Important medical decisions: Using brief motivational interviewing to enhance patients' autonomous decision-making.

Goals: The use of motivational interviewing (MI) when the goals of patient and physician are not aligned is examined. A clinical example is presented of a patient who, partly due to anxiety and fear, wants to opt out of further evaluation of his hematuria while the physician believes that the patient must follow up on the finding of hematuria.

Background: As patients struggle in making decisions about their medical care, physician interactions can become strained and medical care may become compromised.

Medical students as teachers: how preclinical teaching opportunities can create an early awareness of the role of physician as teacher.

Background: As future physicians, questions about when medical students realize they will have to teach remain under-explored.

Aim: To understand when students serving in pre-clinical teaching roles make the connection between teaching and being a physician.

Methods: Medical students involved in a peer instruction program included: (1) archived first-year student interview candidate data (n = 60/150); (2) focus groups of first-year students selected as instructors (n = 16/60); and (3) focus groups of second-year students (n = 16/24) who taught for the program.

The advisory dean program: a personalized approach to academic and career advising for medical students.

Advising and mentoring programs for medical students vary in their official names, scope, and structures. Catalyzed by negative student feedback regarding career advising and a perceived disconnection between faculty and students, in academic year 2003-2004, Columbia University College of Physicians and Surgeons implemented its formal Advisory Dean (AD) Program and disbanded its former advising system that used faculty volunteers. The AD Program has become a key element for enhancing the students' professional development throughout their student training, focusing on topics including, but not limited to, career counseling, professionalism, humanism, and wellness resources.

How endangered is dynamic psychiatry in residency training?

The future of psychodynamic psychotherapy in residency training is in jeopardy. New priorities and forces currently aligned in academic psychiatry challenge the importance of psychodynamic psychotherapy and, by extension, its core concepts of the unconscious, defense and resistance, transference and countertransference, and the past repeating itself in the present. The exit of psychoanalysts from academic centers in the last quarter of the past century was propelled by forces including biological psychiatry, managed care, and competition from other mental health disciplines.

Psychotherapy competencies: development and implementation.

New requirements by the Psychiatry Residency Review Committee of the Accreditation Council for Graduate Medical Education maintain that residents must be competent in five specified psychotherapies. This shift toward evidence-based education and assessment highlights psychotherapy as an integral part of a psychiatrist's training and identity, while introducing accountability of training programs, faculty, and individual residents. Training directors must now find the resources in faculty, patients, and residency teaching time to teach, supervise and assess residents so they graduate with competency.