Academic Psychiatry 23:227-232, December 1999
© 1999 Academic Psychiatry
Media Training for Psychiatry Residents
Lawrence Kutner, Ph.D. and
Eugene V. Beresin, M.D.
Dr. Kutner is a Lecturer on Psychology in the Department of Psychiatry, Harvard Medical School; and Dr. Beresin is Director, Child and Adolescent Psychiatry Residency Training, Massachusetts General Hospital, McLean Hospital, and Associate Professor of Psychiatry Harvard Medical School, Boston. Address correspondence and reprint requests to Dr. Beresin, Massachusetts General Hospital, 55 Fruit Street, Department of Psychiatry, Bulfinch 449, Boston, MA 02114–2696; E-mail: EBERESIN{at}PARTNERS.ORG
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ABSTRACT
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Psychiatric residency training programs rarely prepare residents for exposure to the media. Increasingly, however, physicians are called upon to disseminate current knowledge about a wide range of topics pertinent to mental health and illness. The authors describe a model seminar used in a psychiatric residency training program providing residents with skills in effective communication through the mass media. The goal of the seminar is to prepare residents for an important role in public health psychiatry.
Key Words: Psychiatry • Media Column • Residency Training
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INTRODUCTION
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Dealing with the media frightened him more than facing loaded weapons—he had training for the latter but not for the former. —Tom Clancy, Rainbow Six (p. 109) (1)
Mental health professionals are increasingly called upon by the mass media to provide insight and perspective into not only mental illness, but also social trends and behaviors (2). Psychiatrists have the opportunity to play key roles in the dissemination of accurate information to the general public on these matters (3). Despite their intense training in the subtleties of direct patient and family communication, few psychiatrists receive any formal training, either during their residencies or in continuing medical education, in how to be effective communicators through the mass media. One result of this is that many of the people interviewed by the media on mental health topics are not well qualified, but are selected for their media skills. Others have strong content knowledge, but are unable to communicate that knowledge effectively through the mass media. This situation is occurring while both adults and children are receiving increasing amounts of health-related information through mass and especially electronic media (4–6).
To help rectify this situation, we have developed a program that helps give young psychiatrists the perspective, skills, and structured practice they need to become more effective communicators. Since 1991, we have included formal "media training" as part of the "Transition to Practice Curriculum" for child psychiatry and psychiatry residents in the Massachusetts General/McLean Hospital Training Program. We also invite psychology interns, general psychiatry residents, and junior faculty interested in this training.
Our approach is to present this seminar within the context of "public health psychiatry." The seminar provides students with 1) a context for understanding how different forms of the mass media operate, 2)specific skills for both handling interviews and using the mass media as extensions of their clinical practice or research, and 3) a safe place in which to practice those skills and receive helpful feedback.
The seminar's goal is to give psychiatrists who have extensive knowledge of mental health issues the specific skills and confidence they need to become more effective communicators of that knowledge to the general public through a range of media (7, 8). While we did not intend or expect any of our students to become full-time "media docs," we were pleasantly surprised to find that a number of graduates have integrated the mass media into their professional careers due, in part, to their experience with this program. One graduate is a frequent guest on television networks, talking about children's mental health issues, and has created nonbroadcast videotapes for parents and teachers. Another graduate is writing syndicated newspaper articles for a news service. Several have written for popular magazines. Many are occasional interview subjects.
We have experimented with different formats, ranging from single workshops to multiweek seminars. The lessons we have learned from these programs can help training directors and psychology internship coordinators develop plans to provide similar experiences for their students.
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TRAINING ISSUES
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While media training is common among business executives, it is relatively rare within academic medicine. The "Essentials for Graduate Medical Education in Child and Adolescent Psychiatry" (9) require resident experience in teaching community groups about mental health issues. The "General Psychiatry Essentials" (10) require only teaching students in the health professions.
This shortcoming is a missed opportunity, especially in light of the proliferation and growing public dependence upon mass media for both factual information and perspective. Learning how to use those media effectively to educate the public about such issues as normal vs. pathological behavior, treatments, and the workings of the delivery system for mental health care is critical to residency training. Residency review committees should consider basic mass media skills a necessary part of residency education.
When communicating through the mass media, physicians and other psychiatric health care professionals face different legal, ethical, and technical issues than most businesspeople (11). Therefore, we decided that a generic media training program would be inappropriate or even counterproductive. In addition, such a program might seem irrelevant to many of the residents. We needed something specifically developed for doctoral-level researchers and clinicians.
One of the authors (LK) has extensive experience as a journalist covering medicine and child development in major market and network television, as a national columnist for newspapers and magazines, as a radio talk-show host, and as an Internet content provider. The other (EVB) has worked as a consultant to network and cable television programs, as a training film producer, and is frequently interviewed by the media on mental health topics. We used those experiences to develop a program aimed specifically at the needs of physicians and other health care professionals in advanced stages of training.
The vast majority of our students had little or no experience with the mass media. Of those who did—mostly as interview subjects for news programs—many categorized their experiences as "bad." They complained of being misquoted, of having their statements taken out of context, and of not being able to get across the points they had wished. Two other common themes in their descriptions were that they had felt powerless or overwhelmed. In addition, most of the residents approached the idea of being interviewed by the media in the future with trepidation. They were afraid of how their professional colleagues might react. They worried about making fools of themselves or of coming across as hucksters. They were concerned about whether their comments would be twisted or misused by the interviewer or reporter, resulting in an inadequate, misleading, or overly simplistic presentation. Finally, they were acutely aware that the editing of their comments would sometimes be out of their control. These fears resulted in a considerable amount of anxiety among the students during the initial part of the training. Indeed, one child psychiatry fellow became so anxious as her turn came to participate in a mock radio interview that she started hyperventilating. (She later completed the interview and felt much better.)
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PROVIDING CONTEXT
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The first step in the training seminar is to provide the students with some context for understanding how reporters, talk-show hosts, call-in radio hosts, and program producers think. This includes a "who's who in the cast," examining the different roles of producers, reporters, columnists, assignment editors, public relations agents, and others. From this starting point, we explore some of the subtle differences between types of interviews, for example, breaking news covered by a newspaper reporter vs. a feature story written by a magazine writer, with quotes and critical issues checked by a fact-checker.
We also provide printed support materials that explore these roles and offer advice on handling different interviews. Participants also discuss how they might discern the hidden (or overt) agendas of journalists and others with whom they might interact. The clinical skills of psychiatrists and psychologists can be quite useful at sorting through these agendas and anticipating awkward or challenging questions.
The emphasis in this phase is on getting the residents to understand the differing and sometimes competing motivations of the people involved in reporting a news story or creating an information/entertainment program. There is often much cynicism or suspicion among the students of the motives of the reporters and producers. ("All they want is the sensational stuff." "If it's technical, they won't get their facts straight.") While this point of view is, unfortunately, sometimes warranted, it can also be a reflection of the initial discomfort felt by the students when dealing with journalists. By bringing these concerns to the table, providing a context for understanding the motivations and behaviors of journalists, and showing how the residents' clinical skills can play a role in making sense of the situation, we lower their anxieties and prepare them for the mock interviews.
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STRUCTURING RESPONSES
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The second part of the program teaches the students how to structure their answers to questions asked (and not asked) by journalists. This process includes not only the content of their responses but also the manner in which they answer the questions. We have found that students have difficulty with this in three distinct areas: 1) They worry about appearing authoritative. Consequently, they sometimes unintentionally come across as pompous or arrogant. 2) They lapse into medical jargon rather than using nontechnical but equally accurate words that would be appropriate to the situation. This distances them even more from their audience. 3) They spend too much time building up to the crux of their statements, which increases the likelihood that what they say will not be accurately reported and that their important points may be omitted.
Many students are concerned about how the viewing, listening, or reading audience—and, of course, their colleagues—will perceive them on the basis of their comments. Unfortunately, this concern leads them to speak in a stilted and convoluted style instead of using simple words and short sentences. The result is that they may come across as aloof or even frightening, building a barrier to their audience instead of a bridge.
We work with the students to speak as if they were talking one-on-one with a patient's family member. We also explore some of the illusions of mass media to help them build that bridge. For example, even though a radio program may be listened to by hundreds of thousands of people, the listeners are generally unaware of each other. To them, it is much more like a personal conversation. An interviewee who takes that personal approach will come across as not only authoritative, but also friendly. The audience is much more likely to pay attention to the message instead of the speaker's tone.
The switch from medical jargon to more ordinary speech is an extension of the residents' patient communication and family communication skills. We also discuss how even the best scientific lecturers combine excellence in content with a bit of showmanship. We explore how dramatic but appropriate presentation of accurate information can be an excellent public teaching tool.
Years of academic and scientific training have taught these students that they should firmly establish the underlying bases for their answers, methodically building to an insightful and logical conclusion. This same training has taught them to answer the specific questions asked of them. Unfortunately, effective media skills sometimes require that they invert or ignore these approaches.
For example, there are many instances in which it is most effective to state a conclusion first in an interview before providing supportive material. For example, "Adolescents who are clinically depressed may not look sad. In fact, they may come across as angry or even prickly." Only then should the details of making the diagnosis of depression among adolescents be explored.
By "setting up" the interviewer in this way, the subject takes more control of the interview, whether it's live, taped, or for print. The physician has established the key aspect he or she wishes to focus on. The reporter, whose familiarity with mental health might range from very little to a graduate degree, is much more likely to follow-up with more questions in the area highlighted by the physician.
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REHEARSAL
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The next step in the training seminar is a series of structured mock interviews. These might be simulated print, radio, or television interviews in various formats (brief "sound bites" vs. long-format panel discussions or documentaries), depending upon the needs and interests of the students and the amount of time available.
When the course is condensed, we have found it best to focus on long-format radio interviews, since that experience generalizes most easily to the other media and formats. This format also appears to be viewed by the students as producing a moderate amount of anxiety—less than a live television interview but more than a newspaper interview.
Since one of the goals of the seminar is to teach the students how to use their anxious feelings to their advantage, this usually works out well. For example, a mildly anxious resident can channel that extra emotional energy into using his hands while speaking. With many such residents, this is simply a matter of giving them permission to do so. The more anxiety-laden residents, however, often come across as emotionally flat. One approach we take with them is to insist that they try one time to answer a question in a highly melodramatic style, complete with exaggerated arm movements and vocal quality. ("The RESULTS we're getting with this type of medication are REALLY IMPRESSIVE!") The feedback they get from their colleagues in the seminar is that they are not coming across as melodramatic, but rather as appropriately enthusiastic. Both of these techniques lead the residents to speak with a more expressive voice and greater comfort with appropriate silent pauses.
The mock interviews start out very simply and build in complexity as the students gain confidence and experience. For example, in the beginning students might be asked before the interview about their clinical or research interests. They are then asked to come up with three points related to one of those interests that they wish to get across to a general audience. By focusing on the students' specific expertise, we allow them to begin from a feeling of greater confidence than if we had simply chosen a topic within psychiatry and asked them to expound upon it.
We make the tone of these interviews as realistic as possible, even though we cannot replicate the physical aspects of a radio or television studio. It's especially important for the teacher to treat the mock interview as if it were the real thing. Doing so requires the students to respond as if they really were being broadcast or taped and can lead to very useful teaching points around both successes and difficulties. At the same time, it's important to emphasize to the students that this program is designed to be a place for them to make mistakes. It is far better to make many mistakes here, where they can receive the support of their colleagues and have an opportunity to correct and learn from problems, than to make those same mistakes in front of a large audience.
The first interview is straightforward. It is used mostly to establish the format and context of the exercise. Starting with the second, the interviewer begins to make the situation more stressful: not getting around to the intended topic, misinterpreting a student's statement, building upon a false premise, or "sandbagging" the interview subject (asking a surprising and emotionally charged question that may be totally irrelevant).
For example, in a mock interview on attention-deficit disorder, the interviewer might begin by saying, "Look, doc, I think we can all agree that most of these kids would benefit from a good swat on the behind—Lord knows that the times my father took a belt to me never hurt me any—and that the underlying problem is lower standards in school and at home. But the real question is whether the mothers of these children should be working instead of caring for their kids."
A flustered physician or psychologist faced with so much misinformation runs the risk of getting lost in the verbal quagmire. Focusing on the second sentence becomes a tacit endorsement of the first, and vice versa. Students are shown ways of identifying such situations both ahead of time and during the interview. They are taught how to respond to irrelevant questions, misleading questions, and questions or comments based upon false premises. Students also learn ways to redirect the interview when it appears to be going astray. In a radio interview with a resident who's come to talk about outreach services for teenagers struggling with their sexual identity, the talk show host might begin by asking such questions as, "Is it fair to say that times are tougher now for teens than they were when you and I were that age?" "Clearly there's been an increase in the availability of sexually explicit material on everything from prime-time television to the World Wide Web. What role does that play in how children feel about themselves?" "How should we, as parents, talk to our children about sex and dating?"
While such questions are legitimate and might even make for useful public discussion, they are only tangentially related to the topic on the resident's agenda. Indeed, despite the earlier discussions of this situation, during a mock interview a resident is likely to respond directly to those questions, waiting for an appropriate time to segue to his/her own topic, only to discover that his/her time is up before the topic can be broached.
In response, we discuss how a news interview, much like a clinical interview, is not a social interaction despite their superficial similarities. Moving quickly and smoothly to the agreed-upon topic is not rudeness, but an effective public education technique.
The mock interviews are initially no more than 2 minutes, but increase in time as the session progresses. Although one student at a time is the focus of the interview, the others use the opportunity to analyze and provide feedback on what went well and what did not in the interviewee's performance. In the beginning, it's not unusual for the students to be hypercritical of themselves, but generous in their comments to others.
Indeed, the supportive comments and observations of their peers help the students shed their hypercritical perceptions of their own skills so that they can arrive at a more realistic and useful self-assessment. Because these sessions are taught in small groups of about a half-dozen students at a time, each student gets several mock interviews of increasing intensity and with more sophisticated goals. For example, while the first interview might focus on disclosing and exploring the students' preestablished three factual points, later interviews might add providing a more detailed context for those points (e.g., why businesses should be as interested in the treatment of depression as in other medical treatments) or responding to another interviewee whose position is different or antagonistic.
Students also explore appropriate reasons for declining to be interviewed or to participate in a program, such as when they are inappropriate interview subjects or when they have serious doubts about the intentions of the producers of a particular television show. The students practice how to respond to questions that deal with ethical issues, such as when a producer asks for a referral for a patient to become involved in a radio interview or television documentary. When time is available, a final segment is spent exploring students' related interests, such as writing books and articles for the general public or presenting speeches.
While there has been no formal analysis of the results of the media training program, both student comments and the professional activities of graduates indicate that it has a significant and positive effect. Students tend to view the mass media, as well as their future relationship with the media, differently. They feel more confident in their abilities to handle interviews and are, therefore, more likely to participate and contribute.
As the public increasingly turns to electronic media for health care information, media skills are becoming more important tools for physicians. Integrating formal and specialized media training into a psychiatry training program can help give young physicians some of the skills and confidence they will need to make effective and ethical use of the mass media as public health tools.
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REFERENCES
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Clancy T: Rainbow Six. New York, Berkley Publishing Group, 1999
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Kutner L: New roles for psychologists in the mass media, in Perspectives on Psychology and the Media, edited by Kirschner DA, Kirschner S. Washington, DC, American Psychological Association, 1997
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Olson C, Kutner L: Dissemination strategies: spreading the word about youth issues and solutions, in Proceedings of the AAFCS national research and policy agenda conference on investment in youth, edited by Meszaros P. Arlington, VA, American Association of Family and Consumer Sciences, 1995
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Flay BR: On improving the chances of mass media health promotion programs causing meaningful changes in behavior, in Health Education by Television and Radio, edited by Meyer M. Munich, Germany, Saur, 1981, pp. 56–89
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Resnick MD: Study group report on the impact of televised drinking and alcohol advertising on youth. Journal of Adolescent Health Care 1990; 11:25–30[Medline]
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Wallack LM, Dorfman L, Jernigan D, et al: Media Advocacy and Public Health. Newbury Park, CA, Sage Publications, 1993
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Schwartz T: The Responsive Chord. Garden City, NY, Anchor Press (Doubleday), 1973
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Schwartz T: Media: The Second God. Garden City, NY, Anchor Press (Doubleday), 1983
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Program requirements for Residency Education in Childhood and Adolescent Psychiatry (Psychiatry), in Graduate Medical Education Directory, edited by Donini-Lenhoff F. Chicago, IL, Medical Education Products, 1999, pp. 296–300
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Program Requirements for Residency Education in Psychiatry, in Graduate Medical Education Directory, edited by Donini-Lenhoff F. Chicago, IL, Medical Education Products, 1999, pp. 284–310
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Fox JA, Levin J: How To Work With The Media. Newbury Park, CA, Sage, 1993
This article has been cited by other articles:
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K. Kaliebe and A. Sondheimer
The Media: Relationships to Psychiatry and Children: A Seminar
Acad Psychiatry,
September 1, 2002;
26(3):
205 - 215.
[Abstract]
[Full Text]
[PDF]
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ABSTRACT
INTRODUCTION
