Donald H. Naftulin

Therapists' physiological activation and patient difficulty.

The differential effects of an easy and difficult-to-interview patient on therapist self-reported behavioral arousal and physiological activation were observed. Eighteen experienced white male psychiatrists each interviewed two patient simulators believing they were real patients. Each actress was programed to act the part of a difficult-to-interview patient and an easy-to-interview patient. Each randomly played either part as assigned and the order of patient and role was counterbalanced. Differences in patient roles were validated by the participating therapists and independent raters. Fifteen-minute rest periods with soft music preceded each therapy session such that a complete experimental session consisted of rest 1, therapy 1, rest 2, and therapy 2. Self-reported arousal was assessed during each of the four periods by Thayers factors from the Nowlis Mood Adjective List. Physiological activation was measured by electromyogram, heart rate, blood pressure (systolic and diastolic), and skin conductance. Therapist self-reported behavioral arousal and measured physiological activation during therapy were significantly greater than during rest. The difficulty of the patient did not appear to affect either behavioral or physiological activation level of the therapists. Several explanations for this are explored.

Mental health courses as a facilitator for change in a rural community

This study documents a university effort to assist a rural community in developing a mental health educational program for primary interveners within the community. Program goals were established and evaluated on a pre- and postcourse basis and compared with a noncourse-taking group of similar professionals within the community. Results suggest some significant change in the desired direction in the course groups. The satisfaction of program participants, the request for and provision of further programs, and the substantive community changes occurring in association with the courses support the concept of community-university liaison in the development of acceptable and realistic mental health programs in rural communities.

The Summer Preceptorship in Psychiatry as a Facilitator of Medical Career Choice

The authors surveyed the sixty-three preceptees who had completed a university psychiatry summer preceptorship in the past five years as to their perception of the preceptorship and its relation to their specialty choices. Fifty-four former preceptees responded (86%). Of the forty-three who indicated choice of specialty, twenty-six chose person-oriented (including fourteen who chose psychiatry) as opposed to technique-oriented specialties. Subsequent performance in the third year psychiatry clerkship of recent sophomore preceptees exceeds that of sophomores who did not participate in the preceptorship. Direct inferences of these findings cannot be made without more information about early socialization factors of the subjects. Nevertheless, results support continuation of the summer preceptorship program as an effective technique for training prospective physicians to be more person-oriented, providing an experience from which students can increase their knowledge of psychiatry, and allowing for a unique experience from which a more rational choice of medical specialty may be made.

Basic Science Knowledge and Clinical Applications in Psychiatry: Issue or Artifact?

Intercorrelations among paper-and-pencil test results of basic science knowledge, patient management questions, and ratings of actual clinical performance are repesented. The findings emphasize the complexity in evaluating students because the level of basic knowledge was not correlated with knowledge of clinical application, and neither were correlated with clinical performance ratings. Alternative explanations of these findings are discussed and corrective actions suggested.