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What is PCFA?
The Psychiatric Clinical Faculty Association (PCFA) is a 501(c)(3) California corporation based in Los Angeles, California. The organization is dedicated to teaching the art and science of psychiatry to trainees at the University of California, Los Angeles. Membership consists of UCLA clinical faculty members who volunteer their time and energies to teach the university's psychiatry trainees across a variety of settings, including: clinical supervision, on-site staffing, seminars, lectures and mentoring.
PCFA contributes expertise to the clinical curriculum in the university's psychiatric residency training programs and provides funds for residency activities. It also serves its members by representing them in the university and by providing ongoing educational activities.
From the President’s Perspective
by Wayne Sandler, M.D., Ph.D.
As a long term member of the Executive Committee and Board of the PCFA I have participated in examining the Clinical Faculty’s role in the education of the residents over the years. Whether or not you are a believer of climate change, one can not deny that the climate within the psychiatric residency is very different than when many of us finished our training. To avoid what some of our clinical colleagues describe as marginalization, the clinical faculty needs to adapt in order to maintain our very important role in residency education. Sharing information about some of the changes in and requirements of the residency may help us to understand what we can do.
Let us first look at the quality of the residents. I have heard several of the full time faculty say, “If I were applying to the program today I would not get in.” UCLA is an extremely competitive psychiatric program that attracts many of the best and the brightest medical students. Many of the current applicants and residents come with rich, varied backgrounds as well as additional advanced degrees. Due to the time constraints inherent in their need to balance service and education requirements, the residents may choose to forego certain learning experiences. These choices are based on assessing time spent versus the value of the learning. So, in order to maintain our relevance, we must constantly evaluate the quality of our teaching.
Resident teaching fits in a framework that was delineated after many of our members had completed training. I feel it is important to describe the six core competencies the Accreditation Council for Graduate Medical education (ACGME) have outlined for psychiatric residencies.
Patient Care and Procedural Skills
Residents must be able to provide patient care that is compassionate, appropriate, and effective for the treatment of health problems and the promotion of health.
Residents must demonstrate knowledge of established and evolving biomedical, clinical, epidemiological and social-behavioral sciences, as well as the application of this knowledge to patient care.
Practice-Based Learning and Improvement
Residents must demonstrate the ability to investigate and evaluate their care of patients, to appraise and assimilate scientific evidence, and to continuously improve patient care based on constant self-evaluation and life-long learning.
Interpersonal and Communication Skills
Residents must demonstrate interpersonal and communication skills that result in the effective exchange of information and collaboration with patients, their families, and health professionals.
Residents must demonstrate a commitment to carrying out professional responsibilities and an adherence to ethical principles, including:
- compassion, integrity and respect for others
- responsiveness to patient needs that supercedes self interest
- respect for patient privacy and autonomy
- accountability to patients, society and the profession
Residents must demonstrate an awareness of responsiveness to the larger context and system of health care, as well as the ability to call effectively on other resources in the system to provide optimal health care.
Competency is a primary psychological need and without it one would find it difficult to meet the two other psychological needs of autonomy and relatedness. As clinical faculty we are models for the practice of psychiatry outside of the academic setting. We need to model the core values and competencies outlined above, as well as these maturational goals of autonomy and relatedness.
Autonomy can also be developed through the residents’ personal experiences of moonlighting. This is particularly important now because the current structure of their clinics results in the residents feeling less autonomous in the care of their patients. When describing their moonlighting experiences, however, residents emphasize the educational value of their experiences more than the economics. They feel that their moonlighting experiences instill confidence and ease the transition toward completion of the residency. In our roles as supervisors or as therapists (in Psych 483), we need to understand those moonlighting experiences and support them. On several occasions I have discussed moonlighting activities with supervisees. I see this as assisting in the development of their autonomy. I believe this is important because many residents may choose moonlighting over supervision. When they have supervision, discussing moonlighting can enhance their education.
I remember one of my supervisors telling me, “Patients don’t care how much you know until they know how much you care.” Caring is the foundation of relatedness and is something that is not easy to teach. When I thought about how to teach relatedness to residents, I remembered dialogue from the television show “The West Wing.” Since we all practice in Los Angeles, drawing from “the industry” seems only fitting.
“This guy is walking down the street when he falls into a hole. The walls are so steep he can’t get out. A doctor passes by and the guy shouts up, 'Hey can you help me out?' The doctor writes a prescription and throws it into the hole and moves on. Then a priest comes along and the guy shouts up, 'Hey Father can you help me out?' The priest writes out a prayer and throws into the hole and moves on. Then a friend walks by, 'Hey Joe its me; can you help me out?' The friend jumps into the hole. Our guy says, 'Are you stupid? Now we’re both down here.' The friend says, 'Yeh, but I’ve been down here before and I know the way out.'"
Let’s hope we are teaching our residents to be the type of doctors who will join with their patients “in the hole,” and then by using both compasson and expertise, emerge with them from the hole together.
We as volunteer clinical faculty provide the residents with a model for competency, autonomy and relatedness while demonstrating the accountability to self, patients, and colleagues. In our role as mentors, we need to be mindful of our profession’s required competencies, the changing demands that residents face, and their needs to develop autonomy and to hone their compassion skills. Keeping these values and needs in mind will help us to provide residents with a maximum of learning and wisdom for the time they invest with us.
As the current President of the PCFA I find myself in a unique position. If it were not for the untimely death of David Coffey in January 2012, I would not have replaced him as President-elect. David was a dedicated member of the Clinical Faculty, and he was actively engaged in promoting the PCFA’s mission. What makes my position unique is that David left a generous bequest which I have the responsibility to help direct over the next two years. I feel it is important to honor David’s vision and interests by executing many of his ideas.
A vision without execution could be considered an hallucination. Keeping this in mind, I will describe what the PCFA is doing to promote and enhance clinical psychiatric education for all psychiatry residents, medical students and other health trainee at UCLA.
Due to the closure of several psychiatric facilities in Los Angeles, there has been an increase in the service demands of the residency. The clinical faculty strives to maximize teaching within the time constraints of these increased service demands. The ability to observe therapy being provided, whether by yourself or others, would add a valuable dimension to this teaching. Understanding this, the PCFA has directed funds toward current technologies in two ways.
First, we started a pilot project using Samsung split screen technology to capture video recordings of residents providing therapy to their patients. The goal of this project is to provide a simple and convenient method for residents to tape therapy sessions with their patients. This will facilitate later review of the sessions with their supervisors.
A second area where funds are being directed is in the building of a digitized video library. The library will eventually be available to residents and faculty via the PCFA website. We are fortunate that Dick Metzner generously volunteered both his limited time and his limitless expertise to spearhead both of these projects. Note that the impetus for this video library project arose directly from resident requests. The residents emphasized how this library will enhance the teaching of psychotherapy by directly illustrating psychotherapy principles. Since the editing is best done by a fellow psychiatrist, the board decided to provide Dick Metzner with the equipment necessary to more easily maintain and edit the vast material available.
Another project that David Coffey was involved with was Psychiatry and the Cinema. A sponsored event occurred on 4/16/14 at which Roman Polanski’s movie “Repulsion” was screened. Dr. Behnaz Jalai was the discussant from the Department of Psychiatry and Ron Kelly was the discussant from the UCLA School of Theater, Film and Television. James Greenberg author of Roman Polanski: A Retrospective also participated as a discussant. We funded the event from the David Coffey Fund. We plan to sponsor similar Psychiatry and the Cinema nights at regular intervals and to call them the Dr. David Coffey Memorial Film Night.
Other ongoing programs that the PCFA maintains include the Psychotherapy Program. This program, which is in its 22nd year, is where residents participate in their own psychotherapy provided by clinical faculty at a nominal fee ($35.00 session). The funds collected are then redirected back to the PCFA to fund resident activities. Another ongoing program is the Distinguished Psychiatrist Seminar, now in its 18th year. Prior participants were: James Masterson, Glen Gabbard, Ethel Person, Robert Michels, Otto Kernberg, Robert Naborski, Mardi Horowitz, Lenore Terr, Vamik Volkan, Roy Menninger, Russel Meares, John Gunderson, Anthony Bateman, Margaret Kraft Goin, Richard Green, Peter Kramer, and Allen Francis. The next speaker on October 17 and 18th, 2014 will be Dr. Salmar Akhtar. Quite a distinguished list!
Other ways in which we support the education of the residents is in the yearly Hatos Prizes. These are divided into the Alex Rogawski and 21st Century Prizes. For the past 18 years we have requested scholarly papers that address either “Psychiatry’s Role in the New Millenium” (21st Century Prize) or areas of interest of Alex Rogawski’s (i.e.., role of preventive efforts in psychiatry, psychodynamic understanding and its application to community psychiatry, the role of psychiatry in primary care, or transcultural issues in psychiatry). Last years winners were Dr. Elizabeth Nakamura for her paper entitled “Should Psychiatrists Have a Role in the Gun Control Debate?” and Dr. Misty Richards for her paper, "Cross-cultural Comparisons of Attitudes Toward Schizophrenia Amongst the General Population and Physicians in Japan and the United States.” Dr. Nakamura, who previously attended the PCFA Board and Executive Meetings as chief resident, is now a clinical faculty member. She has recently volunteered for and been voted onto the PCFA Board and Executive Committee. As both a recent graduate and an actual member of the millennial generation, the executive community unanimously approved her as the PCFA Awards Coordinator. She will interface with the residents regarding award opportunities. These awards will include the Hatos Prizes, and possibly a new award created from the Coffey Funds to support resident leadership and innovation.
The PCFA is continuing the Terzian Book Fund which began in 2003. This was a fund established in the memory of Sherry Terzian, a faculty member and the first librarian at the UCLA Neuropsychiatric Institute. Using this fund, we provide a book for third year residents at UCLA, Harbor and San Fernando. This is a way to help the residents add to their personal library.
Dr. Coffey was also involved in establishing the annual PFCA picnic. June 22, 2014 will be the fifth annual intern picnic. The picnics are held at the Sunset Recreation Center and provide an opportunity for the clinical faculty to interface with the interns and to welcome them to UCLA.
The Volunteer Clinical Faculty is dedicated to maintaining the high quality of the UCLA Psychiatric Residency. Clearly the clinical faculty makes invaluable contributions to the UCLA psychiatry residency culture. Our mentoring plays an important role in training residents as both compassionate clinicians and competent leaders. I recall the Oslerian Principal that a “good” doctor treats the disease and a “great” doctor treats the person who has the disease. Through our vital involvement we help UCLA psychiatry residents realize their full potential as “great” doctors.