importance of didactics

[rkaz]

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I wanted to ask about the importance of formal didactics on one's training experience. For those who have completed their training, where did you feel you learned the most: a) formal didactics, b) rounding with attendings and discussing cases afterwards, c) seeing patients on your own/high volume, d) other?

In terms of formal didactics, I've seen programs range from as little as 1 single hour of didactics weekly to up to 6 hours, though the average seems to be 3-4 hours per week. Should I assume that the program with 6 hours cares way more about training residents than the program which only offers 1 hour?

During interviews, I had a difficult time assessing which programs valued education over service. Maybe I wasn't knowing the right questions to ask, but I had a hard time differentiating which programs I'd get the lower volume but more time to discuss cases with the attendings from. I have created my rank list, but there are a few programs I keep switching around.

Thanks! You all have been amazingly helpful during this process. I know I have gotten so much advice this season, and I sincerely thank all of you for continuing to entertain my questions. Only a few more weeks to go until we have to submit our ROL....

 

[rkaz]

The program that only offers 1 hour per week is a community program and I was previously thinking of ranking it #1 or #2, as I am very comfortable here and can see myself working here in the future. The program also has a wonderfully supportive PD and the residents are very happy. But the lack of formal training is something I find concerning. Taking it further, year 1 and 2 attend didactics together since didactics is not protected in off-service rotations, so residents get a repeat in year 2 to cover the gaps from year 1. All other programs I've come across have a different curriculum of didactics every year, so it seems this particular program only offers about 15-20% of the didactics of others. Furthermore, this program offers about 1/2 an hour weekly of case discussions with attendings on rounds. At the university program I rotated though, we got a lot more time with attendings to discuss cases, and I really liked having lower volume but more time to discuss cases in depth with attendings, as there were more teaching points to be gained (such as differential diagnoses and how to differentiate medical vs psych causes of pathology, clinical presentations of pathology, etc).

 

[VMSmith]

What you're describing does not sound like adequate teaching or supervision to me. Are you really saying that the residents only round once a week for half an hour with the attending?

You would certainly learn by doing, unfortunately I would hesitate to trust what you learn.

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[shan564]

I agree with the above comment - what you're describing sounds grossly inadequate. You should be able to discuss cases with your attending on a daily basis, and you should be able to call them if you need to do any further discussion. With my last attending, we would spend 30-60 minutes in his office on a daily basis just to discuss my plans, and then we'd see the patients together.

With regard to didactics - at my program, we have 7-8 hours of didactics every week. Some didactics are more useful than others, but all of them are useful. As interns, we get an hour-long interview skills course on Monday, three hours of formal teaching on Tuesday (1.5 hrs Grand Rounds, 1.5 hrs resident lecture about a translational topic where we learn about the basic science behind novel clinical ideas from an expert in the field), an hour with the supervising PGY4 on Wednesday where we can choose the topic, 1.5 hrs with the vice chair of the department on Thurs to discuss interesting cases and/or pharmacokinetics and/or clinical neuroscience, and Professor's Rounds on Friday where one resident presents an interesting case to one of our full professors, who then subsequently either interviews the patient while we watch (so that we can observe his/her interview skills) or proceeds to teach us about particular aspects of the case. After each of those didactics, I walk out feeling like I know a little bit more about how to be a better psychiatrist.

That said, the didactics mostly teach us subtleties. Rounding with attendings every day is probably the most important thing for learning the basics of how to practice general everyday psychiatry. You don't need to know pharmacokinetics in order to prescribe citalopram 20mg qDay for depression. But I think it helps to be familiar with a lot of the other things, since that forces you to think outside the box on a regular basis and to make sure that you know what you're treating with the drugs that you prescribe.

 

[rkaz]

What you're describing does not sound like adequate teaching or supervision to me. Are you really saying that the residents only round once a week for half an hour with the attending?

You would certainly learn by doing, unfortunately I would hesitate to trust what you learn.

No, they round daily - probably spending a few hours per day rounding with the attending and discussing cases in total... and then the residents put together their notes and see patients on their own in the afternoons. I have heard that the teaching on rounds is good.

The only thing is that there aren't much formal didactics - only 1 hour per week (with it repeating the same curriculum in year 2). This is my main issue. If I am not mistaken, I think Grand Rounds is one hour per month.

They have 1 hour per week of therapy supervision in year 3. I am unsure if that is sufficient either, as I have a strong interest in learning therapy.

I have put together my entire rank list - except this is the one program I still have to figure out how to fit it into the picture. I'd be very VERY happy at this location (as this is the city where I ultimately want to live), but I just need to reconcile the lack of didactics. Also this program has a greater affluent, mostly insured population, so I'd have to try to get 4th year electives in emergency psych or at the state hospital to give me more exposure to the SMI population.

 

[jno]

The only thing is that there aren't much formal didactics - only 1 hour per week (with it repeating the same curriculum in year 2). This is my main issue.

1 hour of formal didactics a week seems very low IMHO. But I'm not sure how real a concern this should be.

 

[notdeadyet]

1 hour of formal didactics a week seems very low IMHO. But I'm not sure how real a concern this should be.

To be honest, I'm not sure how big a deal only having one hour of didactics a week really is, but I would be very worried about what it says about their approach to education.

One hour of didactics, limited supervision, once monthly grand rounds? This does not sound like a very education focused program. I'd also wonder about what post-graduate support they give. If you really love the area, it might not be a deal killer, but it would knock the program down on my list...

 

[Shikima]

Find a program that is heavy on didactics. Also, inquire about faculty being able to philosphoically discuss the finer points of psychiatric care to flesh out diagnoses/personalities, engagement of talk therapy and education on therapeutics.

Ideally the residency needs to be a mentorship, not a slave labor camp.

 

[StECT]

Find a program that is heavy on didactics. Also, inquire about faculty being able to philosphoically discuss the finer points of psychiatric care to flesh out diagnoses/personalities, engagement of talk therapy and education on therapeutics.

Ideally the residency needs to be a mentorship, not a slave labor camp.

I'm not a resident yet, but it makes sense to me that one should want to go a place that offers the highest quality of didactics and supervision for the four years of training.

The quality of didactics was a major factor for me in ranking. I specifically requested all programs I interviewed at to let me attend one of their didactics sessions. Most complied!

 

[MacDonaldTriad]

I think it would be very hard to get a good bead on a program’s quality of didactics during the interview process. I think programs are more similar than different in the first couple of years. It is the PGY-III and PGY-IV material that separates the excellent from the so so. Even if you attend a lecture, you only get to sample one professor. You might see the weakest lecture of the year, or the only good one in a sea of pedestrian lectures. I understand the focus on quantity as that is the easily obtainable data, but I think quality is much more important to learning than quantity. How many superstars are in a department is another measure that can be used, but ask who does most of the teaching. Some well-known academics love to teach and others are not particularly good at it. Some of the best teachers don’t have large reputations. Having said this, it is true that talented people are often talented at many things.

 

[vistaril]

To be honest, I'm not sure how big a deal only having one hour of didactics a week really is, but I would be very worried about what it says about their approach to education.

One hour of didactics, limited supervision, once monthly grand rounds? This does not sound like a very education focused program...

perhaps, but outside of some academic positions it probably wouldn't hurt the person's future job prospects or future income in any way.

 

[StECT]

I think it would be very hard to get a good bead on a program’s quality of didactics during the interview process. I think programs are more similar than different in the first couple of years. It is the PGY-III and PGY-IV material that separates the excellent from the so so. Even if you attend a lecture, you only get to sample one professor. You might see the weakest lecture of the year, or the only good one in a sea of pedestrian lectures. I understand the focus on quantity as that is the easily obtainable data, but I think quality is much more important to learning than quantity. How many superstars are in a department is another measure that can be used, but ask who does most of the teaching. Some well-known academics love to teach and others are not particularly good at it. Some of the best teachers don’t have large reputations. Having said this, it is true that talented people are often talented at many things.

Very good points!

And about the sample variation, I guess I hoped they would make me sit in on their best class that week.

 

[notdeadyet]

perhaps, but outside of some academic positions it probably wouldn't hurt the person's future job prospects or future income in any way.

Well, sure. You could theoretically go to a totally garbage residency program and not have it limit you if you apply to non-competitive jobs, but I'm making the assumption that folks are hoping to go to the best training experience because they want to be the best psychiatrist they can.

 

[vistaril]

Well, sure. You could theoretically go to a totally garbage residency program and not have it limit you if you apply to non-competitive jobs, but I'm making the assumption that folks are hoping to go to the best training experience because they want to be the best psychiatrist they can.

'non-competitive' positions means different things to different people. I'm sure there is a lot of competition for junior faculty positions at UCSF or whatever amongst certain types, but there is also a lot of competition in much different practice settings where those same people may not be the most competitive for those spots(then again they probably wouldnt want them). Of course the really bad programs don't really train most candidates to be well suited for either type, although my guess is hard working candidates who just have it naturally can adapt to well run, high volume inpatient/outpt shops with good business reps and contracts in the community.

I mean the place I'm going isn't competitive in either way either. It's obviously not an academic center and it obviously isn't a well run high volume practice with good payer mix. But I'm just saying I think it would be very possible to go to a pretty bad residency program with terrible clinical sites and still have a rewarding lucrative career that is enjoyable. Many people do.

 

[shan564]

To be honest, I'm not sure how big a deal only having one hour of didactics a week really is, but I would be very worried about what it says about their approach to education.

One hour of didactics, limited supervision, once monthly grand rounds? This does not sound like a very education focused program. I'd also wonder about what post-graduate support they give. If you really love the area, it might not be a deal killer, but it would knock the program down on my list...

I was going to say the same thing. Most of your learning will happen on the wards, so lack of didactics probably won't kill your ability to be a competent psychiatrist. But the quality/quantity of didactics is one of the few objective indicators of the level of emphasis that the program places on education. It's not a direct correlation, but it's certainly a factor.

 

[Shikima]

IMHO, the didactics are necessary to help bring a vocabulary in communicating what's happening to your colleagues as well as to patients. There is no doubt that any leaving residency will be reasonably competent to do the job, but rather having a direct effect upon how you complete the job.