BRIEF
COMMUNICATIONS
15. Collins
GGS, Sandier M: Human blood platelet monoamine oxiBiochem Pharmacol 20:289-296, 1971 Murphy D, Connelly CH: Monoamine oxidase in man: enzyme characteristics in platelets, plasma, and other human tissues, in Neuropsychopharmacology of Monoamines and Their Regulatory Enzymes, Advances in Biochemical Pharmacology, vol 12. Edited by Usdin E. New York, Raven Press, 1974, pp 71-85 Nies A, Robinson DS, Lamborn KR, et a]: Genetic control of platelet and plasma monoamine oxidase activity. Arch Gen Psychiatry 28:834-838, 1973 Murphy DL, Weiss R: Reduced monoamine oxidase activity in blood platelets from bipolar depressed patients. Am J Psychiatry 128:1351-1357, 1972 Nies A, Robinson DS, Ravaris CL, et al: Amines and monoamine oxidase in relation to aging and depression in man. Psychosom Med 3:470, 1971 Horwitt MK: Fact and artifact in the biology of schizophrenia. Science 124:429-430, 1956
21.
dase.
16.
17.
18.
19.
20.
Consultation-Liaison BY WALTER
Psychiatry:
A. BROWN,
M.D.,
AND
22. 23.
24.
25. 26.
27.
Kety 55: Biochemical theories ofschizophrenia, part I. Science 129:1528-1532, 1959 Kety 55: Biochemical theories of schizophrenia, part II. Science 129:1590-1596, 1959 Friedhoff AJ, Van Winkle E: Isolation and characterization of a compound from the urine of schizophrenics. Nature 194:897898, 1962 Gershon S. Lonigro A: A study of lymphocytes stained with Masson’s trichrome stain in psychiatric patients. I Nerv Ment Dis 139:569-573, 1964 Perry TL, Hestnin M, McDougall L, et a]: Urinary amines of intestinal bacterial origin. Clin Chim Acta 14: 116-123, 1966 Tourney G, Hatfield LM: Androgen metabolism in schizophrenics, homosexuals, and normal controls. Biol Psychiatry 6:23-35, 1973 Garelis E, Gillin JC, Wyatt Ri, Ct al: Elevated blood serotonin concentration in unmedicated chronic schizophrenic patients: a preliminary study. Am J Psychiatry 132:184-186, 1975
Current
ERIC
M.
Responsibilities
JACOBSON,
M.D.
medicine
The authors describe their experiences as consultation-liaison psychiatrists in two general teaching hospitals. Current medical house staff members appear to be more aware ofthe importance ofpsychosocial issues in patient care than were interns and residents in the past. Consultation-liaison teaching may nowfocus on the application of this psychologic awareness to patient management, the correct use ofpsychotropic drugs, and the differentiation ofdelirium from functional psychoses.
(1,
of medical and accept in
medical
practice
son
teaching
that
such
medical
efforts
ical
focused
students
his teaching and
chosocial
issues
interview
technique,
tion
and
and
concepts
Veterans and
house
efforts
staff
in medical
of
is Director, Administration Assistant
of
has
to the
relevance
and assessment,
Psychiatric
medof psy-
management,
psychiatric
psychogenicity
tradi-
on sensitizing
illness
personality
management
Dr. Brown 02908,
psychiatrist
CONSULTATION-LIAISON
recogni-
syndromes,
and
psychosomatic
Consultation-Liaison
Service,
Hospital, Davis Park, Providence, R.I. Professor of Psychiatry, Brown University,
Providence, RI. Dr. Jacobson is senior resident in the Department of Psychiatry, Brown University, Providence, RI. The authors would like to thank Drs. Thomas Laughren and Demmie Mayfield
326
for their
Am
help
J Psychiatry
in preparing
133:3,
this paper.
March
/976
been
noted
should
as
a
(2, 3). The to “disease” frustrating
McKegney
primary
orientarather to liai-
(3) to suggest
be directed
instead
toward
students.
Much
house
to lead
teaching
of the literature records who did
experience tionally
has
obstacle to these teaching efforts tion of nonpsychiatric house staff than “person” has been sufficiently
psychiatry this area,
THE
2). However, the reluctance or inability house staff to think in psychologic terms the importance of psychosocial variables
over staff
teaching of house
and
regarding
the experiences their initial work
the
past
medical
academic
consultation-liaison of the before
year
students
and
that
the
teaching
with
rotating
medical services suggests that staff of the 1970s to psychologic
be different
pioneers 1960.
role
the
in Our
medical through
approach issues may
of the
present-
day consultation-liaison psychiatrist may require a different emphasis. One of us, W.A.B. (a psychiatrist), makes liaison rounds once weekly with medical house staff and students notating tals affiliated
through medicine at two general hospiwith a medical school; he also provides
formal psychiatric consultation to teaching medical and surgical services. The other, E.M.J. (a secondyear resident in psychiatry), makes morning workrounds with medical house staff two times weekly; in addition, he provides psychiatric consultation to the
BRIEF
medical and surgical services of a general hospital. Through these activities we have had contact with about 50 medical residents and interns from a variety of medical schools and geographic areas. Neither general hospital had psychiatric consultation-liaison teaching prior
to this
TEACHING
academic
year.
AREAS
Although mentioned areas
clinical by previous
of the
psychopharmacology authors as one
consultation-liaison
has been of the teaching
psychiatrist,
it is not
one of the teaching functions that has been emphasized (1). A considerable portion ofoun time was taken up in teaching proper use of psychotropic drugs. Our knowledge of psychopharmacology was probably called upon as frequently (if not more frequently) as our fund of information about psychodynamics and psychosomatic
medicine.
Medical
house
staff
seemed
to be aware of the general classes of psychotropic drugs but had only a vague sense of how and when they should be used. Much of our teaching in psychopharmacology was directed toward defining those conditions appropriate for treatment with specific psychopharmacologic agents; for example, indicating the type of depression most appropriate for the use of tnicyclic antidepressants and identifying the target symptoms of these medications. Staff members typically tended to prescribe neunoleptics and tnicyclic antidepressants in dosages fan below the therapeutic level and also tended to prescribe benzodiazepines indiscriminately. In addition, the side effects of psychotropic drugs and the organic conditions that contraindicate their use were not generally appreciated. After appropriate explanations, medical house staff members appeared quite willing to prescribe full therapeutic doses of these medications. This emphasis on psychopharmacology is, of course, partly a result of the current availability and effectiveness of a variety of psychopharmacologic agents. It may also reflect a trend among young medical professionals to view the psychopharmacologist, the manipulator of brain neurochemistry, as the current “wizard” in psychiatry. Recognition
not generally
delirium
is undendiagnosed
ATTITUDES TOWARD AND PSYCHOLOGIC
Contrary two
to our
general
sistant
have able.
expectations,
our
presence,
the
We
found
that
the importance agement and
PSYCHIATRIST
we
but
development
were
not
ne-
pleased
to
services availstaff itself had
psychiatry
interns
of psychologic almost invariably
of the
were
instead
house
and
staff
taught
of liaison
residents
services.
the house
in which
psychiatric consultation-liaison In one hospital the medical
initiated ing.
THE LIAISON CONCEPTS
hospitals
to
on medical
teach-
were
aware
of
issues in patient manconsidered situational
stress, personality style, and psychologic symptoms to be worthy of serious consideration in dealing with their medical patients. Thus it became clear that indoctrination regarding the relevance ofpsychosocial issues in the practice of medicine would not be one of
our
major This
functions.
is not
to say
that
the
residents
and
encountered
had a well-developed
sense
psychologic
variables
illness
management,
in medical
on that
necessarily
their
rather that they accepted ic issues in their work.
of the house and disease-was
psychologic
in their
reflected
l960s
ioral
and
we
role
of
medical
awareness
was
style of patient care, but importance of psychologpsychologic mindedness
the This
staff-their orientation to both person in contrast to the attitudes recorded
by previous workers. This may be related to the social an concerns characteristic
the
interns
of the
and
to the
science
in the
apparent change awareness and of the college
increasingly medical
firm
school
in attitude humanitaristudents of
place
of behav-
curriculum.
DISCUSSION
of Delirium
Although house the features of the tures differentiating ses were
functional psychosis and their relative insensitivity to the manifestations of delirium may be related to the fact that the organic brain syndromes, particularly delinium, fall somewhere between the cracks in medical school teaching; they are not emphasized by the departments ofpsychiatny, neurology, or medicine. Clinical clerkships in psychiatry tend to focus on the functional psychoses rather than on the organic brain syndromes. We believe, along with previous authors (4),
that
Psychopharmacology
COMMUNICATIONS
staff members were familiar with chronic brain syndromes, the feadelirium from functional psychoappreciated,
and
the
subtle
man-
ifestations of delirium were not usually recognized. There was a tendency to attribute psychotic behavior and confusion to schizophrenia, without an adequate medical on psychiatric evaluation for the presence of an organic etiology. House staff tended to rely on whether patients were oriented on not as the indicator of cognitive functioning. The readiness of house staff to make diagnoses of
In developing ices
over ing
psychiatric
medical
in two
the past with
academic
somewhat
pected. This the consumers social
and
consultation-liaison
school-affiliated
year, different
medical
school
we found issues
is not surprising of our teaching
senv-
general
hospitals
ourselves than
we
dealhad
ex-
in view of the fact that arose out of a different
context
than
did
their
fore-
bears. Although and discussing
some of our time was spent teaching concepts of psychosomatic medicine,
psychoanalytic
developmental
psychology,
and
chanac-
ten style, a considerable portion was spent teaching psychopharmacology and the differential diagnosis of Am
J Psychiatry
/33:3, March
1976
327
BRIEF
COMMUNICATIONS
psychotic
behavior.
psychiatrist
who
Thus,
we feel it is crucial
undertakes
such
thoroughly grounded in and in the recognition brain syndromes, as well chodynamic theory. The lack of resistance the sensitivity ofthe house may
represent
from that however,
confronting this possible
previous change
any
be
apparent
a change
in attitude
workers. in attitude
change
At present, is more im-
in style
of patient
care. The important task of current consultation-liaison psychiatrists may be to guide new nonpsychiatnic
The
Role
BY JACK
of the
Chief
F. WILDER,
M.D.,
Resident: ROBERT
THE ROLE OF THE CHIEF RESIDENT dency programs has received little
ination. However, the Department bert Einstein College of Medicine
crease
leadership
throughout a weekend skills
their
in psychiatric systematic
the United workshop
and
11: Consultation-liaison 131:623-630, 1974
2. Kimball CP: The second Psychosom Med 36:85-88,
and many
Romano I Chronic
HOPE
Conte stein Ave.,
328
is Research
Associate,
College of Medicine, Bronx,N.Y. 10461.
Am
J Psychiatry
and Operations, of Psychiatry,
Department
of Psychiatry,
Yeshiva
133:3,
University,
March
1300
1976
Dr. Plutand Dr.
Albert Morris
psychiatry:
an overview.
Am
psychiatric
liaison
workshop.
teaching of psychosomatic obstacles. J Nerv Ment Dis of cerebral
in-
PH.D.
chief residents. schools throughout residents decided workshop, they course material. plete a questionnaire tudes concerning
Notices were sent to all medical the country, and a total of 65 chief to attend. During their stay at the were exposed to formal and informal In addition, they were asked to corndesigned to determine their attithe roles they would soon assume as
chief residents. this initial survey
This with
the
chief
report compares the results of the results of a follow-up survey
residents
had
had
approximately
six
their jobs. Thirty-five both surveys.
of
the
METHOD
A 46-item mation
used
questionnaire for the
marily from questionnaire
was constructed.’
development
their
resident-staff
survey.
based
principally
on information
tion
of a panel
for
ofthe
The inforitems
came
two sources. The first was the used by Grant and associates
,
for Planning Department
to
Reality
R. CONTE,
questionnaire
This
.
of the
meeting of The second items
was
APA, source
pri-
19-item (1) for
questionnaire
provided
on the function
at the 124th annual D.C. May 3-7, 1971 Dr. Wilder is Associate Dean chik is Associate Professor,
awareness
J: Delirium, a syndrome Dis 9:260-277, 1959
and
AND
ceedings
incoming
annual 1974
3. McKegney FP: Consultation-liaison medicine: opportunities and 154:198-205, 1972
months’ experience on chief residents completed
States. The dedesigned to inof
J Psychiatry
after
at Aloppon-
attitudes from
sensitivities
I . Lipowski
PH.D.,
resiexam-
of Psychiatry had a unique
psychologic
of patients.
Expectations
PLUTCHIK,
tunity in June 1974 to investigate the functions of chief residents in psychiatry
schools offered
in applying
management
4. Engel GL, sufficiency.
Thejob expectations of35 incoming chief residents were tested by questionnaire when they attended a weekend workshop on leadership and were reexamined after they had had six months’ experience on theirjobs. Such personal qualities as a sense of humor andpersistence and such administrative skills as the ability to exercise authority and set objectives significantly increased in importance six months after these residents began work. The authors recommend educational programs in administration for chief residents.
medical partment
physicians
their
REFERENCES
to psychologic concepts and staffwe encountered to psy-
issues
than
the
should
clinical psychopharmacology and management of organic as in psychosomatic and psy-
chosocial
pressive
that
teaching
was
by the prochief
resident
Washington, of infonma-
consultations
with
EmPark
‘Copies request
of the complete from Dr. Wilder.
questionnaire
and
results
are available
by
COMMUNICATIONS
15. Collins
GGS, Sandier M: Human blood platelet monoamine oxiBiochem Pharmacol 20:289-296, 1971 Murphy D, Connelly CH: Monoamine oxidase in man: enzyme characteristics in platelets, plasma, and other human tissues, in Neuropsychopharmacology of Monoamines and Their Regulatory Enzymes, Advances in Biochemical Pharmacology, vol 12. Edited by Usdin E. New York, Raven Press, 1974, pp 71-85 Nies A, Robinson DS, Lamborn KR, et a]: Genetic control of platelet and plasma monoamine oxidase activity. Arch Gen Psychiatry 28:834-838, 1973 Murphy DL, Weiss R: Reduced monoamine oxidase activity in blood platelets from bipolar depressed patients. Am J Psychiatry 128:1351-1357, 1972 Nies A, Robinson DS, Ravaris CL, et al: Amines and monoamine oxidase in relation to aging and depression in man. Psychosom Med 3:470, 1971 Horwitt MK: Fact and artifact in the biology of schizophrenia. Science 124:429-430, 1956
21.
dase.
16.
17.
18.
19.
20.
Consultation-Liaison BY WALTER
Psychiatry:
A. BROWN,
M.D.,
AND
22. 23.
24.
25. 26.
27.
Kety 55: Biochemical theories ofschizophrenia, part I. Science 129:1528-1532, 1959 Kety 55: Biochemical theories of schizophrenia, part II. Science 129:1590-1596, 1959 Friedhoff AJ, Van Winkle E: Isolation and characterization of a compound from the urine of schizophrenics. Nature 194:897898, 1962 Gershon S. Lonigro A: A study of lymphocytes stained with Masson’s trichrome stain in psychiatric patients. I Nerv Ment Dis 139:569-573, 1964 Perry TL, Hestnin M, McDougall L, et a]: Urinary amines of intestinal bacterial origin. Clin Chim Acta 14: 116-123, 1966 Tourney G, Hatfield LM: Androgen metabolism in schizophrenics, homosexuals, and normal controls. Biol Psychiatry 6:23-35, 1973 Garelis E, Gillin JC, Wyatt Ri, Ct al: Elevated blood serotonin concentration in unmedicated chronic schizophrenic patients: a preliminary study. Am J Psychiatry 132:184-186, 1975
Current
ERIC
M.
Responsibilities
JACOBSON,
M.D.
medicine
The authors describe their experiences as consultation-liaison psychiatrists in two general teaching hospitals. Current medical house staff members appear to be more aware ofthe importance ofpsychosocial issues in patient care than were interns and residents in the past. Consultation-liaison teaching may nowfocus on the application of this psychologic awareness to patient management, the correct use ofpsychotropic drugs, and the differentiation ofdelirium from functional psychoses.
(1,
of medical and accept in
medical
practice
son
teaching
that
such
medical
efforts
ical
focused
students
his teaching and
chosocial
issues
interview
technique,
tion
and
and
concepts
Veterans and
house
efforts
staff
in medical
of
is Director, Administration Assistant
of
has
to the
relevance
and assessment,
Psychiatric
medof psy-
management,
psychiatric
psychogenicity
tradi-
on sensitizing
illness
personality
management
Dr. Brown 02908,
psychiatrist
CONSULTATION-LIAISON
recogni-
syndromes,
and
psychosomatic
Consultation-Liaison
Service,
Hospital, Davis Park, Providence, R.I. Professor of Psychiatry, Brown University,
Providence, RI. Dr. Jacobson is senior resident in the Department of Psychiatry, Brown University, Providence, RI. The authors would like to thank Drs. Thomas Laughren and Demmie Mayfield
326
for their
Am
help
J Psychiatry
in preparing
133:3,
this paper.
March
/976
been
noted
should
as
a
(2, 3). The to “disease” frustrating
McKegney
primary
orientarather to liai-
(3) to suggest
be directed
instead
toward
students.
Much
house
to lead
teaching
of the literature records who did
experience tionally
has
obstacle to these teaching efforts tion of nonpsychiatric house staff than “person” has been sufficiently
psychiatry this area,
THE
2). However, the reluctance or inability house staff to think in psychologic terms the importance of psychosocial variables
over staff
teaching of house
and
regarding
the experiences their initial work
the
past
medical
academic
consultation-liaison of the before
year
students
and
that
the
teaching
with
rotating
medical services suggests that staff of the 1970s to psychologic
be different
pioneers 1960.
role
the
in Our
medical through
approach issues may
of the
present-
day consultation-liaison psychiatrist may require a different emphasis. One of us, W.A.B. (a psychiatrist), makes liaison rounds once weekly with medical house staff and students notating tals affiliated
through medicine at two general hospiwith a medical school; he also provides
formal psychiatric consultation to teaching medical and surgical services. The other, E.M.J. (a secondyear resident in psychiatry), makes morning workrounds with medical house staff two times weekly; in addition, he provides psychiatric consultation to the
BRIEF
medical and surgical services of a general hospital. Through these activities we have had contact with about 50 medical residents and interns from a variety of medical schools and geographic areas. Neither general hospital had psychiatric consultation-liaison teaching prior
to this
TEACHING
academic
year.
AREAS
Although mentioned areas
clinical by previous
of the
psychopharmacology authors as one
consultation-liaison
has been of the teaching
psychiatrist,
it is not
one of the teaching functions that has been emphasized (1). A considerable portion ofoun time was taken up in teaching proper use of psychotropic drugs. Our knowledge of psychopharmacology was probably called upon as frequently (if not more frequently) as our fund of information about psychodynamics and psychosomatic
medicine.
Medical
house
staff
seemed
to be aware of the general classes of psychotropic drugs but had only a vague sense of how and when they should be used. Much of our teaching in psychopharmacology was directed toward defining those conditions appropriate for treatment with specific psychopharmacologic agents; for example, indicating the type of depression most appropriate for the use of tnicyclic antidepressants and identifying the target symptoms of these medications. Staff members typically tended to prescribe neunoleptics and tnicyclic antidepressants in dosages fan below the therapeutic level and also tended to prescribe benzodiazepines indiscriminately. In addition, the side effects of psychotropic drugs and the organic conditions that contraindicate their use were not generally appreciated. After appropriate explanations, medical house staff members appeared quite willing to prescribe full therapeutic doses of these medications. This emphasis on psychopharmacology is, of course, partly a result of the current availability and effectiveness of a variety of psychopharmacologic agents. It may also reflect a trend among young medical professionals to view the psychopharmacologist, the manipulator of brain neurochemistry, as the current “wizard” in psychiatry. Recognition
not generally
delirium
is undendiagnosed
ATTITUDES TOWARD AND PSYCHOLOGIC
Contrary two
to our
general
sistant
have able.
expectations,
our
presence,
the
We
found
that
the importance agement and
PSYCHIATRIST
we
but
development
were
not
ne-
pleased
to
services availstaff itself had
psychiatry
interns
of psychologic almost invariably
of the
were
instead
house
and
staff
taught
of liaison
residents
services.
the house
in which
psychiatric consultation-liaison In one hospital the medical
initiated ing.
THE LIAISON CONCEPTS
hospitals
to
on medical
teach-
were
aware
of
issues in patient manconsidered situational
stress, personality style, and psychologic symptoms to be worthy of serious consideration in dealing with their medical patients. Thus it became clear that indoctrination regarding the relevance ofpsychosocial issues in the practice of medicine would not be one of
our
major This
functions.
is not
to say
that
the
residents
and
encountered
had a well-developed
sense
psychologic
variables
illness
management,
in medical
on that
necessarily
their
rather that they accepted ic issues in their work.
of the house and disease-was
psychologic
in their
reflected
l960s
ioral
and
we
role
of
medical
awareness
was
style of patient care, but importance of psychologpsychologic mindedness
the This
staff-their orientation to both person in contrast to the attitudes recorded
by previous workers. This may be related to the social an concerns characteristic
the
interns
of the
and
to the
science
in the
apparent change awareness and of the college
increasingly medical
firm
school
in attitude humanitaristudents of
place
of behav-
curriculum.
DISCUSSION
of Delirium
Although house the features of the tures differentiating ses were
functional psychosis and their relative insensitivity to the manifestations of delirium may be related to the fact that the organic brain syndromes, particularly delinium, fall somewhere between the cracks in medical school teaching; they are not emphasized by the departments ofpsychiatny, neurology, or medicine. Clinical clerkships in psychiatry tend to focus on the functional psychoses rather than on the organic brain syndromes. We believe, along with previous authors (4),
that
Psychopharmacology
COMMUNICATIONS
staff members were familiar with chronic brain syndromes, the feadelirium from functional psychoappreciated,
and
the
subtle
man-
ifestations of delirium were not usually recognized. There was a tendency to attribute psychotic behavior and confusion to schizophrenia, without an adequate medical on psychiatric evaluation for the presence of an organic etiology. House staff tended to rely on whether patients were oriented on not as the indicator of cognitive functioning. The readiness of house staff to make diagnoses of
In developing ices
over ing
psychiatric
medical
in two
the past with
academic
somewhat
pected. This the consumers social
and
consultation-liaison
school-affiliated
year, different
medical
school
we found issues
is not surprising of our teaching
senv-
general
hospitals
ourselves than
we
dealhad
ex-
in view of the fact that arose out of a different
context
than
did
their
fore-
bears. Although and discussing
some of our time was spent teaching concepts of psychosomatic medicine,
psychoanalytic
developmental
psychology,
and
chanac-
ten style, a considerable portion was spent teaching psychopharmacology and the differential diagnosis of Am
J Psychiatry
/33:3, March
1976
327
BRIEF
COMMUNICATIONS
psychotic
behavior.
psychiatrist
who
Thus,
we feel it is crucial
undertakes
such
thoroughly grounded in and in the recognition brain syndromes, as well chodynamic theory. The lack of resistance the sensitivity ofthe house may
represent
from that however,
confronting this possible
previous change
any
be
apparent
a change
in attitude
workers. in attitude
change
At present, is more im-
in style
of patient
care. The important task of current consultation-liaison psychiatrists may be to guide new nonpsychiatnic
The
Role
BY JACK
of the
Chief
F. WILDER,
M.D.,
Resident: ROBERT
THE ROLE OF THE CHIEF RESIDENT dency programs has received little
ination. However, the Department bert Einstein College of Medicine
crease
leadership
throughout a weekend skills
their
in psychiatric systematic
the United workshop
and
11: Consultation-liaison 131:623-630, 1974
2. Kimball CP: The second Psychosom Med 36:85-88,
and many
Romano I Chronic
HOPE
Conte stein Ave.,
328
is Research
Associate,
College of Medicine, Bronx,N.Y. 10461.
Am
J Psychiatry
and Operations, of Psychiatry,
Department
of Psychiatry,
Yeshiva
133:3,
University,
March
1300
1976
Dr. Plutand Dr.
Albert Morris
psychiatry:
an overview.
Am
psychiatric
liaison
workshop.
teaching of psychosomatic obstacles. J Nerv Ment Dis of cerebral
in-
PH.D.
chief residents. schools throughout residents decided workshop, they course material. plete a questionnaire tudes concerning
Notices were sent to all medical the country, and a total of 65 chief to attend. During their stay at the were exposed to formal and informal In addition, they were asked to corndesigned to determine their attithe roles they would soon assume as
chief residents. this initial survey
This with
the
chief
report compares the results of the results of a follow-up survey
residents
had
had
approximately
six
their jobs. Thirty-five both surveys.
of
the
METHOD
A 46-item mation
used
questionnaire for the
marily from questionnaire
was constructed.’
development
their
resident-staff
survey.
based
principally
on information
tion
of a panel
for
ofthe
The inforitems
came
two sources. The first was the used by Grant and associates
,
for Planning Department
to
Reality
R. CONTE,
questionnaire
This
.
of the
meeting of The second items
was
APA, source
pri-
19-item (1) for
questionnaire
provided
on the function
at the 124th annual D.C. May 3-7, 1971 Dr. Wilder is Associate Dean chik is Associate Professor,
awareness
J: Delirium, a syndrome Dis 9:260-277, 1959
and
AND
ceedings
incoming
annual 1974
3. McKegney FP: Consultation-liaison medicine: opportunities and 154:198-205, 1972
months’ experience on chief residents completed
States. The dedesigned to inof
J Psychiatry
after
at Aloppon-
attitudes from
sensitivities
I . Lipowski
PH.D.,
resiexam-
of Psychiatry had a unique
psychologic
of patients.
Expectations
PLUTCHIK,
tunity in June 1974 to investigate the functions of chief residents in psychiatry
schools offered
in applying
management
4. Engel GL, sufficiency.
Thejob expectations of35 incoming chief residents were tested by questionnaire when they attended a weekend workshop on leadership and were reexamined after they had had six months’ experience on theirjobs. Such personal qualities as a sense of humor andpersistence and such administrative skills as the ability to exercise authority and set objectives significantly increased in importance six months after these residents began work. The authors recommend educational programs in administration for chief residents.
medical partment
physicians
their
REFERENCES
to psychologic concepts and staffwe encountered to psy-
issues
than
the
should
clinical psychopharmacology and management of organic as in psychosomatic and psy-
chosocial
pressive
that
teaching
was
by the prochief
resident
Washington, of infonma-
consultations
with
EmPark
‘Copies request
of the complete from Dr. Wilder.
questionnaire
and
results
are available
by
