Innovation in Psychiatric Education: Interaction and Measurement (with Dr. Arbuckle, part 2 of 2)

​In the second part of our interview with Melissa Arbuckle, MD, she continues to discuss active learning methods. What makes interaction in a learning environment difficult for people? She then summarizes the use of quantitative measurement in psychiatric care, including in therapy. She details its effectiveness as a tool for self-monitoring in patients and whether it can predict relapse and to quantify a "baseline." She further mentions the use of the Working Alliance Inventory as not only an outcome measure but also a teaching tool. Can doctors learn to tolerate that not every patient likes them?
Dr. Arbuckle is Vice Chair for Education and Director of Resident Education in the department of psychiatry at Columbia University and the New York Psychiatric Institute,
TRANSCRIPT
Intro: Welcome to Psyched!, a podcast about psychiatry, that covers everything from the foundational to the cutting edge, from the popular to the weird. Thanks for tuning in.
Arbuckle: I remember the first grand rounds I did, where I decided I wasn't going to do a lecture, and I think it kind of shocked people in the audience, that no, we're actually going to do something different, and yet they walked away saying, "This was fun. Wow."
David Carreon: Tell that story. Where were you, who invited you, and did they know what was coming?
Arbuckle: The first time I did it, it was for a quality improvement curriculum that I teach, and the idea ... I asked everybody to come up with something they want to change in their own life and use that as a prompt for walking through the steps of quality improvement and how you set aims, how you measure outcomes.
For example, if you're going to set a goal for yourself ... My favorite goal that residents always say when I say, "Oh, let's set some goals," it's always read more. That translates into, probably nothing's going to happen. So if you think about it in the context of a quality improvement paradigm, then you're going to think about, what exactly am I going to read, how much am I going to read, what's my goal, what's my timeline for doing that, and it's far more likely to happen.
So we use that framework, I use that framework for teaching about quality improvement. So I did that exercise in a grand rounds and people played. I said, "You're going to pair up with a neighbor, and I want you to talk to your neighbor and report back," and it was fun.
David Carreon: Where was it? What was the room like? Tell us more about that picture.
Arbuckle: It was a traditional auditorium, so people were sitting in seats in an auditorium and kind of scattered about the room. I think the one thing that I sometimes have to do is get people to sit next to each other. So sometimes I say, "Okay, you're going to have to move, to sit next to somebody, because we're going to do something interactive." I think it takes people off guard. I think people are still a little uncomfortable about it. I did some interactive stuff, here at the APA, and a couple of people snuck out of the room rapidly.
Jessi Gold: I noticed that, too. Not in yours, but I was noticing that it was like as soon as the workshop part started, everyone was like ... some people just snuck out.
Arbuckle: Yeah.
Jessi Gold: Yeah.
Arbuckle: Yeah.
Jessi Gold: I wonder what ... I mean, I guess it's scary to have to actively do something. I don't know.
Arbuckle: Well, I think there's a piece of this thing that we're all afraid of being found out as a fraud, that we don't really know something, and perhaps, if you have to do something with someone else as part of an exercise, you're going to feel stupid or people are going to realize you're not the expert you're supposed to be. I think there's some performance anxiety that comes with that.
Jessi Gold: Probably scary for all levels of whatever for different reasons.
Arbuckle: Absolutely, yeah.
Jessi Gold: Yeah.
Arbuckle: Yeah.
David Carreon: I mean, if somebody find out that we're not all omniscient, how are we going to be able to keep our jobs?
Arbuckle: Exactly.
David Carreon: Another thing we wanted to talk to you about was the ... In psychiatry, I mean, medicine in general, but particularly psychiatry, we like to not measure things. We prefer to just sort of go along without measuring things and particularly in psychotherapy training. There's a lot of thought, particularly in psychodynamic or those sorts of approaches, that it really isn't science, and so you really can't measure things. I know that some of your work has involved trying to measure that and trying to improve that.
Arbuckle: Yeah.
David Carreon: How would you even approach ... ? I mean, with all of the squishiness of the psychodynamic approach, how do you nail that down into something that is quantitative?
Arbuckle: Well, I think it depends on, with any treatment, what your goals are. Many patients that come to us for trea...