It's been 18 years since the last major summit was held on psychiatric
education, and with the numerous changes that psychiatry in particular and
medicine in general have undergone since then, the time is ripe to discuss how
psychiatric education during medical school must evolve in the coming years to
better meet current challenges and prepare for expected challenges. Thus, a
number of experts in psychiatric education have been invited to meet at APA
headquarters later this month to participate in a consensus conference titled"
Educating a New Generation of Physicians in Psychiatry." Our
overall goal is to achieve a beginning consensus on how best to
reconceptualize and restructure medical student education as resources
continue to shrink and expenses
This is a critical time for our field. While the good news is that the
number of graduating medical students choosing to enter psychiatry has risen
slightly each year for the past five years (Psychiatric News, April
15), we need to continue to pass on our excitement about the field and its
critical importance to ensure that the number of psychiatrists in the future
is sufficient to meet the growing demand for care.
And students do indeed become excited about psychiatry once they learn more
about the work we do. I recently taught a seminar with Dr. Tamara Gay, the
director of medical student education at the University of Michigan, where I
am on faculty. Our task was to teach the abnormal mental status examination to
a group of first-year medical students using videotaped vignettes. The
students were not only interested, but fascinated. Discussion about the fine
points of diagnosis, treatment, etiology, and biology took a back seat to
discussion about what the students saw on the videotape. They clearly came to
the realization that evaluating patients' mental status is an important part
of their medical education and future roles as effective physicians.
As we retool for the future, these are just some of the questions that we
need to answer: What are the best methods of teaching psychiatry at various
levels of medical school? How do we close the gap between what is currently
taught and what should be learned? What should be the content of didactic
lectures? What should the clinical experience consist of? What is the role of
research in medical student training? Should students be taught how to use
computers to access medical information and make treatment decisions? How can
we incorporate research and mentorship opportunities?
Our medical school recently acknowledged the importance of psychiatric
education for medical students and expanded the length of the psychiatry
clerkship from four weeks to six weeks. We were asked to include child and
adolescent psychiatry, substance abuse, geriatrics, community psychiatry, and
psychosomatic medicine and base the clerkship in an outpatient setting rather
than the traditional inpatient setting. Other medical schools are similarly
emphasizing the importance of psychiatric education.
Today many departments of psychiatry are more focused on conducting
research and their grant income than on educating students and literally
cannot afford to have faculty spend time on mentoring and modeling for
students. Furthermore, with lengths of stay on inpatient units so short, it is
getting harder and harder to provide a continuity experience for students.
There are different models of psychiatric education to consider. Some
involve teaching students in primary care settings so students can see mental
health problems in the settings in which they are most likely to
practice—in medicine, ob/gyn, and pediatric clinics. But that raises
another problem: reimbursement. Many patients are covered through mental
health carveouts or have no coverage at all. Medicare patients must pay a 50
percent copay for most psychiatric services.
The need for behavioral interventions is also growing to address such
health and "lifestyle" issues as smoking, obesity, alcohol abuse,
substance abuse, high blood pressure, high cholesterol, and so on. What are
the best ways for students to master these types of interventions? In many
places, nurses, nutritionists, physician assistants, behavioral psychologists,
and other specialized paraprofessionals have taken over such care. Through
psychosomatic medicine, we should be able to determine the most appropriate
and productive role for psychiatrists in this area.
I'd like to thank Dr. Jay Scully, APA's medical director; Dr. Deborah
Hales, director of APA's Division of Education and Career Development; and
Nancy Delanoche, associate director, for their encouragement and support of my
presidential initiative on psychiatric education. I'd also like to thank Dr.
Richard Balon, chair of the Council on Medical Education and Lifelong
Learning, for his help in organizing the consensus conference.
A report on the conference will appear in a future issue ofPsychiatric News. ▪