Promoting and facilitating professional development are among the highest priorities of the American Psychiatric Association. As a national medical specialty society with more than 36,000 physician members, APA has a multifaceted mission: to promote the highest quality care for individuals with mental disorders and their families, to promote psychiatric education and research, to advance and represent the profession of psychiatry, and to serve the professional needs of its membership. Accomplishment of the first three elements of this mission is contingent on our success in meeting the professional and educational needs of our members.
A commentary on professional development in psychiatry brings to mind its parallels to all human growth and development as well as our evolving understanding of brain development. Like both psychological maturing and neurogenesis, which we know to occur across the lifespan, professional growth and development is possible and necessary well beyond the formative years of formal education; it must continue throughout the span of a career. Further, we know that, much like the brain, a psychiatrist’s development reflects an ongoing dynamic interplay in which environmental factors, extending from changes in the structure and financing of health care to scientific advances, necessarily modify individual behaviors.
The importance of an extended investment in development is not unique to psychiatry. Six years before Abraham Flexner (1) wrote his influential report on the state of medical education in the United States, John Dewey (2) wrote an equally influential report on education. In it, he noted that because practice-only is a conservative force, theory must drive education, and he urged teachers to study medical and legal education to resolve issues of balancing practice with education.
Lee Shulman, Ph.D., current president of the Carnegie Foundation for the Advancement of Teaching, commented more recently on professional education in an era in which many view professionalism as being under siege. In addition to responding to diminishing public trust in the ability of professions to self-regulate and the unprecedented capacity of the Internet to break down knowledge barriers, medicine must confront rapid health care system-driven changes in the traditional models of education. Witness, for example, the movement of patients from inpatient to outpatient care in every specialty and controversies over commercial support of medical education. Shulman (3) identified six features characteristic of professional work:
A “calling”—obligation of service to others
Scholarly or theoretical understanding
Skilled performance or practice
Exercise of judgment in uncertainty
Need to learn from experience
Professional community-regulation, dissemination of new knowledge, and promotion of ethical standards
Reflecting on Shulman’s review of “professionalism,” I was moved to recall my own professional development. Entering medical school, I felt I was answering a calling and I looked forward to serving my patients. My residency in social pediatrics was an explicit commitment to service, in addition to training. During those years, my interest in behavioral pediatrics matured into an interest in psychiatry. Although the birth of my first child sidetracked my planned entry into child psychiatry, I eagerly took a position as residency training director at the San Mateo County Mental Health Services Program. As part of this job, I was also director of CME for our county mental health system. As an educator, I sought out colleagues for career advice and was lucky to know senior women psychiatrists who kept me involved with APA in spite of the difficulty remaining connected to the organization while my children were young and my income limited. Their wise counsel led me to seek leadership roles in the psychiatric education organizations, such as the American Association of Directors of Psychiatry Residency Training (AADPRT) and the Association of Academic Psychiatry (AAP). These activities, mentorship relationships, and my continuing interest in education led to my current position at APA.
APA membership, throughout one’s working life, is structured to provide support to psychiatrists in the spirit of professionalism as outlined by Shulman. Eligible to join as a medical student, as a member-in-training (MIT), the young psychiatrist can move on to serve as an elected MIT Trustee (MITT) or Trustee-Elect (MITTE), positions that afford national leadership opportunities through an active role on APA’s governing body, the board of trustees. An assembly committee of area MIT representatives and deputy representatives offers a broader pool of opportunities for young psychiatrists to network with peers and to serve as a reference group for assembly actions that address MIT interests.
Since 1971, APA’s committee of residents and fellows has facilitated resident participation in the association and helped residents establish effective liaisons with many APA components and other organizations that are involved in education and the profession. High among the committee’s valuable benefits is its capacity to assist residents in planning their careers and clarifying professional identity issues.
Additional support for early career psychiatrists—including programs designed exclusively for minority group members—are available via an array of competitive clinical and research training fellowships sponsored by APA with support from government and industry sources. Training opportunities cover the diverse span of career activities psychiatrists are likely to encounter, from public sector/public health practice, to academic research careers, to the pursuit of independent practice. All of these careers are complemented by involvement in leadership roles within the profession. Of particular relevance to PGY-2 and -3 residents in general, and child psychiatry with an interest in public health, is the industry-funded Jeanne Spurlock Congressional Fellowship. Participants serve a 6-month fellowship in Washington, D.C., in which they are introduced to the structure and development of federal and Congressional health policy while participating in activities such as helping develop legislative proposals, briefing members of Congress and staff, and interacting with constituents, primarily on issues affecting children and minorities.
We in APA’s division of education constantly strive to design activities and initiatives that create new professional development opportunities for both new and established psychiatrists in all walks of the profession. A recent example was the 2005 President’s Education Summit, “Educating a New Generation of Physicians in Psychiatry” (4). In December 2005, APA hosted a conference with peers from other medical specialties. Representatives from the American Academy of Family Physicians (AAFP), the American Academy of Pediatrics (AAP), the American College of Obstetricians and Gynecologists (ACOG), the Alliance for Academic Internal Medicine (AAIM), and surgery, along with medical student educators from these areas, shared experiences with medical student education activities with a focus on clerkships and clinical teaching in psychiatry.
Space precludes descriptions of the many programs APA administers and coordinates to enhance professional development across the career span of established psychiatric clinicians, system administrators, academicians, clinical investigators, and others. We urge members and nonaffiliated psychiatrists who are interested in becoming a member to visit our home page (www.psych.org) to keep abreast of the many opportunities available to enrich further your own experience as a psychiatrist as well as the collective strength of our organization. We welcome your suggestions as to how we might further serve psychiatrists’ professional development and, in turn, improve the quality of care available to our patients.