Points to Ponder regarding Contemporary Psychiatric Training in Israel

Article excerpt

Abstract: In an era in which neuroscience is developing rapidly and different psychotherapeutic modalities are proliferating, psychiatric training encounters new difficulties. This article raises various issues that the authors feel are not adequately addressed in contemporary psychiatric residency programs in Israel. These include basic issues of doctor-patient relationship; different cultural trends such as the increase in popularity of CAM (complementary and alternative medicine), the increase in substance abuse, and the increasing popularity of different spiritual movements; transcultural aspects affecting the prevalence and understanding of different psychopathologies in various sectors of the population; ethical issues particular to psychiatric research; and the future psychiatrist's role as communicator and educator of GPs, mental health workers and the general public. In a time characterized by an abundance of models and theories in psychiatry, the authors stress the need to assist residents in integrating various theories and models into a comprehensive outlook regarding the psyche and psychiatric disorders. As mental hospitals vary greatly in their general psychiatric outlook, emphases, and competence of the senior staff in different fields and treatment modalities, the authors see programs for continuing medical education (CME) as the natural arena in which the issues mentioned in this paper should be addressed.

As in all other fields of medicine, professional training in psychiatry is an ongoing process that virtually never comes to an end. Not only must the psychiatrist continue to update his knowledge by familiarizing himself with recent medical literature, he must also be in touch with the "zeitgeist," as psychiatric disorders are always regarded in a cultural and environmental context. The basic psychiatric training, in the form of psychiatric residency, must inevitably be based on a certain ideology regarding the understanding of the psyche and psychiatric disorders, and of the role of the psychiatrist at large. In addition, as psychiatrists must take into account various cultural aspects and norms in their work, psychiatric training must address characteristic aspects crucial in treating local psychiatric patients.

It seems that the ideal psychiatrist today is one who is familiar with different aspects of medicine, psychology, sociology, anthropology, neuroscience, law, philosophy, education, spirituality, religion and more. The numerous fields psychiatry touches upon, alongside the endless pastures of knowledge that are relevant when dealing with the psyche and psychiatric disorders, obviously dictates that requirements from psychiatric residents be prioritized and sufficiently formalized and supervised.

Psychiatric training in Israel today consists of a four-and-a-half year residency program, of which three-and-a-half years are dedicated to clinical psychiatry (inpatient wards and outpatient clinics), six months of clinical neurology and six months of basic scientific research. All psychiatric residents are required to complete two exams, the first of which emphasizes the theoretical and scientific background of psychiatry, and the second in which clinical practice and technique are emphasized. Many psychiatric residents augment these requirements by studying in programs for continuing medical education (CME) (usually during the first years of their residency) and different programs of psychotherapy (usually during the latter years of their residency or after completing the residency). In addition, each hospital, acting as an autonomic academic unit, provides various supervisions and seminars.

This paper does not pretend to present a comprehensive outline regarding psychiatric training at large, but rather it will emphasize certain points that are currently not adequately addressed during contemporary psychiatric training, particularly those specific to psychiatric work in Israel. …