Academic Psychiatry 25:109-111, June 2001
© 2001 Academic Psychiatry
Model Curricula in Psychiatric Residency
Evangelical Failures or Evocative Facilitators?
James W. Lomax II, M.D.
Dr. Lomax is Associate Chair and Director of Education Programs, Department of Psychiatry and Behavioral Sciences, Baylor College of Medicine, Houston, Texas. Address reprint requests to Dr. Lomax, Department of Psychiatry and Behavioral Sciences, Baylor College of Medicine, One Baylor Plaza, Houston, TX 77030.
Key Words: Model Curricula • Commentaries
My Perspective
This article is written in advocacy of both the process and products of model curricula. One of my earliest endeavors within the American Association of Directors of Psychiatric Residency Training (AADPRT) was at a mid-winter meeting workshop led by Jonathan Borus on administrative psychiatry. That workshop was part of what Jonathan did to develop one of the earliest model curricula by the same title. I used his workshop and his publication to define the PGY-IV service Chief Resident position at Baylor, which we subsequently enhanced by using the model curriculum, "Teaching Residents to Teach," developed by Clarke Terrell, at the University of Texas, San Antonio. Our local product, which might not be recognizable by either Jonathan or Clarke, has resulted in a highly appreciated experience for both our PGY-IV residents and the first-year residents they are assigned to help. Along with Paul Mohl, Allan Tasman, William Sledge, and others, I co-authored a model curriculum published in The American Journal of Psychiatry, titled "Psychotherapy Education for Psychiatrists of the Future," which still gets cited with some frequency (in both positive and negative terms [1]). I also developed a much less centrally published curriculum on suicide care (2). It was requested quite a bit more than I had expected, however, and, about 10 years later, was resurrected when Bruce Bongar somehow stumbled onto it writing a suicide-related textbook (3). I have also participated in another version of a model curriculum, the Core Readings in Psychiatry text of Sacks and Sledge (4). These texts provide a basis for didactic curricula in a variety of topics.
A model curriculum will inevitably undergo mild-to-considerable transformation to correspond to local circumstances and personnel. The wholesale adaptation of a model curriculum is not only unlikely, but it is also undesirable. Model curricula should not be developed with the goal in mind of their wholesale adaptation. Success should be measured in the ability to inspire local creative efforts, and not mimicry.
Another measure of success for model-curriculum development is the ability of advocacy or special-interest groups (geriatrics, addiction, religion, etc.) to 1) refine their efforts toward realistic endeavors; and 2) experience integration into a rich and diverse field. Curriculum refinements will inevitably be associated with improvement of the advocacy-group contributions locally. A product of the required exchanges with education entities helping to refine curriculum recommendations is the feeling on the part of advocacy groups that they are being included in the larger endeavor. That process was particularly successful with both geriatric- and gay-and-lesbian-issues curricula. Feeling included avoids the splintering and balkanization of psychiatry, which could be terribly destructive to our overall efforts.
Model curricula describing "ideal curricula" of major content areas generally do require significant translations to local circumstances. However, there is probably a "market niche" for the development of much more focused content curricula in areas where clinical or even didactic exposure to that content is simply not feasible. Small programs and those with extremely homogeneous clinical populations may benefit from receiving packaged curricula that their faculty teach but for which there is not direct clinical experience available. Examples might be curricula related to cultural issues, including religion and spirituality.
Confessions of a Slow Learner
Not only am I an advocate of model-curriculum development, but I am also a very slow responder to the dismal reality that my extremely important gifts will not be universally accepted by programs throughout the United States. I have, in fact, two ongoing efforts that could fall into the rubric of model-curriculum development and that are of significant interest to me. The first is an attempt to look at the interface between psychiatry and religion from a psychoanalytic perspective. In this regard, I have used a small grant from the Templeton Foundation to develop videotaped material illustrating a psychiatric/ psychoanalytic way of listening to religious and spiritual expressions of patients. The listening assesses the implications of those expressions in terms of their growth-producing or growth-inhibiting consequences for the patient. Linda Andrews and I are also developing a model curriculum for leadership development among psychiatric residents. We have presented fledgling efforts at AADPRT (5). Both of these endeavors are inexpensive for programs and easily translatable, given an adequate interest level by one or two local faculty members.
Origin (Sometimes) Predicts Destination (Trashcan or Integration)
Advocacy groups with a particular mission are often the source of model-curriculum development. At times, advocacy groups seem bent on saving the field. That attitude is often received with polite or sometimes not-so-polite irritation. Relatively few psychiatric educators feel the need to be saved. Many of us are somewhat "turned off" by evangelical efforts to being "turned around." Advocacy groups are generally in the business of promoting their ideas and are not too clear regarding at whose expense they wish to promote themselves. In such instances, their ideas are often quite grand, but do not necessarily lead to especially feasible products, given our ongoing explosion of information to convey. Advocacy groups are often motivated by a genuine wish to enlighten others about the idea, cause, or modality of their great affection, but it is important that they have a good sense of just whom they are attempting to enlighten. These educational efforts are more successful if the beneficiary of the enlightenment is conceived of as a generalist psychiatrist—a sensible, but very human practitioner trying to balance good care for his patients, making a living for his or her family, and satisfying an unending stream of external auditors of nearly everything the professional does. That practitioner is unlikely to respond with the same passion as the advocacy group member.
An additional problem, separate from the motivation of advocacy groups, is that they are often people with a subspecialty expertise and interest, who may or may not have been exposed to basic educational pedagogy. Many begin with very good intentions but without a systematic approach in which goals and objectives are tied with didactic and clinical learning experiences and supplemented by a means of evaluating the success or failure of their educational efforts. In the best of circumstances, such advocacy groups will come in contact with either the Curriculum Committee of AADPRT, the Graduate Education Committee of the APA, or some other group of educators who can serve as consultants to them to produce a model curriculum product that is inexpensive enough (in terms of money and time) for residency programs and flexible enough to accommodate "transference phenomena." By "transference phenomena," I am not referring to the psychoanalytic concept, but to the ability to take something that works very well in a particular setting and articulate its principles and essence in a way that is translatable to very different situations.
What has been less successful, in my experience, are the efforts of those we sometimes refer to as "contentless educators" looking for help. For more than 10 years, there have been efforts within AADPRT to develop a translatable model curriculum in the neuroscience of psychiatry and in clinical psychopharmacology. The Glick et al. offering in this issue is the most current of such efforts. As they acknowledge, such efforts have not been terribly successful thus far. The offering in this issue of Academic Psychiatry serves as a good advertisement for the efforts of the American Society of Clinical Psychopharmacology. Seasoned program directors participated in this effort. I genuinely hope it will be more successful than that of the previous iteration of the American College of Neuropsychopharmacology. Only time will tell, and even time will have to be augmented by the use of the right measuring instruments.
Conclusion
Of course, I conclude with the assertion that model curricula are good and the process of model-curriculum development is even better. In fact, I strongly urge the support of both AADPRT and the Association for Academic Psychiatry (AAP) to provide formats for educators, through their annual meetings, to present such thoughtful and comprehensive curricula in content areas that they love and promote. I also encourage Academic Psychiatry to publish such efforts when they have been melded or tempered by the efforts of thoughtful psychiatric educators to be sure that passion is balanced by considerations of reality. Using my measurements, model curricula and model curriculum development are good for the field and good for those who pursue them.
REFERENCES
- Mohl PC, Lomax JW, Tasman, A, et al: Psychotherapy training for the psychiatrist of the future. Am J Psychiatry 1990; 147:7-13[Abstract/Free Full Text]
- Lomax JW: A proposed curriculum on suicide care for psychiatry residency. Suicide Life Threat Behav 1986; 16:56-64[Medline]
- Bongar B, Lomax JW, Marmatz M: Training and supervisory issues in the assessment and management of the suicidal patient, in Suicide: Guidelines for Assessment, Management, and Treatment. Edited by Bongar B. Oxford, UK, Oxford University Press, 1992
- Sacks MH, Sledge WH, Warren C: Core Readings in Psychiatry: An Annotated Guide to the Literature. Washington, DC, American Psychiatric Press, Inc., 1995
- Andrews LB, Lomax JW: Teaching leadership skills to psychiatry residents (abstract). American Association of Directors of Psychiatric Residency Training, March 2000
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