Dr. Kathleen Young’s day embodies the basic aim of residency education in our program: to train outstanding clinicians, capable of evaluating and treating patients with the broad range of psychiatric conditions encountered in clinical practice, using the full armamentarium of psychiatric therapies. This aim is accomplished through a variety of teaching activities. Central to this exercise is the methodological approach to psychiatry (
+1). This ensures a common language and culture in the Department, highly conducive to residency education by encouraging clarity of thought and by eschewing "orientation" driven divisiveness. The teaching-oriented culture, the accomplished faculty, and the teaching methods combine well with the clinical experiences to which residents are exposed. Residents learn how to take care of a wide range of patients, from the very complex to the straightforward, from the indigent underprivileged inner city resident to the international patient seeking a special expertise.
In her essay, Dr. Young points how she came to appreciate that the importance of diagnosis in psychiatry rests on the ability of the clinician to provide more effective treatment for her patients. Diagnosis is primarily derived from phenomenologic study of the patient, which requires, in addition to careful clinical observation, access to historical information, including history from collateral sources. Such history was not available regarding the patient with whose diagnosis she struggled, leading her to resort to another true and tested clinical psychiatric method: reformulation and empirical trail of a different treatment, Lithium. This second lesson of the day produced results; flexibility and adaptability of diagnostic formulations sometimes lead to big benefits for patients.
Dr. Young’s day also illustrates the importance of exposure to a wide range of patients during residency. In a single day, she took care of a woman with a complicated chronic mental illness and a man with chronic pain, opiate addiction, and probably a personality disorder. She went from caring for someone living with the effects of a diseased brain to taking care of someone whose behavior was driven by a complex constellation of factors, including addition, maladaptive personality, and pain. This allowed her to appreciate the differing nature and causes of the full range of psychiatric morbidity.
In addition to learning the importance of diagnostic formulation, she experienced the power of role induction in psychotherapy as illustrated by a traditional teaching method, personal illustration of how to use the technique by a peer supervisor. This set her up for the second part of the "see one, do one, teach one" triad, which has been the foundation of clinical teaching for generations.
Her didactic experience, in addition to teaching her key aspects of the body of scientific knowledge that is the underpinning of psychiatry, also illustrated the importance of ongoing research. She was fertile ground for this, as she came to our program in part with that exposure in mind. But she was also struck by the qualities of her teacher, whose enthusiasm affected her and showed her how one can be clinician, teacher, and researcher at the same time, a true embodiment of the academic "triple threat."
Dr. Young also learned that loyalty and hard work, 12-hour days, and devotion to patients are critical aspects of a career in psychiatry. Not only did she see that in the lives of her supervisors, but she also experienced it herself as part of her routine. She also lived some of the rewards of this complex life: the satisfaction of ministering to the sick, the stimulation derived from learning new things, the excitement that comes from the promise of discovery, and the warmth of interacting with colleagues.
Dr. Lyketsos is Professor of Psychiatry and Behavioral Sciences and CoDirector, Division of Geriatric Psychiatry and Neuropsychiatry, Johns Hopkins School of Medicine, Baltimore, MD. Dr. Young is a graduate of the residency program at Johns Hopkins School of Medicine, Baltimore, MD.