For educators, residents, and medical students, the recently published DSM-5 may be more than a manual for diagnosis—it can be the touchstone for an educational dialogue about the nature of psychiatry itself.
That’s what Richard Summers, M.D., co-director of residency training in psychiatry at the University of Pennsylvania Perelman School of Medicine, said in the article “DSM-5: A Teachable Moment,” in Academic Psychiatry last month. The article is one of six that appeared in the journal based on a symposium on DSM-5 and education at last year’s APA annual meeting.
“The publication of DSM-5 is a teachable moment for educators and trainees because it opens an opportunity for discussing not just how to do a diagnostic assessment, but also that our knowledge about psychiatric illness moves forward in an iterative way,” Summers told Psychiatric News. “We keep learning, and as we do, we have to change how we conceptualize diagnostic assessment.
“So DSM-5 is really an occasion for us to have a discussion about the broader process by which progress takes place in our field,” he said. “I think that people who enter psychiatry have a tolerance for—and interest in—a field that is still evolving. We tolerate some ambiguity as we move toward a more complete understanding of mental illness, and the diagnostic manual can be taught as a next step in the progress of our understanding.”
Summers believes that the international attention focused on DSM-5 opens up avenues for dialogue between trainees and the patients they treat.
“Society really cares about what we do,” he said. “Open conversation about DSM-5, its changes, and what they mean ultimately diminishes stigma. What we are all doing with our patients is helping to educate them and collaborating with them by providing information and having a dialogue.”
In his article, Summers outlined recommendations for education around the new manual. They include the following:
Mobilize and coordinate didactics to teach new criteria and reinforce didactics in bedside teaching, grand rounds, and other clinical teaching settings.
Model lifelong learning through faculty learning alongside trainees.
Teach the scientific methods and results that informed the creation of DSM-5.
Tell stories about the context for past and present nosologic systems.
Incorporate DSM-5 organization and Section III quantitative measures into clinical practice.
Emphasize clinical assessment of stressors, resiliency, and level of functioning.
Clearly delineate for residents when each type of exam will begin testing DSM-5 criteria.
Discuss the impact of DSM-5 on billing, coding, documentation, and patient psychoeducation.
Promote consideration of the patient as a person along with consideration of diagnosis and formulation.
Review and assess departmental clinical settings and their role in teaching psychiatric assessment.
Provide feedback to departmental leadership about the relevance and effectiveness of clinical services.
Improve “teaching the teachers” training and mentoring for residents as they approach their role as teachers of more junior residents and medical students.
Summers believes that residents today have a positive attitude toward DSM-5. Now that the manual is being incorporated into routine practice, the sense of controversy that accompanied the months before publication has died down. “It’s less of an ‘event’ now,” he said.
He added that the University of Pennsylvania was one of the field-test sites for DSM-5, so faculty and trainees there have experience with the manual. “This has given us a commitment to its success and also gave us a perspective on some of the controversies that arose so that everyone sees it as an incremental advance in the field, not an article of religious faith.”
Summers believes that DSM-5 is an opportunity for the best kind of education. “Great teaching and education happens when there is a sense of salience and immediacy and importance to what is going on, when teachers and learners alike give the subject matter their total attention,” he said. “That’s why DSM-5 is important. Residents know that something really important has happened in the intellectual framework of psychiatry, and this lends an immediacy to the education that happens around this important milestone.” ■