The chief resident as reluctant staff therapist.

The author discusses the interactional process between the chief resident and ward staff, with reference to Bion's theory of group functioning. He concludes that the primary task of the chief resident is to serve as psychotherapist to the staff, and that this in not a chosen role but derives from the staff's wish for such a leader.     

The role of the chief resident: expectations and reality.

The job expectations of 35 incoming chief residents were tested by questionnaire when they attended a weekend workshop on leadership and were reexamined after they has had six months' experience on their jobs. Such personal qualities as a sense of humor and persistence and such administrative skills as the ability to exercise authority and set objectives significantly increased in importance six months after these residents began work. The authors recommend educational programs in administration for chief residents.     

Career choices in psychiatry: The evolution from resident to practitioner

There exists very little data on how graduating psychiatry residents make practice choices. By reviewing the psychodynamic and institutional themes that emerged in a Career Planning Seminar taught at The New York Hospital-Cornell Medical Center over the past decade, the authors hope to provide new information about this important developmental task. In addition, the ways in which trainees perceive specific career options will be described.     

Geriatric psychiatry training for the general psychiatric resident

Although there is a real need in variety of settings for psychiatrists trained in working with older people, a large proportion of psychiatric residency programs do not offer the opportunity for clinical experience with this age group. The author stresses the need to include this subject in the curriculum of residency training programs. He describes the features of one program that offers comprehensive training in this area.     

神经科总住院医师607例会诊病例分析

目的分析神经科总住院医师会诊病例的构成特点,从一个方面反映总住院医师的工作情况。方法统计北京协和医院神经科1名总住院医师在2003年8月1日至2004年1月31日会诊的病例。结果共新会诊患者607例,女性305例,男性302例,年龄5个月至92岁,平均年龄55·2岁,平均每周新会诊24例。急症会诊208例(34·3%),常规会诊399例(65·7%)。362例(59·6%)继发于系统性疾病;66例(10·9%)与医源性因素有关。急症会诊以代谢性脑病最多(92例),占急症会诊的44·2%,病因包括呼吸衰竭、肾功能衰竭、多器官功能衰竭等;其次为急性脑血管病51例;第三为癫发作23例。内科常规会诊病例以周围神经病最多(69例),占内科常规会诊的17·3%(69/398),病因包括糖尿病、血管炎/结缔组织病、肿瘤相关的周围神经病等。外科和妇科约请神经科常规会诊主要目的是围手术期的神经科疾病评估和预防。结论会诊工作具有特殊性和挑战性,神经科总住院医师应该了解会诊病例特点,在会诊中学习和积累经验。     

The value of administrative experience for the clinician: Opportunities of the chief residency in psychiatry

Administration has been traditionally contrasted with clinical work; experiences such as the chief residency in psychiatry are viewed as clinically-based training for unfamiliar administrative activity. In contrast to these viewpoints we propose that recognition of tasks common to clinical work and administration leads to a broader understanding of both activities, and that administrative experience can make specific contributions to the development of a clinician.The authors acknowledge their indebtedness to Drs. Russell Vasile and Martin Kelly for their comments and suggestions.     

A pilot study of psychiatry resident psychotherapy competency: the impact of resident attitude and demographics

OBJECTIVE: In psychiatry education, psychotherapy knowledge, skills, and attitudes are new competency objectives. METHODS: Two faculty members independently ranked psychiatry residents for psychotherapy competency. A rank of 1 indicated the most competency and a rank of 15 indicated the least competency for the resident psychotherapist. Several demographic and attitudinal variables of the residents were examined for relationships with psychotherapy competence. RESULTS: When the competency rankings of the two faculty members were compared, they demonstrated a high level of agreement (spearman r = 0.74, p = 0.0016). Of the variables studied, resident age (r = .61, p = .015) and personal attitude toward psychotherapy (S=29, p = .026) were significantly associated with psychotherapy competency. Both variables remained independently significant after statistical adjustment. CONCLUSIONS: Our study indicates that psychiatry resident attitude and age may influence psychotherapy competency. These markers for psychotherapy competency may assist training programs with resident selection parameters and may enhance psychotherapy educational strategies for residents predicted to require assistance in achieving competency.     

Roles of the psychiatric resident on a community psychiatry team

There is a necessity for clear role definitions in the teaching of community psychiatry to psychiatric residents. Several different roles are described, with an emphasis on the roles of therapist and student, and their sub-roles and role behavior. The difficulties in learning these roles are problems of role expectations, feelings towards the resident, the resident's inexperience and need to grow, and the conflict between the student role (education) and therapist role (service).This work was completed while the author was in the Department of Psychiatry, Albany Medical College, Albany, New York. The author would like to thank Alfred Dean, Ph.D., Ronald G. Nathan, M.D., and Raymond Vickers, M.B., B.S., for their comments and criticism on this article.     

Epilogue: Conversations between a psychoanalyst and a psychiatry resident

The authors discuss the importance of psychoanalytic training from the perspectives of a psychiatry resident about to begin psychoanalytic training and a psychiatrist who is a training and supervising psychoanalyst. Drs. Hyun and Alfonso discuss psychoanalytic motivations and engage in a dialogue reflecting on the relevance of psychoanalytic training in current psychiatric practice and the profession’s need for more dynamically trained psychiatrists. In doing so this article provides further insight from their firsthand experiences as to why young psychiatrists today still choose to engage in psychoanalytic training and its positive impact on their clinical practices.     

PBL 与 CBL 教学法在精神科住院医师规范化培训中的联合应用

住院医师规范化培训就是要将学员培养成为具有扎实的临床技能,缜密的临床思维,能独立处置临床常见病、多发病的临床医生。精神症状具有复杂抽象、主观色彩浓厚的特点;精神疾病的诊断和治疗同时涉及生物学、心理学和社会学等多方面的因素,对医生的知识广度和深度以及灵活运用知识的能力都提出了挑战。CBL教学法中导师引导学员充分运用所掌握的各种知识,对病例进行分析、判断,做出正确的诊断和合理的处置;PBL教学中导师调动学员自主学习的能动性,对于CBL中尚不能透彻解决的关键问题继续进行自主学习以及进一步讨论,从而使学员更加全面深入地认识疾病,具备独立处理复杂临床案例的能力,顺利完成从医学生到合格临床医生的转变。     

Experiences of a paraplegic psychiatry resident on an inpatient psychiatric unit

The author reviews the literature on disabled physicians and describes her own adjustment to paraplegia. While she was a medical student and practicing internist, she encountered few comments about her disability, but during her later psychiatry residency, hospitalized psychiatric patients discussed it frequently. The author presents examples and points out that patients' reactions often revealed much about their characteristic response patterns; reactions to her disability became a type of projective test. Her primary defenses against patients' remarks were intellectualization and isolation of affect. Supervisors who were able to discuss the impact of her disability on the doctor-patient relationship were considered most helpful.     

国内神经内科住院总医师临床会诊文献回顾分析

目的总结国内神经内科会诊科室的分布特点及会诊疾病谱的构成,为科室医师临床与科研培训提供借鉴意义。方法通过检索国内文献数据库,检索2005-09—2015-09已发表关于神经内科会诊病例分析的报道,进行文献回顾性分析。结果共纳入研究报道7篇,会诊病例总数4 899例,男2 334例(47.6%),女2 565例(52.4%),年龄5个月~101岁。常规会诊3114例(63.32%),急会诊1 804例(36.68%)。会诊科室以内科最多。急会诊以急性脑血管病、昏迷!意识障碍、癫痫发作等常见,常规会诊以头晕!眩晕、头痛、陈旧性脑血管病、周围神经病变、精神障碍性相关疾病常见。结论会诊中应明辨神经系统疾病的症状及种类,详尽询问病史及体格检查,及时调整自身知识结构,掌握疾病谱系的演变,以辨证哲学思维指导临床医学发展。     

Training directors' opinions about the psychiatry resident in-training examination (PRITE).

OBJECTIVE: The American College of Psychiatrists conducted research to validate the content outline of the Psychiatry Resident In-Training Examination (PRITE) and to assess what residency training directors think about the examination. METHOD: A mail survey was sent to the 218 psychiatry residency training directors who subscribe to the PRITE. RESULTS: The survey response rate was 70%. A majority of the respondents indicated agreement with the relative emphasis given to each content area in the PRITE (range = 52%-80% agreement). Eighty-one percent of the respondents were strongly in favor of continuing the practice of releasing the examination and the correct responses each year after the examinations have been scored. The majority of the respondents use results on the PRITE for individual resident evaluation and program evaluation (90% and 94%, respectively). Very few respondents use the PRITE results as the sole measure for assessing residents' cognitive competence or use it for marketing their residency programs. CONCLUSIONS: The survey provided strong support for the content areas covered in the PRITE and their relative emphases. The current practice of releasing PRITE items and answers (a main difference between the PRITE and the certification examination of the American Board of Psychiatry and Neurology) was well supported by the survey results. The stated purpose of the PRITE, to provide educationally useful feedback for individuals and groups in the form of comparisons with peers in specific areas of knowledge, was supported by a large majority of the respondents.     

Is it still necessary to teach community psychiatry to the psychiatric resident?

After having defined his conception of what community psychiatry is, where it is situated in the line of evolution of modern psychiatry, the author weighs the pertinence of teaching residents knowledge pertaining to a sector in full identity crisis. The effort is worthwhile, since this crisis has permitted the community psychiatrist to better define himself, namely in regard to the other health professionals, and it is therefore easier to determine what kind of knowledge should be transmitted to the resident in this particular field. A tentative teaching program is outlined. In such a program, education aspects should take precedence of training aspects, making the future psychiatrist more prepared to face eventual changes in that field. Such a program should take place in the final part of the residency course following a solid preparation in basic clinical psychiatric knowledge.