Abstract
The concept of a Comprehensive Care Clinic, to which consultants in the medical specialities are attached, is relatively new. The part of such programs that is unique, and has the greatest implication for medical education in general and psychiatric education in particular, is the functioning of the student as a family physician for a period (22½ weeks in the Cornell program, 32 weeks in the Oklahoma program). Such an experience probably parallels the practice of medicine as nearly as is possible during medical school. The importance of psychiatric participation in such a program is obvious and is firmly established.
Since it is so firmly established, there is no need for the psychiatrist to be apologetic about his contribution, and there is no excuse for his allowing it to become a student elective. The medical educator, regardless of his particular field of interest, has the obligation to train physicians in the best way possible. Part of this obligation is to make his subject matter palatable and attractive, but an equally important part is to see that his teaching reaches and is assimilated by all students under his charge, whether or not the individual student expects to find the subject matter interesting or worthwhile. Possibly there is a place in undergraduate psychiatric education for group psychotherapeutic experiences which are designed to break down the student's resistances, but it can in no way replace organized instruction for which students are held responsible.
It is too early to evaluate completely comprehensive care and training programs and the role such programs should play in the training of physicians. The conclusion of most of those who have participated in them is that they are training better physicians, and as a direct result of this training, leading to better and more complete medical care of patients. Where these experiences are used as a guide to future programs in other schools, it should be emphasized that fulltime psychiatric participation in the planning and execution is absolutely necessary in achieving the desired goals.
The psychiatrist can function in a number of specific ways within the clinic setting. He can be available as a consultant for the individual student and his patient, and this will be an important part of his activities. In addition, the curriculum should be so organized that the psychiatrist has time and opportunity to reach all the students. Regularly scheduled seminars with small groups of students, and active participation in the home care program, in my experience are 2 of the most successful means of achieving this goal.
