In this month's Residents' Forum, Gloria Reeves, M.D., a PGY-1 at the newly combined University of Maryland/Sheppard Pratt Hospital Psychiatric Residency Program, describes the benefits and concerns of such a merger, as well as some of the growing pains in a developing program. Dr. Reeves plans a career in child and adolescent psychiatry.
If you wish to contact me about member-in-training concerns, I may be reached by e-mail at abusch@welchlink.welch.jhu.edu; fax, (410) 955-0946; or phone, (410) 955-1976. Submissions for the Residents' Forum may be faxed or e-mailed to me (double spaced). All submissions will be considered.
Alisa Busch, M.D.
Member-in-Training Trustee
By Gloria Reeves, M.D.
Many residents liken it to a marriage.
The recent merger of the Sheppard Pratt and University of Maryland psychiatry residency programs has led to a union of faculty, ideas, and internship class. The merger was initiated because of financial concerns, including the escalating cost of sending Sheppard Pratt residents to other sites for medicine and nonpsychiatric rotations, as well as the desire to attract competitive students despite the recent nationwide decline in psychiatry applicants. More importantly, the merger was finalized because of the compatibility of the two programs in offering a diverse training experience. The combined program is in its honeymoon phase, but it has already produced its first offspring, 14 residents who identify themselves as University of Maryland/Sheppard Pratt residents.
The internship class is a combination of many diverse backgrounds; we represent countries including Brazil, Hungary, Pakistan, and the Philippines, as well as more "local" places like Pennsylvania, Puerto Rico, Tennessee, and Maryland. As an applicant, I was attracted to the emphasis on "eclectic" training, rather than being limited to a more "biologic" or more "psychodynamic" program. The merger offered a breadth of teaching from dissociative disorders to the latest in psychopharmacology.
Although the merger seems to offer "the best of both worlds," there were some early challenges facing this marriage. First, the beginning of the joint program meant the end of two single identities. Sheppard Pratt and University of Maryland residents mourn the loss of their own programs as the two evolve into a combined program. Both sets of residents were initially concerned that the philosophies of their unique programs would be somewhat diluted by a merger. One Sheppard Pratt alumna stated that the merger marked "the end of a dynasty of training," because the new residents would spend significantly less time training at Sheppard Pratt, especially during the first two years of the program.
As the year has progressed, however, many senior residents have pointed out to us benefits of the merger that we should take advantage of. For example, residents have an opportunity to train with exposure to patients with different demographics and work at sites with different lengths of stay. Such input has helped us to identify new options that will be useful in our training.
A second issue that became controversial is how we divide our training among the two institutions. The original plan was for the residents to be assigned six months at either Sheppard Pratt or the University of Maryland.
Our class requested an even split between the two hospitals for our six months of inpatient exposure (three months at each site) to provide greater equity of experience, both in workload and patient diversity. Also, exposure to both programs would help residents decide which sites they prefer to rotate through in the third year. This request, however, raised some concerns from faculty members. A major one was that it required time to orient a new set of residents every three months. Also, there was a question of whether splitting the rotation meant less depth of experience with what each site has to offer. For example, residents would have less time with attendings at each site, perhaps affecting opportunities for mentorship development.
Ultimately, the request was approved. This experience points out the critical need for good communication during the early phases of a residency merger. Before the final decision was made, the intern class had an opportunity to meet with faculty and discuss the options in depth. The dialogue allowed our class to be involved in the process of defining our own program with the support and guidance of faculty. Regardless of the outcome of this particular issue, an important precedent was set in that faculty sought input from the residents before making major decisions about the new program.
As the details of the combined program are being worked out, it has been interesting to see how current applicants view the residency program. I have had the opportunity to meet some of these applicants in an informal setting at the interview lunch. Some questions that applicants have raised are how much additional travel is involved and how much opportunity is there for long-term contact with faculty to facilitate personal development. Overall, the response to the idea of coming to a combined residency program has been overwhelmingly favorable. The most common advantage that applicants described to me has been the opportunity to work with a diverse population of patients. As one applicant stated, "I want a residency program that will show me the big picture."
It is exciting to be a part of the combined University of Maryland/Sheppard Pratt residency program. The success of the program, like many marriages, will depend on its continued flexibility and will be judged largely by the development of its children.
