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Book Forum: Textbooks   |    
Handbook of Psychiatric Education and Faculty Development
RONALD O. RIEDER, M.D.
Am J Psychiatry 2000;157:139-140.
View Author and Article Information
New York, N.Y.

edited by Jerald Kay, M.D., Edward K. Silberman, M.D., Linda Pessar, M.D. Washington, D.C., American Psychiatric Association, 1999, 660 pp., $50.00.

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The nature of this book may not be evident from its title. First, it is very much not a handbook in the tradition of house staff handbooks or others that provide succinct descriptions of topic areas with substantial "how-to" advice and are carried in one’s white coat or are otherwise easily accessible in the office. This volume certainly would not fit in a pocket, since it is a hardback and 660 pages in length.

The book’s size allows for a wide range of contributions. The 31 chapters are divided into four sections: Career Pathways in Academic Psychiatry, Psychiatric Research, Psychiatric Education, and Psychiatric Administration. The three editors are well-known, experienced, and diverse educators, currently holding positions as chairman, director of residency training, and director of medical student education, respectively. The chapter authors are a stellar group, a Who’s Who of psychiatric education, writing on areas of their special interest and expertise. Although the core effort is in the Psychiatric Education section, which includes 15 chapters on medical student and residency education, there is solid advice for faculty regarding how to develop their own administrative skills, teaching abilities, research, and careers within academia, with separate entries aimed toward faculty who are women, minorities, or international medical graduates.

Each chapter is grounded in the literature and well-referenced. There are also very useful tables and appendixes with the addresses and telephone numbers one needs but never can find. The most important material in these chapters is usually the advice of an experienced program director who has learned, probably the hard way, how to achieve a certain educational objective or program component.

The overall quality of the chapters is very high, which is not common in an edited volume. As an educator, I thought it appropriate to grade each of the chapters as I read it. I applied a high standard and expected that I would give marks across the whole spectrum (A–D) and even perhaps fail a few chapters. However, I must report that my lowest grade turned out to be a B plus, and there were only three of these; there were six A minuses, and all the rest of the chapters received an A. There is a similarity in the "voice" in which the various authors speak to the reader (not surprisingly, the voice is like that of a good teacher intent on making sure the material is understood), and this leads me to believe that the editors themselves did the hard work of revising the submissions.

I found certain chapters particularly good; these might even be graded as A plus. In the section on Psychiatric Research, "Doing Research Without Grant Support" by Mantosh Dewan et al. presents solid advice with good illustrations and data on this rarely written-about topic. In the section on Psychiatric Education, "Preclinical Undergraduate Curricula" by Myrl Manley and David Trachtenberg gives a stirring endorsement of the importance of personal interactions of medical students with teachers, plus such good and comprehensive advice regarding core medical student courses that this chapter in itself would merit the price of the book. In "Fulfilling the Special Requirements," Stefan Stein gives exactly the lucid, helpful directives that a residency training director needs to pass the Residency Review Committee site visit. In "Special Problems," Paul Mohl writes about pregnant residents, paternity leave, the dismissal of a resident, patient suicide, etc., and his many years of experience plus his psychological sophistication shine through, especially in his discussion of how to handle communications with residents and faculty when faced with such matters. The chapters by Carol Nadelson and Carol Bernstein are similarly savvy regarding helping residents deal with personal problems and making residencies "user friendly." I could give accolades to many other chapters. The whole book is filled with solid advice, especially regarding the nuts and bolts issues of medical student, resident, and young faculty development. Even continuing medical education is covered, extremely thoroughly, by John Herman et al.

In short, chapter by chapter I liked what is in this book. It was only after finishing it that I thought over what was missing. Since the field of psychiatric education could be expanded to cover an extremely broad area, I am sure that my list of "missing chapters" is somewhat idiosyncratic, but here they are: "What to Teach," "Changes in How to Teach," "Residency Tracks and Early Subspecialization," and "How Those With Educational Responsibility Get Clout."

"What to Teach" would deal with the fact that psychiatric educators struggle to delineate the aspects of neuroscience, epidemiology, clinical psychobiology, and treatment (clinical trials) research that should be taught to those who will practice well into the twenty-first century. Since the theoretical basis of psychiatry in the past has been primarily psychodynamic, should this now be de-emphasized, should the new knowledge be somehow added to the curriculum, or can the two be combined? Similarly, there has been an interesting debate about whether an emphasis on teaching DSM-IV criteria has led to a decreased exploration of not only the broader phenomenology of psychiatric illnesses but also of other aspects of the patients, raising questions about what we should teach in the areas of interviewing, diagnosis, and formulation. Finally, the demonstrated efficacy of psychopharmacology and brief psychotherapies have led to reconsideration of the teaching of these subjects and the teaching of long-term psychotherapy. Even if these questions about what should be taught cannot be answered, thoughtful consideration of how to decide what to teach, with solid advice and personal illustration, as in the existing chapters of this book, would have been useful.

The use of computers is mentioned in this book only with regard to medical students. My new chapter "Changes in How to Teach" would describe how residents and faculty can use current access to rich sources of information on the Internet, computer media, or even videotape libraries. Similarly, the most time-intensive method of psychiatric education, individual supervision, deserves more than the brief discussion it gets here, especially with regard to how the program director gets busy faculty to supervise, how to train them to do it well, and how to make supervision more efficacious and efficient.

Although there are debates about the need in the workforce for general psychiatrists, the need for subspecialists in our field—child, geriatric, substance abuse, forensic, and probably even consultation-liaison and research psychiatrists—seems apparent. One method of fostering such subspecialization is to develop tracks within residency programs that allow for early experience in and commitment to these fields. Since residency training directors are often the central education figure in their departments, a "Residency Tracks and Early Subspecialization" chapter could help them decide whether and how to develop such tracks and the additional fellowships or residencies that would lead to added qualifications. Similarly, although psychiatric research is substantially included in this book, there is no helpful advice on how a residency training director could foster and get funding for a formal research training program in the department.

I am sure that the editors and chapter authors of this book would have reams to say on the topic of my final new chapter, "How Those With Educational Responsibility Get Clout." They could write on battles both won and lost because they have been able to obtain the resources necessary to establish superior educational programs. How did they do it, especially when there are declining resources, great service needs, and neglect to disdain on the part of managed care organizations regarding the education of psychiatrists?

In summary, this is the new handbook for psychiatric education. All departments will need a few copies to develop excellent educational programs and to use as a reference about what to do when something goes wrong. I say a few copies because the book should be on the desk of the chairmen, directors of medical student and residency programs, assistant directors, program coordinators, chief residents, and all those with administrative responsibility for making sure the educational program at your institution works. The only alternative is the school of hard knocks.

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