Academic Psychiatry 23:182-184, December 1999
© 1999 Academic Psychiatry
Handbook of Psychiatric Education and Faculty Development
Edited by Jerald Kay, M.D., Edward K. Silberman, M.D., and Linda Pessar, M.D., Washington, DC, American Psychiatric Press,Inc., 1999 ISBN 0–88048–780–1, 496 pages, $50, Reviewed by Kenneth Z. Altshuler, M.D.
Kenneth Z. Altshuler, M.D.
Key Words: Book Review • Psychiatric Education • Faculty Development
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INTRODUCTION
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 TOP
 INTRODUCTION
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he Handbook of Resident Education appeared in 1991. In the present edition, the section on psychiatric education now includes undergraduate, residency, and continuing medical education (CME), and is flanked by sections on faculty development, research, and administrative psychiatry. Each section is a coherent unit; each includes interesting and important material. And despite its being multi-edited and multi-authored (31 chapters with 53 authors), the book is remarkably clear of redundancy.
I will review the sections separately, out of necessity touching on only a few highlights in a few of the chapters in each. The section on faculty development (seven chapters) describes the different paths and tracks of academic development, the requirements of each when it comes to advancement, and the challenges and rewards of different types of teaching activities. The section has helpful suggestions for self-development (e.g., fellowships), on locating and negotiating a job that will suit the path chosen (e.g., protected time), and a nice heads-up for the would-be writer about how perfectionism or hesitation to seek presubmission critiques can impede success. The section also reviews the special difficulties confronting women and international medical graduates in academia, and there is a chapter commending organizational involvement to the young faculty member, with a list of relevant organizations in our field. Other useful appendices include a bibliography on teaching psychiatry and one on psychiatric journals in which to seek publication.
The section on psychiatric research (four chapters) first discusses the researcher's life-style (more separate than the clinician-teacher from the needs of students and patients, and therefore more separate from other faculty) and such problems as competition with the private sector for patients, the vanishing availability of protected research time, and the high indirect costs of universities that lose drug trials to the private sector. One chapter also advises the young researcher on how to decide where to go for training, and on how to pick a job. Another outlines how to frame a research idea, and how to trim a grand search for a full solution to a more modest, but doable project. Still another gives excellent tips on getting funded, how grants are constructed, and what reviews are about, and it appends a list of government agencies and private foundations from which support can be sought.
My favorite in this section, though, both as a frugal department chair (code for cheap) and because it highlights the irrepressible motivation of those who must research regardless of circumstance, is the chapter on doing research without grant support (Dewan et al.). This section illustrates imaginative studies possible (administering the dexamethasone test to schizophrenia patients to test its specificity; characterizing a cohort of patients by a series of biological and clinical parameters); it also describes types of studies done on a shoestring—questionnaires, chart reviews, medication response in small samples—and it points out that most are done by clinical faculty on their own time, with a small amount of mostly departmental funds, who bootleg resources by bartering authorship or time, or enlisting pre- and postgraduate or other students who want to strengthen their resumes.
The section on education (16 chapters) dominates the book and is the most detailed and valuable. Five chapters are on medical student education, ten pertain to resident education, and one to CME. An excellent chapter on preclinical courses (Manley and Trachtenberg) reminds us that a major purpose of these courses is to demystify psychiatry and show its illnesses are clear and can be rationally managed, that young faculty and eager teachers are most appealing to students, that the course director rather than a disconnected series of super-specialists should give most of the lectures, and that the DSM-IV is not a psychopathological text for beginners—and memorizing it should not be a required student task. The chapter's step-by-step instructions on how to design and what to include in preclinical courses is also excellent, and must reading for new medical student education directors. Also, I liked the old-fashioned but apt reminder that examinations are not all, and that such behavior as "John regularly comes 20 minutes late for small groups" should weigh heavily in grading and evaluation.
The successive chapter on psychiatric clerkships (Brodkey et al.) does as well, and similarly for this area of undergraduate education, outlining the duties and role of the clerkship director, what a clerkship is and needs to be, how to construct it, and what to cover. I must say, though, that the appended "Objectives for the Junior Psychiatric Clerkship" of the Association of Directors of Medical Student Education in Psychiatry, 17 printed pages, appears a bit overly ambitious. The chapter provides an outline of what is to be covered in a psychiatric interview, screens for various symptoms and types of patients, and a medical student interview evaluation form, all of which are excellent aids for the new clerkship director or medical student educator. Other chapters in the series are on undergraduate electives, evaluation of students, and collaborating with other disciplines.
The subsection on residency training is filled with excellent chapters. Topic areas include "Administration of Residency Programs," "Developing and Monitoring the Curriculum," "Fulfilling the Special Requirements," (and preparing for residency review committee site review), and "Evaluations of Residents."
The chapter on "Special Problems" (Mohl) is an absolute gem. I say this impartially, despite the author being a member of our department's faculty. With the balanced wisdom of long experience, Mohl dissects the elements that may be present in such issues as resident illness causing shortage at a site; pregnancy and maternity and paternity leave; residents leaving or being dismissed; the chronically ill resident; patient suicide; residents with legal, ethical, or malpractice difficulties; resident responses to changes in faculty, sites, residency training directors (RTD's), or department chairs; and the closing of programs. His counsel ranges from, "the first thing the residency training director should do (here) is ... nothing," to when to take the heat that comes with any decision, to what specifically should be done to assuage (and prevent) issues arising. And Mohl presents as appendices exemplar policies for resident parental leaves, for due process for residents, and for morbidity and mortality conferences in the case of patient suicide or attempted homicide.
A chapter on "Professional Development of Residents" (Nadelson and Bernstein) wraps-up otherwise uncovered items such as safety issues for residents, ethics, the resident as teacher, psychotherapy for residents, support and training groups, moonlighting, selection of the chief resident, and the like. Each of these has points worth reading and remembering, and will be valuable, especially to the new RTD. A list of fellowships sponsoring residents for organizational meetings is appended.
The chapter on recruitment (Weissman and Rao) focuses on the difficulties in evaluating international medical graduates and school records and letters from foreign shores in relation to their applications. It suggests requesting a personal statement, discussing the applicant's favorite English-language book, checking the WHO's World Directory of Medical Schools, and asking colleagues from the country about it. Having a colleague from the same culture interview the candidate is also advised. Other chapters include those on the requirements of subspecialization, child and adolescent psychiatry, and CME.
The final section on psychiatric administration (four chapters) includes "Development as a Psychiatric Administrator," "Academic Psychiatry and the Public Sector," "Canadian Solutions to Constricting Academic Resources," and one on "Health Care Systems and Academic Psychiatry." This last, by Ross and Scharfstein, is one of the best, and clearly the most thought-provoking, since it addresses several of the conundrums that change has forced on the academic scene. The fact that it is the only one to really do so is a minor cavil with the book, since the editors' introduction enumerates the shifting sands and difficulties we face and promises the contents will deal with them. Valuable as they are, the vast majority of the chapters are mostly curriculum and business-as-they-used-to-be-usual, and say little about managed care. In this chapter, the authors face the facts that the behavioral health care organizations have the money—and the patients—and that our own preferences count little, and that most universities have cumbersome administrations and cost structures ill-suited to competition for contracts. They say outright that most resident programs will have to "right-size," that means downsize, and that the realities of today's care make the Residency Review Committee's 9-month inpatient requirement (to observe course of illness) an anachronism. The authors note that academic psychiatry has to make choices about social workers doing most of the psychotherapy (and the role modeling involved in such a case) and about training residents to work with them on medications, and the authors suggest boldly that feedback on productivity in terms of units of service should be an important measure for both faculty and residents.
Obviously, this book has a lot of important things to say and conveys a range of important information. The problem for it, as with most books, will be in getting it read. Most beginning academic docs (without the inner research-directedness that leads them to also get a Ph.D.) stumble through their early research years opportunistically with whatever comes to hand, and it is hard to see them searching out the information in the first section. They will probably have to be guided to the book, and chairs and RTDs could also suggest its perusal for those whose primary desire is to teach. The national organizations of directors of undergraduate medical education and RTDs could, and I think should, provide the book to each individual who newly takes on these responsibilities; failing that, they might at least recommend each aspirant approach his/her department chair to get one. Anyone who undertakes the read will be rewarded.
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FOOTNOTES
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Dr. Altshuler is the Stanton Sharp Professor and Chair, Department of Psychiatry, the University of Texas Southwestern Medical Center at Dallas.
Copyright © 1999 Academic Psychiatry.
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