Cross-Cultural Psychiatry: Multicultural Education in Psychiatric Residency Programs.

Abstract

This study investigates the question, how are cultural issues addressed in psychiatric residency training programs as they relate to the curriculum, the patients, and the psychiatric residents. It utilizes four methods to obtain information: open ended interviewing, group interviewing, documents and records, and participant observation. The population of the study was drawn from seven accredited public, private, and university hospitals in a midwestern state. A total twenty-nine people including residency directors, residency supervisors, and psychiatric residents were selected for audio taped interviewing. Seventeen informal interviews were conducted with other mental health personnel and twenty-seven residents participated in four group interviews. All participants were asked to respond to the same question. For the analysis of documents, content analysis was used to make inferences by systematically identifying specified characteristics of messages. For the analysis of the audio taped interviews, a coding system was developed to organize the information. Categories were derived from subsidiary questions and important themes. Pattern codes were used to put the materials into meaningful units of analysis. Three cultural typologies were used to analyze the coded responses. The study found differences in perception of what constitutes appropriate methods of instruction on cultural issues. This has led to hospitals not providing instruction on cultural issues adequate for residents to render competent care to non-white patients. Planning and evaluation of culturally relevant curriculum is minimal to non-existent. The study finds treatment differences between black and white patients in all treatment modalities. It finds professional treatment conflicts between supervisors, Black and foreign medical graduate residents. Further, selection of non-white residents appears to be based on physical characteristics. The study finds that monocultural approaches to the teaching and practice of psychiatry ignores the cultural influences of the individual, the cultural implications of transference and fosters an environment of superficial equality. Hospitals appear to ignore the subject of racism as well as communication difficulties between the various culturally different residents and staff. A process called "didactic superficiality" was seen to exist in each of the hospitals studied.