Hi everyone, I am a psychology student and I am wondering if there are different training models in psychiatry like how there is the boulder model, vail model and scientist model in psychology. Any help is appreciated!
Training models in psychiatry?
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There is significant variation on the emphasis of psychotherapy in training programs. The overall move has been to a more "biologic" training paradigm, with some programs only providing rudimentary training in CBT, supportive, and psychodynamic therapies. Programs associated with a stronger academic presence trend toward more complete psychotherapy education, while community based programs often focus on medication management.
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Medical school is medical school (expect MD vs DO, I suppose).
In residency (in psychiatry), there is much variability placed on orientation/approach, psychotherapy, the social/environmental vs biologic causes of psychopathology, etc. But no, nothing really equatable to Boulder vs Vale vs Delaware conference (i.e., clinical science) models.
In residency (in psychiatry), there is much variability placed on orientation/approach, psychotherapy, the social/environmental vs biologic causes of psychopathology, etc. But no, nothing really equatable to Boulder vs Vale vs Delaware conference (i.e., clinical science) models.
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Generally residency often has an intensive/emergency-->routine training path. In most residencies there's a lot of inpatient hospital work the first 2 years, as well as emergency evaluations (ER, etc). Year 3 is often, but not always, a pure outpatient year. Year 4 varies between programs. As others have stated, the larger variability is in how psychotherapy is taught/incorporated, with some beginning 1:1 therapy cases as early as 1st year (most start in 2nd or 3rd year). Then some residencies have different "tracks," such as community health, research (often for MD/PhDs), psychotherapy focused, etc.
I've never heard of anyone calling these different "models" of training, but mostly just areas of emphasis.
I've never heard of anyone calling these different "models" of training, but mostly just areas of emphasis.
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there is no model of psychiatric training. which is possibly the major problem with the training.
D
deleted343839
On the other hand, psychology created separate "models" and look where that got us.
All psychiatrists are first and foremost clinicians, so we don't have models in the way you refer to them. The closest is the idea of clinical competency. Every resident is expected to be able to perform a set of clinical tasks in a relatively autonomous basis by the end of training.
There are programs with research tracks, but that mostly implies more protected time for research and dedicated mentoring.
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As a psychiatry resident I don't know the story there. Has it been problematic?
D
deleted343839
In my opinion, yes, it has been problematic. I'll give my point of view in a nutshell.
Historically, psychologists' training was grounded in research methods and behavioral science coupled with closely supervised clinical training. This was (and still is) known as the "scientist-practitioner" model. In the 1970s, a new model, known as the "practitioner-scholar" model, emerged with presumably greater training emphasis on clinical practice. This gave rise to the PsyD degree - a professional degree - as an alternative to the traditional PhD.
In practice, the reputable, high-performing PsyD programs look an awful lot like PhD programs. And, contrary to the goals of the training model, PsyD students finish their training with no more clinical clock hours, on average, than do PhDs. Meanwhile, there are a glut of mediocre or downright bad PsyD programs, many of which are operated by for-profit institutions, and it is widely believed that graduates of these programs are flooding the market. The math behind this is simple: some PsyD programs have class sizes 10 times that of a typical PhD program.
There are many well-trained PsyDs out there, but my point is that splitting off the training models didn't accomplish much, and it had a really worrisome unintended consequence. Psychology is, at its roots, a behavioral science. In my opinion people who aren't willing to engage with the scientific aspects (that would include developing expertise in research methods, psychometrics, stats, etc.) really don't belong in our field.
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^ This.
Where physicians get into trouble is when we start trying to get tribal. Then you have Group A with one set of ideas and Group B with another and despite assurance of keeping an open mind, people tend to get tunnel vision for selecting evidence that supports their views and discarding information that refutes their views.
You get some of the biological vs. psychotherapeutic thing, but it's so asinine to make that false dichotomy that few participate. You will occasionally find psychiatrists that feel the psychiatric medications have minimal use and cherry pick their evidence to show lack of efficacy. You will also find psychiatrists that feel that psychotherapy is largely sham and cherry pick their evidence to show lack of efficacy.
Avoid "models" and tribes and philosophies. Use what works and avoid what doesn't, question why things work the way they do, keep an open mind, and don't have a favorite anything in medicine.
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Perhaps this is similar to the physician/practitioner models in terms of educational philosophy and educational variability.
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Psychology has long-standing problem with defining what, exactly, it means to be a "Psychologist." Some view it through the lens of what they do. Doing psychological clinical work (therapy, consultation, and assessment/testing) is NOT what being a "psychologist" means in my mind. Its more than that...
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We get that a bit, though it's self-proclaimed "psychopharmacologists," meaning a psychiatrist who doesn't do therapy. Personally I believe it's a generational phenomenon in our field, with the middle generation (training 80s-90s) not doing any therapy, but those before doing a lot (analytic), and those since varying (since newbies are often trained by that middle generation, but are prioritizing therapy more).
I think the psychiatry's identity crisis is: are we glorified, medication dispensing social workers or limited, behavioral neurologists? Neither of those two extremes are particularly satisfying for most psychiatrists, but every program basically expects us to be competent throughout that spectrum. I know a lot of people mention a psychotropic/psychotherapy divide, but I think that's overstated. I don't know a single "biological psychiatrist" that doesn't believe psychotherapy can be effective (or doesn't have empirical merit), and no psychiatrist that has been through an adult residency believes there is no use for medication.
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I think there are quite a few psychiatrists who would be quite happy being behavioral neurologists though the overwhelming majority of psychiatrists have quite frankly woeful knowledge of neuropsychiatric disorders. There are quite a few psychiatrists who don't believe in psychotherapy at all, and even more that don't believe that psychiatrists should be doing psychotherapy. It's much rarer, but there are certainly psychiatrists who don't believe in medication or chemical treatment.
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Unfortunately, I can't get the results I need without my large staff of therapists.
That's really unfortunate. I've met psychiatrists who feel there's no justification to pay psychiatrists a premium for psychotherapy, or don't see any evidence that we do it better than non-MD's. But a psychiatrist who "doesn't believe in psychotherapy" is like an orthopod that "doesn't believe" in PT or a voter that believes Donald Trump is brilliant real estate developer. The evidence is stacked against them, and they basically have to be delusional to believe otherwise. And the anti-medication psychiatrists are generally at the fringe and not dictating training (or at least I hope not).
One emerging model seems to be fast-tracking into a specialty, so that you have less time devoted to long-term therapy cases and more time focusing on an area of interest (geri, CL, addiction, etc.) As of now, for better or worse, we're generally responsible for the administration of mental health in America, so we need to know and have a high level of expertise with all elements and tools in the arsenal.
