EDUCATION
408
Grover F. Powers, M.D., Contributing Editor
The following contribution to arm important subject was written by a psychiatrist teaching in
the l)epartrnemit of Pediatrics of the University of Louisville.
EXPLORING
THE
ROLE
OF
PSYCHIATRY
IN
PEDIATRIC
EDUCATION
By Henry H. Work, M.D.
G.F.P.
N ORGANIZATION having a therapeutic concern parallel to that of the Amen-can Academy of Pediatrics is the American
Orthopsychiatric Association. This group, older than the Academy, represents the 3
disciplines, psychiatry, psychology and
psychiatric social work which have conven-tionally functioned in the child guidance
clinics. It is the organization which
repre-sents in general the field of child psychiatry and which has been concerned over the years with the teaching of the medical
psychology of childhood.
Main’ of the members of this organiza-tion, operating in their own disciplines,
have participated in the teaching of pedia-tricians. As long ago as 1941 a symposium
entitled “Pediatrics in Child Psychiatry” was held at the annual meeting. In 1951, a general meeting entitled “Psychiatric Train-imig of Pediatricians” was held. Since then
there have been 3 smiialler meetings
at-tended by about 50 physicians, all of whom were actively engaged in teaching medical psychology in Departments of Pediatrics.
To some extent these meetings have
car-ned on a discussion begun at the Hershey
Conference on the teaching of psychiatry in
pediatric departments. At the 1952 meeting
of this group, certain definite teaching
pro-grams were outlined by a series of speakers.
At the 1953 and 1954 meetings, the sessions
were devoted to an open discussion of the problemiis of teachers in this field as well as
the problems of teaching.
Many of those attending the meetings
have felt that their teaching was not
ade-quately integrated, either with the teaching
of pediatrics, or of psychiatry, in the
mcdi-cal schools which they represented.
Con-siderable time, therefore, was devoted to a
discussion of the role that a psychiatrist
plays in the teaching of pediatrics. While it
was simple to understand that the status of
such an individual depended partly on his
hierarchical position in a department, it also
appeared important that this position had
less meaning than the attitudinal
relation-ship between the teacher and the chief of
the department. The groups discussed the
various obstacles that arose in this kind of
teaching and the methods of bettering the
psychiatrist’s position in a department
which might accept him warmly but neither
understand nor fully accept the teaching
he was trying to do.
At both meetings a great deal of time was
given to trying to understand the needs of
the student who was learning pediatrics in
relationship to his general medical
expeni-ences as well as his life experiences. It was
felt that pediatrics imposed upon him a
very difficult framework of knowledge
be-cause many of the experiences which he
saw in children repeated personal
expeni-ences either before or during his medical
career. We were early impressed in our
discussion with the apparent paradox
be-tween the knowledge that had been gained
in our field and the knowledge which others
had lumped together in the words “common
sense.” It was felt that this was a very
im-portant area of discussion inasmuch as
EDUCATION 409
last 50 years have in many ways made clear and understandable a scientific way of
thinking about what was formerly gained
primarily through experience. It seemed to
us that there was an area in our teaching
where we could bridge the gap between the learning which came from long
experi-ence and that gained in current training by
adding this known material about the
rela-tionship of a physician to a patient, of a
mother to a child, or of the child to the en-vironment in which he lives.
During our 1953 meeting we discussed
certain ways of interpreting this
knowl-edge area. Several methods were con-sidered such as the assignment of a student
to follow the case of a pregnant woman, the
use of field placements in agencies, and the
well-baby clinic approach. We talked about how a student felt as he came up against these very personal experiences throughout
his medical career and of ways of alleviat-ing some of his anxiety by close supervision,
by conferences following all patient
con-tacts and through interdisciplinary teaching
experiences.
A discussion begun in the 1953 meeting
about the tempo at which a student works
in varying departments-such as pediatrics
and psychiatry-was related to actuality in
the 1954 meeting when some of our
mem-bers presented a specific way of teaching through child psychiatric studies in a pedi-atnic out-patient department.
The methodology of this particular
pro-gram involved the screening of patients in
a pediatric out-patient clinic and immediate
and direct referral to psychiatric
con-sultants who assisted the student in an
elaboration of the history and understand-ing of the patient. In this instance, the
stu-dents, working in pairs, became essentially
intake workers for a child guidance clinic
ty pe of problems which are commonly seen
in a pediatric clinic. An effort had been
made to present this as a part of pediatric
teaching although it could easily be
con-strued as teaching within the Department
of Psychiatry. However, the students had
met some of the faculty earlier in purely
pediatric settings and it was felt that this
was an opportunity to enhance the rapport
with the students. It did become obvious in
the discussion of this paper that the
prob-bern of where and when the student meets
and is introduced to various members of
the faculty sets a tone for the way he
re-gards them and understands their teaching
efforts.
There was no unanimity of feeling about
the value of this method. Members of the
discussion group took strong objection to
the depth of this teaching experience.
Others felt, however, that one should not
be concerned about the exposure of the
student as long as the exposure is
meaning-ful at the point where he meets the patient.
For example, a very disturbed mother may
bring her child to a pediatric clinic with a
common complaint. So usual is this that it
would be wrong to avoid caring for this
mother-child combination. The learning of
how to handle both mother and child would,
then, be appropriate to what the student
might encounter later as a part of his
pedi-atric practice. This becomes particularly
important in thinking about the retention,
by the students, of material offered at
van-ous stages of their school years. It becomes
obvious that the psychiatrist teaching in the
Department of Pediatrics has an
opportu-nity to bring developmental material from
either department to the other and an
op-portunity to offer this to the student early
in his learning career.
par-WORK - PSYCHIATRY IN PEDIATRIC EDUCATION
410
the Department of Psychiatry is needed in
presenting developmental material in order
that the totality of the child be understood. There is also an opportunity, if courses in
development are given early in the students’
careers, to emphasize the relationship of
psychologic material to medicine in
gen-eral.
The discussants were not unaware of the
resistances of the students as shown by their receptivity to psychologic material while
taking psychiatry, a feeling which is totally lost when similar problems occur while the
student is involved in medicine or surgery.
It is very obvious from the forgoing that
there are a number of disputed areas about
the kind of teaching experiences that
should be offered to students in pediatric
teaching. The problem of the use of
seni-ously disturbed children as a teaching
medium remains unanswered. There was
felt to be a need for better understanding
of psychopathology on the part of all
medi-cal students; an understanding which could
come up to their expected level in general
pathology. It became apparent in the
dis-cussions that pediatricians in general and
the psychiatrists in the Pediatrics
Depart-ment often assume a tremendous burden
for giving the student a “readiness” to
practice medicine through his progressive
experience. The group was well aware that
this is not the sole responsibility of
pedi-atrics or psychiatry but felt concerned that
the thinking of this body be represented in
