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Psychiatric role models for medical students
LElTERS only of the half adjacent to the light source indicates a shallow anterior chamber and thus a propensity to acute narrow-angle glaucoma. In practice, some patients will fall between these two extremes: part of the opposite half of the iris will light up. In this case, it can safely be assumed that if greater than two thirds of the opposite half of the iris is illuminated, the anterior chamber is sufficiently deep for there to be little possibility of angle closure resulting from pharmacologic dilation. Robert S. Hoffman, M.D. St. Mary's Medical Center San Francisco Michael J. Bresler, M.D. Stanford University School of Medicine REFERENCES 1. Davidson SI: Reports of ocular adverse reactions. Trans Ophtha/mol Soc UK 93:495. 1973 2. Lowe RF: Amitriptyline and glaucoma. Med J Aust2:509-510.1966.
3. Reid WH, Blouin P: Outpatient psychiatric medications and glaucoma. Psychosomatics 17:83-85, 1976. 4. Grant WM: Ocular complications of drugs. JAMA 207:2089-2091. 1969. 5. Vaughn D, Asbury T: General Ophthalmology. ed 7. Los Altos Calif. Lange Medical Publications. 1974, pp 198-199.
Psychiatric role models for medical students To the Editor: Dr. A.C. Nielsen's article on the decreasing numbers of medical students entering psychiatry, "Psychiatric recruitment: Why they like us, but don't join us" (Psychosomatics 22:343-348, 1981), highlighted well this recent but continuing trend. However, the solution to reversing this trend may be more difficult than the proposals he gives. What may be the major barrier is the lack of a psychiatric role model for the medical student. Dr. Nielsen pointed out the psychi206
atrist's ambiguous role within the false egalitarianism of the community mental health movement. This also seems to exist in the medical school curriculum. Psychologists and social workers do extensive lecturing in the basic science courses and, in addition, provide a great deal, if not most, of the clinical supervision in the basic psychiatry clerkship. This first contact with a nonphysician role model can make the critical difference in a medical student's choice or nonchoice of a psychiatric career. This disturbing trend is allowed and even encouraged by many psychiatric educators. Clearly, they can make a big impact by providing adequate role models for the medical students. Gregory B. Leong, M.D. Los Angeles County-U.S.c. Medical Center Los Angeles The author replies: My summary article could only touch on a few possible methods to improve psychiatric recruitment; more extensive discussions are available elsewhere.1.2 In fact, I agree with Dr. Leong that reversing the trend will be no simple matter. Elsewhere, I have shown that quality medical student psychiatric education exerts only a modest effect on recruitment. 3 I certainly agree with Dr. Leong that the availability of competent, self-confident role models importantly influences attitudes about psychiatry as a specialty. Indeed, the thrust of my argument concerning the influence of family practice was that medical students have become uncertain about the need to specialize in psychiatry. This question of role-blurring
was directly assessed as part of our recent study of 204 senior medical students. 2 Responding to the statement, "With few exceptions, clinical psychologists and social workers are just as qualified [as psychiatrists] to work with emotionally disturbed persons," 31% of students agreed, 20% were neutral, and 49% disagreed, indicating considerable doubt about the special skills of psychiatrists. Dr. Leong appropriately mentions some of the settings where medical students learn that psychiatric skills are performed by others (behavioral science courses, inpatient clerkship supervision, community mental health centers); others reviewed by Hertz4 include inpatient "teams," consultation-liaison consultations performed by nonpsychiatrists, and family practice rotations that rely heavily on nonpsychiatric behavioral scientists. While I agree that role-blurring is fostered by certain aspects of current social structure, I nonetheless maintain my contention that psychiatrists should more forcefully educate medical students concerning their special roles, knowledge, and abilities. Arthur C. Nielsen III, M.D. Institute of Psychiatry Northwestern Memorial Hospital Chicago REFERENCES: 1. Tainter Z, Robinowitz C (eds): The career chOice of psychiatry: A national conference on psychiatric recruitment-Recommendations. J Psychiatr Educ, to be published. 2. Nielsen AC, Eaton JS Jr: Medical students' attitudes about psychiatry: Implications for psychiatric recruitment. Arch Gen Psychiatry 38:1144-1154,1981. 3. Nielsen AC: Choosing psychiatry: The importance of psychiatric education in medical school. Am J Psychiatry 137:428-431, 1980. 4. Herz MI: The impact of role-blurring befween psychiatrists and other mental health professionals on medical students' career selection. Read before the conference on "The Career Choice of Psychiatry," San Antonio, Tex. March 1980.
PSYCHOSOMATICS
3. Reid WH, Blouin P: Outpatient psychiatric medications and glaucoma. Psychosomatics 17:83-85, 1976. 4. Grant WM: Ocular complications of drugs. JAMA 207:2089-2091. 1969. 5. Vaughn D, Asbury T: General Ophthalmology. ed 7. Los Altos Calif. Lange Medical Publications. 1974, pp 198-199.
Psychiatric role models for medical students To the Editor: Dr. A.C. Nielsen's article on the decreasing numbers of medical students entering psychiatry, "Psychiatric recruitment: Why they like us, but don't join us" (Psychosomatics 22:343-348, 1981), highlighted well this recent but continuing trend. However, the solution to reversing this trend may be more difficult than the proposals he gives. What may be the major barrier is the lack of a psychiatric role model for the medical student. Dr. Nielsen pointed out the psychi206
atrist's ambiguous role within the false egalitarianism of the community mental health movement. This also seems to exist in the medical school curriculum. Psychologists and social workers do extensive lecturing in the basic science courses and, in addition, provide a great deal, if not most, of the clinical supervision in the basic psychiatry clerkship. This first contact with a nonphysician role model can make the critical difference in a medical student's choice or nonchoice of a psychiatric career. This disturbing trend is allowed and even encouraged by many psychiatric educators. Clearly, they can make a big impact by providing adequate role models for the medical students. Gregory B. Leong, M.D. Los Angeles County-U.S.c. Medical Center Los Angeles The author replies: My summary article could only touch on a few possible methods to improve psychiatric recruitment; more extensive discussions are available elsewhere.1.2 In fact, I agree with Dr. Leong that reversing the trend will be no simple matter. Elsewhere, I have shown that quality medical student psychiatric education exerts only a modest effect on recruitment. 3 I certainly agree with Dr. Leong that the availability of competent, self-confident role models importantly influences attitudes about psychiatry as a specialty. Indeed, the thrust of my argument concerning the influence of family practice was that medical students have become uncertain about the need to specialize in psychiatry. This question of role-blurring
was directly assessed as part of our recent study of 204 senior medical students. 2 Responding to the statement, "With few exceptions, clinical psychologists and social workers are just as qualified [as psychiatrists] to work with emotionally disturbed persons," 31% of students agreed, 20% were neutral, and 49% disagreed, indicating considerable doubt about the special skills of psychiatrists. Dr. Leong appropriately mentions some of the settings where medical students learn that psychiatric skills are performed by others (behavioral science courses, inpatient clerkship supervision, community mental health centers); others reviewed by Hertz4 include inpatient "teams," consultation-liaison consultations performed by nonpsychiatrists, and family practice rotations that rely heavily on nonpsychiatric behavioral scientists. While I agree that role-blurring is fostered by certain aspects of current social structure, I nonetheless maintain my contention that psychiatrists should more forcefully educate medical students concerning their special roles, knowledge, and abilities. Arthur C. Nielsen III, M.D. Institute of Psychiatry Northwestern Memorial Hospital Chicago REFERENCES: 1. Tainter Z, Robinowitz C (eds): The career chOice of psychiatry: A national conference on psychiatric recruitment-Recommendations. J Psychiatr Educ, to be published. 2. Nielsen AC, Eaton JS Jr: Medical students' attitudes about psychiatry: Implications for psychiatric recruitment. Arch Gen Psychiatry 38:1144-1154,1981. 3. Nielsen AC: Choosing psychiatry: The importance of psychiatric education in medical school. Am J Psychiatry 137:428-431, 1980. 4. Herz MI: The impact of role-blurring befween psychiatrists and other mental health professionals on medical students' career selection. Read before the conference on "The Career Choice of Psychiatry," San Antonio, Tex. March 1980.
PSYCHOSOMATICS