20 Pearls of Wisdom for Psychiatric Residents
March 2, 2012
I am honored to present my first guest blogger. I first new James Knoll, IV, MD, years ago in Dallas, Texas. I briefly served as a psychotherapy supervisor for him. I remember him and his father, a leading member of our local psychiatric society, fondly. Thanks, James, for allowing me to publish this insightful piece.
RESIDENCY: A SURVIVOR’S GUIDE
Twenty Meditations For Residents
By James Knoll, IV, MD, and James Knoll, III, MD | February 2, 2012
Dr Knoll (IV) is Associate Professor of Psychiatry at the SUNY Upstate Medical Center in Syracuse, NY, where he is Director of Forensic Psychiatry and Director of the Forensic Psychiatry Fellowship at Central New York Psychiatric Center. Dr Knoll is Editor in Chief of Psychiatric Times. Dr Knoll (III) is Clinical Professor of Psychiatry and in private practice in Pagosa Springs, Colorado.
We offer the following advice, in the Oslerian spirit of honoring and guiding trainees—today’s psychiatric residents—who will become tomorrow’s psychiatric leaders.
1. Never waste supervision—take it as the very special, once-in-a-lifetime experience that it is.
2. Seek out the best supervisors from different disciplines. Later, focus on the ones that you are drawn to most in the last year of your residency. Ask your trusted supervisors to tell you their favorite readings, books, and articles.
3. Do not leave residency training without very solid skills in: the clinical interview; the mental status exam; differential diagnosis. Forge these skills in your mind with care and dedication.
4. Know thyself. Enter into personal psychotherapy. Invest, at a minimum, 2 years of your time. It will be difficult to foresee the benefits of this investment at first. Sticking with it over time, you will drink deep from the well.
5. Become acquainted with every art. Develop at least a working knowledge of diverse methods and systems involved in evaluating and treating patients.
6. Develop a sound and reliable method of documentation—then work to perfect it.
7. Understand that although you have had to learn much and have worked very hard, life after residency is very different and presents unforeseen challenges. The first 3 to 5 years can be uniquely challenging.
8. Be aware that over time, people claim to “discover” theories which, upon closer examination, are actually older, well-known psychiatric/psychological principles wrapped in a new package. For example, read Freud—not people who quote what he supposedly said.
9. Learn and rely upon on the various practice guidelines or clinical pathways, but not so rigidly that the patient becomes secondary.
10. Try your hand, even if it makes you uncomfortable, at public speaking. If you cannot easily communicate a psychiatric principle to a layperson, it is possible that you do not have a sufficient understanding of that principle.
11. In difficult periods, take time to slow down, recall, and refocus on why you chose this path. Be aware of your emotions and energy.
12. Make time to read poetry and works of literary excellence. See also works of cinematic excellence. Go to art and history museums whenever possible. Seek to understand the effects of suffering and the tragic, thereby developing compassion for the human condition.
13. Tip the balance of work versus family too far in one direction at your own peril. If forced to choose, family is always more important.
14. Think lightly of yourself and deeply of the world.* Never, under any circumstances, lose your sense of humor.
15. Do your best to live in a state of detachment from the 3 tormenting lusts: the desire to be viewed favorably by others, the desire for material riches, and the desire to “surpass” others.*
16. Arrogance or loss of temper is repugnant and dishonorable. Resentment and complaint are appropriate neither for yourself nor for others.* The most psychologically healthy and happy psychiatrists we have encountered did not engage in gossip, complaint, or maligning of their colleagues. Rather, they emanated compassion, and sought to spread a positive message. Neither were they pious, and they invariably had the most entertaining senses of humor.
17. Seek supervision or consultation liberally after graduating residency.
18. Communicate effectively and work collaboratively with other healthcare professionals.
19. Assume leadership positions when possible and appropriate.
20. Do not be false towards your chosen profession. Become familiar with the ethical and legal principles of psychiatry.
* From: The DokkMdM, by Miyamoto Musashi, c. May 12, 1645.
Dedication: To the memory of James Knoll, II, MD
Acknowledgments: We would like to acknowledge, with deep gratitude, all of our supervisors.
Psychiatric Times. Vol. No. February 2, 2012