Senior Educator Has Planted Seeds in Every Field of Psychiatry
Abstract
Yager is a believer in some of the new trends in education—online learning and the “flipped” classroom—but says better evidence of their value is needed and calls for multisite educational assessments of these models.
Getting to know psychiatric educator Joel Yager, M.D., is a close encounter with a voracious mind.
Joel Yager, M.D., says much of what is pushed at residents during traditional seminars—where trainees may or may not want to be—is probably wasted effort.
In 45-plus years as a teacher-administrator-researcher-clinician, Yager’s inquiring spirit has led to a thorough exploration of psychiatry and helped to shape nearly every aspect of what it is today. He has initiated and administered numerous innovative grant programs and research projects, and along the way he has mentored countless young psychiatrists.
“Good learning experiences present trainees with novelty and challenge, push their capacities, and make them stretch their skills,” Yager told Psychiatric News. “Good educators provide enough supervision to make certain that trainees are adequately supported on site and not abandoned when faced with overwhelming challenges. Hopefully trainees are not put into situations where due to lack of backup they can be seriously damaged by demands they’re not yet competent or prepared to handle.”
Today, he is a professor of psychiatry at the University of Colorado, where he works primarily with PGY-3 and -4 residents, teaching seminars, mentoring, and doing clinical supervision.
Department Chair Robert Freedman, M.D. (who is also editor of the American Journal of Psychiatry), said of Yager, “All of us in the department, including myself, look to him for assurance and encouragement.” Alexis Ritvo, M.D., M.P.H., chief psychiatry resident in the outpatient program there, said Yager is “beloved by all trainees who have the good fortune of working with him in the outpatient clinic—he offers sound, practical, and substantiated approaches for working with challenging patients.”
Program Trained Minority Health Services Researchers
The New Mexico Mental Health Mentorship and Education Program, led by Joel Yager, M.D., and Howard Watzkin, Ph.D., at the University of New Mexico (UNM) from 1999 to 2009, is an example of Yager’s unique intellectual and educational “reach,” which has touched every aspect of contemporary psychiatry and influenced countless young health professionals.
The program was designed for Hispanic and Native-American health professionals to receive training as health services researchers; roughly half of the participants were Native Americans from a variety of tribes and parts of the Southwest, and half were of Hispanic origin from Puerto Rico, Mexico, and South America. Graduates of the program include psychiatrist Mario Cruz, M.D., now at the University of Pittsburgh, who began his research on patterns of physician-patient communication. Cruz was at the University of Arizona when he joined the UNM program as a mentee and was then recruited to the University of Pittsburgh; he has also served on UNM’s faculty.
The program consisted of a summer institute including four days of lectures and seminars in which program participants were expected to give a presentation on an area of research interest. Projects included studying traits of mental illness and domestic violence among women seeking care at the Indian Health Services clinic in Albuquerque. One unique initiative involved giving disadvantaged Native-American youth cameras to photograph their lives during the course of a day; the young people later put together an exhibit of their work at a local community center.
“The faculty included many of the most distinguished health services researchers in the field. They traveled to Albuquerque for several days each summer to participate in the week-long institute and served as ‘tele-mentors’ during the year,” Yager said. Mentors in the program included such notables as Jürgen Unützer, M.D., M.P.H., of the University of Washington and Harold Pincus, M.D., a former director of research at APA.
“Slews of good publications and many good careers were assisted by that program,” Yager said.
Ritvo added: “There seems to be only a degree or two of separation between Joel and any psychiatrist in the country.”
That’s true. Yager’s influence and his friendships within the profession are far reaching. “What is so remarkable about Joel is his ability not only to be thoughtful and creative and to explore almost any topic in depth, but to put his thoughts together in a highly organized and instructive fashion and to communicate and educate actively, not just inform,” said longtime colleague Carolyn Robinowitz, M.D., a past president of APA and a leading psychiatric and medical educator. “This ability is reflected in his extensive and broad list of publications. Once he thinks about something, he researches and reflects on it, and then communicates that process to others. I once joked with him that I could imagine an in-depth and thoughtful conversation we were having being the topic of his next publication—but it wasn’t just a joke.”
Yager Earns Reputation as Innovator
Teaching seemed to come naturally to Yager—his mother was an educator—and he says that finding himself on a similar path “just happened.” He trained at Albert Einstein College of Medicine and later worked as a staff psychiatrist in the Army at Fort Ord, where he set up teaching conferences and journal clubs and did clinical research on acute stress and PTSD in soldiers just back from Vietnam.
In 1973, just 32 years old, he was recruited to UCLA as director of psychiatry residency. In the process of overseeing training at a large, multisite academic medical center, Yager became known as an innovator. His “experiments” included new medical student electives in cultural psychiatry, developing new seminar styles (such as an advanced psychopharmacology journal club), advanced clinical-didactic outpatient models, faculty-fellow-resident “affinity groups,” and an advanced eating disorder clinical case conference and journal club. In 1982 he published Teaching Psychiatry and Behavioral Science (Grune and Stratton).
It was during his tenure at UCLA that he also became involved on the national stage, and over the years he was a site visitor for residency training programs at the National Institute of Mental Health, an examiner for the American Board of Psychiatry and Neurology, an officer in the American Association of Directors of Psychiatric Residency Training (and president in 1979), and a member and chair of numerous APA components.
Yager left UCLA in 1995 and joined the University of New Mexico (UNM) as professor and vice chair for education. In the Southwest he worked with a number of Native-American and Hispanic physicians, nurses, and social scientists. Along with colleague Howard Waitzkin, M.D., Ph.D., an internist and sociologist, Yager set up a research training program to help train these minority health professionals for academic careers in health services research.
It is a signature example of the breadth of Yager’s interests. “We secured NIMH grant funding and for 10 years ran an innovative Minority Health Services Research Training Institute at UNM,” Yager said. “The program recruited trainees and mentors from around the country, helping establish mentoring networks, setting up and fostering ongoing research efforts, and helping many of the trainees write K awards and other grant applications” (see sidebar).
New Teaching Models Need to Be Tested
Education is changing, and Yager is a supporter of the newest trends—for example, online learning and the inverted or “flipped” classroom in which students come prepared to class having already absorbed the material they need to know. But as a researcher who hews closely to the data, he wants to see some evidence.
“I think we need experiments to see what aspects of psychiatry that trainees can, in fact, adequately and equivalently learn online versus in face-to-face seminars,” he said. “There are lots of opinions, but too few data right now. These trends are very much worthy of systematic multisite educational study.”
He added, “A huge amount of what we push at residents in scheduled seminars they may or may not want to attend is wasted effort. That’s a 19th century, top-down German model of education. You can get better results if you tell residents, ‘Here is what you need to learn, here are the goals and objectives, go learn it, and come back when you are fresh to demonstrate that you’ve learned it.’
“I assign my residents pretty dense reading, but I give them 15 questions I want them to be able to discuss when they come to class, so they are not just floored by a 100-page article but can focus on what’s important to learn.”
What about teaching psychotherapy? “I think residency is a place for acquiring basic psychotherapy skills, but we know developmental trajectory for psychotherapy requires that these skills are honed and polished with subsequent experience for several years after residency, usually with additional supervision and personal therapy.”
At the tail end of an expansive career, Yager has the pleasure—he uses the Yiddish word “kvell,” meaning pride—of knowing that his reach as an educator will extend into the future, having trained many young physicians who today are shaping the psychiatry of tomorrow.
“The legacy of which I’m proudest has to be helping numerous fabulous people along in their careers, many of whom have become leaders in the field of psychiatry,” he said. “It was my good fortune to be in the right places at the right time and to have put together programs that recruited the best and brightest. For the most part, it was a matter of providing them resources, running interference for them to flourish, being available when they asked for guidance and advice, and getting out of their way.” ■
