Psychiatry residents' experiences with systems-based practice: a qualitative survey.

OBJECTIVE: The aim of this study is to analyze qualitative data collected during field-testing of an instrument to assess psychiatric residents' experiences with systems-based practice (SBP). METHODS: A total of 237 psychiatry residents from 6 levels of training in 12 different psychiatry residency training programs responded to a 60-item instrument measuring their experiences with SBP during residency. Qualitative techniques adapted from content analysis were used to review narrative responses to open-ended questions on the instrument. RESULTS: Certain themes emerged in the residents' answers reflecting their opinions about the opportunities for (and barriers to) performing SBP in their work. CONCLUSIONS: Psychiatric residents express an eagerness for opportunities to learn about and perform SBP but often feel constrained by the lack of resources, teaching, and supervision. Moreover, many residents desire a better understanding of healthcare economics and how to factor cost consideration into clinical care.

A day in the life of a public psychiatry fellow.

Now in its 29th year, the Public Psychiatry Fellowship of the New York Psychiatric Institute at Columbia Medical Center selects 10 fellows per year for its 1-year program (1). This award-winning fellowship trains future leaders for the public mental health sector. The curriculum (2) employs a combination of a didactic seminar series, management-problem-focused presentations by guest speakers, field trips, and supervision by fellowship faculty to instill the values and skills required for practice and leadership in the public sector. Fellows utilize the framework of the academic curriculum to carry out a series of presentations throughout the year that allow them to organize, implement and evaluate concepts that they learn during the year. The following account, written from bird's eye view, details one fellow's day at his field placement in a State Hospital outpatient clinic setting, with the aim of illustrating how the concepts taught by the fellowship find application in day to day practice.