In Response: The Ideal Psychiatry Residency Training Program

There is little to be added in th e way of specifics to J ames Deming's review of the necessary ingredients for an ideal Resid ency T rain ing Program (I ). He not only reviews the specific issues wh ich must be add ressed regard ing the " nuts and bolts" of training, but also emphas izes th e need for ph ase specificity of bo th clinical and didactic ex periences and th e need to view residency training fr om a developmental perspective. Rather than comment specifica lly on th e points Deming raises, I would like to address other ingred ients in residency training which are to be value d in th e ideal program. With th e exp losio n of kn owledge in the field over the last several decades, tra ining directors and facul ty, as well as t ra inees, are faced with enormous co nce r ns about how this infor ma tio n can be most usefull y present ed and integrated. My own bias places this task under th e rubric of needing to learn an appreciat ion for process. T his phenomenon is often discu ssed primari ly from th e perspective of psych otherapy practice , but I mean something di ffe rent here . T he biopsychosocial model encompasses a view th at in understand ing th e individual, we must be prepared to understand th e processes with in that person from biologic, intrapsychic, interpersonal, familial , and environmental points of view. The ideal training program shou ld not on ly provide a set of cli nica l and didactic experiences which cover this knowledge, but a lso provide a means within which these varying levels of observation and understanding of a patient can be integrated. I find that this integration occurs most effec t ive ly in th e supervisors office, when a resident presents case material and is helped to put together what is seen clinically, what is experienced by th e physician , and wha t is known about psychopathology from a variety of points of view. It is th erefore essential, in order for this process to occur optimally, that th e supervisors ha ve the requisite appreciation for process and capac ity to integrate different levels of understanding. Departments of Psychiatry rarely feature a monolithic approach to understanding psychopathology, although th ere are excep tions . It is important in the choice of those individuals who are selected for supervision, that attention be paid to the particular interests and teaching skills of faculty members. It is essential to have super visors who not o nly have a specific area of expertise in psychiatric knowledge and practice , bu t also the capacity to