To the Editor: The revision of the Diagnostic and Statistical Manual of Mental Illnesses, 4th Edition (DSM IV-TR) has been a captivating topic, not only in the psychiatric world but also in the media. What we now use as our guide for diagnosis, the DSM IV-TR, will soon be outdated. The diagnosis of illnesses ranging from somatization disorders to personality disorders will be transformed, giving rise to a new way of thinking about these illnesses. This raises an interesting question in the minds of those involved in residency training. Are trainees being taught material that is already obsolete; and, for trainees, will they be entering a psychiatric world where they are not adequately trained in the guidelines to diagnose and treat patients? Also, was the perspective of the trainees considered, and was this subject discussed before the decision to revise the manual? To our understanding, the attempts to involve residency training programs in the early stages of change have been minimal. There have been multiple editorials written by experts in the field, but, to our understanding, this is the first written from the perspective of a trainee.

An area we will focus on and one that has garnered some of the most attention is the diagnosis of personality disorders. Currently, a section containing 10 diagnoses, arranged in 3 clusters, could now possibly be changed to 6 personality-disorder types, accompanied by their individual trait domains and specific levels of personality functioning (1).

There are some commonly proposed reasons why a shift from the categorical model to the dimensional model may be necessary. First is the idea that the categorical model is too rigid to encompass all patients and that inherently there will be patients having characteristics of multiple different personality disorders. This reinforces the idea that there can be no “cookie-cutter” approach to diagnosing personality pathology. Furthermore, the new dimensional model is expected to be more empirically-based, providing a better understanding of the complex nature of personality, making it more into a spectrum of illness severity. Although we realize that the current system of diagnosis of personality disorders is in need of revision, a question that arises is: How do we effectively educate trainees in these guidelines while making the transition smoother?

We wonder what could be done differently to anticipate the resident-education implications of these changes and, during this time of transition, we propose ideas that may make the shift more fluid. These suggestions include a proposal for training programs to be more involved in the revision, with trainees at all levels getting a first-hand look at the origin and reasons for change. Also, the DSM-5 taskforce could create recommendations for residency programs on how to implement changes, giving curriculum coordinators a better understanding of how to incorporate these changes.

Although we realize that science is a dynamic process, we hope to address the idea that, innately, residents and fellows find safety in facts and clear explanations of how they are derived. Realistically speaking, novice physicians do not have the confidence or clinical experience that their seasoned counterparts have in order to acclimate to these changes as smoothly.