Mobile Unifying Shrink Hospital (M.U.S.H.)?

I read Dr. William Yates’ recent post on the promise of neuroscience education in medicine.

Bill was one of my favorite teachers and his enthusiasm has always been infectious to me and other trainees he has mentored. He announces an upcoming post on his proposal for a name change for neurology and psychiatry which might help speed the evolution for integrating basic neuroscience training into medical education. Bill has already mentioned this name change not long ago, to replace “Psychosomatic Medicine,” which is sort of a Curate’s Egg, in that there are probably some good parts although mostly it’s bad.

Punch-curates-egg2

The name change he proposed was “Neuroscience Medicine,” involving the combining of Neurology and Psychiatry into one specialty. As the name change saga for Psychosomatic Medicine specialty goes on, recall that Dr. Don R. Lipsitt was not enchanted with the proposal. That reminds me, I still don’t have my copy of Dr. Lipsitt’s book, “Foundations of Consultation-Liaison Psychiatry: The Bumpy Road to Specialization.”

Don Lipsitt book FoundationsofCLPsychiatryBumpyRoadtoSpecialization_

That said, the influence of neuroscience on medical training is already being felt. It’s a part of the ACGME Milestones Project and while the evaluations that I and other faculty members complete for Milestones for residents actually don’t count for individuals as much as they count for the evaluation of the residency program itself, the anchors are interesting. I want to point out that there are milestones for psychotherapy as well. Furthermore, it’s timely to remind interested parties of the importance of psychotherapy considered as a neuroscientific process also, as Dr. James Griffith and Lynne Gaby point out in their November 28, 2014 Psychiatric Times article “Brief Psychotherapy at the Bedside: Existential Neuroscience to Mobilize Assertive Coping”:

Understanding the neurobiological underpinning of assertive coping provides an additional map for rapid assessment, formulation, and intervention to bolster assertive coping. It does not replace but complements other psychotherapeutic tools that can be implemented in brief encounters. Existential neuroscience provides an integrative model that describes how salutatory effects of dissimilar biological and psychosocial interventions converge at the level of brain circuits, whether these are the use of spiritual resources, psychoeducation, a social network, or medications. In particular, this neuroscience perspective highlights the additive effects of metabolic brain impairment and stress-induced compromise of executive functions when assertive coping is failing. It underscores the importance of bolstering emotion regulation even though the desired end-effects are cognitive ones.

To cope assertively with renewed morale is to live as fully human. In this manner, existential neuroscience can help further a humanistic mission to restore personhood despite the ongoing stresses of disease.

– See more at: http://www.psychiatrictimes.com/special-reports/brief-psychotherapy-bedside-existential-neuroscience-mobilize-assertive-coping/page/0/4#sthash.rOZC1wFu.dpuf

I recall glancing at one of the latest articles on the Milestones Project in the March/April 2015 issue of Psychosomatics [1]. This was on the Milestones for Psychosomatic Medicine; I didn’t see the word “neuroscience” in it. On the other hand, many psychiatrists are enthusiastic about incorporating clinical neuroscience courses into residency programs [2] . Coverdale and colleagues point out:

In order to bring clinical neuroscience teaching forward in the education of medical students and residents in psychiatry, goals and the specific curricular objectives for teaching the neurosciences should be developed. These goals and objectives in turn should reflect a thoughtful approach to how the neurosciences are conceptualized and defined. Similarly, they should reflect a very thoughtful approach to what should be taught. For example, a changing environment in medical education has led to a reassessment of assumptions and practices about what should be taught in neuroanatomy. Although broad goals were described for these curricula, when defining a learning objective, a statement is required of (1) observable, behavioral outcomes, (2) criteria for successful performance of the behaviors, and (3) the situational context in which the behaviors are to be performed. We also need to learn more about the relative efficacy of teaching methods for imparting knowledge and skills. In particular, we need to learn about how to most efficaciously teach the skills of synthesizing and critically appraising newly published and potentially clinically relevant findings in the neurosciences.

Returning to the full article which Bill highlighted in his post–this stuff sounds pretty dry and I wonder how to make it practical.

It’s funny how all of this seems to spring from a growing awareness of the importance of semantics–names. For example, I saw this sign at a local discount store.

Pauls Sign

What the heck would I want with a bug soother? It might come in handy if the bug is a monster.

Bug

This bug looks very annoyed; it needs soothing immediately.

And I’m not sure when or where I would need a “Giant Destroyer.”

Giant

A giant which definitely does not need destroying

But I think a new name for Psychosomatic Medicine is in order, at least for the hospital side of psychiatric consultation. I’ve often compared our general hospital psychiatric consultation service as a sort of “M.A.S.H.” unit (that stands for Mobile Army Surgical Hospital) and reminds almost everyone except the very young about the TV show which followed the movie about the 4077th MASH unit in the Korean War. They filled a critical need for what was sometimes called “meatball surgery,” which involved making quick decisions about what to save and what to amputate in order to keep a soldier alive long enough to get back to a stateside medical center where more refined surgical treatment could take place.

By analogy, the general hospital psychiatric consultation service does what I call “meatball psychiatry.” And it includes providing supportive psychotherapy which is, in turn, supported by existential neuroscience. Consulting psychiatrists also try to unify the many moving parts of the hospital using communication skills: social workers, med-surg specialists, neuropsychologists, nurses, and more.

But it should have another name. Maybe “Mobile Amalgamating Shrink Hospital (M.A.S.H.).” However, if I called it “Mobile Unifying Shrink Hospital (M.U.S.H.),” I could bark at the trainees, “MUSH you huskies!”

References:

1.Boland, R. J., et al. (2015). “The milestones for psychosomatic medicine subspecialty training.” Psychosomatics 56(2): 153-167.
BACKGROUND: The Accreditation Council of Graduate Medical Education Milestones project is a key element in the Next Accreditation System for graduate medical education. On completing the general psychiatry milestones in 2013, the Accreditation Council of Graduate Medical Education began the process of creating milestones for the accredited psychiatric subspecialties. METHODS: With consultation from the Academy of Psychosomatic Medicine, the Accreditation Council of Graduate Medical Education appointed a working group to create the psychosomatic medicine milestones, using the general psychiatry milestones as a starting point. RESULTS: This article represents a record of the work of this committee. It describes the history and rationale behind the milestones, the development process used by the working group, and the implications of these milestones on psychosomatic medicine fellowship training. CONCLUSIONS: The milestones, as presented in this article, will have an important influence on psychosomatic medicine training programs. The implications of these include changes in how fellowship programs will be reviewed and accredited by the Accreditation Council of Graduate Medical Education and changes in the process of assessment and feedback for fellows.

2.Coverdale, J., et al. (2014). “Teaching Clinical Neuroscience to Psychiatry Residents: Model Curricula.” Academic Psychiatry 38(2): 111-115.

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