In recent years, psychiatric residents have been increasingly interested in the American Psychiatric Association. The APA has shown a corresponding interest in listening to the concerns of the Members-In-Training (MITs) and integrating their ideas into its policies. Much of this information has traditionally come from the more than 70 psychiatry residents appointed to different councils and components of the APA. These residents include fellows associated with the APA (Glaxo/Wellcome, Mead Johnson, and CHMS), members of the Committee of Residents and Fellows (CORF), Area MIT Assembly Representatives, and the MIT Trustee and the MIT Trustee-Elect.
In recent months, it has become evident that the views presented by the appointed residents to the governing bodies of the APA may at times reflect their personal opinions and not “the residents' opinions.” This has raised the issues of communication among and representation of residents. More fundamentally, it has raised the issue of what the APA is for residents, what residents want it to be, and how to make it more resident-friendly.
As a response to the need for a forum where all residents could voice their concerns, obtain information about organizational activities, and suggest policy, resident leaders decided to organize a Residents' Summit during the 1997 annual meeting of the APA in San Diego. Among the organizers of the summit were two Fellows of the American: Carlos Blanco (1996-97) and Donna Chen (1997-98). The Residents' Summit was sponsored by all the resident groups in the APA — something that had never happened before.
Organizing the summit was a fascinating experience. Most of the preparation was done via e-mail, although it was not initially planned to be that way. E-mail allowed the resident organizers to send simultaneous messages to many people. They did not need to coordinate schedules for different institutions and time zones and were able to have very lively discussions on controversial topics. It was astounding to see how the residents could brainstorm ideas, solve disagreements, organize subcommittees, and assign tasks via e-mail. Most of the organizers met each other for the first time in San Diego one or two days before the summit.
The summit took place in two separate sessions on consecutive days. A high percentage of residents attended both sessions. Four main issues were discussed:
Communication between resident representatives and their constituencies. Most residents do not know how to make their voices heard in the organization or even how to reach their representatives. Resident leaders are in the process of establishing overlapping resident communication networks. The main line of communication will continue to be the APA's GRASSMITS (from grassroots and MITs), the residents' e-mail communication system . The next level will be a network of chief residents (or designates) throughout the country. This will permit current information to be sent to all training programs. Finally, an additional network of resident representatives at the district branch level is being organized. Publicizing the list of all residents appointed to APA components will enhance their role; discussions between the components and the residents will help coordinate the actions of residents sitting on different components.
Mentorship. Most residents at the summit felt that one of the most important aspects of training and the acquisition of professional identity comes from having mentors. At present, the APA's Office of Research runs a mentorship program for residents. There are other mentorship opportunities, such as the programs run by AADPRT and The American. However, there is no one place in which residents can learn about these programs. The plan is to publicize the existing mentorship programs and try to add to them, so that residents interested in administrative opportunities or political activism can also find appropriate mentors. Chen, the current representative of the Mead Johnson Fellows to the APA Board of Trustees, will work with a group of residents to develop specific proposals to achieve this goal.
Special problems of minorities. The discussion of minority issues focused on International Medical Graduates (IMGs). Several recent reports have suggested that the number of IMGs entering training programs be drastically reduced in order to prevent physician oversupply. Eva Szigethy, a 1997-98 Fellow of The American and the resident representative on the APA Task Force on Workforce Issues, was chosen to convey the summit's opinion that the number of IMGs should be related to the work force needed and not to the number of American medical graduates.
Communication and coordination among residents holding positions in APA components. It was decided that the chairs of each fellowship, the Member-in-Training Trustee and Trustee-Elect, and the chair of the Assembly Committee of MITs would frequently discuss the initiatives of all the groups. Overlap and duplication of work would thus be avoided and timely presentation of proposals to different bodies of the APA made possible.
In addition to the above issues, many residents expressed concern about the weakening and/or lack of in-depth psychotherapy training in their residency program curricula. Some residents told of a lack of a consistent core of quality supervisors, while others were concerned about the poor quality of didactic curricula. Some thought that as a result of the lack of institutional emphasis, residents put a lower priority on learning about the dynamics inherent in all patient-physician interactions. Some residents reported that, in their own programs, residents in therapy were stigmatized.
Many similar concerns were informally discussed during the annual orientation meeting in Tarrytown, N.Y., last June for Chief Residents in Psychiatry. The quality of psychotherapy training is important to future leaders in psychiatry and is currently being threatened in many residency training programs. Future discussions of a broader mentorship program for residents should address the possibility of psychotherapy mentors.
The possibility of creating an APA Office of the Trainee was also discussed at the summit. This office's mandate would be to coordinate all resident activities and groups and be an informational resource for issues of particular interest for residents. Following the summit, the chairs of the residents' groups met with Herbert Sacks, President of the APA, and Steve Mirin, the incoming APA Medical Director. Both were very supportive of the residents' initiatives. A proposal to this effect was presented to the APA Board of Trustees in June. The Board referred it to the Medical Director, who will report back to the Board in October.
Residents will continue to discuss, among themselves and with educators, what they want to be for the APA and what they want the APA to be for them. For more information, contact Carlos Blanco by e-mail (), by telephone (212-543-5544), or by fax (212-543-5356) or Donna Chen by e-mail (), by telephone (212-543-5516), or by fax (212-543-5356).
Carlos Blanco, M.D., Ph.D., a 1996-97 Fellow of The American, is a fourth-year resident at Columbia University/New York State Psychiatric Institute in New York City and chair of the APA Assembly Committee of MITs. Donna Chen, M.D., M.P.H., a 1997-98 Fellow of The American, is a fourth-year resident and chief resident at Columbia University/New York State Psychiatric Institute. She is also the 1996-98 representative from the Mead Johnson Fellowship to the APA Board of Trustees.