Psychiatry Oral Boards will soon be a thing of the past.  This development will no doubt cause considerable consternation for those who make a living by providing week-long practice sessions, but will be welcome news to psychiatry residents who suffer from performance anxiety!  I have mixed feelings about the news myself.   I confess to the feelings that anyone has when there is a sense that the journey has become a bit lighter for those following in one’s footsteps.  I remember similar feelings years ago when resident work hours were reduced to the limit of ‘only’ 80 hours per week!  After all, misery loves company.

But I found that I was wrong about those feelings about resident work hours.  I teach medical students now, and I realize that current grads have it as tough as I ever did.  I had to remember the name of one or two beta-blockers, I needed only a general understanding that something called ‘cytochromes’ degrade medications at the liver,  and there were no classes that required an understanding of the human genome project’!  I would guess that psychiatry residents will face new challenges that are not anticipated now. 

I do hope that there is a significant hurdle placed at some point in the process– for reasons that current psychiatry residents may not yet fully appreciate.  Right now, Psychiatry Board Certification means something.  Those residents who work hard to truly understand the most difficult aspects of the art and science of psychiatry should have for their work to ‘count.’  As a solo practice psychiatrist who does not belong to insurance panels, I must rely on providing a good product– i.e. being a good psychiatrist– to keep my practice going.  I see patients who have become fed up with what they describe as ‘psychiatry mills’ where they are hurried through appointments, are prescribed medications for reasons they do not understand, and who never feel a sense of support from the psychiatrist who has been assigned to provide their care.  I am always surprised when I ask a patient the name of his/her previous psychiatrist and the patient cannot remember the name!  The sad thing is that such an occurence is not unusual.  I encourage residents and others studying to be mental health practitioners to continue to demand a rigorous curriculum, as that is what will allow psychiatry to remain a respected field of medicine.  I also encourage individual practitioners to strive to set themselves apart by being a psychiatrist who is truly valued by your patients– not someone who just happens to be on all of the panels.

The changes in the exams mean that I will have to change the way that I market my recordings to some extent– for example the keywords ‘oral psychiatry boards’ will no longer be all that useful!  But the good news is that the recordings that I have prepared are as valuable for the new standards as they were before.  I now recommend that people consider the recordings that provide an understanding of the DSM criteria for psychiatric disorders for use earlier in their residencies;  I used to recommend the recordings for the oral boards, but now the plan is to assess competence at earlier points in the residency.  The recordings for the diagnositic criteria are useful to lay the bedrock for your psychiatric education;  I recommend listening to the recordings during your commute many times over (they are over 3 hours long, so it will take some time!) so that you have an automatic understanding of where different illnesses are categorized and the criteria required to make each diagnosis.  Once a person has a good understanding of the diagnostic criteria he/she is miles ahead in the learning process, able to focus on the details, the studies of treatment paradigms, the theories of disease… or just to more quickly finish the write-up and for once get home at a respectable hour! 

Good luck, everyone–

JJ