but by others lacking
patient orientation and dedication," Riba said.
She recounted an experience from her internship when she was called to the
emergency room at 2 a.m. to evaluate a 30-year-old single mother of two
children with no insurance; she presented with physical complaints in every
Michelle Riba, M.D.: "It is essential that we not allow
ourselves... to surrender the opportunity and privilege to teach students and
"She said her scalp itched, her eyeballs burned, her chest ached all
the way down to the soles of her feet, [which] were prickly and numb at the
same time," Riba recalled.
The patient was admitted to the psychiatry inpatient service, but after
extensive review by attending physicians and medical consultants, the
patient's diagnosis turned out to be a severe form of systemic lupus
"She had a severe medical condition, but it presented with symptoms
that overlapped with psychiatric symptomatology," Riba said. "A
major group of patients who deserve the attention of psychiatrists are those
patients who have both chronic medical as well as psychiatric problems and
[whose care] falls under the field of psychosomatic medicine, our newest
"The possibilities to enhance our care of patients with chronic
medical illnesses are tremendous, have been relatively untapped, and are but
one example of the importance of the work that psychiatrists can provide
patients while working together with our medical colleagues," she
She recounted also the case of a 14-year-old girl admitted to the inpatient
psychiatry unit during Riba's third-year clerkship. The girl had been placed
in a cold body of water as part of a religious ritual and was unable to walk
or talk. After neurology colleagues found nothing wrong, a diagnosis of
conversion disorder was made.
"In the safe environment of the hospital using a variety of
therapeutic modalities, we were able to help this girl resume her normal
functioning," Riba said. "But two weeks later, the girl was
readmitted with symptoms very similar to those at her first
What emerged was a history of trauma and sexual abuse that illustrated for
Riba how "complicated it really was to help a patient" and the
value of excellent medical student and resident education in psychiatry.
"It is essential that we not allow ourselves, because of financial or
other pressures, to surrender the opportunity and privilege to teach students
and residents," Riba said. "While it is more labor intensive and
certainly not as efficient to have a student or trainee to teach and
supervise, it is also the best way to nurture those who will follow and
ultimately take over in the demanding work we do." ▪