Psychiatric Resident Training Programme

Dr Usman Amin Hotiana MBBS, FCPS(Psych)

Assistant Professor (HEC) Psychiatry & Behavioural Sciences

What will be expected of you Dont save others if you dont know how to swim yourself....

Maximize Learning Experience “We don’t have anything to contribute.” a typical resident

What this talk is about: Not Clinical

Coffee talk

Making the journey bearable or maybe interesting

Medical professionals like society ....

'medical professionals have no greater understanding

of mental illness than society at large'

also add the legal system..

Clinical skills ....extinction Fairly confident of clinical skills

Focus on brain and mind

Analytically oriented settings: Transference and countertransference issues

Therapeutic alliance esp. psychotherapy

Living in a psychiatric island... Separate buildings

Locked, isolated

Limited interaction

Building Bridges.... Consultation Liaison psychiatrists

Calls & Emergency / OPD.

Psychiatrists are real doctors... Eg of orthopedic surgeon helping dermatology pt. fracture...

Whats our unique ways to help?

How to retain basic medical skillls

Ways of daily exposure... liaison ...

understand , discuss clinical conditions , interactions, therapeutic options...

talk to other consultants..

Use it or lose it.

Reading Washington Manual

Current Series

JAMA journal

Practice Division of labour...

Do whenever you can..

Spend a weekend at emergency/OPD medical.

Will improve confidence and interaction quality

Never try a medical problem...out of your league.

Practice makes perfect.

How to keep up with the Literature

Journals , texts, newletter

Limited cash

Limited time

TIme to develop lifelong efficient mechanisms

Selecting the literature In 2005, the ten psychiatric journals with the highest impact

factor, in descending order, were: Archives of General Psychiatry,

Molecular Psychiatry, American Journal of Psychiatry, Biological

Psychiatry, Neuropsychopharmacology, Journal of Clinical

Psychopharmacology, Journal of Clinical Psychiatry, Psychotherapy

and Psychosomatics, British Journal of Psychiatry, and Sleep.

Impact Factor

Evaluating the Literature Out of the scope for now.

Desirable

Statistical Analysis

Critical Appraisal of literature

Literature Management Example of Dr Anuradh Mittal

2 articles per journals

Choose after your interest... practice appraisal

Present and polish the skills

Academic Psychiatry ap.psychiatryonline.org

Acta Psychiatrica Scandinavica www.blackwellpublishing.com

Addiction www.addictionjournal.org

Addiction Biology www.blackwellpublishing.com

Alcohol www.elsevier.com

Summaries of recent findings Some publications that publish summaries of recent, relevant

findings include: Psychiatric News (pn.psychiatryonline.org), Clinical

Psychiatry News (www.eclinicalpsychiatrynews.com), and the

Psychiatric Times (www.psychiatrictimes.com). The Carlat Psychiatry

Report (www.thecarlatreport.com) is a monthly newsletter that

provides reports on various areas of psychiatry. It is “unbiased” in

that it receives no money from the industry. There is also Journal

Watch: Psychiatry (psychiatry.jwatch.org), a publication providing a

review and commentary of articles in over 50 journals.

American Journal of Psychiatry ajp.psychiatryonline.org

British Journal of Psychiatry bjp.rcpsych.org

Reading List DSM V

Kaplan and Sadock's Comprehensive Textbook of Psychiatry

New Oxford Textbook of Psychiatry

SIMS : Symptoms in teh MIND

General Psychopathology by Karl Jaspers

Psychodynamic psychotherapy in Psychiatry by Gabbard

Psychiatric Calls: Guidelines Know what is your exact part

Doctors room, safety

Nursing/seniors ... who are most helpful?

Telephone central data/ chain of help

does it help to do mini rounds? Notes writing policy?

Any postive oppotunities... time to study?

Maximum limits Duty hours limit to 80 hours /week

On call no more frequent than every third night

Continuous duty not to exceed 24 hours... transferring time may take additional no more than 6 hours.

Set Limits Know yourself and needs

Eg heartburn.... related to cups of tea/coffee

No harm in rest

Afterall you are in training...

Spell out your responsibilites and stick to them

Marshal Resources Senior residents and faculty backup

Textbooks and Internet

Establish a mini library adjacent Doctors Room....

'You will survive calls, again and again, with some preparation you might even enjoy it'

How to get most out of your Psychotherapy Supervision

Finding & Developing relationship with a Mentor

Finding a Mentor Which ones? General Interests?

As Peers? Good teachers/Leaders?

How they react/enjoy?.....continue do it if become independent wealthy...

Talk to trainees, check recommendations,opportunities, active interest,

Past trainees relationships...peers or competitors?

Check out mentors publications.. first author?

Team player? Reviewer? Leaders? Editors?

Dont be afraid to ask any question even if busy...they will make time ...

Developing a mutually respectable relationship with mentor

Hardwork and proactive

Involve in research. Do simple tasks to get trust.

Consider not necessarily act on , all advice your mentor gives you.

Take professional risks as guided. Authorship?

Watch and Learn. Learn how they priortize and delegate responsibility.

Mentor -protege ..open and honest.

Short and long range goals inventory

Make a commitment to pass the important things you ve learned to someone...

Doing research as a Resident Faculty and their researches

Develop an idea and do a literature review

Involve in research related activities in the department

Negotiate authorship

Attend professional conferences/meetings

Look for opportunities to present at scientific meetings

Beaware the extra time it requires

Getting published during residency

Ultimate primary currency for promotion, jobs, scientific/clinical niche folowing training

For FCPS/ either two papers or thesis

What can you publish?

When do residents find time to write?

Identifying topics

Gathering material

analyzing already collected data

split the work .... first author keeps tracks

case reports... soon after it inspires.....takes shortest time

Where can resident send their work?

Journals.

Introspections..

Academic Psychiatry

Local journals

How to get started... Enlist support

Corrospond the editor...journals....to gauge the response..

Residents and Pharmaceutical Industry

getting reprints, ballpen, lunches...

WHen does it crosses the line?

Even when residents are aware of these guidelines, their

interactions with industry are not very different than those of

residents who were unaware of their guidelines (Sergeant 1996).

How does it influence....

Read the journals

Follow a guideline in the training programme. Eg. Maudsley ..

Meetings on bioethical issues, industry-physician interaction

Dose response interactions...Less is better.

STEP (Safety, Tolerability, Effectiveness, and Price)

Patient oriented evidence that matters

Plan advance meetings..with critical appraisal.

Avoid before educational rounds/grand rounds.

Diluting the brand...if institution accepts money...spent by department than individual.

Stand out: How to become a Psychiatric Leader

Role as a Team Leader Psychiatrist as a team leader in multidisciplinary team

Rules of courtesy ... team player

Appropriate feedback, encouragement, ...

Knowing teams strengths ...

Learning, Trial and error..

Teamwork as a consultant You would be called for difficult situations

suicidal attempts, hostile attitudes

personality pathologies , projection, good and bad ....

Listening , understanding, reassurances..

Not only patients ...also caregivers.. health care team

Resident role as a teacher.. No training

Difficult process

Thankless sometimes

Central part of identity as a healer Mentoring emphasized in hippocratic oath

Teaching factual info

Teaching central skills....

How to be a Chief Resident Boundary postition

Not a popularity contest

Regular meeting with the faculty

Core duties of Chief Resident What effects the morale or the residents and increases stress?

Second most important duty?

Qualities to look for in Chief Resident

Availability

Methodical & Role model

Can demonstrate how to be a resident..

straightforward, compassionate, patient as possible, honest about feelings...

sense of humour,

can prioritize issues...

fair and consistent in application of rules

Focused on completion of tasks rather psychopathology of other residents..

Protect and support other residents...

Getting involved in professional organizations

Potential benefits

Network of professionals

Getting the bigger picture

Would you like to have a Residents meeting....

List of Professional organisations

Being assertive in professional roles

IN YOUR RESIDENCY (Good observation helps..) WITH PATIENTS (Sometimes.. your job is to tell what they dont want to hear...)

WITH MENTORS /SUPERVISORS PROFESSIONAL ORGANISATIONS GETTING CREDIT

Aggressiveness and assertiveness...requesting more training... networking.. introducing yourself,....

Dont forget who is the number one coach and advisor...?

Taking care of yourself in residency

Charting your course: Personal and Professional

Last dying wish... more time in office?

Personal goals..

Compass and clock...

Regular review, achievable..

Win win or win-lose

Common errors... procrastination, perfection, taking extra work...

“But where and how is the poor wretch to acquire the ideal qualifications which he

will need in his profession? The answer is in an analysis of himself.” (S. Freud

1937)

Benefits and Pitfalls of getting your own psychotherapy

Helps experiences and obstructs inexperiences...review.

confusion, irritability, social isolation , and depression... 4-8% residents.

20 % vs 70 % getting psychotherapy earlier.

Marriage, Parenthood and Residency

Marriage, Parenthood and Residency

Starting a family is challenging but can be rewarding.

Residency is not a contraindication for having children.

No RCTs upon the right time to have children.

Marriage, Parenthood and Residency

Planning... is the key. Analyze your energy and wishes..

Considerations while planning parenthood..

Rotations order/ safety net/expectations/ residency culture/how long exactly is parental leave/...

Spirituality and Resident In DSM IV...a category called ... religious or spiritual problem

80 % psychiatrists believers..vs 96 % belief

Since we are assessing the beliefs of the patients, it is helpful to evaluate our own belief system

Organized religion

Patients care

Mindfulness

Romance, Relationships and residency

Myths or Truths...

Does residency effects our relationships...

Still find a partner...

Away from the kid...

Coping with training and time away from home

Solutions...

Opening the closet door

Your personal mental health : Foundation of your career

Legal issues in Psychiatric Training

What is harrassment? If someones behaviour and statements make you uncomfortable, discuss with a trusted mentor or supervisor.

What needs to be reported to training director

Persistent comments upon attire or attractiveness.

Fellow resident constant insistence despite your decline.

Steps

You can ask to stop the offensive behaviour

Your employer is legally required to investigate the incident, protect your confidentiality..etc.

If serious, may consider filing a police report and temporary restraining order...

Gender biased issues Hardball for Women, Pat Heim says, “To change

the game we’ve got to get the power first, and that usually requires

adhering to the establishment rules…we need to learn how to rely on

other women.” (

How to address such issues...

When physicians look impaired..

Special issues related to patients

Looking part: Professional attire

When its time to say goodbyes

Disaster Issues

Advocating for psychiatric patients

FInances during and after residency

Try to never blame your patients...

A look towards the future...

Couch time; Psychoanalytical Training

“Psychoanalysis is a remarkable combination, for it comprises not only a method

of research into the neuroses but also a method of treatment based on the etiology

thus discovered. I may begin by saying that psychoanalysis is not a child of

speculation, but the outcome of experience; and for that reason, like every new

product of science, is unfinished. It is open to anyone to convince himself by his

own investigations of the correctness of the theses embodied in it, and to help in the

further development of the study.” (S. Freud, 1911)

Subspecialities Addiction

Forensics

Child

Geriatrics

Child Neurophysiology

Psychosomatics

Pain & Sleep Medicine

Thanks, Any feedback/questions