The program for professional values and ethics in medical education.

BACKGROUND: Medical educators are very interested in the teaching and evaluation of professional attitudes and behaviors among medical students, residents, and faculty. At Tulane University School of Medicine, we created the Program for Professional Values and Ethics in Medical Education (PPVEME) to return the focus of our curriculum to the physician-patient-community relationship and to the nurturing of professionalism. DESCRIPTION: PPVEME brings together students, residents, and faculty into learning teams that create longitudinal curricula about five themes: integrity, communication, teamwork, leadership, and service. The emphasis is on learner-driven self- and group-reflection about shared experiences, thus modeling essential professional attributes. EVALUATION: The program is evaluated using surveys, student and faculty focus groups, and portfolios developed by student volunteers on each team. The first program event, a retreat for entering medical students, was highly successful. CONCLUSIONS: PPVEME is an attempt to construct a medical school learning environment around professionalism. Evaluation over time will tell how successfully that has been accomplished.

Double duty: students' perceptions of Tulane's MD-MPH dual degree program.

PURPOSE: Although MD-MPH programs exemplify the initiative for collaboration between schools of medicine and public health and address the expanding requirements for effective medical practice, information on such programs is scant. Perspectives and motivations of students enrolled in a 4-year MD-MPH program are explored to benefit existing and new programs as well as to inspire future research. SUMMARY: A questionnaire, based on previously identified themes, was mailed to all 110 students enrolled in the MD-MPH program at Tulane University. The typical respondent felt prepared for the program, expected to practice medicine full time, and expected to practice internationally up to 3 months annually. Perceived enhancements and barriers to dual degrees are addressed. CONCLUSIONS: Increased awareness of MD-MPH programs at the undergraduate level might be beneficial. Respondents valued the broader perspectives on the doctor-patient-society triad and additional career opportunities gained through their combined studies. Findings of this study can facilitate program planning and improvement elsewhere.

The life cycles of professional associations: organizational and administrative dynamics.

The life cycles of professional associations have received little attention in the literature. Using the Canadian Group Psychotherapy Association as an example, the author discusses the general dynamic underpinnings of systems and organizations, and caveats for the leaders of professional associations.

Student ratings of outpatient learning favor rural community mental health centers.

All students (N = 185) in 8 consecutive rotations within a private Southern schools multisite, inpatient-based psychiatry clerkship completed a survey of perceived educational experiences while assigned to 1 of 5 part-time outpatient services (usable response rate 82%). The rural community mental health center (CMHC) students reported increased 1) appreciation for the nature and implications of psychiatric disorders; 2) appreciation for treatment effectiveness; 3) interest, enjoyment, and hopefulness; 4) firsthand experience with patient evaluation and treatment; 5) community treatment resource information; and 6) teaching model helpfulness. The rural CMHC and Veterans Affairs Medical Center students reported a learning model based on experience. The rural CMHC and university student mental health service better exemplified the biopsycho-social treatment approach.

Psychiatrists as treatment team leaders: pitfalls and rewards.

The multidisciplinary treatment team has become a conventional component of inpatient psychiatric care delivery. Treatment team dynamics and their implications for the patient, the team members, the organization, and the team leader in particular have been generally understated in the training of psychiatrists, however, as has its value as a model for learning about administration. This article highlights the history and evolution of the multidisciplinary treatment team in psychiatry, the mix of mental health disciplines, philosophies, and roles involved, the characteristics of mental health care professionals, the conflicting manifest and latent work group tasks, and the dynamics and functions of team leadership. While reviewing information on which to base a systematic approach to team leadership, the author advocates for application of universal standards for education in administrative psychiatry including supervised leadership of multidisciplinary treatment teams and discussions of complimentary readings, examples of which are provided.

On the future of psychotherapy supervision in psychiatry.

Because psychotherapy supervision skills are learned primarily through experience as a psychotherapy supervisee, today's diminished training in psychodynamic psychotherapy can negatively influence future instruction in this important treatment modality. The author discusses role preparation for psychotherapy supervisors, suggests minimum standards for supervisor proficiency, and recommends ongoing instructional skills training.

A survey of psychiatrists with APA certification in administrative psychiatry.

OBJECTIVE: Psychiatrists with American Psychiatric Association certification in administrative psychiatry were surveyed to determine their perceptions of the benefits of certification, their certification-related learning activities and interests, and their recommendations for enhancing the value of certification. METHODS: A questionnaire was mailed in January 1994 to all 427 psychiatrists who had obtained certification in administrative psychiatry. A total of 254 usable responses were received. Respondents were divided into two age groups, younger than 50 years and age 50 and older, for comparison purposes. RESULTS: Fifty-five percent of the older group (204 psychiatrists) and 89 percent of the younger group (50 psychiatrists) responded. Nine percent of the older group and 18 per cent of the younger group held advanced degrees in administration, mainly master's degrees in public health. Both groups devoted 62 percent of their time to administrative work. Roughly 80 percent of both groups would recommend that colleagues seek administrative certification. Both groups rated self-satisfaction and increased skills as the greatest benefits of certification, and increased income as the least. As learning activities, the older group was more likely to participate in mentorships, and the younger group in self-study and continuing education activities. CONCLUSIONS: Interest in administrative psychiatry and certification should be stimulated by increased emphasis on administration in residency programs and in continuing education, linkages with degree programs, recognition of administrative psychiatry as a subspecialty by the American Board of Psychiatry and Neurology, and increased support from APA and the American Association of Psychiatric Administrators.

Cultural barriers to mental health care delivery in Alaska.

Geographically diverse providers from all mental health disciplines attended a recent conference in Anchorage and discussed cultural barriers to the delivery of mental health care in Alaska. Based on their knowledge, experience, and perceptions, this article describes barriers contributed by the mental health care delivery system as well as those contributed by the American Indian and Alaska Native cultures. American Indians and Alaska Natives are experiencing deculturation, outmigration, alienation, distrust, and despair. The difficulties at the interface between Alaskan mental health care providers and consumers indigenous to Alaska have implications for administrative and clinical endeavors in culturally diverse settings elsewhere. Progress in this area will require special administrative skills.

Toward a multidimensional model for psychotherapy supervision based on developmental stages.

The need for a systematic approach to psychotherapy training in psychiatric education is greater than ever. Most models of psychotherapy supervision focus on supervisee development and ignore developmental issues concerning the other participants in the supervisory triangle. The author reviews theories of psychotherapy supervision and identifies factors that contribute to the dynamic interrelationships among psychiatrists who are supervising psychotherapy, the psychiatry resident supervisees, and their patients as each party progresses through stages of development. A dynamic formulation of psychotherapy supervision based on developmental stages can result in a better understanding of the instructional process, its greater effectiveness, and associated changes in program structure. Further development of a comprehensive dynamic model depends on additional research.

Combining psychopharmacotherapy and group psychotherapy: problems and advantages.

This report presents the responses to the authors' survey of therapists' attitudes and perceptions regarding the problems and advantages of combining pharmacotherapy with group psychotherapy. Group therapists representing physicians, psychologists, and social workers were asked about their practices and attitudes regarding this practice. One hundred forty-three valid responses were received to the questionnaire (response rate = 55.4%). No significant differences among the three professions were found in years of experience, number of groups conducted, or percentage of included patients taking medication. The authors categorized the responses for both problems and advantages. The problem categories were medication arrangements and effects, impact on the group processes, relationship to the therapist, and interprofessional collaboration. The advantages were identical except for the initial category, which addressed group composition. The responses reflect clinicians' concerns, both positive and negative, and provide a framework for therapists to examine their practices.

Psychiatry residency programs: trends in psychotherapy supervision.

The evolving dominance of psychobiologic over psychodynamic theoretical influences on education and practice presents new challenges for psychiatry. This article features selected data from the 1989 American Association of Directors of Psychiatric Residency Training annual survey (n = 215) that describe current teaching activities related to psychodynamic psychiatry, mainly psychotherapy. Results are based on a 50 percent return rate (107/215 questionnaires). Responses confirm the emergence of psychobiological (48%) over psychodynamic (40%) departmental orientations and report that the psychodynamic orientation has maintained strength as a secondary emphasis. Residents generally gain experience in a range of psychotherapy theories and modalities, including psychodynamic, cognitive, behavioral, individual, couples, family, and group therapies. Training in brief and short-term individual psychodynamic psychotherapy predominates, however. Use of video- and audiotaping in supervision is limited. Full-time faculty provide the bulk of psychotherapy instruction. This is carried out in both individual and group sessions, which are organized primarily around case reviews. Supervision-related problems include faculty availability, skill diversity, competence, theoretical flexibility, and attitudes, as well as program structure and standards.

Gender influence on specialists' ratings of residency program candidates.

Sexism has been perceived at all levels of medical education. Although specialty training has been scrutinized from various perspectives, there have been few objective assessments of sexual discrimination in the selection of candidates. This study evaluates the responses of board-certified physicians to fictional residency applicants' personal statements, which were identical except for gender. Male and female physicians from six specialties in which women were overrepresented and six specialties in which women were underrepresented all favored female candidates. Female physicians in both groups rated male candidates as less hardworking than did male physicians. Implications of these and other findings are discussed.

Combining group psychotherapy and pharmacotherapy: a survey.

Group psychotherapists, primarily members of the American Group Psychotherapy Association, were surveyed to determine their practice and attitude toward inclusion of patients receiving psychotropic medication in their "typical" outpatient psychotherapy groups. One hundred forty-three questionnaire responses were received from 258 contacted practitioners (55.4% return rate). More than two-thirds of the physicians, social workers, and psychologists reported including medicated members, and the professions did not significantly differ. Mood disordered patients were most frequently and schizophrenic and manic patients were least frequently reported to receive medication. Overall, clinicians' attitudes favored including medicated patients in the group. Indeed, therapists did not view inclusion of drugs as a detriment to the treatment process. Clinicians having only one medicated patient in their group felt more strongly that such individuals did not interfere with the treatment process when compared with those having none or more than one medicated patient. The one difference by discipline was that social workers and psychologists did not endorse the idea that medicated patients needed to be in groups led by psychiatrists.

Gender bias of Ohio physicians in the evaluation of the personal statements of residency applicants.

Sexism has been documented at every level of medical training as well as in the community of practicing physicians. Although there is speculation in the literature about sexist attitudes and perceived sexual discrimination influencing a medical student's choice of specialty, there are few data on gender bias in the evaluation of residency candidates applying in different specialties. In 1989, the authors created six personal statements of interest in a residency, each from a different type of fictitious residency candidate (three men, three women, at three levels of medical school achievement) and mailed one or another of the statements, chosen at random, to the 2,478 board-certified Ohio physicians practicing in six specialties in which U.S. women in residencies were underrepresented (less than 12%) compared with the percentage of women in medical schools, and to the 3,586 board-certified Ohio physicians in another six specialties in which women in residencies were overrepresented (more than 38%). The physicians consistently rated the women candidates more favorably than they did the men candidates.

Social and economic influences on psychiatric education: a commentary.

This issue of Psychiatric Quarterly is dedicated to psychiatric educators and psychiatric education. The authors contributing to this special publication are committed to the pursuit of excellence in education and in the clinical application of current knowledge. Because psychiatry encounters turbulence at its boundaries and encroachments on its roles in society, the psychiatric educational process struggles to adapt to society's concerns and expectations, while at the same time continuing to emphasize the development of clinical excellence for trainees.

Residency education in administrative psychiatry : a national survey.

In 1989, the authors surveyed all general psychiatry residency programs to assess the availability, extent, and emphasis of administrative teaching currently being offered during residency training. With a return rate of 74.5%, the results reveal that 69.5% of the respondents presently include administrative training within their curricula and 56% offer didactic teaching about administrative issues. These results are compared with a similar survey performed 10 years previously in which 85% of the respondents reported offering some administrative training but only 39% offered didactic instruction in this area. An analysis of these data and a review of proposed curricula for training in administration are provided.

Community psychological effects following a non-fatal aircraft accident.

Following a non-fatal military aircraft accident, two of the authors interviewed the crewmen involved in the accident, their spouses, fellow squadron members and their spouses, and individuals from the fire crew and control tower on duty during the accident. A total of 37 respondents completed questionnaires which reported the presence of intrusive, avoidant, depressive/anxious, and post-traumatic stress symptoms. Spouses reported more symptoms after the accident than their flying husbands. Intrusive symptoms were most common. Symptoms were correlated with various perceptions and experiences occurring prior to and following the accident. Several kinds of symptoms and experiences were significantly correlated with a perception of morale decline. This study suggests that even non-fatal aircraft accidents may have important psychological effects on those involved and on the surrounding community. Implications of these findings and recommendations for helping communities process traumatic events are discussed.