Teaching to Teach: A Personality Disorders Curriculum.

To the Editor: Teaching is a vital aspect of clinical medicine. To ensure that the future generation of practicing physicians is comfortable and competent as teachers, residency programs have incorporated formal curricula to help residents teach while adapting to the needs of adult learners [1–4]. During training, residents frequently teach utilizing the traditional clinical apprenticeship model. Although valuable, this model may miss opportunities for senior residents to expand their medical knowledge base with new and challenging information. A formal teaching program can potentially address this limitation by providing an opportunity and additional responsibility for senior residents to learn new concepts and review old material while teaching junior residents [5]. A formal program also allows dedicated faculty to teach adult learning theory pertinent to psychiatric pedagogy and assess teaching-related milestones. Our program has a formal “Teaching to Teach” course that we developed primarily to provide senior residents with experience in curriculum development and psychiatric pedagogy. Each year, the senior class meets with the program director, who also serves as the faculty lead for this program, and finalizes the program’s content on the basis of feedback from the previous year’s resident retreat and the residents’ areas of interest. This approach keeps the curricular content current to the “felt needs” of the residents, and they have relative independence in choosing subject areas that they find stimulating, thereby encouraging a higher level of mutual participation. After reviewing the goals of the 2014–2015 Teaching to Teach program, senior residents decided to focus on one subset of DSM diagnoses to provide more in-depth review to junior residents. They considered covering multiple topics across diagnostic categories, but that would have meant relatively superficial overview in limited time, potentially compromising the learning experience for the junior residents. While designing this curriculum, senior residents confronted three key challenges. First, given the intricacy of human personality, diagnosing personality disorders is complicated in clinical practice. Observation of patients during short clinical encounters in one narrow setting, often without collateral information, is fairly limiting for seasoned clinicians and even more for residents. Second, without an actual patient diagnosed with a personality disorder, these disorders are often challenging to teach in a classroom setting. Third, inherent biases in clinical judgment may impact teaching. To assist with teaching these complex disorders, the residents integrated unique media resources into the lecture series. Using media in various forms (particularly video and audio) helped illustrate nuances of personality disorders that otherwise may have been missed. Residents were encouraged to keep the allotted time for each disorder flexible, depending upon the unique aspects of each disorder and clusters, rather than an arbitrary 1-h slot for each. Residents used standard textbooks and DSM-5 for content description. Video clips, from movies such as Remains of the Day and Taxi Driver and an interview with Jeffrey Dahmer, helped illustrate the clinical aspects of personality disorders and symptom clusters. To teach borderline personality disorder, they showed a video including experts Marsha Linehan, Otto Kernberg, and John G. Gunderson, as well as three real cases shared by the patients themselves and their family members. * Deepak Prabhakar dprabha1@hfhs.org