Medical Students' Experiences of Unplanned Leaves of Absence.

Context: Many medical students take leaves of absence (LOA), both planned and unplanned. Unplanned LOA relate to personal or academic situations which arise and create the need for a student to temporarily suspend their medical education. This can be a high-stakes decision for the student and the school.

Obstacles to early career psychiatrists practicing psychotherapy.

Though psychiatric residents are expected to be competent psychotherapists on graduation, further growth in skill and versatility requires continued experience in their ongoing career. Maturity as a psychotherapist is essential because a psychiatrist is the only mental health provider who, as a physician, can assume full responsibility for biopsychosocial patient care and roles as supervisor, consultant, and team leader. Graduating residents face an environment in which surveys show a steady and alarming decline in practice of psychotherapy by psychiatrists, along with a decline in job satisfaction.

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.

Sustaining an advisory dean program through continuous improvement and evaluation.

Purpose: In 2003, the advisory dean program at Columbia University College of Physicians and Surgeons was created to better connect students and faculty by supporting student academic progress and improving career advising. With the program in its eighth year, the authors were interested in identifying key factors in maintaining ongoing vitality and effectiveness.

Method: In 2011, the authors conducted a reflective analysis to study the program, using available information from dean interviews, student surveys, meeting agendas, and program leader reflections, aided by the Bolman and Deal four-part framework for organizational functioning (structural, human resource, political, and symbolic).

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.

The RRC mandate for residency programs to demonstrate psychodynamic psychotherapy competency among residents: a debate.

Objective: The Residency Review Committee (RRC) requirement that residents must achieve competency in psychodynamic psychotherapy has generated considerable deliberation.

Methods: The authors debated this subject at the 2004 American Psychiatric Association (APA) meetings.

Results: Arguments favoring current requirements emphasize the importance of psychodynamic psychotherapy for psychiatric training and practice, as essential skill and as part of core psychiatric identity.

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.

Assessing the subjective experience of being a participant in psychiatric research.

Objective: To address both clinical and ethical concerns in psychiatric research, the study assessed the subjective experience of being a participant in a feasibility study of outcome in long-term psychodynamic psychotherapy and psychoanalysis.

Method: A questionnaire assessing positive and negative reactions to three typical research methodologies (self-report questionnaires, structured diagnostic interviews, and tape-recording of sessions) was administered to 23 patient-therapist pairs.

Results: Patients reported that questionnaires and interviews were slightly to moderately helpful in promoting self-realization and facilitating therapy, and not at all to slightly intrusive and disruptive.

Can we do psychoanalytic outcome research? A feasibility study.

Despite the widespread use of long-term psychodynamic treatments, methodologically rigorous outcome studies have not been conducted. The authors describe the results of a feasibility study designed to (1) investigate whether patients in psychodynamic treatment, including psychoanalysis, could be recruited and retained as research subjects, (2) determine patient and therapist compliance with self-report measures, rater-administered structured interviews and session audiotaping and (3) obtain pilot data on changes in these measures after one year of treatment. Nine patients entering psychoanalysis and fifteen entering psychodynamic psychotherapy were studied at baseline, six months and one year.

A match made in heaven? A pilot study of patient-therapist match.

The authors report on a study of patient-therapist match in 50 psychodynamic psychotherapy dyads. Sixty-six percent of patients and therapists agreed about the quality of the match, with 58% of patients and 56% of therapists reporting that the match was positive. Positive match correlated with positive patient and therapist assessments about the progress and process of therapy, but not with perceived similarity of personal characteristics.