The use of audiotaped treatment sessions for supervision of psychiatric
trainees was described in the October 21, 2005, issue by Dr. Tomar Levin. He
pointed out how much is lost or distorted in the description of treatment when
supervisors meet with trainees at some time after the session in question was
held. While the time invested in listening to audiotapes more than doubles the
time for the supervisor, at least a close replica of what actually transpired
in the treatment session becomes available for scrutiny and discussion.
However, there is yet a better way to conduct supervision, one that I have
used to good advantage for over 30 years. I meet with the patient and the
trainee together—with the patient's permission. As the session unfolds,
the trainee employs his/her skills for me to observe directly, including the
subtleties of nonverbal communication, relating, timing, and reciprocity. In
addition, I am able to demonstrate interviewing and therapeutic techniques, as
the educational process dictates. The trainee is prepared for this spontaneous
interplay, benefiting from the positive feedback that is contingent upon
his/her emerging competencies as well as from my professional modeling. The
learning experience is reinforced by approximately 15 minutes of debriefing
after the session ends. This pedagogical method is used for diagnostic
evaluations and individual, family, and group treatment.
This is the traditional "bedside" or "clinic"
rounding that has been a keystone of teaching in all medical specialties for
100 years—except for psychiatry. The inexplicable failure of psychiatry
to use the most effective teaching technique has been yet another nail in the
coffin of psychiatry's credibility with our colleagues in medicine, surgery,
and primary care. A false curtain drawn around confidentiality and solipsistic
self-disclosure in the psychoanalytic tradition has led to psychiatry's
indirect and watered down modes of teaching.
In three decades of teaching buttressed by principles of learning, there
have been fewer than a handful of patients who have been uncomfortable with
the spontaneity of this direct teaching; most feel that they are benefiting
from two physicians' experiences and expertise, give permission, and cooperate
fully. Residents and other trainees respond with enthusiasm to this
competency-based approach to teaching.