On Saturday, December 19, 1998, at 9:00 a.m. at the meeting of the American Psychoanalytic Association in New York City, there will be a Presidential Symposium on psychoanalysis and medical student education. Planned as the first in a series of symposia on psychoanalytic education in the health-care professions, this symposium will describe the opportunities for psychoanalysts in American medical schools. Speakers will include psychoanalytic leaders in American medical education.
American medical schools are undergoing a crisis of resources as clinical income falls because of managed care and research grants become more competitive. Although faculty have less time for teaching, curricula requirements are increasing as medical education shifts to a more humanistic, patient- and student-centered, small-group and case-oriented pedagogy. This means that students must be trained early in patient interviewing and in the doctor-patient relationship because they will come into contact with patients early in their training. It also means medical education focuses on the patient as a person, emphasizing development and adaptation in the life cycle, and on the doctor-patient dynamic as a two-way relationship. Humanistic values and ethics are taught as directly related to patient care.
These changes mean increased opportunity for voluntary faculty interested in teaching, especially faculty versed in human psychology. Such teachers can address mental functioning, character adaptation to illness, psychodynamics of transference and countertransference in doctor-patient relationships, and life-cycle development of human emotional life. All are areas that psychoanalysis has pioneered.
As departments of psychiatry shift to biological research and to managed-care medication treatment, psychoanalysts are the faculty members with psychodynamic training — and the information, skills, and teaching capability in psychodynamic disciplines. Departments of psychiatry in medical schools need us to pass on this information to medical students.
The content and venues of medical student teaching have broadened and changed. Psychoanalysts who want to teach must learn about modern medical education and adapt to its format in order for our contribution to be accepted. The Presidential Symposium will describe the new medical school curriculum and show how psychoanalysts around the country are developing successful teaching programs. The rewards for affiliation with a medical school are many and varied for our profession, for our institutes, and for us as individuals.
Psychoanalytic institutes committed to medical student and residency training tend to recruit more psychoanalytic candidates with M.D. degrees and Ph.D. psychologists. Such institutes have found that cultivating medical school and hospital referral sources helps make more patients available as control cases.
The intellectual stimulation of teaching — and hence of relearning and developing psychoanalytic ideas — is very rewarding. Because of the large number of patients seen by medical students who graduate and go into practice, the respected clinical teacher-mentor becomes a nidus for a large potential referral network. General internists and pediatricians may have thousands of patients in their practice. One hundred doctors may create a patient base of close to a million. Medical school teachers may teach 150 students per year in small group seminars and more than 300 students per year in large lectures.
Medical students come in contact with psychoanalytic teachers at a crucial period, when the students are able and willing both to acquire information rapidly and to identify with mentors' interests, skills, and values. Psychoanalytic values are the very clinical, psychological, and humanistic values now promulgated in medical school curricula. Analysts could become part of the clinical group that medical students see as their professional culture carriers.
The symposium will begin with Herbert Pardes, dean of the College of Physicians and Surgeons of Columbia University and chair of its Department of Psychiatry. He is a former president of the American Psychiatric Association and of the American Association of Medical Colleges and is a member of the American Psychoanalytic Association. He will talk about the future of psychological education within departments of psychiatry and the shift to a more humanitarian, patient-centered curriculum, an area in which he is a leader.
Allan Tasman, president-elect of the American Psychiatric Association, chair of the Department of Psychiatry at the University of Louisville School of Medicine, and a member of The American, will discuss new opportunities for teaching psychodynamics in a department of psychiatry. Steven Levy, chief of psychiatry at Grady Memorial Hospital and director of the Emory University Psychoanalytic Institute, will describe the flexibility needed for psychoanalytic teaching in medical schools.
Eric R. Marcus, longtime director of medical student education in psychiatry at Columbia University College of Physicians and Surgeons and a supervising and training analyst at the the Columbia University Psychoanalytic Center for Training and Research, will discuss the unconscious developmental process of medical training. He will describe how this information was used to help redesign the medical curriculum at P&S. Such knowledge can also lead to a psychodynamic understanding of how to teach medical students at different phases of their development.
Miriam Tasini, a training and supervising analyst at the Los Angeles Psychoanalytic Institute and the third-year clerkship director at UCLA School of Medicine, will describe her innovative teaching program using general medical patients. Janice Cutler, a senior candidate at the Columbia University Psychoanalytic Center for Training and Research and co-director of medical student education in psychiatry there, will describe the special qualities needed in psychoanalytic lecturing to medical students. Burton Lerner, a training and supervising analyst at the Columbia University Psychoanalytic Center for Training and Research and director of psychiatric student health services at Columbia University College of Physicians and Surgeons, will discuss treating medical students as patients in psychoanalysis.
The last hour of the symposium will be devoted to discussion stations manned by the discussants and by other psychoanalytic teachers with innovative programs in medical education.
Eric R. Marcus, M.D., is a training and supervising analyst at the Columbia University Center for Psychoanalytic Training and Research. He is Director of Medical Student Education in Psychiatry and the Behavioral Scence Curriculum of the Columbia University College of Physicians and Surgeons.