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The Small-Group System and Training on an Acute Psychiatric Ward

The functions of an acute, general hospital psychiatric inpatient teaching unit include patient evaluation and treatment, resident training and the staff communication necessary to both. On our ward, this work is complicated by heterogeneity of patient population, a large and diverse staff, and a pivotal role for inexperienced first-year residents. This paper describes a model using a small group system to integrate the multiple ward functions in light of the complicating factors. The ward is divided into two teams, and the staff and patients of each meet together four times weekly; a post-group staff meeting follows. The patient meeting is oriented around the realities of daily living. The post-group flexibly covers four areas: diagnosis and management; group process and techniques; intra-staff conflict; and ward issues. Converging on the system are multiple and overlapping observations which can be used to integrate ward functions. The simultaneous presence of all the staff increases the efficiency and accuracy of patient evaluation. Data complementing or contradicting individual interviews are supplied, enriching both assessment and teaching. Better staff communication and conflict resolution reflect the intimacy and constancy of the small group. Adjustment to the shifting and blurring of traditional roles has been progressive and there has been an impressive acceptance of more assessment and treatment responsibility by the non-medical staff. Residents' adaptation is consistently an unpredictable factor.