Redefining the general psychiatrist: values, reforms, and issues for psychiatric residency education

The structure and content of general psychiatric residency education must be redesigned to ensure the continued relevance of the profession of psychiatry as managed care and cost containment become more influential in the health care delivery system. The general psychiatrist in this new health care environment must be prepared to participate in a multidisciplinary team of health care professionals, have expertise in treating complex cases that often combine physical and psychological disorders, critically examine the role of psychotherapy, acknowledge patients as active participants in treatment, and integrate clinical and financial decision making. Reformed psychiatric residency curricula should include an expanded range of training settings, preparation for a variety of clinical roles, practice in developing strategies for improved service utilization, and opportunities to develop expertise in neuropsychopharmacology, to work with patients with serious mental illness, and to practice integration of psychotherapy with other core skills. In addition, redesigned curricula should enhance residents' appreciation of the interaction between patients' everyday behavior and mental illness and should provide training in supervision and in utilization review. Redefinition of the structure and organization of psychiatric residency education will depend on the resolution of several key issues such as length of training, financing of graduate medical education, and the role of subspecialization programs.