Regular Articles
The Role of Medical School Electives in the Choice of Child Psychiatry as a Subspecialty Walter Weintraub, M.D. s. Michael Plaut, Ph.D. Phillppe Weintraub, M.D. Part ofchild psychiatry's recruitment problem stems from defections among medical students who were planning careers in child psychiatry when theyentered medical school. The auihors present data showing thatbetween 1974 and 1984 University ofMaryland Medical School graduates specializing in psychiatry were more than twice aslikely to enter fellowships in child andadolescent psychiatry if theywere participants in theCombined Accelerated Program in Psychiatry (CAPP) asmedical students. The CAPP, a 4-yetlr medical school track thatcontains a strong child psychiatry component, appetlrs to prevent theerosion ofstudents' interest in child psychiatry.
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ecruitment problems eontinue to beset the field of ehild and adolescent psyehiatry . A number of educators believe that many medical students and psychiatrie residents begin their training with a positive view of ehild psyehiatry. Negative socialization experienees in medical school and faulty integration ofehild psyehiatry into the adult residency curriculum apparently lead to loss of interest by some medical students and psychiatrie residents in ehild psyehiatry fellowships (1,2). From the Department of Psychiatry, University of Maryland School of Medicine, Baltimore, where Dr. W. Weintraub is a clinical professor and Dr. Plaut is an associate professor and dean of Student Affairs; and the Department of Psychiatry, University of Colorado School of Medicine, Denver. where Dr. P. Weintraub is an assistant professor and director of the Child Psychiatry Clinic. Address reprint requests to Dr. Walter Weintraub at the School of Medicine, University of Maryland at Baltimore, Department of Psychiatry, 645 West Redwood Street, Baltimore, MD 21201 . Copyright © 1991 Academic Psychiatry.
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Opinions differ as to when in the course of medical school education and psychiatrie residency training intervention might be most helpful for recruitment into ehild psyehiatry . Certain aeademicians favor enrichment of the adult residency experienee by providing early eontaet with ehildren and ehild faculty (1).Others (3,4) emphasize the importanee for recruitment of eertain medieal school experienees, such as: 1) direct eontact with disturbed ehildren 2) eontact with ehild and adolescent psyehiatry faculty and researehers 3) curriculum exposure to ehild development, the family cyde, and emotional problems of ehildren 4) maintenanee of professional roles among the various disciplines involved in the teaching of ehild psyehiatry 5) medical school teaehing by ehild fellows
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6) the use of eonsultation and liaison elinieal sites 7) the stressing of teaehing excellence 8) the formation of a "psychiatric club" for medical students interested in child psychiatry 9) summer fellowships 10) combating negative medical school socialization experiences 11) the use of ehild psychiatry faculty as student advisers THE COMBINED ACCELERATED PROGRAM IN PSYCHlATRY What is the effect on recruitment into child and adolescent psychiatry of a 4-year medical school track that offers to participants most of the experienees described above? The Combined Accelerated Program in Psychiatry (CAPP) was initiated in 1970 by the University of Maryland as an effort to explore new approaches to medical education. This behavioral science and psychiatry track enables medical students to enroll in a psychiatrie specialty training program while continuing in the usual curriculum, beginning in the freshman year and continuing through the 4 years of medical school. Participants are selected from applicants with an interest in the social and behavioral aspects of medicine. No pledge of a career interest in psyehiatry is required, and no preference is given to applicants planning careers in psychiatry. Twelve students are admitted to the program each year, usually from about twice that number of applicants. CAPP students are chosen in the following manner. The program director sees all applieants briefly and screens out obviously unsuitable students. Reasons for rejection at this stage include immaturity, gross psychopathology, and a misunderstanding of the goals of the program. Applieants may withdraw at this point when they realize that the CAPP requires more time than they are willing to give. The second stage of the selection process consists of two interviews, one with \ \.\ll! \llll'-') ( II I\ IR)
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a CAPP faculty member and one with an upper-class CAPP student. The written reports of the two interviewers are referred to a committee that makes the final selections. A student's chances for acceptance into the program are improved if he or she 1) has an unusually impressive college record, 2) has a special accomplishment (Ph.D., published research, etc.), 3) belongs to a minority group, or 4) comes from rural Western Maryland or the Bastern Shore rather than from metropolitan Baltimore or Washington, O.c. This preference for rural applicants helps ensure a geographie balance. From the first month of medical school, the CAPP provides an unfolding progression of combined didactic and clinical experiences in the behavioral sciences and in clinical psyehiatry. The heart of the program is supervised psychotherapy with adults, ehildren, and families beginning in the sophomore year. Ouring the time students do psychotherapy, they may receive up to 3 hours per week of individual supervision from CAPP faculty. The students get a great deal of personal attention in other ways also. They are taught psychiatrie theory in smallgroup seininars by senior faculty and are offered individual psychotherapy by experienced psychoanalysts at reduced fees. CAPP students derive a number of extracurricular benefits from the program also. They are given preference by the Oepartment of Psychiatry when applying for fellowships and jobs, are invited into professors' hornes for dinners and parties, and often develop close relationships with many of the psychiatrie faculty. We have estimated that approximately 40% of undergraduate teaehing time is absorbed by CAPP students, who eonstitute less than 10%of the medical student body. Readers wishing additional information about the goals and strategies of the CAPP are referred to previous publications (5,6). Although there have been minor ehanges in the curriculum and elinieal offerings of the CAPP during the 20 years of its ' \\
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existence, supervised psychotherapy with children and a child case conference have always been part of the program. The inclusion of a strong child psychiatry component is consistent with the program's emphasis on a developmental perspective. University of Maryland child psychiatry facu1ty and child psychiatry fellows have served as seminar leaders and psychotherapy supervisors.
TRAINING IN PSYCHIATRY FOR NON-eAPP UNNERSITY OF MARYLAND STUDENfS The Department ofPsychiatry offers a strong undergraduate program for non-CAPP students. During the preclinical years, 150 hours are devoted to teaching the behavioral sciences and psychopathology. Large-group lectures and small postlecture discussion groups are used for instruction. A 6-week junior derkship, which combines outpatient and inpatient assignments, completes the formal requirements. Hands-on dinical experience with children and adolescents is not required of non-CAPP medical students. METHODS AND RESULTS To study the influence of the CAPP on recruitment into child and adolescent psychiatry, a list of all University of Maryland School of Medicine graduates choosing psychiatry as a specialty between 1974and 1984 was compiled. These dates were chosen to coincide with the year of the first CAPP graduating dass and the last year for which data about entrance into child and adolescent fellowships are available. Information about choice of psychiatry as a specialty and child and adolescent psychiatry as a subspecialty was obtained from the American Psychiatrie Association, CAPP research files maintained by the Department of Psychiatry, the School of Medicine's Office of Student Affairs, and the Directory of Medical Specialists (7). 1
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Between 1974 and 1984/ 11 dasses graduated from the University of Maryland School of Medicine. One hundred twentyfour graduates chose psychiatry as their specialty. Of the 124 graduates choosing psychiatry, 61 had participated in the CAPP and 63 had taken the regular psychiatry curriculum. Nineteen (30.6%) of the former CAPP students entered child and adolescent fellowships compared to only 9 (14.3%) of the non-CAPP graduates (X2=4.1, df=1, p
The Role of Medical School Electives in the Choice of Child Psychiatry as a Subspecialty Walter Weintraub, M.D. s. Michael Plaut, Ph.D. Phillppe Weintraub, M.D. Part ofchild psychiatry's recruitment problem stems from defections among medical students who were planning careers in child psychiatry when theyentered medical school. The auihors present data showing thatbetween 1974 and 1984 University ofMaryland Medical School graduates specializing in psychiatry were more than twice aslikely to enter fellowships in child andadolescent psychiatry if theywere participants in theCombined Accelerated Program in Psychiatry (CAPP) asmedical students. The CAPP, a 4-yetlr medical school track thatcontains a strong child psychiatry component, appetlrs to prevent theerosion ofstudents' interest in child psychiatry.
R
ecruitment problems eontinue to beset the field of ehild and adolescent psyehiatry . A number of educators believe that many medical students and psychiatrie residents begin their training with a positive view of ehild psyehiatry. Negative socialization experienees in medical school and faulty integration ofehild psyehiatry into the adult residency curriculum apparently lead to loss of interest by some medical students and psychiatrie residents in ehild psyehiatry fellowships (1,2). From the Department of Psychiatry, University of Maryland School of Medicine, Baltimore, where Dr. W. Weintraub is a clinical professor and Dr. Plaut is an associate professor and dean of Student Affairs; and the Department of Psychiatry, University of Colorado School of Medicine, Denver. where Dr. P. Weintraub is an assistant professor and director of the Child Psychiatry Clinic. Address reprint requests to Dr. Walter Weintraub at the School of Medicine, University of Maryland at Baltimore, Department of Psychiatry, 645 West Redwood Street, Baltimore, MD 21201 . Copyright © 1991 Academic Psychiatry.
;
~
Opinions differ as to when in the course of medical school education and psychiatrie residency training intervention might be most helpful for recruitment into ehild psyehiatry . Certain aeademicians favor enrichment of the adult residency experienee by providing early eontaet with ehildren and ehild faculty (1).Others (3,4) emphasize the importanee for recruitment of eertain medieal school experienees, such as: 1) direct eontact with disturbed ehildren 2) eontact with ehild and adolescent psyehiatry faculty and researehers 3) curriculum exposure to ehild development, the family cyde, and emotional problems of ehildren 4) maintenanee of professional roles among the various disciplines involved in the teaching of ehild psyehiatry 5) medical school teaehing by ehild fellows
\
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,
\
I .
J ' . \ -,
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, .
I \,!
' ..\./;
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6) the use of eonsultation and liaison elinieal sites 7) the stressing of teaehing excellence 8) the formation of a "psychiatric club" for medical students interested in child psychiatry 9) summer fellowships 10) combating negative medical school socialization experiences 11) the use of ehild psychiatry faculty as student advisers THE COMBINED ACCELERATED PROGRAM IN PSYCHlATRY What is the effect on recruitment into child and adolescent psychiatry of a 4-year medical school track that offers to participants most of the experienees described above? The Combined Accelerated Program in Psychiatry (CAPP) was initiated in 1970 by the University of Maryland as an effort to explore new approaches to medical education. This behavioral science and psychiatry track enables medical students to enroll in a psychiatrie specialty training program while continuing in the usual curriculum, beginning in the freshman year and continuing through the 4 years of medical school. Participants are selected from applicants with an interest in the social and behavioral aspects of medicine. No pledge of a career interest in psyehiatry is required, and no preference is given to applicants planning careers in psychiatry. Twelve students are admitted to the program each year, usually from about twice that number of applicants. CAPP students are chosen in the following manner. The program director sees all applieants briefly and screens out obviously unsuitable students. Reasons for rejection at this stage include immaturity, gross psychopathology, and a misunderstanding of the goals of the program. Applieants may withdraw at this point when they realize that the CAPP requires more time than they are willing to give. The second stage of the selection process consists of two interviews, one with \ \.\ll! \llll'-') ( II I\ IR)
j)
I! "f
a CAPP faculty member and one with an upper-class CAPP student. The written reports of the two interviewers are referred to a committee that makes the final selections. A student's chances for acceptance into the program are improved if he or she 1) has an unusually impressive college record, 2) has a special accomplishment (Ph.D., published research, etc.), 3) belongs to a minority group, or 4) comes from rural Western Maryland or the Bastern Shore rather than from metropolitan Baltimore or Washington, O.c. This preference for rural applicants helps ensure a geographie balance. From the first month of medical school, the CAPP provides an unfolding progression of combined didactic and clinical experiences in the behavioral sciences and in clinical psyehiatry. The heart of the program is supervised psychotherapy with adults, ehildren, and families beginning in the sophomore year. Ouring the time students do psychotherapy, they may receive up to 3 hours per week of individual supervision from CAPP faculty. The students get a great deal of personal attention in other ways also. They are taught psychiatrie theory in smallgroup seininars by senior faculty and are offered individual psychotherapy by experienced psychoanalysts at reduced fees. CAPP students derive a number of extracurricular benefits from the program also. They are given preference by the Oepartment of Psychiatry when applying for fellowships and jobs, are invited into professors' hornes for dinners and parties, and often develop close relationships with many of the psychiatrie faculty. We have estimated that approximately 40% of undergraduate teaehing time is absorbed by CAPP students, who eonstitute less than 10%of the medical student body. Readers wishing additional information about the goals and strategies of the CAPP are referred to previous publications (5,6). Although there have been minor ehanges in the curriculum and elinieal offerings of the CAPP during the 20 years of its ' \\
1,\ \1 1 \
I1 \
1J 1 11(
\
1 "\
1 1\
)\ \1 I
~
1l 1 \ I "
existence, supervised psychotherapy with children and a child case conference have always been part of the program. The inclusion of a strong child psychiatry component is consistent with the program's emphasis on a developmental perspective. University of Maryland child psychiatry facu1ty and child psychiatry fellows have served as seminar leaders and psychotherapy supervisors.
TRAINING IN PSYCHIATRY FOR NON-eAPP UNNERSITY OF MARYLAND STUDENfS The Department ofPsychiatry offers a strong undergraduate program for non-CAPP students. During the preclinical years, 150 hours are devoted to teaching the behavioral sciences and psychopathology. Large-group lectures and small postlecture discussion groups are used for instruction. A 6-week junior derkship, which combines outpatient and inpatient assignments, completes the formal requirements. Hands-on dinical experience with children and adolescents is not required of non-CAPP medical students. METHODS AND RESULTS To study the influence of the CAPP on recruitment into child and adolescent psychiatry, a list of all University of Maryland School of Medicine graduates choosing psychiatry as a specialty between 1974and 1984 was compiled. These dates were chosen to coincide with the year of the first CAPP graduating dass and the last year for which data about entrance into child and adolescent fellowships are available. Information about choice of psychiatry as a specialty and child and adolescent psychiatry as a subspecialty was obtained from the American Psychiatrie Association, CAPP research files maintained by the Department of Psychiatry, the School of Medicine's Office of Student Affairs, and the Directory of Medical Specialists (7). 1
:
Between 1974 and 1984/ 11 dasses graduated from the University of Maryland School of Medicine. One hundred twentyfour graduates chose psychiatry as their specialty. Of the 124 graduates choosing psychiatry, 61 had participated in the CAPP and 63 had taken the regular psychiatry curriculum. Nineteen (30.6%) of the former CAPP students entered child and adolescent fellowships compared to only 9 (14.3%) of the non-CAPP graduates (X2=4.1, df=1, p
