Impact of biopsychosocial factors on psychiatric training in Japan and overseas: are psychiatrists oriented to mind, brain, or sociocultural issues?

摘要: Psychiatry has been strongly influenced by culture, society, history and the prevailing public needs of particular country.1–3 Accordingly, psychiatric training systems differ from country to country, which might be a mirror country's current situation its future prospects toward mental health.4 A well-balanced view psychiatry, is often described as ‘biopsychosocial model psychiatry’, proclaimed ideal. However, recent increasing demand for biological factors psychiatry presents potential gap between expected actually acquired skills in terms psychosocial factors, leading younger psychiatrists fall mind–brain (or mind–body) dichotomy.5–8 How do young (in this article, ‘young psychiatrists’ are defined residents, trainees, certified with clinical experience 10 years or fewer) see themselves biopsychosocial perspectives? Do they define doctors ‘brain’, ‘mind’, who address sociocultural issues? The answer may multiple including their original motivation become psychiatrists, domains interests, level education/training undertaken. Facing changes, such aging society high suicide rate, Japan implemented new system postgraduate medical education (PGME) 2004. Until that time, residents would start immediately after graduating school, join specific department universities, known ikyoku,9 rotate through hospitals.9–11 Therefore, under pre-2004 PGME system, used devote most time psychiatry11 have very little approaches epitomized evidence-based medicine systematic problem–solution approach. Since 2004, two-year general residency required graduates,12–14 order improve basic all primary care settings.15 In first-year internal medicine, surgery, emergency anesthesiology, second-year pediatrics, community obstetrics/gynecology at least one month each. Thereafter, specialty training, up 4 years.9 The balance among biological, psychological orientations implementation system. We hypothesized trained lay more emphasis on because rotation medicine. Thus, present study aimed explore psychiatrists' attitudes – namely, whether consider issues. Changes before well possible contributing were also explored. same questionnaire was distributed both out Japan, highlight differences.