The psychiatrist and family medicine: a different training approach

A unique 8-year training programme for 110 family medicine residents is described. The psychiatrist works in a family medicine setting with the staff doctors, residents, and patients. The approach evolved because patients wanted a brief problem intervention, and because doctors wanted rapid and efficient methods to identify and treat problems, without using a psychodynamic model. For empirical data collection and clear problem description, a behavioural model is employed. For assessment and therapy, a problem-orientated approach is emphasized, which is rapidly acquired and effectively applied. 'Diagnoses' are not used unless relevant, and paradigms or methods of handling common patient problems are employed. The residents learn in groups and develop skills through supervision of actual patient encounters. There is a phase progression of skill acquisition which is reinforced by the staff doctors. Eighty-seven per cent of the residents achieve the required objectives, and can apply and utilize an approach geared to the needs and realities of everyday practice.