ALUMNI APPRAISAL OF PSYCHIATRIC EDUCATION

1. Physicians, on the whole, are not satisfied with their undergraduate courses in psychiatry. This is concluded not only from the number of grievances but also from the comments. Since only adverse criticisms were listed, it might be argued that the mere piling up of more and more hundreds of returns would be meaningless since if the questionnaire had listed only favorable comments for checking, we could have accumulated a long list of desirable characteristics. But in writing the supplementary comments, the participants were free. Here is how these comments shaped up.

Of the 412 officers, 162 or 40% made comments.

Of the 162 comments, 12 were favorable, and 150 (or 93%) were unfavorable.

(More striking, but perhaps less valid is this: Of the 412 officers, only 12 thought that their courses were good enough to warrant defensive comments; that is only 3%: And 97% did not feel that their undergraduate courses justified any favorable comment.)

2. Constructive suggestions for the improvement of undergraduate training in psychiatry may be drawn from two sources: (1) The correction of the indicated grievances, and (2) Affirmative suggestions made by the participants in their comments. Consolidating these two sources, the following constructive suggestions seem justified:

a. With reference to clinical material:

(1) More patients should be presented. (2) A higher proportion of the case-material should be nonpsychotic. (3) Out-patient departments for nonpsychotic patients should be set up and more widely utilized. (4) Lecture material should be correlated with the cases available.

b. With reference to the instructors:

(1) Teaching skill should count more than it apparently has in the selection of faculty members, even if it means selecting teachers with fewer nominal honors; (2) A certain amount of normalness of outlook, apparent common sense, and enthusiasm for psychiatry should be expected of the teachers and should be a significant factor in instructor selection; (3) Instructors should identify themselves with the other members of the clinical faculty. Thus, selection of doctors from isolated hospitals or sanitaria should be avoided in favor of practitioners identified with the local medical community; (4) Instructors should have rich contact with the peripheral disciplines of psychiatry, such as public health, social work, psychologists and the like; (5) Instructors should be proud and conscious of the fact that they are doctors of medicine so that their identification with medical practice on one hand, and these peripheral disciplines on the other, may make it possible for them to serve as the bridges between the somatic and social aspects of psychiatry.

c. With reference to doctrine:

(1) In the early stages of psychiatric teaching, conflicting doctrinal theories should be avoided, but (2) No doctrine should be dismissed as nonsense (a number of the students complained that the Freudian theories were made to seem repulsive as well as untrue: result was, not avoidance of psychoanalytic doctrine by these students, but apparently a contempt for their instructors). (3) In later stages of instruction, a certain amount of eclecticism appears to be healthy. (4) Source material of all doctrines and facets of psychiatry should be made available.

d. With reference to content of the teaching program:

(1) More time should be provided for presentation of case material (see a, above); (2) More emphasis should be placed on the utilization of the psychiatry in daily practice, even if it means less emphasis on the more esoteric phases of the specialty; (3) The overlap of psychiatry with medicine at one end and psychology and social-science at the other, should be recognized and places found in the curriculum for adequate stress at these margins; (4) Less emphasis should be placed on the psychoses, more on the nonpsychotic syndromes; (5) More, much more, stress should be laid on therapy, with particular emphasis on office procedures; (6) Space and time should be found for preventive psychiatry and mental hygiene.

e. With reference to the medical school as a whole:

(1) Psychiatry should start earlier with attention being directed (a) To simple psychosomatic mechanisms and (b) To variations in normal behavior; (2) A larger share of the medical school program as a whole should be given to psychiatry; (3) Effort should be made to indoctrinate other departments with psychiatric concepts, at least to the point where internists, surgeons and obstetricians do not ignore or jeer at the emotional aspects of disease in their specialties; (4) A competence in psychiatry should be required for graduation to the extent that competence is required in the other departments.

f. With reference to teaching methods:

(1) Methods should be worked out for the follow-up of cases which have been presented for diagnostic demonstration, so that students may learn something of the effects of time and treatment; (2) Better use should be made of mental hygiene clinics in the community; (3) Better liaison should be established with social agencies, psychologists and correctional institutions; (4) Students themselves should be given much more opportunity to interview patients; (5) Methods of therapy should be more often and more widely demonstrated; students should have a chance to hear therapeutic interviews, for instance, even if only on phonograph recordings or through sound films; to see demonstrations of shock therapy, hypnotism, narcosynthesis, group therapy, etc.; (6) Psychiatrists should participate in medical ward rounds and contribute to discussions in medical clinical conferences; (7) An active openward (nonpsychotic) psychiatric service should be part of every medical school hospital; (8) Better use should be made of out-patient departments in psychiatry; (9) Lecture material should more often be supported by case presentations; (10) The suggestions made under d (content of program) should be implemented by suitable teaching methods; (11) Recovered patients should be presented, both to overbalance the general therapeutic pessimism of psychiatry, and to serve in group therapy; (12) Some agreement should be reached among various instructors as to differences in doctrine with a view to avoiding suppression of academic freedom at one extreme and the confusing conflict of theories at the other; (13) Methods utilizing text-books should be prescribed, and their use verified, or factual reference material should be furnished in some other way; (15) Psychiatry should be taken as seriously as any other course in the school with reference to examinations, roll-calls, study assignments, etc., and; (16) Discussion of diagnostic possibilities, treatment technics and mechanisms, by members of the faculty (students participating or at least attending) should be part of case presentations. More than one instructor should participate in each discussion.