II. A method of reporting formulation

Instructions for Australian and New Zealand trainees in developing skills in formulation: a systematic review of local evidence

OBJECTIVE

To examine the peer-reviewed literature on psychiatric formulation.

METHODS

The term (formula*) was used to systematically search Australasian Psychiatry, Australian and New Zealand Journal of Psychiatry, British Journal of Psychiatry, BJPsych Bulletin, American Journal of Psychiatry and Academic Psychiatry. The resulting papers were reviewed.

RESULTS

Of the 42 papers located, 22 (52%) were published between 2002 and 2019; 90% papers were published in Australasian Psychiatry (15), Academic Psychiatry (12) or BJPsych Bulletin (10), journals that focus on training and clinical practice. The papers varied in their aims and recommendations and not all justified the need for formulation. Formulation was recommended as a necessity for training, a communication tool and a guide to treatment. No article provided evidence for the superiority of any type of formulation, and the role of consumers in formulation was conspicuously lacking.

CONCLUSION

There are many ways to structure formulation. However, the existing literature does not support any particular approach. More consideration needs to be given to the needs of consumers in conceptualising and practicing formulation.

Teaching some principles of individual psychodynamics through an introductory guide to formulations

One objective of psychiatric education can be to help trainees describe and understand major concerns patients experience in their key relationships, inner conflict and sense of self. A precis of major concepts and principles in this area (usually known as psychodynamics) is presented without the metapsychological framework which makes some of the literature difficult to grasp. This is intended to make learning more efficient and to facilitate the formulation of hypotheses about the presence or absence of specific conflicts, and problems in key relationships. We do not propose that these hypotheses necessarily explain psychopathology but that they (a) supplement formal diagnosis; (b) enrich the clinical data base by providing hypotheses which are testable in part by clinical observation and which can be tested scientifically; (c) provide understanding crucial to psychotherapy.

Psychiatry clerkship success: skills and styles

In recent years, medical students and psychiatry have been a provocative mix, causing much concern among students and faculty. Disagreement has been frequently offered regarding clerkship content, degree of learning, and even the basic importance of the topic of psychiatry itself. To help overcome these problems, 10 suggestions are offered for a curriculum learning skill foundation and 13 suggestions for clerkship teaching staff approach. These truism ingredients have been the major formula of a successful psychiatry teaching program as consistently reported by almost a decade of students and faculty. It is believed these principles might have wider applicability for enhancement of student recruitment to psychiatry residencies and for general stimulation of interest and learning in clerkship programs of various medical disciplines. Relevant literature is cited which addresses some of these individual issues.