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Abstract
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Though instruction in ethics and forensic psychiatry is required of child and adolescent psychiatry training programs, the nature of the education commonly provided is not known. The 1992 American Association of Directors of Psychiatric Residency Training Child and Adolescent Psychiatry Caucus survey sought to obtain this information by sending pertinent questionnaires to the 120 national member programs. Ninety-four programs responded, and the vast majority reported formal training in both subject areas. The specific topics covered, professions of the instructors, time devoted to instruction, and nature of clinical experiences offered are described. Furthermore, comparisons between time devoted to instruction and various demographic variables are presented. The results suggest that, while current teaching of ethics and forensic psychiatry in the responding training programs generally seems robust, it would be desirable to develop relevant core curricula and evaluation mechanisms, and to use the expertise of pertinent nonmental health professionals in instruction.
Postgraduate medical programs in general psychiatry are required by the American Council for Graduate Medical Education to provide education for trainees in ethics, socioeconomics, and the law (R1S17941). Reflecting this expectation, gradually increasing attention has been paid to instruction in ethics (R1S17942,R1S17943) and forensic psychiatry (R1S17944,R1S17945) by training programs during the past two decades. Relevant contributions to the literature on education in ethics include Michels and Kelly's (R1S17946) discussions of varied teaching approaches and curricular content for medical students and psychiatry residents, and Coverdale et al.'s (R1S17947) survey of general psychiatry training directors and chief residents, which attempted to determine pertinent subject matter (e.g., psychiatrist--patient sexual contact and confidentiality) for a residency ethics curriculum. In 1996, Academic Psychiatry devoted its entire fall issue to the education of psychiatric residents in ethics, discussing such facets as supervision, problem-based learning, and cost containment (R1S17948).
In a similar vein, Dietz (R1S17949), Ciccone (R1S179410), and Hassenfeld and Grumet (R1S179411) have outlined forensic issues to which general psychiatry residents ought to receive exposure, as they describe the interface between psychiatric practice and civil law, criminal law, and legal procedure. Furthermore, Marroco et al. (R1S179412) recently published the results of a survey of residencies in the United States and Canada that establishes current approaches to the teaching of forensic psychiatry in general psychiatry programs. Specific foci of their study included descriptions of key didactic topics, the professional backgrounds of the educators, and the settings used for forensic psychiatry rotations.
Child and adolescent psychiatric work draws, in part, on approaches and conceptualizations resembling those used in general psychiatry. However, the exact nature of child and adolescent psychiatric work demands knowledge of ethics (R1S179413) and forensic psychiatry (R1S179414) pertinent to the subspecialty's practice. Accordingly, the accreditation requirements for the training programs mandate education in these areas. Previous writings have indicated directions that the instruction might take. For example, Sondheimer and Martucci (R1S179415) propose the discussion of pertinent ethical dilemmas, in the context of case-centered child and adolescent psychiatry seminars, to convey approaches to ethical analyses that prove useful for subsequent clinical interventions. Similarly, Cohen et al. (R1S179416) describe the participation of residents in courtroom experiences to permit trainees to obtain firsthand knowledge of the intricacies of legal procedures involving domestic relations. In an effort to describe the nature of current education in ethics and forensic psychiatry provided by child and adolescent psychiatry training programs, I describe the responses to a national survey obtained from their training directors. |