Leah J. Dickstein

A Psychiatric Residency Curriculum About Gender and Women’s Issues

Over the last 30 years, major advances have been made in our understanding of how bio-logical factors and sociocultural influences contribute to gender differences, gender identity formation, and gendered role behavior. Sensitivity to the psychological effects of changing family structure and workforce composition, the contribution of reproductive events, and the high rates of exposure to trauma in women is essential for optimal psychiatric assessment and treatment planning. This knowledge has not been systematically integrated into residency training. The authors present an outline for a curriculum in gender and women’s issues, including educational objectives, learning experiences through which residents could meet these objectives, and recommended readings. The authors also discuss potential obstacles and suggest helpful strategies for implementing the proposed curriculum.

Recruiting Researchers in Psychiatry: The Influence of Residency vs. Early Motivation.

BackgroundThe declining numbers of clinician-researchers in psychiatry and other medical specialties has been a subject of growing concern. Residency training has been cited as an important factor in recruiting new researchers, but there are essentially no data to support this assertion. This study aimed to explore which factors have influenced motivation to conduct research among senior psychiatry residents.MethodsThe authors surveyed senior residents, inquiring about their level of interest in research, demographics, background, research experiences, and factors influencing motivation for research. The authors had confirmed participation from 16 of 33 residency programs with a class size of 10 or more. They received 127 responses, a 67% response rate, from participating programs.ResultsResidents with high stated interest in research differed from those with low and moderate interest in their research-intense post-residency plans. They were more likely to have graduate degrees. Those planning research careers had a consistent pattern of interest and involvement in research, starting well before residency. The majority of residents had had research exposure in college, but research involvement of those with very high versus lower interest diverged sharply thereafter. Those with high research interest were overwhelmingly male and tended to have lower debt than those with less interest.ConclusionThe great majority of residents appear to have decided whether or not to pursue a research career by the time they reached residency, and few of those with less than the highest research interest were enrolled in research tracks. Efforts to increase recruitment into research should center on identifying early developmental influences, eliminating barriers specific to women, and ensuring adequate funding to provide secure careers for talented potential researchers.

Impact of the Information Age on Residency Training: Communication, Access to Public Information, and Clinical Care

Access to technology in practice helps physicians manage information, communicate, and research topics; however, those in training receive almost no formal preparation for integrating web-based technologies into practice. One reason for this is that many faculty—aside from junior faculty or those in recent generations—did not grow up using Internet communication, may use it minimally, if at all, in their own practices, and may know little about its forms and varieties. This report presents a case to illustrate how these disparities may play out in the supervisory situation and makes suggestions about helping supervisors integrate technology-awareness into their teaching.

Health Care Reform and Postgraduate Psychiatric Education

Psychiatric educators must prepare to teach in an era in which funding for education is more difficult to obtain, all forms of treatment are shorter, patients are discharged from the hospital while they are still acutely ill, the burden of paperwork and other administrative tasks is greater, psychiatrists provide less psychotherapy, and residents are no longer able to play a primary role in the treatment of patients covered by third-party payment schemes. A surcharge on a national insurance plan could make up for funding deficits, but this is not likely to occur in the near future. A more realistic model involves billing for services of faculty who integrate direct participation in patient care with teaching and better definitions of the role that residents can play in modern patient care. Overage from clinical activities driven by faculty may provide sufficient funding for resident services that provide an opportunity for longitudinal patient experiences. Strategies for political action and for better collaborations with primary care faculty are discussed.

The mental health of women: an overview.

The past decade has opened up new understanding of the importance of gender in the diagnosis, treatment, and outcome of psychiatric as well as general medical disorders. Differences in biologic and psychosocial environments contribute to differences in incidence, presentation, and symptom expression, and they affect the diagnostic procedures that are used, as well as the prognosis and treatment of illnesses. Unique experiences differentiate women and men throughout the life cycle. Differences between males and females based on genetic and physiologic factors may confer different risks of morbidity and mortality. For example, the greater cerebral blood flow rate and higher ratio of adipose tissue to body water in women affect the absorption, utilization, and consequently dosage and toxicity of psychotropic as well as other medications. For example, in posttraumatic stress disorder, which is more common in women, there is evidence that patients have brain reactivity and hormonal changes that may contribute to their subsequent altered responses to stress. It is likely that biologic factors as well as gender differences in health behaviors contribute, to some degree, to the longevity difference of 4 to 10 years between men and women in North America. In general, women appear to take better care of their health and are more frequent users of health care services, including mental health services. It is estimated that women make 25% more visits per year to physicians. There has been evidence that women are more likely to have a regular source of care, to see physicians earlier in the course of an illness, to make return visits at the request of their physician, and to obtain more preventive, diagnostic, and screening services than men, including Pap tests and mammograms. These behaviors are also affected by the physician’s gender. Research has indicated that women have been more likely to comply with recommendations if they see a female rather than a male physician. In general, women have less health insurance coverage than men. Women are more likely to seek preventive health care (mammograms and Pap tests). Women physicians spend more time with their patients and are seen as listening more and providing more information, and women patients volunteer more information to women doctors. Some have Correspondence: Carol C. Nadelson, MD, Director, Partner Office for Women’s Careers, Brigham and Women’s Hospital, 75 Francis Street, MA 02115. E-mail: Carol_Nadelson@hms.harvrd.edu PROD. # GRF20414

Primary Prevention and Practical Techniques to Encourage Mental Wellness

Women patients must be made aware that they need to train and perhaps readjust their attitudes and minds to handle and improve their mental wellness. Being their own person, with awareness of whom and how they want to be, strengthens their sense of self and simplifies their lives with awareness and understanding of the choices unique to them as individuals.