Residency Education in Administrative Psychiatry A NatiotUll Survey William N. Arnold, M.D. Paul Rodenhauser, M.D. Milton Greenblatt, M.D.
In 1989, theauthors surveyed allgeneral psychiatry residency programs toassess the availability, extent, andemphasis ofadministrative teaching currently being offered during residency training. With a return rate of 74.5%, theresults reveal that 695% ofthe respondents presently include administrative training within their curricula and56% offer didactic teaching about administrative issues. These results are compared witha similar survey performed 10 years previously in which 85% of therespondents reported offeringsome administrative training but only 39% offered didactic instruction in this area. An analysis ofthese data anda review ofproposed curricula for training in administration are provided. ver the last two decades, fewer psychiatrists have undertaken high-level administrative management positions in mental health care systems (1-4). This shortage of psychiatrist-executives has occurred despite an abundance of postresidency educational opportunities offered in administration (5-7). The increasingly complex mental health care environment, with its added emphasis on cost regulation and quality psychiatric care (8-11), would itself seem to predict a shift toward more administrative training for psychiatrists. This, however, does not
O
Dr. Arnold is staff psychiatrist, Department of Psychiatry, Wright-Patterson Air Force Base, Dayton, OH, and assistant professor, Department of Psychiatry, Wright State University, Dayton , OH; Dr. Rodenhauser is professor of psychiatry, Department of Psychiatry and Neurology, Tulane University School of Medicine, New Orleans, LA; Dr. Greenblatt is chief of psychiatry, University of California at Los Angeles, Oliveview Medical Center, Sylmar, CA. Address correspondence to Dr. Arnold, Dept. of Psychiatry, USAF Medical Center, Wright-Patterson AFB, Dayton, OH 45433-5300.
presently appear to be the case (12). What role should residency programs play in preparing graduates for administrative positions? The literature has long suggested a generalized lack of structured residency education in administration (1317), though Silver and Marcos (11) contend in a recent review of the subject that formal administrative training during residency is critical. They noted, as have others (18,19), the importance of physician-executive role models on psychiatric residents' interest and future work in administration. Recent paradigms also suggest that leaders are not born but develop through experience and education (20,21). A 1979American Association of Directors of Psychiatry Residency Training (AADPRT) task force survey on education indicated that only 30% of psychiatry residency programs had assigned readings or required core training in administration and only 39% offered some didactic instruction or seminars on this subject (22). In light of the
\, i· \ .I ),, i) :
apparent need for increased interest, involvement, and education of psychiatrists in administration, questions arise about present administrative teaching in psychiatric residencies. The purpose of this article is to present the results of our recent survey of all general psychiatry residency programs that address the availability, extent, and emphasis of administrative teaching within training programs. METHODS In October 1989, an eight-item survey on education in administrative psychiatry was mailed to all residency training directors of general psychiatry programs listed in the
Directory of Psychiatry Residency Training Programs (5). Of the 207 questionnaires sent, 120 were completed and returned. This represents a return rate of 58%. In December 1989, a second mailing was sent to the 87 nonresponders. An additional 34 surveys were collected from this mailing to provide a total sample of 154. This represents 74.5% of all general psychiatry residency programs listed in the Directory. A complete copy of the survey is available upon request. The first question on our survey asked training directors if their program offered any formal educational experience in administration, including leadership and management skills. If they responded in the negative, they were referred to the final question, which asked if there were any plans to start such training. For those training directors who reported having a formal
administrative experience, the final survey question inquired whether they planned to continue, expand, reduce, or discontinue their current teaching. In addition, those with current teaching programs were asked to characterize the components of their administrativeexperiences.Thesurveyasked when in the residency curriculum the administrative teaching is offered and whether both didactic and experiential components are included. Respondents were also asked to list the percentage of time spent teaching the management of systems and organizations vs. the administrative issues in private practice vs. other areas of administration. Finally, two S-point Likert scales were used to assess the respondents' opinions of both the usefulness of their administrative teaching program and their residents' receptivity to the experience. On this scale, a score of 5 represented"extremely interested or useful" and a score of 1 represented "no interest or usefulness."
RESULTS Table 1 lists the distribution of psychiatry residency programs responding to our survey that currently offer formal administrative teaching. In addition, the table includes the programs' expressed plans to continue or to add administrative teaching to their curricula. As shown, 69.5% of the respondents to the survey presently offer some type of formal education in administration. Of these programs, 72% plan to continue with their present curriculum, while the remaining 28% plan to expand their current ad-
TABLE L Current and projected future status of formal administrative education Current ± Planned
Current
Psychiatry residency programs with formal administrative teaching Psychiatry residency programs without formal administrative teaching
.V
\1'1 \ii ( i'-,J( III \IR't
Number
Percent
Number
107
695
107+31=138
90
47
30.5
47-31=16
10
Percent
i ''' '
'.
l '
f I '\
l ~,
~
" r
I
.
'
, '''-,, ' '
(
!
j
1
"I
"1
ministrative teaching. In addition, of the 47 programs not currently offering any formal administrative teaching, 31 reported having plans to add administration to their curricula . Ifthis proves to be the case, a total of90% of the respondents should soon be offering formal administrative teaching. Of the residency programs currently offering administrative teaching, almost all (89%) provide at least part of it during PGY-4. An additional 28% of the training centers offer some of their administrative experience during PGY-3, while only 20% begin their teaching of administration in PGY-1 or PGY-2. Table 2 shows that a majority (63%)of the programs currently teaching administration offer both didactic and experiential components to their residents, and 80% (56% of all responding programs) offer some didactic teaching about administrative issues. Examples of the experiential components that respondents listed are diverse and include chief and senior resident responsibilities in managing treatment teams and in serving as program planning consultants at community mental health centers, NTL and T groups to assess leadership styles, and clinical rotations with state departments of mental health and state legislatures. With regard to the various administrative components currently being taught, only 89 responses were included in our data because 10 respondents failed to answer this question and for 7 others, response totals did not equal 100%. Analysis ofthe remaining 89 programs revealed that most (72%) of their time spent teaching administration is focused on the management of systems and organizations. An additional 19% of their time is spent teaching about the administrative issues in the private practice of
psychiatry. The remaining 9% of their administrative teaching time involves a number of other areas related to administration. Finally, the residency training directors' assessment of the usefulness of their teaching program in administration on the 5point Likert scale revealed a mean score of 4, which correlates to "greater than average usefulness." Their opinion of their residents' receptivity to this teaching was somewhat lower, with a mean of 3.6, representing above average interest in this subject.
DISCUSSION Given the complexity of contemporary psychiatric care delivery (8-12), the trends in administration of mental health care systems (23), and the belief that ''leaders are made, not born" (21), the involvement of future psychiatrists in administration is de:pendent in part on the interest of psychiatric educators in providing education and inspiration for students and residents (24,25). The current status of residency education in administrative psychiatry is largely unknown, despite the inclusion of both experiential and didacticadministrative training requirements by the Residency Review Committee (RRC) in psychiatry (26). Why is the teaching of administrative principles to psychiatry residents relevant today, when residency programs already struggle to provide a thorough education in the increasingly complex field of psychiatry? Feldman (27)argues that the delivery of clinical services and the administration of mental health care systems directly affect one another. He states that "the substance of mental health programs is inseparable from mental health administration-in effect, ad-
TABLE 2. Current experiential and didactic teaching components in administrative education Experiential Component Only
Didactic Component Only
Combined Didactic and Experiential Components
Number of residency programs
22
18
67
Percent
20
17
63
ministration is program and program is ad- specialties are offered annually by both the ministration." Further support for this posi- Utah Department of Family Practice and the tion emanates from the concern that American College of Physician Executives in diminished clinical authority and preroga- collaboration with the University of Southtive will result from a decline in the numbers ern California School of Medicine and the of psychiatrist-executives. Lipton and George Washington Medical Center. The Loutsch (28) argue that "if further justifica- limitations of this administrative training, tion for the study of management technique however, are significant. In general, most is needed, it should now be abundantly clear residency programs select only onechief resthat in our field, management decisions are, ident per year, and such administrative exin the end, clinical decisions. To the extent periences and education are not distributed that clinicians relinquish their leadership re- across the program. There are also no spesponsibilities, they also surrender their clin- cific standards for or uniformity in the adical authority." These legitimate concerns ministrative experiences of chief residents at would seem to mandate the incorporation of various institutions. administrative education into the psychiatry The requirements for training psychiatry residents in administrative issues, as residency curriculum. Diverse opportunities for further ad- listed in the RRC's Special Essentials for Psyministrative training in mental health care chiatry, are addressed in two ways: 1) "faare available after completion of residency. miliarity with the issues of financing and These include master's degree and profes- regulation of psychiatric practice, including sional certificate programs in business and information about the structure of governhealth administration, continuing education mental and private organizations that influcourses in administration offered by the De- ence mental health care," and 2) "experience partment of Psychiatry at various academic in psychiatric administration, especially institutions, and a limited number of fel- such as leadership of interdisciplinary lowship programs in administrative psy- teams" (26). As reported in the 1978-79 chiatry (23). In addition, since 1954 the AADPRT survey on the teaching of adAmerican Psychiatric Association has ministration in psychiatry residencies, most offered credentialing in administration programs that were teaching administration through their Committee on Certification in focused their attention on the administrative Administrative Psychiatry. Despite these at- issues of psychiatric practice (22).Since then, tempts to advance administrative training, several proposals toward the establishment psychiatry has no singular direction or stan- of a model curriculum for the formal teachdards for formal management education. ing of administration within psychiatry resJust as on-the-job training accounted for idency programs have been suggested most clinicians' education in administration (22,34-36), although, as noted previously, a decade ago (29), we suspect that this con- these ideas have not become generalized tinues to be the primary method of admini- across residencies. strative training today. What is the educational methodology in The chief resident position has long been administrative management best suited for recognized as an experience base for training incorporation into the core curricula of genin management process and leadership (30- eral psychiatry residency programs? This 33). The Albert Einstein College of Medicine issue was addressed at a 1990 AADPRT Department of Psychiatry hassponsored an workshop on residency education in adminannual Chief Resident in Psychiatry Confer- istrative psychiatry attended by residency ence in Tarrytown, NY, for the past 19 years. training directors and residents with an exIn addition, chief resident conferences for all pressed interest in the subject. Topics de-
't
.),
\
'
(
I ) .
'r ( : 'I
\!
k ')
'II
\1 '\11"'- 1"'" \ 11\ I I',",} ( i ll \ rJ, )
bated included the amount of time that should be allocated for administrative training, the optimum period within the residency to incorporate such teaching, and the various components of the teaching experience. After a lengthy discussion of the RRC requirements for administrative training and the merits of such training, participants agreed that provisions for formal didactics on administrative topics be incorporated into residency curricula. Arguments against inclusion of the subject focused on some training directors' desire to utilize all available didactic time for the teaching of clinical psychiatry issues. Proponents argued that teaching administration is critically important to the present and future practice of psychiatry and must be included in the curriculum. It was agreed that didactic teaching of administration should be added to the curriculum during PGY-3 and PGY-4 when residents have more administrative duties such as supervising interns and medical students or leading treatment teams. Participants felt that providing the didactics while the residents were engaged in administrative experiences would make the information presented immediately practical and interesting. Although no agreement on specific course content was realized at this workshop, sentiment among participants favored inclusion of some standard readings while allowing opportunities for selections that complement the specific training experiences available in each program. Similarly, though no clear standards were offered regarding the supervision of experiential components of a curriculum, it was agreed that supervisors should ideally have experience and training in administration. The results of our 1989 survey of U.S. training directors appear to indicate an increase in administrative teaching within residency programs, compared with the findings of the similar 1979 survey (22). However, the current results are disconcerting in light of RRC requirements that all I"'::
accredited psychiatry residencies provide training and didactics in administration (26). It is also possible that in an attempt to appear in compliance with these guidelines, the residency training directors' responses to our survey represented what their programs offer to residents rather than what they require of them. Therefore, our survey can only suggest, rather than conclusively demonstrate, an increase in administrative teaching over the last decade. Our data also suggest some consistency in the educational methods used to teach administration across those programs presently offering formal administrative training. For example, in almost all of the programs, such teaching is offered in the final two postgraduate years of training. In addition, most programs are providing both didactic and experiential components to their residents. Also noteworthy is that the emphasis of teaching seems to be focused on the management of systems and organizations. However, it is unclear from our data what percentage of residents actually participate in the available didactic or experiential training in administrative psychiatry offered in their programs. Interestingly, the data suggest considerable positive regard by training directors for the administrative training now being offered . Their responses also indicate their belief that residents are interested in incorporating this training into their education. This notion is supported by a previous study that demonstrated an increase in interest in psychiatric administration as residents progress through their training (37). The decline in numbers of senior level psychiatrist-administrators and the possibly related decline in the clinical prerogative required to formulate and implement mental health policy at the local, state, and national levels should inspire interest in the role of education in preparing psychiatrists for administrative positions . Research is needed to discover relevant and inviting mechanisms to promote interest in administration among \U I L \ 11 . I:; . \il\-lIJ l 1
In 1989, theauthors surveyed allgeneral psychiatry residency programs toassess the availability, extent, andemphasis ofadministrative teaching currently being offered during residency training. With a return rate of 74.5%, theresults reveal that 695% ofthe respondents presently include administrative training within their curricula and56% offer didactic teaching about administrative issues. These results are compared witha similar survey performed 10 years previously in which 85% of therespondents reported offeringsome administrative training but only 39% offered didactic instruction in this area. An analysis ofthese data anda review ofproposed curricula for training in administration are provided. ver the last two decades, fewer psychiatrists have undertaken high-level administrative management positions in mental health care systems (1-4). This shortage of psychiatrist-executives has occurred despite an abundance of postresidency educational opportunities offered in administration (5-7). The increasingly complex mental health care environment, with its added emphasis on cost regulation and quality psychiatric care (8-11), would itself seem to predict a shift toward more administrative training for psychiatrists. This, however, does not
O
Dr. Arnold is staff psychiatrist, Department of Psychiatry, Wright-Patterson Air Force Base, Dayton, OH, and assistant professor, Department of Psychiatry, Wright State University, Dayton , OH; Dr. Rodenhauser is professor of psychiatry, Department of Psychiatry and Neurology, Tulane University School of Medicine, New Orleans, LA; Dr. Greenblatt is chief of psychiatry, University of California at Los Angeles, Oliveview Medical Center, Sylmar, CA. Address correspondence to Dr. Arnold, Dept. of Psychiatry, USAF Medical Center, Wright-Patterson AFB, Dayton, OH 45433-5300.
presently appear to be the case (12). What role should residency programs play in preparing graduates for administrative positions? The literature has long suggested a generalized lack of structured residency education in administration (1317), though Silver and Marcos (11) contend in a recent review of the subject that formal administrative training during residency is critical. They noted, as have others (18,19), the importance of physician-executive role models on psychiatric residents' interest and future work in administration. Recent paradigms also suggest that leaders are not born but develop through experience and education (20,21). A 1979American Association of Directors of Psychiatry Residency Training (AADPRT) task force survey on education indicated that only 30% of psychiatry residency programs had assigned readings or required core training in administration and only 39% offered some didactic instruction or seminars on this subject (22). In light of the
\, i· \ .I ),, i) :
apparent need for increased interest, involvement, and education of psychiatrists in administration, questions arise about present administrative teaching in psychiatric residencies. The purpose of this article is to present the results of our recent survey of all general psychiatry residency programs that address the availability, extent, and emphasis of administrative teaching within training programs. METHODS In October 1989, an eight-item survey on education in administrative psychiatry was mailed to all residency training directors of general psychiatry programs listed in the
Directory of Psychiatry Residency Training Programs (5). Of the 207 questionnaires sent, 120 were completed and returned. This represents a return rate of 58%. In December 1989, a second mailing was sent to the 87 nonresponders. An additional 34 surveys were collected from this mailing to provide a total sample of 154. This represents 74.5% of all general psychiatry residency programs listed in the Directory. A complete copy of the survey is available upon request. The first question on our survey asked training directors if their program offered any formal educational experience in administration, including leadership and management skills. If they responded in the negative, they were referred to the final question, which asked if there were any plans to start such training. For those training directors who reported having a formal
administrative experience, the final survey question inquired whether they planned to continue, expand, reduce, or discontinue their current teaching. In addition, those with current teaching programs were asked to characterize the components of their administrativeexperiences.Thesurveyasked when in the residency curriculum the administrative teaching is offered and whether both didactic and experiential components are included. Respondents were also asked to list the percentage of time spent teaching the management of systems and organizations vs. the administrative issues in private practice vs. other areas of administration. Finally, two S-point Likert scales were used to assess the respondents' opinions of both the usefulness of their administrative teaching program and their residents' receptivity to the experience. On this scale, a score of 5 represented"extremely interested or useful" and a score of 1 represented "no interest or usefulness."
RESULTS Table 1 lists the distribution of psychiatry residency programs responding to our survey that currently offer formal administrative teaching. In addition, the table includes the programs' expressed plans to continue or to add administrative teaching to their curricula. As shown, 69.5% of the respondents to the survey presently offer some type of formal education in administration. Of these programs, 72% plan to continue with their present curriculum, while the remaining 28% plan to expand their current ad-
TABLE L Current and projected future status of formal administrative education Current ± Planned
Current
Psychiatry residency programs with formal administrative teaching Psychiatry residency programs without formal administrative teaching
.V
\1'1 \ii ( i'-,J( III \IR't
Number
Percent
Number
107
695
107+31=138
90
47
30.5
47-31=16
10
Percent
i ''' '
'.
l '
f I '\
l ~,
~
" r
I
.
'
, '''-,, ' '
(
!
j
1
"I
"1
ministrative teaching. In addition, of the 47 programs not currently offering any formal administrative teaching, 31 reported having plans to add administration to their curricula . Ifthis proves to be the case, a total of90% of the respondents should soon be offering formal administrative teaching. Of the residency programs currently offering administrative teaching, almost all (89%) provide at least part of it during PGY-4. An additional 28% of the training centers offer some of their administrative experience during PGY-3, while only 20% begin their teaching of administration in PGY-1 or PGY-2. Table 2 shows that a majority (63%)of the programs currently teaching administration offer both didactic and experiential components to their residents, and 80% (56% of all responding programs) offer some didactic teaching about administrative issues. Examples of the experiential components that respondents listed are diverse and include chief and senior resident responsibilities in managing treatment teams and in serving as program planning consultants at community mental health centers, NTL and T groups to assess leadership styles, and clinical rotations with state departments of mental health and state legislatures. With regard to the various administrative components currently being taught, only 89 responses were included in our data because 10 respondents failed to answer this question and for 7 others, response totals did not equal 100%. Analysis ofthe remaining 89 programs revealed that most (72%) of their time spent teaching administration is focused on the management of systems and organizations. An additional 19% of their time is spent teaching about the administrative issues in the private practice of
psychiatry. The remaining 9% of their administrative teaching time involves a number of other areas related to administration. Finally, the residency training directors' assessment of the usefulness of their teaching program in administration on the 5point Likert scale revealed a mean score of 4, which correlates to "greater than average usefulness." Their opinion of their residents' receptivity to this teaching was somewhat lower, with a mean of 3.6, representing above average interest in this subject.
DISCUSSION Given the complexity of contemporary psychiatric care delivery (8-12), the trends in administration of mental health care systems (23), and the belief that ''leaders are made, not born" (21), the involvement of future psychiatrists in administration is de:pendent in part on the interest of psychiatric educators in providing education and inspiration for students and residents (24,25). The current status of residency education in administrative psychiatry is largely unknown, despite the inclusion of both experiential and didacticadministrative training requirements by the Residency Review Committee (RRC) in psychiatry (26). Why is the teaching of administrative principles to psychiatry residents relevant today, when residency programs already struggle to provide a thorough education in the increasingly complex field of psychiatry? Feldman (27)argues that the delivery of clinical services and the administration of mental health care systems directly affect one another. He states that "the substance of mental health programs is inseparable from mental health administration-in effect, ad-
TABLE 2. Current experiential and didactic teaching components in administrative education Experiential Component Only
Didactic Component Only
Combined Didactic and Experiential Components
Number of residency programs
22
18
67
Percent
20
17
63
ministration is program and program is ad- specialties are offered annually by both the ministration." Further support for this posi- Utah Department of Family Practice and the tion emanates from the concern that American College of Physician Executives in diminished clinical authority and preroga- collaboration with the University of Southtive will result from a decline in the numbers ern California School of Medicine and the of psychiatrist-executives. Lipton and George Washington Medical Center. The Loutsch (28) argue that "if further justifica- limitations of this administrative training, tion for the study of management technique however, are significant. In general, most is needed, it should now be abundantly clear residency programs select only onechief resthat in our field, management decisions are, ident per year, and such administrative exin the end, clinical decisions. To the extent periences and education are not distributed that clinicians relinquish their leadership re- across the program. There are also no spesponsibilities, they also surrender their clin- cific standards for or uniformity in the adical authority." These legitimate concerns ministrative experiences of chief residents at would seem to mandate the incorporation of various institutions. administrative education into the psychiatry The requirements for training psychiatry residents in administrative issues, as residency curriculum. Diverse opportunities for further ad- listed in the RRC's Special Essentials for Psyministrative training in mental health care chiatry, are addressed in two ways: 1) "faare available after completion of residency. miliarity with the issues of financing and These include master's degree and profes- regulation of psychiatric practice, including sional certificate programs in business and information about the structure of governhealth administration, continuing education mental and private organizations that influcourses in administration offered by the De- ence mental health care," and 2) "experience partment of Psychiatry at various academic in psychiatric administration, especially institutions, and a limited number of fel- such as leadership of interdisciplinary lowship programs in administrative psy- teams" (26). As reported in the 1978-79 chiatry (23). In addition, since 1954 the AADPRT survey on the teaching of adAmerican Psychiatric Association has ministration in psychiatry residencies, most offered credentialing in administration programs that were teaching administration through their Committee on Certification in focused their attention on the administrative Administrative Psychiatry. Despite these at- issues of psychiatric practice (22).Since then, tempts to advance administrative training, several proposals toward the establishment psychiatry has no singular direction or stan- of a model curriculum for the formal teachdards for formal management education. ing of administration within psychiatry resJust as on-the-job training accounted for idency programs have been suggested most clinicians' education in administration (22,34-36), although, as noted previously, a decade ago (29), we suspect that this con- these ideas have not become generalized tinues to be the primary method of admini- across residencies. strative training today. What is the educational methodology in The chief resident position has long been administrative management best suited for recognized as an experience base for training incorporation into the core curricula of genin management process and leadership (30- eral psychiatry residency programs? This 33). The Albert Einstein College of Medicine issue was addressed at a 1990 AADPRT Department of Psychiatry hassponsored an workshop on residency education in adminannual Chief Resident in Psychiatry Confer- istrative psychiatry attended by residency ence in Tarrytown, NY, for the past 19 years. training directors and residents with an exIn addition, chief resident conferences for all pressed interest in the subject. Topics de-
't
.),
\
'
(
I ) .
'r ( : 'I
\!
k ')
'II
\1 '\11"'- 1"'" \ 11\ I I',",} ( i ll \ rJ, )
bated included the amount of time that should be allocated for administrative training, the optimum period within the residency to incorporate such teaching, and the various components of the teaching experience. After a lengthy discussion of the RRC requirements for administrative training and the merits of such training, participants agreed that provisions for formal didactics on administrative topics be incorporated into residency curricula. Arguments against inclusion of the subject focused on some training directors' desire to utilize all available didactic time for the teaching of clinical psychiatry issues. Proponents argued that teaching administration is critically important to the present and future practice of psychiatry and must be included in the curriculum. It was agreed that didactic teaching of administration should be added to the curriculum during PGY-3 and PGY-4 when residents have more administrative duties such as supervising interns and medical students or leading treatment teams. Participants felt that providing the didactics while the residents were engaged in administrative experiences would make the information presented immediately practical and interesting. Although no agreement on specific course content was realized at this workshop, sentiment among participants favored inclusion of some standard readings while allowing opportunities for selections that complement the specific training experiences available in each program. Similarly, though no clear standards were offered regarding the supervision of experiential components of a curriculum, it was agreed that supervisors should ideally have experience and training in administration. The results of our 1989 survey of U.S. training directors appear to indicate an increase in administrative teaching within residency programs, compared with the findings of the similar 1979 survey (22). However, the current results are disconcerting in light of RRC requirements that all I"'::
accredited psychiatry residencies provide training and didactics in administration (26). It is also possible that in an attempt to appear in compliance with these guidelines, the residency training directors' responses to our survey represented what their programs offer to residents rather than what they require of them. Therefore, our survey can only suggest, rather than conclusively demonstrate, an increase in administrative teaching over the last decade. Our data also suggest some consistency in the educational methods used to teach administration across those programs presently offering formal administrative training. For example, in almost all of the programs, such teaching is offered in the final two postgraduate years of training. In addition, most programs are providing both didactic and experiential components to their residents. Also noteworthy is that the emphasis of teaching seems to be focused on the management of systems and organizations. However, it is unclear from our data what percentage of residents actually participate in the available didactic or experiential training in administrative psychiatry offered in their programs. Interestingly, the data suggest considerable positive regard by training directors for the administrative training now being offered . Their responses also indicate their belief that residents are interested in incorporating this training into their education. This notion is supported by a previous study that demonstrated an increase in interest in psychiatric administration as residents progress through their training (37). The decline in numbers of senior level psychiatrist-administrators and the possibly related decline in the clinical prerogative required to formulate and implement mental health policy at the local, state, and national levels should inspire interest in the role of education in preparing psychiatrists for administrative positions . Research is needed to discover relevant and inviting mechanisms to promote interest in administration among \U I L \ 11 . I:; . \il\-lIJ l 1
