The Measure of Success

Modern medical education is rife with requirements for measurable outcomes. The Accreditation Council for Graduate Medical Education wants to know how many of our residents finish their training on time, how many pass the boards, and how many are able to achieve numerical milestones of competency throughout each year of training.

I started thinking about this recently after I had the opportunity to teach forensic psychiatry to a small group of first-year residents. It was a wonderful experience. Even post-call, they were alert, enthusiastic, and questioning. I remembered being at that stage of my career, feeling that I had a very short time to learn everything I would need to know as a psychiatrist. I remembered feeling torn between specialties as my interests changed with each rotation, from consultation liaison and later to emergency psychiatry before I finally decided to go into forensic work.

As I was speaking to the young residents, I knew that most would not become forensic psychiatrists, so I had to find a way to make my subject relevant to general adult practice. I thought about the clinical experiences they had been exposed to up to that point. Most had worked in the emergency room either as a consulting psychiatrist or as an intern, all had inpatient experience, all were working with primarily an impoverished inner city group of patients. They were familiar with patients facing addiction, legal issues, homelessness, and serious mental illness. Whether they realized it or not, they were working with my forensic patients. That was my connection.

What I wanted them to know was how much they were needed by these patients. I knew from my own training experience that psychiatry residents risk becoming jaded and cynical after seeing substance-abusing patients seek repeated admissions for detoxification, or not-so-mentally ill patients who seem to come to appointments only when their disability paperwork needed to be updated. Success stories are rare and usually happen only after years of therapeutic effort.

It doesn’t surprise me that some residents graduate and quickly flee to the neuroimaging lab or the comfortable private therapy office. My job was to catch them before they got caught up in concerns about insurance reimbursement, conference presentations, publications, and electronic health information systems, and to open their eyes to options they may not have considered such as work in a public mental health clinic or correctional facility.

I feel I need to do this, because teaching is more than the transmission of a curriculum. It involves helping residents recognize where they are needed, what needs to be changed or improved in a health care system, and the role they can play in that change. Professional engagement with the public mental health system can only happen if professionals feel they can make a change.

Community and forensic psychiatrists are in the forefront of public mental health services, and we should encourage our trainees to become involve through direct clinical care and participation in professional organizations. This is particularly important as non-physician subscribers use the psychiatrist shortage as a reason to seek prescribing privileges. Work in the public sector benefits our profession as well as our patients.

<[QM—Annette Hanson, M.D.

 Dr. Hanson is a forensic psychiatrist and co-author of Shrink Rap: Three Psychiatrists Explain Their Work. The opinions expressed are those of the author only, and do not represent those of any of Dr. Hanson’s employers or consultees, including the Maryland Department of Health and Mental Hygiene or the Maryland Division of Correction.

Modern medical education is rife with requirements for measurable outcomes. The Accreditation Council for Graduate Medical Education wants to know how many of our residents finish their training on time, how many pass the boards, and how many are able to achieve numerical milestones of competency throughout each year of training.

I started thinking about this recently after I had the opportunity to teach forensic psychiatry to a small group of first-year residents. It was a wonderful experience. Even post-call, they were alert, enthusiastic, and questioning. I remembered being at that stage of my career, feeling that I had a very short time to learn everything I would need to know as a psychiatrist. I remembered feeling torn between specialties as my interests changed with each rotation, from consultation liaison and later to emergency psychiatry before I finally decided to go into forensic work.

As I was speaking to the young residents, I knew that most would not become forensic psychiatrists, so I had to find a way to make my subject relevant to general adult practice. I thought about the clinical experiences they had been exposed to up to that point. Most had worked in the emergency room either as a consulting psychiatrist or as an intern, all had inpatient experience, all were working with primarily an impoverished inner city group of patients. They were familiar with patients facing addiction, legal issues, homelessness, and serious mental illness. Whether they realized it or not, they were working with my forensic patients. That was my connection.

What I wanted them to know was how much they were needed by these patients. I knew from my own training experience that psychiatry residents risk becoming jaded and cynical after seeing substance-abusing patients seek repeated admissions for detoxification, or not-so-mentally ill patients who seem to come to appointments only when their disability paperwork needed to be updated. Success stories are rare and usually happen only after years of therapeutic effort.

It doesn’t surprise me that some residents graduate and quickly flee to the neuroimaging lab or the comfortable private therapy office. My job was to catch them before they got caught up in concerns about insurance reimbursement, conference presentations, publications, and electronic health information systems, and to open their eyes to options they may not have considered such as work in a public mental health clinic or correctional facility.

I feel I need to do this, because teaching is more than the transmission of a curriculum. It involves helping residents recognize where they are needed, what needs to be changed or improved in a health care system, and the role they can play in that change. Professional engagement with the public mental health system can only happen if professionals feel they can make a change.

Community and forensic psychiatrists are in the forefront of public mental health services, and we should encourage our trainees to become involve through direct clinical care and participation in professional organizations. This is particularly important as non-physician subscribers use the psychiatrist shortage as a reason to seek prescribing privileges. Work in the public sector benefits our profession as well as our patients.

<[QM—Annette Hanson, M.D.

 Dr. Hanson is a forensic psychiatrist and co-author of Shrink Rap: Three Psychiatrists Explain Their Work. The opinions expressed are those of the author only, and do not represent those of any of Dr. Hanson’s employers or consultees, including the Maryland Department of Health and Mental Hygiene or the Maryland Division of Correction.

Modern medical education is rife with requirements for measurable outcomes. The Accreditation Council for Graduate Medical Education wants to know how many of our residents finish their training on time, how many pass the boards, and how many are able to achieve numerical milestones of competency throughout each year of training.

I started thinking about this recently after I had the opportunity to teach forensic psychiatry to a small group of first-year residents. It was a wonderful experience. Even post-call, they were alert, enthusiastic, and questioning. I remembered being at that stage of my career, feeling that I had a very short time to learn everything I would need to know as a psychiatrist. I remembered feeling torn between specialties as my interests changed with each rotation, from consultation liaison and later to emergency psychiatry before I finally decided to go into forensic work.

As I was speaking to the young residents, I knew that most would not become forensic psychiatrists, so I had to find a way to make my subject relevant to general adult practice. I thought about the clinical experiences they had been exposed to up to that point. Most had worked in the emergency room either as a consulting psychiatrist or as an intern, all had inpatient experience, all were working with primarily an impoverished inner city group of patients. They were familiar with patients facing addiction, legal issues, homelessness, and serious mental illness. Whether they realized it or not, they were working with my forensic patients. That was my connection.

What I wanted them to know was how much they were needed by these patients. I knew from my own training experience that psychiatry residents risk becoming jaded and cynical after seeing substance-abusing patients seek repeated admissions for detoxification, or not-so-mentally ill patients who seem to come to appointments only when their disability paperwork needed to be updated. Success stories are rare and usually happen only after years of therapeutic effort.

It doesn’t surprise me that some residents graduate and quickly flee to the neuroimaging lab or the comfortable private therapy office. My job was to catch them before they got caught up in concerns about insurance reimbursement, conference presentations, publications, and electronic health information systems, and to open their eyes to options they may not have considered such as work in a public mental health clinic or correctional facility.

I feel I need to do this, because teaching is more than the transmission of a curriculum. It involves helping residents recognize where they are needed, what needs to be changed or improved in a health care system, and the role they can play in that change. Professional engagement with the public mental health system can only happen if professionals feel they can make a change.

Community and forensic psychiatrists are in the forefront of public mental health services, and we should encourage our trainees to become involve through direct clinical care and participation in professional organizations. This is particularly important as non-physician subscribers use the psychiatrist shortage as a reason to seek prescribing privileges. Work in the public sector benefits our profession as well as our patients.

<[QM—Annette Hanson, M.D.

 Dr. Hanson is a forensic psychiatrist and co-author of Shrink Rap: Three Psychiatrists Explain Their Work. The opinions expressed are those of the author only, and do not represent those of any of Dr. Hanson’s employers or consultees, including the Maryland Department of Health and Mental Hygiene or the Maryland Division of Correction.