Acad Psychiatry 31:375-379, September-October 2007
doi: 10.1176/appi.ap.31.5.375
© 2007 Academic Psychiatry
A Novel Partnership in Psychiatric Education
Murray A. Brown, M.D. and
James A. Astman, Ph.D.
Received January 1, 2007; revised May 8, 2007; accepted May 14, 2007. Dr. Brown is affiliated with the Department of Psychiatry and Bio-Behavioral Services, David Geffen/UCLA School of Medicine, and with the Department of Psychiatry, Sepulveda VA Medical Center, Los Angeles, California. Dr. Astman is affiliated with Oakwood School, North Hollywood, California, and the David Geffen/UCLA School of Medicine, Los Angeles, California. Address correspondence to Dr. Brown, Department of Psychiatry, Sepulveda VA Medical Center, 16111 Plummer Street, Building 10, Room 109, North Hills, CA 91343; murray.brown{at}med.va.gov (e-mail).
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ABSTRACT
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OBJECTIVE: The authors describe a unique institutional partnership between an adult psychiatry training program and a K–12 school that focuses on enriching educational opportunities and improving outcomes at both institutions. METHOD: Beginning with reciprocal consultations, the partnership has expanded to involve the students and faculty at both institutions. Feedback has confirmed that both residents in the training program and teachers at the school consider the exchanges highly beneficial. RESULTS: A wide range of educational improvements has resulted. In the training program, these have included recurring exposure to and interactions with children and adolescents in normative educational environments and increased reflection about effective pedagogy. In the school, improvements have ranged from more rounded intervention strategies to teachers’ increased sophistication about neurodevelopmental phenomena in a learning setting. CONCLUSIONS: Collaboration between an adult psychiatry training program and a K–12 school can provide significant benefits not otherwise available to both institutions. The authors believe this partnership model is valuable and might be replicated in other settings where adult and/or child training programs can establish similar relationships with a school.
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INTRODUCTION
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Among the many challenges that confront psychiatry training programs today, perhaps none is greater than the need to maintain and develop rich and varied educational experiences for psychiatry residents. An expanding set of skill competencies to meet current training goals requires curriculum change and pedagogical innovation. These, in turn, obligate programs to find new resources and use current ones more efficiently. A similar statement can be made for elementary and secondary schools, which must provide for ongoing teacher training and curriculum development to meet the changing needs of children and families.
Collaborative relationships between institutions can significantly enrich training opportunities without creating undue financial burdens or taxing personnel. This article describes a unique collaboration between two educational institutions: a K–12 coeducational not-for-profit day school and an adult psychiatry training program. The purpose is to create complementary educational activities that would enrich both institutions’ educational outcomes, provide resources not otherwise available, and enhance professional practices at both institutions.
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The Genesis of the Partnership
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Informal discussions between educators at both institutions enabled us to identify a variety of administrative needs and educational goals that each partner in the collaboration could help the other meet. These initial conversations led to pilot projects involving a faculty member from one institution presenting at the other, and vice versa. Thus, for example, a psychiatrist from the adult training program spoke on psychopharmacology to the school faculty, and a teacher specializing in child and adolescent development guest lectured on cognitive and moral development in the PGY-3 child psychiatry curriculum.
Those preliminary presentations were succeeded by more sophisticated exchanges. For example, the psychiatric education training director conducted liaison "systems" consultations for the entire administrative team, for which the educators presented school-based cases involving children’s learning, social, and/or emotional problems, sometimes complicated by family dynamics and poor compliance. Reciprocally, the head of school, who is a professor of education, conducted in-service workshops on pedagogical theory and practice for the psychiatry teaching faculty.
One important outcome of engaging professional educators in a collaborative process with the psychiatry teaching faculty was to enhance the teaching repertoire of psychiatrists and physicians who are generally not schooled in pedagogy (1, 2). A correlative outcome was to assist teachers in developing a more sophisticated understanding of neurophysiology and neurocognitive development, as endorsed by the developmental pediatrician Mel Levine (3). In addition, teachers have been introduced to current principles of psychopharmacology and psychological intervention.
Other exchanges of mutual benefit soon followed. In a series of presentations, another faculty member from the training program introduced a family systems approach to the school’s K–12 administrators, increasing their understanding of the school’s families and of faculty-staff dynamics. Conversely, a teacher from the school participated in curriculum reviews for the psychiatry training program, helping to develop scope and sequence, and to assess methods used to evaluate the program’s compliance with Accreditation Council for Graduate Medical Education (ACGME) standards.
These early exchanges have now evolved into an established relationship between the school and the training program, which yields significant benefits to both institutions. The head of the school has received a faculty appointment in the school of medicine and teaches an annual course to third-year residents in child and adolescent development. And members of the psychiatry faculty have assumed a recurring instructional and consultative role at the school.
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Current Collaboration: Benefits to the Training Program
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1. The course in child and adolescent development has been an ongoing requirement of the adult training curriculum for the past 6 years. The course emphasizes the healthy growth and development of children and adolescents, not only within the contexts of family and culture but also within the educational setting, where pathologies are often first identified. In addition to cognitive, moral, gender, social, and emotional development, residents are introduced to learning differences, including assessment and intervention at breakdown points, the implications of attachment difficulties in the school setting (victimization and bullying in particular), and the nature of effective partnerships between educational practitioners and mental health professionals.
2. Residents have direct interactions with school-aged children of various ages. Through direct conversations with small groups of young people who come to several of the residents’ seminars (for example, six 17-year-old girls and, the week following, six 12-year-old boys), residents develop a more rounded understanding of the theories they have studied regarding gender development, moral growth, and cognitive differences. In addition, the students are given the opportunity to "interview" the residents about the field of psychiatry and their own career choices. These exchanges have also been videotaped, enabling residents to compare and contrast boys’ and girls’ conversations in terms of content and styles of interaction.
3. Residents reciprocate by visiting the school. Each year, they spend several hours on the elementary school campus, where they observe classroom behavior and unstructured play, interview children in small, age-specific groups, and participate in demonstrations of developmental milestones with infants and children. Residents who have their own children have, on several occasions, brought them to class, where they have observed and learned to conduct similar demonstrations.
4. Residents are introduced to several educational professionals who teach various aspects of child growth and development and a range of cognitive, emotional, and social problems that arise in a school setting. Topics include the development of racial awareness, aggression and vulnerability in children and adolescents, parenting styles, varieties of educational assessment measures, and educational intervention for identified pathologies.
5. Through the viewing of videotaped interviews of children over time conducted by the school’s educators, residents have been able to investigate children’s intelligence, morality, and views on parenting and teaching. (The school’s enrollment contract contains a provision whereby all parents give written consent to allow the school to videotape their children for educational purposes.) The use of videotape in teaching child development is well documented in the literature (4). In addition to providing vivid illustrations of changes in cognition, beliefs and attitudes, these tapes also help to sharpen the residents’ skills of observation.
6. Residents have viewed children of various ages engaging in block-building exercises (using wooden building blocks borrowed from the school’s kindergarten classes). In addition, the residents themselves have participated in the same exercises, in which they have also been videotaped. Self-reports, and reviewing the videotapes of their own block building, have helped residents understand Erikson’s epigenetic chart of development and, in particular, gender-specific development of spatial awareness (5).
7. To date, the feedback has been encouraging from both faculty and residents at the training program, and teachers and students at the school. Residents who completed the course in child and adolescent development have been consistently surveyed about their experience. Their uniformly positive comments reflect the educational enrichment the experience provides (Appendix 1).
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Current Collaboration: Benefits to the School
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1. A member of the psychiatriy teaching faculty conducted a full-day workshop in which administrators presented a range of cases in order to assess intervention at school, understand treatment modalities and management of psychopharmacology of children, and improve parent compliance. Administrators were introduced to the biopsychosocial model as a conceptual framework for school management.
2. A member of the psychiatriy teaching faculty has, on several occasions, lectured upper division psychology students on neuropsychology, the essentials of diagnosis, stress psychology, and the use of a biopsychosocial framework.
3. Another faculty member in the training program, who teaches a course on attachment and neuroaffective theory, has consulted with the school as it has endeavored to develop instructional and evaluation models informed by attachment theory. One such model involves two-way videotaping in the classroom so that teachers can simultaneously view themselves and their students. This enables them to focus on the affective and relational dimensions of their work rather than the performative aspects alone (6).
4. High school psychology students pursuing advanced work have received ongoing assistance, including direct tutorial support, from other members of the psychiatry teaching staff. Two examples: a) a student undertaking an independent study of forensic psychiatry, being guided by a forensic psychiatrist, and b) a group of students studying attachment and neuroaffective development, using published and unpublished material of a highly regarded expert in the field.
5. Additional benefits of the collaboration between the school and the training program: a) the school has been able to make significantly increased use of community mental health professionals who are on the clinical faculty of the training program, both for consultative purposes and for direct patient and/or family referral; and b) the school’s faculty have developed increased understanding of neurocognitive development and the role of psychopharmacology in the treatment of behavioral and learning difficulties. Recent research indicates that nearly 20% of school-aged children are on some type of psychotropic medication.
6. Current discussion is underway about the development of an educational research laboratory at the school which will provide ongoing opportunities for faculty and psychiatry residents to conduct in vivo educational and developmental research on areas of mutual interest. The school constitutes a 13-year child development laboratory that makes it an ideal setting for such research.
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Discussion
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A few factors have helped ensure the success of this partnership: the shared emphasis on a biopsychosocial model for both psychiatric diagnosis and treatment and systems approaches to the school’s students and families; the mutually beneficial exchanges by faculty from one institution presenting at the other; and the ongoing discussions between the leadership of the training program and the school about expanding this partnership for the educational enrichment of both institutions.
Psychiatrists on the teaching faculty, though expert in their fields, may not be pedagogically sophisticated; furthermore, curricula in training programs have not always been coordinated for their content or been subject to systematic evaluation. To assist the teaching faculty, professional educators at the school have led staff retreats focused on pedagogical theory and practice. They have also provided ongoing consultation, which has helped raise awareness about and provided models for curriculum development and evaluation technology. This is particularly relevant for ACGME guidelines and Residency Review Committee reviews. At a recent extended meeting among the psychiatry teaching faculty and residents, pre- and post-course assessments in certain courses were refined, so as to link scope and content concerns with performance outcomes on the Psychiatry Resident-In-Training Examination (PRITE). One result is a sharpened focus among the psychiatry teaching faculty on content, evaluation, skill acquisition, evaluation technology, and curriculum development.
Another educational enhancement is the variety of in vivo demonstrations of normal childhood development, which are not seen usually in inpatient or outpatient psychiatric settings. Because of their visits to the campus, residents have had the opportunity to observe a normative population and normative development. For example, residents have spent time in elementary school classrooms where they have been able to observe children diagnosed with attention deficit disorder or mild spectrum disorders in a regular school setting. They have also observed children in unstructured play, with particular attention paid to gender and age differences.
Advantages to the school have been equally significant. The psychiatry faculty have reinforced the work of Mel Levine’s Schools Attuned course and helped to demystify neurodevelopmental phenomena and psychopharmacology for both faculty and students (7). They have done this through consultations with the school’s support services professionals who, in turn, work directly with teachers through direct instruction in workshops and faculty meetings, and through ongoing collaboration with the school’s academic staff when students and/or families have been referred for therapy.
Increased communication between mental health providers and the school has also played a positive role in those instances when students are in treatment. As administrators and teachers in the school develop greater understanding, they can help support the therapeutic process. Administrators can assist families in understanding the importance of compliance with medication regimens and the advantages of various academic recommendations the school may make (e.g., tutorial support, additional educational assessment). Teachers can expand their teaching repertoires, become more flexible in their curricula, and provide more effective classroom accommodations.
School administrators have also become more knowledgeable and effective in supporting the teaching staff, students, and their families as a result of their participation in several workshops offered by members of the psychiatry teaching faculty on the multidimensional complexities of student learning, neurodevelopmental phenomena, and family systems. There is also increased awareness and identification of childhood disorders which are prevalent in the school-age population. We have received extensive feedback from the school’s administrators about the positive impact of those workshops on their performance, their understanding, and their professional self-esteem. There has been in schools a virtual epidemic of attention deficit disorder diagnoses and treatments, including a narrow spectrum of accommodations like extended test-taking times and providing testing environments which minimize distractions. In the wake of mandated accommodations, teachers often feel impotent and ineffective. As they develop more understanding of the anxiety and mood disorders that can underlie learning and behavioral problems, they come to feel more credible, more competent, more confident, and optimistic about their impact.
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Conclusions
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To the best of our knowledge, there is no precedent for a collaborative relationship between a K–12 school and a psychiatry training program that is built around educational enrichment. What began as a novel set of institutional exchanges has grown into a mutually beneficial educational partnership which the authors believe can be replicated in other settings where adult and/or child training programs can establish similar relationships with a school. We are aware of partnerships between psychiatry training programs and public schools for the purpose of expanded diagnosis and treatment of children and adolescents. However, a search of the current literature, using both PubMed and ERIC databases, has not yielded any evidence of similar educational enrichment projects.
As the institutional collaboration has grown, certain boundary issues have arisen that are presently being addressed. First, increased communication between therapists and the school underscores the need for confidentiality with respect to HIPAA requirements. Second, with increased attention paid to neurodevelopmental issues, some parents have developed unrealistic expectations about what therapeutic services the school can provide. Finally, teachers sometimes struggle with what constitutes appropriate academic expectations as they become more sophisticated about students’ neuropsychiatric complications.
Notwithstanding the above issues, the consensus from the involved constituents at both institutions is that the collaboration is educationally enriching, highly worthwhile and, not least of all, enjoyable. We are interested in sharing our experiences and encouraging other psychiatry training programs to seek similar collaborative undertakings within their communities.
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REFERENCES
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- MacDougall J, Drummond MJ: The development of medical teachers: an enquiry into the learning histories of 10 experienced medical teachers. Med Educ 2005; 39:1213–1220[CrossRef][Medline]
- Steinert Y, Mann K, Centeno A, et al: A systematic review of faculty development initiatives designed to improve teaching effectiveness in medical education: BEME Guide No. 8. Med Teach 2006; 28:497–526[CrossRef][Medline]
- Levine M: Developmental Variation and Learning Disorders. Cambridge, Mass, Educators Pub Service, 1987
- Fox G: Teaching normal development using stimulus videotapes in psychiatric education. Acad Psychiatry 2003; 27:4
- Erikson E: Childhood and Society, 2nd ed. New York, Norton, 1963
- Beebe B: Forms of Intersubjectivity in Infant Research and Adult Treatment. New York, Other Press, 2005
- Weiner I, Murawski W: Schools Attuned: A Model for Collaborative Intervention. Intervention in School and Clinic, Vol. 40, number 5, May 2005, pp 284-290
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ABSTRACT
INTRODUCTION
