How researchers view the mind is being enhanced through technology that enables the modeling of virtual nervous systems. Functional brain imaging is promoting consideration of new paradigms of brain organization.
Emerging information and expert systems technologies are quickly becoming valuable to the delivery of psychiatric services as well. Practitioners are beginning to see the benefit of computer-based therapy and diagnostic adjuncts or "virtual therapists." For example, systems have been developed to help primary care physicians begin the assessment, diagnosis and treatment planning processes. Patients respond to questions posed by a computer, before being interviewed by their doctors, to help sharpen the focus of their presenting complaint. In preliminary ventures, patients have expressed satisfaction with computer-based interviewing, Yager said. Computer adjuncts may free practitioners from having to spend as much time on checklist-type interviewing, enabling them to use personal interviews with clients to address how symptoms are creating problems in living and to help improve patient functioning.
Yager described other experiments in computer-assisted therapy, such as those reported by Roger Gould, M.D., which include the use of computer-based interviews before patients interact in group therapy. Following a 45-minute interview with a computer, which guides patients through progressive iterations to help them identify how they feel, patients meet with one another and with a group therapist. Computer-driven treatments are also being developed to provide "virtual reality desensitization."
On-line systems that provide access to the Internet, including e-mail and home pages, offer fast information as well as new opportunities for patients and their families to communicate with one another about their experiences. In addition, on-line communication (as well as the use of video phones) opens up new opportunities for psychiatrists to provide remote-site treatment and consultation. Psychiatrists need to become well-versed in these rapidly developing resources.
On-line continuing education programs are anticipated. As funding for graduate education falls under increasing pressure, teaching efficiency will assume paramount importance, opening the door for cost-effective alternative training opportunities. Residents may be able to accomplish at least part of their knowledge-based learning on-line, even through access to transdepartmental curricula. Systems designed to present interactive interdisciplinary scenarios can promote problem-based learning. Will it be possible, Yager wonders, to complete a "virtual residency"? Faculty members may find their roles shifting accordingly.
Other training implications of changes in health care revolve around supply-and-demand forces for psychiatrists. Training institutions need to address the potential consequences of preparing too many or too few psychiatrists. Yager questioned the approach of preparing psychiatrists when they cannot be absorbed into the workforce.
As psychiatry anticipates the next century, Yager said, he believes outstanding clinical work, with honesty, integrity, caring and respect in the professional-patient relationship will still be possible. Practitioners will need to be flexible, but the potential for a rewarding career as a psychiatrist will remain.