For Over 50 Years, APA Has Been a Leader in Education

In 1969, a decision by the American Board of Psychiatry and Neurology (ABPN) would prove a turning point in APA’s involvement in education: The one-year medical internship in psychiatry was terminated. It was a decision made in the context of many other changes in medical education but stemmed also from trends within the profession that had distanced it increasingly from the medical model.

In the three decades after World War II, APA’s educational activities had been limited. The Association published two journals and produced two national meetings each year focused on formal presentations submitted by researchers and clinicians, with minimal emphasis on the learning experience. APA was not actively involved in supporting residency training or medical student education.

But the 1969 decision “sent a shock wave through most of psychiatry,” wrote past APA Medical Director Melvin Sabshin, M.D., in his 2008 memoir, Changing American Psychiatry: A Personal Perspective. “The impact of this decision was a catalyst for many psychiatrists who finally recognized that the demedicalization of psychiatry had gone too far.”

The reaction was indeed powerful, and the decision was reversed in 1973. In 1977, the new Psychiatry Residency Review Committee (composed of members of the American Board of Psychiatry and Neurology and the AMA Council on Medical Education) mandated four months of internal medicine, pediatrics, or family medicine and two months of neurology in the first postgraduate year. Hence, psychiatry residency became a four-year program.

The ABPN decision and its reversal in 1973 was also arguably the beginning of APA’s contemporary involvement in education. The following year, Sabshin became medical director of APA, and in 1976 he recruited Carolyn Robinowitz, M.D., as the first director of APA’s new Office of Education. Previously she had been director of education in psychiatry at George Washington University and chief of the Physician Training Section in the Continuing Education Branch of Manpower and Training Programs at the National Institutes of Health. She was later elected president of APA.

The Office of Education’s initial mission was to monitor compliance with APA requirements for continuing medical education credits. But Robinowitz had a larger vision.

“My goal was to make APA a leader in psychiatric education,” she told Psychiatric News. “To that end, I insisted that education be structured as an independent office reporting directly to the medical director with the title of deputy medical director. I recognized that APA did not have the resources to engage in direct education programs and did not want to use resources in competition with the academic departments of psychiatry. But we could multiply our effectiveness by working with and helping to coordinate the organizations that did have a more direct role in education.”

Several organizations—the American Association of Directors of Psychiatric Residency Training, the Association of Directors of Medical Student Education in Psychiatry, the American Association of Chairs of Departments of Psychiatry, and the Association for Academic Psychiatry—became key collaborators. “They were my go-to groups, and I attended all the executive committee meetings,” Robinowitz said. “It was a marriage made in heaven.”

An early fruit of this collaboration was advocacy around getting psychiatry recognized as a shortage specialty and extra federal funding for training slots. In 1977, the Office of Education helped to organize the first national conference focused exclusively on psychiatric education and public policy, “The Psychiatrist as a Teacher.”

Collaboration among APA and the academic groups also led to the identification of psychiatric leaders in education and an expansion of the efforts of APA’s Council on Medical Education and Career Development (today known as the Council on Medical Education and Lifelong Learning).

In 1979 the chair of the council, Paul Fink, M.D. (who later became APA president), took the lead in developing the Psychiatry Resident in Training Examination (PRITE). PRITE (now administered solely by the American College of Psychiatrists) is not a certifying exam but is used as an educational tool to gauge the progress of residents.

Another of Robinowitz’s initiatives was outreach to medical schools and medical students to help reverse a historic antipathy toward psychiatry expressed by some medical school faculty, improve the medical student experience of psychiatry, and boost recruitment. In March 1980 the Office of Education organized “The Career Choice of Psychiatry: A National Conference on Manpower and Recruitment.” That conference brought together stakeholders in education and training, as well as members of the general medical community, private hospital systems, and government mental health systems. Their recommendations resulted in greater attention to the medical school experience and the need for appropriate compensation for psychiatric care.

The Office of Education initiated formal courses at the APA Annual Meeting and IPS: The Mental Health Services Conference (then called the Institute on Hospital and Community Psychiatry), with a focus on the learning experience of attendees. APA also hired an educational researcher to assess and evaluate educational programs.

Importantly, APA also became the third organization (along with the ABPN and the AMA’s Council on Medical Education) represented on the Residency Review Committee for Psychiatry, which shapes residency training.

The 1980s saw a lot of growth and activity. The Office of Education procured funding from the National Institute of Mental Health (NIMH) for teaching and curriculum development in special areas (such as women’s health, minority health, and chronic mental illness). One result was an NIMH-funded program begun by then APA President John Talbott, M.D., to strengthen relationships between state mental health programs and academic medical centers. The program included a working conference, guideline development, and problem-based consultations to states and academic departments focusing on best care for people with chronic mental illness.

In 1986, the Office of Education established the HIV/AIDS Education Project.

Also beginning in the mid-1980s, the Office of Education worked with the ABPN, subspecialty organizations, and appropriate APA components to address expanded subspecialty certification through added qualifications. This became a major responsibility for James Scully, M.D., when he succeeded Robinowitz as director of the Office of Education. Scully went on to become APA’s medical director.

Other activities of the Office of Education included collaboration with the APA departments of Government Relations and Public Affairs around advocacy and coordination with APA district branches to assist them in addressing CME requirements in their states.

Today, APA’s Division of Education offers a broad range of programs for faculty, medical students, and trainees as well as for practicing psychiatrists seeking education in evidence-based psychiatry. It routinely works with academic organizations and has modernized its offerings to meet the needs of today’s learners, many of whom want on-demand, online, and interactive content.

Outside of APA’s Annual Meeting and IPS, many of the division’s offerings today are online. In recent years, APA has launched a number of novel learning formats that appeal to “on-the-go learners”: interactive question banks, intensive learning collaboratives, hundreds of on-demand webinars, and dynamic self-assessment activities designed to meet Maintenance of Certification requirements. Many of these activities can be accessed on mobile devices and apps.

The Division of Education also administers SMI Adviser, the national Clinical Support System for Serious Mental Illness (CSS-SMI), established with a five-year, $14.2 million grant from the Substance Abuse and Mental Health Services Administration. SMI Adviser incorporates educational courses, fact sheets, toolkits, and consultation to expand the base of clinicians—including physicians, nurses, recovery specialists, peer-to-peer specialists, and others—able to provide evidence-based care to individuals with SMI.

“We have built on the foundation laid down in earlier years that made APA an indispensable player in psychiatric education,” said APA Director of Education Tristan Gorrindo, M.D. “Today, we are leveraging technology and innovative ways of teaching to help our members stay up to date as lifelong learners. We strive to be a go-to source for educational resources for psychiatrists throughout their career.” ■