April 16, 1999

Residents face numerous challenges and transitions in the course of their training. As they move from one phase to the next, program directors can intervene and nurture their professional and personal growth, said panelists at the March annual meeting of the American Association of Directors of Psychiatric Residency Training (AADPRT).

Just choosing a residency program can be anxiety provoking, said John Herman, M.D., director of adult residency training and postgraduate education at Massachusetts General Hospital in Boston.

He has identified three main concerns students have about picking a residency program. "In primitive evolutionary survival terms, they are anxious about whether they will be adequately fed or become food. They want to know whether they will receive adequate training opportunities or be used by the institution for too much on-call and other purposes," said Herman.

"Medical students are also concerned about their preparedness for the next stage of their training, which is fundamental to their survival," he pointed out. "I tell them that they have gotten this far and that the best predictor of their future success is their past experiences and skills."

Herman said he also tries to be sensitive to stressful experiences in training such as the first time residents are exposed to a patient with borderline rage or charmed out of medications by a sociopath. "I am also aware of their heavy financial burden and the loneliness residents experience when they relocate, which is why I try to have two residents on any given rotation."

Christopher Thomas, M.D., director of residency training for child and adolescent psychiatry at the University of Texas Medical Branch in Galveston, said, "We need to intervene early and provide continuity and support across transitions." Initiatives that have been implemented at his program include:

• Developing a survival manual with useful information about clinical rotations including contacts and emergency procedures written by third- and fourth-year residents.


• Working with student psychiatry organizations to feature presentations on careers and provide residency applications.


• Encouraging students to join professional psychiatric organizations such as APA and the American Academy of Child and Adolescent Psychiatry.


• Providing recruitment packets with information about the community including employment agencies for a significant other and a list of realtors from the Chamber of Commerce.


• Preparing students for psychiatric careers with information on licensing, moonlighting, awards, fellowships, and boards.

Thomas continued, "We should not think of ourselves as simply helping residents survive their experience but as career brokers. We need to know their aspirations so we can match them with contacts in the field."

Eva Szigethy, M.D., a second-year resident in child psychiatry at Children's Hospital in Boston, commented, "We shouldn't underestimate the value of pairing medical students with housestaff and faculty."

In her second year of medical school, she was matched with a child psychiatrist faculty member "who listened to my ideas and concerns and slipped in some pearls of wisdom. This approach proved to be effective because ultimately I chose child psychiatry."

Szigethy added, "When I feel incompetent during my child psychiatry training, I have appreciated being able to switch to other areas that I am competent in and being reminded of my previous successes."

Eugene Beresin, M.D., director of child and adolescent psychiatry residency training at Massachusetts General Hospital in Boston, noted that his program allows residents who are already trained in adult psychiatry to maintain small private practices. "This increases their knowledge about practicing psychiatry and creates a positive sense of self-esteem."

He recommended that residents be introduced to child and adolescent psychiatry gradually in multiple settings so they are not overwhelmed.

"There needs to be more exposure of residents to faculty in a variety of activities whether it's deciding what form of therapy to use or consultations to medical and nonmedical professionals," said Beresin.

-C.L.