“RACI” Curriculum for Psychiatric Residents
Psychiatrist Dr. Priya Raju helped to start The Resident and Consumer Initiative (RACI) seven years ago as an opportunity for psychiatric residents and people with lived experience to get to know one another informally over dinner. But she says, the group has far exceeded their original goal.
"We really wanted to start by educating ourselves by having access to different kinds of teachers. We discovered that RACI has actually given lots of [psychiatric] residents access to survivor teachers, not just people who are coming to the meetings,” she says.
From l to r, Suzie Berkhout, Katie Zhu. Pat Capponi, Emma Hapke and Tessa Wilson-Ewing
RACI co-founder Pat Capponi says the group has had a “profound effect" on the medical residents and on members with lived experience. The members with personal experience with the mental health system have learned more about psychiatric training and witnessed the residents move “beyond the label, to seeing the whole person and getting an understanding of the challenges people have."
Psychiatric resident Dr. Emma Hapke first cameto a RACI meeting two years ago after hearing Pat speak at the residents' orientation session. She says the group provides an opportunity to question the premise of what psychiatrists do and challenge the power dynamic. “Our patients can’t do that when we’re sitting with them in a clinical situation, but in this other more informal setting-- we can challenge each other." She adds thatseeing people with lived experience at RACI "doing well, working,contributing to the community, raising families and having a really full life" can help to reduce the stigma that results when psychiatric residents only see people with lived experience when they are ill.
Reaching out to Psychiatric Residents
Still, not all psychiatric residents are keen to attend the voluntary group. "Some residents think if they come to a meeting they are going to get severely criticized or condemned, but that’s not what happens,” Pat says.
Emma agrees, saying she has learned that RACI members with lived experience are not anti-psychiatry nor necessarily against using community treatment orders or Form 1s (physician application for psychiatric assessment). Rather she has learned about using such tools in more collaborative ways that “maintain people’s dignity and give them as much autonomy, choice and power in a situation where they are already feeling powerless.”
To help spread their learnings beyond those who attend, the group is preparing a qualitative analysis of RACI for submission to an academic journal. Survivor and resident members have also co-presented at mandatory resident events including the annual Advocacy Day and have conducted mock RACI meetings at conferences, garnering interest among some other medical schools to start similar groups.
RACI has also supported people with lived experience to be more visible in the psychiatry resident curriculum. Pat is now co-facilitating a group of four consumer advisors who will be teamed up with residents as part of the Resident Advisory pilot project led by CAMH psychiatrist, Dr. Sacha Agrawal. As well, several RACI members participate in the recovery curriculum for fourth year residents initiated by Dr. Kwame McKenzie, Lucy Costa of CAMH’s Empowerment Council and Dr. Ari Zaretsky, former head of the psychiatric residency program. Personal narratives from people with lived experience, films, discussion and small group supervision are used to help improve the residents’ recovery-oriented practice.
Dr. Ivan Silver, CAMH’s Vice-President Education, says, “The RACI experience opens up a very different kind of conversation between clients and residents, enriching the learning experience of both. RACI provides a template for a new curriculum for residents based on the client experience, their recovery and the phenomena of ‘client as teacher.’"