University of Virginia Health System

            In an effort to improve both access to care and quality of treatment for Virginia’s mentally ill, the Department of Psychiatric Medicine at the University of Virginia has started a new program—The Public and Community Psychiatry Scholarship Program.  The intent of this program is to encourage psychiatry residents to practice in an under-served area of the state.  Up to four residents may participate and will contract with the University and the Department of Mental Health, Mental Retardation and Substance Abuse (DMHMRSAS) to practice in such a designated area.  MCV and Eastern Virginia Medical School are also program affiliates, and can also each provide four residents.  The program is made possible through a grant from DMHMRSAS, according to the recommendation of Governor Gilmore, and in exchange for their service the residents are contracted to receive a salary stipend.

            The residency program at the University of Virginia had begun implementing changes to include the Public and Community Psychiatry Program.  At the start of the summer several new key elements still needed to be incorporated at every level of medical training:

Faculty—Edward Kantor had been appointed the Gilmore Faculty Fellow to serve as coordinator and supervisor of the program at UVA. In addition, an advisory group composed of University and community physicians or other mental health workers still needed to be organized.

Residents— Two residents were already contracted to participate.  More recruitment was necessary to further increase participation.

Training Sites— Most of the residency training was available in the University Hospital.  The addition of community-oriented training sites was necessary to provide quality preparation for community based practice.

Instructional Curriculum— Alterations in the residency instructional curriculum were needed to educate all residents in issues related to community and public psychiatry.

Medical Students—  I was the key person responsible for researching and proposing the necessary changes in the instructional curriculum.  Additionally, I served as an assistant to Dr. Kantor and David Lieb, another medical student intern, in the other described aspects of the program.

Methods

            The first step in changing the psychiatry residency curriculum was familiarizing myself with both the Public and Community Psychiatry Proposal (as described in the grant application) and the current UVA Psychiatry Residency Program.  This familiarization of the Public Psychiatry Program entailed reading the grant and identifying the elements specifically related to curriculum or residents’ responsibilities.  I also familiarized myself with the Program Contract.  To understand the current program I reviewed on-line descriptions and obtained course syllabi.  Particularly helpful were my meetings with Dr. Kantor, the residency coordinator and Gilmore Fellow, who explained the motivation and focus of the new curriculum, as well as the structure of the existing curriculum.

            Next, based on my discussions with Dr. Kantor and a thorough literature review, I generated a list of the key issues specifically related to Public and Community Psychiatry.  This topic list was later refined and compared with the lecture topics traditionally covered in the UVA curriculum.  I decided that in the interest of limited time for additional lectures in the proposed curriculum, it would be best to try to incorporate where possible the new material into the old lectures. Where the public and community-related issues nicely overlapped with the curriculum in place, no new lecture was added.  Instead, several readings that focus on Community Psychiatry and deal with the particular topic were assigned.  This will nicely allow the traditional lectures to be taught, with a new focus on Community Psychiatry.  Furthermore, for the participating residents, there are additional readings that will help prepared them for their practice in underserved areas.

            In order to help with the other aspects of the program, I reviewed letters and press releases and attended project meetings.  One meeting was with the Inspector General for Mental Health Services, Anita Everett.  I also shadowed several psychiatrists at Western State, Region 10 Community Mental Health Center, and the University Hospital.  These experiences increased my understanding of the administrative, economic, and medical aspects of psychiatry, as well as boosting a personal interest in pursuing a career in the field.

Results

            The results are best presented in Figure Form.  See Figures 1 through 4 for a detailed description of the New Proposed Curriculum that includes additions to support the new public and community focus.

Figure 1: Overview of