Rubin Eugene H, Zorumski Charles F
Department of Psychiatry, Washington University School of Medicine, St. Louis, Missouri 63110-1093, USA.
Acad Med. 2003 Apr;78(4):351-4. doi: 10.1097/00001888-200304000-00002.
Scientific advances in the fields of molecular biology, neurobiology, pharmacology, epidemiology, genetics, neuroimaging, and cognitive neuroscience are influencing psychiatric diagnosis and treatment, and this influence will grow substantially in the future. The current shortage of psychiatrists will increase over the next several decades, resulting in the need to train primary care physicians in basic psychiatric care and the use of non-physician mental health professionals to administer time-intensive, formal psychotherapies. The juxtaposition of these two trends-an increasing scientific influence on the clinical practice of psychiatry and fewer psychiatrists to deliver that treatment-is cause for changes in the approach to psychiatric education. In addressing these issues, the authors suggest that (1) psychiatry should be more integrated into undergraduate medical education in both basic science and clinical curricula, (2) residents in primary care disciplines should have more direct exposure to psychiatric training, (3) joint instructional experiences involving psychiatry and primary care residents should be encouraged, (4) psychiatry residency programs should maintain flexibility in order to incorporate rapid advances in diagnostic procedures and treatments into residency training, (5) research experience should be integrated into psychiatry residency programs, and (6) departments of psychiatry must develop the leadership and expertise necessary to implement the incorporation of rapidly advancing scientific discoveries into the psychiatric curriculum.
分子生物学、神经生物学、药理学、流行病学、遗传学、神经影像学和认知神经科学领域的科学进展正在影响精神疾病的诊断和治疗,而且这种影响在未来还会大幅增强。未来几十年,精神科医生目前的短缺状况将会加剧,这就需要培训基层医疗医生进行基本的精神科护理,并利用非医生心理健康专业人员来实施耗时较长的正规心理治疗。这两种趋势并存——科学对精神科临床实践的影响日益增大,而提供治疗的精神科医生却越来越少——这使得精神科教育的方式需要做出改变。在解决这些问题时,作者们建议:(1)在本科医学教育的基础科学和临床课程中,精神医学都应得到更充分的整合;(2)基层医疗学科的住院医师应更多地直接接受精神科培训;(3)应鼓励精神科与基层医疗住院医师开展联合教学体验;(4)精神科住院医师培训项目应保持灵活性,以便将诊断程序和治疗方法的快速进展纳入住院医师培训;(5)研究经验应融入精神科住院医师培训项目;(6)精神科各部门必须培养必要的领导力和专业知识,以便将快速发展的科学发现纳入精神科课程。