Understanding the dynamics of change and the impact on psychiatric education.

Academic departments of psychiatry are experiencing unprecedented changes that are difficult and challenging for faculty and administrators. This article examines the factors that influence change and the barriers to effective change. The author reviewed the business literature on change in organizations and examined the psychodynamic factors that mediate individual and organizational response to change. Several business models for effective change management exist and can be utilized by psychiatric educators. The psychodynamic models of change are useful for understanding the psychological impact of change on organizations and individuals. Effective management of change requires careful attention to the goals of the organization, development of a detailed plan to implement change, adequate resources to carry out the change, effective leadership and communication, and contingency plans for unforeseen events. Individual and organizational needs must also be considered. A model for dealing with change in education is presented.

Problem-oriented instruction as a predictor of success in early psychiatric interviewing.

Of 77 second-year medical students, the 27 who were randomly assigned to problem-oriented instruction (POI) in interviewing skills rated themselves as better prepared and more successful in interviews of psychiatric patients, compared with students receiving lecture only or no classroom instruction in interviewing skills. POI-trained students also rated themselves as better in focusing on nonverbal aspects, effective questioning, and exploring feelings. The POI involved hierarchically organized, skills-focused role-plays in which students rotated through the roles of "doctor," "patient," and "observer." The method enhances the similarity between the instructional environment during training and the problem-solving processes necessary at the time of transfer to a new problem. Supervisors who observed the interview did not rate the three groups differently on interviewing skills.