The Michigan Psychoanalytic Institute has been fairly successful at recruitment, attracting an average of five to seven well-qualified candidates each year. However, in recent years we have become increasingly concerned that many, if not most, of our applicants were middle-aged, having received their training in another era; further, it had been 10 to 15 years since we had attracted significant numbers of medical applicants.
“We were completely losing the younger generation of psychiatry residents,” lamented Marvin Margolis, chair of the Strategic Planning Committee, which took up this issue as one of the institute's most significant current challenges. “Our quite substantial teaching efforts were not having the desired effects.” Also, this class size was hardly sufficient for the needs of a state of over 10 million people. We felt we could, in fact must, do much better.
Meanwhile, a competing psychoanalytic group not affiliated with APsaA, with more flexible and generally less demanding requirements, was becoming increasingly successful in recruiting many younger colleagues who would have been quite suitable for analytic training with us.
We put together a small ad hoc committee to study the problem. We contacted or visited many psychoanalytic institutes around the country with innovative programs, and discussed the issues with residents who were known to have psychoanalytic interests, as well as recent graduates who had either not applied or moved to other cities.
We found that many psychiatry residents were interested in psychoanalytic training, but felt put-off by a number of logistical issues. First, despite lots of teaching by analysts, most residents were not knowledgeable about our many educational programs, never or rarely had visited the institute, and generally did not feel welcome. A second issue involved scheduling: Our training program met for classes two weekday mornings per week, a commitment that residency directors adamantly opposed and for which they would not allow the residents to leave their clinical assignments. It was a deal-breaker. The final objection was financial: A nearly full-fee analysis was simply not possible on a resident's salary, even with moonlighting income.
The end result of these difficulties was that many of the most talented residents were graduating, often moving to other states, without ever considering analytic training as a realistic option. In short, it appeared that our present system, designed several generations ago, was no longer in tune with today's realities.
The end result of these difficulties was that many of the most talented residents were graduating, often moving to other states, without ever considering analytic training as a realistic option. In short, it appeared that our present system, designed several generations ago, was no longer in tune with today's realities.
Responding to these concerns and utilizing ideas from other programs in the country that seemed likely to work well for us, we formulated the following Early Admission Program. Residents would be able to apply for full analytic training as early as PGY-1 through a streamlined application process. Most of our training analysts agreed to see these trainees at drastically reduced fees. They would not be required to be in analysis when applying; the idea was they would at least be in therapy with a training analyst, with the intent of progressing to analysis according to individual readiness and circumstances. It was also assumed that fees would gradually increase as the candidates' professional success increased.
We planned a Saturday seminar series for the prematriculation students, clinically based. Each would be assigned an advisor from our faculty. We hoped that these components would encourage an early identification with the institute and psychoanalysis. Progress to full matriculation would then be individually determined according to emotional and clinical readiness, with the approval of their advisor, and accompanied by an in-depth interview with clinical material presented. We anticipated that the prematricualtion phase would last one to three years for most applicants.
A final piece would be converting the curriculum from the two-weekday morning format to one day per week. We discussed this with the Curriculum Committee, and it was felt to be workable by 2006. This change would not only allow resident attendance, but also make it possible for trainees in other communities more than an hour away to obtain training.
Interestingly, the training directors at our four local psychiatric residencies, none of whom were particularly psychoanalytically oriented, ultimately expressed unqualified support for the program. This seemed to be the result of two factors. First, these proposals came in the context of a long-term experience of our faculty providing solid teaching and supervision; thus, we had established their trust and confidence. Second, by conceiving the program in a way that wrapped around the structure of the residencies, we addressed their main concern that the residents' service obligations not be interrupted. Not only did their objections evaporate, they, in fact, came to see it as a selling point for their residencies.
This accomplished, we began several initiatives to publicize the program. We began offering informal evening gatherings with refreshments at analysts' homes, combining
Steve Nickoloff, M.D., is on the faculty at the Michigan Psychoanalytic Institute.
information, conviviality, and usually a clinical presentation. This seemed to facilitate the building of relationships, and residents came to see us as more approachable and welcoming. We arranged to give formal informational presentations on the program to all residents at each of the residency programs. Also, we coordinated these efforts with those of our Student and Trainees Association (SATA) and sent informational mailings. We worked with our faculty on the importance of discussing training opportunities as part of their teaching.
Mel Bornstein, our liaison to one local residency, noted: “It is crucial for our faculty to have active roles in the local educational initiatives, to be available and encouraging to trainees, to be sources of identification. Institutes cannot survive if they are insular and apart from the training facilities.”
Barely more than a year after beginning these initiatives, our efforts appear to have paid off. We are delighted to have five applicants to the program; four have been accepted. All are psychiatric residents, from PGY-1 through 4. They are a very bright and motivated group; while much younger and less experienced than our typical applicants, they give every indication of the potential to become excellent analysts. Several of them felt that it was the individual mentoring and encouragement to apply that they received from faculty that were most instrumental in their decision.
Al Garmo, a recently accepted PGY-4 applicant, said, “It's what I imagined psychiatrists really doing. I was taken with their deep understanding of patients and their obvious enthusiasm. I wanted to be part of that, and [the Early Admission Program] made it practical.”
We anticipate in the near future half of our candidates may be products of our Early Admission Program. In a parallel way we would like to offer the same opportunity to psychologists and social workers and have begun the multi-step process of obtaining approval at the national level for such initiatives. We hope that our program will serve as a model for other institutes as they reach out to a new generation of psychiatry professionals.