Research Training in Psychiatry Residency Strategies for Reform (2003) / Chapter Skim
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3 Regulatory Factors
3 Regulatory Factors
Pages 61-90
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From page 61... ...
is the organization with principal responsibility for setting the minimal standards and content for adult and child and adolescent psychiatry residency training programs. It, along with 24 other medical specialty RRCs, operates under the aegis of the nonprofit and volunteer-driven Accreditation Council for Graduate Medical Education (ACGME, 2002a)
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From page 62... ...
The accreditation process is designed to safeguard the public by maintaining necessary clinical standards in psychiatric graduate medical education. Additionally, the RRC must evaluate and update the written requirements for residency programs at least every 5 years.
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From page 63... ...
Winstead was describing the five psychotherapy requirements mandated by the RRC for all psychiatric training programs as of January 2001. One of the five is psychodynamic psychotherapy.
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From page 64... ...
They're protecting their livelihood....But the issue is, are we sending a message that...we're going to require something for which there is no evidence? This exchange clearly demonstrates the reality that preferences rooted in traditional psychiatric practice play a role in both the conception and revision of residency training requirements.
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From page 65... ...
, suggesting that therapies focused on helping patients understand and better cope with negative experiences are likely to be valuable in treating these disorders. For this report, the committee felt compelled by numerous suggestions from outside its ranks to consider whether the inclusion of psychodynamics as an explicit residency training requirement represents an impediment to psychiatric research training.
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From page 66... ...
Regarding that more far-reaching debate, the committee believes that great progress has occurred such that disagreements between those espousing biological determinism and those arguing for the supreme importance of upbringing and social environment have in many ways been transformed into a collaboration- that collaboration being based on a large body of research in recent years that has eloquently demonstrated the influence of both innate genetics and external factors, including psychosocial ones, on behavioral and emotional health (Pinker, 2003~. ~ considering the potential resistance that might ensue from criticism of psychodynamic psychotherapies, one should Ilot confuse psychodynamic psychotherapies with all forms of psychotherapy, and one should also realize that a number of different forms of psychotherapy that deal with conflicts, defense mechanisms, and maladaptive reactions to adverse life events fall under the general rubric of psychodynamic psychotherapy.
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From page 67... ...
(Olfson et al., 1999~. A suggestion that psychodynamic psychotherapies be Reemphasized in residency training is not, at least in the committee's view, linked to shifting psychiatry from a brain and behavioral discipline to one more focused on neuroscience.
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From page 68... ...
Finally, the triple board of pediatrics, adult psychiatry, and child and adolescent psychiatry was chosen as an example of combined Gaining that includes psychiatric training. Table 3-1 lists several medical specialties and the duration of t~aining for each, and notes whether research activity and research literacy are required or encouraged by each specialty's RRC requirements.
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From page 69... ...
and child and adolescent psychiatry to understand as fully as possible the ACGME-mandated goals of residency training and to focus on the research Gaining didactic learning or practical experiences included in those requirements. The first postgraduate year (PGY1)
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From page 71... ...
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From page 72... ...
psychiatry residency. Based on the information provided in Box 3-2, and assuming that the six untimed requirements in the box occupy 12 months of additional training time, child and adolescent psychiatry residents have a maximum of ~ months of elective time.
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From page 73... ...
REGULA TOR Y FA CTORS 73 quirements. Additionally, there are other opportunities to free up time for concentrated research training, as described in the next section.
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From page 75... ...
Each of these psychiatric subspecialties might alternatively be covered during inpatient and outpatient clinical service, and in fact the latter two can be covered during those rotations. Consultation/liaison could be part of inpatient or outpatient service if the organizational infrastructure existed to divide residents' time between direct patient care and periodic outside contacts.
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From page 76... ...
This 'pick list' approach is not the committee's idea, but one that was suggested during the last revision of the Psychiatry RRC requirements (personal communication, D Winstead, Tulane University, April 7, 2003~.
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From page 77... ...
, the following types of adjustments to the training requirements might logically be permissible and act as an incentive to pursue a specialty that currently is in great need of more applicants (Kim et al., 20011: 2 months of adult neurology could be exchanged for pediatric neurology (an untimed requirement) ; 12 months of adult outpatient service could be reduced and replaced by requirements associated with child outpatient service; the substance abuse requirements could be focused on those issues in childhood and adolescence; and the geriatrics requirement could be eliminated from child and adolescent training or folded into adult inpatient training as suggested previously in this report for general psychiatric trainees.
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From page 78... ...
The requirements of the Psychiatry RRC state that residency training "must" take place in an "environment of inquiry and scholarship in which residents participate in the development of new knowledge" and "should" include such scholarly activities as journal clubs, conferences, peer-rev~ewed publications, and research projects, as well as "guidance and technical support for resident participation in scholarly activities." Pathology and neurology have similarly worded requirements. However, the Pathology RRC emphasizes these requirements in a separate section titled "Resident Research," which explicitly calls for the encouragement and promotion of resident involvement in research activities, while the Neurology RRC appears to mandate research literacy for all residents to a greater extent than is the case for either pathology or psychiatry.
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From page 79... ...
that the "following components of a scholarly environment should be present...the program must promote an atmosphere of scholarly inquiry, including the provision of access to ongoing research activity...temphasis added] ." Stated another way, it appears that some requirements are actually optional, a situation that could confi~se program administrators about the level of resources they need to devote to research training, didactic or otherwise.
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From page 80... ...
to the Psychiatry RRC and has input into the process for formulating program requirements. In contrast with the Psychiatry RRC, which accredits residency training programs, the ABPN certifies individual psychiatrists by means of written and oral examinations and an audit of specific training experiences leading up to those examinations (ABPN, 2003b)
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From page 81... ...
REGULA TOR Y FA CTORS 81 facts and concepts in lieu of others (ABPN, 20021. Thus it is arguably the principal national organizing body that can impact residency training, and residency-based research training efforts that are not in some fashion sanctioned or promoted by the ABPN are likely to have more limited success than those that are.
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From page 82... ...
Barzansky, AMA, October 22, 2002~. ~ its 2002 annual report to the AMA membership, the CME commented about a great variety of issues affecting graduate medical education, including resident work hours, Medicare funding for graduate medical education, and medical school debt.
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From page 83... ...
Is Communication via the following document: Version 5.0 (February 2003) of Integrated Residency Training in Child and Adolescent and Adult Psychiatry, a product of a task force assembled by the AACAP.
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From page 84... ...
CONCLUSIONS AND RECOMMENDATIONS The two regulatory bodies with the greatest influence over residency training are the Psychiatry RRC and the ABPN. The committee understands and respects the fact that these two bodies aim to safeguard consumer health by ensuring that residency graduates are trained to deliver quality psychiatric care.
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From page 85... ...
The American Board of Psychiatry and Neurology and the Psychiatry Residency Review Committee should make the requirements for board certification and residency accreditation more flexible so research training can occur during residency at a level that significantly increases the probability of more residents choosing research as a career. The committee further recommends that residents who successfully fulfill core requirements at an accelerated pace, with competency being used as the measure, be allowed to spend the time thus made available to pursue research training.
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From page 86... ...
The American Board of Psychiatry and Neurology and the Psychiatry Residency Review Committee should require patient-oriented research literacy as a core competency of residency training in adult and child and adolescent psychiatry. Program directors and the American Board of Psychiatry and Neurology should evaluate residents on these competencies.
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From page 87... ...
Thus, the following recommendation is made: Recommendation 3.3. The organizations that nominate members for the Psychiatry Residency Review Committee and the American Board of Psychiatry and Neurology should include on their nomination lists substantial numbers of extramurally funded, experienced psychiatrist-investigators who conduct patientoriented research.
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From page 88... ...
A notable example is the AACAP's recent initiative to develop and broadly disseminate a mode] curriculum for child and adolescent psychiatry residency programs interested in infusing more research into their training curriculum.
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From page 89... ...
I need ~ provide respaces ad ~po~hies, including rcse~cb tin, mentors, ad a culture ~1 genuinely values 1be i~odancc of generating new clinical knowledge. Me neat cb~t~ details the state of research training at Me insh~tiona1 leveL
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