1999 Newsletter


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President's Column

by Thomas B. Mackenzie, M.D.

You may have heard one of the following. Time in the curriculum is needed for a primary care clerkship that emphasizes ambulatory care. Creating such a rotation will reduce the Psychiatry Clerkship from six to four weeks. Or, faculty gathering information for an LCME self-study asks for the Psychiatry Clerkship goals and objectives. Our organization has anticipated these scenarios.

Owing to the vision of this yearís annual meeting program chair, Amy Brodkey, AMDSEP had a set of clerkship goals and objectives before the cry went out. Thanks to the work of Mark Reed, ADMSEP maintains a LISTSERV that affords members rapid feedback about urgent issues and local solutions. Within hours one can find out what is happening at other institutions, adding valuable cachet to pronouncements made at a curriculum meeting.

At a time when many of us think of organizational affiliation in the Groucho mode (to paraphrase - I wouldnít belong to any club that would have me as a member), ADMSEP meetings remain a sustaining and validating experience for educators, old and new. Old members come year after year and say the same thing, but being great educators make it memorable each time. New members bring a vitality and excitement that is renewing.

ADMSEP is without artifice or facade. Though membership has occasionally advanced a career, it more often has sustained careers in education, supported innovation and increased the probability that the ranks of senior educators at a medical school have psychiatric faculty.

Thomas B. Mackenzie, M.D.
President, ADMSEP

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Fred Sierles, A Personal Tribute

by Myrl Manley, M.D.


At the close of the business meeting at the end of the 25th annual ADMSEP meeting in Samoset, Fred Sierles will rotate off the executive counsel. Fred served as President of ADMSEP from 1993 to 1995 after having held several other executive offices in the years before. Certainly during the two years of his presidency, but also throughout his entire association with ADMSEP, Fred has been a force for change, guiding ADMSEPís transformation into a professional educational organization of national significance. His spearheading our work on the textbook of behavioral science gave us a collaborative enterprise that brought focus and pride of membership which continue undiminished.

Fred has also been an effective advocate for our alliance with sister organizations such as AADPRT, ACP and ACE, and in the process has not only gained ADMSEP national recognition, but taught us much about the politics of organizational work. It may be a weakness of teachers in general (it is certainly mine personally) to get distracted by dreamy idealistic visions of what might be. Fred has helped us move from tilting at windmills to the realm of solid accomplishments in the real world.

One of the things I most love about working with Fred is his passionate belief that our work should be fun, that we should enjoy ourselves, that weíre entitled to have a good time. Few images are as strikingly fixed in my memory as one of my earliest meetings with him when he caught a whiff of something funny, started chuckling, then shaking with laughter, and finally convulsing, face beet red, tears streaming down his face, fists pounding on the table. I though he was asphyxiating and tried to calm my panic as a I mentally rehearsed the Heimlich maneuver, but of course, this was just Fred having a good time, in fact, a fairly routine occurrence.

Fred gives so generously of himself, his advice, counsel, career guidance of junior colleagues, collaboration on professional writing, he will be missed on the council. We hope you stay active in ADMSEP, Fred. Donít go far away.

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Constructing Your Educational Portfolio

by Michael Weissberg, University of Colorado


The following is adapted from Dr. Weissbergís presentation at the 24th annual ADMSEP meeting in Tucson.

When I first heard of "constructing an educational portfolio" it sounded more like educational basket weaving, an activity thought up by educo-hustlers who meet so they could talk about silly things ó a Monte Python sort of thing. You know, group in the morning, constructing portfolios in the afternoon. But, I was wrong.

Done correctly, portfolios will accomplish important things for you. Since you are its author, this process encourages self-reflection and self-improvement and creates a potential context for serious discourse about teaching with your department. And, of course, your portfolio will capture the complexities of your teaching career by documenting what you teach and how you teach, a great help for academic promotion and professional advancement.

The form of your portfolio is that of an album ó word pictures of your work as an educator. Neither the order nor specific categories are prescribed. The following is an amalgam of formats used at the University of Colorado, The Medical College of Wisconsin, and East Carolina University School of Medicine.

Begin with your:

1. Philosophy of Education: Write a 1-2 page summary of your philosophy of education.

This may include discussion of the following:

o Your theory of learning (what happens inside students when they learn)
o The goals of instruction (what should be learned)
o The roles/responsibilities of students in this process
o The roles/responsibilities of instructors in this process
o A description of the variables which promote learning

2. Curriculum development and instructional design

Many of you who present evidence of scholarly activities in curriculum development are also responsible for the development of new or revised courses, clerkships, seminars etc. The process of systematically transforming goals into objectives, methods and materials = instructional design. Include:

o Measurable educational objectives
o Sequencing of instructional units
o Selection of teaching method(s)
o Preparation of materials
o Evaluation of program/curriculum

3. Teaching Skills

This focuses on your teaching techniques and abilities. These techniques include what strategies you use to present/reinforce information, stimulate thinking, discussion and synthesis, the ability to take advantage of those "teachable moments" and to respond to unplanned events. Evidence of teaching competency should use as many of the following as possible:

o Systematic peer reviews: colleagues, departmental evaluation committees, chairperson evaluations etc.
o Systematic student reviews: ratings of instruction, subscription of electives, unsolicited student/peer comments and letters and awards
o Consultant reports: ratings of performance by direct observations, etc.
o Videos of examples of teaching
o The diversity of student audiences

4. Assessment of Learner Performance

This is a very difficult area since ideally measures must have both reliability and validity. The competency to construct/implement reliable and valid assessments is an essential goal for all educators but is accomplished by few. Evidence of this competence should include any of the following:

o Written examinations
o Oral examinations
o Objective Structured Clinical Examinations
o Chart reviews
o Ratings of performance
o Examples of student work (their presentations, posters, articles etc.)

5. Advising/Mentoring

As you know, instruction occurs in informal settings too. Advising, mentoring, participating in non-credit student experiences, collaboration in research, participating in career counseling are all important. Collecting evidence in this area is sometimes difficult but the following will help document your contributions as an informal educator:

o List of advisees and current status (where are they and what are they doing?)
o List of informal advisees. Mentors can ask advisees to write 1-2 page summary of their experiences with you
o Examples of advisee work (their presentations, posters, articles, etc.)

6. Education Administration

Include here your work as course directors, curriculum coordinators, members of residency, departmental, school-wide committees involved with the planning and/or evaluation of education. Provide evidence of:

o Committee membership
o Abilities to recruit instructors
o Provision of feedback to instructors
o Preparation for accreditation
7. Your collaboration with other programs, departments, schools

Include examples of:

o Courses, programs, studies
o Your work products (e.g. syllabi, teaching methods) adopted by other programs, departments, schools

8. Regional/National Scholarship

Typically, scholarship should be peer-reviewed and are of two types: Peer-reviewed presentations and publications and receipt of peer reviewed grants/contracts. Participation in national organizations is a third piece evidence about your reputation. List the following:

o Publications
o Presentations
o Serving as a discussant
o Peer reviewer for educational materials
o Reviewer for regional/national education-related conferences and journals
o Grants/Contracts
o Membership and service in education-related professional organizations

9. Continuing Education

Education is a constantly changing field and you must stay current by learning new skills and polishing old ones. Document all continuing education, both clinical and educator.

10. Awards and Honors

List it all. Include a brief description of the awards if not immediately apparent from the title.

11. Your goals

Write a 1-2 page description of your future plans as an educator. You may want to include:

o Faculty promotion
o Advancement in administrative position
o Future projects
o Future teaching skills you wish to develop
o Plans for continuing education
o Plans for assessment/evaluation

Constructing a portfolio will prove to be a useful exercise for you and benefit your students and school. Just as it is important for departments to undergo periodic self-assessments, so it is for individual faculty members. The construction of an educational portfolio, in my view, is an excellent way to accomplish this important task.

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In and Out of Academia

by Irv Hassenfeld, M.D.


Myrl has kindly invited me to share my thoughts about the past and future of our field. This is a good time for taking stock, as I transition from academia to full time practice of hospital psychiatry. The thing I miss the most, apart from a few treasured colleagues and my secretary of 15 years, whom I can see for lunch, since I have not moved very far from Albany, is my designated parking space. I have gone back to visit it, but alas, someone elseís license plate number proudly claims the space. Instead of Emeritus I would have been more honored had the school retired my old parking spot like the Bulls have done with Michael Jordanís jersey. Now to a Janus-like look backward and forward. These are the best of times and the worst of times for psychiatry.

The Best of Times

It is the best of times because of the manyfold increase in the ways that we are now able to help our patients, as compared with the late 50s and early 60s when I began practicing. At that time we had available to us, phenothiazines, tricyclics, MAOIs, and a few benzodiazepines. I remember the excitement when lithium became available in the early 60s, first as an investigational drug and then as a fully approved agent for bipolar patients. It seemed like a breakthrough miracle drug, rivaling penicillin. For the first time we had the means, not only to treat manic and depressed episodes, but to prevent or reduce, drastically, the incidence of recurrence. Lithium made a dramatic difference in the lives of may patients and their families. We had to wait until the eighties for a similarly exciting breakthrough with the advent of cholmipramine, the first effective treatment for OCD. At first we had to bootleg chlomipramine from Canada where it is an approved agent. This drug, too, rescued many of our patients form constricted lives of misery, and we psychiatrists from the futility of treating OCD patients with psychotherapy alone (An occasional patient responded to MAOIs). More recently clozapine has done for some patients with Schizophrenic Disorder what lithium does for patients with Bipolar disorder. A mother told me that because of Clozaril, she had her daughter back. Another promising development is the movement in psychiatry toward the practice of evidence-based medicine. Todayís computer networks make it possible to stay abreast of cutting edge developments in treatment strategies.

The Worst of Times

This is the worst of times because it is becoming more and more difficult to maintain professional values in todayís health care climate. The fallout from this climate for the practice of psychiatry includes: loss of patient confidentiality, and sometimes, as a result, loss of patience confidence; curtailed stays in hospital and outpatient visits, making it all but impossible to do much more than stabilize and apply emotional band-aids to our patients; "no risk" management, making it difficult to apply clinical judgement, which implies, occasionally taking acceptable risks; and long-distance "clinical supervision" by managed care physicians, who never meet, let alone, examine our patients. This is only a partial list to which all of you could readily add, based on your own experiences. Let me close with an example from my experience, illustrating what I believe is a serious, but overlooked, assault on our professional values: For progress notes to be clinically useful, they should accurately reflect the clinicianís assessment of the patientís symptoms, thinking, feeling, mood, behavior etc. However, since insurance companies are reluctant to pay for inpatient care, if they believe an alternative level of care, such as partial hospitalization, will suffice, the clinician is pressured by the hospital to record the presence of symptoms even after they have resolved, and to exaggerate the severity of those symptoms that continue to be present. If the clinician doesnít produce these fictional progress notes, it is very likely that the patientís stay will not be paid for as soon as suicide or homicide disappears as an issue. This can lead to premature discharge of a partially improved but still depressed patient whose risk of suicide is considerable. But even if you beat the odds: the patient survives and is not quickly rehospitalized, the act of massaging progress notes, expedient as it might be, and done for a good cause, remains highly unprofessional, if not bordering on the unethical. This is but one example of the erosion of professional values which is sure to continue, and very likely to multiply, into the foreseeable future.

All things considered, psychiatry remains an exciting and challenging profession, in which it is more possible than ever to do considerable good, while doing well, and with effort, to maintain your principles.

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Cyberspace Update

by Mark Reed, Dartmouth Medical School


As we approach the end of our second year in Cyberspace both our use of the ADMSEP Listserve and Webpage have grown. I will review where we are with each of these endeavors and explore ways we can enhance them further.

I am especially pleased with the growth of our listserve. We now have just over 80 members on the listserve which has become an actively used medium for all of us to both keep in touch between annual meetings and learn from each otherís experience so we donít have to reinvent the wheel every time we encounter a challenging situation.

I save all our listserve discussions and put them in a folder/library to reconsult when I find myself confronted with issues we have discussed recently over email. I have gone back to our "archives" frequently and been very pleased with the time saving pearls that I have found. As I reviewed our topics of conversations over the last year I was impressed by their breadth and how many of the topics are also on the program for our meeting in Maine to be explored in more depth. The topics we talked about include: The ADMSEP test bank, away electives, Sexual History, textbook suggestions for many different topics, neuroscience courses, neuropsychiatry newsletter, family medicine/psychiatry residencies, summer fellowships, humanities, APA Task Forces, Cinema and Psychiatry, clerkship under siege, annual meeting info, sex, osce cases, behavioral science course syllabus, cultural psychiatry award, sexual harassment, papers in philosophy, psychotherapy electives for medical students, evaluation of learning disabilities, psychiatry in primary care, case based teaching in large groups, combined clerkships, and appropriate use of our listserve.

The last topic "appropriate use of our listserve" I consider evidence of our listserve maturing. I think all of our topics have been appropriate. The main question is when to respond to the entire listserve and when to respond to the individual who sent the message. One great thing about our listserve is we all benefit from the questions other members ask and the suggestions others have. I think all questions and original responses should be addressed to the entire listserve. Certain responses are probably best made to the individual to save 80 other people the time of opening and reading the message. These include individual communications (i.e. if I sent an email to the entire listserve to say I was also interested in copy of someoneís syllabus). Most of these responses to the whole group are unintentional, as many people donít realize that by hitting "reply to sender" to a listserve message it not only goes to the person who wrote the message but the entire group as well. To respond to an individual you have to "highlight and copy" their email address from the "title" section of their message and then "paste" it in the address part of note you are composing. Addresses are highlighted in different ways depending on your computer system. I will give a couple of examples of what might appear under the title section and how to find an individualís email address:

"<:Reply-To": "ADMSEP Bulletin." <ADMSEP@listserv.dartmouth.edu>
"<:Sender": "ADMSEP Bulletin." <ADMSEP@listserv.dartmouth.edu>
"<:From": "Levine, Ruth" <rlevine@UTMB.EDU>
Subject: Re: FW: OSCE case needed -Reply -Reply
"<:To": ADMSEP@listserv.dartmouth.edu

For the above title section if I wanted to reply only to Ruth I would highlight only what was between the arrows after her name...i.e.

rlevine@UTMB.EDU

The above address should work. If I tried to send an email to everything after "From:" i.e. sent it to the following address I would get back a message that it was undeliverable.

"Levine, Ruth" <rlevine@UTMB.EDU>

What some people get in their title section defers. I get addresses surrounded by < > and it looks like from one of Ruthís recent messages she gets something a bit different. This is from the title section of Ruthís recent message:

"<:From": Robert Bright[SMTP:bbright@POL.NET]
"<:Reply To": ADMSEP Bulletin
Sent: Thursday, March 18, 1999 3:02 PM
"<To": ADMSEP@LISTSERV.DARTMOUTH.EDU
Subject: Re: FW: OSCE case needed
So for people with title sections that look like this and you wanted to respond only to Bob then highlight whatever follows the SMTP: not including the [ ]. So you would highlight:

bbright@POL.NET

Our Webpage has also been growing. The address is:
http://www.dartmouth.edu/~admsep/  (updated= http://www.admsep.org)

Under "National Meeting" we have the program, registration material, and directions for our meeting this June in Maine. There are also email links to our program chair-Amy Brodkey and facilities chair Darlene Shaw if anyone has questions. Under "Resources" we have added a section on movies that illustrate psychopathologies that had many contributors from our listserve (I suspect we will keep updating this). We have also added a bibliography on Cultural Psychiatry to this section that was compiled by Francis Lu.

Please let me know if you have further ideas for our webpage. If there are specific things you are interested in seeing on the webpage send them to me. We are on a Mac system here at Dartmouth so sometimes enclosures or discs written with IBM compatible programs are a bit more of a challenge to open. If you do send me an enclosure or disc, Office 98 is a fairly friendly thing to write it in. If sending a document in an enclosure or on a disc, please let me know what program was used to write it.

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