The influence of the curriculum in psychiatry residency education.

Extraordinary economic forces are influencing graduate medical education in this country. Federal, state, and third party cost containment efforts, managed care, medical student loan indebtedness, and decreasing governmental and industry enthusiasm to support residency training are producing significant external pressures on academic health centers, recruitment into psychiatry, and on the practice of psychiatry. Other pressures on the psychiatry residency curriculum are being generated from the rapid expansion in our scientific knowledge base in clinical psychiatry and the influence of subspecialization. The future psychiatrist will be trained for a life long career in continuing education to accommodate for the explosive scientific contributions to our field. The residency training program will promote the ability to think scientifically, to teach others, to administrate and lead, and to achieve clinical competence in a more rigorous fashion. Regardless of the number and forms of emerging practice settings, it is best to train our residents for flexibility through emphasizing fundamental clinical and scientific excellence.