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In an era of diminishing resources, teaching psychiatry has gradually become a forgotten item on the agenda of academic psychiatry, according to Richard Balon, M.D., a professor of psychiatry at Wayne State University.
"It is not by chance that we do not attract U.S. medical students to psychiatry and fail more than 50 percent of the candidates on the board certification examination," Balon said in a lecture at APA's annual meeting in Toronto in June.
Psychiatric education, he observed, has been in a long-term crisis due to numerous factors. These include managed care pressure to downsize facilities in which teaching takes place, an identity crisis caused in part by nonmedical mental health professionals seeking expanded practice privileges and being regarded as less expensive replacements for psychiatrists, the movement to make psychiatry a primary specialty, rapid changes in educational settings, anxiety over the influx of international medical graduates (IMGs) into American psychiatry, an artificial split between the biological and the psychosocial (for example, the pendulum's swinging to the biological extreme), poor translation of neuroscience research into clinical practice, lack of interest in psychiatry among medical students, and a lack of interest in teaching among faculty.
The decreased emphasis on teaching psychiatry during a time of profound changes in the health care marketplace must be challenged, said Balon. Poor teaching in psychiatry will not only undermine the quality of patient care, he said, but also threaten the level of excellence within the field of psychiatry. Inadequately prepared psychiatrists will not be able to fend off external pressures from nonmedical mental health professionals and managed care, or internal pressures to apply rapidly emerging research findings to clinical practice.
Teaching psychiatry needs to be reevaluated for different categories and levels of students-medical students, psychiatry residents, professionals in other disciplines, and practicing psychiatrists, he observed.
Balon said that the teaching of psychiatry is currently hampered by the absence of a modern, comprehensive text focused on teaching psychiatry similar to the 1982 text Teaching Psychiatry and Behavioral Science edited by Joel Yager, M.D. Balon also called for focusing attention on areas in psychiatry that have not been properly addressed before, such as collaboration with mental health professionals, managed care, organized medicine, and patients' groups and related organizations.
Finally, Balon commented that psychiatry teaching needs to be reassessed and evaluated through outcome research to determine whether "our students are better physicians by virtue of our teaching methods."
Recognizing the many challenges facing psychiatric education is an important first step in confronting them, he concluded.
Balon, a representative of the IMG psychiatrists to APA's Assembly, was presented the George Tarjan Award at his annual meeting lecture. This award is given in recognition of significant contributions to the enhancement of the integration of IMGs into American psychiatry.