Rediscovering General Psychiatry: Creation of
David?S Goldbloom,?MD, FRCPC1, Robert A?Buckingham, MD, FRCPC2, Peter Voore, MD, FRCPC3
within a university setting.
Method: Literature review, observation, and description.
Results: Within 2 years of its inception, the General Psychiatry Division of the University of Toronto has begun
to realize some of its goals and further elucidate specific objectives.
Conclusions: In anera of increasing academic subspecialization,the preservation of core skillsin psychiatry and
the recognition of the continuing public need for psychiatric generalists must be enshrined within academic
(Can J Psychiatry 1997;42:58–62)
Key Words: psychiatry, education, residency, generalist
pants was described as arguing that “generalpsychiatristsare
the specialists do not want to treat. There is no objective
evidence that specialization in psychiatry is of benefit. Psy-
chiatry is not highly technical so there is little need for
specialization and if it occurs it should not be solely on the
basis of one major research project” (1; p 121). Another
speaker commented that “one cannot become a subspecialist
without being a good general psychiatristfirst.It isa paradox
to erect a fence around general psychiatry to save it from its
n 1994, a forum held at the Winter Meeting of the Royal
College of Psychiatrists in England centred around the
While this forum did not generate specific solutions, the fact
that it occurred suggests a tension within psychiatric training
that crosses national boundaries.
Similarly, in the United States there has recently been a
call to redefine the general psychiatrist. Beigel and Santiago
(2) call for a new set of values for general psychiatrists that
increase emphasis on multidisciplinary teamwork; complex
cases which traverse boundaries between medicine and psy-
chology; the severely mentally ill; and the role and delivery
of psychotherapy, “some of which can be effectively deliv-
ered by nonmedical mental health professionals” (2; p 770).
In order to achieve this, the authors suggested curricular
reform that included a wider range of training settings such
as community support programs and family practice clinics;
more formal training in multidisciplinary teamwork and the
nature of leadership; more awareness of service use patterns
and implications as well as fundamentals of quality assur-
comfort with, confidence in, and commitment to working
with chronically mentally ill patients; and retaining psycho-
therapy asa coreskillbut placing moreemphasisona variety
of short-term interventions and balancing it with skills such
as crisis intervention, complex diagnostic assessment, phar-
macotherapy, and consultation to primary care providers.
Over the last 3 decades, the Department of Psychiatry at
the University of Toronto has grown into the largest such
department and residency training program in Canada and
one of the largest in North America.It currently includes 500
Manuscript received March 1996, revised August 1996.
Portions of this manuscript were originally presented as part of the Robin
Hunter Memorial Lecture by the senior author in June 1993.
1Vice President Medical Affairs and Chief of Staff, Clarke Institute of
Psychiatry; Associate Professor and Head, General Psychiatry Division,
University of Toronto, Toronto, Ontario.
2Clinical Director, Department of Psychiatry, The Toronto Hospital; Asso-
ciate Professor and Deputy Head, General Psychiatry Division, University
of Toronto, Toronto, Ontario.
3Associate Head, General Psychiatry Division, Clarke Institute of Psychia-
try; Assistant Professor, University of Toronto, Toronto, Ontario.
try, 250 College Street, Toronto, ON M5T 1R8
Can?J?Psychiatry, Vol 42, February 1997